Optic Disc Microvasculature Reduction and Visual Field Progression in Advanced Primary Open-Angle Glaucoma.

PurposeTo evaluate supine and sitting intraocular pressure (IOP) self-measurements using iCare-HOME2 self-tonometry (iCare-HOME2) and to compare the results with corresponding iCare IC200 IOP (iCare) measurements by health care professionals on Japanese glaucoma patients.MethodsThirty-six eyes of 36 consecutive primary open-angle and normal-tension glaucoma patients were examined. IOP was measured in sitting position using Goldmann applanation tonometry (GAT), iCare, and iCare-HOME2 self-tonometry, then after a 10-minute supine rest with iCare tonometry and iCare-HOME2 self-tonometry in supine position. ANOVA, intraclass correlation coefficients (ICC) and Bland–Altman analyses were used.ResultsMean IOPs were 15.8 mmHg (GAT), 13.6 mmHg (iCare), and 14.6 mmHg (iCare-HOME2) in sitting (P ≤ 0.049), and 16.8 mmHg (iCare) and 16.8 mmHg (iCare-HOME2) in supine position (P = 0.99). ICCs between iCare-HOME2 and iCare were 0.899 (95% CI, 0.712–0.957) in sitting and 0.976 (95% CI, 0.954–0.988) in supine position. Bland–Altman analysis showed minimal bias in both positions (mean differences: 1.03 mmHg [limits of agreement: −2.07 to 4.14] in sitting; and −0.003 mmHg [−2.18 to 2.17] in supine position).ConclusioniCare-HOME2 self-tonometry can accurately measure IOP in both sitting and supine positions. Based on the ICC values, the agreement between IOP values measured by health-care professionals with iCare and by trained open-angle glaucoma patients with iCare HOME2 was higher in the supine position than in the sitting position. Our results suggest that self-measured sitting and supine iCare-HOME2 IOP data are reliable on trained glaucoma patients and may potentially be applied to assist clinical decision making in glaucoma care.

Low care continuity increases the risk of glaucoma surgery in primary open angle glaucoma patients, especially in females and older adults. Enhancing care continuity may improve treatment outcomes. To investigate the association between care continuity and the risk of glaucoma surgery in patients newly diagnosed with primary open angle glaucoma (POAG). This nationwide cohort study utilized data from the Korean National Health Insurance Service-Senior Cohort (2002-2019) on patients who were newly diagnosed with POAG between 2004 and 2016 and had at least 4 ambulatory clinic visits for POAG within 2 years after diagnosis. On the basis of their continuity of care indices, we categorized participants into high and low-care continuity groups. We utilized the Kaplan-Meier method to determine the cumulative incidence of glaucoma surgery, excluding laser treatments, and applied Poisson regression to estimate incidence rates. We used a Cox proportional hazards regression model to assess the relationship between care continuity and the risk of glaucoma surgery in patients with POAG. Among the 12,713 newly diagnosed patients with POAG, 6769 (53.1%) were female, with a mean (SD) age of 66.58 (8.24) years. The cumulative incidence of glaucoma surgery was significantly higher in patients with low care continuity ( P <0.001). Similarly, the incidence rate of glaucoma surgery was higher in these patients (adjusted hazard ratio, 1.64; 95% CI, 1.31-2.06, P <0.001). This increased risk was particularly pronounced in female patients, patients aged ≥70 years, and those with lower comorbidities. Low care continuity is associated with increased risk of glaucoma surgery in patients with POAG. Therefore, interventions aimed at improving care continuity in patients with POAG should be considered to improve glaucoma treatment outcomes.

Effects of Optic Nerve Head Structures on Retinal Nerve Fiber Layer Defects in Primary Open Angle Glaucoma Eyes: Analyses Using Retinal Optical Texture Analysis.

Primary open-angle glaucoma (POAG) is a major cause of irreversible blindness, yet its underly mechanisms remain unclear. Elevated intraocular pressure (IOP), the only modifiable risk factor for POAG, arises from increased resistance to aqueous humour outflow within the conventional outflow pathway, which comprises the trabecular meshwork (TM) and the inner wall of Schlemm's canal. Dysfunction and cellular loss within this pathway, particularly in the TM, are consistent features of the disease; however, the mechanisms responsible for impaired tissue maintenance and regenerative failure remain unclear. Trabecular meshwork progenitor cells (TMPCs) have the capacity to replace lost TM cells, suggesting that impaired progenitor function may contribute to disease progression. Transforming growth factor beta 2 (TGFβ2), which is consistently elevated in the aqueous humour of POAG patients, plays a key role in regulating stem cell differentiation. We proposed that excess TGFβ2 disrupts TMPC function, leading to progenitor depletion and TM dysfunction. Here, we show that TGFβ2 drives TMPCs toward a differentiated, fibrotic phenotype, increasing TM and profibrotic gene expression while reducing progenitor markers. These effects are mediated through TGFβ2-SMAD2/3 signalling, as inhibition of this pathway preserves TMPC characteristics and suppresses fibrotic gene induction. Our findings identify TGFβ2-SMAD2/3 signalling as a regulator of TMPC fate in vitro and suggest a potential mechanism by which elevated TGFβ2 may influence TM progenitor cell behaviour under pathological conditions.

ABSTRACTPurposePsychological distress is highly prevalent in glaucoma and is associated with worse adherence, reduced quality of life, and faster disease progression. However, distress is rarely assessed in ophthalmology settings due to time, workflow, and staffing constraints. We evaluated two artificial intelligence (AI)-based screening strategies, designed to efficiently identify distressed primary open angle glaucoma (POAG) patients during routine care, aiming to achieve effective, resource conscious, low burden clinical screening.DesignHybrid retrospective cohort and prospective cross-sectional study.ParticipantsThe retrospective cohort included >3,000 POAG patients from the Duke Ophthalmic Registry. Prospective validation was conducted in a separate 300 POAG patient cohort who completed patient-reported distress screening.MethodsUsing retrospective data, a neural network model was trained to predict an electronic health record (EHR)-derived computable phenotype of distress (“silver standard”). Prospective validation used the 8-item Patient Health Questionnaire (PHQ-8) as the “gold standard.” Three screening strategies were compared against PHQ-8: (1) universal PHQ-2 screening (two-item screener administered to all patients), (2) AI-only screening (fully automated EHR-based screener), and (3) sequential screening, (only patients flagged as high risk by AI screener completed the PHQ-2). Performance metrics included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and screening burden.Main Outcome MeasuresSensitivity; specificity; PPV; NPV; accuracy; proportion of patients requiring secondary screening (screening burden).ResultsDistress prevalence was 17% (PHQ-8 > 6). Universal PHQ-2 screening (> 0) achieved high sensitivity (0.96) but lower specificity (0.73) and PPV (0.41), while requiring screening of all patients. The AI-assisted sequential approach substantially reduced screening burden while maintaining strong diagnostic performance. By administering PHQ-2 to ∼25% of patients, sequential screening achieved sensitivity 0.64, specificity 0.93, PPV 0.64, NPV 0.93, and accuracy 0.88, representing a ∼50% increase in PPV compared to PHQ-2 alone. AI-only screening reduced burden further but did not achieve comparable sensitivity or predictive performance.ConclusionsAI-assisted sequential screening enables scalable, resource efficient identification of psychological distress in glaucoma care, substantially reducing screening burden while preserving clinically meaningful performance. This framework offers a practical pathway for integrating distress screening into routine ophthalmology workflows and improving the identification and referral of at-risk patients.

To assess the effect of diabetes mellitus (DM) type 2 on the functional progression of primary open-angle glaucoma (POAG) by comparing the rate of progression (RoP) of POAG in eyes with and without diabetes. In a retrospective observasional study from our practice were included 32 followed-up POAG patients with accompanying disease DM type 2 (60 eyes) (group I, POAG + DM) and 32 patients with POAG without DM (58 eyes) (group II, POAG-DM). The groups were matched by age and gender but not by stage of POAG iat the start of investigation. The mean period of disease tracking was 6.0 ± 3.4 years (from 2 to14 years) for POAG + DM group and 5.4 ± 2.3 years (from 2 to 10 years) for POAG -DM group. Visual field (VF) changes were determined by standard automatic perimetry, Humphrey analyzer, program 30 - 2. For each eye the slope of MD (Mean deviation) changes over time was calculated and the RoP was established. A significant difference was observed for initial MD values in eyes of both groups: -5.52dB in groupI vs. -10.66 dB in group II. The number and percentage of eyes with initially severe VF losses was three times higher in group II: 21 eyes (36.2%) vs. 7 eyes (11.7%). A real progression in one or both eyes was established in 21 patients of POAG + DM group and in 25 patients of POAG-DM group. During the follow-up period the progressing eyes were 34 eyes (56.7%) in POAG + DM group and in 38 eyes (65.5%) in POAG-DM group. The difference between both groups was not significant (P > 0.05) about progressing eyes. The mean value of RoP in the progressing eyes was - 0.98 ± 1.12/year in POAG + DM group and - 0.78 ± 0.66/year in POAG-DM group. Although RoP was larger in progressing POAG + DM, no significant difference was found in both groups (Z - 0.017, Sig 0.986, Mann-Whitney Test). The real influence of DM on functional progression of POAG was not established in this comparative study. The rate of progression in POAG eyes with DM type 2 was slightly higher but without statistical significance. It was due to the significantly greater percentage of eyes with severe visual field changes in POAG patients without DM. The severity of POAG influences the assessment of the functional progression in eyes with and without DM.

To compare the effects of Preservative-free (PF) and benzalkonium chloride (BAK)-preserved latanoprost on intraocular pressure (IOP), objective ocular surface signs, and subjective symptoms in patients with primary open-angle glaucoma (POAG). A prospective, randomized, crossover study was conducted with 29 POAG patients. Participants were randomized to receive either PF or BAK-preserved latanoprost for two months, followed by a crossover to the alternative formulation for another two months. IOP, tear break-up time (TBUT), conjunctival staining, and patient-reported symptoms were assessed at baseline and after each treatment period. IOP was significantly and comparably reduced by both formulations (PF: from 16.49 ± 3.89 to 15.05 ± 2.55 mmHg, P = 0.007; preserved: from 15.60 ± 3.79 to 13.79 ± 3.53 mmHg, P < 0.001). However, BAK-preserved latanoprost significantly shortened TBUT (from 7.23 ± 2.37 to 6.07 ± 2.40 s, P = 0.007) and worsened conjunctival staining (from 0.31 ± 0.60 to 0.69 ± 0.71, P = 0.013), whereas PF latanoprost maintained tear film stability (TBUT: from 5.61 ± 2.19 to 5.22 ± 2.26 s, P = 0.337) and improved conjunctival staining (from 0.76 ± 0.83 to 0.31 ± 0.60, P = 0.003). Subjective symptoms including burning (PF: 0.34 ± 0.81 vs. preserved: 1.21 ± 1.17, P = 0.001), stinging (0.14 ± 0.35 vs. 0.79 ± 0.79, P < 0.001), and pruritus (0.21 ± 0.41 vs. 0.50 ± 0.64, P = 0.030) were markedly lower with the PF formulation. After crossover, patients switching from preserved to PF latanoprost showed improvements in burning (P = 0.012) and photophobia (P < 0.001). PF latanoprost provides equivalent IOP-lowering efficacy to BAK-preserved latanoprost while offering significant advantages in ocular surface health and symptom tolerability. These findings support PF formulations as a preferred first-line option for glaucoma management to enhance treatment tolerability and patient's quality of life.

To evaluate the associations of single-nucleotide polymorphisms (SNPs) in 17 loci with primary open-angle glaucoma (POAG) and subtypes in Chinese and Japanese. 17 SNPs in 17 genes, selected from a recent genome-wide association study, were genotyped in a Hong Kong Chinese cohort of 1093 POAG patients, including 557 high-tension glaucoma (HTG) and 536 normal-tension glaucoma (NTG) patients, and 584 controls. Seven SNPs showing association in the Hong Kong cohort were genotyped in a Shantou Chinese cohort of 155 POAG patients and 380 controls and an Osaka Japanese cohort of 254 POAG patients and 207 controls. The SNP-disease association of individual and pooled cohorts was analysed. In combined Chinese and Japanese subjects, three SNPs were significantly associated with POAG: AFAP1 rs938604 (Pmeta =6.40×10-5, OR=0.70), FNDC3B rs62283813 (Pmeta =0.0050, OR=1.24) and GAS7 rs9913911 (Pmeta =0.0060, OR=1.19). In subgroup analysis, these three SNPs showed stronger association with HTG: AFAP1 rs938604 (Pmeta =8.00×10-6, OR=0.59), FNDC3B rs62283813 (Pmeta =6.00×10-7, OR=1.55) and GAS7 rs9913911 (Pmeta =0.0040, OR=1.24). In addition, SPRED2 rs4414666 (Pmeta =8.00×10-4, OR=1.29) was also significantly associated with HTG. No SNP showed a significant association with NTG. This study confirms AFAP1 rs938604, FNDC3B rs62283813, GAS7 rs9913911 and SPRED2 rs4414666 as HTG-specific loci in Chinese and Japanese populations. These findings provide new insights into the genetic architecture of POAG, highlighting distinct molecular mechanisms between HTG and NTG subtypes.

Aqueous humor outflow (AHO) is significantly lower in primary angle closure glaucoma (PACG) compared to primary open angle glaucoma (POAG). To quantitatively compare circumferential,perilimbal aqueous humor outflow(AHO) pathways in patients of primary open angle glaucoma(POAG) and primary angle closure glaucoma(PACG) using Aqueous Angiography(AA). Thirty-two eyes of 32 patients were included with 16 patients of POAG and 16 age-matched PACG patients presenting with age-related cataract and planned phacoemulsification surgery.IOP and the number of antiglaucoma medications(AGMs) were noted. All patients underwent AA with 0.1% indocyanine green dye injected into the anterior chamber prior to the capsulorrhexis step, followed by capture of images up to 60 seconds. Images at 60 seconds were exported for image analysis, where mean gray value was assessed to calculate angiographic signal intensity(ASI) along the limbus into eight sectors(45° each),four quadrants(90° each) and overall flow(360°) for POAG & PACG.Statistical tests for relationship of age and severity of disease with overall flow were performed. The mean age(years) was 58.8±5.8(POAG) and 59.8±8.6(PACG)[P=0.704]. The mean preoperative IOP[POAG(16.5±2.48mmHg) & PACG(18.44±4.03mmHg)] and median number of AGMs[POAG{3 (1.75-3.25)} & PACG{3 (2.75-4)}] between the two groups were comparable(P>0.05).There was no significant difference in the severity of baseline disease for POAG(MD= -16.79±8.73) and PACG(MD= -16.39±9.57),P=0.904.The overall flow was lower in PACG[123.72(105.18-205.68)] compared to POAG[188.32(163.58-234.40)],P=0.029. In multivariate linear regression analysis, higher overall flow in POAG compared to PACG(β=56.705,P=0.010)was noted.The correlation with age[POAG(r= -0.267,P=0.316); PACG(r= -0.301, P=0.256)] and MD[POAG (r=0.106, P=0.697);PACG (r=0.515, P=0.044)]was documented. Both POAG and PACG had segmental AHO. PACG eyes had lower functional AHO compared to POAG in phakic, dilated patients. With increasing disease severity, a decrease in overall flow was noted in PACG.

In patients with untreated primary open angle glaucoma, the higher the corneal deformability, the lower the changes in 24-hour intraocular pressure variation. To investigate the relationship between corneal biomechanics and 24-hour intraocular pressure (IOP) variation in patients with untreated primary open angle glaucoma (POAG). Two hundred forty-five (245) eyes of 124 patients with POAG were included in this cross-sectional study. Each patient underwent measurement of corneal biomechanics with Corvis ST. IOP measurements were taken every 2 hours during a 24-hour period by a noncontact tonometer. The study included 70 men and 54 women. The mean age was 51.41 ± 14.42 years. In the multivariate regression analyses, lower SP-A1 was associated with smaller values of 24-hour IOP fluctuation (difference between peak and trough IOP of 24-hour recordings), mean amplitude of intraocular pressure excursion (MAPE) and average, peak and trough IOPs of the 24-hour, diurnal and nocturnal time periods. Integrated radius was negatively correlated with average, peak, and trough IOPs of both the 24-hour and diurnal time course, as well as with the trough nocturnal IOP. Corneal deformability reflected by biomechanical properties measured by Corvis ST is associated with 24-hour IOP variation in untreated POAG patients. Increased corneal deformability is associated with lower 24-hour IOP changes.

To compare canaloplasty and trabecular micro-bypass surgery outcomes in primary open-angle glaucoma (POAG). Ambispective study using data from the International Glaucoma Surgery Registry (IGSR) to evaluate mild-to-moderate POAG patients who underwent iTrack ab-interno canaloplasty (Nova Eye Medical, USA) (prospective cohort) or iStent trabecular micro-bypass implantation (Glaukos, USA) (retrospective cohort), with or without concomitant phacoemulsification, and ≥12 months of follow-up. Primary outcomes were intraocular pressure (IOP), medication usage, and surgical success as defined by the American Academy of Ophthalmology (2024). The study included 339 eyes (iStent: n = 115; iTrack: n = 224) of which ≥94% underwent concomitant phacoemulsification (iStent: n = 109, iTrack: n = 210). There were nonsignificant differences in baseline IOP (p = 0.417) and medications (p = 0.741) between groups. At last follow-up, mean IOP (mmHg) and medication usage decreased from 17.3 ± 4.2 and 2.0 ± 1.1 at baseline to 14.2 ± 3.5 and 1.3 ± 1.1 in the iStent group (p < 0.001; mean follow-up: 27.2 ± 14.5 months), and from 16.9 ± 5.0 and 2.0 ± 1.1 at baseline to 14.3 ± 3.4 and 1.1 ± 1.3 in the iTrack group (p < 0.001; mean follow-up: 20.3 ± 7.7 months). Both groups showed no significant differences in reduction of IOP (p = 0.422) and medications (p = 0.211). More eyes were medication-free in the iTrack group (42% vs 29%; p = 0.029). Success was achieved in 61% of eyes in both groups (p = 1.000). Postoperatively, both groups demonstrated infrequent and self-limited complications, no sight-threatening events, and low reoperation rates. In POAG, iTrack canaloplasty and iStent implantation showed no statistically significant differences in effectiveness outcomes. Both procedures had favourable safety profiles with limited additional glaucoma surgeries. More canaloplasty eyes were medication-free compared to stent eyes.

This study aimed to evaluate postoperative angle changes following gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with primary open-angle glaucoma (POAG) over 1 year of follow-up. We conducted a retrospective analysis of 60 eyes from 41 POAG patients who underwent GATT, assessing intraocular pressure (IOP), number of ocular hypotensive medications, and gonioscopic findings preoperatively and at 3, 6, and 12 months postoperatively using the Spaeth classification. Postoperative IOP and medication use were significantly reduced throughout follow-up. Gonioscopic examination revealed forward movement of the iris root insertion in all quadrants, most notably inferiorly, with angle width narrowing up to 10°, primarily in the nasal quadrant. Overall pigment angle decreased initially, then gradually increased, with the nasal quadrant showing the highest pigment levels; the pigment pattern changed from diffuse preoperatively to stacked postoperatively. Peripheral anterior synechia (PAS) developed in 39 eyes (65%) and stabilized by 3 months, with the nasal quadrant most affected and showing a gradually increasing extent of involvement. Regarding the trabeculotomy cleft, 28 eyes (46.7%) maintained a widely patent opening, 29 (48.3%) showed a narrow opening, and 3 (5%) were completely closed. Angle rebleeding sites varied among patients, occurring most frequently in the nasal quadrant. In conclusion, GATT significantly reduced IOP and medication use over 12 months, with characteristic angle changes including forward iris insertion, narrowing angle width, altered pigment distribution with accumulation, predominant PAS formation in the nasal quadrant, and variable rebleeding sites.

Background:Primary open-angle glaucoma (POAG) is characterized by increased resistance to aqueous humor outflow. Transforming growth factor beta-1 (TGF-beta1) contributes to this resistance by promoting synthesis and remodeling of the extracellular matrix in the trabecular meshwork, thereby reducing outflow facility. This study aimed to investigate the association between the TGF-beta1 gene polymorphism at position −800 G>A (rs1800468) and POAG in patients from Khorasan Razavi Province, Iran.Methods:In this case-control study, patients with POAG referred to Khatam-al-Anbia Hospital were enrolled as the case group, and age-matched healthy individuals served as controls. Demographic and clinical data of participants were recorded, collecting 5 mL of whole blood from each individual. DNA was extracted, genotyping the TGF-beta1 −800 G>A polymorphism using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).Results:We included 105 individuals diagnosed with POAG and 105 healthy controls, with comparable mean age and sex distribution between the two groups (both P > 0.05). In the case group, genotype frequencies were 88.6% GG (n = 93), 10.5% GA (n = 11), and 1.0% AA (n = 1), in the control group 79.0% GG (n = 83), 19.1% GA (n = 20), and 1.9% AA (n = 2). Allele frequencies were 94.0% G (n = 197) and 6.0% A (n = 13) in cases, compared to 88.6% G (n = 186) and 11.4% A (n = 24) in controls. No significant association was observed between genotype frequencies and POAG or between alleles and POAG (both P > 0.05). Analysis under various inheritance models (codominant, dominant, recessive, overdominant) showed no significant associations either (P > 0.05).Conclusions:The TGF-beta1 −800 G>A polymorphism does not appear to play a significant role in POAG development in this population. Inheritance of the mutant A allele is not a risk factor for POAG in northeastern Iran.

To assess inter-eye differences of circumpapillary vessel density (cpVD) in patients with primary open-angle glaucoma (POAG) and elucidate factors implicated in glaucomatous vascular pathology. POAG subjects and controls underwent optical coherence tomography (OCT) and OCT angiography (OCTA) imaging in both eyes. Inter-eye differences of OCT, OCTA, visual field (VF) and other ophthalmic parameters were assessed. Seventy-two POAG subjects and 53 controls were similar in age, gender, and visual acuity (P ≥ 0.28 for all). POAG subjects had greater retinal nerve fiber layer (RNFL) asymmetry than controls (10 ± 10 µm vs. 5 ± 5 µm, P < 0.001). POAG patients also demonstrated significantly asymmetric mean deviation (MD) between the worse (-5.2 ± 4.0 dB) and better eye (-1.5 ± 2.6 dB, P < 0.001). However, POAG subjects had similar inter-eye cpVD asymmetry compared to controls (3.5% ± 2.6% vs. 3.1% ± 1.9%, respectively; P = 0.32). In a multivariable regression, MD asymmetry was associated with greater RNFL asymmetry (β = 0.540; 95% confidence interval [CI], 0.249-0.830; P < 0.001), whereas treated systemic hypertension (β = -0.415; 95% CI, -0.679 to -0.151; P < 0.001) was associated with decreased cpVD asymmetry in POAG subjects. POAG subjects demonstrated greater inter-eye RNFL asymmetry than controls, but similar cpVD asymmetry. Although RNFL asymmetry was associated with difference in VF, inter-eye difference of circumpapillary microvasculature was minimized by systemic hypertension treatment, supporting systemic determinants of glaucomatous vascular pathology. Our findings highlight a discordance in vascular pathology and structural RNFL damage between eyes in POAG, suggesting a systemic predisposition of vascular pathology in POAG.

Aim: To evaluate the prevalence and characteristics of ocular surface disease (OSD) in patients with glaucoma treated with topical anti-glaucoma medications. Methods: This prospective observational study was conducted between May 2022 and May 2024 at a tertiary care hospital in coastal Odisha. Newly diagnosed primary open-angle glaucoma patients were enrolled. Baseline evaluation included the OSDI questionnaire, TBUT, Schirmer’s test, fluorescein staining, and conjunctival impression cytology. Follow-up assessments were done at 6 and 12 months. Results: A total of 187 eyes of 95 patients were included. At 12 months, 54.74% developed OSD. Prevalence increased significantly with age (p &lt; 0.001) and was higher in rural populations (65.4%). OSD was more common with multiple drug therapy (75.86%). TBUT and Schirmer’s values significantly declined over time. Preservative-containing medications showed a higher association with OSD (p &lt; 0.05). Conclusion: Long-term use of anti-glaucoma medications significantly contributes to the development of OSD, especially with multiple drugs and preservatives. Recommendation: Routine ocular surface evaluation and use of preservative-free formulations should be encouraged to improve patient compliance and outcomes.

Background: To evaluate the effects of a preservative-free artificial tear formulation containing trehalose, sodium hyaluronate, and N-acetyl-aspartyl-glutamate (NAAGA) on ocular surface parameters and quality of life in patients with primary open-angle glaucoma (POAG) treated with preserved versus preservative-free prostaglandin analogues. Methods: For this prospective, observational clinical study, thirty-eight patients (76 eyes) with POAG receiving stable topical prostaglandin therapy were enrolled and divided into two groups: preserved prostaglandins (Group 1, n = 44) and preservative-free prostaglandins (Group 2, n = 32). All patients received adjunctive preservative-free artificial tears (trehalose, sodium hyaluronate, NAAGA) three times daily for one month. Assessments at baseline (T0) and 1 month (T1) included best-corrected visual acuity (BCVA), intraocular pressure (IOP), contrast sensitivity, Schirmer test, tear break-up time (BUT), Efron grading scale, Ocular Surface Disease Index (OSDI), visual field (VF) indices (Mean Deviation (MD), Pattern Standard Deviation (PSD), Visual Field Index (VFI)), and quality of life (QoL) measured using Visual Analogue Scales (VAS). Results: After 1 month, both groups demonstrated significant improvement in ocular surface parameters. Schirmer test increased by approximately 4-5 mm (p = 0.001 in both groups), and BUT improved by 5 s (p = 0.001 in both groups). OSDI scores significantly decreased (Group 1: -18.5; Group 2: -23; p = 0.001 for both), and Efron grading significantly improved (p = 0.001 in both groups). Artificial tears-related QoL markedly increased in both groups (p = 0.001), while pathology-related QoL remained unchanged. IOP showed a modest but significant reduction in both groups (Group 1 p = 0.011; Group 2 p = 0.003), without intergroup differences. VFI significantly improved in both groups from T0 to T1 (Group 1 p = 0.013; Group 2 p = 0.04). Group 1 also showed an improvement in terms of PSD (p = 0.025). Conclusions: Adjunctive treatment with preservative-free artificial tears containing trehalose, sodium hyaluronate, and NAAGA significantly improved tear film stability VF indexes, ocular surface signs and symptoms, and patient-reported QoL in POAG patients treated with prostaglandins, regardless of preservative status. Routine ocular surface optimization should be considered an integral component of comprehensive glaucoma management.

Purpose To compare nasal and inferior 180° selective laser trabeculoplasty (SLT) in primary open-angle glaucoma patients regarding postoperative pressure spikes, intraocular pressure (IOP) fluctuation, and short-term efficacy. Patients and methods A total of 46 eyes (23 in each group) having open-angle glaucoma with insufficient IOP control were enrolled. Preoperative and postoperative IOP were measured by Goldmann-applanation-tonometer. 50 nonoverlapping laser pulses were applied over 180° of the angle (nasal in group 1 or inferior in group 2). IOP was measured before and 1 h after SLT. Follow-ups were scheduled at the first week, first, third, and sixth months thereafter. Results The mean pre laser IOP was 19.57±4.71 mmHg in the nasal SLT group and 20.04±4.40 mmHg in the inferior SLT group. Both groups showed significant IOP reduction, with nasal SLT decreasing to 15.04±2.39 mmHg ( P &lt;0.001) and inferior SLT to 16.13±3.55 mmHg ( P &lt;0.001) at 6 months. However, no statistically significant differences were observed between the two treatment approaches throughout follow-up. Conclusion Nasal and inferior SLT provide comparable IOP reductions, with nasal SLT maintaining slightly lower values. Inferior SLT poses a higher risk of postoperative IOP spikes, necessitating caution in heavily pigmented angles. Nasal SLT may offer a safer alternative with fewer complications.

Background The choroid contributes to optic nerve head perfusion, and its vascular dysfunction potentially contributes to glaucoma pathogenesis. Variations in blood flow and choroidal thickness (CT) can influence optic nerve vulnerability, highlighting the choroid’s importance in understanding glaucomatous damage. Aim To evaluate the effect of commonly used glaucoma medications on CT in patients with primary open-angle glaucoma using enhanced depth imaging optical coherence tomography (EDI-OCT). Patient and methods This cross-sectional, comparative, noninvasive study comprised 20 normal eyes and 60 eyes suffering of mild to moderate primary open-angle glaucoma who were under either monotherapy or combined therapy. Participants divided into four groups: Group I (included 20 normal eyes as control group), while Groups II, III, IV comprised glaucomatous eyes treated with (alpha-adrenergic agonists), (combined carbonic anhydrase inhibitors and β-blockers), and (prostaglandin analogues) respectively. CT was assessed at three locations: subfoveal (SFCT), 1 mm nasal, and 1 mm temporal to the fovea by Spectralis HRA-OCT in enhanced depth imaging (EDI) mode. Results Patients receiving combined carbonic anhydrase inhibitor and β-blocker therapy showed significantly decreased subfoveal and parafoveal CT compared with controls and other treatment groups. These findings suggest a more pronounced choroidal thinning effect with this combination. Conclusions Topical antiglaucoma therapy with CAIs and β-blockers may impact ocular perfusion, unlike prostaglandin analogues or alpha-adrenergic agonists. Clinicians should consider these vascular effects, particularly in patients with chorioretinal diseases or compromised ocular circulation when selecting long-term treatment options.

Methylome profiling reveals epigenetic alterations in the trabecular meshwork of primary open-angle glaucoma.