Primary Open-angle Glaucoma Eyes Research Articles

Corneal thickness and endothelial change after use of ocular hypotensive agents.

Corneal transplantation can restore visual function when visual impairment is caused by a corneal disease. However, this treatment is associated with the scarcity of cornea donors. The suitability of corneal donation from patients with glaucoma using ocular hypotensive agents (OHAs) is controversial. This study aimed to elucidate changes in corneal thickness, corneal endothelial cell density, and corneal endothelial cell hexagonality after OHA use in patients with primary open-angle glaucoma. We retrospectively reviewed the data of 53 glaucoma suspect eyes without OHA use and 106 primary open-angle glaucoma eyes under OHA use. All participants underwent corneal parameter assessment using SP-3000P (Topcon Corp., Tokyo, Japan) at the time of diagnosis and the final visit. The OHA dose and timing of use were recorded. The ocular hypotensive agents score (OHAS) was determined based on the number, formula, frequency, and duration of OHA use. Baseline data showed no significant differences between the two groups with and without OHA use. At the final visit, the OHA-treated group showed significantly lower corneal thickness and corneal endothelial cell density than those of the control group. A weak positive correlation between the OHAS and changes in corneal endothelial cell hexagonality was noted. However, no correlation was observed between the OHAS and changes in corneal thickness or endothelial cell density. In conclusion, patients with glaucoma and using OHAs should undergo the corneal structural properties examinations before donation to ensure the quality of donor cornea.

Assessment of glaucoma severity and deterioration by using Spaeth/Richman contrast sensitivity (SPARCS) and its correlation with retinal nerve fiber layer thickness and perimetry.

To assess the severity of glaucoma and its worsening using Spaeth/Richman contrast sensitivity (SPARCS). To evaluate its correlation with retinal nerve fiber layer thickness (RNFL) and perimetry. In this prospective observational study, 90 eyes of primary open-angle glaucoma were categorized into mild, moderate, and severe glaucoma (30 each). All eyes were subjected to contrast sensitivity measurements by using the Pelli-Robson (PR) chart and SPARCS, Humphrey automated perimetry, and optical coherence tomography (OCT) RNFL, along with routine ophthalmological evaluation at baseline. Contrast sensitivity was repeated at 1, 3, and 6 months. Other investigations were repeated at 6 months. The correlation between contrast sensitivity and other parameters was analyzed at baseline and 6 months. Total SPARCS showed a significant positive correlation with visual field index, pattern standard deviation, mean deviation, OCT RNFL, and a negative correlation with best corrected visual acuity. Central SPARCS and PR scores exhibited strong positive correlations. Both total and quadrantic SPARCS significantly reduced from mild to moderate to severe glaucoma. The quadrant-wise SPARCS also correlated well with opposite-side RNFL thickness. At 6 months, SPARCS showed a significant reduction along with RNFL measurements preceding any significant changes in visual field parameters. This study establishes SPARCS as a reliable and reproducible tool in assessing the deterioration of visual function in glaucoma patients even before significant perimetric changes. The specific relationship of quadrantic SPARCS with opposite-side RNFL is a novel yet expected finding. The findings advocate integrating SPARCS into routine glaucoma assessment for timely detection of any worsening and prompt intervention, improving the visual outcomes in these patients.

Bent ab interno needle goniotomy versus gonioscopy-assisted transluminal trabeculotomy in primary open-angle glaucoma: study protocol of a randomized clinical trial

BackgroundMinimally invasive glaucoma surgery (MIGS) is a new class of surgeries, which combines moderate to high success rates and a high safety profile. Bent Ab interno Needle Goniotomy (BANG) and Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) are two low-cost MIGS procedures that communicate the anterior chamber to Schlemm’s canal. Most of the available publications on MIGS are either case series or retrospective studies, with different study protocols. The aim of this manuscript is to describe a randomized clinical trial (RCT) protocol to compare the long-term intraocular pressure (IOP) control and the safety of both procedures in eyes with primary open-angle glaucoma.MethodsThis is a parallel, double-arm, single-masked RCT that includes pseudophakic primary open-angle glaucoma (POAG) eyes. After inclusion criteria, medications will be washed out to verify baseline IOP before surgery. Patients will be randomized to BANG or GATT using a sealed envelope. Follow-up visits will be 1, 7, 15, 30, 60, 90, 180, 330 and 360 days after surgery. On PO330, a new medication washout will be done. The main outcome is the IOP reduction following the procedures. Complimentary evaluation of functional and structural parameters, safety, and quality of life will be done after 30, 90, 180, and 360 days.DiscussionOur study was designed to compare the long-term efficacy and safety of two low-cost MIGS. Most of the published studies on this subject are case series or retrospective cohorts, with different study protocols, which included different types and severities of glaucomas, combined with cataract extraction. Our study only included mild to moderate POAG eyes, with previous successful cataract extraction. Moreover, it provides a standardized protocol that could be replicated in future studies investigating various types of MIGS. This would allow comparison between different techniques in terms of efficacy, safety, and patients’ quality of life.Trial registrationRetrospectively registered at the Registro Brasileiro de Ensaios Clínicos (ReBEC) platform RBR-268ms5y. Registered on July 29, 2023.The study was approved by the Ethics Committee of the University of Campinas, Brazil.

Anterior Segment Changes in Patients With Glaucoma Following Cataract Surgery.

This prospective observational study investigates the impact of cataract surgery on anterior segment parameters innonglaucomatous and primary open-angle glaucoma (POAG) eyes, utilizing anterior segment optical coherence tomography (AS-OCT). The study involved 42 Caucasian patients, divided into a control group and a POAG group. Comprehensive ophthalmic examinations were performed along with AS-OCT imaging and biometry preoperatively, as well as on one day, one week, and one month following cataract surgery. The results showed significant post-operativechanges in anterior chamber depth (ACD) and angle width in both groups, suggesting that cataract surgery may influence the structural parameters associated with glaucoma risk and management. Specifically, a marked increase in ACD and improvement in angle-opening distances were observed, highlighting the potential of cataract extraction to alter intraocular fluid dynamics favorably. Despite these changes, the study noted an initial spike in increased intraocular pressure (IOP) in POAG patients immediately post-operative, which stabilized during follow-up. For the control group, IOP showed gradually reducing IOP values in the follow-up visits. The findings underscore the role of advanced imaging technologies in understanding glaucoma's pathophysiology and the potential benefits of cataract surgery in glaucoma patients. The study advocates for further research with a larger, more diverse patient population and extended follow-up to explore the long-term implications of cataract surgery on glaucoma dynamics, emphasizing the importance ofpersonalized management and treatment strategies particularly for glaucoma patients.

Intraocular pressure profile following selective laser trabeculoplasty in pigmentary and primary open-angle glaucoma.

To compare the intraocular pressure (IOP) profile and the incidence of IOP spikes following selective laser trabeculoplasty (SLT) between pigmentary glaucoma (PG) and primary open-angle glaucoma (POAG). Retrospective comparative study of 65 PG eyes of 51 patients matched with 65 POAG eyes of 65 patients who received SLT. Matching was done based on age, gender, glaucoma severity, pre-laser IOP, and number of medications. Post-SLT IOP spike was defined as IOP elevation ≥5mmHg, 30-45 min after the laser. In PG and POAG groups, the average age was 62.33 ± 9.18 and 62.58 ± 9.19 years (p = 0.95). The glaucoma severity (p = 0.708), baseline IOP (PG = 21.61 ± 1.34mmHg vs. POAG = 21.13 ± 5.09mmHg, p = 0.943), and number of topical glaucoma medications(PG = 2.34 ± 1.34 vs. POAG = 2.1 ± 1.41, p = 0.342) were comparable. More PG patients were on oral acetazolamide (PG = 26.15% vs. POAG = 1.5%, p < 0.001). Average logMAR visual acuity was significantly higher in the POAG group (0.207 ± 0.3 vs. 0.192 ± 0.37, p = 0.012). Eyes with PG received lower laser energy (POAG = 63.65 ± 22.03 mJ vs. PG = 43.71 ± 25.68 mJ, p < 0.001). IOP spikes were recorded in 5 PG eyes (7.6%) and none in the POAG group (p = 0.058). Failure rates were similar (PG = 50.7% and POAG = 43.1%, p = 0.205). In multivariable analysis, only pre-laser IOP (coefficient = 2.154 [CI: 0.765-3.543], p = 0.003) was a significant predictor of IOP change percentage after 12 months. SLT was comparably effective in both PG and POAG. IOP spikes were observed only in the PG group, though the total laser energy was lower in this group compared with POAG.

The long-term effects of topical latanoprost 0.005% treatment on pupillary functions: A 2-year longitudinal study.

To investigate the long-term effects of topical latanoprost 0.005% treatment on pupillary functions in early-stage primary open-angle glaucoma (POAG) eyes using automated pupillometry. This prospective study involved 20 eyes of 20 treatment-naive subjects with early-stage POAG. After comprehensive ophthalmic examination, static and dynamic pupillometry measurements were performedbefore treatment, at the 1st follow-up visit (1.10 ± 0.30 months) and the 2nd follow-up visit (25.85 ± 10.26 months) after treatment initiation. Dynamic parameters included resting diameter (mm), amplitude (mm), latency (ms), duration (ms), and velocity (mm/s) of pupil contraction and dilation. Static pupillometry parameters were pupil diameter (PD, mm) in high-photopic, low-photopic, mesopic and scotopic conditions. The velocity of pupil dilation significantly decreased during the 1st visit (p = 0.008) and the 2nd visit (p = 0.0003) of treatment compared to the pre-treatment visit. The resting PD was also significantly higher after the 1st visit (p = 0.003) and the 2nd visit (p = 0.001) compared to the pre-treatment visit. However, the difference in resting PD measured between the 1st and 2nd visits did not reach statistical significance (p = 0.065). There were no significant changes in other dynamic parameters (p > 0.05 for all). Additionally, a mild, but not significant, mydriatic effect was observed in PD measurements under scotopic, mesopic and low photopic lighting conditions after follow-up. None of the static and dynamic parameters correlate with age, changes in intraocular pressure (IOP) or mean deviation (MD) values of visual field tests. The long-term topical latanoprost 0.005% treatment in early-stage POAG has a slight mydriatic effect on the pupil. Further longitudinal clinical studies with larger patient cohorts are necessary to better understand the effects of latanoprost on pupillary functions.

Is Primary Open-Angle Glaucoma a Vascular Disease? Assessment of the Relationship between Retinal Arteriolar Morphology and Glaucoma Severity Using Adaptive Optics.

Retinal vascular abnormalities may be associated with glaucomatous damage. Adaptive optics (AO) is a new technology that enables the analysis of retinal vasculature at the cellular level in vivo. The purpose of this study was to evaluate retinal arteriolar parameters using the rtx1 adaptive optics fundus camera (AO-FC) in patients with primary open-angle glaucoma (POAG) at different stages and to investigate the relationship between these parameters and changes in spectral-domain optical coherence tomography (SD-OCT) and perimetry. Parameters of the retinal supratemporal and infratemporal arterioles (wall thickness (WT), lumen diameter (LD), total diameter (TD), wall-to-lumen ratio (WLR), and cross-sectional area of the vascular wall (WCSA)) were analysed with the rtx1 in 111 POAG eyes, which were divided into three groups according to the severity of the disease, and 70 healthy eyes. The associations between RTX1 values and the cup-to-disk ratio, SD-OCT parameters, and visual field parameters were assessed. Compared with the control group, the POAG groups showed significantly smaller TD and LD values (p < 0.05) and significantly higher WLR and WT values (p < 0.05) for the supratemporal and infratemporal arterioles. TD was significantly positively correlated with the retinal nerve fibre layer (RNFL) and ganglion cell complex (GCC) (p < 0.05). LD was significantly positively correlated with the RNFL, GCC, and rim area (p < 0.05). The WLR was significantly negatively correlated with the RNFL, GCC, rim area, and MD (p < 0.05), while it was significantly positively correlated with the cup-to-disc ratio and PSD (p < 0.05). The results suggest that vascular dysfunction is present in POAG, even at a very early stage of glaucoma, and increases with the severity of the disease.

Changes in Optic Nerve Head Blood Flow During Horizontal Ocular Duction.

In this study, we aimed to compare blood flow changes in the optic nerve head (ONH) during horizontal ocular duction among normal, primary open-angle glaucoma (POAG), and normal-tension glaucoma (NTG) eyes. In this cross-sectional study, we included 90 eyes from 90 participants (30 control eyes, 30 POAG eyes, and 30 NTG eyes). ONH blood flow was measured with laser speckle flowgraphy using an external fixation light to induce central gaze, abduction, and adduction at 30 degrees for each eye. The mean blur rate (MBR) of the entire ONH area (MA), vascular region (MV), and tissue region (MT), and the change ratio were analyzed. The change ratio was defined as abduction or adduction value/central gaze value. In the control group, MA significantly decreased during adduction (22.9 ± 3.7) compared with that during central gaze (23.6 ± 3.9, P < 0.05). In the POAG group, MA (adduction = 17.4 ± 3.8 and abduction = 17.3 ± 3.6) and MV (adduction = 37.9 ± 5.6 and abduction = 38.0 ± 5.6) significantly decreased during adduction and abduction compared with those during central gaze (18.0 ± 4.1 and 39.5 ± 6.3, respectively, P < 0.05). In the NTG group, MA significantly decreased during adduction (17.4 ± 4.2) compared with that during central gaze (18.1 ± 4.6) and abduction (18.1 ± 4.8, P < 0.05). The change ratio did not differ between the glaucoma and control groups. ONH blood flow decreased during horizontal ocular duction regardless of normal or glaucoma states; however, the change ratio was comparable between the normal and glaucoma groups.

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...

Assessing the Efficacy of the PAUL Glaucoma Implant in Pseudoexfoliative Glaucoma.

The aim of the study was to evaluate the outcomes and complications associated with PAUL glaucoma implant (PGI) surgery in pseudoexfoliation glaucoma (PXG) patients, comparing them with a primary open-angle glaucoma (POAG) control group. A retrospective analysis included 39 PXG and 29 POAG eyes undergoing PGI surgery between January 2020 and December 2022. Surgical success was defined as intraocular pressure (IOP) between ≤21 and ≥6 mmHg at 12 months and no loss of light perception. Demographic data, ocular examinations, and complications were recorded. PXG patients (68.5±9.9 years) differed significantly in age from POAG patients (54.1±10.6 years) (p<0.05). Surgical success rates at 12 months were 97.4% (PXG) and 86.2% (POAG). No significant inter-group differences in gender, laterality, lens status, vertical cup/disc ratio, or pre-operative best-corrected visual acuity were observed. Mean IOP comparisons showed significant differences within both groups (p<0.001). Ripcord suture removal occurred at mean 30.3±7.43 days (PXG) and 30.6±9.89 days (POAG). Median pre-operative AGM use was 4 (PXG) and 3 (POAG). No significant differences were noted postoperatively. To the best of our knowledge, this is the first study to evaluate the results of PGI in PXG and POAG, demonstrating a remarkable success rate and limited complications. Encouragingly, PXG patients with a history of unsuccessful filtration surgery demonstrated positive outcomes. The findings affirm PGI as a promising surgical intervention for PXG and POAG, exhibiting high success rates and manageable complications.

Possibilities of Preservative-Free Therapy for Primary Open-Angle Glaucoma

Purpose: to evaluate the efficacy and safety of preservative free travoprost generic in primary open-angle glaucoma patients. Patients and methods. 40 patients with compensated primary open-angle glaucoma (POG) and dry eye (DE) were examined: 1st group (20 patients) with the initial stage of POG (travoprost with a preservative monotherapy), 2nd group with an advanced stage of POG (travoprost with a preservative in combination therapy). In all patients, travoprost with a preservative was replaced with preservative free travoprost (Traviolan, 1 time per day, in the evening). Control: 1 — when included in the study; 2 — 4 weeks after replacing travoprost with a preservative for preservative free travoprost. Efficiency criteria: absence of negative dynamics of intraocular pressure (IOP) and MD and PSD perimetric indices (dB; Optos). Safety criteria: absence of OSDI (scores), tear film brake up time (TBUT; Norn’s test, s), lower tear meniscus height (LTMH, µm; OptoVue) and Bijsterveld’s xerosis index (XI, scores) negative dynamics. Results. At the 2nd control point, all observed did not have a statistically significant dynamics of IOP, MD, PSD. In patients of both groups, at the 2nd control point, there was the OSDI and TBUT statistically significant positive dynamics, and in patients of the 1st group — XI statistically significant positive dynamics. The trend towards to XI decreasing in 2nd group patients and the LTMH dynamics in both groups turned out to be statistically insignificant. Conclusion. Preservative free travoprost has shown efficacy comparable to that of travoprost with preservative in both monotherapy and combination therapy. Significant positive dynamics of OSDI and TBUT in patients of both groups and XI in 1st group patients after switching to preservative free travoprost indicates a good “safety profile” of therapy in terms of its effect on the ocular surface state in DE conditions, which, from our point of view, may contribute to maintaining the “quality of life” and patients compliance.

Comparison of Patterns of Structural Progression in Primary Open Angle Glaucoma and Pseudoexfoliation Glaucoma.

Primary open angle glaucoma and pseudoexfoliation glaucoma showed different progression patterns of the retinal nerve fiber layer and ganglion cell-inner plexiform layer thinning in OCT-guided progression analysis. To compare the patterns of progression of retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL) thinning by guided progression analysis (GPA) of optical coherence tomography (OCT) in primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). The progression of RNFL and GCIPL thinning was assessed by the GPA of Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA). By overlaying the acquired images of the RNFL and GCIPL thickness-change maps, the topographic patterns of progressive RNFL and GCIPL thinning were evaluated. The rates of progression of RNFL and GCIPL thinning were analyzed and compared between patients with POAG and those with PXG. Of the 248 eyes of 248 patients with POAG (175 eyes of 175 patients) or PXG (73 eyes of 73 patients) enrolled, 156 POAG eyes and 48 PXG eyes were included. Progressive RNFL thinning was significantly more common in PXG than in POAG ( P =0.005). According to the RNFL progression-frequency maps, progression appeared mainly in the superotemporal and inferotemporal areas in POAG, whereas it had invaded more into the temporal area in PXG. According to the GCIPL maps, progression was most common in the inferotemporal area in both POAG and PXG. The average progression rate of GCIPL thinning was faster in PXG than in POAG ( P =0.013), and when analyzed in 2 halves (superior/inferior), the progression rate of the inferior half was faster in PXG than in POAG ( P =0.011). OCT GPA showed progression patterns of RNFL and GCIPL thinning in POAG and PXG. Understanding the specific patterns of progressive RNFL and GCIPL thinning according to glaucoma type may prove helpful to glaucoma-patient treatment and monitoring.

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.

Role of Glucocorticoids and Glucocorticoid Receptors in Glaucoma Pathogenesis.

The glucocorticoid receptor (GR), including both alternative spliced isoforms (GRα and GRβ), has been implicated in the development of primary open-angle glaucoma (POAG) and iatrogenic glucocorticoid-induced glaucoma (GIG). POAG is the most common form of glaucoma, which is the leading cause of irreversible vision loss and blindness in the world. Glucocorticoids (GCs) are commonly used therapeutically for ocular and numerous other diseases/conditions. One serious side effect of prolonged GC therapy is the development of iatrogenic secondary ocular hypertension (OHT) and OAG (i.e., GC-induced glaucoma (GIG)) that clinically and pathologically mimics POAG. GC-induced OHT is caused by pathogenic damage to the trabecular meshwork (TM), a tissue involved in regulating aqueous humor outflow and intraocular pressure. TM cells derived from POAG eyes (GTM cells) have a lower expression of GRβ, a dominant negative regulator of GC activity, compared to TM cells from age-matched control eyes. Therefore, GTM cells have a greater pathogenic response to GCs. Almost all POAG patients develop GC-OHT when treated with GCs, in contrast to a GC responder rate of 40% in the normal population. An increased expression of GRβ can block GC-induced pathogenic changes in TM cells and reverse GC-OHT in mice. The endogenous expression of GRβ in the TM may relate to differences in the development of GC-OHT in the normal population. A number of studies have suggested increased levels of endogenous cortisol in POAG patients as well as differences in cortisol metabolism, suggesting that GCs may be involved in the development of POAG. Additional studies are warranted to better understand the molecular mechanisms involved in POAG and GIG in order to develop new disease-modifying therapies to better treat these two sight threatening forms of glaucoma. The purpose of this timely review is to highlight the pathological and clinical features of GC-OHT and GIG, mechanisms responsible for GC responsiveness, potential therapeutic options, as well as to compare the similar features of GIG with POAG.

Comparison of the Choroid in Primary Open-angle and Angle-Closure Glaucoma Using Optical Coherence Tomography.

The current study highlights distinct choroidal alterations in primary open-angle and angle-closure glaucoma, underscoring the potential of choroidal vascularity index as a valuable indicator for understanding glaucoma pathogenesis. To evaluate choroidal structural changes in patients with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) and healthy controls utilizing the choroidal vascularity index (CVI) and subfoveal choroidal thickness (SFCT) by enhanced depth imaging optical coherence tomography (EDI-OCT). This study was cross-sectional. A total of 171 eyes of 171 subjects, comprising 69 eyes with untreated POAG, 58 eyes with untreated PACG and 44 healthy eyes, were enrolled in this study. SFCT, luminal area (LA), stromal area (SA) and total choroidal area (TCA) were measured on EDI-OCT scans. The CVI parameter is calculated as the proportion of LA to TCA. This study included 69 POAG patients with a mean age of 51.4±13.3 years, 58 PACG patients with a mean age of 57.0±7.3 years, and 44 healthy subjects with a mean age of 51.11±10.7 years. The CVI in the POAG and PACG groups was significantly lower than that in the control group (P = 0.001 and P = 0.005, respectively), however not significantly different between the two glaucoma groups (P = 1.000). POAG eyes had significantly lower LA than PACG and controls (P = 0.014 and P = 0.049, respectively), while PACG eyes had significantly greater SA than controls (P = 0.041). The CVI of POAG and PACG eyes was significantly lower than that of normal eyes. A reduced LA was observed mainly in eyes with POAG, and an increased SA was observed mainly in eyes with PACG. The role of the choroid may differ between POAG and PACG eyes.

Comparison of Goldmann and ORA tonometers in newly diagnosed, untreated, POAG and OHT eyes

Background and objectiveThe corneal biomechanical properties in naïve, untreated glaucoma and ocular hypertension (OHT) eyes is interesting, because it may be a source of error in intraocular pressure (IOP) measurements by Goldmann applanation tonometer (GAT) and Ocular Response Analyzer (ORA)The main objective of this study was to evaluate the IOP values obtained using GAT and the ORA, in primary open angle glaucoma (POAG) and in OHT untreated eyes. Material and MethodsObservational, masked, cross sectional observational study. Newly diagnosed, untreated POAG and OHT eyes were included. Results51 POAG and 34 OHT eyes were analyzed. We found that IOPcc (IOP corneal-compensated) was significantly higher than GAT IOP in POAG (p = 0.0002) while we did not find any significant difference between both tonometers in OHT (p = 0.1). ConclusionsGAT seems to underestimate the real IOP in untreated POAG eyes and it seems to be quite accurate in OHT eyes.

Estudio comparativo entre tonómetros Goldmann y ORA en pacientes recién diagnosticados de GPAA o HTO, sin tratamiento

Background and objectiveThe corneal biomechanical properties in naïve, untreated glaucoma and ocular hypertension (OHT) eyes is interesting, because it may be a source of error in intraocular pressure (IOP) measurements by Goldmann applanation tonometer (GAT) and ocular response analyzer (ORA).The main objective of this study was to evaluate the IOP values obtained using GAT and the ORA, in primary open angle glaucoma (POAG) and in OHT untreated eyes. Material and methodsObservational, masked, cross sectional observational study. Newly diagnosed, untreated POAG and OHT eyes were included. ResultsFifty-one POAG and 34 OHT eyes were analyzed. We found that IOPcc (IOP corneal-compensated) was significantly higher than GAT IOP in POAG (P=.0002) while we did not find any significant difference between both tonometers in OHT (P=.1). ConclusionsGAT seems to underestimate the real IOP in untreated POAG eyes and it seems to be quite accurate in OHT eyes.

Association Between Optic Disc Perfusion Determined by Swept-Source Optical Coherence Tomography Angiography and Visual Field Progression in Glaucoma.

Reduced optic disc vessel density determined by swept-source optical coherence tomography angiography (SS-OCTA) was associated with visual field (VF) deterioration in glaucomatous eyes, which suggested that this parameter can be a potential biomarker that correlates well with functional deterioration. The purpose of this study was to identify the association between optic disc perfusion evaluated by SS-OCTA and VF progression in primary open angle glaucoma (POAG) eyes. A total of 266 POAG eyes of 266 patients (5.4y of mean follow-up) were included. Optic nerve head SS-OCTA was performed to evaluate the optic disc vessel density (dVD), parapapillary choroidal vessel density (pcVD), choroidal microvascular dropout (cMvD), and optic disc microvascular dropout (dMvD). VF progression was defined using Early Manifest Glaucoma Trial criteria. Factors associated with VF worsening were assessed by Cox proportional hazard analysis. Eighty (30.1%) out of the 266 POAG eyes showed VF progression. The progression group showed a significantly higher proportion of disc hemorrhage, cMvD, and dMvD but lower dVD and pcVD than the stable group (all P <0.05). Considering the strong association between the parameters [dMvD vs. dVD ( r = -0.757, P =0.010], cMvD vs. pcVD ( r = -0.745, P =0.012), dMvD vs. cMvD ( r = 0.802, P <0.001], dVD vs. pcVD ( r = 0.862, P <0.001), CMvD vs. dVD ( r = -0.698, P =0.031), and dMvD vs. pcVD ( r = -0.688, P =0.034)], 6 models with different combinations of covariates compensating for multicollinearity were developed. Younger age, presence of disc hemorrhage, and lower dVD were consistently associated with progression in all models that included these parameters. Optic disc perfusion, represented as dVD, may be a useful biomarker that correlates well with functional deterioration in POAG eyes.

Multimodal Deep Learning Classifier for Primary Open-angle Glaucoma Diagnosis Using Wide-field Optic Nerve Head Cube Scans in Eyes With and Without High Myopia.

An OCT-based multimodal deep learning classification model including texture information is introduced that outperforms single-modal models and multimodal models without texture information for glaucoma diagnosis in eyes with and without high myopia. To evaluate the diagnostic accuracy of a multimodal deep learning (DL) classifier using wide optical coherence tomography (OCT) optic nerve head cube scans in eyes with and without axial high myopia. 371 primary open-angle glaucoma (POAG) eyes and 86 healthy eyes, all without axial high myopia (axial length AL≤26mm) and 92 POAG eyes and 44 healthy eyes, all with axial high myopia (AL>26mm) were included. The multimodal DL classifier combined features of 3 individual VGG-16 models: 1) texture-based en face image, 2) retinal nerve fiber layer (RNFL) thickness map image and 3) confocal scanning laser ophthalmoscope (cSLO) image. Age, AL, and disc area adjusted area under the receiver operating curves (AUROC) were used to compare model accuracy. Adjusted AUROC for the multimodal DL model was 0.91 (95% CI = 0.87, 0.95). This value was significantly higher than the values of individual models (0.83 [0.79, 0.86] for texture based en face image; 0.84 [0.81, 0.87] for RNFL thickness map; and 0.68 [0.61, 0.74] for cSLO image; all P≤0.05). Using only highly myopic eyes, the multimodal DL model showed significantly higher diagnostic accuracy (0.89 [0.86 , 0.92]) compared to texture en face image (0.83 [0.78 , 0.85]), RNFL (0.85 [0.81 , 0.86]) and cSLO image models (0.69 [0.63 , 0.76]) (all P≤0.05). Combining OCT-based RNFL thickness maps with texture based en face images showed better ability to discriminate between healthy and POAG than thickness maps alone, particularly in high axial myopic eyes.

Evaluation of microvascular changes in the retina and choriocapillaris in primary glaucoma and neuromyelitis optica spectrum disorder with optical coherence tomography angiography

BackgroundTo assess quantitatively the microvascular changes in the retina and choroid of healthy eyes, eyes of subjects with primary angle-closure glaucoma (PACG), primary open-angle glaucoma (POAG) and neuromyelitis optica spectrum disorder (NMOSD) using optical coherence tomography angiography (OCTA). MethodsA series of healthy individuals and subjects with PACG, POAG and NMOSD were recruited in this cross-sectional study. OCTA was performed to capture the optic nerve head and macula images and the vessel density (VD) and retinal nerve fiber layer (RNFL) thickness were quantified. The choriocapillary flow density (CFD) was calculated as the percentage of flow area to the whole selected area. ResultsA total of 68 PACG subjects, 25 POAG subjects, 51 NMOSD subjects and 37 healthy controls were enrolled. Significant decreases in peripapillary VD and RNFL thickness were observed in PACG (p < 0.001) and POAG (p < 0.001) eyes and also in NMOSD subjects with an optic neuritis history (p < 0.001) compared with healthy controls. Unaffected eyes in PACG and POAG subjects had lower baseline peripapillary VD than healthy controls (p = 0.002 and p = 0.011, respectively). PACG eyes showed a lower baseline CFD than POAG (p = 0.0027) and the CFD in early and advanced PACG eyes showed a significantly much more decrease than POAG (p = 0.002 and p < 0.001, respectively). ConclusionsThe peripapillary vessel density and RNFL thickness was reduced in glaucomatous and NMOSD eyes compared with healthy controls. PACG eyes showed a lower CFD than POAG and the distinct peripapillary and choriocapillaris microvasculature changes may be correlated to different PACG and POAG pathogenesis.