Glaucomatous Eyes Research Articles

Preservatives in ophthalmic formulations and the urgent need for preservative-free formulation

Topical treatment of ocular diseases is mainly through eye drops. One of the short outcomes of eye drops is using preservatives, particularly for chronic diseases such as glaucoma and dry eye syndrome. Preservatives are chemical compounds that must be incorporated into an eye drop to preserve sterility during storage and use. Their chronic use may cause side effects to the eye, such as irritation, allergy, tear film instability, conjunctival inflammation, sub-conjunctival fibrosis and corneal surface impairment. Ophthalmologists and formulation scientists are moving towards preservative-free formulations. Strategies to manufacture preservative-free formulations are either through changing the container type of formulation or converting it into a solid dosage form. Preservative-free formulations were superior to traditional eye drops by minimizing side effects experienced by the patient. Keywords: preservative-free formulation, chemical substance, growth

Influence of Long-term Oral Steroid Intake on Glaucoma and Ocular Hypertension

Purpose: The aim of this study was to evaluate the risk factors associated with glaucoma or ocular hypertension (OHT) in patients taking oral corticosteroids for extended periods, and to aid in managing intraocular pressure (IOP) in patients with these risk factors.Methods: A cross-sectional study was performed involving 690 patients who visited a tertiary referral hospital and had been using oral corticosteroids for more than six months. Patients' demographics, tonometry results, drug type, dosage, duration, ophthalmic history, and the use of glaucoma eye drops were analyzed to determine the risk factors associated with glaucoma or OHT.Results: In a generalized linear model analysis comparing patients' eyes diagnosed with glaucoma or ocular hypertension to those without such diagnoses, no statistical difference was observed between the two groups in terms of drug type, age, and duration of oral corticosteroid use. However, the dosage was found to be statistically significant (odds ratio 1.09, p = 0.0294).Conclusions: No difference in the incidence of glaucoma or OHT was found based on the type of oral steroid, age, or duration of use. However, a higher incidence of glaucoma and OHT was observed among patients taking higher doses of oral steroids. Therefore, it is suggested that using lower doses of oral steroids may be more beneficial for managing IOP.

Changes in the morphofunctional parameters of the eye in neovascular glaucoma on the after vitreoretinal surgery

Purpose: to assess morphological and functional parameters of the eyeball in patients with neovascular glaucoma (NVG) and diabetic macular edema (DME) after vitreoretinal interventions.Material and methods. This study involved 60 patients (60 eyes), aged 59 ± 12 including 34 men and 26 women. The patients were divided into three groups: group 1 — 19 patients (19 eyes) with NVG and DME after a vitreoretinal surgery (VRS) for proliferative diabetic retinopathy performed no earlier than a year ago. If DME was found within 6 months after the surgery, a drug was administered intravitreally (3 loading injections given with monthly intervals). The patients’ history contained cataract phacoemulsification with an implantation of an intraocular lens (IOL). Group 2 (23 patients, 23 eyes) consisted of persons with stage III primary open-angle glaucoma (POAG) with the duration of the glaucomatous process of up to 5 years, who received no laser or surgical antiglaucomatous interventions. The history of these patients also contained phacoemulsification operations with IOL implantation. Group 3 (18 patients, 18 eyes), which was composed of patients with pseudophakia but no symptoms of glaucoma or other eye pathology, served as control.Results. The opening of the anterior chamber angle (ACA) in NVG (group 1) was 2.73 times smaller (p = 0.034) than in POAG (Group 2) and 3.69 times smaller than in the control group (p = 0.034). Neovascularization of the iris and the ACA could primarily be seen in patients with NVG (84 %). Goniosynechiae in the ACA of group 1 patients were seen 6.35 times more often than in group 2 patients and 14.45 times more often than in group 3 patients. Rubeosis occurred in group 1 patients 4.65 times as often as in group 2 and 6.64 times more often than in group 3 patients (p = 0.034). Statistically significant differences of morphometric parameters of the optic disc between groups 1 and 2, on the one hand, and group 3, on the other hand were found. Meanwhile, the figures for groups 1 and 2 were statistically comparable, which is explained by the same degree of severity of the glaucomatous process in these groups. The analysis of indices of computer perimetry MD, MS and sLV showed a developed glaucomatous process in groups 1 and 2. The revealed changes are based on pathognomonic factors. In particular, they may be caused by the prior surgical intervention affecting the vitreoretinal interface in group 1 patients.Conclusion. The onset of NVG is primarily caused by a grave course of proliferative diabetic and changes in the ACA profile, due to the formation of synechiae. Regardless of the risk factors, the result of surgical treatment depends on the condition of the ischemic retina and the anterior segment of the eye. Thus, the assessment of the morphofunctional parameters of the eye in patients with NVG and DME after VRS is of great interest. Changes in such parameters as the degree of openness of the ACA, distance from the iris to the IOL, the presence of rubeosis and synechia may be used to determine the methods and tactics of surgery, which will eliminate the pathophysiological factors of the onset and progression of CVH, and reduce postoperative complications.

The Effectiveness of a Nurse-led Glaucoma Education on Patient Knowledge and Compliance Motivation Levels: A 1-year Prospective Case Series.

To evaluate the impact of a nurse-led glaucoma education program on patient knowledge and compliance levels in an Asian population. A 1-year prospective case series involving 69 adult glaucoma patients. Each patient attended a standardized nurse-led glaucoma education session. A questionnaire was administered by a single nurse-clinician and analyzed at three time points (preeducation for baseline, immediately posteducation, and at the 1-year follow-up) to evaluate for associations with patient knowledge and compliance motivation levels. A total of 64 patients were included in the final analysis. Patients with higher educational qualifications or who were employed had better baseline knowledge of glaucoma. Younger patients had higher baseline compliance motivation levels. Immediately posteducation, both median patient knowledge score and compliance motivation levels had a statistically significant increase. Patients on more glaucoma eye drops had greater immediate improvement in confidence in eye drop application. Patients with more positive Humphrey visual field mean deviation values had a greater immediate improvement in confidence in their understanding of glaucoma. A total of 34 patients were readministered the questionnaire at the 1-year time point. Median score for patient knowledge was highest at this point. Employed patients demonstrated better patient knowledge at baseline and at 1-year time point compared to unemployed patients. Unemployed patients experienced a significant improvement in scores from baseline to immediately posteducation, but improvement from immediately posteducation to the 1-year time point was insignificant was insignificant. Our study has examined the effectiveness of a nurse-led glaucoma education program in an Asian population, demonstrating improvement in both patient knowledge and compliance motivation levels up to 1 year after intervention. Sng JJ, Ang BCH, Soo Hoo WC, et al. The Effectiveness of a Nurse-led Glaucoma Education on Patient Knowledge and Compliance Motivation Levels: A 1-year Prospective Case Series. J Curr Glaucoma Pract 2023;17(3):149-156.

Terahertz Attenuated Total Reflection Spectral Response and Signal Enhancement via Plasmonic Enhanced Sensor for Eye Drop Detection.

With chronic ocular diseases such as glaucoma and dry eye syndrome, patients have to apply eye drops over the long term. The therapeutic effects of eye drops depend on the amount of drug contained and the stability of the solution. In addition, contamination during usage and transport can also negatively affect the quality and efficacy of eye drops. The current techniques for the characterization of eye drops are often complicated and time-consuming. Developing a fast and non-invasive way of accurately measuring eye drop quality remains an ongoing challenge. The biggest challenge and primary prerequisite for the application of this new detection technique for eye drops is the obtention of a sufficient spectral response and resolvable signal, considering the large background signal contributed by water. In this work, we use terahertz (THz) attenuated total reflection (ATR) spectroscopy combined with a sensitive hybrid graphene oxide (GO) and carbon nanotube (CNT) thin-film sensors to obtain distinct THz spectral signals in commercial eye drops. Various commercial eye drop products have been tested, and we show that they can be differentiated via their spectral signals. Our results provide a solid foundation for the future fine analysis of eye drops and the detection of their quality. Furthermore, THz spectroscopy combined with GO/CNT films has significant potential and advantages for the non-destructive characterization of aqueous pharmaceutical products.

Comparison of the extracellular vesicle proteome between glaucoma and non-glaucoma trabecular meshwork cells.

Extracellular matrix (ECM) materials accumulate in the trabecular meshwork (TM) tissue of patients with glaucoma, which is associated with a decrease in aqueous humor outflow and therefore an increase in intraocular pressure. To explore a potential mechanism for ECM regulation in the TM, we purified extracellular vesicles (EVs) from conditioned media of differentiated TM cells in culture isolated from non-glaucomatous and glaucomatous human donor eyes. EVs were purified using the double cushion ultracentrifugation gradient method. Fractions containing EV markers CD9 and TSG101 were analyzed using nanoparticle tracking analysis to determine their size and concentration. We then determined their proteomic cargo by mass spectrometry and compared protein profiles of EVs between normal and glaucomatous TM cells using PANTHER. Key protein components from EV preparations were validated with Western blotting. Results showed changes in the percentage of ECM proteins associated with EVs from glaucomatous TM cells compared to non-glaucomatous TM cells (5.7% vs 13.1% respectively). Correspondingly, we found that two ECM-related cargo proteins found across all samples, fibronectin and EDIL3 were significantly less abundant in glaucomatous EVs (<0.3 fold change across all groups) compared to non-glaucomatous EVs. Overall, these data establish that ECM materials are prominent proteomic cargo in EVs from TM cells, and their binding to EVs is diminished in glaucoma.

Early Proteomic Characteristics and Changes in the Optic Nerve Head, Optic Nerve, and Retina in a Rat Model of Ocular Hypertension

The pathogenesis of glaucoma is still unknown. There are few studies on the dynamic change of tissue-specific and time-specific molecular pathophysiology caused by ocular hypertension (OHT). This study aimed to identify the early proteomic alterations in the retina, optic nerve head (ONH), and optic nerve (ON). After establishing a rat model of OHT, we harvested the tissues from control and glaucomatous eyes and analyzed the changes in protein expression using a multiplexed quantitative proteomics approach (TMT-MS3). Our study identified 6403 proteins after 1-day OHT and 4399 proteins after 7-days OHT in the retina, 5493 proteins after 1-day OHT and 4544 proteins after 7-days OHT in ONH, and 5455 proteins after 1-day OHT and 3835 proteins after 7-days OHT in the ON. Of these, 560 and 489 differential proteins were identified on day 1 and 7 after OHT in the retina, 428 and 761 differential proteins were identified on day 1 and 7 after OHT in the ONH, and 257 and 205 differential proteins on days 1 and 7 after OHT in the ON. Computational analysis on day 1 and 7 of OHT revealed that alpha-2 macroglobulin was upregulated across two time points and three tissues stably. The differentially expressed proteins between day 1 and 7 after OHT in the retina, ONH, and ON were associated with glutathione metabolism, mitochondrial dysfunction/oxidative phosphorylation, oxidative stress, microtubule, and crystallin. And the most significant change in retina are crystallins. We validated this proteomic result with the Western blot of crystallin proteins and found that upregulated on day 1 but recovered on day 7 after OHT, which are promising as therapeutic targets. These findings provide insights into the time- and region-order mechanisms that are specifically affected in the retina, ONH, and ON in response to elevated IOP during the early stages.

Optical Coherence Tomography Angiography (OCTA) Differences in Vessel Perfusion Density and Flux Index of the Optic Nerve and Peri-Papillary Area in Healthy, Glaucoma Suspect and Glaucomatous Eyes.

To assess the ability of vascular perfusion parameters determined by optical coherence tomography angiography (OCTA) to detect and monitor glaucoma. This prospective study included healthy, glaucoma suspect and glaucomatous eyes. All eyes underwent comprehensive glaucoma examination, including visual field tests and ocular imaging scans by OCTA. Parameters measured included retinal nerve fiber layer (RNFL) thickness, ganglion cell analysis (GCA), vascular perfusion density (VPD) and flux index (FI) of the optic nerve and peri-papillary area. Ocular parameters in healthy, glaucoma suspect, and glaucomatous eyes were compared by generalized estimating equations (GEE) with adjustments for age, with their relationships analyzed by Pearson's correlation coefficient. Rates of change per year were compared in glaucomatous eyes with and without glaucoma progression. This study enrolled 238 eyes, including 56 healthy, 79 glaucoma suspect, and 103 glaucomatous eyes. After adjustments for age, the average VPD (45.40 ± 0.19% vs 45.05 ± 0.22% vs 42.89 ± 0.32%, p < 0.001) and FI (0.4210 ± 0.0055 vs 0.4105 ± 0.0039 vs 0.3801 ± 0.0048, p < 0.001) in these three groups differed significantly. Average VPD in the glaucoma group was inversely associated with the severity of glaucoma, being 43.99 ± 0.32%, 42.63 ± 0.43% and 39.27 ± 0.48% in eyes with early, moderate and severe glaucoma, respectively (p < 0.001). Average VPD, as well as VPD in the superior and inferior quadrants correlated well with both OCT determined RNFL and visual field parameters. The decreases per year in both superior (-0.012 vs -0.001, p = 0.002) and inferior (-0.008 vs -0.003, p = 0.007) FI were significantly greater in glaucomatous eyes with than without glaucoma progression. Both VPD and FI as measured by OCTA are promising ocular parameters that can distinguish between normal and glaucomatous eyes. VPD is sensitive in comparing eyes at different glaucoma stages, whereas FI can detect rates of glaucoma progression. Thai Clinical Trial Registry, TCTR20181031002.

An effective deep learning network for detecting and classifying glaucomatous eye

&lt;span lang="EN-US"&gt;Glaucoma is a well-known complex disease of the optic nerve that gradually damages eyesight due to the increase of intraocular pressure inside the eyes. Among two types of glaucoma, open-angle glaucoma is mostly happened by high intraocular pressure and can damage the eyes temporarily or sometimes permanently, another one is angle-closure glaucoma. Therefore, being diagnosed in the early stage is necessary to safe our vision. There are several ways to detect glaucomatous eyes like tonometry, perimetry, and gonioscopy but require time and expertise. Using deep learning approaches could be a better solution. This study focused on the recognition of open-angle affected eyes from the fundus images using deep learning techniques. The study evolved by applying VGG16, VGG19, and ResNet50 deep neural network architectures for classifying glaucoma positive and negative eyes. The experiment was executed on a public dataset collected from Kaggle; however, every model performed better after augmenting the dataset, and the accuracy was between 93% and 97.56%. Among the three models, VGG19 achieved the highest accuracy at 97.56%.&lt;/span&gt;

Glaucoma and Dry Eye Disease: Opportunity to Assess and Treat.

Dry eye disease (DED) has been found to occur at a higher prevalence in individuals with glaucoma than in individuals without glaucoma. The relationship between glaucoma and DED may be, in part, a result of glaucoma therapy. Greater number of antiglaucoma medications used and greater number of antiglaucoma eyedrops instilled per day have been associated with ocular surface disease in patients with glaucoma. Use of antiglaucoma medication has also been associated with higher levels of ocular surface inflammatory markers and ocular surface alterations. There is evidence to suggest that antiglaucoma medications with preservatives and, to some extent, antiglaucoma medication formulations without preservatives may contribute to ocular surface signs and symptoms. Trabeculectomy for glaucoma has also been associated with ocular surface signs related to DED; however, there may be benefits of trabeculectomy and other procedures for glaucoma due to reduced use of antiglaucoma medications. Patients with glaucoma with ocular surface disease have been found to have greater ocular surface symptoms, poorer vision-related quality of life, and poorer antiglaucoma medication adherence compared with patients with glaucoma without ocular surface disease. Because of the potential negative impact of DED on patients with glaucoma, patients with glaucoma may benefit from evaluation for DED. Management of DED in patients with glaucoma may include modifications to antiglaucoma medications and use of treatments for DED.

Racial Differences in the Diagnostic Accuracy of OCT Angiography Macular Vessel Density for Glaucoma

To evaluate and compare the diagnostic accuracy of macular vessel density (VD) measured by OCT angiography (OCTA) in individuals of African descent (AD) and European descent (ED) with open-angle glaucoma. Observational, cross sectional study. A total of 176 eyes of 123 patients with glaucoma and 140 eyes of 88 healthy participants from the Diagnostic Innovations in Glaucoma Study. Whole-image ganglion cell complex (wiGCC) thickness and macular VD (parafoveal VD and perifoveal VD) were obtained from 6× 6 macula scans. Area under the receiver operating characteristic (AUROC) curves were used to evaluate the diagnostic accuracy of macular VD and ganglion cell complex (GCC) thickness in AD and ED participants after adjusting for confounders such as age, visual field mean deviation (VF MD), signal strength index, axial length, self-reported hypertension and diabetes. Macular VD and wiGCC measurements. Parafoveal and perifoveal VD were significantly lower in ED than AD patients with glaucoma. Parafoveal and perifoveal VD performed significantly worse in AD participants compared with ED participants for detection of glaucoma (adjusted AUROC, 0.75 [95% confidence interval (CI), 0.62, 0.87], 0.85 [95% CI, 0.79, 0.90], P= 0.035; and 0.82 [95% CI, 0.70, 0.92], 0.91 [95% CI, 0.87, 0.94], respectively; P= 0.020). In contrast to VD, diagnostic accuracy of GCC thickness was similar in AD and ED individuals (adjusted AUROC, 0.89 [95% CI, 0.79, 0.96], 0.92 [95% CI, 0.86, 0.96], respectively; P= 0.313). The diagnostic accuracies of both macular VD and GCC thickness for differentiating between glaucoma and healthy eyes increased with increasing VF MD in both AD and ED participants. Diagnostic performance of OCTA macular VD, but not GCC thickness, for glaucoma detection varies by race. Moreover, macular VD parameters had lower accuracy for detecting glaucoma in AD individuals than in ED individuals. The diagnostic performance of macular VD is race-dependent, and, therefore, race should be taken into consideration when interpreting macular OCTA results. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Intraoperative iStent versus postoperative selective laser trabeculoplasty in early glaucoma patients undergoing cataract surgery: A retrospective comparative study

To compare the efficacy and safety of iStent inject® versus 360° selective laser trabeculoplasty (SLT) in patients with early glaucoma undergoing cataract surgery. A retrospective non-randomized study was conducted in 73 eyes divided into two groups: cataract surgery+intraoperative iStent (n=40) versus cataract surgery+postoperative SLT at one month (n=33). The primary endpoint was intraocular pressure (IOP) lowering≥20% between baseline and 6 months postoperatively. The secondary endpoints were IOP lowering at 1, 6 and 12 months, and the mean number of IOP-lowering medications at 6 and 12 months. The mean baseline IOP was 19.1 mmHg with no significant difference between groups. The mean baseline number of IOP-lowering medications was higher in the iStent group (n=1.95) compared to the SLT group (n=1.53; P=0.04). At 6 months, 18 (60%) patients in the SLT group and 20 (51%) patients in the iStent group achieved IOP lowering≥20% with no significant difference between groups (P=0.431). At 6 months, no difference in the mean number of IOP-lowering medications was found between groups (-0.92 and -0.89 in the iStent and SLT groups, respectively). Similar results were found at 12 months. These results suggest similar safety and efficacy of intraoperative iStent and postoperative 360° SLT in lowering IOP and reducing glaucoma eye drops in early glaucoma patients undergoing cataract surgery. Treatment choice should be based on the ophthalmologist's experience and on the cost-benefit ratio.

Оценка коэффициента LAF в качестве критерия риска острого приступа закрытоугольной глаукомы

Purpose. To study the possibility of using the LAF coefficient in predicting an acute attack of angle-closure glaucoma (AACG) in anatomically short eyes of Europoids. Material and methods. In total, 4 groups of patients were formed: healthy individuals with hyperopia, patients with primary angle closure (PCA) of the anterior chamber, patients with primary angle-closure glaucoma (PACG), and patients with an acute attack of angle-closure glaucoma. The anteroposterior axis of the eye (APA), lens thickness (LT) were studied, and the LAF coefficient was calculated based on the results of these studies. Results. For each of the three factors studied (LT, APA, and LAF), an ROC analysis was performed to identify the cut-off points that best separate the hyperopic and acute attack groups. Cut-off points, sensitivity, specificity, areas under the ROC-curves (AUC) were found. Conclusion. Comparative analysis of LT and LAF parameters in the groups of hypermetropes, patients with PCA and with the initial stage of PACG did not reveal significant differences. In the acute attack group, LT and LAF were statistically significantly higher than the other groups. It was revealed that the LAF coefficient provides a better separation of the group of hypermetropes and the group of acute attack of the primary angle-closure, in comparison with the indicators of LT and especially the APA of the eyes. Our data showed that a high risk of an acute attack of glaucoma in eyes with a short APA occurs at LAF values greater than 2.332. This is confirmed by the high sensitivity, specificity and AUC of this indicator. Keywords: LAF coefficient, acute attack of angle-closure glaucoma, hypermetropia, primary closure of the anterior chamber angle

Early Postoperative Changes in Macular Choroidal Thickness After Uncomplicated Phacoemulsification in Patients With and Without Glaucoma: A Swept-Source Optical Coherence Tomography Study.

Purpose The objective of this study was to examine the impact of uncomplicated phacoemulsification on macular choroidal thickness (CT) within the first three postoperative months and to investigate its relationship with postoperative cystoid macular edema (CME) in both glaucomatous and healthy subjects, utilizing swept-source optical coherence tomography (SS-OCT). Methods The non-randomized prospective study involved 82 patients, selected via convenience sampling from the First Department of Ophthalmology, Medical School of Athens, "G. Gennimatas" Hospital, Athens, Greece, between May 2018 and May 2022, undergoing phacoemulsification and intraocular lens (IOL) implantation. The inclusion criteria encompassed patients aged 50 years or above, with or without glaucoma. Patients with ocular pathologies that could influence macula or CT measurements were excluded. Data collection focused on retinal and CT variablesof the macular area, measured using SS-OCT. Baseline measurements were established preoperatively, with follow-up assessments at one week, one month, and three months postoperatively to monitor CT and macular edema onset. Results A total of 82 eyes from 82 patients with a mean age of 79.1±8.3 years were included. The study population was divided into a glaucoma group (n=28 eyes) and a control group (n=54 eyes). Our findings indicate a consistently significant increase in macular CT measurements one month after cataract surgery, observed in both glaucomatous and non-glaucomatous eyes. In the first postoperative week, statistically significant changes in CT were observed only in patients with CME. Subsequently, at one-month interval, both patient groups, those with and without CME, exhibited statistically significant changes in CT across all macular sectors. CME was detected in 10 out of 28 eyes in the glaucoma group and in 16 out of 54 eyes in the control group. When evaluating the impact of postoperative CME on groups of glaucomatous and non-glaucomatous eyes, it was observed that glaucomatous eyes exhibited a significantly larger magnitude of change in subfoveal CT (SFCT) (p=0.03) at one month (relative to baseline) compared to non-glaucomatous eyes. There was also a 31% increase in the odds of developing CME for glaucoma patients; this result was not statistically significant (odds ratio {OR}, 1.31; 95% confidence interval {CI}, 0.50-3.47; p=0.57). Conclusions During the early postoperative period, the study revealed a significant increase in CT at one month after phacoemulsification in both glaucomatous and non-glaucomatous eyes. When CME was present, a significantly more pronounced magnitude of change in SFCT was observed at one month in glaucomatous eyes, as opposed to non-glaucomatous eyes. This observation suggests a possible selective susceptibility of glaucomatous eyes in the early postoperative period that requires further research.

Agreement and precision of wide and cube scan measurements between swept-source and spectral-domain OCT in normal and glaucoma eyes

This study aimed to evaluate agreement of Wide scan measurements from swept-source optical coherence tomography (SS-OCT) Triton and spectral-domain OCT (SD-OCT) Maestro in normal/glaucoma eyes, and to assess the precision of measurements from Wide and Cube scans of both devices. Three Triton and three Maestro operator/device configurations were created by pairing three operators, with study eye and testing order randomized. Three scans were captured for Wide (12 mm × 9 mm), Macular Cube (7 mm × 7 mm–Triton; 6 mm × 6 mm-Maestro), and Optic Disc Cube (6 mm × 6 mm) scans for 25 normal eyes and 25 glaucoma eyes. Parameter measurements included circumpapillary retinal nerve fiber layer(cpRNFL), ganglion cell layer + inner plexiform layer (GCL+), and ganglion cell complex (GCL++). A two-way random effect analysis of variance model was used to estimate the repeatability and reproducibility; agreement was evaluated by Bland–Altman analysis and Deming regression. The precision estimates were low, indicating high precision, for all thickness measurements with the majority of the limits < 5 µm for the macula and < 10 µm for the optic disc. Precision of the Wide and Cube scans were comparable. Excellent agreement between the two devices was found for Wide scans, with the mean difference < 3 µm across all measurements (cpRNFL < 3 µm, GCL+ < 2 µm, GCL ++ < 1 µm), indicating interoperability. A single Wide scan covering the peripapillary and macular regions may be useful for glaucoma diagnosis and management.

From the past to the present, optical coherence tomography in glaucoma: a practical guide to a common disease

Glaucoma comprises a group of disorders of the optic nerve that cause degenerative optic neuropathy, characterised by failure of neuroretinal rim tissue in the optic nerve head, retinal nerve fibre layer, and retinal ganglion cells. Glaucoma imposes a serious epidemiological threat, with an steady increase in the global number of cases. In the current ophthalmological practice, glaucoma is diagnosed via a series of examinations, including routine funduscopic examination, ocular tonometry, gonioscopy, measurement of the visual field, and assessment using the optical coherence tomography (OCT) technique. Nowadays, the OCT technique helps in systematising the diagnostic pathway and is a basic diagnostic tool for detection of early glaucomatous eye changes. It is also vital in assessing progression and monitoring treatment results of patients. The aim of this review was to present the OCT technique as a main tool in diagnosing and monitoring glaucoma.

Elimination of increased risk of acute angle closure glaucoma in eyes with a short anteroposterior axis by preventive phacoemulsification

Aim. A clinical analysis of the efficacy of eliminating the risk of acute glaucoma attack by performing preventive minimally invasive cataract surgery in patients at such a risk.Materials and methods. In total, 70 eyes with a short anteroposterior axis and a thickened lens shape, and an increased risk of acute glaucoma attack were investigated. The main group included 45 patients subjected to preventive phacoemulsification (PE), and the reference group included 25 patients not subjected to PE. According to the position of the ciliary body (middle and posterior), each group was divided into two subgroups. The parameters of lens cross-sectional area (CSA) and anterior chamber cross-sectional area (ACCSA) were studied using B-scan ultrasonography of the anterior eye segment.Results. On the 2–3rd day after PE, the main group showed an increase in the anterior chamber depth and ACCSA values, along with an opening of the anterior chamber angle (ACA) to grade 3. These indicators remained at the same level by the end of the 4–5 year observation period. After 1–3 years, the reference group demonstrated a statistically significant decrease in the anterior chamber depth and ACCSA values, a narrowing of the ACA width, as well as an increase in intraocular pressure. After 4–5 years, the ACA was completely closed (0°), and the CSA indicator significantly increased.Conclusion. Immediately after preventive surgery, all patients of the main group showed a statistically significant improvement in the studied parameters, which remained stable following the period of 4–5 years.

Deep Learning Estimation of 10-2 Visual Field Map Based on Macular Optical Coherence Tomography Angiography Measurements

To develop deep learning (DL) models estimating the central visual field (VF) from optical coherence tomography angiography (OCTA) vessel density (VD) measurements. Development and validation of a deep learning model. A total of 1051 10-2 VF OCTA pairs from healthy, glaucoma suspects, and glaucoma eyes were included. DL models were trained on en face macula VD images from OCTA to estimate 10-2 mean deviation (MD), pattern standard deviation (PSD), 68 total deviation (TD) and pattern deviation (PD) values and compared with a linear regression (LR) model with the same input. Accuracy of the models was evaluated by calculating the average mean absolute error (MAE) and the R2 (squared Pearson correlation coefficients) of the estimated and actual VF values. DL models predicting 10-2 MD achieved R2 of 0.85 (95% confidence interval [CI], 74-0.92) for 10-2 MD and MAEs of 1.76 dB (95% CI, 1.39-2.17 dB) for MD. This was significantly better than mean linear estimates for 10-2 MD. The DL model outperformed the LR model for the estimation of pointwise TD values with an average MAE of 2.48 dB (95% CI, 1.99-3.02) and R2 of 0.69 (95% CI, 0.57-0.76) over all test points. The DL model outperformed the LR model for the estimation of all sectors. DL models enable the estimation of VF loss from OCTA images with high accuracy. Applying DL to the OCTA images may enhance clinical decision making. It also may improve individualized patient care and risk stratification of patients who are at risk for central VF damage.

Association of Bergmeister Papilla and Deep Optic Nerve Head Structures With Prelaminar Schisis of Normal and Glaucomatous Eyes

To investigate factors associated with the severity of prelaminar schisis (PLS) in heathy subjects and glaucoma patients. Prospective cross-sectional study. A total of 217 eyes of 217 subjects (110 normal eyes and 107 open angle glaucoma eyes) were studied. Frequency and severity of PLS were compared between normal and glaucomatous eyes. Multivariate logistic models were used to assess factors associated with the severity of PLS. Factors considered were age, axial length, glaucomatous damage indices, Bruch membrane opening (BMO) and anterior scleral canal opening parameters, tractional forces (posterior vitreous staging and presence of Bergmeister papilla), circumpapillary choroidal thickness, lamina cribrosa (LC) parameters, and peripapillary scleral (PPS) angle. The frequency of PLS was 70.9% in normal eyes and 72.0% in glaucomatous eyes. There was no difference in frequency and severity between the groups. The presence of Bergmeister papilla was the strongest predictor of a more severe PLS in both normal and glaucomatous eyes (odds ratio [OR]+9.78, 12.5; both P < .001). A larger PPS angle in normal eyes (OR=1.19; P=.003) and a larger BMO area and a deeper LC depth in glaucomatous eyes (OR=1.08, 1.05; both P=.038) were associated with severity of PLS. The severity of PLS was strongly associated with the presence of Bergmeister papilla, suggesting a traction-related phenomenon. Correlation of PLS severity with larger BMO area and deeper LC depth, which are optic nerve head structures associated with glaucoma, suggested its possible relationship with glaucomatous damage.

Choriocapillaris, Photoreceptors, and Inner Retinal Layer in Spatial Relationship to Parapapillary Alpha, Beta, Gamma, and Delta Zones.

To examine the spatial relationships between the retinal inner nuclear layer (INL), outer nuclear layer (ONL), retinal pigment epithelium (RPE) layer, Bruch's membrane (BM), and choriocapillaris in the parapapillary region. Human eyes enucleated due to uveal melanomas or secondary angle-closure glaucoma were histomorphometrically examined. We compared the tissue dimensions between four groups of eyes categorized based on the presence/absence of high myopia and glaucoma. The investigation consisted of 100 globes (axial length: 25.6 ± 3.1mm; range: 20.0-35.0mm). In non-highly myopic nonglaucomatous eyes, the INL, ONL, RPE, BM, and choriocapillaris ended approximately at the end of the RPE layer, with no significant (all P ≥ 0.10) difference between the layers in their distance to the RPE-layer end. From non-highly myopic nonglaucomatous eyes to non-highly myopic glaucomatous eyes, highly myopic nonglaucomatous eyes, and eventually highly myopic glaucomatous eyes, the choriocapillaris, INL, and ONL increasingly extended into the beta zone, most marked for the choriocapillaris and least marked for the ONL. A larger extension of the choriocapillaris into the parapapillary beta zone correlated with longer axial length (standardized regression coefficient β, 0.24; B, 23.0; 95% confidence interval [CI], 1.6-44.5; P = 0.04) and wider parapapillary beta zone (β, 0.59; B, 0.32; 95% CI, 0.22-0.41; P < 0.001); a larger extension of the INL correlated with longer axial length (β, 0.34; B, 43.7; 95% CI, 11.6-75.7; P = 0.009), longer gamma zone (β, 0.52; B, 0.28; 95% CI, 0.15-0.41; P < 0.001), and diagnosis of non-highly myopic glaucoma (β, 0.28; B, 267; 95% CI, 80.8-454; P = 0.006); and a larger extension of the ONL into parapapillary beta zone correlated with longer axial length (β, 0.50; B, 32.2; 95% CI, 21.6-42.8; P < 0.001) and wider parapapillary beta zone (β, 0.28; B, 0.10; 95% CI, 0.04-0.16; P < 0.001). Nonglaucomatous non-highly myopic eyes differ from highly myopic eyes and glaucomatous eyes in the spatial relationship of the parapapillary tissue layers.