Mild Primary Open-angle Glaucoma Research Articles

Socioeconomic and Racial Disparities in Primary Open-Angle Glaucoma in the US.

Socioeconomic status is a potentially significant, although difficult to isolate, factor in determining glaucoma severity. To analyze the level of glaucoma severity (mild, moderate, or severe) based on demographic factors, including age, gender, ethnicity, insurance profile, and zip code, and to use this data to extrapolate the effect of socioeconomic status (SES) and race on glaucoma severity at the community level in Memphis, TN. 2913 patients from a tertiary care center with three clinic locations in Memphis, TN who had been given the diagnosis of Primary Open Angle Glaucoma (POAG) through use of the ICD-10 codes for mild (H40.1111, H40.1121, H40.1131), moderate (H40.1112, H40.1122, H40.1132) and severe (H40.1113, H40.1123, H40.1133) POAG between January 2016 and July 2021 were included in this study. Diagnoses were made after a complete glaucoma workup consisting of Snellen visual acuity, applanation IOP measurement, gonioscopy, automated Humphreys Visual Fields (10-2 and 24-2), and optic nerve OCT. Demographic information, including age, gender, ethnicity, insurance profile, and zip code, was also collected with disease severity for each patient. SES was approximated using zip code-level census poverty data and insurance profiles. Statistical analyses were performed, including descriptive, multivariable ordinal logistic modeling and stepwise multivariable linear modeling. Glaucoma severity was shown to increase with poverty rate (OR=1.089, P<0.0071), age (OR=1.030, P<0.0001), male sex (OR=1.374, P<0.0001), and Black race (OR=1.896, P<0.0001). Severity was shown to be decreased in patients with private insurance compared to Medicare (OR=0.895, P<0.093) and those from Shelby County compared to other counties (OR=0.703, P<0.0001). Our findings indicate that worsening glaucoma severity was associated with higher poverty rates in our patient population. However, isolating socioeconomic status (SES) as an independent factor influencing the incidence and severity of glaucoma remains challenging, given the strong correlation between race and SES.

Racial Disparities in Microinvasive Glaucoma Surgery for Management of Primary Open-Angle Glaucoma: A Propensity Matched Cohort Study: Racial Disparities in MIGS for the Management of POAG

PurposeTo evaluate racial/ethnic differences in the use of microinvasive glaucoma surgery (MIGS) for the management of mild-moderate primary open-angle glaucoma (POAG) in the United States. DesignRetrospective cohort study. ParticipantsPatients with a diagnosis of mild or moderate POAG, as defined by current procedural terminology (CPT) codes, were included. The experimental group comprised African American (AA) patients and the control group consisted of patients without an AA designation in the TriNetX database. MethodsPropensity scoring was used to match cohorts for age at diagnosis, Charlson Comorbidity Index, sex, nicotine dependence, glaucoma medications, family history of POAG, Body Mass Index, and weight. Outcome was incidence of MIGS over 1 year of follow up. Odds ratios were calculated between cohorts Main Outcome MeasureIncidence of MIGS over 1 year of follow-up post-POAG diagnosis. Results63,418 POAG patients were included (50% AA, 50% non-AA). AA patients were found to undergo MIGS at a significantly lower rate (1,268 of 31,709) compared to non-AA patients (1,508 of 31,709) (OR 0.834, 95% CI: 0.773 – 0.900). ConclusionAlthough POAG is understood to be more prevalent among African Americans, these patients display lower utilization of MIGS, suggesting a possible nationwide racial disparity in the management of POAG.

Association of Social Determinants of Health with the Likelihood of Treatment with Laser Trabeculoplasty in a United States Database.

Among 1,861 adults with ocular hypertension or mild or moderate primary open-angle glaucoma, those with Medicaid or no insurance had a statistically significantly lower likelihood of receiving laser trabeculoplasty compared with those with other insurance. To determine whether social determinants of health are associated with undergoing treatment with laser trabeculoplasty (LTP) among individuals with ocular hypertension (OHT) or mild or moderate primary open angle glaucoma (POAG). In this cross-sectional study, we included patients with OHT or mild or moderate POAG from the National Institutes of Health All of Us Research Program, a diverse US nationwide dataset. Logistic regression was performed to study the association between LTP treatment status and seven covariates (diagnosis severity, age, gender, race/ethnicity, income, insurance status, and education). 1,861 subjects were included (median age of 72y). In univariable logistic regression, diagnosis severity, older age, higher income, and insurance (non-Medicaid) were associated with LTP treatment. On multivariable logistic regression models, those with mild POAG (OR, 3.49; 95% CI [2.12-5.87]) and moderate POAG (OR, 7.15 [4.49-11.8]) were still more likely than OHT patients to have received LTP. Moreover, compared with participants with Medicaid or no insurance, participants with other insurance (e.g. employer provided, Medicare) were still more likely to have received LTP (OR, 2.24 [1.08-5.29]). There was no significant difference in the LTP treatment likelihood based on race/ethnicity. After controlling for confounders, the likelihood of receiving LTP appears to be driven primarily by insurance rather than income or race/ethnicity. Potential reasons for decreased utilization of LTP among Medicaid patients include higher rates of declining the procedure, or LTP may have been offered less frequently due to Medicaid's lower levels of reimbursement and longer reimbursement delays.

Evaluation of glaucomatous macular and optic nerve vascular damage by optical coherence tomography angiography

Purpose The aim of this study was to compare the macular and optic nerve head vessel perfusion density in mild primary open-angle glaucoma (POAG) and moderate–severe POAG patients to normal eyes as a control cohort. Patients and methods This is a retrospective comparative case–control study that included 80 eyes of 46 participants. The study included 60 eyes of 36 POAG patients and 20 eyes of 10 healthy participants (control group). The patients underwent 3.0×3.0 mm optical coherence tomography angiography (OCTA) scans centered on the macula and 4.5×4.5 mm scans on the optic disc. Results The OCTA scans of the glaucomatous eyes revealed a reduction in microvasculature in the peripapillary area, which was absent in the control cohort. The whole disc vessel density (VD) was significantly less in the glaucomatous eyes (mean=38.02±8.74) compared to the control cohort (mean=50.41±2.58, P&lt;0.001). The severity of glaucoma was linked to a decrease in macular VD percentage, with a mean superficial VD of 36.09±5.67 in the glaucoma cohorts and 46.64±5.53 in the control cohort (P&lt;0.001), which was more pronounced than in the deep layer (P&lt;0.008). There was no statistically significant difference in the foveal avascular zone size between the control and glaucoma cohorts at any stage (P=0.999). Conclusion The OCTA vascular density accurately distinguished the glaucoma from healthy eyes, with superior performance in the peripapillary region. The foveal avascular zone size did not indicate glaucoma severity. The OCTA noninvasive assessment of the capillary networks showed a potential for managing the glaucoma patients by characterizing the retinal vascular changes.

Long-Term Efficacy of Successful Excisional Goniotomy with the Kahook Dual Blade.

To report clinical outcomes of successful excisional goniotomy with the Kahook Dual Blade (KDB), through 60 months. This was a noncomparative, single-surgeon, retrospective review of eyes receiving successful KDB goniotomy with or without concomitant phacoemulsification between October 2015 and January 2016 with five years of uninterrupted follow-up. Intraocular pressure (IOP), number of glaucoma medications, best corrected visual acuity (BCVA), and complications were recorded. Primary outcomes included changes from baseline in IOP, medication use, and BCVA, through five years. Fifty-two eyes of 28 patients were analyzed. Most eyes had mild primary open angle glaucoma (73%). Of the eyes analyzed, 41 underwent combined surgery and 11 underwent standalone surgery. With all eyes combined, mean (standard deviation) baseline IOP was 21.0 (4.1) mmHg and mean baseline medication use was 1.8 (1.1) medications per eye. Across time points at months 6, 12, 24, 36, 48, and 60, mean postoperative IOP ranged from 13.0 to 13.7 mmHg, representing mean reductions of 7.3-8.0 mmHg (34.7-38.3%; p <0.0001 at every time point). Similarly, mean medication use ranged from 0.4 to 0.6 medications per eye, representing mean reductions of 1.2-1.4 medications (66-75.5%; p <0.0001 at every time point). Mean logMAR BCVA improved from 0.321 (0.177) preoperatively to 0.015 (0.035) at month 60 (p < 0.0001). In eyes not requiring secondary surgical procedures (eg, long-term surgical successes), excisional goniotomy provided clinically and statistically significant reductions in both IOP and the need for medications that were highly consistent through five years of follow-up. KDB goniotomy appears to be highly successful in Caucasian patients with open angle glaucoma on ≥1 IOP-lowering medications at baseline and with no history of prior ocular surgery. Successful excisional goniotomy with the KDB can be expected to improve long-term glaucoma-related visual outcomes through IOP reduction and to improve quality of life through medication reduction.

ZEISS VISULAS green SLT in primary open‐angle glaucoma and ocular hypertension: 6 month follow up in a real‐world setting

Aims/Purpose: The aim of this study is to report preliminary data of efficacy and safety of ZEISS VISULAS® green Selective Laser Trabeculoplasty (SLT) in primary open‐angle glaucoma (POAG) and ocular hypertension (OHT) in a real‐life clinical setting.Methods: We prospectively collected data of 34 treated eyes in 17 patients during 2022. Patients followed a regular clinical management in our center (San Giuseppe Hospital, University Eye Clinic, IRCCS Multimedica, Milan, Italy). Follow up was of 6 months. Inclusion criteria were adult patients, diagnosis of POAG or OHT. Exclusion criteria were previous laser trabeculoplasty (LT), filtration surgery, and cyclophotocoagulation procedures. Main outcome was ≥20% intraocular pressure (IOP) reduction at 6 months. All the procedures were performed by two doctors (CB, DT). Adverse events were recorded.Results: We included 34 eyes of 17 patients. Mean age was 67.4 ± 11.5 years. Patients were 88.2% Caucasian, 47.1% females, with a diagnosis of OHT (64.7%), mild POAG (29.4%), or moderate POAG (5.9%). The mean IOP was significantly decreased from baseline to 6 months (21.5 ± 2.1 vs 18.0 ± 2.6 mmHg, p &lt; 0.05). Primary outcome (≥ 20% IOP reduction at 6 months) was reached in 52.9% cases. There was no significant increase in glaucoma medical therapy at 6 months (1.1 ± 1.0 vs 1.4 ± 1.0 medication per eye, p = 0.23). No patient received a second SLT treatment or underwent filtration surgery or cyclophotocoagulation procedures during the follow‐up. No major ocular or systemic side effects were found. The most common adverse event was ocular discomfort in 10 cases (29.4%), always mild and transient. SLT treatment was performed with an average of 100.2 ± 6.7 spots, 27.4 ± 4.7 μJ energy, and a 360° distribution for 32 of 34 eyes (2 eyes treated at 270°).Conclusions: We reported the preliminary short‐term data of efficacy and safety of ZEISS VISULAS® green SLT treatment in POAG and OHT. To the best of our knowledge, this is the first report of ZEISS VISULAS® green SLT in a real‐life clinical setting. This technology has been shown to be effective and safe in lowering IOP at 6 months after the treatment. Limits of this study were the small sample size and the short follow‐up time.

Evaluation of inner retinal function at different stages of primary open angle glaucoma using the photopic negative response (PhNR) measured by RETeval electroretinography.

To investigate the objective function of the inner retinal layer in each stage of primary open angle glaucoma (POAG) using the photopic negative response (PhNR) measured by RETeval full-field electroretinography (ERG), and to identify which PhNR parameter is the most useful. Ninety eyes of 90 patients with POAG (30 with mild POAG (mean deviation (MD) ≥ -6dB) and 60 with moderate-to-advanced POAG (MD < -6dB)) and 76 eyes of 76 control cases were examined. We investigated six PhNR parameters and their relationships with the results of the Humphrey 30-2 visual field test and the thickness of the circumpapillary retinal nerve fiber layer (cpRNFL) obtained from optical coherence tomography. The following PhNR parameters were assessed: base-to-trough (BT), peak-to-trough (PT), 72msPhNR, the W-ratio, P-ratio, implicit time (IT), and a-wave and b-wave amplitudes on ERG. All PhNR parameters other than IT significantly differed between the all POAG (all stages) and control groups and between the moderate-to-advanced POAG and control groups. BT and 72msPhNR in the mild POAG group, significantly differed from those in the control group. Regarding the relationships between PhNR parameters and the visual field and between these parameters and cpRNFL thickness, correlations were observed between all PhNR parameters, except PT and IT, and both the visual field and cpRNFL thickness in the all and moderate-to-advanced POAG groups. 72msPhNR correlated with cpRNFL thickness in the mild POAG group. The area under the receiver operating characteristic curve was greater for BT than for the other PhNR parameters in both the mild and moderate-to-advanced POAG groups. The discriminant linear function for examining the presence or absence of POAG and the threshold for diagnosis were quantitatively obtained as follows. Regarding BT: discriminant = 0.505 × BT + 2.017; threshold = positive for POAG, negative for no POAG; correct answer rate = 80.7%. Concerning 72msPhNR: discriminant = 0.533 × 72msPhNR + 1.553; threshold = positive for POAG and negative for no POAG; correct answer rate = 77.1%. RETeval-measured PhNR parameters were useful for an objective evaluation of visual function in moderate-to-advanced POAG. BT appeared to be the most diagnostically useful parameter.

Amsler Grid Versus 10-2 Test in Primary Open Angle Glaucoma.

Glaucoma is the leading cause of global irreversible blindness. The goal of management in glaucoma lies in its early detection and treatment to prevent further optic neuropathy. Available equipment for early glaucoma detection is not cost-effective or readily available in resource-scarce settings such as Nigeria. Thus, there is a need for a simple cost-effective tool to detect glaucomatous central visual field (CVF) defects in all the stages of glaucoma within the community in resource scarce-settings. The aim of this article is to determine the validity of the Amsler grid in detecting central glaucomatous visual field defects in primary open angle glaucoma (POAG). This was a cross-sectional study of follow-up glaucoma patients at a secondary eye care hospital in Nigeria. All patients had detailed ophthalmic examination in addition to 24-2 and 10-2 CVF tests and Amsler grid test. POAG was classified using the Hodapp-Parrish-Anderson criteria into mild, moderate, and severe on 24-2 CVF. The diagnostic validity of the Amsler grid was calculated using the 10-2 CVF as a reference standard. Regression analyses were performed between the Amsler grid scotoma area and 10-2 CVF parameters [mean deviation (MD), scotoma extent (SE), and scotoma mean depth (SMD)]. A total of 150 eyes of 150 patients were enrolled. The sensitivity, specificity, and positive predictive value and negative predictive value of the Amsler grid compared with the 10-2 CVF was 49.5%, 95.9%, 96.2%, and 47.9%, respectively, with an area under curve of 0.7. Sensitivity increased with increasing severity (P < 0.001) from 20.0%, 31.0%, and 76.6% in mild, moderate, and severe POAG, respectively. The Amsler grid scotoma area had the strongest relationship with the 10-2 MD, followed by 10-2 SE and 10-2 SMD with a quadratic R2 of 0.579, 0.370, and 0.307, respectively. The Amsler grid has a low sensitivity in mild-to-moderate POAG. However, it may serve as an adjunctive tool in resource-scarce settings for detection of severe POAG in the community by primary eye care providers.

Association between Serum Uric Acid Levels and Primary Open-angle Glaucoma: A Cross-sectional Study

Introduction: There is an intricate association between serum Uric Acid (UA) levels and Primary Open Angle Glaucoma (POAG). UA levels in the blood are known to be a good indicator of antioxidant function, and a decrease in UA plays a key role in the pathogenesis of POAG. However, the association of serum UA and Uric Acid Creatinine Ratio (UACR) in POAG cases in the Indian population remains unexplored. Aim: To investigate the association of serum UA levels and serum UACR with POAG. Materials and Methods: This cross-sectional study was conducted among patients who attended the Outpatient Department (OPD) of Opthalmology at Maharajah’s Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India. The duration of the study was one year and six months, from January 15, 2021 to July 15, 2022. The study included 200 recently diagnosed patients with POAG, who were divided into three groups based on Intraocular Pressure (IOP): Group 1 (mild) with an IOP of 21-30 mmHg, group 2 (moderate) with an IOP of 31-50 mmHg, and group 3 (severe) with an IOP greater than 51 mmHg. Age and gender-matched 199 healthy subjects were included as the control group. Blood samples were collected from the study subjects after obtaining informed consent and were tested for serum UA (using the modified Trinder method) and serum creatinine (using Jaffe’s method) in a semiautomatic analyser (Erba chem 7). The data were analysed using Statistical Package for Social Sciences (SPSS) version 21.0 software and MS Excel 2007. Results: The mean age of the study participants of all three groups was found to be 51.19±5.06 years with 46.7% male and 53.3% female subjects. The serum UA levels were 5.55±0.74 mg/dL in the mild POAG group, 4.1±0.5 mg/dL in the moderate POAG group, and 2.67±0.6 mg/dL in the severe POAG group (p-value &lt;0.001). The present study also found that among the three study groups of POAG, UA levels were the lowest in the severe POAG group, followed by the moderate POAG group, and then the mild POAG group. This pattern was observed in both the males and females population. Conclusion: The present study found that serum UA levels were decreased in POAG patients compared to the normal healthy control group. Furthermore, the study revealed a significant negative association between serum UA levels and serum UACR levels with the severity of POAG.

Correlation of Intraocular pressure and Visual Field Defects in Primary Open Angle Glaucoma

Aim: To correlate between intraocular pressure (IOP) with visual field pattern in primary open angle glaucoma (POAG). Methods: Pretreatment IOP at presentation was measured in 94 eyes of patients diagnosed with POAG in a descriptive correlational study. At least two Humphrey Visual Field(HVF) assessment two weeks apart was performed. Glaucomatous visual field defect and its severity was diagnosed on the basis of Hodapp-Parrish-Anderson criteria. The relationship between visual field defect and IOP were analyzed. Results: Superior arcuate scotoma was most common visual field defect seen in 18(19.1%) eyes. 56 eyes (59.6%) had mild POAG (MD of &lt;-6dB) with no cases having double arcuate scotoma whereas 1 eye (16.0%) with moderate POAG (MD of -6 to -12dB) had 1 double arcuate scotoma and 23 eyes (24.5%) with severe POAG (MD of &gt;-12dB) had 14 double arcuate scotoma. The mean IOP in mild POAG was 24.29 mmHg (range 21-30); 26.40mmHg (range 22-31) in moderate POAG and 29.70 mmHg (range 22-36) in severe POAG. Significant relation was demonstrated between elevated IOP at presentation and higher negative values of MD (p&lt;0.001). Conclusions: Higher IOP at presentation is associated with severity of POAG. Aggressive treatment should be initiated to arrest the rate of progression.

Alterations in Fixation Indices in Primary Open-Angle Glaucoma by Microperimetry.

The aim of this study was to determine whether primary open-angle glaucoma (POAG) is associated with changes in fixation stability parameters assessed by microperimetry (MP) and whether the severity of glaucoma is related to a deterioration in these indicators. This study analyzed fixation stability using MP macular analyzer integrity assessment (MAIA) in patients with mild and moderate/severe POAG and healthy controls. The resulting fixation indices were correlated with parameters used to assess retinal function with MP and standard automated perimetry (SAP) and retinal structure with optical coherence tomography (OCT) and OCT angiography (OCTA). We enrolled 54 eyes in the POAG groups (32 eyes with mild POAG and 22 eyes with moderate/severe POAG) and 24 eyes in the healthy group. It was shown that fixation stability in POAG eyes deteriorated with increasing disease severity, and significant differences in bivariate contour ellipse area (BCEA) including 95% of fixation points were observed among groups (p = 0.042). Quantitative analysis of structural and functional retinal parameters also showed significant deterioration with the progression of glaucoma (p < 0.001). Correlations among fixation parameters and abnormalities in the retinal structure and function were confirmed. We concluded that POAG is associated with disturbances in the fixation pattern, which worsen as the disease progresses and can be effectively assessed by performing a MP test.

Preliminary efficacy of ab interno canaloplasty combined with micro-incision cataract surgery in primary open angle glaucoma combined with cataract: one-year results

Objective: To evaluate the preliminary efficacy and safety of ab interno canaloplasty (ABiC) combined with micro-incision cataract surgery for treating primary open angle glaucoma (POAG) combined with cataract. Methods: Prospective case series study. Patients diagnosed with POAG and concurrent cataract were enrolled to receive ABiC combined with micro-incision phacoemulsification and intraocular lens implantation in the Eye Center of the Second Affiliated Hospital of Zhejiang University School of Medicine from June 2018 to October 2019. Intraocular pressure (IOP), use of hypotensive medications, visual acuity, visual field, and optic nerve at baseline as well as at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively were assessed. Subgroup analyses were further performed to evaluate these data between controlled and uncontrolled POAG, as well as among mild, moderate, and advanced POAG. Success rate and complications were analyzed. Results: A total of 68 eyes in 42 patients completed a follow-up of 12 months. Compared to the baseline IOP under medical control [(18.25±2.65) mmHg (1 mmHg=0.133 kPa)], the mean postoperative IOP at 1 month [(14.31±3.25) mmHg], 3 months [(14.00±3.09) mmHg], 6 months[ (14.58±2.93) mmHg], and 12 months[ (14.84±2.73) mmHg] was all significantly reduced (P<0.05). The median (upper quadrant, lower quadrant) of the hypotensive medication number was 2.5 (2, 3) at baseline, which was significantly reduced to 0 (0, 1) at 1 month, and 0 (0, 0) at 3, 6, and 12 months (P<0.05). The complete success rate and qualified success rate at 12 months were 80.88%(55/68) and 89.71%(61/68), respectively. No deterioration in the visual field or optical coherence tomography scan of the optic nerve was observed at 12 months compared to the baseline status. Hyphema (26 eyes, 38.24%) and transient IOP spike (23 eyes, 33.82%) were the most common complications, but no severe case was present. Conclusion: ABiC combined with micro-incision cataract surgery is considerably effective and safe in the treatment of POAG combined with cataract in the Chinese population.

Discrimination Between Healthy Eyes and Those With Mild Glaucoma Damage Using Hemoglobin Measurements of the Optic Nerve Head.

The Laguna ONhE, a software that measures the hemoglobin (Hb) concentration of the optic nerve head (ONH) from fundus photographs, demonstrated good accuracy in discriminating healthy eyes from eyes with mild glaucoma. The aim was to evaluate Hb concentration of the optic nerve to distinguish between healthy eyes and eyes with mild glaucoma. Eyes from patients with mild primary open angle glaucoma (MD > -6 dB) (n=58) and from healthy subjects (n=64) were selected. Retinal nerve fiber layer thickness measurements of all eyes were acquired with optical coherence tomography. Optic disc photographs were also obtained, and the images were analyzed using the Laguna ONhE software, which measures the amount of Hb in 24 sectors of the ONH. The software also calculates the Glaucoma Discriminant Function (GDF), an index that expresses the chance of the ONH being compatible with glaucoma. Areas under the receiver operating characteristic curve and sensitivities at fixed specificities of 90% and 95% of each Laguna ONhE parameter were calculated. The mean retinal nerve fiber layer thickness and vertical cup/disc ratio of the control and glaucoma groups were 90.0±10.6 μm versus 66.28±9.85 μm ( P <0.001) and 0.5±0.09 versus 0.65±0.09 ( P <0.001), respectively. Total Hb (67.9±4.45 vs. 62.89±4.89, P <0.001) and GDF (11.57±15.34 vs. -27.67±20.94, P <0.001) were significantly higher in the control group. The Hb concentration was also significantly higher in 21 of the 24 sectors in the control group compared with the glaucoma group ( P <0.05). The GDF had the largest areas under the receiver operating characteristic curve (0.93), with 79.3% sensitivity at a fixed specificity of 95%. Measurements of optic nerve Hb concentration using a colorimetry photographic device demonstrated good accuracy in discriminating healthy eyes from eyes with mild glaucoma. Further studies are need to understand vascular factors implicated in the development of glaucoma.

Correlation of retinal nerve fiber layer thickness with perimetric staging in primary open-angle glaucoma – A cross-sectional study

BACKGROUND:Glaucoma is a progressive optic neuropathy, characterized by structural optic nerve damage with corresponding field defects. Primary open-angle glaucoma (POAG) is the most common. Although perimetry is the gold standard, retinal nerve fiber layer (RNFL) thickness by spectral-domain optical coherence tomography (SD-OCT) has proved reliable in the detection of pre-perimetric glaucoma. There is preferential involvement of various sectors of the peripapillary RNFL in the different stages of POAG.PURPOSE:The purpose of this study is to assess RNFL thickness and determine preferential involvement of different sectors of peripapillary RNFL in the various stages of POAG using SD-OCT.MATERIALS AND METHODS:Forty-nine patients with POAG underwent complete ophthalmic examination including visual field testing and RNFL thickness measurement. Perimetric findings were used to categorize them into mild, moderate, and severe stages of glaucoma. The RNFL thickness values were analyzed and compared with perimetric results.RESULTS:The average RNFL loss in mild, moderate, and severe POAG was 25.44%, 29.67%, and 44.15%, respectively. A statistically significant correlation (P < 0.05) between RNFL loss and severity of glaucoma was found in all except the superior and temporal sectors. A statistically significant (P < 0.05) negative correlation was noted between visual field index and RNFL loss in all sectors except the nasal-superior in moderate POAG and all sectors in severe POAG. Mean deviation and RNFL loss showed a significant positive correlation in temporal-inferior (TI) sector in mild POAG and all sectors in the severe group.CONCLUSION:RNFL thickness decreases with increase in glaucoma severity and is a reliable parameter to differentiate mild from severe POAG. The TI followed by nasal-inferior RNFL sector is the most sensitive to glaucomatous damage in all three stages.

Melatonin, circadian rhythms and glaucoma: current perspective.

Melatonin, circadian rhythms and glaucoma: current perspective.

Measurements of OCT Angiography Complement OCT for Diagnosing Early Primary Open-Angle Glaucoma

To compare measurements of global and regional circumpapillary capillary density (cpCD) with retinal nerve fiber layer (RNFL) thickness and characterize their relationship with visual function in early primary open-angle glaucoma (POAG). Cross-sectional study. Eighty healthy eyes, 64 preperimetric eyes, and 184 mild POAG eyes from the Diagnostic Innovations in Glaucoma Study. Global and regional RNFL thickness and cpCD measurements were obtained using OCT and OCT angiography (OCTA). For direct comparison at the individual and diagnostic group level, RNFL thickness and capillary density values were converted to a normalized relative loss scale. Retinal nerve fiber layer thickness and cpCD normalized loss at the individual level and diagnostic group. Global and regional areas under the receiver operating characteristic curve (AUROC) for RNFL thickness and cpCD to detect preperimetric glaucoma and glaucoma, R2 for the strength of associations between RNFL thickness function and capillary density function in diagnostic groups. Both global and regional RNFL thickness and cpCD decreased progressively with increasing glaucoma severity (P < 0.05, except for temporal RNFL thickness). Global and regional cpCD relative loss values were higher than those of RNFL thickness (P < 0.05) in preperimetric glaucoma (except for the superonasal region) and glaucoma (except for the inferonasal and superonasal regions) eyes. Race, intraocular pressure (IOP), and cpCD were associated with greater cpCD than RNFL thickness loss in early glaucoma at the individual level (P < 0.05). Global measurements of capillary density (whole image capillary density and cpCD) had higher diagnostic accuracies than RNFL thickness in detecting preperimetric glaucoma and glaucoma (P < 0.05; except for cpCD/RNFL thickness comparison in glaucoma [P= 0.059]). Visual function was significantly associated with RNFL thickness and cpCD globally and in all regions (P < 0.05, except for temporal RNFL thickness-function association [P= 0.070]). Associations between capillary density and visual function were found in the regions known to be at highest risk for damage in preperimetric glaucoma eyes and all regions of mild glaucoma eyes. In early glaucoma, capillary density loss was more pronounced than RNFL thickness loss. Individual characteristics influence the relative magnitudes of capillary density loss compared with RNFL thickness loss. Retinal nerve fiber layer thickness and microvascular assessments are complementary and yield valuable information for the detection of early damages seen in POAG.

Quality of life of patients with primary open-angle glaucoma based on EQ-5D in Wenzhou

Objective: To evaluate the quality of life of patients with primary open-angle glaucoma (POAG) and its related factors in Wenzhou. Methods: Cross-sectional analysis. A total of 339 POAG patients diagnosed in the Wenzhou glaucoma progression study conducted in the Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University from March 2014 to October 2019 were included. Quality of life of POAG patients was assessed by EQ-5D including the visual analogue scale (VAS). The effects of gender, age, visual field loss (VFL), family history of glaucoma, hypertension, diabetes, migraine, sleep quality, and amateur exercise on the quality of life were analyzed. The utility value (UV) and VAS score were expressed as the median (P25, P75), and Mann-Whitney U was used for the comparison between two groups. Kruskal-Wallis H was performed to compare the differences among multiple groups. Results: A total of 339 POAG patients were included in the study; 164 were males (48.4%), and 175 were females (51.6%). The mean age was (63±10) years. Thirty-four patients (10.0%) had received medication (including one with combined surgical treatment), while the remaining 305 patients (90.0%) had received no anti-glaucoma treatment. Among the patients, 10.5% (32/305) had no VFL, 68.9% (210/305) had mild VFL, 17.0% (52/305) had moderate VFL, and 3.6% (11/305) had severe VFL. In all patients, the median of UV was 1.000 (1.000, 1.000), the mean of UV was 0.964, and the median of VAS score was 80 (75, 90), the mean of VAS score was 81.58. Anxiety or depression and pain or discomfort occurred in 45.7% (43/94) and 34.1% (32/94), respectively, of POAG patients with decreased UVs, as well as mobility constraints in 13.8 % (13/94) and usual activity constraints in 6.4% (6/94). The median of UV of the eye with a better visual field in the group without VFL or with mild or moderate VFL was 1.000 (1.000, 1.000), and in the group with severe VFL was 1.000 (0.862, 1.000), but there was no significant difference in the UV and the VAS score of the eye with a better visual field among groups with different degrees of VFL (both P>0.05). There was statistically significant difference in the UV among groups with different sleep qualities (H=17.465; P<0.01). Using pairwise comparison, the median of UV of the very good sleep group was 1.000 (1.000, 1.000), significantly different to the slightly poor sleep group 1.000 (0.866, 1.000) (z=3.613; P<0.05). The median of UV in patients with migraine was 1.000 (0.875, 1.000), without migraine 1.000 (1.000, 1.000), and in patients with hypertension was 1.000 (0.875, 1.000), without hypertension 1.000 (1.000, 1.000), and in patients with diabetes was 1.000 (0.875, 1.000), without diabetes was 1.000 (1.000, 1.000), the difference was statistically significant (Z=-2.189, -3.864, -2.417; all P<0.05). The UV was not related to age, gender, family history of glaucoma, amateur exercise, alcohol and tobacco, and history of anti-glaucoma medication (all P>0.05). Conclusions: VFL is related to the UV of POAG patients in Wenzhou. Quality of life in mild POAG patients is good but decrease in advanced POAG patients. Sleep quality, systemic complications and physical or psychological discomfort impact on quality of life in POAG patients. (Chin J Ophthalmol, 2021, 57: 207-214).

Peripapillary Perfused Capillary Density in Acute Angle-Closure Glaucoma: An Optical Coherence Tomography Angiography Study.

To compare peripapillary perfused capillary density (PCD) on optical coherence tomography angiography among resolved acute angle-closure (AAC), primary open-angle glaucoma (POAG), and control eyes. Prospective, cross-sectional, observational study. All patients with resolved AAC or POAG of varying severity and controls were enrolled. We obtained 4.5 × 4.5 mm2 optical coherence tomography angiography images of the optic nerve head. PCD was analyzed using customized software with major vessel removal. Continuous variables were assessed using the analysis of variance and Bonferroni correction test. A marginal model of generalized estimating equations was used to adjust for confounding factors and interocular correlation. The study included 44 eyes with resolved AAC (mean duration of elevated intraocular pressure, 8.1 ± 10.9 days), 69 eyes with POAG, and 49 control eyes. PCD showed a similar decrease between AAC and POAG eyes (P > 0.99). After adjusting for age and sex, the mean difference in global PCD between each of the POAG stage groups and the AAC group was the highest in the severe POAG group (-3.43; 95% confidence interval [CI], -11.38 to 2.52; P = 0.211), followed by the mild POAG (0.68; 95% CI, -3.26 to 4.62; P = 0.735) and moderate POAG (0.20; 95% CI, -5.21 to 5.61; P = 0.942) groups. The duration of increased intraocular pressure did not affect PCD (P = 0.258 and 0.168 for global and annular PCDs, respectively). The degree of microvascular attenuation in AAC eyes was not different from that in POAG eyes.

Analysis of structural and vascular changes of the optic nerve head and macula in different stages of primary open angle glaucoma

Background/Aim. It is possible that patients with open-angle glaucoma be asymptomatic in the early stage of the disease. The aim of this study was to determine the structural and vascular changes of the optic disc (OD) and macula in healthy and primary open-angle glaucoma (POAG) eyes, detected by optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) as well as the correlation of the OCT and OCTA measurements and their association with the presence of POAG. Methods. A total of 196 eyes were included and classified into four groups, out of them 48 were healthy eyes, 51 eyes were with mild POAG, 50 eyes with moderate POAG, and 47 eyes with advanced glaucoma. All subjects underwent standard ophthalmic examination. OCT measured the mean, superior and inferior retinal nerve fiber layer (RNFL) thickness and macular ganglion cell complex (GCC). OCTA evaluated the vessel capillary density (VCD) in OD, foveal avascular zone (FAZ) and macular vessel density (VD) in the superficial (SL) and deep (DL) retinal vascular plexus. Results. Patient characteristics were similar except for decreased visual acuity, thinner corneas, higher intraocular pressure and higher cup/disc ratio in POAG patients. OCT results showed that RNFL and GCC thickness gradually de-creased according to POAG severity. Within the assessment conducted by OCTA, VCD?s value in OD also diminished with the progression of POAG, having the lowest value in patients with advanced glaucoma. The same pattern was observed in vessel density around FAZ and VD values. Comparing the structural and vascular changes, a significant positive correlation was found between RNFL thickness and VCD inside OD, and GCC and VD SL in the macular zone. Conclusion. OCT and OCTA allow of a noninvasive quantification of the structural and vascular changes in OD and the macular zone and accurately distinguish between healthy eyes and eyes with POAG, showing an association with the presence and progression of glaucoma.

Detection of serum uric acid in primary open angle glaucoma: A pilot study.

To assess the association between the serum levels of uric acid (UA) and primary open-angle glaucoma (POAG). In this pilot study, 46 eyes of 23 patients with a clinical history of POAG and 30 eyes of 15 healthy subjects were included. All patients underwent a complete ophthalmological examination, including best corrected visual acuity (BCVA), intraocular pressure (IOP), and gonioscopy. Visual field parameters, such as mean deviation (MD) and pattern standard deviation (PSD), and optical coherence tomography (OCT) values of the optic nerve head, including retinal nerve fiber layer (RNFL) thickness and vertical cup/disc ratio (VCDR), were noted. A blood sample was collected from each subject for serum UA measurement. IOP, MD, PSD, RNFL thickness, and VCDR resulted significantly different in POAG patients, when compared with controls (p < 0.05). POAG patients showed significantly lower levels of mean serum UA than healthy controls (4.00 ± 0.66 mg/dL vs 4.95 ± 0.86 mg/dL, respectively, p < 0.0001). Furthermore, severe POAG patients showed mean serum levels of UA lower than mild POAG patients (3.36 ± 0.70 mg/dL vs 4.22 ± 0.51 mg/dL, respectively, p = 0.01). Visual field and OCT parameters were statistically correlated with the mean serum levels of UA in POAG eyes (p < 0.05). Results suggest that in POAG patients, serum UA levels may be decreased and correlated with visual field and OCT parameters worsening. Further larger multi-center prospective studies are necessary to confirm our findings and establish the role of UA in glaucoma.