Progression Of Visual Field Defects Research Articles

Glaucoma progression due to refraining examination amid the pandemic of COVID-19.

Some patients refrained from seeking an ophthalmologist due to the anxiety and morbidity associated with the coronavirus disease (COVID-19) pandemic. We investigated progressive visual field defects in patients with glaucoma who refrained from ophthalmological examinations. This was a retrospective study. We analyzed data from 886 patients with glaucoma who visited Inouye Eye Hospital in June 2022 and were followed-up prior to January 2020. We examined the number of times patients canceled visits between January 2020 and May 2022 due to coronavirus concerns. We assessed the mean deviation (MD) values of the Humphrey Visual Field Assessment (HFA) program 30-2 SITA Standard values after visit interruptions for worsening beyond the MD values predicted by the MD slope. Factors influencing this difference were analyzed using logistic regression analysis. The study included 374 men and 512 women. The mean age was 68.7 ± 12.0years. Visit interruptions occurred in 146 patients (16.5%), with 95 (65.1%) rescheduling once, 27 (18.5%) twice, and 24 (16.4%) three or more times. Among 90 patients who underwent HFA regularly, 50 (55.6%) experienced worse-than-expected MD values and 12 (13.3%) deteriorated by 2dB or more. Longer interruptions and high intraocular pressure before interruption worsened the MD values by 2dB or more. Patients with glaucoma with visit interruptions due to the pandemic should be monitored for the progression of visual field impairment.

Sector-specific Association of Intraocular Pressure Dynamics in Dark-room Prone Testing and Visual Field Defect Progression in Glaucoma

PurposeTo investigate sectoral differences in the relationship between intraocular pressure (IOP) dynamics during dark-room prone testing (DRPT) and visual field (VF) defect progression in primary open-angle glaucoma (POAG) patients. DesignRetrospective, longitudinal study ParticipantsThis retrospective study included 116 eyes of 84 POAG patients who underwent DRPT and had at least five reliable VF tests conducted over a more than two-year follow-up period. We excluded eyes with mean deviation worse than -20 dB or a history of intraocular surgery or laser treatment. MethodsAverage total deviation (TD) was calculated in the superior, central, and inferior sectors of the Humphrey 24-2 or 30-2 program. During DRPT, IOP was measured in the sitting position, and after 60 minutes in the prone position in a dark room, IOP was measured again. The relationship between IOP change during DRPT, IOP after DRPT, and TD slope in each quadrant was analyzed with a linear mixed-effects model, adjusting for other potential confounding factors. Main Outcome MeasuresTD slope in each quadrant, IOP change during DRPT, and IOP after DRPT ResultsIOP after DRPT and IOP change during DRPT were 18.16±3.42 mmHg and 4.92±3.12 mmHg, respectively. Superior TD slope was significantly associated with both IOP after DRPT (β=-0.28, p=0.003) and IOP change during DRPT (β=-0.21, p=0.029), while central (β=-0.05, p=0.595; β=-0.05; p=0.622) and inferior (β=0.05, p=0.611; β=0.01, p=0.938) TD slopes were not. ConclusionDRPT might be a useful test to predict the risk of superior VF defect progression in eyes with POAG.

폐암의 전이로 인해 발생한 뇌하수체졸중

A collision tumor refers to a rare phenomenon where two distinct neoplasms coexist occupying the same anatomical location. While metastatic brain tumors and pituitary adenoma are two of the most common intracranial tumors, the collision of the two tumors are extremely rare. We report a 76-year-old female patient with progressive visual field defect. She had a history of a stable pituitary adenoma and was recently diagnosed with lung adenocarcinoma with no known distant metastasis but with malignant pleural effusion. Her brain magnetic resonance imaging suggested a possible pituitary apoplexy with profound optic nerve compression. The patient underwent transsphenoidal surgery for tumor removal and the presence of metastatic cancer was confirmed by histopathological examination.

Autosomal Dominant Optic Atrophy Plus Syndrome

Background: Dominant optic atrophy (DOA) is the most commonly encountered hereditary optic neuropathy in clinical practice and is the result of a mutation in the OPA1 or OPA3 genes encoding mitochondrial membrane proteins. The resultant mitochondrial dysfunction causes a distinct set of ophthalmic findings and may progress to extra-ocular systems known as OPA plus syndrome. We present a case of late-onset OPA plus syndrome encompassing both typical ophthalmic findings and the rarer extra-ocular findings. Case Report: A 41 year-old Caucasian male presents for a second opinion regarding a previously diagnosed traumatic optic neuropathy. Examination revealed decreased best-corrected acuities, optic nerve pallor, optical coherence tomography thinning of the retinal nerve fiber layers, progressive centrocecal visual field defects and tritanomalous color vision defects. All findings proved to be bilateral and symmetric. As the ophthalmic findings were inconsistent with a traumatic optic neuropathy, genetic testing was pursued resulting in a DOA diagnosis. Specialty consults demonstrated high-frequency hearing loss and mitochondrial myopathy consistent with OPA plus syndrome. Conclusion: While not a common diagnosis, hereditary optic neuropathies are most likely to present initially to primary eye care. The practitioner should be familiar with the ophthalmic findings and the need for specialty consult should a DOA diagnosis be confirmed.

Leber's Hereditary Optic Neuropathy (LHON): Clinical Experience and Outcomes after Long-Term Idebenone Treatment.

Leber's hereditary optic neuropathy (LHON) is a rare disease. Large studies are difficult to conduct; therefore, case reports provide valuable data. Since 2015, patients have been treated with Idebenone. The aim of this paper is to share our experience with diagnosing and managing patients in different stages of LHON. We designed a case series study, including four patients undergoing genetic testing and ophthalmologic examination. Criteria for Idebenone administration and follow-up were presented. All patients had mutation 11778G>A in MT-ND4. The first patient, an 82-year-old man, with long history of vision loss, had no indication for Idebenone. Two additional cases emerged within the same family: a 40-year-old brother and a 31-year-old sister. Both received Idebenone, with good outcomes only for the female. After a one-year regimen, they were lost to follow-up. The fourth patient, a 46-year-old man, was diagnosed in the subacute stage. Idebenone administration was deferred, allowing progression of visual field defects. After 17 months of treatment, visual improvement appeared. The treatment was continued for 36 months, with short interruptions, resulting in good outcomes. Our study demonstrated positive results with long-term Idebenone use. Contrary to medical literature, our female patient had a favorable evolution, despite the delayed diagnosis.

The Relationship Between Artificial Intelligence–Assisted OCT Angiography–Derived Foveal Avascular Zone Parameters and Visual-Field Defect Progression in Eyes with Open-Angle Glaucoma

To investigate clinical factors associated with foveal avascular zone (FAZ) parameters obtained using OCT angiography (OCTA) with assistance from a previously developed artificial intelligence (AI) platform in eyes with open-angle glaucoma (OAG). Retrospective longitudinal. This study followed up 885 eyes of 558 patients with OAG for ≥ 2 years; all eyes underwent≥ 5 Humphrey visual-field (VF) tests and had 3.0×3.0 mm macular OCTA scans available. Average total deviation (TD) in the superior, superocentral, inferocentral, and inferior sectors of the Humphrey 24-2 program was calculated. We collected 3.0×3.0 mm macular OCTA images from each patient and used a previously developed AI platform with these images to obtain FAZ parameters, including FAZ area, FAZ circularity index (CI), and FAZ perimeter. Multivariable linear mixed-effects models were used to analyze the relationship between FAZ parameters, TD or TD slope in each quadrant, and systemic factors, adjusting for potential confounding factors, including axial length. Ophthalmic and systemic variables, FAZ parameters, and TD or TD slope in each quadrant. The multivariable model showed that FAZ parameters were correlated with both TD and TD slope in the inferocentral quadrant (β=-0.244 - 0.168, P < 0.001). Both upper-half and lower-half FAZ parameters were better associated with TD-inferocentral and TD-inferocentral slope than TD-superocentral or TD-superocentral slope in terms of β size and statistical significance, indicating that there was no evident vertical anatomical correspondence between TD in the central quadrant and FAZ parameters. Foveal avascular zone area enlargement was associated with female gender (β=0.242, P= 0.003). Loss of FAZ circularity was associated with both aging and comorbid sleep apnea syndrome (SAS) (yes: 1, no: 0) (β=-0.188, P < 0.001; β=-0.261, P= 0.031, respectively). Foveal avascular zone perimeter elongation was associated with aging and female gender (β=0.084, P= 0.040; β=0.168, P= 0.042, respectively). Artificial intelligence-assisted OCTA-measured FAZ enlargement and irregular shape might be good markers ofocular hypoperfusion and associated inferocentral VF defect progression in eyes with OAG. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Effect of yoga on intra-ocular pressure in patients with glaucoma: A systematic review and meta-analysis.

Glaucoma is the second leading cause of blindness in the world, with an estimated 57.5 million people suffering from glaucoma globally. Treatment of glaucoma focuses on lowering intra-ocular pressure to prevent progression of visual field defects, which is the only proven method for treating this disease. Yoga practices are believed to lower intra-ocular pressure in the eyes and prevent further damage in patients with glaucoma. Therefore, this systematic review was planned to explore the available scientific studies on yoga and intra-ocular pressure in glaucoma patients. PubMed, Cochrane Library, and Google Scholar were the basis for the investigation of the literature. The Jadad Scale was used to assess the quality of included clinical trials, and the JBI Critical Appraisal Checklist was used to assess the quality of included case studies. Based on the quality assessment and eligibility, six studies on yoga and intra-ocular pressure in glaucoma patients carried out between 2007 and 2021 were included in the final review. The results showed a reduction in intra-ocular pressure in patients with glaucoma through Jyoti-trataka (gazing steadily on a point or candle flame) and some other slow yogic breathing techniques, whereas studies on inversion Asanas (yoga postures) showed a rapid increase in intra-ocular pressure soon after starting. The three high-quality RCTs included in the meta-analysis showed a greater improvement in intra-ocular pressure in the yoga groups in both eyes than in the control groups; however, there were some limitations related to a small sample size, study quality, a long-term follow-up period, and variations in the yoga practices. Therefore, further studies with larger sample sizes and long-term follow-up are needed to overcome the limitations for a better understanding.

Pathologically high intraocular pressure induces mitochondrial dysfunction through Drp1 and leads to retinal ganglion cell PANoptosis in glaucoma

Glaucoma is a common neurodegenerative disease characterized by progressive retinal ganglion cell (RGC) loss and visual field defects. Pathologically high intraocular pressure (ph-IOP) is an important risk factor for glaucoma, and it triggers molecularly distinct cascades that control RGC death and axonal degeneration. Dynamin-related protein 1 (Drp1)-mediated abnormalities in mitochondrial dynamics are involved in glaucoma pathogenesis; however, little is known about the precise pathways that regulate RGC injury and death. Here, we aimed to investigate the role of the ERK1/2-Drp1-reactive oxygen species (ROS) axis in RGC death and the relationship between Drp1-mediated mitochondrial dynamics and PANoptosis in ph-IOP injury. Our results suggest that inhibiting the ERK1/2-Drp1-ROS pathway is a potential therapeutic strategy for treating ph-IOP-induced injuries. Furthermore, inhibiting Drp1 can regulate RGC PANoptosis by modulating caspase3-dependent, nucleotide-binding oligomerization domain-like receptor-containing pyrin domain 3(NLRP3)-dependent, and receptor-interacting protein (RIP)-dependent pathways in the ph-IOP model. Overall, our findings provide new insights into possible protective interventions that could regulate mitochondrial dynamics to improve RGC survival.

Development and validation of a routine blood parameters-based model for screening the occurrence of retinal detachment in high myopia in the context of PPPM.

Timely detection and treatment of retinal detachment (RD) could effectively save vision and reduce the risk of progressing visual field defects. High myopia (HM) is known to be associated with an increased risk of RD. Evidently, it should be clearly discriminated the individuals with high or low risk of RD in patients with HM. By using multi-parametric analysis, risk assessment, and other techniques, it is crucial to create cutting-edge screening programs that may be utilized to improve population eye health and develop person-specific, cost-effective preventative, and targeted therapeutic measures. Therefore, we propose a novel, routine blood parameters-based prediction model as a screening program to help distinguish who should offer detailed ophthalmic examinations for RD diagnosis, prevent visual field defect progression, and provide personalized, serial monitoring in the context of predictive, preventive, and personalized medicine (PPPM/3 PM). This population-based study included 20,870 subjects (HM = 19,284, HMRD = 1586) who underwent detailed routine blood tests and ophthalmic evaluations. HMRD cases and HM controls were matched using a nested case-control design. Then, the HMRD cases and HM controls were randomly assigned to the discovery cohort, validation cohort 1, and validation cohort 2 maintaining a 6:2:2 ratio, and other subjects were assigned to the HM validation cohort. Receiver operating characteristic curve analysis was performed to select feature indexes. Feature indexes were integrated into seven algorithm models, and an optimal model was selected based on the highest area under the curve (AUC) and accuracy. Six feature indexes were selected: lymphocyte, basophil, mean platelet volume, platelet distribution width, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. Among the algorithm models, the algorithm of conditional probability (ACP) showed the best performance achieving an AUC of 0.79, a diagnostic accuracy of 0.72, a sensitivity of 0.71, and a specificity of 0.74 in the discovery cohort. A good performance of the ACP model was also observed in the validation cohort 1 (AUC = 0.81, accuracy = 0.72, sensitivity = 0.71, specificity = 0.73) and validation cohort 2 (AUC = 0.77, accuracy = 0.71, sensitivity = 0.70, specificity = 0.72). In addition, ACP model calibration was found to be good across three cohorts. In the HM validation cohort, the ACP model achieved a diagnostic accuracy of 0.81 for negative classification. We have developed a routine blood parameters-based model with an ACP algorithm that could potentially be applied in the clinic with a PPPM approach for serial monitoring and predicting the occurrence of RD in HM and can facilitate the prevention of HM progression to RD. According to the current study, routine blood measures are essential in patient risk classification, predictive diagnosis, and targeted therapy. Therefore, for high-risk RD persons, novel screening programs and prompt treatment plans are essential to enhance individual outcomes and healthcare offered to the community with HM. The online version contains supplementary material available at 10.1007/s13167-023-00319-3.

Rates of Visual Field Change in Eyes With Optic Disc Drusen.

Optic disc drusen (ODD) are calcified deposits in the prelaminar portion of the optic nerve head. Although often asymptomatic, these deposits can cause progressive visual field defects and vision loss. The purpose of this study was to evaluate rates of functional loss in eyes with ODD and to investigate risk factors associated with rates of visual field progression. This was a retrospective cohort study including 65 eyes of 43 patients with ODD from the Duke Ophthalmic Registry. All eyes had at least 12 months of follow-up and at least 3 reliable standard automated perimetry (SAP) tests. Linear mixed models were used to estimate rates of SAP mean deviation (MD) loss over time. Univariable and multivariable models were used to assess the effect of clinical variables and intraocular pressure (IOP) on rates of change. Subjects were followed for an average of 7.6 ± 5.3 years. The mean rate of SAP MD change was -0.23 ± 0.26 dB/year, ranging from -1.19 to 0.13 dB/year. Fifty-seven eyes (87.7%) had slow progression (slower than -0.5 dB/year), 6 eyes (9.2%) had moderate progression (between -0.5 dB/year and -1 dB/year), and 2 eyes (3.1%) had fast progression (faster than -1 dB/year). In multivariable models, older age and worse SAP MD at baseline were significantly associated with faster rates of change. Mean IOP was not associated with faster rates of MD change in both univariable and multivariable analyses. Most eyes with ODD had slow rates of visual field loss over time. Age and baseline severity were significantly associated with faster rates of visual field loss.

Personal Computer-Based Visual Field Testing as an Alternative to Standard Automated Perimetry.

Introduction Standard automated perimetry (SAP) is the gold standard of visual field assessment in patients with neuro-ophthalmic conditions. Glaucoma is a progressive optic neuropathycharacterized by damage to the ganglion cell complexwith corresponding visual field defects and intraocular pressure (IOP) being the only modifiable ocular risk factor. Recent advances in technology have paved the way for remote screening and monitoring of visual field defects with the aid of a computer or tablet-based software. One such personal computer (PC)-based software is 'Specvis', which has shown promising reliability as compared to SAP. The primary objective of this study was to compare Specvisand Humphrey Field Analyzer (HFA) visual field reports in the graphical domain while secondary objectives were to estimate the ease of use of Specvis in comparison to HFA and comparison of test duration between Specvis and HFA. Materials and methods This was a cross-sectional validation study performed at a tertiary care ophthalmology institute in Rawalpindi, Pakistan. Subjects presenting to the outpatient department were recruited based on consecutive sampling technique and were divided into healthy and diseased groups.Basic data collection instrument afterinformed consent was filled with demographic data, ophthalmic data, disease condition, and attached with analysis reports of both HFA and Specvis for assessment by three senior ophthalmology consultants independently. A total of 218 eyes of 109 subjects were included in this pilot study.SAP was done on the VF 30-2 program using HFA 3. The same patient then performed the visual field assessment on a PC with Specvis installed andsettings adjusted to match the VF 30-2 program of HFA as closely as possible. Visual fields of a subject obtained from HFA and Specvis were then coupled and sent to three different senior ophthalmologists. The assessment was done by comparing the greyscale visual field printouts in the graphical domain and scored based on a 5-point Likert scalewhich were then analyzed for inter-observer reliability. After each test, all subjects were asked to rate the difficulty level of performing the test on HFA and Specvis based on a 5-point Likert scale. The duration of the test performed on HFA and Specvis was also noted for comparison. Results We observed male preponderance in our study participants (n=128, 58.72%). The majority of the participants were non-diseased (n=170, 77.98%) while advanced glaucoma was the commonest disease in the diseased group (n= 22, 10.09%). The mean age of the participants was 40.71 (SD=15.24). The observations for the HFA test duration had an average of 213.33 seconds (SD=33.49, Min=174.00, Max=314.00) while the Specvis test duration had an average of 267.36 seconds (SD=35.98, Min=228.00, Max=370.00). A significant positive correlation was observed between score 1, score 2, and score 3 given by the three ophthalmologists. A significant negative correlation was observed between ease of using HFA and age, with a correlation of -.28. A significant negative correlation was also observed between ease of using Specvis and age. Conclusion Specvis, a computer-based free open-source software used in our study, can give promising results in diagnosing as well as monitoring the progression of visual field defects. It can act as a significantly cost-effectiveand readily available bridge between visual field examination by confrontation method and SAP.

Case report of a large, right, temporal arteriovenous malformation in the brain manifested by a progressive visual field defect

AbstractPurpose: Emphasizing the importance of regular vision screening with visual fields and rapid MRI investigations where a field defect is unexplained. A 44 yo patient with a history of headache and incipient development of hemianopia gradually noticed bumping into things on the left‐hand side. In the last 6 months she also described 2 clear episodes of 5 min absence seizures, when she was staring into space. She has a history of iron deficiency being treated. Visual acuity was 6/6 corrected, right eye and 6/6‐2, corrected left eye. Normal pupillary reflexes. Visual fields showed gross left homonymous hemianopia. Optic discs showed no palor or cupping.Methods: Brain MRI showed a complex right temporal arteriovenous malformation (AVM) predominately supplied from the middle cerebral artery. There is a variceal dilation. There was some gliosis in the right temporal lobe suggesting previous bleed.Results: Urgent neurosurgeon assessment and catheter angiogram found a complex AVM which will likely be treated with gamma knife or embolization given patient age and previous evidence of bleed.Conclusions: This interesting case illustrates the importance of urgent imaging when faced with an abnormal visual field defect with no other underlying pathology.

Progression of functional and structural glaucomatous damage in relation to diurnal and nocturnal dips in mean arterial pressure.

Systemic hypoperfusion plays a pivotal role in the pathogenesis of primary open-angle glaucoma (POAG). Extreme dips in mean arterial pressure (MAP) due to high 24-h variability are associated with POAG, however, whether this is driven by diurnal or nocturnal dips remains undocumented. We aimed this study to investigate the association of POAG damage with variability and dips in the diurnal and nocturnal MAP. We conducted a retrospective longitudinal study that included 110 POAG patients who underwent 24-h ambulatory blood pressure monitoring. Our outcomes included (i) functional [visual field defects expressed as mean deviation (MD)] and (ii) structural (optic disc cupping obtained from cup-to-disc ratio) glaucoma damage. MAP variability independent of the mean (VIMmap) was computed for diurnal and nocturnal MAP. Dips were the five diurnal and three nocturnal lowest drops in MAP. We also calculated the night-to-day ratio. We applied mixed models to evaluate the progression of visual field defects and optic disc cupping in relation to diurnal and nocturnal MAP measures. The mean age was 64.0 y (53% women). The median follow-up was 9 years. In adjusted mixed models, functional progression of glaucoma damage was associated with VIMmap (-2.57 dB change in MD per every 3 mmHg increase in VIMmap; P < 0.001) and diurnal MAP dips (changes in the MD ranged from -2.56 to -3.19 dB; P < 0.001). Every 5 mmHg decrease in the nocturnal MAP level was associated with -1.14 dB changes in MD [95% confidence interval (CI), -1.90 to -0.40] and 0.01 larger optic disc cupping (95% CI, 0.01-0.02). Lower night-to-day ratio was also related to both outcomes (P ≤ 0.012). Functional glaucoma damage worsened if nocturnal hypotension was combined with high variability or extreme dips in the diurnal MAP (P ≤ 0.022). Progression of glaucoma damage in POAG associates with high variability and extreme dips in the diurnal MAP. Structural glaucoma damage seems more vulnerable to nocturnal hypotension. Ambulatory blood pressure monitoring allows the assessment of sporadic diurnal and persistent nocturnal hypotension episodes. These phenotypes might offer an opportunity to improve the risk-stratification of open-angle glaucoma (OAG).

Intraocular pressure screening during high-volume cataract surgery outreach in Ethiopia

IntroductionGlaucoma is the leading cause of irreversible blindness worldwide and is often undetected in resource-limited settings. Early screening and treatment of elevated intraocular pressure (IOP) reduces both the development and progression of visual field defects. IOP screening in developing countries is limited by access to ophthalmic equipment, trained ophthalmic staff, and follow up. High-volume cataract surgery outreaches in resource-limited countries provide ample opportunity for glaucoma screening, intervention and follow up.MethodsThis prospective cross-sectional study took place during a cataract outreach campaign sponsored by the Himalayan Cataract Project (HCP) in partnership with Felege Hiwot Hospital in Bahir Dar, Ethiopia, during April 5th – April 10th 2021. IOP was measured on the surgical eye of patients before undergoing small incision cataract surgery (SICS) using rebound tonometry with an iCare tonometer model IC100.ResultsIntraocular pressure (IOP) was measured in 604 eyes of 595 patients who received SICS. Mean IOP was 12.1 mmHg (SD = 5.0 mmHg). A total of 29 patients had an IOP greater than 21 mmHg representing 4.8% of total IOP measurements. A total of 17 patients received oral acetazolamide prior to surgery to acutely lower IOP. Six of these patients had their surgery delayed due to elevated IOP and 9 patients received excisional goniotomy at the time of SICS. A temporal approach during SCIS was taken for all patients with elevated IOP to allow for possible trabeculectomy at a future date.DiscussionIOP screening during high-volume cataract outreach campaigns can be performed safely, accurately and on a large scale with minimal resources and supplemental training. Pre-operative IOP measurement can improve surgical care at the time of cataract surgery as well as help establish long-term follow up for patients with glaucoma.

The safety and validity of contact lens sensor (Triggerfish) in measuring diurnal variation of intraocular pressure (IOP)

With the current understanding of pathophysiology of glaucoma, the reduction of intraocular pressure (IOP) is the main evidence-based treatment which can prevent the progression of visual field defect (1). Several studies have shown that IOP varies throughout the day and night and patients with different glaucoma subtypes can have different circadian IOP patterns (2-4). In clinical practice, most ophthalmologists rely on the single measurement of IOP in clinic at each patient visit to monitor the control of IOP and thereby monitor the control of glaucoma. The peak IOP during after-hours is frequently underestimated by this form of measurement because it can only provide a single temporal value. Therefore, it is clear that in order to better manage glaucomatous patients, it is necessary to keep track of how their IOP changes over time.

New strategies for neuro protection in glaucoma.

Glaucoma is a progressive, irreversible loss of retinal ganglion cells (RGCs) and axons that results in characteristic optic atrophy and corresponding progressive visual field defect. The exact mechanisms underlying glaucomatous neuron loss are not clear. The main risk factor for glaucoma onset and development is high intraocular pressure (IOP), however traditional IOP-lowering therapies are often not sufficient to prevent degeneration of RGCs and the vision loss may progress, indicating the need for complementary neuroprotective therapy. This review summarizes the progress for neuro protection in glaucoma in recent 5 years, including modulation of neuroinflammation, gene and cell therapy, dietary supplementation, and sustained-release system.

The relationship between choroidal blood flow and glaucoma progression in a Japanese study population.

To determine whether choroidal blood flow (BF) is related to visual field (VF) defect severity and progression in eyes with open-angle glaucoma (OAG). Retrospective and longitudinal. This study comprised 443 eyes of 285 OAG patients who underwent laser speckle flowgraphy (LSFG), optical coherence tomography, and visual-field (VF) testing at baseline. The patients were then observed for at least 2 years and at least 5 reliable VF tests were performed. In the LSFG images, we set regions of interest at the optic nerve head (ONH) and the parapapillary choroid to obtain ONH-tissue mean blur rate (MBR) and choroidal MBR, respectively. We used univariable and multivariable linear mixed-effects models to determine clinical factors associated with choroidal MBR at baseline. We also used a linear mixed-effects model to determine the contribution of ONH-tissue MBR and choroidal MBR to baseline mean deviation (MD) and to MD slope during follow-up, adjusting for potential confounding factors, including circumpapillary retinal nerve fiber layer thickness. Choroidal MBR was associated with age, MD slope, and ONH-tissue MBR (β = -0.181, P = 0.001; β = 0.134, P = 0.002; β = 0.096, P = 0.049, respectively). ONH-tissue MBR was associated with both MD and MD slope (β = 0.146, P = 0.004; β = 0.152, P = 0.009, respectively), whereas choroidal MBR was associated only with MD slope (β = 0.147, P = 0.005). LSFG-derived choroidal MBR might be a useful biomarker to predict VF defect progression in a Japanese population.

Resolution of Visual Field Defect in Macroprolactinoma After Treatment With Cabergoline

We report the case of a 49-year-old woman presenting with amenorrhea and progressive visual field defect for one month. Endocrinological workup revealed a high concentration of serum prolactin, and magnetic resonance imaging (MRI) showed pituitary macroadenoma with extrasellar extension as well as compression of optic nerves. Treatment with a dopamine agonist, cabergoline, for eight weeks led to the resolution of the visual field defect accompanied by a rapid decrease in the serum prolactin level. Follow-up MRI three months after the initial diagnosis revealed alleviation of visible mechanical compression of the optic chiasm by the tumor. We considered that the absence of retinal nerve damage and prompt initiation of cabergoline contributed to the rapid recovery of the visual acuity.

Neurovascular Compression in the Anterior Visual Pathway: A Case Series.

A retrospective review of 29 patients with neurovascular compression syndrome (NVCS) involving the anterior visual pathway was conducted. Various patterns of NVCS and visual defects were identified, most commonly involving the optic nerve and internal carotid artery. Most patients were stable, except one with progressive visual field defects. Although mostly asymptomatic, NVCS can rarely cause compressive optic neuropathy. NVCS should be kept in the differential diagnosis of normal tension glaucoma, especially with progressive visual loss despite treatment. Patients with progressive visual loss may require decompression surgery. Non-contrast computed tomography scan may miss NVCS, and magnetic resonance imaging is diagnostic.

Long-term Intraocular Pressure Fluctuation Is a Risk Factor for Visual Field Progression in Advanced Glaucoma.

Intraocular pressure (IOP) fluctuations increase the risk of visual field progression of primary open-angle glaucoma (POAG) in the advanced stage even when IOP is maintained low on average. The purpose of this study was to identify risk factors associated with the progression of visual field defect in patients with advanced POAG. A retrospective review of medical records was conducted to identify patients who met the Hodapp-Parrish-Anderson criteria for advanced POAG. A total of 122 eyes of 122 patients had undergone IOP measurement with Goldmann applanation tonometer, standard automated perimetry, Cirrus optical coherence tomography, and fundus photography at 6-month intervals. Visual field progression was defined as the deterioration of a minimum of 3 visual field locations more than baseline at 5% levels in 4 consecutive visual fields with 24-2 SITA testing. Thirty-six eyes of 122 eyes (29.5%, 51.9±13.9 y old) showed visual field progression during 100.7±44.2 months of follow-up. The progression group showed greater long-term IOP fluctuations (2.6±1.4 mm Hg) than the no progression group (53.5±13.5 y; 2.0±1.0 mm Hg, P=0.008). Disc hemorrhage was detected more frequently in the progression group (40.5% vs. 17.4%, P=0.005). Multivariate Cox regression analysis revealed long-term IOP fluctuations [hazard ratio (HR)=2.567, 95% confidence interval (CI): 1.327-5.370, P=0.012] and disc hemorrhage (HR=2.351, 95% CI: 1.120-4.931, P=0.024) to be independent risk factors of visual field progression. Patients who showed both disc hemorrhage and long-term IOP fluctuations were at greater risks of progression (HR=2.675, 95% CI: 1.072-6.457, P=0.035). Long-term IOP fluctuations and disc hemorrhage are independent and additive risk factors of visual field progression in advanced glaucoma even at low IOPs. Patients in whom these risk factors are identified require close monitoring and vigorous treatment.