Baseline Mean Deviation Research Articles

Long-term Visual Field Variability in Patients with Primary Open-angle Glaucoma

Purpose: To investigate factors associated with variability in the longitudinal visual field (VF) test in patients with primary open-angle glaucoma (POAG).Methods: This retrospective study enrolled POAG patients with VF ≥ 12 who were followed up for ≥ 6 years. First, 52 total deviation values of VF series for each eye were linearly regressed against time (years), and the root mean square error (RMSE) of the residuals was used to measure long-term pointwise VF variability. The mean deviation (MD) of the VF series for each eye was linearly regressed against time (years), and the RMSE of the residuals was used to measure long-term global VF variability. Using hierarchical clustering, variable clustering was performed to select variables and Spearman’s correlation was used as a similarity index. We fitted a mixed effect linear regression model and evaluated factors associated with the long-term VF variability in each regression model.Results: The study included 246 eyes of 157 patients with POAG. Worse baseline peripapillary retinal nerve fiber layer (RNFL) thickness, lower baseline intraocular pressure (IOP), lower mean IOP, greater IOP fluctuation, and a faster VF decay rate were associated with increased long-term pointwise VF variability in the RNFL thickness model (all <i>p</i> ≤ 0.037). Worse baseline MD, lower baseline IOP, lower mean IOP, and faster VF decay rate were associated with increased long-term global VF variability in the MD model (all <i>p</i> ≤ 0.035).Conclusions: Lower baseline and mean IOP, greater IOP fluctuation, worse glaucoma severity, and a faster VF decay rate were associated with greater long-term VF variability in patients with POAG. These factors should be considered when evaluating VF progression.

Evaluation of the Variability of Ambient Interactive Zippy Estimation of Sequential Rapid Tests on the "imo" Perimeter in Patients With Stable Glaucoma.

Analysis of Ambient Interactive Zippy Estimation of Sequential Testing (AIZE) Rapid test variability in patients with stable glaucoma showed that the 95% prediction interval of the mean deviation (MD) value, potentially an index for judging progression, was ±1.63 to ±1.78dB in early-to-moderate-stage patients. To explore the 95% prediction interval of the MD value using the AIZE Rapid test strategy for glaucoma observation. This study included 72 patients with stable or suspected glaucoma who underwent the imo AIZE Rapid test 3 times or more within 2 years. Both eyes from each patient were classified as better or worse eyes. They were divided based on baseline MD values into the following 4 groups: MD > -3dB, -6dB < MD ≤ -3dB, -12dB < MD ≤ -6dB, and MD ≤ -12dB. The variability of MD during the observation period and the 95% prediction intervals were analyzed. Pointwise variability of limits at each test location was also calculated. The numbers of better and worse eyes included in the study were 46 and 33. The median follow-up period was 1.3 years (range: 0.5 to 1.9 y). The 95% prediction intervals for MD values were ±1.41dB for better eyes (n = 46) and ±1.47dB for worse eyes (n = 33). The 95% prediction intervals in the MD > -3dB, -6dB < MD ≤ -3dB, -12dB < MD ≤ -6dB, and MD ≤ -12dB groups were ±1.63dB, ±1.34dB, ±1.78dB, and ±1.33dB, respectively. Pointwise variability of worse eyes was larger than that of better eyes, especially between 10 to 15 dB. In the case of a difference in MD greater than the 95% prediction intervals when compared with the previous visual field result, we should pay much attention to the possibility of progression of the glaucomatous visual field in patients with stable glaucoma.

Can Baseline Parapapillary Atrophy Morphology Predict Future Glaucoma Progression?—An OCT Glaucoma Imaging Study

PurposeTo investigate glaucoma progression based on Optical Coherence Tomography (OCT) Guided Progression Analysis (GPA) according to baseline β-zone parapapillary atrophy (PPA) morphology in glaucoma patients. DesignRetrospective cohort study. MethodsPatients over 20 years of age who had been diagnosed with primary open-angle glaucoma (POAG) at Seoul National University Hospital, Seoul, Korea between 2010 and 2020. This study included POAG patients with a minimum of 5 years of follow-up. We quantitatively measured the baseline β-zone PPA parameters, classified β-zone PPA morphology according to new classification standard we created and analyzed the corresponding GPA progression of the retinal nerve fiber layer (RNFL). ResultsA total of 210 patients with POAG (mean age: 53.8 years) were enrolled in the study. The mean follow-up period was 9.8 years. The average value of the baseline mean deviation in visual field perimetry was -2.48 dB. Longer radial extent and larger angular extent of β-zone PPA were significantly associated with progression on GPA, as was the presence of disc hemorrhage. Among the 4 classified β-zone PPA morphologies (Crescent type 1 & 2, Solar-eclipse type 1 & 2), the Solar-eclipse type 2 group showed the highest progression. A Kaplan-Meier survival analysis demonstrated significant differences among the 4 types. ConclusionsThe larger the radial and angular extents of β-zone PPA, the more progression that was shown on OCT GPA. Furthermore, significant differences in progression were noted based on the morphological type of β-zone PPA. Our findings indicate that baseline β-zone PPA parameters and morphology are valuable predictors of future glaucoma progression.

The Impact of Social Vulnerability on Structural and Functional Glaucoma Severity, Worsening, and Variability

To determine the associations between social vulnerability index (SVI) and baseline severity, worsening, and variability of glaucoma, as assessed by visual field (VF) and OCT. Retrospective longitudinal cohort study. Adults with glaucoma or glaucoma suspect status in 1 or both eyes. Visual fields were derived from 7897 eyes from 4482 patients, while OCTs were derived from 6271 eyes from 3976 patients. All eyes had a minimum of 5 tests over follow-up using either the Humphrey Field Analyzer or the Cirrus HD-OCT. Social vulnerability index, which measures neighborhood-level environmental factors, was linked to patients' addresses at the census tract level. Rates of change in mean deviation (MD) and retinal nerve fiber layer (RNFL) thickness were computed using linear regression. The slope of the regression line was used to assess worsening, while the standard deviation of residuals was used as a measure of variability. Multivariable linear mixed-effects models were used to investigate the impact of SVI on baseline, worsening, and variability in both MD and RNFL. We further explored the interaction effect of mean intraocular pressure (IOP) and SVI on worsening in MD and RNFL. Glaucoma severity defined based on baseline MD and RNFL thickness. Worsening defined as MD and RNFL slope. Variability defined as the standard deviation of the residuals obtained from MD and RNFL slopes. Increased (worse) SVI was significantly associated with worse baseline MD (β=-1.07 dB, 95% confidence interval [CI]: [-1.54, -0.60]), thicker baseline RNFL (β=2.46 μm, 95% CI: [0.75, 4.17]), greater rates of RNFL loss (β=-0.12 μm, 95% CI: [-0.23, -0.02]), and greater VF variability (β=0.16 dB, 95% CI: [0.07, 0.24]). Having worse SVI was associated with worse RNFL loss with increases in IOP (βinteraction=-0.07, 95% CI: [-0.12, -0.02]). Increased SVI score is associated with worse functional (VF) loss at baseline, higher rates of structural (OCT) worsening over time, higher VF variability, and a greater effect of IOP on RNFL loss. Further studies are needed to enhance our understanding of these relationships and establish their cause. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Disparities in Visual Field Testing Frequency Among Subjects With Glaucoma.

Prior evidence suggests racial disparities in the utilization of visual field testing (VFT) for the diagnosis and monitoring of glaucoma. In this study, we considered the effect of baseline glaucoma severity and socioeconomic disadvantage along with other potential confounders such as test reliability, ancillary tests, and glaucoma surgeries on racial disparity in the frequency of VFT. The records of all subjects with a diagnosis of glaucoma who received VFT at an academic, tertiary care facility from January 2018 to December 2021 were accessed. Analysis was performed to compare VFT frequency, the total number of office visits (DoS), and the ratio of VFT frequency to DoS (VFT/DoS) across self-reported races while controlling for sex, age, socioeconomic disadvantage (Area Deprivation Index), VF reliability indicators and baseline mean deviation, optical coherence tomography frequency, and glaucoma surgeries. Among the 2654 subjects (1515 White, 782 Black, and 357 Asian) included in this study, Black subjects had the worst socioeconomic status and disease severity at baseline. They also experienced a 3% lower VFT/DoS ratio compared to White subjects (P = 0.031). Asian subjects had a 5% lower VFT/DoS ratio compared to White subjects (P = 0.015). We identified racial disparity in performing VFT in subjects with glaucoma even when multiple confounders were considered. Further investigation is necessary to identify other race-associated factors to work toward reducing racial disparities in VFT. Black and Asian subjects with glaucoma receive fewer VFT per visit compared to White subjects even when considering socioeconomic disadvantage and disease severity.

A multi-label transformer-based deep learning approach to predict focal visual field progression.

Tracking functional changes in visual fields (VFs) through standard automated perimetry remains a clinical standard for glaucoma diagnosis. This study aims to develop and evaluate a deep learning (DL) model to predict regional VF progression, which has not been explored in prior studies. The study included 2430 eyes of 1283 patients with four or more consecutive VF examinations from the baseline. A multi-label transformer-based network (MTN) using longitudinal VF data was developed to predict progression in six VF regions mapped to the optic disc. Progression was defined using the mean deviation (MD) slope and calculated for all six VF regions, referred to as clusters. Separate MTN models, trained for focal progression detection and forecasting on various numbers of VFs as model input, were tested on a held-out test set. The MTNs overall demonstrated excellent macro-average AUCs above 0.884 in detecting focal VF progression given five or more VFs. With a minimum of 6 VFs, the model demonstrated superior and more stable overall and per-cluster performance, compared to 5 VFs. The MTN given 6 VFs achieved a macro-average AUC of 0.848 for forecasting progression across 8 VF tests. The MTN also achieved excellent performance (AUCs ≥ 0.86, 1.0 sensitivity, and specificity ≥ 0.70) in four out of six clusters for the eyes already with severe VF loss (baseline MD ≤ - 12dB). The high prediction accuracy suggested that multi-label DL networks trained with longitudinal VF results may assist in identifying and forecasting progression in VF regions.

Risk Factors for Progression of Primary Open-Angle Glaucoma with Lower Normal Intraocular Pressure

Introduction: This study aimed to investigate intraocular pressure (IOP)-independent factors associated with the progression of primary open-angle glaucoma (POAG) with IOP ≤15 mm Hg. Methods: POAG patients with maximum IOP ≤15 mm Hg at the Kyoto University Hospital between January 2011 and August 2021 were retrospectively enrolled. We evaluated effects of various factors on the rate of mean deviation (MD) changes in the visual field (VF) examinations using a linear mixed model. These factors included hypertension, diabetes mellitus (DM), hyperlipidemia (HL), cardiovascular disease, arrhythmia, disc hemorrhage, sleep apnea syndrome, orthopedic diseases, and malignant tumors. Results: In total, 98 eyes from 68 patients were included. The baseline MD was −9.74 ± 7.85 dB. The mean rate of MD change and IOP during the observation period were −0.28 ± 0.04 dB/year and 11.8 ± 1.0 mm Hg, respectively. Comorbidity of DM or HL showed a significant positive association with the rate of MD change (β = 0.35, p = 0.0006 and β = 0.18, p = 0.036, respectively) in the model adjusted for age, sex, axial length, mean IOP, and standard deviation of IOP during the observation period. However, no significant association of DM or HL was found after adjusting for central corneal thickness. Conclusion: This study suggests that DM or HL is associated with VF deterioration in glaucoma with lower IOP, but the association may be due to differences in IOP characteristics.

Frontloading visual field tests detect earlier mean deviation progression when applied to real-world-derived early-stage glaucoma data.

To examine the diagnostic accuracy of performing two (frontloaded) versus one (clinical standard) visual field (VF) test per visit for detecting the progression of early glaucoma in data derived from clinical populations. A computer simulation model was used to follow the VFs of 10,000 glaucoma patients (derived from two cohorts: Heijl etal., Swedish cohort; and Chauhan etal., Canadian Glaucoma Study [CGS]) over a 10-year period to identify patients whose mean deviation (MD) progression was detected. Core data (baseline MD and progression rates) were extracted from two studies in clinical cohorts of glaucoma, which were modulated using SITA-Faster variability characteristics from previous work. Additional variables included follow-up intervals (six-monthly or yearly) and rates of perimetric data loss for any reason (0%, 15% and 30%). The main outcome measures were the proportions of progressors detected. When the Swedish cohort was reviewed six-monthly, the frontloaded strategy detected more progressors compared to the non-frontloaded method up to years 8, 9 and 10 of follow-up for 0%, 15% and 30% data loss conditions. The time required to detect 50% of cases was 1.0-1.5 years less for frontloading compared to non-frontloading. At 4 years, frontloading increased detection by 26.7%, 28.7% and 32.4% for 0%, 15% and 30% data loss conditions, respectively. Where both techniques detected progression, frontloading detected progressors earlier compared to the non-frontloaded strategy (78.5%-81.5% and by 1.0-1.3 years when reviewed six-monthly; 81%-82.9% and by 1.2-2.1 years when reviewed yearly). Accordingly, these patients had less severe MD scores (six-monthly review: 0.63-1.67 dB 'saved'; yearly review: 1.10-2.87 dB). The differences increased with higher rates of data loss. Similar tendencies were noted when applied to the CGS cohort. Frontloaded VFs applied to clinical distributions of MD and progression led to earlier detection of early glaucoma progression.

Longitudinal evaluation of advanced glaucoma: ten year follow-up cohort study

This study focused on patients with advanced open-angle glaucoma (OAG) and aimed to identify key factors for monitoring them. We included 127 such patients who were followed for seven years or more, undergoing annual ophthalmic examinations. Glaucoma progression was defined as a deterioration in either structure or function. The progression rates and risk factors were evaluated. The patients were divided into upper- and lower-half subgroups based on the reduction in intraocular pressure (IOP) from the baseline. Over an 11-year period, glaucoma progression was detected in 59 eyes (46.5%). The rate of change in mean deviation (MD) was − 0.43 dB/year for the entire population; − 0.67 dB/year for progressors; and − 0.20 dB/year for non-progressors. Hypertension and disc hemorrhage (DH) were more common in progressors compared to non-progressors (45.8 vs. 23.5%, 11.9 vs. 1.5%; P = 0.008 and P = 0.016). Multivariate Cox’s proportional hazard model revealed that the presence of DH and a better baseline MD were associated with glaucoma progression. Additionally, patients with a higher percentage reduction in IOP (> 20.94%) had a lower risk of progression compared to those with less reduction. Inadequate IOP reduction, better baseline MD, presence of DH, and lower central corneal thickness were identified as risk factors for progression in advanced OAG patients.

Factors associated with visual field or structure progression occurring first in a prospective study on patients with untreated open-angle glaucoma with normal intraocular pressure

Background/ObjectivesTo identify factors associated with disc/retina deterioration in stereo fundus photographs preceding that of the visual field (VF), as determined with a Humphrey Field Analyzer (HFA) (Structure First deterioration) and factors associated with the latter preceding the former (Field First deterioration) in open-angle glaucoma (OAG) with lower normal intraocular pressure (IOP).Subjects/MethodsProspective cohort study. Ninety eyes of 90 patients with OAG and a baseline IOP < 15 mmHg participated in a 5-year prospective study without treatment. IOP measurements and HFA 24-2 Swedish Interactive Test Algorithm Standard tests were performed every 3 months, and fundus photographs were obtained every 6 months. VF deterioration was determined by Guided Progression Analysis and deterioration of disc/retina was determined on stereophotographs by an independent committee. A multivariable Cox proportional hazard model was used to identify factors associated with Structure First deterioration, and with Field First deterioration.ResultsThe average baseline age and mean deviation were 53.9 ± 9.8 years and −2.8 ± 2.8 dB, respectively. During the 5-year follow-up, the probability of Field First deterioration was 49% ± 6.6% (standard error) and that of Structure First deterioration was 33% ± 6.4% (P = 0.062, log-rank test). Disc hemorrhage (DH) prior to the event (P = 0.006) was associated with Structure First deterioration, and older age was associated with Field First deterioration (P = 0.040).ConclusionsIn OAG eyes with lower normal IOP, DH was significantly associated with Structure First deterioration, and age was significantly associated with Field First deterioration.

Multiple (frontloaded) visual field tests increase identification of very slow mean deviation progression in glaucoma

ObjectifÉvaluer l'effet de la multiplication des tests de champs visuels (CV) lors d'une seule et même visite afin de percevoir une variation de la déviation moyenne (DM) du champ visuel dans le glaucome lentement progressif. MéthodesIl s'agit d'une étude de simulation par ordinateur. La DM initiale (fourchette : 0 à –12 dB) et le taux de progression (fourchette : 0 à –0,4 dB/année, taux non inclusif) ont été générés pour 10 000 patients. On a simulé, pour chaque patient, 6 tests de CV de départ « stables ». Par la suite, des CV de suivi (jusqu’à concurrence de 10 ans) ont été générés en incorporant un taux de progression et une variabilité intra- et inter-visites. Les variables indépendantes étaient le nombre de tests de CV par visite (test unique ou 2 tests), la fiabilité du CV (100 %, 85 % ou 70 %), la répétition des tests en raison de l'obtention de résultats non fiables (oui ou non) et l'intervalle de suivi (aux 6 mois ou 1 fois par année). La détection de la progression (pente de la DM qui était négative et significative à p < 0,05), la DM lors de la détection et le nombre d'années avant la détection comptaient au nombre des paramètres de mesure. RésultatsLa multiplication initiale des tests a permis d'identifier plus de cas de progression (62,7 %–79,2 %), comparativement à l'absence de multiplication initiale des tests (31,0 %–36,7 %) à 10 ans (p < 0,0001). Les suivis à 6 mois ont donné lieu à une meilleure détection de la progression que les suivis annuels. Les patients ayant progressé, détectés par chaque méthode, ont été décelés plus rapidement en l'absence de la multiplication initiale (jusqu’à concurrence de 0,26 an), mais la différence était faible et non significative sur le plan clinique (différence de la DM: 0,06 dB). Une augmentation (moins importante) de la DM, un accroissement (plus lent) du taux de progression et une hausse de la DM du CV de départ ont tous réduit la probabilité de détecter une progression. ConclusionsLa multiplication initiale des tests de CV réalisés à des intervalles de 6 mois améliore le taux de détection de la progression de la DM en présence de glaucome lentement progressif, comparativement à la réalisation de 1 seul test par visite à des intervalles de 1 an.

Ex-PRESS Implantation versus Trabeculectomy for Long-Term Maintenance in Patients with Open-Angle Glaucoma.

To compare the efficacy of Ex-PRESS implantation (EXP) with that of trabeculectomy (TLE) with mitomycin C for maintaining low target intraocular pressure (IOP) in patients with open-angle glaucoma. Patients were randomly assigned to receive EXP or TLE. Surgical success was defined according to three target mean IOP ranges (5 mmHg ≤ IOP ≤ 18 mmHg [criterion A], 5 mmHg ≤ IOP ≤ 15 mmHg [criterion B], and 5 mmHg ≤ IOP ≤ 12 mmHg [criterion C]) representing reductions of at least 20% below the baseline on two consecutive follow-up visits 3 months post-surgery, with or without antiglaucoma medication and without further glaucoma surgery. Participants were divided into three subgroups based on baseline mean deviation (MD) values: early (MD ≥ -6 dB), moderate (-6 dB > MD ≥ -12 dB), and advanced (-12 dB > MD). Survival rates were calculated by subgroup. A total of 73 patients, including 30 in the EXP group and 43 in the TLE group, were included in the study. No significant differences in baseline ocular or demographic characteristics were found between the two groups. No significant difference in IOP was noted every 6 months. After the 3-year follow-up, success rates were A) 60.0% and 60.2%, B) 45.7% and 58.1%, and C) 31.5% and 40.5% for the EXP and TLE groups, respectively. Moreover, there was no difference in success rate based on glaucoma level. Many glaucoma medications administered before surgery were associated with a higher failure rate in the TLE group but not in the EXP group. Both procedures resulted in similar IOP reductions and success rates for a low target IOP. The number of preoperative glaucoma medications was a risk factor for TLE failure.

Fluctuation of Intraocular Pressure and Vascular Factors Are Associated With the Development of Epiretinal Membrane in Glaucoma

To identify factors associated with the development of epiretinal membranes (ERM) in glaucoma patients. Multicenter, propensity-score matched, case-control study. One hundred ninety-two eyes of 192 patients with glaucoma from the Catholic Medical Center Glaucoma Suspect Cohort Study were analyzed. We identified 64 eyes who developed ERM from the cohort, and 128 eyes without ERM were selected by propensity score matching (1:2) according to baseline age and mean deviation (MD) of the visual field (VF). Demographic, systemic, and ocular characteristics were determined at baseline. Intraocular pressure (IOP) was measured, including baseline, mean IOP, and IOP fluctuation. Early-stage ERM, defined as translucent membrane with no underlying retinal distortion, was detected by fundus photography and optical coherence tomography. Central VF progression was considered when new VF defets developed in one either or both hemifields or when there was an increase of 3 or more abnormal points within 12 points of central 10° fixation. Autonomic nervous system status was evaluated by heart rate variability. Patients who developed ERM were more frequently receiving medication for systemic hypertension and had higher systolic blood pressure, greater IOP fluctuation, more frequent disc hemorrhage (DH), worse VF MD, and a higher rate of central VF progression than patients without ERM. Additionally, patients with early glaucoma who developed ERM had higher rate of autonomic imbalance while patients with moderate-to-advanced glaucoma who developed ERM had greater baseline and peak IOP and worse MD of the last follow-up VF (MD < 6.0 dB). Older age (P=.048), medication for systemic hypertension (P < .001), IOP fluctuation (P < .001), presence of DH (P < .001), and worse last MD of VF (P=.033) were significantly associated with ERM in Cox proportional hazard analysis. Early stage of ERMs in glaucomatous eyes are significantly associated with glaucoma progression, medication of systemic hypertension, presence of DH, and IOP fluctuation. These suggest that glaucoma patients who develop early stage of ERMs should be carefully monitored in terms of IOP fluctuation, vascular factors, and glaucoma progression.

Poor oral health predicts cognitive impairment in elders

AbstractBackgroundTooth loss, periodontal disease, dementia, and Alzheimer’s disease share several risk factors in older adults. Several previous studies have reported positive associations between these dental problems and global cognitive defects. However, limited is known about the relationships among multiple dental/periodontal statuses and different cognitive domains.MethodThis six‐year (2011‐2017) cohort study includes 515 older adults (65+). Global cognition was assessed by Montreal cognitive assessment‐Taiwan version (MoCA‐T). For cognitive domains, we used logical memory tests (immediate and delayed theme and free recall) in Wechsler Memory Scale‐Third Edition (WMS‐III) to assess memory. Trail Making Test A and B was used to assess attention and executive function, respectively. Digit span‐forward and backward was used to evaluate attention and working memory/short‐term memory, respectively. Verbal fluency tests were used to assess category/semantic fluency. A Z‐score was calculated for each cognitive domain‐specific test according to baseline mean and standard deviation. Oral health status includes tooth defect (dental caries, tooth wear, cervical abrasion, retained root or crown fracture), periodontal health (disease severity from healthy periodontal status, gingivitis to periodontitis), and arch integrity (no tooth loss nor retained root or crown fracture). Generalized linear mixed models were used to assess the associations above adjust important covariates.ResultAt baseline, periodontitis was associated with poor performance in executive function [Trail Making Test A: b = ‐0.14, 95% confidence interval (CI) = ‐0.27 to ‐0.01]. The association between baseline severity of tooth defect and poor memory decreased (logical memory‐immediate theme recall: b = ‐0.05, 95% CI = ‐0.10 to ‐0.01); similarly finding was found for attention domain (digit span‐forward: b = ‐0.04, 95% CI = ‐0.07 to ‐0.001). At baseline, loss of arch integrity was associated with a better working memory/short‐term memory (digit span‐backward: β = 0.18, 95% CI = 0.01 to 0.36); as follow‐up time increased, this association decreased over six years (β = ‐0.04, 95% CI = ‐0.07 to ‐0.003).ConclusionPeriodontitis, tooth defects, or arch integrity was associated with poor performance of cognitive domains (memory, attention, and executive function) over time. A oral health evaluation may serve as predictors of the preclinical phase of dementia in its upcoming years.

Outcomes of microPulse transscleral laser therapy in eyes with prior glaucoma aqueous tube shunt.

To evaluate the outcomes of micropulse transscleral laser therapy (MP-TLT) in patients with uncontrolled glaucoma and prior glaucoma aqueous tube shunt. In this single‑center, retrospective, interventional case series, eyes that underwent MP-TLT and had prior glaucoma aqueous tube shunt surgeries were included. The Cyclo Glaucoma Laser System (IRIDEX Corporation, Mountain View, CA, USA) with the MicroPulse P3 probe (version 1) was used. Post‑operative data were collected at day 1, week 1, and months 1, 3, 6, 12, 18, 24, 30 and 36. A total of 84 eyes (84 patients) with mean age of 65.8 ± 15.2years and with advanced glaucoma (baseline mean deviation -16.25 ± 6.80dB and best-corrected visual acuity 0.82 ± 0.83 logMar) were included in the study. Baseline mean IOP was 19.95 ± 5.6mm Hg with a mean number of medications 3.39 ± 1.02. There were statistically significant differences in IOP between baseline and all follow-up visits (p < 0.01 for all). The mean percentage of IOP reduction between baseline and different follow-up visits ranged from 23.4% to 35.5% (p < 0.01). There was a significant reduction of visual acuity (≥ 2-lines) at 1year (30.3%) and 2years (76.78%). There was a statistically significant reduction in the number of glaucoma medications between baseline and all follow-up visits after postoperative week 1 (p < 0.05 for all). No severe complications including persistent hypotony and related complications were observed. At the last follow-up visit, only 24 (28%) eyes out of 84 eyes remained in the study. MP-TLT is an effective treatment for reducing IOP and decreasing the number of medications in patients with advanced glaucoma and prior glaucoma aqueous tube shunt.

Risk factors for structural and functional progression of primary open-angle glaucoma in an African ancestry cohort

Background/aimsTo investigate the rates of structural and functional progression of primary open-angle glaucoma in an African ancestry cohort and identify risk factors for progression.MethodsThis retrospective study included 1424 eyes from...

Normotensive Glaucoma in the Fellow Eye of Patient with Unilateral Pseudoexfoliation

To investigate the characteristics of normotensive glaucoma (NTG) in the fellow eye of patients with unilateral pseudoexfoliation syndrome (PXS). This study is a retrospective chart review. We included 313 patients with NTG. Using the 1:1 matched propensity score, only 94 well-matched patients were selected. A total of 47 NTG patients who had PXS in their contralateral eye (PXS group) and 47 NTG patients who did not (control group) were compared. The propensity score was matched based on age, mean intraocular pressure (IOP), baseline retinal nerve fiber layer (RNFL) thickness and baseline mean deviation (MD) of visual field (VF) score. The diagnosis of NTG was based on the presence of glaucomatous optic nerve head injury with VF defect, intraocular pressure less than 22 mmHg, open angles and no pseudoexfoliation material. The PXS group had a higher ratio of males (34.0%) than the control group (17.0%). No significant differences were observed between the two groups in terms of CCT, axial length, untreated baseline IOP, baseline PSD of VF, systemic blood pressure and follow-up duration. The rate of RNFL thinning was significantly faster in the PXS group (-1.88 ± 2.83 μm/year) compared with the control group (-0.27 ± 5.29 μm/year) (p = 0.02). The progression rate of VF MD was slightly faster in PXS than in the control group, but there was no statistically significant difference (PXS group, -0.33 ± 0.90 dB/year; control group, -0.11 ± 0.84 dB/year; p = 0.236). NTG eyes with PXS showed faster RNFL thinning than did control NTG eyes.

Real-world efficacy of the intrascleral ciliary sulcus suprachoroidal microtube technique in Black and Afro-Latinx patients with glaucoma: a 1-year retrospective study.

Suprachoroidal surgery can lower intraocular pressure and medication use. There is currently no commercial suprachoroidal product on the market. Here, we report our 1 year results of a novel ciliary sulcus suprachoroidal microtube technique. To determine the real-world efficacy of intrascleral ciliary sulcus suprachoroidal microtube technique in Black and Afro-Latinx patients with glaucoma refractory to topical ocular hypertensive medications. A retrospective non-comparative single center study of 36 Black and Afro-Latinx patients with glaucoma and pseudophakia who underwent intrascleral ciliary sulcus suprachoroidal microtube surgery for glaucoma as a stand-alone procedure at a single practice. Investigated parameters were number of medications, visual acuity (VA), intraocular pressure (IOP), mean deviation on visual field (VF) test. Success was defined as (a) IOP ⩽ 15 mmHg and or ⩾ 20% reduction in IOP and (b) a reduction in number of medications. We used paired t-test to compare baseline and follow-up parameters. We reviewed a total of 36 patients who had undergone the procedure. Twenty had success with 12-month follow-up in the study. The mean number of medications decreased significantly from 4.2 ± 1.0 preoperatively to 2.4 ± 1.7 in 12 months (p = 0.021) with five patients being medication free. In addition, the IOP decreased significantly from 21 ± 8.2 to 13.5 ± 4.4 mmHg (p = 0.032). In the 20 patients who had 12-month follow-up, the VA remained stable from Log Mar 0.62 ± 0.6-0.46 ± 0.6 (p = 0.052). VF in patients with successful procedure (no further interventions) remained stable from baseline mean deviation of -16.53 ± 10.04 to -16.82 ± 9.80 dB at 6-12 months. Adverse effects were transient and included IOP spike, hypotony, hyphema, and cornea edema that were treated and resolved. This 12-month retrospective study demonstrated that intrascleral ciliary sulcus suprachoroidal microtube surgery can reduce IOP and medication burden in pseudophakic patients with glaucoma. However, despite several successes, surveillance should take place for IOP spikes, possible tube obstruction, and need for additional glaucoma surgery.

Evaluation of Risk Factors Affecting Progression in Primary Open-Angle Glaucoma and Exfoliation Glaucoma in a Turkish Population

Objective: To evaluate the effects of risk factors on progression in primary open-angle glaucoma (POAG) and exfoliation glaucoma (XFG). Materials and methods: The study included 139 patients with POAG and XFG followed up at Hacettepe University Faculty of Medicine, Department of Ophthalmology, Glaucoma Unit. A number of factors were evaluated through a cross-sectional design for all the patients, including age, sex, hypertension, diabetes, thyroid disease, cardiovascular disease, migraine, alcohol, smoking, family history, affected side, lens status, central corneal thickness (CCT), number of medications, body mass index (BMI), cup-to-disc (C/D) ratio, intraocular pressure (IOP), computerized automated visual field mean deviation (MD), and prior surgery. Results: The patients were divided into two groups, POAG and XFG, and further divided into the following two subgroups: progressive and non-progressive. Of the patients, 75 (53.9%) had POAG, and 64 (46.1%) had XFG. In the patients followed up, annual MD change was 0.96 ± 1.5 dB/year, baseline MD was −5.06 ± 5.61 dB, and IOP was 15.94 ± 1.93 mmHg. Potential risk factors for progression in the whole group were evaluated, but no significant difference was found between the groups with and without progression for all factors. Subgroup analysis revealed that in the POAG group, BMI was significantly higher in the non-progressive disease subgroup (p=0.01); furthermore, in the XFG group, IOP was significantly higher in the progressive disease subgroup (p=0.02). According to multiple logistic regression analysis, a 1-unit decrease in BMI in the POAG group increased the risk by 1.3 times (p=0.01), and smoking in the XFG group resulted in a 6-fold reduction in the risk of progression (p=0.04). Conclusion: Although mean IOP was higher in XFG group, the present study found BMI in POAG and smoking in XFG as independent factors that reduced progression in our series.

Longitudinal change of peripapillary vessel density and retinal nerve fibre layer thickness in normal tension and primary angle closure glaucoma

PurposeTo compare the rates of peripapillary vessel density (pVD) loss and retinal nerve fibre layer (RNFL) thinning in normal tension glaucoma (NTG) and primary angle closure glaucoma (PACG).MethodsBaseline age and...