Risk Of Glaucoma Research Articles

Fourteen-Year Outcome of Angle-Closure Prevention with Laser Iridotomy in the Zhongshan Angle-Closure Prevention Study: Extended Follow-up of a Randomized Controlled Trial

This study aimed to evaluate the efficacy of laser peripheral iridotomy (LPI) prophylaxis for patients with primary angle-closure suspect (PACS) after 14 years and to identify risk factors for the conversion from PACS to primary angle closure (PAC). Extended follow-up of the Zhongshan Angle-Closure Prevention Study. Eight hundred eighty-nine Chinese patients 50 to 70 years of age with bilateral PACS. Each patient received LPI in 1 randomly selected eye, with the fellow untreated eye serving as a control. Because the risk of glaucoma was low and acute angle closure (AAC) occurred only rarely, the follow-up was extended to 14 years despite substantial benefits of LPI reported after the 6-year visit. Incidence of PAC, a composite end point including peripheral anterior synechiae, intraocular pressure (IOP) of > 24 mmHg, or AAC. During the 14 years, 390 LPI-treated eyes and 388 control eyes were lost to follow-up. A total of 33 LPI-treated eyes and 105 control eyes reached primary end points (P < 0.01). Within them, 1 LPI-treated eye and 5 control eyes progressed to AAC. Primary angle-closure glaucoma was found in 2 LPI-treated eyes and 4 control eyes. The hazard ratio for progression to PAC was 0.31 (95% confidence interval, 0.21-0.46) in LPI-treated eyes compared with control eyes. At the 14-year visit, LPI-treated eyes showed more severe nuclear cataract, higher IOP, and larger angle width and limbal anterior chamber depth (LACD) than control eyes. Higher IOP, shallower LACD, and greater central anterior chamber depth (CACD) were associated with an increased risk of end points developing in control eyes. In the treated group, eyes with higher IOP, shallower LACD, or less IOP elevation after the darkroom prone provocative test (DRPPT) were more likely to demonstrate PAC after LPI. Despite a two-third decrease in PAC occurrence after LPI, the cumulative risk of progression was relatively low in the community-based PACS population over 14 years. Apart from IOP, IOP elevation after DRPPT, CACD, and LACD, more risk factors are needed to achieve precise prediction of PAC occurrence and to guide clinical practice. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Longitudinal Changes of Bruch's Membrane Opening, Anterior Scleral Canal Opening, and Border Tissue in Experimental Juvenile High Myopia.

To investigate the relative positional changes between the Bruch's membrane opening (BMO) and the anterior scleral canal opening (ASCO), and border tissue configuration changes during experimental high myopia development in juvenile tree shrews. Juvenile tree shrews were assigned randomly to two groups: binocular normal vision (n = 9) and monocular -10 D lens treatment starting at 24 days of visual experience to induce high myopia in one eye while the other eye served as control (n = 12). Refractive and biometric measurements were obtained daily, and 48 radial optical coherence tomography B-scans through the center of the optic nerve head were obtained weekly for 6 weeks. ASCO and BMO were segmented manually after nonlinear distortion correction. Lens-treated eyes developed high degree of axial myopia (-9.76 ± 1.19 D), significantly different (P < 0.001) from normal (0.34 ± 0.97 D) and control eyes (0.39 ± 0.88 D). ASCO-BMO centroid offset gradually increased and became significantly larger in the experimental high myopia group compared with normal and control eyes (P < 0.0001) with an inferonasal directional preference. The border tissue showed a significantly higher tendency of change from internally to externally oblique configuration in the experimental high myopic eyes in four sectors: nasal, inferonasal, inferior, and inferotemporal (P < 0.005). During experimental high myopia development, progressive relative deformations of ASCO and BMO occur simultaneously with changes in border tissue configuration from internally to externally oblique in sectors that are close to the posterior pole (nasal in tree shrews). These asymmetric changes may contribute to pathologic optic nerve head remodeling and an increased risk of glaucoma later in life.

Obstructive sleep apnoea and glaucoma: a systematic review and meta-analysis.

Obstructive sleep apnoea (OSA) has been thought to be associated with glaucoma, however there are many conflicting studies on this topic. With many new studies having been published since the previous meta-analysis, we believe it is important to clarify this association. Hence, in this study we meta-analyse the recent literature regarding the association between OSA and glaucoma. Pubmed, Embase, Scopus and Cochrane Library were searched from inception till the 28th February 2022 for observational as well as cross-sectional studies examining the association between OSA and glaucoma. Two reviewers selected studies, extracted data, graded the quality of included non-randomized studies using the Newcastle-Ottawa scale. The overall quality of evidence was assessed using GRADE. Random-effects models were used to meta-analyse the maximally covariate- adjusted associations. 48 studies were included in our systematic review, with 46 suitable for meta-analysis. Total study population was 4,566,984 patients. OSA was associated with a higher risk of glaucoma (OR 3.66, 95% CI 1.70 to 7.90, I2 = 98%, p < 0.01). After adjustment for various important confounders including age, gender and patient comorbidities such as hyperlipidaemia, hypertension, cardiovascular diseases and diabetes, patients with OSA had up to 40% higher odds of glaucoma. Substantial heterogeneity was eliminated through subgroup and sensitivity analyses after consideration of glaucoma subtype, OSA severity and adjustment for confounders. In this meta-analysis, OSA was associated with higher risk of glaucoma, as well as more severe ocular findings characteristic of the glaucomatous disease process. We suggest more clinical studies looking into the effects of OSA treatment on the progression of glaucoma to help clinical decision making for patients.

Associations between Niacin Intake and Glaucoma in the National Health and Nutrition Examination Survey.

This study examined the association between dietary niacin intake and glaucoma in the 2005-2008 National Health and Nutrition Examination Survey. Increased niacin intake was associated with lower odds of glaucoma overall and among women. To examine the association between dietary niacin intake and glaucoma in the 2005-2008 National Health and Nutrition Examination Survey (NHANES). This cross-sectional study included adult participants of the 2005-2008 NHANES. The exposure was dietary niacin intake which was examined as a continuous and categorical variable. The outcome was glaucoma as defined by regraded disc images. Covariates included age, sex, race/ethnicity, education level, income, body mass index, smoking status, alcohol use, cardiovascular disease, diabetes mellitus, daily energy intake, vitamins B2 and B6 consumption, and macular degeneration. Adjusting for all covariates, logistic regression was performed to examine the association between niacin intake and glaucoma in the overall population and stratified by sex. The weighted population included 5,371 individuals (109,734,124 weighted), of whom 55 (1.0%) had glaucoma. Each 1mg increase in niacin intake was associated with 6% decreased odds of glaucoma odds (adjusted odds ratio [aOR]= 0.94, 95% confidence interval [CI]=0.90, 0.98). Among women, increased niacin intake was associated with decreased odds of glaucoma both with niacin as a continuous (aOR=0.89, 95% CI=0.80, 0.99 per 1mg increase in niacin intake) and binary variable (aOR=0.35, 95% CI=0.14, 0.90 for higher versus lower niacin intake). In the 2005-2008 NHANES population, higher levels of niacin intake were associated with decreased odds of glaucoma overall and in women. Further studies are needed to examine potential protective effects of niacin on glaucoma risk.

Forecasting Risk of Future Rapid Glaucoma Worsening Using Early Visual Field, OCT, and Clinical Data

To assess whether we can forecast future rapid visual field (VF) worsening using deep learning models (DLMs) trained on early VF, OCT, and clinical data. A retrospective cohort study. In total, 4536 eyes from 2962 patients. Overall, 263 (5.80%) eyes underwent rapid VF worsening (mean deviation slope less than -1 dB/year across all VFs). We included eyes that met the following criteria: (1) followed for glaucoma or suspect status; (2) had at least 5 longitudinal reliable VFs (VF1, VF2, VF3, VF4, and VF5); and (3) had 1 reliable baseline OCT scan (OCT1) and 1 set of baseline clinical measurements (clinical1) at the time of VF1. We designed a DLM to forecast future rapid VF worsening. The input consisted of spatially oriented total deviation values from VF1 (including or not including VF2 and VF3 in some models) and retinal nerve fiber layer thickness values from the baseline OCT. We passed this VF/OCT stack into a vision transformer feature extractor, the output of which was concatenated with baseline clinical data before putting it through a linear classifier to predict the eye's risk of rapid VF worsening across the 5 VFs. We compared the performance of models with differing inputs by computing area under the curve (AUC) in the test set. Specifically, we trained models with the following inputs: (1) model V: VF1; (2) VC: VF1+ Clinical1; (3) VO: VF1+ OCT1; (4) VOC: VF1+ Clinical1+ OCT1; (5) V2: VF1+ VF2; (6) V2OC: VF1+ VF2+ Clinical1+ OCT1; (7) V3: VF1+ VF2+ VF3; and (8) V3OC: VF1+ VF2+ VF3+ Clinical1+ OCT1. The AUC of DLMs when forecasting rapidly worsening eyes. Model V3OC best forecasted rapid worsening with an AUC (95% confidence interval [CI]) of 0.87 (0.77-0.97). Remaining models in descending order of performance and their respective AUC (95% CI) were as follows: (1) model V3 (0.84 [0.74-0.95]), (2) model V2OC (0.81 [0.70-0.92]), (3) model V2 (0.81 [0.70-0.82]), (4) model VOC (0.77 [0.65-0.88]), (5) model VO (0.75 [0.64-0.88]), (6) model VC (0.75 [0.63-0.87]), and (7) model V (0.74 [0.62-0.86]). Deep learning models can forecast future rapid glaucoma worsening with modest to high performance when trained using data from early in the disease course. Including baseline data from multiple modalities and subsequent visits improves performance beyond using VF data alone. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Low ambient temperature and temperature drop as novel risk factors of acute glaucoma: a case-crossover study.

The prevalence of glaucoma has seasonal variation in population, but the role of ambient temperature and its variation remains unclear in this seasonal trend. So, we conducted a time-stratified case-crossover study to examine the association of ambient temperature and temperature change between neighboring days (TCN) with the risk of acute glaucoma. Data on meteorological parameters and glaucoma outpatient visit between 2015 and 2021 covered all districts of Shanghai. Conditional logistic regression with distributed lag nonlinear model was applied to estimate the association of temperature or TCN with the risk of acute glaucoma. A total of 7,746 patients diagnosed with acute primary angle-closure glaucoma (APACG) were included in this analysis. We observed a significant increase in therisk of acute glaucoma with cold temperature and temperature drop. Compared with the referent temperature (32℃), moderate low (12°C) and extreme low (4°C) temperature exposures were associated with higher risk of acute glaucoma outpatient visit, with the highest cumulative OR of 1.46 (95% CI: 1.11, 1.91) and 1.50 (95% CI: 1.09, 2.06) over lag 0-2days. Temperature drop (TCN = - 4°C) also increases the risk of acute glaucoma (OR = 1.34, 95% CI: 1.07, 1.67) over lag 0-7days, comparing with no temperature change. Patients of female and above age 65 were more vulnerable to cold exposure and temperature drop. This case-crossover study provided novel and robust individual-level evidence that low ambient temperature and temperature drop significantly increase the acute glaucoma risk. The findings provide protective strategies for glaucoma patient, especially for female and the old, under cold exposure and sudden temperature decline.

A Practical Guide to Measuring Optic Disc Size and its Clinical Correlation in Diagnosing Glaucoma for the Eye Care Professional

This study examines the connection between glaucoma and the optic disc, cup, and neuroretinal rim size. The use of a slit-lamp and funduscopy lens as a technique for determining and estimating the optic disc size is particularly emphasized. Through this study, a clinical manual for working clinicians will be developed by summarizing this information and making it easily accessible for in-office use. PubMed, Science Direct, Ovid, Medline journals, and inter-library journals were used to find papers and abstracts of relevant studies for this review. The most common search terms were: procedures for assessing optic disc size, variance in optic disc size between populations, and ophthalmoscopic methods for measuring optic discs. The search period spanned 2020 to 2022. The following criteria were used to determine whether an article should be included or excluded: a critical evaluation of the various methods used to measure the optic disc, the significance of including population-specific variations in the size of the optic disc, and justifications for the relative risk of glaucoma associated with the size of both the optic disc and the optic cup. According to numerous studies, a slit lamp and funduscopy lens can be used to estimate the size of the optic disc. Additionally, this review discovered a weak association between measures taken at a slit lamp and those taken with more exact office tools, including fundus photography. Using fundoscopic technologies is an effective and affordable method for measuring the optic nerve head while retaining a high level of accuracy. These dimensions can be used to divide the sizes of optic discs into three groups: small, average, and large.

Clinical risk stratification in glaucoma.

Glaucoma is the leading cause of preventable sight loss in the United Kingdom and the provision of timely glaucoma care has been highlighted as a significant challenge in recent years. Following a recent high-profile investigation, The Healthcare Safety Investigation Branch recommended the validation of risk stratification models to safeguard the vision-related quality of life of glaucoma patients. There continues to be no nationally agreed evidence-based risk stratification model for glaucoma care across the United Kingdom. Some models have used simple measures of disease staging such as visual field mean deviation as surrogates for risk, but more refined, individualised risk stratification models should include factors related to both visual impairment and visual disability. Candidate tools should also incorporate both ocular and systemic co-morbidities, rate of disease progression, visual needs and driving status and undergo clinical refinement and validation to justify implementation. The disruption to routine glaucoma care caused by the COVID-19 pandemic has only highlighted the importance of such risk stratification models and has accelerated their development, application and evaluation. This review aims to critically appraise the available evidence underpinning current approaches for glaucoma risk stratification and to discuss how these may be applied to contemporary glaucoma care within the United Kingdom. Further research will be essential to justify and validate the utility of glaucoma risk stratification models in everyday clinical practice.

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.

Michigan Screening and Intervention for Glaucoma and Eye Health Through Telemedicine Program: First-Year Outcomes and Implementation Costs

The Michigan Screening and Intervention for Glaucoma and Eye Health Through Telemedicine (MI-SIGHT) program aims to engage people who are at high risk of glaucoma; we assess first-year outcomes and costs. Clinical cohort study. Participants ≥18 years of age were recruited from a free clinic and a federally qualified health center in Michigan. Ophthalmic technicians in the clinics collected demographic information, visual function, ocular health history, measured visual acuity, refraction, intraocular pressure, pachymetry, pupils, and took mydriatic fundus photographs and retinal nerve fiber layer optical coherence tomography. Data were interpreted by remote ophthalmologists. During a follow-up visit, technicians shared ophthalmologist recommendations, dispensed low-cost glasses, and collected participant satisfaction. The primary outcome measures were prevalence of eye disease, visual function, program satisfaction, and costs. Observed prevalence was compared with national disease prevalence rates using z tests of proportions. Among 1171 participants, the average age was 55 years (SD 14.5 years), 38% were male, 54% identified as Black, 34% as White, 10% as Hispanic, 33% had less than or equal to a high school education, and 70% had an annual income <$30,000. The prevalence of visual impairment was 10.3% (national average 2.2%), glaucoma and suspected glaucoma 24% (national average 9%), macular degeneration 2.0% (national average 1.5%), and diabetic retinopathy 7.3% (national average 3.4%) (P < .0001). Seventy-one percent of participants received low-cost glasses, 41% were referred for ophthalmology follow-up, and 99% were satisfied or very satisfied with the program. Startup costs were $103,185; recurrent costs were $248,103 per clinic. Telemedicine eye disease detection programs in low-income community clinics effectively identify high rates of pathology.

The association between obesity and glaucoma in older adults: evidence from the China Health and Retirement Longitudinal Study.

This study evaluated the association between obesity and glaucoma in middle-aged and older people. A population-based retrospective cohort study was conducted using data from the China Health and Retirement Longitudinal Study. Glaucoma was assessed via self-reports. Multivariate logistic regression analysis and a Cox proportional hazards model were used to assess the relationship between obesity and glaucoma risk. Older males living in urban areas who were single, smokers, and non-drinkers were found to have a significantly higher incidence of glaucoma (all p<0.05). Diabetes, hypertension, and kidney disease were also associated with higher glaucoma risk, while dyslipidemia was associated with lower risk (all p<0.05). After the model was adjusted for demographic, socioeconomic, and health-related variables, obesity was significantly associated with a 10.2% decrease in glaucoma risk according to the Cox proportional hazards model (hazard ratio, 0.90; 95% confidence interval [CI], 0.83 to 0.97) and an 11.8% risk reduction in the multivariate logistic regression analysis (odds ratio, 0.88; 95% CI, 0.80 to 0.97). A further subgroup analysis showed that obesity was associated with a reduced risk of glaucoma in people living in rural areas, in smokers, and in those with kidney disease (all p<0.05). Obesity also reduced glaucoma risk in people with diabetes, hypertension, or dyslipidemia more than in healthy controls (all p<0.05). This cohort study suggests that obesity was associated with a reduced risk of glaucoma, especially in rural residents, smokers, and people with kidney disease. Obesity exerted a stronger protective effect in people with diabetes, hypertension, or dyslipidemia than in healthy people.

Surgical Glaucoma Treatment in Patients with Juvenile Idiopathic Arthritis-Associated Uveitis: Results after Trabeculectomy or Ahmed Glaucoma Valve Implantation

ABSTRACT Purpose Patients with juvenile idiopathic arthritis (JIA) associated uveitis (JIAU) are at risk for secondary glaucoma, frequently requiring surgical management. We compared the success rates for trabeculectomy (TE) and Ahmed glaucoma valve (AGV) implantation. Methods We conducted a retrospective analysis of TE (45 eyes), primary AGV (pAGV) (7 eyes), or secondary AGV (sAGV) implantation after TE (11 eyes) in JIAU at the 2-year follow-up. Results All groups achieved significant pressure reduction. After 1 year, the overall success rate was higher in the Ahmed groups (p = 0.03). After adjusting the p-value according to Benjamin Hochberg, there is no significant difference between the groups in the Kaplan–Meier, despite a significant logrank test between all groups (p = 0.0194) and a better performance in the Ahmed groups. Conclusion Slightly better success rates were achieved with pAGV in managing JIAU patients with glaucoma refractory to medical treatment.

Lens extraction versus laser peripheral iridotomy for acute primary angle closure.

Lens extraction versus laser peripheral iridotomy for acute primary angle closure.

Causal Association between Iritis or Uveitis and Glaucoma: A Two-Sample Mendelian Randomisation Study.

Recent studies have suggested an association between iritis or uveitis and glaucoma. This study investigated the causal relationship between glaucoma and iritis and uveitis as exposures in a multi-ethnic population. Single-nucleotide polymorphisms associated with exposures to iritis and uveitis from the genome-wide association study (GWAS) data of Biobank Japan (BBJ) and the meta-analysis data from BBJ and UK Biobank (UKB) were used as instrumental variables (IVs). The GWAS dataset for glaucoma was extracted from the meta-analysis data (n = 240,302) of Genetic Epidemiology Research in Adult Health and Aging and UKB. The casual estimates were assessed with a two-sample Mendelian randomisation (MR) test using the inverse-variance-weighted (IVW) method, weighted median method, MR-Egger method, and MR-Pleiotropy Residual Sum and Outlier test. The IVW method revealed a significant causal association between iritis and glaucoma using IVs (p < 5.0 × 10-8) from the East Asian population (n = 2) (odds ratio [OR] = 1.01, p = 0.017), a significant association between iritis exposures (p < 5.0 × 10-8) in the multi-ethnic population (n = 11) (OR = 1.04, p = 0.001), and a significant causal association between uveitis exposures (n = 10 with p < 5.0 × 10-8) and glaucoma in the multi-ethnic population (OR = 1.04, p = 0.001). Iritis and uveitis had causal effects on glaucoma risk based on IVs from the multi-ethnic population. These findings imply that the current classifications of uveitic glaucoma and open-angle glaucoma overlap, indicating the need for further investigating these complex relationships.

Association of diabetes, fasting glucose, and the risk of glaucoma: a systematic review and meta-analysis.

We designed this systematic review to summarize the diabetes-related glaucoma articles produced from 2011 to 2022. We further aimed to perform a meta-analysis to determine the vital association between these two parameters. Data sources like PubMed, MEDLINE, and EMBASE were used to find the relevant research. Reviews, case reports, and editorial letters were excluded. Articles inspection was conducted by the main author who extracted the study title and abstract in the first screening by using keywords to find the eligible articles. Heterogeneity was accessed by using the Cochrane Q test and I2 test. 10 studies were reported with 2,702,136 cases of diabetes. Out of these, 64,998 incidents of glaucoma were observed. The pooled prevalence of diabetic retinopathy was 11.7% associated with glaucoma. A significant I2 value was achieved (100%) with Cochran's Q of 183.6. In conclusion, we found diabetes duration, elevated IOP, and fasting glucose levels are one of the leading risk factors for glaucoma. Fasting glucose levels and diabetes are also major contributors to elevated IOP levels.

Risk of Dementia in Newly Diagnosed Glaucoma: A Nationwide Cohort Study in Korea

To investigate the risk of dementia in participants with newly diagnosed glaucoma. A nationwide cohort study using authorized data provided by the Korean National Health Insurance Service (NHIS). A total of 788,961 participants aged ≥ 45 years in 2006, who did not have dementia or glaucoma between 2002 and 2005, were included. Data were collected from a nationwide population-based retrospective cohort study using the Korean NHIS database. From January 2006 to December 2017, participants were tracked for the diagnosis of glaucoma or dementia using claims data. The prospective association between newly diagnosed glaucoma and the risk of dementia was investigated using a multivariable Cox proportional hazard model adjusted for age, sex, behavioral factors, and systemic and ocular comorbidities. Hazard ratios and 95% confidence intervals for dementia development according to the parameters, including glaucoma diagnosis. Overall, 7.0% of the participants developed dementia after an average of 7.4 years. A newly diagnosed glaucoma was associated with a higher risk of dementia (hazards ratio [HR] 1.89, 95% confidence interval [CI] 1.57 to 2.27) independent of age, sex, body mass index, income, smoking and drinking status, visual acuity, and other systemic comorbidities, such as diabetes, hypertension, stroke, and depression. An association between the risk of dementia and glaucoma was noted in participants with Alzheimer's disease (AD) but not in those with vascular dementia. The risk of dementia in relation to glaucoma was higher in older participants (HR = 3.15 (≥ 65 years) vs. 1.56 (< 65 years), P < 0.0001). This nationwide cohort study found that individuals with newly diagnosed glaucoma were at a higher risk of developing dementia, particularly AD. This association was greater among older individuals in the studied population.

Age-Based Association of Glaucoma with the Prevalence of Diabetes and Hypertension at a National Hospital in Seoul

Glaucoma can have profound consequences on vision. Although diabetes and hypertension have been suggested as risk factors for glaucoma, their relevance in epidemiological studies remains controversial. Accordingly, we investigated whether diabetes and hypertension, as well as factors such as age and sex, affected the risk of glaucoma. From May 30, 2022, to June 24, 2022, 1152 patients were selected from a national hospital (Seoul, Korea) to analyze the association among visual field test results, diabetes, and hypertension. Patients who visited the hospital for glaucoma treatment or those referred for glaucoma were randomly selected. The mean deviation value, obtained from visual field test results, is an index of the overall change in the visual field. Based on the mean deviation value, patients with glaucoma were classified into early- (-6<MD<0), middle- (-12<MD<-6), and late-stage (MD<-12) glaucoma groups. Among the 1152 patients, 110 (10%) had diabetes co-occurring with hypertension and 997 (87%) had glaucoma. Among the patients with glaucoma, those with early glaucoma were the most represented and most of them did not have comorbid diabetes or hypertension. Moreover, the incidence of glaucoma was higher in older adults aged ≥60 years. No major sex-based changes in the occurrence of diabetes and hypertension were detected in patients with glaucoma. This retrospective study suggests that diabetes and hypertension may affect glaucoma risk; however, other factors such as age may also play a role in glaucoma progression. Regular medical and ophthalmic examinations are necessary to diagnose and manage glaucoma.

High−Accuracy Film−Integrated Optical Sensor for Real−Time Intraocular Pressure Monitoring

Intraocular pressure (IOP) is a key indicator to evaluate the risk and status of glaucoma, which is one of the main causes of irreversible blindness. However, the IOP value is susceptible to circadian changes and is difficult to be measured real-time. In this paper, we designed a thin-film integrated optical IOP sensor based on the interferometry principle, which could read out the IOP value by interference patterns and monitor the value changes real-time at the same time. The theoretical and experimental results indicated that our sensor exhibited a sensitivity of 0.19 μm/mmHg and an average accuracy of 0.84 mmHg over the pressure range of 0-45 mmHg, which is comparable with the other reported optical systems but with the advantage of easier fabrication process and low-cost. Our sensor device implies great potential in the application of human physiological index measurement and other chip-integrated medical sensing instruments.

Association between Serum Total Bilirubin Level and Patients with Primary Open-Angle Glaucoma in China: A Cross-Sectional, Case-Control Study.

To investigate the relationship between peripheral blood total bilirubin (TBIL) levels and the risk of primary open-angle glaucoma (POAG). This study was a cross-sectional, case-control study design. Between April 2021 and January 2022, 198 POAG patients and 205 healthy subjects were recruited from the EENT Hospital of Fudan University. Their clinical information (intraocular pressure, central corneal thickness, vertical cup-disk ratios (VCDR), and axial length) and demographic data were collected. Serum levels of TBIL were measured in enzymes using a Roche C702 biochemical analyzer. The POAG subgroups were classified by gender and VCDR: mild (VCDR ≤ 0.64), moderate (VCDR ≤ 0.85), and severe (VCDR > 0.85). Univariate and multivariate logistic regression analyses were performed. The level of TBIL (11.58 ± 5.16 μmol/L) in the POAG group was higher than that in the control group (10.18 ± 3.38 μmol/L; p < 0.05). In the male subgroup, TBIL was also significantly higher than in the normal control group; TBIL levels were lower in the mild subgroup (10.82 ± 4.48 μmol/L), followed by the moderate subgroup (12.00 ± 5.55 μmol/L) and the severe subgroup (14.47 ± 5.45 μmol/L). The results of the multivariate logistic regression analysis showed that high TBIL levels were a risk factor for male POAG, at 1.126 (95% CI 1.009-1.256). Pearson's analysis revealed that TBIL was positively correlated with intraocular pressure (r = 0.134, p = 0.012), VCDR (r = 0.142, p = 0.046), anterior chamber depth (r = 0.190, p = 0.014), and axial length (r = 0.179, p = 0.019) in the patients. However, no statistical difference (p < 0.05) was observed in the female patients with POAG. The results showed that high levels of TBIL may be related to the pathogenesis of POAG and that the severity of the disease is positively correlated, especially in male patients.

Does Diabetes Influence Adherence in Glaucoma Patients?

With chronic diseases, patient adherence plays a crucial role in delaying disease progression and in determining the success of therapy. Problems arise not only from low medication adherence, but also non-adherence to recommended follow-up examinations. Obtaining an accurate estimate of adherence is difficult, especially in glaucoma patients, due to the fact that most antihypertensive drugs are administered in the form of eye drops. There is great variability in the published adherence values for glaucoma patients. Most studies report an average medication adherence of approximately 70%, with around 50% of patients having good adherence (at least 80% of medication administered as planned). Furthermore, 6.8 - 31.4% of the eye drops do not end up in the patient's eye, which means there is even less active ingredient to achieve a therapeutic effect. Glaucoma patients also show low persistence and adherence to follow-up appointments. Since diabetes increases the risk for POAG and secondary glaucoma and given that diabetics have particularly low adherence, the question arose whether a diabetes diagnosis is associated with reduced adherence in glaucoma patients. Previous studies found no significant association between diabetes and reduced adherence in glaucoma patients, although a significant impact of elevated HbA1c on adherence in glaucoma patients was found in one study. However, this connection still needs to be examined more closely in studies with larger samples.