Primary Open Angle Glaucoma Suspects Research Articles

Twenty-Four-Hour Intraocular Pressure Pattern In Glaucoma Suspects in an African Population.

Twenty-four-hour intraocular pressure measurement (Phasing) among glaucoma suspects showed higher intraocular pressure (IOP), greater fluctuation, and more varying peak times occurring mostly outside clinic hours, between 12 midnight and 8 am in 68.9% of them. To characterise 24-hour variation in IOP, in glaucoma suspects and normal individuals in an African population. A cross-sectional analytical study was carried out between March and October 2019 at the University of Ilorin Teaching Hospital. A total of 204 study participants, comprising 102 primary open angle glaucoma (POAG) suspects and 102 age and sex-matched controls with healthy eyes were recruited. Participants had a comprehensive ophthalmic examination. Measurements of IOP were taken every 2 hours during a 24-hour period using an iCare tonometer. The mean age was 43.64±14.02 SD and 43.02±13.55 SD ( P =1.000) for POAG suspects and controls, respectively. The mean peak IOP was significantly higher in POAG suspects (21.87± 4.65mmHg) compared with controls (17.17± 2.32mmHg) ( P <0.001). Whereas, the mean trough IOP reading was not significantly different between the 2 groups. In both groups of participants, the peak and trough IOP in the majority were recorded outside of clinic hours. The majority (68.9%) of POAG suspects had a peak IOP between midnight and 8 am, whereas the control group peaked mostly at 4 pm (16.7%) and 4 am (41.7%). Twenty-four-hour IOP variation was 6mmHg or less in 73.6% of control eyes, while in the POAG suspects, 83.3% of eyes had variation greater than 6mmHg. Compared with age and sex-matched healthy controls, glaucoma suspects of African descent showed significantly higher mean IOP and IOP variation, with most peak IOP detected outside of clinic hours.

Comparison of Contrast Sensitivity and Central Corneal Thickness in Primary Open Angle Glaucoma Suspects and Visually Normal Participants

Introduction: Glaucoma causes a reduction of contrast sensitivity (CS) while thinner central corneal thickness is (CCT) associated with the risk of glaucoma. Thus, in glaucoma suspect patients, CS and CCT measurements may better evaluate and monitor the disease. The purpose of this study was to compare CS and CCT between a Primary Open Angle Glaucoma (POAG) suspect group and a normal group of similar age. Methods: CS was measured with the Pelli-Robson CS chart, while CCT was measured with a hand-held pachymeter. In total, 115 glaucoma suspects and 102 normal participants were included. Results: There was a significant effect of the clinical condition on CS [F(1,209)=5.409, p=0.02]. The effect of age on CS was also significant [F(3,209)=20.419, p&lt;0.001]. The interaction between age and clinical condition was not statistically significant [F(3,209)=0.815, p=0.49]. CS of POAG suspects was significantly lower than that of the normal group for the younger age groups (40 to 59 years old) but not for the older age groups (50 to 80 years old). There was no significant effect of clinical condition on CCT [F(3,209)=0.754, p=0.39]. However, there was a significant effect of age on CCT [F(3,209)=3.789, p=0.01]. Conclusion: Contrast sensitivity measurement is potentially useful to be integrated with routine investigations for POAG suspect patients, especially those who are younger than 60 years old. Measurements of central corneal thickness alone may not be able to differentiate between POAG suspects and visually normal individuals.

Association between statin use and rates of structural and functional loss in glaucoma

Background/aimsTo evaluate the association between statin use and rates of standard automated perimetry (SAP) and retinal nerve fibre layer (RNFL) change in patients with glaucoma and glaucoma suspects.MethodsThis retrospective cohort...

Association of Primary Open Angle Glaucoma with Axial myopia

Background: Primary open angle glaucoma (POAG) is observed to be associated with axial myopia, if diagnosed at an early stage and early age can help in a great extent to avoid irreversible blindness and reduce the blind years of the patient. Aims: We intend to take up the study to correlate Axial Myopia with POAG and POAG Suspects and also to document the correlation between the severity of Axial Myopia and POAG and with POAG Suspects. Settings and Design: This was an observational study, where axial myopes (axial length more than 24.50 mm and spherical equivalence equal to or more than -0.5D) were included. Methods and Material: Intraocular pressure (IOP) measurement, gonioscopy, fundus evaluation and visual field analysis was done. Patients were examined and diagnosed as POAG, IOP suspects and Disc suspects. Each of the groups were again correlated as per severity in axial length. Results: Out of 162 eyes, males were 55.56% (n= 90) and females were 44.44 % (n=72) of the study population. 62.9 % of the patients (n=102) belonged to the age group 41-50 years and 37.8 % (n=60) belonged to 30-40 years. The average age noted was 43 +5.97 years. 22.22 % (n=26) were diagnosed POAG and had an association with axial length (p=0.046), while no association with age (0= 0.361) and gender (p=0.933). IOP suspects formed 8.64 % (n=14) of the population, showed association with gender (p=0.008) but there was no association with age (p=0.637) and axial length (p=0.361). Disc suspects formed 27.16 % (n=44) of the population, showed no association with age (p=0.797), gender (p=0.316) and axial length (p=0.070). Conclusions: Our study showed association of axial myopia (aged 41-50 years) with POAG (22.2 %). IOP suspects had predilection to male population (p=0.046). No such association was found in disc suspects. Keywords: Primary Open Angle Glaucoma (POAG), axial length, axial myopia, intraocular pressure (IOP), disc suspects, intraocular pressure suspects

Agreement of Optic Nerve Head Evaluation of Primary Open-Angle Glaucoma Between General Ophthalmologists and Glaucoma Specialists.

PurposeTo investigate the agreement of optic nerve head evaluations and initial diagnoses of primary open-angle glaucoma (POAG) by general ophthalmologists and glaucoma specialists in Shanghai, China.MethodsThis multicenter, cross-sectional study involved the outpatients from the general ophthalmology departments of four top eye hospitals in Shanghai. The participants underwent ocular examinations, including intraocular pressure, fundus photography, corneal thickness, refractometry, visual acuity, visual field and gonioscopy. General ophthalmologists and glaucoma specialists performed the diagnoses and classified them as non-glaucoma, POAG suspects, and POAG. The consistency of initial diagnosis between general ophthalmologists and glaucoma specialists was measured using the weighted kappa coefficient. Logistic regression analysis was used to detect the risk factors for the reliability of POAG diagnosis.ResultsIn 922 participants, the initial diagnosis rates of POAG and non-glaucoma were much higher in the glaucoma specialist group than in the general ophthalmologist group, while the initial diagnosis rates of POAG suspects were higher in the general ophthalmologist group. The weighted kappa coefficient between the two groups was 0.831±0.027 (95% confidence interval, 0.779–0.884). Logistic regression analysis of the risk factors for the reliability of POAG diagnosis showed that the independent risk factors were intraocular pressure (OR 8.363, 95% CI: 4.27–16.37) and vertical cup-to-disc ratio (OR 3.459, 95% CI: 1.54–7.76).ConclusionThe diagnosis consistency between the general ophthalmologists and the glaucoma specialists was similar among outpatients in the area of Shanghai. However, general ophthalmologists tended to classify the indefinite subjects as POAG suspects, and their accuracy in diagnosing POAG was low. By paying more attention to the risk factors of POAG diagnosis, general ophthalmologists could improve the diagnosis accuracy.

Use of machine learning to predict the risk of early morning intraocular pressure peaks in glaucoma patients and suspects.

To use machine learning to predict the risk of intraocular pressure peaks at 6 a.m. in primary open-angle glaucoma patients and suspects. This cross-sectional observational study included 98 eyes of 98 patients who underwent a 24-hour intraocular pressure curve (including the intraocular pressure measurements at 6 a.m.). The diurnal intraocular pressure curve was defined as a series of three measurements at 8 a.m., 9 a.m., and 11 a.m. from the 24-hour intraocular pressure curve. Two new variables were introduced: slope and concavity. The slope of the curve was calculated as the difference between intraocular pressure measurements at 9 a.m. and 8 a.m. and reflected the intraocular pressure change in the first hour. The concavity of the curve was calculated as the difference between the slopes at 9 a.m. and 8 a.m. and indicated if the curve was bent upward or downward. A classification tree was used to determine a multivariate algorithm from the measurements of the diurnal intraocular pressure curve to predict the risk of elevated intraocular pressure at 6 a.m. Forty-nine (50%) eyes had intraocular pressure measurements at 6 a.m. >21 mmHg, and the median intraocular pressure peak in these eyes at 6 a.m. was 26 mmHg. The best predictors of intraocular pressure measurements >21 mmHg at 6 a.m. were the intraocular pressure measurements at 8 a.m. and concavity. The proposed model achieved a sensitivity of 100% and a specificity of 86%, resulting in an accuracy of 93%. The machine learning approach was able to predict the risk of intraocular pressure peaks at 6 a.m. with good accuracy. This new approach to the diurnal intraocular pressure curve may become a widely used tool in daily practice and the indication of a 24-hour intraocular pressure curve could be rationalized according to risk stratification.

Central corneal thickness and intraocular pressure in primary open angle glaucoma suspects in a south Indian population. Is it time for “corneal anthropology”?

To study correlation between central corneal thickness (CCT) and intraocular pressure (IOP) in the primary open angle glaucoma (POAG) suspects and to assess the importance of the local population reference CCT in pachymetry adjusted IOP.Prospective, cross sectional study.A total of 100 patients aged 40-70 years of age diagnosed as POAG suspects were included. CCT measurements using ultrasound pachymetry and IOP measurement with Goldmann applanation tonometer (GAT) was done. IOP was corrected to the local south-Indian baseline CCT and also to the International CCT and comparison was done.The study included 100 patients (58 male and 42 female) with mean age of 51.7 ± 6.1 years. The mean CCT was 518.91 ± 24.26 μm, 522.19 ± 21.56 μm among females, males respectively. The mean uncorrected IOP (GAT) was 19.50 mmHg, 20.14 mmHg (right, left sides). Significant, moderate positive correlation between CCT and IOP was observed. The two groups i.e mean IOP corrected for South-Indian CCT (Mean_CX_IOP) versus IOP corrected for CCT international (Mean_CX_INT_IOP) showed significant difference. The mean IOP in Indian CCT corrected group was 19.76 ± 2.81 mmHg and in international CCT group was 21.51 ± 2.83 mmHg. Levene's test indicated significant difference in mean IOP of 2 groups (p=0.000).CCT is an important parameter in glaucoma management and known to vary in different ethnic groups. Local ethnicity specific CCT should be used in IOP correction with the help of anthropologists.

Corneal Stiffness Parameters Are Predictive of Structural and Functional Progression in Glaucoma Suspect Eyes

To investigate corneal stiffness parameters (SPs) as predictors of future progression risk in glaucoma suspect eyes. Prospective, longitudinal study. Three hundred seventy-one eyes from 228 primary open-angle glaucoma suspects, based on optic disc appearance, with normal baseline Humphrey Visual Field (HVF; Carl Zeiss Meditec) results. Baseline corneal SPs were measured using Corvis ST (Oculus Optikgeräte GmbH). Participants were followed up every 6 months with clinical examination, HVF testing, and OCT. The baseline SP at first applanation (SP-A1) and highest concavity predicted the prospective outcome measures. Structural progression was measured by the OCT rate of thinning of the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL). Functional progression was assessed by permutation analysis of pointwise linear regression criteria on HVF testing. Stiffness parameters correlated positively with central corneal thickness (CCT), which was adjusted for in all analyses. A higher SP-A1, suggestive of a stiffer cornea, was associated with a faster rate of RNFL thinning (P < 0.001), synergistic with thinner CCT (P= 0.004) over a mean follow-up of 4.2 years. Eyes with higher SP-A1 and thinner CCT (thin and stiff corneas) showed accelerated RNFL thinning by 0.72 μm/year relative to eyes with lower SP-A1 and thicker CCT (95% confidence interval [CI], 0.17-1.28; P= 0.011) and were at 2.9-fold higher likelihood of fast RNFL progression of more than 1 μm/year (95% CI, 1.4-6.1; P= 0.006). Consistent results also were observed with GCIPL thinning. Furthermore, a higher SP-A1 was associated with a greater risk of visual field progression (P= 0.002), synergistic with thinner CCT (P= 0.010). Eyes with higher SP-A1 and thinner CCT were at 3.7-fold greater risk of visual field progression relative to eyes with thicker CCT and lower SP-A1 (95% CI, 1.3-10.5; P= 0.014). Glaucoma suspect eyes with higher corneal SPs and lower CCT, suggestive of thin and stiff corneas, are at greater risk of progression. Corneal SPs seem to act synergistically with CCT as risk factors for glaucoma progression.

Study of Retinal Nerve Fiber Layer Thickness by Optical Coherence Tomography in Primary Open Angle Glaucoma, Glaucoma Suspect and Normal Nepalese Population

The measurement of retinal nerve fiber layer thickness can help significantly in the early diagnosis of glaucoma and monitoring of its progression. The objective of this study was to compare the retinal nerve fiber layer (RNFL) thickness by optical coherence tomography in primary open angle glaucoma, glaucoma suspects and normal Nepalese population. This was a hospital based cross-sectional study conducted in the Ophthalmology Out Patient Department of Manipal Teaching Hospital, Pokhara. Total 100 numbers of subjects (40 primary open angle glaucoma, 30 glaucoma suspects and 30 normal people) were evaluated. Complete ophthalmological examinations including tonometry, gonioscopy, optical coherence tomography, perimetry were performed. Statistical analysis was carried out using Epi-info 7. The result showed that the average retinal nerve fiber layer (RNFL) thickness was 70.22±12.07μm in right eye and 69.42±11.53μm in left eye in primary open angle glaucoma (POAG), 88.87±10.39μm in right eye and 88.73±9.59μm in left eye in glaucoma suspects (GS) and 94.40±9.21μm in right eye and 94.73±6.76μm in left eye in normal group respectively. The mean RNFL thickness was statistically significant in all three comparison groups except in nasal quadrant. The mean RNFL thickness was statistically significant in two comparison groups except in GS-Normal (nasal and temporal quadrant), GS-POAG (left nasal quadrant) and Normal-POAG (left nasal quadrant). The study concluded that the RNFL thickness is lower in POAG as compared to glaucoma suspects and normal group in the Nepalese population.

Clinical Profile and Subtypes of Glaucoma in a District Hospital in North Goa

Background: Glaucoma, a leading cause of blindness in the world, has a global burden of 64.3 million. Studies in other States in India have described the clinical profile of glaucoma. However, no such study was conducted in Goa. Hence, our study was undertaken to identify and the clinical profile and subtypes of glaucoma in Goa. Methodology: A prospective hospital-based study was conducted over 6 months among patients attending Ophthalmology OPD at the North Goa District Hospital. The study participants underwent a detailed Ophthalmological evaluation by the senior Ophthalmic surgeon. The data so collected was entered in pre-tested semi-structured proformas. Statistical analysis was done using SPSS version 22. Result: Most glaucoma patients were females (62.5%) and elderly (60.71%). The most common glaucoma was primary angle closure glaucoma (58.93%), followed by primary open angle glaucoma and glaucoma suspects. Majority patients had associated risk factors such as diabetes, hypertension and family history of glaucoma. How to cite this article:Naik S, Cacodcar J, Naik S, Raiturcar TP. Clinical Profile and Subtypes of Glaucoma in a District Hospital in North Goa. Epidem Int 2020; 5(3): 15-18. DOI: https://doi.org/10.24321/2455.7048.202022

Association of Systemic Medication Exposure With Glaucoma Progression and Glaucoma Suspect Conversion in the Groningen Longitudinal Glaucoma Study.

To determine the association of statins, five classes of antihypertensive medications, and proton pump inhibitors with (1) primary open-angle glaucoma (POAG) progression and (2) conversion of POAG suspects to POAG. We retrospectively investigated the records of a cohort with POAG cases and suspects from the Groningen Longitudinal Glaucoma Study. To quantify visual field (VF) deterioration in cases, we used the rate of progression of the mean deviation (MD). Suspects were considered to have converted at the time point after which two consecutive VF tests for at least one eye were abnormal (glaucoma hemifield test outside normal limits). Progression and conversion were analyzed with quantile and logistic regression, respectively, with the systemic medications as predictors, controlling for age, sex, body mass index, pretreatment IOP, corneal thickness, and baseline MD. The multivariable models were built with and without IOP intervention. No systemic medications were associated with POAG progression in the final IOP/treatment-adjusted or unadjusted model. However, angiotensin II receptor blockers (ARBs) appeared to slow progression in older patients (b = 0.014, P = 0.0001). Angiotensin-converting enzyme inhibitors (ACEIs) were significantly associated with a decrease in POAG suspect conversion in both the IOP/treatment-adjusted and -unadjusted model (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.07-0.79, P = 0.012; OR=0.24, 95% CI 0.07-0.78, P = 0.021, respectively), as were ARBs (OR 0.12, 95% CI 0.01-0.98, P = 0.014; OR 0.11, 95% CI 0.01-0.87, P = 0.005, respectively). No overall association of VF progression with systemic medication was found; ARBs delayed progression in older patients. ACEIs and ARBs were associated with lower risk of suspect conversion. The pathophysiology of this relationship is to be disentangled.

Pattern electroretinogram changes in patients with primary open-angle glaucoma in correlation with visual field and optical coherence tomography changes.

To study the pattern electroretinogram changes in primary open-angle glaucoma patients in correlation with visual field changes and optical coherence tomography measurements of retinal nerve fiber layer thickness in the peripapillary region in an attempt to evaluate the clinical value of pattern electroretinogram as an objective test of functional deficit in glaucoma. The study included 81 eyes of 81 participants: 50 primary open-angle glaucoma patients, 16 primary open-angle glaucoma suspects, and 15 controls. All subjects underwent visual field testing using 24-2 Humphrey standard automated perimetry, peripapillary retinal nerve fiber layer average thickness using the 3.4-mm circular scan of the Heidelberg OCT spectralis and pattern electroretinogram using CSO RetiMax device in accordance with the International Society for Clinical Electrophysiology of Vision guidelines. We had three main groups: normal, glaucoma suspect, and primary open-angle glaucoma patients, and the last group included three subgroups: mild, moderate, and severe. There was significant difference in the visual field mean deviation, peripapillary retinal nerve fiber layer average thickness, and most pattern electroretinogram measured parameters between the three main groups and in between primary open-angle glaucoma subgroups. There was significant positive correlation between visual field mean deviation and the peripapillary retinal nerve fiber layer average thickness, P50 amplitude, and P50-N95 amplitude (p < 0.001, p = 0.018, and p < 0.001, respectively). Significant negative correlation was also found between peripapillary retinal nerve fiber layer average thickness and N95 amplitude (p < 0.001). Significant positive correlation was found between retinal nerve fiber layer average thickness and P50-N95 amplitude (p = 0.001). Significant negative correlation was found between peripapillary retinal nerve fiber layer average thickness and N95 amplitude (p = 0.001) and significant positive correlation of retinal nerve fiber layer average thickness with P50-N95 amplitude (p = 0.017) in primary open-angle glaucoma patients. Peripapillary retinal nerve fiber layer average thickness shows significant negative correlation with pattern electroretinogram N95 amplitude and a significant positive correlation with P50-N95 amplitude. In combination with optical coherence tomography, pattern electroretinogram can be used to objectively assess functional loss in glaucoma.

Compliance With Primary Open-angle Glaucoma and Primary Open-angle Glaucoma Suspect Preferred Practice Patterns in a Retail-based Eye Clinic.

To determine the level of adherence to the American Academy of Ophthalmology preferred practice pattern (PPP) guidelines for quality primary open-angle glaucoma (POAG) and POAG suspect (POAGS) care among retail-based optometrists. Patients with a diagnosis of POAG or POAGS who participated in a telemedicine pilot project were included. Patients' charts were evaluated for 15 elements of PPP guidelines for glaucoma care. Results were further stratified by number of follow-up visits and diagnosis. Of 360 identified patients, 10 elements were documented in over 98%. Documentation of the remaining 5 components was as follows: dilated fundus examination 91.1%, central corneal thickness (CCT) 88.6%, visual field 78.9%, gonioscopy 47.5%, and target intraocular pressure (IOP) 15.6%. in total, 32.8% of patients were seen once, whereas the remaining 67.2% had multiple visits. In patients with multiple visits, providers were more likely to document systemic history (100.0% vs. 97.5%; P=0.0346), review of systems (100.0% vs. 97.5%; P=0.0346), gonioscopy (60.0% vs. 22.0%; P<0.001), CCT (94.2% vs. 77.1%; P<0.001), visual field (97.5% vs. 40.7%; P<0.001), and target IOP (22.4% vs. 1.7%; P<0.001) compared with single visit patients. In stratifying results by diagnosis, POAG patients more often received visual field testing (92.7% vs. 68.9%; P<0.001) and had an established target IOP (35.1% vs. 1.4%; P<0.001) compared with POAGS patients. Compliance with PPP guidelines for glaucoma care was very high for most elements but lower for performing dilated fundus examination, CCT, visual field, gonioscopy, and target IOP. This study highlights deficiencies in care likely to hamper the detection of glaucoma progression.

Clinical Profile of Primary Open Angle Glaucoma Suspects

Clinical Profile of Primary Open Angle Glaucoma Suspects

A Comparison of Retinal Nerve Fibre Layer Thickness by Spectral Domain Optical Coherence Tomography in Primary Open Angle Glaucoma, Normotensive Glaucoma and Glaucoma Suspect

A Comparison of Retinal Nerve Fibre Layer Thickness by Spectral Domain Optical Coherence Tomography in Primary Open Angle Glaucoma, Normotensive Glaucoma and Glaucoma Suspect

Resident Compliance With the American Academy of Ophthalmology Preferred Practice Patterns for Primary Open-Angle Glaucoma Suspect.

To study resident compliance with the American Academy of Ophthalmology (AAO) Preferred Practice Patterns (PPPs) for primary open-angle glaucoma suspect (POAGS) in a resident ophthalmology clinic. Two hundred charts were selected for analysis of adult patients with the International Classification of Diseases diagnosis code for POAGS during their initial visit between November 2, 2010 and May 6, 2014 at the Kresge Eye Institute resident clinic. Electronic medical records of clinic visits for POAGS patients were evaluated for documentation and compliance with 17 elements of AAO PPPs. The overall mean compliance was 73.8% for all charts (n=200), 74.4% for first-year residents (n=53), 74.5% for second-year residents (n=38), and 73.3% for third-year residents (n=109). Documentation rates were high (>90%) for 9 elements, which included most elements of physical examination and history. Documentation of ocular history, central corneal thickness, gonioscopy, optic nerve head and retinal nerve fiber layer analysis, and visual field ranged from 40% to 80%. Documentation was lowest for patient education elements which ranged from 0% to 10%. Compliance was not significantly different (P>0.05) between residents or between different resident years for any element. Residents' compliance was high for most elements of the PPPs for POAGS. We identified elements with poor compliance especially regarding patient education. Adherence to AAO PPPs can be a helpful method of assessing resident performance.

Contrast Sensitivity Change– A Tool of Monitoring Glaucoma Progression

Introduction: Glaucoma is a potentially blinding disease,causing gradual loss of sight. It is often associated with increased intraocular pressure that can damage the optic nerve, which transmits images to the brain. Glaucoma can lead to permanent vision loss, if the damage continues. Without treatment, glaucoma can cause total permanent blindness within a few years. Glaucoma is one of the major causes of ocular morbidity and primary open–angle glaucoma is a major health problem. The prevalence of primary open- angle glaucoma (POAG) is estimated as being from 1.1-3% of western populations, over the age of 40 years, in both past and more recent population surveys.&#x0D; Objective: To evaluate and compare the value of Contrast sensitivity (CS) and automated perimetry among primary open-angle glaucoma (POAG) patients, glaucoma suspects and normal control.&#x0D; Materials and Methods: It was a prospective observational hospital based study conducted in National Institute of Ophthalmology &amp; Hospital (NIO&amp;H), Dhaka during the period from January 2006 to December 2006. A total of 30 POAG patients, 30 glaucoma suspects and 30 normal control subjects were recruited for the study. After complete baseline evaluation, all the study subjects underwent visual field assessment by Octopus automated field analyzer and CS evaluation by Low Contrast Flip Chart. Outcome measures were baseline CS of POAG patients, glaucoma suspects and normal controls, mean CS of POAG patients at 3 months after treatment, baseline MS of POAG patients, glaucoma suspects and normal controls in Octopus perimetry and retinal mean sensitivity (MS) of POAG patients 3 months after treatment.&#x0D; Results: Among the POAG patients MS was 22.23 dB, among glaucoma suspects MS was 27.50 dB and among normal controls mean MS was 30.0 dB; among the POAG patients mean CS was 2.99% whereas it was 2.20% and 1.41% respectively among glaucoma suspects and normal controls. Baseline CS had negative correlation with MS among POAG patients (correlation co-efficient, r = -0.908). It indicates that better CS is associated with higher MS. Out of 30 cases of POAG, 20 (66.67%) received medical and 10 (33.33%) received surgical treatment. Mean CS improves to 2.66% from baseline 2.99% after treatment and MS improves to 23.16 dB from base 22.23 dB after treatment. Correlation after three months of treatment was significantly negative (r = -0.86).&#x0D; Conclusion: As increased loss of MS of perimetry has been found to be associated with increased loss of CS, assessment of CS may become an easy, convenient tool for glaucoma diagnosis.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.12(2) 2016: 90-92

Angle Closure Scoring System (ACSS)-A Scoring System for Stratification of Angle Closure Disease.

PurposeTo evaluate the angle closure scoring system (ACSS) for stratifying primary angle course disease.MethodsThis observational cross sectional institutional study included patients with primary open angle glaucoma suspects (n = 21) and primary angle closure disease (primary angle closure, PAC, n = 63 and primary angle course glaucoma, PACG, n = 58 (defined by International society of Geographical and Epidemiological Ophthalmology, ISGEO). Two independent examiners blinded to clinical details, graded good quality pre-laser goniophotographs of the patients incorporating quadrants of peripheral anterior synechieae (PAS), non-visibility of posterior trabecular meshwork (PTM) and blotchy pigments (ranging from 1–4 quadrants), iris configuration, angle recess (sum of above depicting ACSSg) and lens thickness/axial length ratio (LT/AL), cup disc ratio and baseline intraocular pressure (IOP) to give total score (ACSSt).ResultThere were significant differences in ACSSg scores within the same ISGEO stage of PAC and PACG between eyes that required nil or >1medicines after laser iridotomy, p<0.001. The ACSSg was associated with need for >1 medicines in both PAC and PACG eyes, p<0.001. An ACSSg score>12 and 14 in PAC (odds ratio = 2.7(95% CI-1.7–5.9) and PACG (Odds ratio = 1.6(95%CI-1.19–2.2) predicted need for single medicines while ACSSg scores >14 and 19 predicted need for ≥2 medicines in PAC and PACG eyes, respectively. The LT/Al ratio, IOP score or cup disc score did not influence the need for medical treatment independently.ConclusionThe ACSS can be a useful clinical adjunct to the ISGEO system to predict need for medicines and prognosticate each stage more accurately.

Ocular blood flow in glaucoma - the Leuven Eye Study.

Elevated intra-ocular pressure (IOP) has been identified as a major risk factor for glaucoma. Additionally, extensive literature depicts a vascular dysfunction to exist in these patients. However, a large ocular blood flow-oriented trial to integrate these findings in the clinical setting is lacking. This study would likely help to identify which of these vascular data can be used as a clinical tool for screening and disease stratification. Prospective, cross-sectional, case-control hospital-based study. Patients with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), ocular hypertension (OHT), glaucoma suspects and healthy volunteers were recruited. In addition to a comprehensive ophthalmological examination, a vascular-oriented questionnaire was completed and ocular blood flow assessment (colour Doppler imaging of retrobulbar vessels, retinal oximetry, dynamic contour tonometry, optical coherent tomography enhanced-depth imaging of the choroid) were performed. Statistical analysis was based on multiple imputation to account for missingness. A total of 614 subjects (291 males) were recruited between March and December 2013 (POAG: 214, NTG: 192; OHT: 27; glaucoma suspect: 41; healthy controls: 140). Glaucoma groups (NTG and POAG) were age and gender matched with the control group (p>0.05). Glaucoma groups were paired in terms of functional and structural parameters (p>0.08). Mean ocular perfusion pressure was higher in the glaucoma groups than in controls (p<0.001). Glaucoma groups had lower retrobulbar velocities, higher retinal venous saturation and choroidal thickness asymmetries when compared to the healthy group, in line with the current literature. The Leuven Eye Study stands as one of the largest clinical trials on ocular blood flow in glaucoma. The creation of this vast database may help integrate the vascular aspects of glaucoma into the clinical practice of glaucoma.

Suitability of the Visual Field Index according to Glaucoma Severity.

ABSTRACTPurpose: To investigate the suitability of the visual field index (VFI) in different degrees of disease severity in glaucoma patients.Methods: In this cross-sectional study, we consecutively enrolled patients with primary open-angle glaucoma and glaucoma suspects (ocular hypertension). All eyes required a reliable standard automated perimetry (SAP) test to be included. Subjects were categorized into five groups based on glaucoma severity using SAP’s mean deviation (MD). To evaluate the correlation among VFI, MD and pattern standard deviation (PSD), a linear regression model was built. To evaluate the nature of the correlation (i.e. linear vs nonlinear), results were plotted in a scatterplot graph.Results: One hundred and twenty-two eyes of 81 patients (mean age, 59.8 ± 14.5 years) were included. A strong, positive association was found between MD and VFI values (R2 = 0.98, p < 0.001), showing a 3.2% reduction in the VFI for each dB loss in the MD index. It was noticed that 15% of eyes with mild glaucoma (average MD of -3.1 dB) had VFI > 99%. Considering only the eyes with mild and moderate damage in the regression, we found a weaker (nonlinear) correlation than the one we found using all eyes (R2 = 0.85, p < 0.001). There was also a significant, nonlinear correlation between VFI and PSD (R2 = 0.85, p < 0.001). Although higher PSD values were found with increasing visual field damage, this initial trend was reversed when VFI became smaller than 50%, approximately.Conclusion: Visual field index had a strong correlation with MD; however, this correlation was weaker in mild disease, as some patients with early disease had very high VFI values (ceiling effect). Therefore, initial deterioration in visual field status (as assessed by MD values) in patients with early disease may not be detectable using the VFI alone.How to cite this article: Sousa MCC, Biteli LG, Dorairaj S, Maslin JS, Leite M, Prata TS. Suitability of the Visual Field Index according to Glaucoma Severity. J Curr Glaucoma Pract 2015;9(3):65-68.