Severe Primary Open-angle Glaucoma Research Articles

Central Corneal Thickness and Its Association with the Severity of Primary Open-Angle Glaucoma

Abstract Background: Understanding the relationship between central cornea thickness and glaucoma severity will help in assessing individualised risk and will enhance evidence-based decision-making in the early diagnosis and management of glaucoma. Aim: We aimed to determine the correlation between central corneal thickness (CCT) and the severity of glaucoma at different stages of primary open-angle glaucoma (POAG) at the Federal Medical Centre (FMC), Lokoja, Nigeria. Materials and Methods: A cross-sectional study of POAG patients at presentation to FMC, Lokoja. Biodata, use of anti-glaucoma medications, and family history of glaucoma were obtained. Examinations included visual acuity, central visual fields, slit lamp examination, pachymetry, gonioscopy, indirect fundoscopy, and fundus photograph. The correlation between CCT and the above parameters was ascertained. Using the mean deviation, the severity of glaucoma was classified: as mild glaucoma <−6 dB, moderate glaucoma −6 to −12 dB, severe glaucoma −12 to −18 dB, and end-stage glaucoma >−18 dB. Results: A total of 242 eyes of 121 POAG patients were studied. The male-to-female ratio was 1.5:1. The mean age was 55 ± 10 years (range = 40–78 years). Most (65.7%) had not used anti-glaucoma medications and 17.4% gave a positive family history of glaucoma. There was no clinical correlation between positive family history and CCT (P = 0.71) and no correlation between family history and glaucoma severity (P = 0.96). The patients were classified as mild glaucoma 63(29.9%), moderate glaucoma 95(45%), severe glaucoma 30 (14.2%), and end-stage glaucoma 23 (10.9%). The mean CCT was 508.0 ± 32μm. There was a decrease in CCT from 517.94 ± 26μm in mild glaucoma to 504.96 ± 40μm in end-stage glaucoma; this difference was statistically significant (P = 0.031). The mean intraocular pressure (IOP) was 24 ± 7 mm Hg, whereas the mean corrected IOP was 27 ± 8 mm Hg. Conclusion: There was a negative significant correlation between CCT and glaucoma severity and between CCT and true IOP. CCT did not correlate with age, sex, family history, or laterality of POAG.

Relationship between central corneal thickness and optic nerve head parameters in primary open-angle glaucoma

Background: Primary open-angle glaucoma (POAG) is an ocular entity that causes optic neuropathy. Thin central corneal thickness (CCT) in patients with POAG correlates with changes in various optic nerve head structural parameters. Additionally, racial differences exist in CCT and optic disc parameters. Herein, we assessed the potential relationship between CCT and optic nerve head parameters in treatment-naive patients of Persian ethnicity who were diagnosed with POAG of varying severity levels. Methods: This hospital-based analytical cross-sectional study recruited patients of Persian ethnicity diagnosed with treatment-naive POAG. Participants underwent detailed optometric and ophthalmic examinations. Visual field testing was performed using a Humphrey perimeter. Spectral-domain optical coherence tomography (OCT) was performed using a Cirrus OCT device to record optic nerve head parameters: disc area, rim area, vertical cup-to-disc ratio, average cup-to-disc ratio, cup volume, and average retinal nerve fiber layer thickness (RNFLT). The CCT was measured using an ultrasonic pachymeter. Results: We recruited 168 eyes of 84 patients with POAG with a mean (standard deviation) age of 60.30 (12.50) years, comprising 33 (39.29%) men and 51 (60.71%) women. While weak but statistically significant inverse correlations of CCT with the vertical cup-to-disc ratio (r = - 0.19; P < 0.05), average cup-to-disc ratio (r = - 0.17; P < 0.05), and cup volume (r = - 0.17; P < 0.05) were found, other optic nerve parameters showed no significant correlations with CCT (all P > 0.05). Stepwise multiple linear regression analysis indicated that, for each unit increase in the vertical cup-to-disc ratio, the CCT decreased by 54.98 µm (P < 0.05). Conclusions: The CCT in eyes with treatment-naive POAG of varying severity levels in a Persian ethnic group was weakly but statistically significantly inversely correlated with the vertical cup-to-disc ratio, average cup-to-disc ratio, and cup volume. For every unit increase in the vertical cup-to-disc ratio, the CCT decreased by 54.98 µm. Our findings indicate that in patients with POAG, CCT correlates with some changes in structural optic nerve head parameters, including the cup volume and vertical/average cup-to-disc ratios. Further longitudinal studies including individuals from various racial backgrounds and POAG severity levels are needed to verify the relationship between CCT and optic nerve parameters at different time points of disease progression.

Influence of age, baseline severity and follow‐up time on visual field progression in primary open angle glaucoma

Aims/Purpose: Challenges in modeling rates of visual field (VF) progression relate to flooring effects and sensitivity to inclusion criteria like follow‐up (FU) duration. We explored the relationship between VF progression and age, disease severity, and FU duration in primary open angle glaucoma (POAG).Methods: Mean Deviation (MD) of 655 POAG eyes of 424 patients from the UZ Leuven Glaucoma Clinic with at least 5 VFs and 2 years of follow‐up were used. Baseline severity was defined as Above 0 (≥0dB), mild ( < 0 and ≥‐6dB), moderate ( < ‐6 and ≥‐12dB), advanced ( < ‐12 and ≥‐15dB), and severe ( < ‐15dB) disease. Linear mixed models and changepoint detection were used. Sensitivity analysis of modeled progression rates within each severity group was done by varying maximally included duration of FU.Results: MD progression rates per year were ‐0.34dB (p < 0.001) for Above 0, ‐0.49dB (p < 0.001) for mild, ‐0.49dB (p < 0.001) for moderate, ‐0.26dB (p = 0.009) for advanced, and +0.1dB (p = 0.317) for severe POAG. Random effects correlation between baseline MD and progression rates was 0.36. The fixed effects for age and test related learning effect were non‐significant (p = 0.65) and ‐0.21 (p = 0.004) respectively. The correlation between the implied slope and baseline age was ‐0.26. Changepoint analysis showed that group level progression estimates stabilized when minimum FU times were at least 2.17, 1.99, 2.18, and 4.56 years for mild, moderate, advanced and severe POAG respectively.Conclusions: Older patients progress faster across severity levels and a significant learning effect is present when excluding patients with severe POAG. Excluding patients with a baseline MD above 0dB, the modeled average MD change is similar between mild and moderate POAG. Less progression is observed in advanced and no progression in severe POAG, consistent with the flooring effect. In mild and moderate POAG patients progression estimates converged after a minimum FU of at least 2 years.

Socioeconomic and environmental factors associated with glaucoma in an African Ancestry Population: findings from the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study.

Glaucoma is the leading cause of irreversible blindness, disproportionately affecting individuals of African ancestry. Limited research has examined the impact of neighbourhood quality and socioeconomic factors on primary open-angle glaucoma (POAG) risk in this population. This study aims to address these gaps by evaluating associations between ocular health and neighbourhood characteristics using geospatial data. We conducted a case-control study with 5192 African ancestry individuals from the Philadelphia area using data from the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study. Geocoded U.S. Census data were merged with individual-level demographics and neighbourhood-level measures, including air quality, food accessibility, and socioeconomic indicators, to assess their association with glaucoma risk and severity. The study included 3039 controls (58.5%) and 2153 POAG cases (41.5%). Higher POAG risk was associated with older age (OR 1.72 per 10-year increase, p < 0.001), male gender (OR 2.04, p < 0.001), lower BMI (OR 0.87 per 10 kg/m2 increase, p = 0.003), and nonuse of alcohol (OR 0.56 for alcohol use, p < 0.001). Low food access was more common in controls (OR 0.86, p = 0.03), and severe POAG cases were associated with lower homeownership rates (OR 0.95 per 10% increase, p = 0.049). However, most socioeconomic and environmental factors (air quality, education, income, occupation, family structure) were not significantly linked to POAG risk or severity. Socioeconomic status did not significantly protect against POAG in African ancestry individuals. Individual factors were more influential, suggesting neighbourhood and socioeconomic factors may have a lesser impact than previously hypothesised.

Impact of Open-Angle Glaucoma Severity on Vision-Related Quality of Life: A Cross-Sectional Study in a Single Center in Indonesia

Background: Glaucoma is a progressive optic neuropathy characterized by the gradual loss of retinal ganglion cells (RGCs) and their axons, leading to irreversible visual field loss. This study aimed to investigate the relationship between the severity of primary open-angle glaucoma (POAG) and vision-related quality of life (VRQoL) in a single center in Indonesia. Methods: A cross-sectional study was conducted at the eye polyclinic of Dr. M. Djamil General Hospital, Padang, Indonesia, from June to August 2024. A total of 54 patients with POAG were included and categorized into mild, moderate, and severe groups based on their cup-to-disc ratio and visual field index (VFI). VRQoL was assessed using the Indonesian version of the National Eye Institute Visual Function Questionnaire (NEI-VFQ 25). Results: The mean VRQoL score was significantly lower in the severe group (60.63 ± 13.04) compared to the moderate (81.79 ± 10.42) and mild (85.04 ± 10.52) groups (p = 0.000). A strong negative correlation was observed between glaucoma severity and VRQoL (r = -0.667, p = 0.000). The social functioning subscale showed the strongest correlation with severity (r = -0.573, p = 0.000). Conclusion: The severity of POAG significantly impacts VRQoL, with more severe disease associated with lower QoL scores. The social functioning domain appears to be particularly affected. These findings underscore the importance of comprehensive glaucoma management that addresses not only clinical parameters but also the patient's overall quality of life.

Socioeconomic and Racial Disparities in Primary Open-Angle Glaucoma in the US.

Socioeconomic status is a potentially significant, although difficult to isolate, factor in determining glaucoma severity. To analyze the level of glaucoma severity (mild, moderate, or severe) based on demographic factors, including age, gender, ethnicity, insurance profile, and zip code, and to use this data to extrapolate the effect of socioeconomic status (SES) and race on glaucoma severity at the community level in Memphis, TN. 2913 patients from a tertiary care center with three clinic locations in Memphis, TN who had been given the diagnosis of Primary Open Angle Glaucoma (POAG) through use of the ICD-10 codes for mild (H40.1111, H40.1121, H40.1131), moderate (H40.1112, H40.1122, H40.1132) and severe (H40.1113, H40.1123, H40.1133) POAG between January 2016 and July 2021 were included in this study. Diagnoses were made after a complete glaucoma workup consisting of Snellen visual acuity, applanation IOP measurement, gonioscopy, automated Humphreys Visual Fields (10-2 and 24-2), and optic nerve OCT. Demographic information, including age, gender, ethnicity, insurance profile, and zip code, was also collected with disease severity for each patient. SES was approximated using zip code-level census poverty data and insurance profiles. Statistical analyses were performed, including descriptive, multivariable ordinal logistic modeling and stepwise multivariable linear modeling. Glaucoma severity was shown to increase with poverty rate (OR=1.089, P<0.0071), age (OR=1.030, P<0.0001), male sex (OR=1.374, P<0.0001), and Black race (OR=1.896, P<0.0001). Severity was shown to be decreased in patients with private insurance compared to Medicare (OR=0.895, P<0.093) and those from Shelby County compared to other counties (OR=0.703, P<0.0001). Our findings indicate that worsening glaucoma severity was associated with higher poverty rates in our patient population. However, isolating socioeconomic status (SES) as an independent factor influencing the incidence and severity of glaucoma remains challenging, given the strong correlation between race and SES.

Exploring the Relation Between Peripapillary Retinal Vessel Caliber and Visual Field Defects in Primary Open-Angle Glaucoma.

Background Primary open-angle glaucoma (POAG) is a progressive optic neuropathy characterized by loss of retinal ganglion cells, optic nerve head changes, and visual field defects. Vascular factors, alongside intraocular pressure, play a crucial role in POAG pathogenesis, and this study aims to explore the relationship between retinal vessel caliber and visual field defects in POAG patients. Purpose To evaluate the association between retinal vessel calibers in the peripapillary area with visual field defects in one or both hemifields. Materials and Methods This cross-sectional study was conducted at a tertiary eye care center in northern Karnataka for one year, enrolling 100 eyes from 50 primary open-angle glaucoma (POAG) patients with visual field abnormalities. Fundus color stereoscopic photographs were taken using a Canon digital camera, and diameters of the superior and inferior temporal arteries (STA and ITA) and veins (STV and ITV) in the peripapillary area were measured. Visual field defects were categorized, and statistical analyses were performed to correlate retinal vessel calibers with field defect locations. Results Participants had a mean age of 89.68 years, with 72% male. Visual field defects included superior arcuate scotoma (20%), inferior arcuate scotoma (32%), double arcuate scotoma (30%), and tubular vision (18%). Significant vessel caliber changes were observed: for superior hemifield defects, the mean STA: ITA ratio was 1.15 (p = 0.001), and for inferior defects, it was 0.94 (p = 0.04). STV: ITV ratios also showed significant changes corresponding to visual field defects. Eyes with defects in both hemifields showed pronounced narrowing, particularly in inferotemporal vessels. Conclusions Decreased retinal vessel caliber is significantly associated with visual field defects in primary open-angle glaucoma and can be a valuable diagnostic parameter tool for assessing glaucomatous damage and the progression and severity of POAG.

A parafoveal retinal cones analysis using adaptive-optics retinal camera in patients with primary open angle glaucoma

ObjectivesTo study the density, spacing, and regularity of retinal cone photoreceptors using an Adaptive Optics (AO) retinal camera (Rtx1TM, Imagine Eyes, Orsay, France) in patients with Primary Open Angle Glaucoma (POAG) and to compare the outcomes with those of healthy age-matched control subjects.MethodsThe study included 43 eyes with POAG and 31 eyes of normal subjects. POAG patients were divided into three groups according to the severity of the visual field defect. The AO Rtx1TM was used to obtain images of the parafoveal cone mosaic to calculate cone values. Analysis was performed at two and four degrees of eccentricity from the fovea along the four meridians (nasal, temporal, superior, inferior).ResultsIn POAG eyes, the mean ± standard deviation (SD) cone density at 2° considering all meridians was significantly lower than in normal controls (23,058.6 ± 3532.0 cones/mm2, and 25,511.7 ± 3157.5 cones/mm2, respectively; p = 0.003). Cone spacing was 7.3 ± 0.5 µm in POAG and 7.0 ± 0.4 µm in normal controls (p = 0.005), and cone regularity was 90.5 ± 4.9% and 93.5 ± 1.9% in POAG and normal controls, respectively (p < 0.001). At 4° similar trends were observed. However, no significant differences were found among patients with different severity of POAG (p > 0.05).ConclusionsUsing AO Rtx1TM, significant differences in retinal photoreceptors mosaic pattern were found between POAG eyes and age-matched controls, indicating a reduction in photoreceptors in POAG. No significant differences in retinal photoreceptor values were found among the three POAG groups.

No Evidence That Vitamin D Levels or Deficiency Are Associated with the Risk of Open-Angle Glaucoma in Individuals of European Ancestry: A Mendelian Randomisation Analysis.

Glaucoma is the second leading cause of blindness worldwide, with intraocular pressure as the only known modifiable risk factor. Vitamin D has been proposed to influence intraocular pressure and decrease retinal ganglion cell degeneration. Based on these findings, vitamin D has been suggested to prevent or reduce the severity of primary open-angle glaucoma (POAG), which is the most common form. We applied two-sample Mendelian randomisation (MR) analyses to data from the SUNLIGHT consortium and the UK Biobank to assess the causal effect of vitamin D levels and vitamin D deficiency on primary open-angle glaucoma (POAG). MR analysis, including sensitivity tests using other GWAS summary statistics from FinnGen, was also performed. We also investigated the association between single nucleotide polymorphisms (SNPs) on genes involved in vitamin D metabolic pathways and POAG. We found no statistical evidence that vitamin D levels (OR = 1.146, 95% CI 0.873 to 1.504, p = 0.326) or vitamin D deficiency (OR = 0.980 (95% CI 0.928 to 1.036, p = 0.471) causally affect the risk of developing POAG. Sensitivity analyses, including the use of a more relaxed p-value threshold, and use of winter-measured samples only, replication in the FinnGen dataset, and exploration of specific genetic markers also showed no evidence of association between SNPs for genes involved in key steps of vitamin D metabolism and POAG. These results indicate that vitamin D may not be a significant factor in modifying POAG risk, challenging the hypothesis that vitamin D supplementation could be effective in reducing POAG risk. Further research should focus on identifying other potential risk factors for POAG prevention strategies.

The association between airborne particulate matter (PM2.5) exposure level and primary open-angle glaucoma

The eye is vulnerable to the adverse effects of air pollution. Previous experimental study found that fine particulate matter (PM2.5) had a direct toxic effect on intraocular tissues. However, clinical evidence for the impact of air pollutants exposure on functional and structural changes in glaucoma remains scarce. A total of 120 patients with primary open-angle glaucoma (POAG) who met the inclusion criteria were included in this retrospective study. The standardized ophthalmic examination, such as intraocular pressure (IOP), visual field, optical coherence tomography, and comprehensive physical examination, were performed. The air pollution data, including PM2.5 concentration and air quality index (AQI), were collected. PM2.5 and AQI for the day of the medical examination, as well as one month, and three months before the medical examination date, were investigated. In our results, higher average exposure levels for one-month and three-month, were associated with increased IOP (r=0.229, P=0.013; r=0.204, P=0.028, respectively) and decreased visual field mean sensitivity (MS) (r=-0.212, P=0.037; r=-0.305, P=0.002, respectively). PM2.5 concentrations for the day of the medical examination was not significantly associated with ocular parameters. In multiple linear regression analysis adjusted for demographic and clinical factors, higher PM2.5 exposure for one month was associated with elevated IOP (P=0.040, β=0.173, 95 %CI=0.008–0.337). We also found an association between PM2.5 and MS (one-month exposure: β=-0.160, P=0.029; three-month exposure: β=-0.238, P=0.002). The logistic regression analysis found that three-month average PM2.5 exposure level was significantly associated with the disease severity (β=0.043, P=0.025, 95 %CI=1.005–1.084). In conclusion, this study is the first to investigate the relationship between air pollution and detailed ocular parameters of POAG patients in Shanghai over a three-year period, and to explore the effects of different exposure times of PM2.5 on glaucoma. This study found that PM2.5 exposure was correlated with elevated IOP and decreased MS. The one-month PM2.5 exposure level had the most significant effects on IOP. The three-month PM2.5 exposure level was an independent risk factor for POAG severity. Current evidence suggests there may be an association between PM2.5 exposure and POAG.

Factors Associated with Nonreturn after Loss to Follow-Up from Glaucoma Care: An IRIS® Registry Retrospective Analysis

PurposeLoss to follow-up (LTFU) in primary open-angle glaucoma (POAG) can lead to undertreatment, disease progression, and irreversible vision loss. Patients who become LTFU either eventually re-establish glaucoma care after a lapse or never return to the clinic. The purpose of this study is to examine a large population of POAG patients who became LTFU to determine the proportion that return to care and to identify demographic and clinical factors associated with non-return after LTFU. DesignRetrospective longitudinal cohort study ParticipantsPatients with a diagnosis of POAG with a clinical encounter in 2014 in the IRIS® Registry (Intelligent Research in Sight) MethodsWe examined follow-up patterns for 553,663 patients with POAG who had an encounter in the IRIS Registry in 2014 by following their documented clinic visits through 2019. LTFU was defined as exceeding one calendar year without an encounter. Within the LTFU group, patients were classified as returning after a lapse in care (return after LTFU) or not (non-return after LTFU). Main Outcome MeasuresProportion of patients with non-return after LTFU and baseline demographic and clinical characteristics associated with non-return among LTFU POAG patients. ResultsAmong 553,663 POAG patients, 277,019 (50%) had at least one episode of LTFU over the 6-year study period. Within the LTFU group, 33% (92,471) returned to care and 67% (184,548) did not return to care. Compared to those who returned to care, LTFU patients with non-return were more likely to be older (age >80 years; RR=1.48; 95% CI: 1.47-1.50), to have unknown/missing insurance (RR=1.31; 95% CI: 1.30-1.33), and to have severe-stage POAG (RR=1.13; 95% CI: 1.11-1.15). Greater POAG severity and visual impairment were associated with non-return with a dose-dependent relationship in the adjusted model that accounted for demographic characteristics. Among those with return after LTFU, almost all returned within 2 years of last appointment (82,201; 89%) rather than 2 or more years later. ConclusionHalf of POAG patients in the IRIS Registry had at least one period of LTFU, and two-thirds of LTFU POAG patients did not return to care. More effort is warranted to re-engage the vulnerable POAG patients who become LTFU.

Outcomes of bent ab interno needle goniectomy with phacoemulsification in moderate to severe primary open angle glaucoma.

To assess the safety and efficacy of bent ab interno needle goniectomy (BANG) in moderate to severe primary open angle glaucoma (POAG) eyes undergoing phacoemulsification (phaco). Single-arm, prospective, interventional study. POAG patients with medically uncontrolled intraocular pressure (IOP), >15 mmHg for moderate and >12 mmHg for severe POAG, with visually significant cataract were recruited. All patients underwent BANG using a 26-gauge needle to excise 30° of the trabecular meshwork, along with phaco. Primary outcome was IOP. Secondary outcomes were success rate, percentage reduction in IOP/antiglaucoma medications (AGMs), and intraoperative complications. Success at 12 months was defined as: criterion A: IOP <15 mmHg for moderate glaucoma or <12 mmHg for severe glaucoma with or without AGMs OR criterion B: reduction in number of AGMs by >1. Thirty-two eyes of 32 patients underwent BANG + phaco. Mean age of the participants was 62.7 ± 8.4 years and there were 25 males and seven females. At 12 months, a significant decrease was noted in both IOP (from 17.6 ± 3.6 to 12 ± 1.6 mmHg, 31.8%; P < 0.001) and AGMs (from 3.7 ± 0.9 to 2.8 ± 0.8, 24.3%; P < 0.001). Twenty percent or more reduction in IOP was achieved in 62.5% (20/32) of eyes. Overall success (meeting either of the criteria A or B) at 12 months was achieved in 87.5% eyes. Mild postoperative hyphema was noted in 10 (31.2%) eyes, and two eyes (6.2%) required additional filtration surgery at 7 months. A 30-degree BANG with phaco in patients of POAG appears to be a safe, effective and affordable MIGS for developing countries.

36-Month Outcomes of Ahmed ClearPath® Glaucoma Drainage Device in Severe Primary Open Angle Glaucoma.

To evaluate the safety and effectiveness of the Ahmed ClearPath® (ACP) 250 mm2 glaucoma drainage device (GDD) in managing refractory primary open-angle glaucoma (POAG). This was a retrospective case series focused on adult patients diagnosed with severe POAG who underwent implantation of an ACP GDD. Over a 36-month follow-up period, data on intraocular pressure (IOP), the number of glaucoma medications, and complications were recorded. The primary objectives were to assess the reductions from baseline in both IOP and medication usage, through 36 months. Secondary objectives included the proportion of eyes achieving an IOP reduction of ≥ 20% from baseline at 36 months. Intraoperative and postoperative complications were also assessed. Twelve eyes from 11 patients (mean age: 71.3 ± 14.1 years) met the inclusion criteria and were included in the study. All patients had severe POAG (n=11), with the majority being Caucasian (n=8) and female (n=10). The mean (standard deviation) IOP and number of glaucoma medications at baseline were 29 (7.6) mmHg and 3 (0.9), respectively. At 36 months, mean IOP was reduced to 10.6 (5.5) mmHg (-61.8%; p= 0.0008) and mean number of medications was reduced to 0.9 (0.9) (-71.4%; p=0.0005), with 88.9% of eyes achieving an IOP reduction by ≥20%. No vision threatening complications were observed. To our knowledge this is the first study to report 36-month outcomes of the novel ACP device in the treatment of refractory POAG. The safety profile and efficacy of the ACP was found to be comparable to that of other commonly utilized GDD models.

Micropulse Transscleral Cyclophotocoagulation in Non-Incisional Eyes with Ocular Hypertension and Primary Open-Angle Glaucoma.

To investigate the safety and effectiveness of micropulse transscleral cyclophotocoagulation (MPTSCPC) in non-incisional eyes with ocular hypertension (OHT) and early, moderate, and severe primary open-angle glaucoma (POAG). Retrospective cohort study of eyes that underwent MPTSCPC from 2016 to 2019 at an outpatient clinic in Canada. Eyes were excluded if any incisional procedures, except cataract surgery, were performed prior to MPTSCPC treatment. Laser power ranged from 900 to 2500mW. A total of 153 eyes from 93 patients were included (OHT n=22; early POAG n=46; moderate POAG n=35; severe POAG n=50). The baseline IOP was 18.37 ± 4.76mmHg in the total cohort. All cohorts experienced a significant mean IOP reduction by final follow-up (total p<0.001; OHT p=0.003; early POAG p<0.001; moderate POAG p=0.022; severe POAG p=0.015). Overall, 52.9% of eyes achieved an IOP reduction of ≥20% from baseline to final follow-up (OHT 59.1%; early POAG 58.7%; moderate POAG 45.7%; severe POAG 50.0%). There was worsening in best-corrected visual acuity in the total cohort (mean difference=0.11 ± 0.36 logMAR, p=0.11), mostly attributable to cataract progression (34.1% of phakic eyes) and ocular surface disease (7.2%). The number of topical medications and drug classes remained unchanged in the total cohort (p=0.425 and p=0.791, respectively). Twenty-two eyes (14.4%) required retreatment, which provided an additional IOP reduction of 1.26mmHg (p=0.344). By final follow-up, 8 eyes (5.2%) required escalation to incisional procedures. MPTSCPC is a safe and effective adjunct IOP-lowering treatment in non-incisional eyes with OHT and POAG.

Aqueous humour protein dysregulation in Asian eyes with primary open angle glaucoma

The pathophysiology of Primary Open Angle Glaucoma (POAG) remains poorly understood. Through proteomic analysis of aqueous humour (AH) from POAG patients, we aim to identify changes in protein composition of these samples compared to control samples.High resolution mass spectrometry-based TMT6plex quantitative proteomics analysis is performed on AH samples collected from POAG patients, and compared against a control group of patients with cataracts. Data are available via ProteomeXchange with identifier PXD033153.1589 proteins were quantified from the aqueous samples using Proteome Discoverer version 2.2 software. Among these proteins, 210 were identified as unique master proteins. The proteins which were up or down-regulated by ±3 fold-change were considered significant. Human neuroblastoma full-length cDNA clone CS0DD006YL02 was significantly upregulated in patients with severe POAG on >2 medications, while actin, cytoplasmic 1, V2-7 protein (fragment), immunoglobulin-like polypeptide 1 and phosphatidylethanolamine-binding protein 4 were only present in these patients with severe POAG on >2 medications.Beta-crystallin B1 and B2, Gamma-crystallin C, D and S were significantly downregulated in the severe POAG ≤2 glaucoma medications group.Beta-crystallin B2, Gamma-crystallin D and GCT-A9 light chain variable region (fragment) were significantly downregulated in the non-severe POAG group.Actin, cytoplasmic 1 was significantly upregulated in subjects with severe POAG who required more than 2 glaucoma medications. Crystallins (Beta-crystallin B1 and B2, Gamma-crystallin C, D and S) were significantly downregulated in subjects with severe POAG who required less than 2 glaucoma medications.

Evaluation of glaucomatous macular and optic nerve vascular damage by optical coherence tomography angiography

Purpose The aim of this study was to compare the macular and optic nerve head vessel perfusion density in mild primary open-angle glaucoma (POAG) and moderate–severe POAG patients to normal eyes as a control cohort. Patients and methods This is a retrospective comparative case–control study that included 80 eyes of 46 participants. The study included 60 eyes of 36 POAG patients and 20 eyes of 10 healthy participants (control group). The patients underwent 3.0×3.0 mm optical coherence tomography angiography (OCTA) scans centered on the macula and 4.5×4.5 mm scans on the optic disc. Results The OCTA scans of the glaucomatous eyes revealed a reduction in microvasculature in the peripapillary area, which was absent in the control cohort. The whole disc vessel density (VD) was significantly less in the glaucomatous eyes (mean=38.02±8.74) compared to the control cohort (mean=50.41±2.58, P&lt;0.001). The severity of glaucoma was linked to a decrease in macular VD percentage, with a mean superficial VD of 36.09±5.67 in the glaucoma cohorts and 46.64±5.53 in the control cohort (P&lt;0.001), which was more pronounced than in the deep layer (P&lt;0.008). There was no statistically significant difference in the foveal avascular zone size between the control and glaucoma cohorts at any stage (P=0.999). Conclusion The OCTA vascular density accurately distinguished the glaucoma from healthy eyes, with superior performance in the peripapillary region. The foveal avascular zone size did not indicate glaucoma severity. The OCTA noninvasive assessment of the capillary networks showed a potential for managing the glaucoma patients by characterizing the retinal vascular changes.

Association of the Severity of Primary Open-Angle Glaucoma with Serum Vitamin D Levels

Association of the Severity of Primary Open-Angle Glaucoma with Serum Vitamin D Levels

Relative Flow Index as a Novel Optical Coherence Tomography Angiography Biomarker in Primary Open Angle Glaucoma.

Relative flow indices as novel optical coherence tomography angiography (OCTA) biomarkers demonstrated reduced optic nerve head and peripapillary large vessel and capillary perfusion in primary open angle glaucoma (POAG). Large vessel perfusion correlated with disease severity and progression. To introduce relative flow indices as novel OCTA biomarkers and their pathologic insights in POAG. This is a retrospective case-control study where 57 POAG and 57 control eyes were included. OCTA 4.5×4.5mm optic nerve head (ONH) were analyzed using ImageJ 1.53t to calculate global flow indices (GFIs) and relative flow indices (RFIs) for whole image optic nerve head, isolated radial peripapillary capillary plexus, and isolated large vessel angiograms. Retinal nerve fiber layer thickness (RNFLT), ONH vascular density (VD), except inside disc and large vessel VD, GFIs, and RFIs were lower in POAG than control. There was a positive correlation between RNFLT and both VD and GFIs. Among RFIs, only large vessel RFI (ONHLVRFI) demonstrated a positive correlation with average RNFLT. Linear regression demonstrated a significant positive coefficient for ONHLVRFI with RNFLT as the dependent variable. The area under receiver operating characteristic curve showed diagnostic accuracy ranging fair, good, and excellent for all biomarkers. Inferior RNFLT had the highest area under the curve (0.922) while optic nerve head large vessel density had the lowest (0.523). POAG showed structural loss of RNFL neurovascular unit manifesting as positively correlated reduction of VD and RNFLT. Also, POAG had lower global perfusion of the optic nerve head and peripapillary area, resulting in the positively correlated reduction of GFIs and RNFLT. Although RFIs were lower in POAG, only ONHLVRFI demonstrated a positive correlation and regression with RNFLT, implying that large vessel hypoperfusion was associated with POAG severity and progression.

Ab-Externo MicroShunt versus Trabeculectomy in Primary Open-Angle Glaucoma: Two-Year Results from a Randomized, Multicenter Study

PurposeTo compare the effectiveness and safety of the MicroShunt (Santen Inc., Emeryville, CA, USA) versus trabeculectomy in patients with primary open-angle glaucoma (POAG). DesignProspective, randomized, multicenter trial conducted in the United States and Europe. ParticipantsAdult patients (aged 40-85 years) with mild to severe POAG inadequately controlled on maximum tolerated medical therapy and intraocular pressure (IOP) ≥15 mmHg and ≤40 mmHg. MethodsPatients were randomized 3:1 to standalone MicroShunt implantation (n=395) or trabeculectomy (n=132), both augmented with mitomycin C (MMC) 0.2 mg/mL for 2 minutes. Main Outcome MeasuresThe primary effectiveness endpoint was surgical success, defined as ≥20% reduction in mean diurnal IOP from baseline with no increase in glaucoma medications. Secondary endpoints included changes in mean IOP and medication use from baseline and the need for postoperative interventions. ResultsAt 2 years, the rate of surgical success was lower in the MicroShunt than in the trabeculectomy group (50.6% versus 64.4%, p=0.005). Mean diurnal IOP was reduced from 21.1 ± 4.9 mmHg at baseline to 13.9 ± 3.9 mmHg at 24 months in the MicroShunt group and from 21.1 ± 5.0 mmHg at baseline to 10.7 ± 3.7 mmHg at 24 months in the trabeculectomy group (p<0.001 compared with baseline in both groups). Mean medication use decreased from 3.1 to 0.9 in the MicroShunt group and from 2.9 to 0.4 in the trabeculectomy group (p<0.001 compared with baseline in both groups). Adverse events at 2 years were generally similar in the two groups, except that hypotony was more common in eyes undergoing trabeculectomy (51.1% versus 30.9%, p<0.001). Repositioning or explantation of the implant occurred in 6.8% of MicroShunt patients. The majority of these patients had device removal at the time of subsequent glaucoma surgery. Vision-threatening complications were uncommon in both groups. ConclusionAt 2 years, both the MicroShunt and trabeculectomy provided significant reductions in IOP and medication use, with trabeculectomy continuing to have greater surgical success.

Peripapillary Retinoschisis in a Patient with Severe Primary Open Angle Glaucoma

Peripapillary retinoschisis is a rare finding that may be associated with the progression of primary open angle glaucoma (POAG). Potential pathophysiological mechanisms have been proposed to explain this association, such as acute and chronic increase in intraocular pressure, vitreopapillary traction, and Müller cell dysfunction from optic nerve head deformation. OCT imaging has revealed hyper-reflective strut-like pillars within the schisis cavity described as “bridging structures.” While peripapillary retinoschisis may spontaneously resolve, other strategies may include lowering intraocular pressure, intraocular injections, or pars plana vitrectomy.present a patient with peripapillary retinoschisis incidentally found during a workup for primary open angle glaucoma.