Diagnosis Of Primary Open-angle Glaucoma Research Articles

"APOPTOSIS COLOR." SCREENING STRATEGY FOR DIAGNOSIS EARLY STAGES OF PRIMARY OPEN-ANGLE GLAUCOMA

Purpose: to develop a screening strategy for the early diagnosis of primary open-angle glaucoma. Patients and Methods : 1 group — 250 patients with suspected glaucoma (42–75 years), 2 — 250 with the 1st stage primary open-angle glaucoma (42–61), 3 — 3,000 healthy persons (35 to 50). Surveys: visometry, tonometry iCare, biomicroscopy, gonioscopy, pachymeria, ophthalmoscopy with a high dioptric lens of 60 D, standard automated perimetry of the SITA-Standard and SITA-SWAP program, assessing the color sensitivity according to the Famsworth-Munsell 100 HueTes method. Results: 1 group — SITA-SWAP: MD -2,55±0,7 dB, PSD 2,46±1,15 dB. Mansell test: TES = 58.6±18.7 (p<0.05), average level of color recognition; mild deficiency of color vision — 41–100 TES; by the RGB system: colors of the first order; tone in RGB (0–239): blue — 160; HCV: blue — 240; range of wavelengths: blue — 440–485 nm; frequency: blue — 620–680 THz. 2 group — on SITA-SWAP: MD — 5,13±1,3 dB, PSD 2,58±0,9 dB. Mansell test: TES = 86,9±21,8; average level of color recognition; mild deficiency of color vision; single deviations in the system of blue (azure, blue, blue); color I order (blue), III order (blue, azure); tone in RGB — (0–239): blue (azure, blue) — 140, blue — 160; HCV — blue (azure, blue) — 210, blue — 240; range of wavelengths: 450–500 nm (blue — 485–500, blue — 440–485); frequencies: 600–680 THz (blue — 600–620, blue — 620–680). Control group — SITA-SWAP within the norm, Mansell test: TES = 40,1±17,3 (p<0.05), medium level of color recognition, lack of color vision absent / mild, single deviations. Conclusion: in patients with glaucoma suspicion, the score of errors was higher than in the control group with Munsell test. In patients with glaucoma, the number of errors is greater than in patients with suspected glaucoma, and 2.2 times higher than in the control group.

Optical coherence tomography (OCT) changes after achieving target intraocular pressure

Purpose The aim of this study was to evaluate the ability of optical coherence tomography (OCT) to detect the changes in retinal nerve fiber layer (RNFL) after reaching target intraocular pressure (IOP) in glaucomatous patients. Patients and methods Thirty-two (58 eyes) patients with a clinical diagnosis of primary open-angle glaucoma were assessed as regards peripapillary RNFL thickness and optic nerve head parameters by 3D-OCT for a follow-up period of 6 months. The drugs used to reach target IOP were Twinzol (dorzolamide 2%/timolol 0.5%) eye drops 5 ml and Ioprost (Latanoprost) 0.005% (50 mcg/ml) eye drops 3 ml. Eleven patients were treated with Twinzol only and reached target IOP after adding Ioprost. Eight patients were treated with Ioprost only and reached target IOP after adding Twinzol, and 13 patients had no added treatment, where four reached target IOP by Ioprost only, six reached target IOP by Twinzol only, and three reached target IOP by both drugs. OCT was done for all patients after achieving target IOP and was repeated after 6 months of medical control. Results The mean IOP before treatment was 29.89 mmHg and decreased significantly (P Conclusion Achieving target IOP in patients with glaucoma results in a significant change in the RNFL and ganglion cell complexes layer as shown by spectral-domain OCT.

Selective Laser Trabeculoplasty Reduces Intraocular Pressure Peak in Response to the Water Drinking Test

To determine the effect of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) peak and fluctuation induced by the water drinking test (WDT) in patients with open-angle glaucoma and ocular hypertension. Patients with open-angle glaucoma or ocular hypertension underwent the WDT before and after SLT within a 12-month period. No other changes to therapeutic regimen were permitted. IOP was measured with a Goldmann applanation tonometer at baseline and every 15 minutes for 45 minutes following a fluid challenge of 800 mL over 15 minutes. Baseline, peak, and percentage fluctuation in IOP from baseline were compared using a repeated measures analysis of variance with Bonferroni adjustment. Twenty eyes from 20 patients were included in this study. The median patient age was 73±15 years (interquartile range) and 70% of patients were female. Ten eyes (50%) had a diagnosis of primary open-angle glaucoma and 10 eyes had ocular hypertension. Following SLT there was a statistically significant reduction in mean baseline IOP from 16.9±2.4 to 14.2±2.3 mm Hg (P<0.001), peak IOP from 21.9±3.7 to 16.9±3.1 mm Hg (P<0.001). Patients with open-angle glaucoma and ocular hypertension treated with SLT have significantly reduced peak IOPs and fluctuation in IOP in response to the WDT.

Assessment of Depression, Anxiety, and Quality of Life in Singaporean Patients With Glaucoma.

To determine the prevalence and risk factors for anxiety disorder and depression among glaucoma patients in Singapore, and to assess the relationship between quality of life (QOL) and depression/anxiety. In this cross-sectional study, glaucoma patients aged 21 and above with a known diagnosis of primary open-angle glaucoma or primary angle-closure glaucoma were recruited from a tertiary care hospital. Patients with other types of glaucoma, and coexisting ocular or psychiatric disorders were excluded.Ophthalmic examination was carried out on all participants, which included best-corrected visual acuity (BCVA), intraocular pressure (IOP), gonioscopy, standard automated perimetry, and optic disc evaluation. Sociodemographic information and treatment histories were also collected.The Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and Visual Function Questionnaire (VFQ25) were administered to evaluate for depression, anxiety, and impact on QOL, respectively. A total of 100 patients were included in this study. The mean age was 67.1±12.0 years (range, 24 to 90 y). The frequency of depression and anxiety among our patients was 30% and 64%, respectively. The mean HAM-D score was 4.37±4.17 (range, 0 to 17), whereas the mean HAM-A score was 2.38±2.80 (range, 0 to 13). The mean VFQ25 score was 78.8±16.0 (range, 42.4 to 97.0). The poorest subscale on the VFQ25 was driving, with a mean score of 42.4±42.6 (range, 0.0 to 100.0).We did not find any significant difference between the presence of depression/anxiety between patients with primary open-angle glaucoma (P=0.263) and primary angle-closure glaucoma (P=0.830). Risk factors for depression included: female sex (P=0.020), higher logMAR BCVA in the worse eye (P=0.004), higher cup-disc ratio (P=0.016), lower MD in the better and worse eye (P=0.022 and 0.001, respectively), and lower mean VFQ25 score (P<0.001). Risk factors for anxiety included: lower MD in the worse eye (P=0.004) and lower mean VFQ25 score (P=0.004). There was also no significant association between the use of topical β-blockers/carbonic anhydrase inhibitors with depression (P=0.793) or anxiety (P=0.282). There is a relatively high prevalence of depression (30%) and anxiety disorders (64%) among glaucoma patients in Singapore. Female glaucoma patients are more likely to suffer from depression. Other risk factors for depression include higher cup-disc ratio, higher logMAR BCVA, lower MD, and a lower mean VFQ25 score. Risk factors for anxiety disorder include lower MD and lower mean VFQ25 score. Ophthalmologists could consider use of the VFQ25 as an assessment for impairments in QOL in a glaucoma patient. If a glaucoma patient is at high risk of depression or anxiety disorder, a multidisciplinary management approach involving ophthalmology and psychiatry may be required.

Primary Open Angle Glaucoma is Associated with MR Biomarkers of Cerebral Small Vessel Disease.

This prospective study tests the hypotheses that: 1) glaucoma is associated with evidence of cerebral small vessel disease; 2) that imaging biomarkers of cerebral small vessel disease in POAG and NTG will show different characteristics. 12 normal controls, 7 patients with primary open angle glaucoma (POAG) and 9 patients with normal tension glaucoma (NTG) were recruited. Ophthalmological clinical assessment and MR imaging of the brain were performed. MR imaging was used to quantify white matter lesion load, frequency of dilated perivascular spaces (PVS) and abnormalities in cerebral hydrodynamics. Patients with POAG had significantly greater white matter lesion load (p < 0.05), more PVS in the centrum semiovale (p < 0.05) and had higher overall PVS scores than controls (p < 0.05). In the POAG group, optic cup-to-disc ratio (CDR) was positively correlated with deep white matter hyperintensities (R2 = 0.928, p < 0.01). Mean deviation on the Humphrey visual field assessment was negatively correlated with deep white matter lesion load (R2 = −0.840, p < 0.01), total white matter lesion load (R2 = −0.928, p < 0.01) and total PVS (R2 = −0.820, p < 0.01). MR evidence of cerebral small vessel disease is strongly associated with a diagnosis of POAG and with the severity of abnormalities in CDR and visual field.

Effectiveness and Cost of a Personalized Reminder Intervention to Improve Adherence to Glaucoma Care.

Glaucoma is the leadi ng cause of irreversible blindness in the USA. Glaucomatous vision loss is preventable with proper eye care, including appointment adherence. Therefore, interventions that improve appointment adherence can reduce the number of patients with more severe glaucoma. The primary study aim was to determine the efficacy and cost-effectiveness of a multifaceted personal reminder intervention, which included a customized letter and personal telephone outreach, in improving appointment adherence of patients with glaucoma. A secondary study aim was to identify patient characteristics that were associated with non-adherence. This prospective, randomized, controlled study included a cost-effectiveness analysis completed using a decision analytic model. The subjects included 256 patients with glaucoma. Study measures included appointment adherence and incremental cost effectiveness ratios. Patients in the intervention group were more likely to adhere to appointments (82.31 vs. 69.05 %; RR 1.23; 95 % CI 1.04-1.37, p < 0.012) than patients in the usual care group. Patients in the intervention group were 23 % more likely to adhere to appointments (RR 1.23; 95 % CI 1.08-1.41, p < 0.0021) than patients in the usual care group, when adjusting for age, secondary insurance, primary open angle glaucoma diagnosis, number of previous visits at Wills Eye Hospital, and follow-up recommendation using Poisson regression. Per-patient cost of the program was US$11.32, and cost per follow-up attended within the adherence window was US$73.56. A low cost reminder intervention consisting of a personalized letter and telephone outreach significantly improved appointment adherence of patients with glaucoma.

Intraocular pressure control in patients with primary open angle glaucoma and diabetes mellitus

ObjectiveTo determine the number of hypotensive drugs required to control the intraocular pressure (IOP) in patients with primary open angle glaucoma (POAG) and diabetes mellitus (DM), as well as describing their demographic characteristics. DesignObservational, cross-sectional, and descriptive study. MethodsTwenty-four patients (47 eyes) with definitive diagnosis of DM and POAG were included for a six month follow up, recording demographic data and IOP control. ResultsThe mean age was 67.04±8.9 years, and 79% of patients were female. Mean time from diagnosis of DM was 13.87 years, and 6.21 years for POAG. No statistical difference was observed between initial and final visual acuity (p=0.49). There was a statistical difference between initial and final IOP once treatment was started (p=0.002), requiring 1.9 hypotensive drugs (p<0.05). Beta-blockers were the most used hypotensive drugs for the initial (41%), as well as the final IOP control medication (28%). ConclusionThe mean IOP in patients with DM and POAG was 16.8mmHg, with the use of 1.9 hypotensive drugs.

Impact of Socioeconomic Status on the Diagnosis of Primary Open-Angle Glaucoma and Primary Angle Closure Glaucoma: A Nationwide Population-Based Study in Taiwan.

PurposeTo understand the impact of socioeconomic status (SES) on the diagnosis of primary open-angle glaucoma (POAG) and primary angle closure glaucoma (PACG) in Taiwan.MethodsSubjects with glaucoma were identified from the National Health Insurance Research Database of year 2006, which included one million randomly selected insurants. Individuals who had ≥4 ambulatory visits within one year which had the diagnosis code of POAG (ICD-9-CM 365.11 or 365.12) or PACG (365.23) and concurrent prescription of anti-glaucoma medication or surgery were selected. Individual SES was represented by monthly income calculated from the insurance premium. Neighborhood SES was defined based on neighborhood household income averages. Urbanization level of habitation was categorized into 3 levels. The odds ratio of having POAG or PACG in subjects with different SES was evaluated by using multiple logistic regression analysis.ResultsIn total, 752 and 561 subjects with POAG and PACG, respectively, who were treated on a regular basis, were identified. The diagnosis of glaucoma was affected by age, gender, frequency of healthcare utilization, individual SES, and urbanization level of habitation. With the adjustment of age, gender, healthcare utilization, neighborhood SES and level of urbanization, subjects with lower income were more likely to be diagnosed as PACG, but less likely as POAG.ConclusionsSubjects with more frequent healthcare utilization were more likely to be diagnosed with glaucoma. Subjects with low SES were more susceptible to PACG, but subjects with high SES were more likely to be diagnosed as POAG. This information is useful for the design and target participant setting in glaucoma education and screening campaign to maximize the efficacy of limited resources in preventing glaucoma blindness.

Distinctive morphological and functional changes in retinal ganglion cells associated with normal aging and early stage of glaucoma

Early diagnosis of primary open-angle glaucoma (POAG) is closely connected with detection of normal age-related changes in the retina. It is also essential to develop reliable methods for quantitative evaluation of retinal nerve fiber layer (RNFL) thickness and retinal ganglion cells (RGCs) structure and function as well as to extend opportunities for inter-instrumental comparisons. to assess the function of RGCs from parvo- and magnocellular pathways by means of pattern electroretinography and to evaluate the degree of retinal sensitivity loss and RNFL thickness using new methods of analysis in normal aging and the early stage of POAG. Four groups were formed: group 1 - young healthy participants, group 2 - aged controls, group 3 - glaucoma suspects, and group 4 - early-stage POAG patients. In all groups we investigated the MD and PSD indices of static computer perimetry (HEP, Heidelberg Edge Perimeter, SAP and FDF tests) and RNFL thickness provided by HRT III (Heidelberg Engineering). Pattern electroretinograms (PERGs) were recorded with the RETImap system (Roland Consult) at the check sizes of 0.8° and 16°. For steady-state and transient PERGs the 0.8°/16° and N95/P50 ratios were calculated, respectively. There was a statistically significant difference in PERG amplitudes to 0.8° checks (p=0.0001) and in 0.8°/16° ratios (p=0.0001) between the groups 1 and 2. Differences between the groups 2 and 3 as well as 3 and 4 were statistically significant only as to 0.8° checks (p=0.03 and p=0.001, respectively). Responses to 16° checks were alike in all groups. We have also applied original formulas to determine the relative loss of RGCs and their axons and the congruence coefficient for morphological and functional parameters in normal aging and the early stage of POAG. The discovered age-related PERG changes convincingly indicate a greater parvocellular RGC loss as compared to magnocellular. Thus, the PERG ratio (0.8°/16°) should be corrected for the subject's age. The proposed indices of relative decline in retinal light sensitivity and RNFL thinning have been shown to be useful for quantifying the loss of RGC bodies and axons in normal aging and early-stage glaucoma.

Control de la presión intraocular en pacientes con glaucoma primario de ángulo abierto y diabetes mellitus

ObjectiveTo determine the number of hypotensive drugs required to control the intraocular pressure (IOP) in patients with primary open angle glaucoma (POAG) and diabetes mellitus (DM), as well as describing their demographic characteristics. DesignObservational, cross-sectional, and descriptive study. MethodsTwenty four patients (47 eyes) with definitive diagnosis of DM and POAG were included for a six month follow up, recording demographic data and IOP control. ResultsThe mean age was 67.04±8.9 years, and 79% of patients were female. Mean time from diagnosis of DM was 13.87 years, and 6.21 years for POAG. No statistical difference was observed between initial and final visual acuity (P = 0.49). There was a statistical difference between initial and final IOP once treatment was started (P = 0.002), requiring 1.9 hypotensive drugs (P < 0.05). Beta-blockers were the most used hypotensive drugs for the initial (41%), as well as the final IOP control medication (28%). ConclusionThe mean IOP in patients with DM and POAG was 16.8mmHg, with the use of 1.9 hypotensive drugs.

Long-Term Use of Selective Serotonin Reuptake Inhibitors and Risk of Glaucoma in Depression Patients

This study investigated whether the long-term use of selective serotonin reuptake inhibitors (SSRIs) influences the risk of primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) in the Chinese ethnic population in Taiwan.The authors retrieved the data under analysis from the National Health Insurance Research Database in Taiwan and identified 26,186 newly diagnosed depression patients without preexisting glaucoma. The study cohort included 13,093 patients with over 1 year of SSRI use, and a comparison cohort of 13,093 patients who had never used SSRIs. The main outcome was a diagnosis of POAG or PACG during follow-up. The authors used univariable and multivariable Cox proportional hazards regression models to assess the effects of SSRIs on the risk of POAG and PACG.The cumulative incidences of POAG and PACG between the SSRI and comparison cohorts exhibited nonsignificant differences (log-rank test P = .52 for POAG, P = .32 for PACG). The overall incidence of POAG in the SSRI cohort was nonsignificantly higher than that in the comparison cohort (1.51 versus 1.39 per 1000 person-years), with an adjusted hazard ratio of 1.07 (95% confidence interval = 0.82–1.40). The overall incidence of PACG in the SSRI cohort was nonsignificantly lower than that in the comparison cohort (0.95 versus 1.11 per 1000 person-years), with an adjusted hazard ratio of 0.85 (95% confidence interval = 0.62–1.18).The long-term use of SSRIs does not influence the risk of POAG or PACG in depression patients.

Effect of Prior Anti–VEGF Injections on the Risk of Retained Lens Fragments and Endophthalmitis after Cataract Surgery in the Elderly

To investigate the effect of prior intravitreal anti-vascular endothelial growth factor (VEGF) injections on surgical and postoperative complication rates associated with cataract surgery in a nationally representative longitudinal sample of elderly persons. Retrospective, longitudinal cohort analysis. A total of 203 643 Medicare beneficiaries who underwent cataract surgery from January 1, 2009, to December 31,2013. By using the 5% sample of Medicare claims data, the study assessed risks of 3 adverse outcomes after receipt of cataract surgery for beneficiaries with a history of intravitreal injections. Risks of these outcomes in beneficiaries with a history of intravitreal injections relative to those without were calculated using the Cox proportional hazard model. The primary outcome was the risk of subsequent removal of retained lens fragments (RLFs) within 28 days after cataract surgery. Secondary outcomes were a new diagnosis of acute (<40 days) or delayed-onset (40+ days) endophthalmitis and risk of a new primary open-angle glaucoma (POAG) diagnosis within 365 days after cataract surgery. Prior intravitreal anti-VEGF injections were associated with a significantly increased risk of subsequent RLF removal within 28 days after cataract surgery (hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.19-4.30). Prior injections were also associated with increased risk of both acute (HR, 2.29; 95% CI, 1.001-5.22) and delayed-onset endophthalmitis (HR, 3.65; 95% CI, 1.65-8.05). Prior injections were not a significant indicator of increased risk of a new POAG diagnosis. A history of intravitreal injections may be a risk factor for cataract surgery-related intraoperative complications and endophthalmitis. Given the frequency of intravitreal injections and cataract surgery, increased preoperative assessment, additional intraoperative caution, and postoperative vigilance are recommended in patients with a history of intravitreal injections undergoing cataract extraction.

A prospective, longitudinal, observational cohort study examining how glaucoma affects quality of life and visually-related function over 4 years: design and methodology.

BackgroundThe aim of this study is to summarize the design and methodology of a prospective, longitudinal, observational cohort study to investigate how glaucoma affects patients’ quality of life and visually-related function over a 4-year period.Methods/DesignOne hundred sixty-one (161) subjects were enrolled in this ongoing study. Patients between the ages of 21–85 years with a minimum 2-year diagnosis of primary open-angle glaucoma, chronic primary angle-closure glaucoma or pseudoexfoliation glaucoma were included. Each patient visited Wills Eye Hospital for a baseline visit. Follow-up is planned for a minimum of 4 years, with annual visits. Each visit includes (1) Clinical evaluation: a slit lamp examination, fundoscopy, intraocular pressure measurement, visual field examination, spectral domain optical coherence tomography, Pelli-Robson Contrast Sensitivity test and the Spaeth-Richman Contrast Sensitivity test; (2) a performance based measure: the Compressed Assessment of Ability Related to Vision; and (3) Subjective measures of vision-related quality of life (the National Eye Institute Visual Functioning Questionnaire 25 and the Modified Glaucoma Symptom Scale).DiscussionThe results of this ongoing, prospective, longitudinal study are expected to shed light on the relationships between clinical measures, performance-based measures and subjective measures of well-being, in order to assess changes in the quality of life and the ability to function of patients with glaucoma over time.

Diagnostic Consistency and Relation Between Optical Coherence Tomography and Standard Automated Perimetry in Primary Open-Angle Glaucoma

Purpose: To assess diagnostic consistency and relation between spectral-domain optical coherence tomography (SD-OCT) and standard automated perimetry (SAP) in patients with primary open-angle glaucoma (POAG). Methods: This retrospective study comprised 51 eyes of 51 patients with a confirmed diagnosis of POAG. The qualitative and quantitative SD-OCT parameters (retinal nerve fiber layer thicknesses [RNFL; average, superior, inferior, nasal and temporal], RNFL symmetry, rim area, disc area, average and vertical cup/disc [C/D] ratio and cup volume) were compared with parameters of SAP (mean deviation, pattern standard deviation, visual field index, and glaucoma hemifield test reports). Results: Fifty-one eyes of 51 patients with POAG were recruited. Twenty-nine eyes (56.9%) had consistent RNFL and visual field (VF) damage. However, nine patients (17.6%) showed isolated RNFL damage on SD-OCT and 13 patients (25.5%) had abnormal VF test with normal RNFL. In patients with VF defect, age, average C/D ratio, vertical C/D ratio, and cup volume were significantly higher and rim area was lower when compared to those of the patients with normal VF. In addition to these parameters, worsening in average, superior, inferior, and temporal RNFL thicknesses and RNFL symmetry was significantly associated with consistent SD-OCT and SAP outcomes. Conclusions: In routine practice, patients with POAG can be manifested with inconsistent reports between SD-OCT and SAP. An older age, higher C/D ratio, larger cup volume, and lower rim area on SD-OCT appears to be associated with detectable VF damage. Moreover, additional worsening in RNFL parameters might reinforce diagnostic consistency between SD-OCT and SAP.

Identification of a novel MYOC mutation in a Chinese family with primary open-angle glaucoma

PurposeThe myocilin (MYOC) gene has been shown to be related to primary open-angle glaucoma (POAG). This study was aimed to detect the mutations in MYOC in a Chinese family with POAG. MethodsA family with four members, the parents, a son and a daughter, was enrolled in this study. All members of the family underwent the complete ophthalmologic examinations. Genomic DNA was collected from peripheral blood of all the participants. The coding sequence of MYOC was amplified by polymerase chain reaction (PCR), followed by direct DNA sequencing. ResultsThe son, who was the proband of this family, was diagnosed as early-onset POAG in both eyes. His mother was diagnosed as POAG ten years ago. A novel heterozygous missense mutation c.761C<G (p.P254R) in the MYOC gene, was identified as being co-segregated with the phenotype of this family. This mutation was detected in the two affected patients, but not present in the other normal family members or 384 normal controls. ConclusionsThis study provides a mutation spectrum of MYOC resulting in POAG development in a Chinese population, which may help to better understand the molecular pathogenesis and clinical diagnosis of MYOC-associated POAG.

Age-based analysis of choroidal thickness and choroidal vessel diameter in primary open-angle glaucoma.

We aimed to assess choroidal thickness and vessel diameter in patients with primary open-angle glaucoma (POAG) using enhanced depth imaging (EDI) optical coherence tomography (OCT) with age-based analysis. Fifty-four patients with a confirmed diagnosis of POAG and 44 age-sex matched healthy subjects were included into the study. A masked physician performed measurements of largest choroidal vessel diameter and choroidal thicknesses (subfoveal, nasal, and temporal) using EDI OCT. Subgroup analyses were performed to compare choroidal measurements based on age (with a cut point of 70years). The study cohort comprised 54 patients with POAG (mean age of 63.2±8.8years) and 44 healthy control subjects (mean age of 62.9±8.5years) (P=0.870). We found no significant differences in terms of choroidal measurements (P>0.05) between the glaucoma and control groups. However, in the glaucoma group, patients with an age≥70years had significantly thinner subfoveal and nasal choroid compared to those of the patients with <70years of age (P=0.017, 0.002 respectively). In the control group, choroidal thickness and vessel measurements showed no significant difference when the subjects were subgrouped according to the age cut point (P>0.05). Choroidal thickness and vessel caliber seem not to differ between patients with POAG and healthy controls. However, an age≥70years might be associated with thinning in subfoveal and nasal choroid in patients with POAG. Further studies are needed to elucidate whether choroidal thinning is a cause or result in POAG.

Serum vitamin D status is associated with the presence but not the severity of primary open angle glaucoma

ObjectivesVitamin D is involved in visual health and function. Our objective was to determine whether age-related vitamin D insufficiency was associated with the presence and the severity of primary open angle glaucoma (POAG) in a case-control study of older adults. Study designCase-control study.Main outcome measures. One hundred fifty cases diagnosed with moderate-to-severe POAG (mean, 75.1±8.5 years; 42.0% female) and 164 healthy controls (mean, 73.0±7.9 years; 59.8% female) were included. POAG diagnosis was based on classical diagnostic criteria of optic nerve cupping and/or RNFL thinning, measured with optical coherence tomography. Severe POAG was defined as Humphrey visual field mean deviation (MD) worse than −12dB. Vitamin D insufficiency was defined as serum 25OHD≤75nmol/L. Age, gender, mean arterial pressure, vitamin D supplementation, visual acuity, and intraocular pressure were used as potential confounders. ResultsPOAG cases had lower mean serum 25OHD concentration than controls (42.9±25.7nmol/L versus 49.4±29.5nmol/L, P=0.039) and a greater prevalence of vitamin D insufficiency (90.7% versus 82.3%, P=0.032). Increased mean serum 25OHD concentrations were associated with lower POAG frequency, even after adjustment for potential confounders (OR=0.89 per 10nmol/L of 25OHD, P=0.045). Similarly, vitamin D insufficiency was associated with POAG (OR=2.09, P=0.034). Among POAG cases, no 25OHD difference was observed between moderate and severe POAG cases (respectively, 39.2±23.3nmol/L versus 45.1±26.7nmol/L, P=0.188); and no between-group difference regarding the prevalence of vitamin D insufficiency (88.9% versus 94.0%, P=0.313). ConclusionsDecreased serum 25OHD concentration was associated with POAG. There was no 25OHD difference between moderate and severe POAG.

Associations between primary open angle glaucoma, Alzheimer’s disease and vascular dementia: record linkage study

AimsThe potential association between primary open angle glaucoma (POAG) and Alzheimer's disease (AD) is uncertain and has implications for understanding disease pathogenesis, referral and treatments. The aim was to determine...

Visual status in primary open-angle glaucoma: A hospital-based report from Nepal

Background: Primary open-angle glaucoma (POAG) is the commonest cause of irreversible blindness. Most hospitals in Nepal are carrying out opportunistic glaucoma screening for those attending hospitals for any eye consultation. However, there are no reports detailing the visual damage at the time of diagnosis confirming the early detection of cases.Objectives: This study aimed to investigate the clinical features and visual status at the time of diagnosis of POAG in the Nepalese population.Methods: We evaluated 173 newly diagnosed consecutive cases of POAG from three hospitals across Nepal. Glaucoma evaluation was carried out detailing the findings of visual acuity and visual fields. Continuous data were presented as means and standard deviations (SD) and categorical data as proportions (95% CI). Unpaired t-tests compared continuous variables with p value set at a 5% level of significance.Results: Out of total patients, 82.1% were diagnosed incidentally while they visited the hospital for symptoms not expected to be for glaucoma. Only 9.8% of cases were aware of them being at risk of developing glaucoma and thus attended hospitals for regular check-up. Visual field examination revealed mean scores of mean deviation (MD) as low as-13.24 dB and pattern standard deviation of 7.34 dB. Glaucoma hemifield test was outside normal limits in 61.5% of eyes tested. Additionally, 4.7% patients were blind.Conclusion: POAG cases presented late with significant visual damage. Existing opportunistic screening for glaucoma in Nepal needs to be combined with community-based glaucoma awareness programs to bring more people to hospital at the early stage of the disease.DOI: http://dx.doi.org/10.3126/jkmc.v3i2.11226Journal of Kathmandu Medical CollegeVol. 3, No. 2, Issue 8, Apr.-Jun., 2014Page : 49-57

Primary Open-Angle Glaucoma in a Population Associated with High Prevalence of Primary Angle-Closure Glaucoma: The Kumejima Study

To evaluate the prevalence of and risk factors for primary open-angle glaucoma (POAG) in a rural population of southwestern Japan. Population-based cross-sectional study. All residents 40 years of age and older in Kumejima, Okinawa, Japan. Of the eligible 4632 residents 40 years of age and older, 3762 subjects (participant rate, 81.2%) underwent screening examinations, including visual acuity (VA) measurement, slit-lamp examination, Goldmann applanation tonometry, gonioscopy, undilated stereoscopic fundus photographs, autorefractometry, noncontact specular microscopy, pachymetry, and visual field (VF) testing using frequency-doubling technology. If glaucoma or other related ocular disorders were suspected, subjects were referred for definitive examinations including VF testing with the Humphrey Field Analyzer. The diagnosis of POAG was based on the criteria of the International Society for Geographical and Epidemiological Ophthalmology. Prevalence and risk factors of POAG. The prevalence of POAG was 4.0% (95% confidence interval [CI], 3.4%-4.7%); 82% of patients had an intraocular pressure (IOP) less than 22 mmHg, resulting in a prevalence of 3.3% (95% CI, 2.8%-3.9%). Because of POAG, 3 subjects had a VA worse than 20/400 in only 1 eye, and 1 subject had VA loss of worse than 20/400 bilaterally. The average IOP values (mean ± standard deviation) were 14.9 ± 3.2 and 14.6 ± 3.3 mmHg in the right and left eyes, respectively; the IOP values were higher in patients with POAG (15.4 ± 3.3 and 15.2 ± 3.3 mmHg, respectively) than in subjects without glaucoma (14.8 ± 3.1 and 14.4 ± 3.1 mmHg, respectively; P<0.045, Student t test). Multivariate analysis showed that male gender (P = 0.003), older age (P<0.001), higher IOP (P<0.001), longer axial length (P<0.001), and thinner central cornea (P = 0.006) were associated with POAG. High prevalence rates of POAG (4.0%) and POAG with normal IOP levels (3.3%), which were comparable with those on the Japanese mainland, were found in a southwestern rural island of Japan, where the prevalence of primary angle-closure glaucoma (previously reported as 2.2%) was considerably higher than on the Japanese mainland (0.6% in the Tajimi Study) or other countries. The risk factors for POAG included male gender, older age, higher IOP, myopia, and a thinner cornea.