Early Primary Open-angle Glaucoma Research Articles

Comparative evaluation of OCT with OCTA changes at the optic disc and macula in glaucoma suspect and early glaucoma.

To compare the diagnostic ability of macular ganglion cell inner plexiform layer (mGCIPL) and peripapillary retinal nerve fiber layer (pRNFL) thickness on optical coherence tomography (OCT) and macular and peripapillary perfusion changes using OCT angiography (OCTA) in glaucoma suspect and early primary open angle glaucoma (POAG). Ninety patients (30 normal, 30 glaucoma suspects, and 30 early POAG) were recruited in this cross-sectional, prospective study. The average thickness of mGCIPL and pRNFL on spectral domain-OCT and macular vessel density (VD), optic nerve head (ONH) perfusion, and ONH flux index (FI) on OCTA were evaluated for early diagnosis of glaucoma. Macular VD, ONH perfusion, and ONH FI were significantly reduced in early POAG eyes compared to normal. The best correlation was observed between ONH FI and the average RNFL in both glaucoma suspects (r = 0.47, P < 0.01) and early POAG patients (r = 0.53, P < 0.01). Out of all the measured OCTA parameters, only ONH perfusion was significantly lower in glaucomatous eyes compared to glaucoma suspects (P < 0.001). Average GCIPL (0.82) and macular VD (0.76) had the highest area under the receiver operating characteristic (AUROC) curve value among all the OCT and OCTA parameters, respectively, for differentiating glaucoma suspects from controls. Rim area (0.92) and ONH FI (0.81) had the highest AUROC value among all the OCT and OCTA parameters for differentiating early POAG patients from controls. OCTA vascular parameters had a good correlation with structural damage both at the disc and the macula. OCT parameters were superior to OCTA parameters for diagnosis of glaucoma, although OCTA parameters are deranged very early in the disease.

Long-term efficacy and safety of ab externo canaloplasty in the Polish Caucasian population with open-angle glaucoma: A 3-year retrospective study.

This study aimed to assess the effectiveness and safety of ab externo canaloplasty over a 3-year follow-up period in Polish Caucasian patients with glaucoma. This retrospective study of a cases series was conducted at the Department of Ophthalmology Medical University of Bialystok, Poland. Primary outcome measures were intraocular pressure and medication burden. Secondary outcome measures were best corrected visual acuity, retinal nerve fiber layer thickness, visual field test results, endothelial cell density, intraoperative and postoperative complications, and additional glaucoma surgery. The study group consisted of 160 eyes diagnosed with early to-moderate primary open-angle glaucoma and treated with ab externo canaloplasty from 2014 to 2020. The criteria for qualified and complete success were intraocular pressure < 18 mmHg or ≥ 20% reduction in intraocular pressure from baseline with or without antiglaucoma medications, respectively. After surgery, the mean intraocular pressure decreased from 19.23 ± 4.33 to 14.52 ± 3.79 mmHg, which constituted a 36.7 ± 7.8% reduction compared to the baseline value. The number of medications decreased by two at the end of the study period (from 2.69 ± 1.05 to 0.32 ± 0.75). Complete and qualified success were achieved in 58.7% and 68.7% of the patients, respectively, at the end of follow-up. An incomplete cannulation of Schlemm's canal was the most common intraoperative complication, occurring in 32 eyes (20%). The most frequent postoperative complications were hyphema, Descemet's membrane detachment, and a transient increase in intraocular pressure. Additional surgical procedure was required in seven cases (4.4%). In 16 patients (10%), medical treatment was re-administered. Overall, our findings suggest that ab externo canaloplasty is a good option for Polish Caucasian patients with primary open-angle glaucoma. It reduces intraocular pressure and has a low postoperative complication rate. Additional glaucoma surgery or re-administration of medications is required if the target intraocular pressure is unsatisfactory.

Contrast Sensitivity Is Impaired in Suspected Primary Open-Angle Glaucoma Patients.

To assess spatial contrast sensitivity (CS) in suspected primary open-angle glaucoma (POAG) patients. CS was measured using sinusoidal gratings of 4 cycles/degree. First, foveal and peripheral CS were assessed in 34 suspected POAG patients and compared with 71 and 28 age-matched healthy individuals for foveal and peripheral conditions, respectively. Second, foveal CS was assessed in 34 early POAG patients age-matched with suspected POAG patients. Analyses were performed considering two age ranges: Under and Over 50 y.o. Correlations were evaluated between CS and clinical parameters. Diagnostic accuracy was also analyzed. Peripheral CS was lower in older suspected POAG patients (23.4 ± 16.1) than the control group (39.1 ± 28.2) (p = 0.040). Foveal CS was reduced in suspected POAG participants (Under 50: 146.8 ± 63.3; p = 0.004. Over 50: 110.5 ± 65.0; p = 0.044) and in early POAG patients (Under 50: 141.2 ± 72.6; p = 0.002. Over 50: 80.2 ± 54.5 p < 0.001), both compared to the control group (Under 50: 213.5 ± 66.2. Over 50: 138.6 ± 71.7). CS was lower in early POAG than in POAG suspected in older patients (p = 0.042). Foveal CS was correlated with age (Early: p = 0.001. Suspect: p = 0.002) and with the cup-disc ratio only in early POAG patients (p < 0.001). Foveal CS had fair (AUC = 0.74) diagnostic accuracy for early POAG patients. CS in suspected POAG patients is lower than in healthy individuals. Our findings evidence the spatial vision loss before the onset of POAG.

Diagnostic ability of the combination of retinal microvasculature evaluation and static automated perimetry for early primary open-angle glaucoma.

To investigate the diagnostic ability of retinal superficial vasculature evaluation by optic coherence tomography angiography (OCTA) combined with visual field (VF) testing for early primary open-angle glaucoma (POAG). In this cross-sectional study, 84 participants were included, including 11 in the ocular hypertension (OHT) group, 11 in the preperimetric POAG (pre-POAG) group, 29 in the early POAG group and 33 in the control group. All participants underwent 6 × 6 mm2 scans of macula and optic nerved head by optic coherence tomography (OCT) and OCTA, along with white-on-white and blue-on-yellow VF testing by static automated perimetry. The ability of diagnosing early glaucoma by either various examinations separately or combination of examinations in both terms of function and structure was studied using the receiver operating characteristic (ROC) curve and the area under the curve (AUC). The superficial retinal vessel densities (VD) in peri-nasal, para-temporal, peri-temporal and peri-inferior regions around the macula, as well as vessel area densities (VAD) in all peripapillary regions, were significantly different among the four groups, with lower VD or VAD in the early POAG patients compared to the normal individuals. The diagnostic ability of peripapillary superficial retinal VAD alone or VF testing alone was limited for early POAG only. However, the combination of these two was more effective in distinguishing normal individuals from OHT subjects or pre-POAG patients without VF defects, with better performance than the combination of peripapillary retinal nerve fiber layer (RNFL) thickness and VF indicators. Peripapillary retinal vessel densities were generally lower in early POAG patients compared to normal individuals. The combination of peripapillary superficial retinal VAD by OCTA with white-on-white VF testing improved the ability to distinguish POAG patients at early stage without function impairment, which may help in providing reference and guidance for the following-up and treatment of suspected POAG patients.

MP-3 microperimeter in early primary open angle glaucoma with a new pattern.

To investigate macular microperimetry in patients with early primary open angle glaucoma (POAG) using a new custom-made pattern, and analyze the characteristics of macular sensitivity. This case-control study included 38 patients with POAG, who were divided into pre-perimetric glaucoma (18 eyes of 18 patients), early-stage (20 eyes of 20 patients), and control (20 eyes of 20 patients) groups. All subjects underwent standard 24-2 humphrey visual field test. An MP-3 microperimeter with a new custom-made pattern (28 testing points distributed in four quadrants, covering the central 10° of the retina) was used to evaluate macular sensitivity. Ganglion cell complex (GCC) thicknesses were examined using an RS-3000 Advance OCT system. The features of structure and function were analysed per quadrant. The pre-perimetric glaucoma group had significantly lower inferior hemifield macular sensitivity compared to controls (P<0.05). The early-stage POAG group had significantly lower average, inferior hemifield, inferonasal, and inferotemporal mean sensitivities compared to the pre-perimetric glaucoma group (P<0.05), and lower macular sensitivity in all sectors compared to controls (P<0.05). Regarding GCC thickness, all sectors in the early-stage POAG group became thinner compared to those in controls (P<0.05); whereas all sectors in the early-stage POAG group, except the superonasal quadrant, became thinner compared to those in the pre-perimetric glaucoma group (P<0.05). Macular sensitivity and GCC thickness were significantly associated in each sector. The inferotemporal quadrant had the highest correlation coefficients (0.840). The structure-function relationship for the inferonasal and inferotemporal sectors was stronger compared to the corresponding superior sectors. Microperimetry reveals variations in macular sensitivity in patients with early glaucoma earlier than conventional perimetry, particularly in pre-perimetric glaucoma cases in which it might be undetectable by conventional methods. The new custom-made pattern may improve the accuracy of microperimetry by enhancing point arrangement and reducing fatigue effects. Macular sensitivity measured by MP-3 with this pattern shows statistically significant structural and functional associations with the thicknesses of the GCC.

Micropulse Transscleral Cyclophotocoagulation in Non-Incisional Eyes with Ocular Hypertension and Primary Open-Angle Glaucoma.

To investigate the safety and effectiveness of micropulse transscleral cyclophotocoagulation (MPTSCPC) in non-incisional eyes with ocular hypertension (OHT) and early, moderate, and severe primary open-angle glaucoma (POAG). Retrospective cohort study of eyes that underwent MPTSCPC from 2016 to 2019 at an outpatient clinic in Canada. Eyes were excluded if any incisional procedures, except cataract surgery, were performed prior to MPTSCPC treatment. Laser power ranged from 900 to 2500mW. A total of 153 eyes from 93 patients were included (OHT n=22; early POAG n=46; moderate POAG n=35; severe POAG n=50). The baseline IOP was 18.37 ± 4.76mmHg in the total cohort. All cohorts experienced a significant mean IOP reduction by final follow-up (total p<0.001; OHT p=0.003; early POAG p<0.001; moderate POAG p=0.022; severe POAG p=0.015). Overall, 52.9% of eyes achieved an IOP reduction of ≥20% from baseline to final follow-up (OHT 59.1%; early POAG 58.7%; moderate POAG 45.7%; severe POAG 50.0%). There was worsening in best-corrected visual acuity in the total cohort (mean difference=0.11 ± 0.36 logMAR, p=0.11), mostly attributable to cataract progression (34.1% of phakic eyes) and ocular surface disease (7.2%). The number of topical medications and drug classes remained unchanged in the total cohort (p=0.425 and p=0.791, respectively). Twenty-two eyes (14.4%) required retreatment, which provided an additional IOP reduction of 1.26mmHg (p=0.344). By final follow-up, 8 eyes (5.2%) required escalation to incisional procedures. MPTSCPC is a safe and effective adjunct IOP-lowering treatment in non-incisional eyes with OHT and POAG.

Reduced Thickness of the Retina in de novo Parkinson's Disease Shows A Distinct Pattern, Different from Glaucoma.

Parkinson's disease (PD) patients experience visual symptoms and retinal degeneration. Studies using optical coherence tomography (OCT) have shown reduced thickness of the retina in PD, also a key characteristic of glaucoma. To identify the presence and pattern of retinal changes in de novo, treatment-naive PD patients compared to healthy controls (HC) and early primary open angle glaucoma (POAG) patients. Macular OCT data (10×10 mm) were collected from HC, PD, and early POAG patients, at the University Medical Center Groningen. Bayesian informative hypotheses statistical analyses were carried out comparing HC, PD-, and POAG patients, within each retinal cell layer. In total 100 HC, 121 PD, and 78 POAG patients were included. We showed significant reduced thickness of the inner plexiform layer and retinal pigment epithelium in PD compared to HC. POAG patients presented with a significantly thinner retinal nerve fiber layer, ganglion cell layer, inner plexiform layer, outer plexiform layer, and outer photoreceptor and subretinal virtual space compared to PD. Only the outer segment layer and retinal pigment epithelium were significantly thinner in PD compared to POAG. De novo PD patients show reduced thickness of the retina compared to HC, especially of the inner plexiform layer, which differs significantly from POAG, showing a more extensive and widespread pattern of reduced thickness across layers. OCT is a useful tool to detect retinal changes in de novo PD, but its specificity versus other neurodegenerative disorders has to be established.

Tear metabolomics for the diagnosis of primary open-angle glaucoma

Primary Open-Angle Glaucoma (POAG) is the most prevalent glaucoma type, and the leading cause of irreversible visual impairment and blindness worldwide. Identification of early POAG biomarkers is of enormous value, as there is not an effective treatment for the glaucomatous optic nerve degeneration (OND). In this pilot study, a metabolomic analysis, by using proton (1H) nuclear magnetic resonance (NMR) spectroscopy was conducted in tears, in order to determine the changes of specific metabolites in the initial glaucoma eyes and to discover potential diagnostic biomarkers. A classification model, based on the metabolomic fingerprint in tears was generated as a non-invasive tool to support the preclinical and clinical POAG diagnosis. 1H NMR spectra were acquired from 30 tear samples corresponding to the POAG group (n = 11) and the control group (n = 19). Data were analysed by multivariate statistics (partial least squares-discriminant analysis: PLS-DA) to determine a model capable of differentiating between groups. The whole data set was split into calibration (65%)/validation (35%), to test the performance and the ability for glaucoma discrimination. The calculated PLS-DA model showed an area under the curve (AUC) of 1, as well as a sensitivity of 100% and a specificity of 83.3% to distinguish POAG group versus control group tear data. This model included 11 metabolites, potential biomarkers of the disease. When comparing the study groups, a decrease in the tear concentration of phenylalanine, phenylacetate, leucine, n-acetylated compounds, formic acid, and uridine, was found in the POAG group. Moreover, an increase in the tear concentration of taurine, glycine, urea, glucose, and unsaturated fatty acids was observed in the POAG group. These results highlight the potential of tear metabolomics by 1H NMR spectroscopy as a non-invasive approach to support early POAG diagnosis and in order to prevent visual loss.

Distal Nasal Part of the Visual Field and RNFL in Primary Open-Angle Glaucoma.

The aim of this study was to compare changes in the conventionally undiagnosed distal nasal visual field with RNFL in patients with early primary open-angle glaucoma (POAG). 59 eyes of 32 patients (18 women, 14 men) with early stage POAG were included. All eyes were found to have a normal visual field (fast threshold program of 50 degrees nasally and 22 degrees temporally) with the Medmont M700. Visual acuity was 1.0 (with a possible correction ±3 D), and they had no other ocular pathology except glaucoma. The visual field was subsequently examined with the same instrument by moving the fixation point 40 degrees temporally (spatially adaptive program) and simultaneously turning the head 10 degrees nasally. A total of 89 examination points were included using flicker stimuli in a range of 0-120 degrees nasally. Nerve fiber layer (RNFL) and vessel density (VD) was measured using the in-built software of the Avanti RTVue XR instrument. Using Pearson's correlation coefficient, the results of visual field examination with RNFL without and after correction (by subtracting VD from total RNFL value) in the superior-nasal (SN-5) and inferior-nasal (IN-8) segments were compared. In all eyes, changes were found in the distal periphery of the nasal part of the visual field. No correlation was noted by comparison with RNFL. After adjusting RNFL for VD, we observed no correlation in the SN segment (5) (r=-0.03) and a very weak correlation in the IN segment (8) (r=-0.16). With a normal visual field tested by the rapid threshold glaucoma program, changes in the distal part of the nasal periphery of the visual field were found in the entire cohort and did not correlate with the RNFL and RNFL results after correction from VD.

Early impairment of magnocellular visual pathways mediated by isolated-check visual evoked potentials in primary open-angle glaucoma: a cross-sectional study

ObjectiveTo explore different performances in the magnocellular (MC) and parvocellular (PC) visual pathways in patients with primary open-angle glaucoma (POAG) and to objectively assess impairment in early stage of POAG.Methods...

Efficacy and safety of the initial hypotensive treatment with an optimized latanoprost composition

Purpose: a comparative study of the efficacy and safety of Latanoprost-Optic, a new composition of excipients and the original latanoprost, in the initial therapy of primary open-angle glaucoma (POAG)Material and methods. We performed a prospective, randomized, comparative study of 60 previously untreated patients (71 eyes) with early and advanced POAG stages. During the screening visit, patients were randomly divided into the main (Latanoprost-Optic) and the control (original latanoprost) groups. The target points included intraocular pressure (IOP), visual acuity, MD and PSD perimetry indices, RNFL thickness, MRW, NFL, GCL, IPL, tear film break time, OSDI, and adverse events. The observation period was 12 weeks. IOP was measured 4 and 12 weeks from observation start.Results. The average decrease in IOP in the study group by the end of the observation was 32% and did not show any statistically significant differences from the original drug at any control point. A positive unreliable dynamic of the values of most functional parameters was noted, which may indicate the presence of an indirect neuroprotective effect. In the study group, there was a positive trend in tear film rupture time and OSDI. According to corneal confocal microscopy, no negative changes in dynamics were noted, in contrast to the control group. Reversible discomfort and mild redness of the bulbar conjunctiva were recorded in both groups. No serious or systemic adverse events were noted.Conclusion. Latanoprost-Optic has a hypotensive efficacy, comparable to the original latanoprost, and a high favorable safety profile.

The Far Nasal Part of the Field of Vision – Part II – Contribution to the Timely Diagnosis of Glaucoma

Aim: The aim of this study was to examine possible changes in the conventionally undiagnosed nasal visual field in patients diagnosed with early primary open angle glaucoma. Material and Methods: Examination of the far nasal part of the visual field was performed in 30 patients (60 eyes) with early stage of primary open angle glaucoma (preperimetric stage of changes). The cohort consisted of 16 women (mean age 46.5 years) and 14 men (mean age 44.7 years). In all eyes, the glaucoma program (rapid threshold program of 50 degrees nasally and 22 degrees temporally) was performed with the Medmont M700 instrument to determine the physiological visual field. Visual acuity was 1.0 with a possible correction less than or equal to ±3 diopters and they had no other ocular defect except glaucoma disease. The visual field was subsequently examined with the same instrument by moving the fixation point 40 degrees temporally (spatially adaptive program) and simultaneously turning the head 10 degrees nasally. A total of 89 examination points were included using flicker stimuli and a range of 0–120 degrees nasally. Results: The far nasal limit of the visual field reached 100° in 13.33% of eyes, 105° in 20% of eyes and up to 110° in 66.67% of eyes. Conclusion: In all eyes, depression of the distal periphery of the nasal part of the visual field was found to range from 50 to 95 degrees, with a normal visual field examined by the glaucoma program.

Macula vessel density and its relationship with the central visual field mean sensitivity across different stages of exfoliation glaucoma

ABSTRACT Clinical relevance Alterations in ocular microvasculature may contribute to pathogenesis of exfoliation glaucoma (XFG) and may improve monitoring this aggressive type of open angle glaucoma. Background This work aims to compare the macula vessel density and the relationship between macula vessel density and central visual field mean sensitivity between eyes with XFG and eyes with primary open-angle glaucoma (POAG) of different stages. Methods In this cross-sectional observational study, the macula vessel density values were compared among 52 POAG cases (26 early stage, 26 moderate to advanced stage) and 53 XFG cases (27 early stage, 26 moderate to advanced stage). The vessel density values were evaluated with optical coherence tomography angiography. Vasculature–function and structure–function relationships were analysed by comparing macula vessel density, inner macula thickness and visual field mean sensitivity in early and moderate to advanced stages of XFG and POAG eyes separately. Results The early stage XFG eyes had a significantly lower global macula vessel density compared with early stage POAG eyes (42.81 ± 3.85% and 46.56 ± 3.90%, respectively; p = 0.02). However, the tendency of XFG eyes for a lower vessel density compared with the POAG eyes did not exhibit any significance in moderate to advanced stages of glaucoma (37.39 ± 5.65% and 38.35 ± 4.67%, respectively; p = 0.9). The macula vessel density (%)–visual field mean sensitivity (1/Lambert) correlation was statistically significant in early stage XFG eyes (r = 0.464 p = 0.01), while no such correlation was notable for the early stage POAG eyes (r = –0.029 p = 0.89). Conclusion The macula vessel density appears to be more severely affected in early stage XFG than POAG of similar severity, suggesting a relatively greater value of vascular insufficiency in XFG. The significant vasculature-function association in early stage XFG, which was absent in early stage POAG, may infer the importance of macula vessel density in monitoring functional loss in early stages of XFG.

Relationships of Macular Functional Impairment With Structural and Vascular Changes According to Glaucoma Severity.

To determine the pointwise relationships of central visual field (VF) defects with macular ganglion cell loss and macular vessel density (VD) loss during various stages of glaucoma. Eyes with primary open-angle glaucoma (POAG) were subjected to optical coherence tomography (OCT) and OCT angiography (OCTA) to evaluate macular ganglion cell layer (GCL) thickness and macular VD in the superficial and deep vascular complexes (SVC and DVC). OCT, OCTA, and VF locations were matched after correcting for retinal ganglion cell (RGC) displacement. Pointwise correlations of GCL thickness and VDs of the SVC and DVC with central VF sensitivity (VFS) were evaluated by Pearson's correlation analysis and compared in eyes with early and advanced POAG by Meng's test. Of the 100 eyes, 52 and 48 were classified as early and advanced POAG. Macular VD showed overall better correlation with central VFS than GCL thickness in both the early and advanced groups. SVC density showed the strongest correlation with central VFS in all groups (R = 0.327 in early group, R = 0.325 in advanced group, all P < 0.001). Although DVC density showed better correlation with VFS (R = 0.311) than GCL thickness (R = 0.212) in the early group (P < 0.001), the correlation was comparable in the advanced group (R = 0.199 and 0.176, respectively, P = 0.254). After adjustment for RGC displacement, macular SVC density was better correlated with central VFS than macular GCL thickness in both early and advanced POAG. Macular DVC density showed better correlation with VFS than GCL thickness in early but not in advanced POAG, indicating that DVC loss may be involved in early central VF loss.

Value of disc topographic measurements for the discrimination of glaucoma suspects from early primary open angle glaucoma cases: A thin discriminative line

PurposeTo determine the diagnostic value of optic nerve head (ONH) topographic parameters measured by swept-source optical coherence tomography (SS-OCT) in differentiating between early glaucoma cases, glaucoma suspects (GSs), and healthy eyes. MethodsThe files of GSs, those with an early primary open angle glaucoma (POAG) diagnosis, and healthy eyes were retrospectively screened. Demographic characteristics, retinal nerve fibre measurements, visual field examinations, and ONH topographic parameters, including rim area, disc area, vertical and horizontal cup-to-disc ratios (CDRs), and cup volume, were compared between the groups. A receiver operating characteristic (ROC) curve analysis was performed on the ONH parameters. ResultsA total of 170 eyes from 85 GSs, 114 eyes from 57 patients with a diagnosis of early POAG, and 70 healthy eyes from 48 subjects were included in the study. The median age was 52.1 ± 0.9 years for the POAG group, 60.2 ± 1.1 years for the GS group, and 60.5 ± 1.6 for the controls. In the comparison of the ONH parameters between the groups, only rim area statistically significantly differed between the POAG and GS groups. However, all ONH parameters statistically significantly differed between the GS and control groups (p< 0.05). The mean rim areas of the GS, POAG, and control groups were 1.278 ± 0.055 mm2, 1.073 ± 0.065 mm2, and 1.446 ± 0.055 mm2, respectively, being statistically significantly higher in the controls and lower in the POAG group (p < 0.001). The highest area under the curve (AUC) value belonged to vertical CDR for the discrimination of the eyes with POAG from healthy eyes [0.806 (0.728–0.869, p < 0.001] and rim area for the discrimination of POAG cases and GSs [0.728 (0.650–0.797, p < 0.001]. ConclusionThere are significant differences in all ONH parameters between the eyes of GSs and healthy eyes. For the discrimination of early POAG and GS cases, topographic disc parameters may have value. In this study, rim area significantly differed between the GS and POAG groups, and it had the highest AUC value amongst the evaluated ONH parameters in the discrimination of early POAG cases S GSs.

Using artificial neural networks for early diagnosis of glaucoma

Purpose: to summarize the experience of the development and application of artificial neural networks (ANW) in early diagnosis of primary open-angle glaucoma (POAG).Material and methods. A total of 690 patients (918 eyes) were tested. The training clinical group consisted of 459 clinical examples (459 eyes), of which 369 eyes had an initial stage of POAG and 90 eyes had no glaucoma. The testing clinical group was represented by 131 examples (131 eyes), of which 110 eyes belonged to patients with POAG and 21 eyes were without glaucoma. The final diagnostic testing using ANW was conducted on 328 eyes with the diagnosis unknown to the researchers, which belonged to people with suspected POAG. The diagnostic complex included an optimally necessary set of research techniques.Results. ANW identified glaucoma in 198 eyes out of those with suspected glaucoma (60.4 %) with 100 % certainty. 76 eyes (23.2 %) were classified as non-glaucoma, or “healthy”; 54 eyes of the suspected glaucoma patients were identified as “doubtful”, whereupon they were retested by a neural network pool consisting of 5 neural networks. According to the results of the retesting, 28 eyes, or 51.9 % of the “doubtful” ones were identified as having glaucoma, whereas 26 eyes (48.1 %) were identified as non-glaucomatous, i. e. healthy.Conclusion. Our experience suggests that artificial neural networks pose no danger to the doctor or the patient and can be viewed as a very convenient tool for early POAG diagnostics.

Optical coherence tomography angiography changes of the macula in early primary open angle glaucoma compared to healthy eyes

Optical coherence tomography angiography changes of the macula in early primary open angle glaucoma compared to healthy eyes

High Polygenic Risk Is Associated with Earlier Initiation and Escalation of Treatment in Early Primary Open-Angle Glaucoma

To assess the association between a glaucoma polygenic risk score (PRS) and treatment outcomes in primary open-angle glaucoma. Prospective, observational cohort study. Participants from the Progression Risk of Glaucoma: Relevant SNPs with Significant Association Study were divided into a cohort with suspect glaucoma who were treatment naive at enrollment and one with early manifest and suspect glaucoma receiving treatment at enrollment. A per-allele weighted glaucoma PRS was calculated for 1107 participants. Multivariable mixed-effects Cox proportional regression analysis assessed the association between PRS and time to commencement of intraocular pressure (IOP)-lowering therapy in 416 patients with suspect glaucoma who were treatment naive at study enrollment. Secondary analysis evaluated the association between PRS and escalation of IOP-lowering therapy among 691 patients with suspect and early manifest glaucoma who were receiving IOP-lowering therapy at enrollment. Commencement or escalation of IOP-lowering therapy. A higher PRS was associated with a greater risk of commencing IOP-lowering therapy within 5 years (hazard ratio [HR], 1.45per 1 standard deviation [/SD]; 95% confidence interval [CI], 1.27-1.62; P < 0.001). Participants in the upper population-based quintile showed a 3.3 times greater risk of commencing therapy by 5 years than those in the lowest quintile (HR, 3.30; 95% CI, 1.63-6,70; P < 0.001) and a 5.4 times greater risk of commencing IOP-lowering therapy by 2 years than the those in the lowest quintile (HR, 5.45; 95% CI, 2.08-14.25; P < 0.001). A higher PRS was associated with a greater risk of treatment escalation among patients receiving treatment at enrollment (HR, 1.19/SD; 95% CI, 1.09-1.31; P < 0.001). In combined analysis of all participants, participants in the top population-based quintile were at 2.3 times greater risk of requiring initiation or escalation of IOP-lowering therapy than those in the lowest quintile (HR, 2.33; 95% CI, 1.75-3.01; P < 0.001). This study demonstrated novel associations between glaucoma polygenic risk and risk of commencement or escalation of IOP-lowering therapy, building on previous work highlighting the potential clinical usefulness of genetic risk stratification in glaucoma. Proprietary or commercial disclosure may be found after the references.

Evaluation of Static and Dynamic Pupillary Functions in Early-Stage Primary Open Angle Glaucoma.

The dynamic parameters of the pupil, evaluated with an automated pupillometry device, differ in newly diagnosed early-stage primary open angle glaucoma (POAG) patients compared with healthy individuals, and this may guide us in early diagnosis and follow-up of glaucoma. To quantitatively determine static and dynamic pupillary functions in treatment-naive, newly diagnosed early-stage POAG patients and compare them with healthy controls. Forty eye of forty subjects with early POAG were compared with 71 eye of 71 age- matched and sex-matched healthy controls in terms of static and dynamic pupillary functions in this prospective and cross-sectional study. Static and dynamic pupillary functions were obtained with an automated pupillometry device. Static pupillometry parameters are pupil diameter (mm) in high photopic (100cd/m 2 ), low photopic (10cd/m 2 ), mesopic (1cd/m 2 ), and scotopic (0.1cd/m 2 ) light conditions. Dynamic pupillometry parameters are resting diameter (mm), amplitude (mm), latency (ms), duration (ms), and velocity (mm/s) of pupil contraction and dilation. Measured data were evaluated and compared with t test for independent groups. Duration of pupil contraction was lower, ( P =0.04) latency of pupil dilation time was longer, ( P =0.03) duration of pupil dilation was shorter ( P =0.04) and velocity of pupil dilation was lower ( P =0.02) in the POAG group. There was no significant difference between the 2 groups in terms of static pupillometry characteristics and the resting pupil diameter ( P >0.05 for all values). These results suggest that dynamic pupillary light responses may be affected in early-stage POAG compared with the normal population. Longitudinal studies with larger series are needed to better understand the quantitative changes in dynamic pupillometry functions in early-stage POAG.

Hypotensive therapy effectiveness evaluation in primary open-angle glaucoma evidenced by pattern electroretinogram data

Purpose. To evaluate the change in the functional activity of retinal ganglion cells (RGCs) in response to intraocular pressure (IOP) drop in patients with newly diagnosed early stage primary open-angle glaucoma (POAG) using a pattern electroretinogram (PERG). Material and methods. A prospective non-randomized cohort study included 12 patients (24 eyes) including 5 men, 7 women, aged 63.42 ± 2.96 years with newly diagnosed early stage POAG in at least one eye, who underwent PERG (Diopsys Nova, Diopsys, Inc.) in addition to an ophthalmologic examination. After being diagnosed with POAG, all patients were prescribed prostaglandin analogues as monotherapy. One and four months into the treatment, repeated examinations took place. Results. At these time points, a significant decrease in IOP was noted, accompanied by an increase in PERG parameters , which indicates an improvement in the functional activity of RGCs, yet no linear relationship between the IOP decrease and the improvement in PERG parameters could be found. Conclusion. Early stage naïve-treatment POAG patients with minimally impaired visual fields as determined by threshold computer perimetry may have their RGCs functional activity partially restored and IOP lessened thanks to continuous IOP-lowering therapy with prostaglandin analogues. PERG can be used as a method for evaluating the effectiveness of glaucoma hypotensive therapy in terms of maintaining and improving the functional activity of RGCs.