Stages Of Open-angle Glaucoma Research Articles

Ocular pulse amplitude (OPA) in canine ADAMTS10-open-angle glaucoma (ADAMTS10-OAG).

Introduction: The role of ocular rigidity and biomechanics remains incompletely understood in glaucoma, including assessing an individual's sensitivity to intraocular pressure (IOP). In this regard, the clinical assessment of ocular biomechanics represents an important need. The purpose of this study was to determine a possible relationship between the G661R missense mutation in the ADAMTS10 gene and the ocular pulse amplitude (OPA), the difference between diastolic and systolic intraocular pressure (IOP), in a well-established canine model of open-angle glaucoma (OAG). Methods: Animals studied included 39 ADAMTS10-mutant dogs with different stages of OAG and 14 unaffected control male and female dogs between 6months and 12years (median: 3.2years). Dogs were sedated intravenously with butorphanol tartrate and midazolam HCl, and their IOPs were measured with the Icare® Tonovet rebound tonometer. The Reichert Model 30™ Pneumotonometer was used to measure OPA. Central corneal thickness (CCT) was measured via Accutome® PachPen, and A-scan biometry was assessed with DGH Technology Scanmate. All outcome measures of left and right eyes were averaged for each dog. Data analysis was conducted with ANOVA, ANCOVA, and regression models. Results: ADAMTS10-OAG-affected dogs displayed a greater IOP of 23.0 ± 7.0mmHg (mean ± SD) compared to 15.3 ± 3.6mmHg in normal dogs (p < 0.0001). Mutant dogs had a significantly lower OPA of 4.1 ± 2.0mmHg compared to 6.5 ± 2.8mmHg of normal dogs (p < 0.01). There was no significant age effect, but OPA was correlated with IOP in ADAMTS10-mutant dogs. Conclusion: The lower OPA in ADAMTS10-mutant dogs corresponds to the previously documented weaker and biochemically distinct posterior sclera, but a direct relationship remains to be confirmed. The OPA may be a valuable clinical tool to assess ocular stiffness and an individual's susceptibility to IOP elevation.

Real-World Outcomes of Canaloplasty and Trabeculotomy Combined with Cataract Surgery in Eyes with All Stages of Open-Angle Glaucoma.

To evaluate the long-term safety and efficacy of sequential canaloplasty and trabeculotomy combined with cataract surgery in patients with mild, moderate, and advanced open-angle glaucoma. Case records of 171 consecutive patients (171 eyes) who had undergone cataract surgery followed by canaloplasty (≥180°) and trabeculotomy (≥90°) for mild, moderate, or advanced open-angle glaucoma (Shaffer grade ≥3) using the OMNI Surgical System (Sight Sciences, Inc., Menlo Park, CA) were analyzed retrospectively. Efficacy endpoints included change in mean IOP and number of medications from baseline to postoperative 12- and 24-months for the overall dataset and stratified by each stage of glaucoma. Kaplan-Meier survival analysis of success (eyes that did not require secondary surgical interventions (SSI)) by postoperative 24 months was also performed. Postoperatively, there was a statistically significant reduction in IOP (baseline of 17.2 mmHg on 1.3 medicines reduced to 14.3 on 0.8 medicines (12 months) and 14.0 on 0.9 medicines (24 months), p<0.001 for both time points). Eyes with advanced glaucoma (N=63) maintained significant IOP reduction (17.8 mmHg on 1.6 medicines at baseline reduced to 13.6 mmHg on 1.3 medicines (12 months) and 13.0 on 1.5 medicines (24 months), p<0.001). Kaplan-Meier analysis showed a 93.0% survival probability for the avoidance of SSI at 2 years after surgery. Canaloplasty and trabeculotomy combined with cataract surgery provided effective IOP reduction for eyes with all stages of glaucoma at postoperative 12 and 24 months, and the procedure yielded a 93% survival rate for SSI avoidance at 2 years.

Use of multifocal electroretinograms to determine stage of glaucoma.

To determine whether multifocal electroretinograms (mfERGs) recorded with natural pupils and skin electrodes can be used to determine the stage of open angle glaucoma (OAG). Two hundred eighteen eyes of 132 OAG patients and 62 eyes of 62 normal subjects whose best-corrected visual acuity (BCVA) was 0.1 logarithm of the minimum angle of resolution (logMAR) units (20/25) or less were studied. The mean deviations (MDs) obtained by Humphrey Visual Field Analyzer (HFA), optical coherence tomographic (OCT) images, and mfERGs were analyzed. The glaucoma was classified into 4 stages: preperimetric glaucoma (PPG), early stage, moderate stage, and advanced stage glaucoma. The parameters of the mfERGs examined were the amplitudes of the two positive peaks (P1, P2) of the second order kernels in the nasal and temporal fields within the central 15° diameter. The mean age of all participants (patients and normals) was 63.8 ± 10.8 years. With the progression of glaucoma, the amplitudes of P1 in the nasal hemifield increased and the amplitudes of P2 decreased. The nasal to temporal ratio (N/T ratio) of the P1 amplitudes and the negative slope of the line between P1 and P2 (P1P2 Slope) in the nasal field were larger at each glaucoma stage except at the PPG stage. Both the N/T amplitude ratio and P1P2 Slope were weakly but significantly correlated with the MD (r = -0.3139, P<0.0001; r = 0.4501, P<0.0001, respectively), and the OCT parameters (all P<0.0001) except the outer layer thickness. Our findings indicate that the amplitudes of P1 and P2 of the second order kernel of the mfERGs in the nasal field of the center region can be good markers for the stages of glaucoma.

Patterns of Visual Field Loss in Early, Moderate, and Severe Stages of Open Angle Glaucoma.

Even in the early stages of glaucomatous visual field defects (VFDs), 49% of the defects occurred in both hemifields and 28% involved the central 5 degrees of the visual field (VF), which may have prognostic values. The aim was to determine the patterns of glaucomatous VFDs in early, moderate and severe stages of primary open angle glaucoma, using the Glaucoma Staging Application. According to the Modified University of Sao Paulo Glaucoma Visual Field Staging System Classification, patients with early, moderate and advanced VFDs were selected by the Glaucoma Staging Application using all databases of the Humphrey Visual Field Analyser of a glaucoma referral practice. We analyzed one VF of the 100 patients included in each group. The analysis consisted of classifying all exams regarding the location of the defects, the hemifields involved, and the connection to the blind spot. We analyzed 300 VF. In the Early group, 27% of the VFDs are connected to the physiological blind spot, 64% in the Moderate group, and 95% in the Severe group ( P <0.01). In the Early group, 28% of the defects involved the central 5 degrees of the fixation, 59% in the Moderate and 88% in the Severe group. In the Early group, 49% of the defects involved both hemifields, 80% in the Moderate and 80% in the Severe group. With increasing glaucoma severity, VFD showed a more central pattern, connected to the blind spot, and involved both hemifields. In early disease, both hemifields were commonly affected and more than a quarter of VFD involved the central 5 degrees close to fixation. Careful monitoring of the central VF in glaucoma is suggested.

Efficacy and safety of XEN 45 gel stent alone or in combination with phacoemulsification in advanced open angle glaucoma patients: 1-year retrospective study.

To assess the effectiveness of the XEN 45 gel stent, either alone or combined with cataract surgery, in advanced stage open angle glaucoma (OAG) patients. Retrospective and single-center study conducted on consecutive OAG patients who underwent a XEN 45 gel stent implantation surgery, between July 2017 and September 2018. The primary efficacy end-point was the mean intraocular pressure (IOP) reduction at the end of the follow-up period. Success was defined as an IOP reduction of at least 20% and an IOP value ≤18 mm Hg without (complete) or with (qualified) hypotensive medication. Seventy-four patients (80 eyes) were included in the study. In the overall study sample, XEN implant significantly reduced IOP from 21.0 (19.8 to 22.1) mm Hg at baseline to 9.3 (8.2 to 10.4), 10.7 (9.6 to 11.9), 13.4 (12.2 to 14.7), 14.5 (13.6 to 15.4), 14.7 (13.8 to 15.6), and 14.7 (13.9 to 15.4) mm Hg at 1d, 1wk, 1, 3, 6, and 12mo of follow-up, respectively (P<0.0001 each). In the overall study population, at the end of the study the mean IOP reduction was 27.4% (23.3% to 31.5%). Adjusted IOP reduction was similar in XEN and XEN+phacoemulsification groups [30.0 (23.4 to 36.4) mm Hg vs 24.8 (18.4 to 31.2) mm Hg, respectively, P=0.2939]. At the last follow-up visit, 52 (65.0%) eyes were considered success, 29 (36.3%) eyes as complete success and 23 (28.7%) as qualified success. Mean number of hypotensive medications was significantly reduced from 2.8 (2.7 to 3.0) at baseline to 1.1 (0.8 to 1.3), P<0.0001. Kaplan-Meier survival analysis did not find any difference in the success rate between XEN and XEN+PHACO, mean hazard ratio 0.56, 95%CI 0.26 to 1.23; P=0.1469. Needling was performed in 7 (8.8%) eyes at months 1 (n=3); 3 (n=2); 4 (n=1) and 11 (n=1). Eleven (13.8%) eyes presented adverse events. XEN implant, either alone or in combination with phacoemulsification, significantly reduced the IOP and the number of hypotensive medications in patients with OAG in advanced stage.

Assessing Early Stage Open-Angle Glaucoma in Patients by Isolated-Check Visual Evoked Potential

Assessing Early Stage Open-Angle Glaucoma in Patients by Isolated-Check Visual Evoked Potential

Assessing Early Stage Open-Angle Glaucoma in Patients by Isolated-Check Visual Evoked Potential.

Recently, the isolated-check visual evoked potential (icVEP) technique was designed and has been reported to detect glaucomatous damage earlier and faster. It creates low spatial frequency/high temporal frequency bright stimuli and records cortical activity initiated primarily by afferents in the magnocellular ON pathway. This pathway contains neurons with larger volumes and axonal diameters, and it is preferentially damaged in early glaucoma, which can result in visual field loss. The study presented here uses standard operative procedures (SOP) of icVEP to obtain reliable results. It can detect visual function loss using a signal-to-noise ratio (SNR) corresponding to the defects of retinal nerve fiber layer (RNFL) in early stage open-angle glaucoma (OAG). A setting of 10 Hz and condition of 15% positive-contrast (bright) are selected to differentiate OAG patients and control subjects, with each check containing eight runs. Each run persists for 2 s (for 20 total cycles). A flowchart is constructed, which consists of pupil size and intraocular pressure over a 30 min rest period before each examination. Additionally, the testing order of eyes is performed to obtain reliable electroencephalographic signals. VEPs are recorded and analyzed automatically by software, and SNRs are derived based on a multivariate statistic. An SNR of ≤ 1 is considered abnormal. A receiver-operating-characteristic (ROC) curve is applied to analyze the accuracy of group classification. Then, the SOP is applied in a cross-sectional study, showing that icVEP can detect glaucomatous visual function abnormality in the central visual field in the form of SNR. This value also correlates with the thickness thinning of RNFL and produces high classification accuracy for early stage OAG. Thus, it serves as a useful and objective diagnostic technology for the early detection of glaucoma.

Методика диагностики начальной открытоугольной глаукомы с помощью гейдельбергской контурной периметрии и ретинальной томографии

Abstract. The aim of the study. Develop a method for identifying the initial stage of open-angle glaucoma using Heidelber contour perimeter and retinal tomograph. Materials and methods. 624 patients (624 eyes), of which 236 were men and 388 were women, the average age was 63.4 ± 9.3 years. These patients were given a standard ophthalmic examination, Heidelberg contour perimeter (HEP), then Heidelberg retinotomography (HRT), depending on the obtained HEP results. Results. Correlation analysis of HRT scores revealed both direct relationships and inverse relationships of disease with certain HRT scores. We determined quantitative characteristics of optic nerve disc parameters, where revealed pathological changes. Each deviation in the individual parameters of the optic nerve disc related to risk factors. We carried out a comprehensive assessment of 7 main parameters, which received the best assessment of diagnostic informativity based on the results of the mathematical method of constructing operational curves (ROC analysis). The more deviations in the studied measures, the more risk factors, that is, the greater likelihood of the disease. The following is a comparison of the number of risk factors with the real value of the sick/healthy characteristic. Conclusion. We developed a technique to identify the initial open-angle glaucoma. According to the methodology, we carried out diagnosis in the presence of deviations in the individual values of the optic nerve disc parameters, which relate to risk factors. The most applicable in diagnostic practice is the presence of five risk factors, where specificity is 95 %.

Relationship Between Foveal Threshold and Macular Structure/Function/Vessel Density in Glaucoma.

To investigate the hypothesis that macular structure, function, and vessel density (VD) measurements can predict foveal threshold (FT) outcomes in glaucomatous eyes. One hundred ninety-five eyes from 195 subjects (134 subjects with early-to-moderate stage open-angle glaucoma and 61 healthy controls) who underwent optical coherence tomography angiography imaging and 24-2 visual field (VF) testing with FT measurements on the same day were retrospectively enrolled in this study. The association of FT with macular structural/functional/VD measurements was evaluated using partial correlation analyses with adjustment for age and linear regression analyses. FT showed significant correlations between the thickness of the macular ganglion cell-inner plexiform layer (mGCIPL) (r=0.330, P<0.001) and the mean sensitivity (MS) of the central 5 and 10 degrees VF points (r=0.448, P<0.001 and r=0.361, P<0.001). Significant correlations were also found between FT and VD measurements at the inferior and superior parafoveal sectors (r=0.455, P<0.001 and r=0.438, P<0.001). In multivariate linear regression analyses controlling the covariates, the thickness of the mGCIPL, central 5 degrees VF MS, and parafoveal VD were significantly associated with FT (all P<0.001). There was also a significant association between FT and logMAR best-corrected visual acuity (β=-5.647, P<0.001). Macular VD along with mGCIPL thickness and central 5 degrees VF MS independently predict FT outcomes even in the eyes of patients with early-to-moderate stage open-angle glaucoma.

Evaluation of episcleral venous fluid wave during gonioscopy assisted transluminal trabeculotomy in patients with advanced glaucoma.

To evaluate episcleral venous fluid wave (EVFW) during GATT surgery in patients with advanced stage open angle glaucoma and to investigate its relationship with the severity of glaucoma. In all, 34 eyes of 28 open angle glaucoma patients who underwent GATT surgery were included into study. The extent of EVFW was evaluated using surgical records of patients and it was defined as number of clock hours. Correlations between the extent of EVFW and GAAT surgical outcomes as determined by intraocular pressures (IOP) and postoperative antiglaucoma medication needs were investigated. The impact of preoperative maximum IOP on EVFW was also evaluated. There was a significant correlation between IOPs and the extent of the EVFW at 1st, 3rd, 6th and 12th months follow-up visits. 10 of (%29.4) 34 eyes required antiglaucoma medications after the surgery. Mean extents of EVFW in patients who needed and did not need medications during follow-ups were 2.6 ± 1.0 (1-4) and 5.9 ± 1.5 (3-8) clock hours and the difference was statistically significant. Cutoff value of <4.5 clock hours for the EVFW (sensitivity 79.2%, specifity 100%) was found to be associated with the need for additional antiglaucoma medication. The extent of EVFW might be a valuable prognostic indicator for the surgical success of GATT since trabeculotomy is circumferential in this surgical technique making all collector channels accessible.

Intraocular Pressure Changes After Selective Laser Trabeculoplasty (SLT) in Open-Angle Glaucoma

Background: Selective laser trabeculoplasty (SLT) use laser to selectively target pigmented trabecularmeshwork without producing collateral damage to adjacent non-pigmented cells or structures. A previousdata suggests that SLT is effective at every stage of open-angle glaucoma (OAG). SLT can be used asa first-line therapy, alternative to medical therapy, or as an adjunctive therapy to topical glaucomadrops. The aim of this study was to determine the changes in intraocular pressure (IOP) after SLT inpatients with OAG.Methods: Design of this research was cohort-prospective study. Twenty-six eyes of 18 patients withOAG were participated in this study. All the patients were treated with 180o SLT to the temporaltrabecular meshwork and followed by 180o SLT to the nasal trabecular meshwork 1 week after the firsttreatment. A frequency-doubled (532 nm) Q-switched Nd:YAG laser with a 400 μm spot size wasused to deliver 0.4-1.0 mJ of energy for 0.3 ns to perform the procedure. Additionally, IOP in thetreated eye was assessed and measured with Goldman applanation before SLT, and 1 hour, 1 week,and 2 weeks following complete SLT. All patientes were given corticosteroid (prednisolone acetat 1%eyedrop) 4 times a day for 7 days after SLT to prevent elevation of IOP caused by inflammation.Results: The average pre-SLT IOP were 19.94 mmHg. The mean IOP 1 hour post-SLT was slightlyincrease. IOP 2 weeks after complete SLT showed a significant decrease compared to before SLT(Wilcoxon-test, before: p=0.033; 1 hour: p=0.915; 1 week: p=0.098; 2 weeks: p=0.009)Conclusion: Intraocular pressure lowering effect was significant at 2 weeks after SLT treatment. SLTeffectively reduces IOP in open-angle glaucoma. It can be used as a primary or adjunctive therapy inpatient with open-angle glaucoma.Keywords: obstructive MGD, quality of meibum, ocular surface damage

Optical Coherent Tomography changes in retinal nerve fiber layer and ganglion cell complex in different stages of open-angle glaucoma

Цел: Да се оценят количествените показатели: ганглийно-клетъчен комплекс (GCC) и перипапиларния неврофибрилерен слой (RNFL ), получени с оптична кохерентна томография (ОСТ) при различни стадии на откритоъгълна глаукома. Методи: Посредством RTVue-100 (Optovue Inc, Fremont, СА) са изследвани 60 очи на З4 болни с откритоъгьлна глаукома и 60 очи на З0 здрави лица. В зависимост от периметричните глобални индекси MD и PSD (Нumphrey analyzer), глаукомните очи са разделени в 2 групи: с начална глаукома ЗЗ очи и с напреднала глаукома 27 очи. На всички обхванати в изследването очи са анализирани GCC и RNFL (по 2 протокола на RTVue - ONH и RNFL З.45). Резултати: Средната стойност на GCC (GCC average) е най-голяма при нормални очи, следвана от тази при глаукомни очи в ранен стадий и глаукомни очи в напреднал стадий (96.7±5.3 с/у 81.0±9.45.3 с/у 75.0±16.8). Между очи с ранна и с напреднала глаукома не се установява статистически значима разлика по отношение на показателите GCC average, GCC superior и GCC inferior. Дебелината на перипапиларния неврофибрилерен слой обаче, измерена и по двата модула, се различава статистически значимо при ранна и напреднала глаукома (Р<0.001). Заключение: Нашите резултати показват, че измерването на перипапиларния RNFL е по-надежден ОСТ-показател за проследяване прогресията на глаукомата.

Selective laser trabeculoplasty (SLT): 1-year results in early and advanced open angle glaucoma.

The purpose of this study was to examine the efficacy of selective laser trabeculoplasty (SLT) in eyes with early and more advanced stages of open angle glaucoma within 1 year of follow-up. Retrospective chart review in a consecutive series of patients treated by SLT to reduce intraocular pressure (IOP) or decrease number of topical medications in cases of discomfort and allergy. The cup-to-disc ratio of the optic nerve and the GSS 2 (glaucoma staging system 2) was used to differentiate between early (group 1) and more advanced (group 2) stages of glaucoma. At the time of SLT treatment, no new signs of glaucoma progression were seen. Only the first treated eye of every patient was included in the analysis. In group 1 (early glaucoma), 27 eyes were included. IOP reduction <21 mmHg/>20 % of the preoperative IOP-value and reduction of medication were achieved in 17 eyes (62.96 %). Successful re-treatment was necessary in 2 eyes (7.4 %). In group 2 (advanced glaucoma), 44 eyes underwent SLT. In eight eyes (18.18 %), filtrating surgery was necessary after initial SLT. In the remaining 36 eyes, IOP reduction <21 mmHg/>20 % of the baseline IOP was achieved in 26 eyes (59.09 % of 44 eyes) and IOP reduction <18 mmHg/> 30 % of the baseline IOP in 22 eyes (50 % of 44 eyes). SLT was safe and effective in nearly 2/3 of early glaucoma patients and also in 50 % of advanced glaucoma patients using stronger criteria of success. Failure of SLT in advanced glaucoma should lead to immediate filtrating surgery, which seems not to be associated with higher risk of fibrosis.

Diagnostic performance and reproducibility of circumpapillary retinal nerve fiber layer thickness measurement in 10-degree sectors in early stage glaucoma.

To study the circumpapillary retinal nerve fiber layer thickness (cpRNFLT) in a 10°-wide sector using spectral-domain optical coherence tomography for diagnostic ability in early stage open-angle glaucoma (OAG). cpRNFLT measurements (3.4-mm diameter centered on the disc) were obtained from 89 eyes with early stage OAG (mean deviation, -2.5 ± 1.8 decibels) and 89 age-matched normal eyes. The ability of 180°-, 90°-, 30°-, and 10°-wide cpRNFLT sectors in discriminating early stage OAG eyes was evaluated by calculating the area under the receiver-operating characteristic curves (AUCs) and sensitivity/specificity per diagnostic criteria with varying sector widths, normative data-based cpRNFLT cutoff levels and numbers of abnormal sectors. The intra- and inter-visit reproducibilities of the cpRNFLT 10°-sector measurements were studied in a separate group of eyes with normal and early stage OAG. The greatest AUC obtained using the cpRNFLT 10° sector, 0.924 (confidence interval, 0.875-0.958), did not differ significantly from those obtained with the 180°, 90°, and 30° sectors. Only calculations using the 10° sectors had sensitivities and specificities of 0.90 or higher with the best performance of the sensitivity/specificity of 0.92/0.94. These values tended to be better (P = 0.070) than with the 30° sectors, 0.85/0.94, which were also selected with several combinations of various cutoff levels and the number of abnormal sectors. The coefficients of variation for the intra- and inter-visit reproducibility of the 10°-sector measurements were 10 % or less in 32 and 24 of the 36 sectors. The cpRNFLT 10°-sector measurements showed reasonable reproducibility and identified eyes with early stage OAG with a sensitivity and specificity of 0.92/0.94.

Relationships of retinal structure and humphrey 24-2 visual field thresholds in patients with glaucoma.

To determine relationships between spectral-domain optical coherence tomography (SD-OCT) derived regional damage to the retinal ganglion cell-axonal complex (RGC-AC) and visual thresholds for each location of the Humphrey 24-2 visual field, in all stages of open-angle glaucoma. Patients with early, moderate, and advanced glaucoma were recruited from a tertiary glaucoma clinic. Humphrey 24-2 and 9-field Spectralis SD-OCT were acquired for each subject. Individual OCT volumes were aligned, nerve fiber layer (NFL), ganglion cell and inner plexiform layers (GCL+IPL) cosegmented. These layers were then partitioned into 54 sectors corresponding to the 24-2 grid. A Support Vector Machine was trained independently for each sector to predict the sector threshold, using these structural properties. One hundred twenty-two consecutive subjects, 43 early, 39 moderate, and 40 advanced, glaucoma were included (122 eyes). Average correlation coefficient (R) was 0.68 (0.47-0.82), and average root mean square error (RMSE) was 6.92 dB (3.93-8.68 dB). Prediction performance averaged over the entire field, superior hemifield, and inferior hemifield had R (RMSE) values of 0.77 (3.76), 0.80 (5.05), and 0.84 (3.80) dB, respectively. Predicting individual 24-2 visual field thresholds from structural information derived from nine-field SD-OCT local NFL and GCL+IPL thicknesses using the RGC-AC concept is feasible, showing the potential for the predictive ability of SD-OCT structural information for visual function. Ultimately, it may be feasible to complement and reduce the burden of subjective visual field testing in glaucoma patients with predicted function derived objectively from OCT.

Laser trabeculoplasty - the first choice surgery for treatment of primary open angle glaucoma

Aim. To analyze the results of laser trabeculoplasty in patients with first and second stage of primary open angle glaucoma with the disease duration over 6 years depending on nature of sclera sinus blockade. Methods. 251 patients aged 38 to 78 years (121 female, 130 males, 285 eyes) with primary open angle glaucoma were observed. The early stage of the disease was observed in 188 eyes, promoted stage of the disease - in 97 eyes. Hypertension, atherosclerosis, diabetes mellitus were among the comorbidities. Visual acuity testing, visual field testing, ocular tonometry and tonography, ophthalmoscopy were performed, sclera sinus blockade features were defined. Laser trabeculoplasty was performed with an argon laser using the universal three mirror lens (600 to 1000 mW, laser beam diameter 50 μm, exposure time 0.1 sec, average number of iterations - 100). Laser linear trabeculoplasty by Wise modified by Mamedov was performed. In case of narrow anterior chamber angle an additional laser gonioplasty by Krasnov and laser peripheral iridotomy were performed prior to trabeculoplasty. Results. In patients with the first stage of the disease in case of a functional blockade the remote hypotensive effect was reached in 81.7% of cases, in case of organic blockade - in 46.7% of cases. In the second stage of an open angle glaucoma decrease in intraocular pressure in functional blockade was reached in 65% of cases, in organic blockade - in 33.3% of cases. Visual acuity decreased in 22.1% of cases. In patients with sclera sinus functional blockade the remote hypotensive effect was twice as better compared to patients with organic blockade. Visual field stabilization in patients with organic blockade was achieved 5.5 times rarely compared to patients with functional blockade. Conclusion. Laser linear trabeculoplasty is still the first choice surgery for primary open angle glaucoma treatment. Defining the nature of sclera sinus blockade allows to predict the laser trabeculoplasty results.

Risk factors for open angle glaucoma â analyses using logistic regression

Glaucoma is one of the main leading causes of blindness; it is a progressive and irreversible disease. Of different types of glaucoma, open angle glaucoma (OAG) is relatively more common but may cause more damage; it is very hard to notice until significant vision loss because of the irreversible disease progression. Therefore, accurate prediction, early detection and diagnosis will be important to assign treatment at the early stage of OAG to prevent or avoid further vision loss. In this paper, we used collinearity analysis to evaluate potential risk factors, logistic regression models to identify a minimum set of risk factors and prognostic factors for the development and diagnosis of the disease.

Sensitivity and Specificity With the Glaucoma Probability Score in Heidelberg Retina Tomograph II in Japanese Eyes

To evaluate the sensitivity and specificity with glaucoma probability score (GPS), a new glaucoma diagnosis program in Heidelberg Retina Tomograph II ver 3.0 in detecting early glaucoma in Japanese eyes. Sensitivity and specificity with GPS were determined in 148 early stage open-angle glaucoma eyes of 148 hospital-based patients (mean deviation >-5 dB) and age-matched and refraction-matched 148 eyes of 148 ophthalmologically normal subjects selected from a population-based sample of the Tajimi Study. The results with GPS were compared with those with Moorfields regression analysis (MRA) and FS Mikelberg discriminant function (FSM). Analysis was also carried out by stratifying the eyes by refraction and disc area. For all glaucoma eyes, sensitivity with GPS (71.7%) was similar to MRA and FSM (75.2%, P=0.8; 77.2%, P=0.5; Fisher exact test). Specificity with GPS (80.7%) was also statistically equivalent with MRA and FSM (91.1%, P=0.06; 87.4%, P=0.3). Although sensitivity with GPS was lower in higher myopic eyes than in the less myopic eyes, specificity did not differ with refractive error. Specificity with GPS was lower and sensitivity higher (P<0.0001) in larger discs (>2.0 mm) than in smaller discs (< or =2 mm). In larger discs, specificity with GPS was lower (P=0.005) than with MRA and in smaller discs, sensitivity with GPS was lower than with MRA or FSM. In Japanese eyes, sensitivity and specificity with GPS to detect early glaucoma were similar with MRA or FSM, although the specificity tended to be lower than results in white eyes. Subgroup analysis revealed a notable dependency in diagnostic ability on disc area and refractive error. The diagnostic ability of GPS is still not sufficient for glaucoma detection in the Japanese population requiring further investigation.

Correlation between Local Glaucomatous Visual Field Defects and Loss of Nerve Fiber Layer Thickness Measured with Polarimetry and Spectral Domain OCT

To study the correlation between local perimetric field defects and glaucoma-induced thickness reduction of the nerve layer measured in the peripapillary area with scanning laser polarimetry (SLP) and spectral domain optical coherence tomography (SOCT) and to compare the results with those of a theoretical model. The thickness of the retinal nerve fiber layer was determined in 32 sectors (11.25 degrees each) by using SLP with variable cornea compensation (GDxVCC; Laser Diagnostics, San Diego, CA) and the newly introduced high-resolution SOCT (Spectralis; Heidelberg Engineering, Heidelberg, Germany). Eighty-eight healthy subjects served as control subjects, to determine the thickness deviation in patients with glaucoma. The relationship between glaucomatous nerve fiber reduction and visual field losses was calculated in six nerve fiber bundle-related areas. Sixty-four patients at different stages of open-angle glaucoma and 26 patients with ocular hypertension underwent perimetry (Octopus G1; Haag-Streit, Köniz, Switzerland) and measurements with the two morphometric techniques. Sector-shaped analyses between local perimetric losses and reduction of the retinal nerve fiber layer thickness showed a significant association for corresponding areas except for the central visual field in SLP. Correlation coefficients were highest in the area of the nasal inferior visual field (SOCT, -0.81; SLP, -0.57). A linear model describes the association between structural and functional damage. Localized perimetric defects can be explained by reduced nerve fiber layer thickness. The data indicate that the present SOCT is useful for determining the functional-structural relationship in peripapillary areas and that association between perimetric defects and corresponding nerve fiber losses is stronger for SOCT than for the present SLP. (ClinicalTrials.gov number, NCT00494923.).

Laser trabeculoplasty for open angle glaucoma

Open angle glaucoma (OAG) is an important cause of blindness worldwide. Laser trabeculoplasty, a treatment modality, still does not have a clear position in the treatment sequence. The objective of this review was to study the effects of laser trabeculoplasty for OAG. We identified trials from CENTRAL in The Cochrane Library, MEDLINE, EMBASE, LILACS and manual searching. We also contacted researchers in the field. We included randomised controlled trials comparing laser trabeculoplasty with no intervention, with medical treatment, or with surgery. We also included trials comparing different technical modalities of laser trabeculoplasty. Two authors independently assessed trial quality and extracted the data. We contacted trial investigators for missing information. This review included 19 trials involving 2137 participants. Only five trials fulfilled the criteria of good methodological quality. One trial compared laser trabeculoplasty with topical beta-blocker to no intervention in early glaucoma. The risk of glaucoma progression was higher in the control group at six years of follow up (risk ratio (RR) 0.71 95% confidence interval (CI) 0.53 to 0.95). No difference in health-related quality of life was observed between the two groups. Three trials compared laser trabeculoplasty to medication (regimens used before the 1990s) in people with newly diagnosed OAG. The risk of uncontrolled intraocular pressure (IOP) was higher in the medication group compared to the trabeculoplasty group at six months and two years of follow up. Three trials compared laser trabeculoplasty with trabeculectomy. The risk of uncontrolled IOP was significantly higher in the trabeculoplasty group at six months but significant heterogeneity was observed at two years. Diode and selective laser are compared to argon laser trabeculoplasty in three trials and there is some evidence showing a comparable effect in controlling IOP at six months and one year of follow up. Evidence suggests that, in people with newly diagnosed OAG, the risk of uncontrolled IOP is higher in people treated with medication used before the 1990s when compared to laser trabeculoplasty at two years follow up. Trabeculoplasty is less effective than trabeculectomy in controlling IOP at six months and two years follow up. Different laser technology and protocol modalities were compared to the traditional laser trabeculoplasty and more evidence is necessary to determine if they are equivalent or not. There is no evidence to determine the effectiveness of laser trabeculoplasty compared to contemporary medication (prostaglandin analogues, topical anhydrase inhibitors and alpha2-agonists) and also with contemporary surgical techniques. Also there should be further investigation in to the effectiveness of laser trabeculoplasty in specific racial groups, specific diagnostic groups, such as pseudoexfoliation and pigmentary glaucoma and different stages of OAG. More research is also required determining cost-effectiveness of laser trabeculoplasty in the management of glaucoma.