Visual Field Index Research Articles

Discriminating Diseases Mimicking Normal-Tension Glaucoma (NTG) from NTG.

Background/Objectives: The aim of this study was to identify the most reliable ocular exam and establish a threshold for deciding whether to perform neuroimaging in order to screen for diverse diseases other than normal-tension glaucoma (NTG). A retrospective, observational, comparative study was used. Methods: In total, 106 individuals with atypical features of NTG who underwent glaucoma assessments and contrast-enhanced MRI of the brain or orbit were included. The criteria for atypical NTG included the following: (1) unilateral normal-tension glaucoma, (2) visual field (VF) damage inconsistent with optic disc appearance, (3) fast VF progression, (4) worsening of visual acuity, (5) optic disc pallor, (6) scotoma restricted by a vertical line, and (7) central scotoma. Glaucoma evaluations included measurements of visual acuity, intraocular pressure, central corneal thickness, axial length, cup-disc ratio, retinal nerve fiber layer (RNFL) thickness, ganglion cell-inner plexiform layer (GCIPL) thickness, mean deviation (MD), and visual field index (VFI). Statistical analyses involved independent t-tests, receiver operating characteristic (ROC) curves, and area under the curve (AUC) in order to differentiate neuro-ophthalmological conditions from NTG, compare the diagnostic power of each factor, and determine the cut-off value. Results: Relatively fewer diagnoses of non-glaucomatous diseases were associated with unilateral NTG, the worsening of VA, and central scotoma. Factors such as rapid visual field progression, optic disc pallor, and scotoma restricted by a vertical line had a relatively higher diagnostic rate of non-glaucomatous diseases. There were significant differences in average RNFL and GCIPL thicknesses at the nasal quadrant between NTG and NTG-mimicking conditions. Only the GCIPL thickness at the nasal quadrant had reliable power for discriminating between neuro-ophthalmological disease and NTG. For the GCIPL thickness at the nasal quadrant, the AUC was 0.659, and the cut-off value was 65.75. Conclusions: When deciding whether to proceed with imaging, such as carrying out an MRI test, for NTG patients with atypical NTG characteristics, it would be advisable to consider the nasal sector cut-off value of GCIPL thickness.

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.

Outcomes of Trabeculectomy and Predictors of Success in Patients of African Ancestry with Primary Open Angle Glaucoma.

To investigate outcomes of trabeculectomy ab externo in African ancestry primary open-angle glaucoma (POAG) patients, and to analyze the impact of demographic and phenotypic factors on surgical success and complication rates. A retrospective case-control study enrolled 63 eyes of 55 POAG cases who underwent trabeculectomy ab externo. Data on demographics, family glaucoma history, surgical specifics, and pre/postoperative measures (intraocular pressure, visual acuity, visual field, medication usage, complications within one year) were collected. Analysis included linear/logistic regression models adjusting for inter-eye correlation. Trabeculectomy yielded success without additional medication in 46%, qualified success with medication in 22%, and surgical failure necessitating further intervention in 32% within one year. Subjects experienced reduction in intraocular pressure (IOP) (46%), daily glaucoma medication (73%), and eye drop usage (67%) 1-year post-trabeculectomy (all P<0.001). However, there was a postoperative decline of 56% in visual acuity (VA) (P<0.001) and a significant worsening of visual field parameters, including a 14% decrease in mean deviation (P=0.02) and a 19% decrease in visual field index (P=0.004). Top of FormBottom of Form59% of patient eyes experienced complications within one year of surgery. Univariate analysis of predictive factors for surgical outcomes revealed that younger age at surgery (P=0.01) and family history of glaucoma (P=0.046) were predictive of lower rates of surgical success. Multivariable analysis revealed worse preoperative VA (OR 0.79 per 0.1 LogMAR increases, P=0.02) was associated with lower likelihood of surgical success. This study underscores the low rates of trabeculectomy success and high rates of complications in an African ancestry population with POAG. While the procedure exhibited positive effects on IOP control and medication reduction, our analysis found that multiple factors, particularly age, family history, and worse preoperative VA play crucial roles in influencing surgical success. Trabeculectomy in African ancestry individuals with primary open-angle glaucoma shows a 46% success rate and frequent complications, indicating that younger age and family history are significant predictors of surgical failure in this high-risk population.

Longitudinal evaluation of circumpapillary structure-function and vasculature-function relationships in acute and sub-acute nonarteritic anterior ischemic optic neuropathy

PurposeTo investigate the global and regional correlations between longitudinal structure-function (S-F) and vasculature-function (V-F) using circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurements, circumpapillary vessel density (cpVD) and the corresponding/final visual outcomes at different stages of nonarteritic anterior ischemic optic neuropathy (NAION). MethodsThirty eyes of 30 patients with acute NAION were included. LogMAR best-corrected visual acuity(BCVA), mean deviation (MD) and visual field index (VFI), cpRNFL thickness and cpVD across different retinal layers were examined at baseline, 2 weeks and 1 month after diagnosis. Potential correlations between the Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) parameters and visual outcomes were investigated in both acute and sub-acute NAION. ResultsSignificant global and regional correlations in S-F relationship were identified exclusively in sub-acute stage (p < 0.05). However, among the OCTA parameters for the acute NAION, the temporal cpVD in superficial vessel complex (SVC) and inner retinal layer (IRL) exhibited positive correlations with corresponding and final visual acuity and visual field outcomes. In the sub-acute stage of NAION, the cpVD of global or temporal section in radial peripapillary capillary (RPC), SVC and IRL were positively correlated with visual outcomes. ConclusionSignificant longitudinal V-F relationships exist both globally and regionally, in acute and sub-acute NAION. The cpVD parameters of the SVC and IRL are potentially valuable for evaluating corresponding and final visual outcomes and highlights the importance of monitoring cpVD over cpRNFL thickness in acute NAION.

A study on correlation between automatedperimetry and optical coherence tomography findings in glaucoma suspects

To evaluate the correlation between optic disc and retinal nerve fiber layer (RNFL) parameters of SD OCT scan of optic disc, and, visual field indices of Humphrey visual field analyzer. This is a prospective, cross-sectional study of 47 patients who are glaucoma suspects. They have been screened for glaucoma by comprehensive ophthalmic examination including visual field testing by automated perimetry and optic nerve head and retinal nerve fiber layer thickness changes assessment by optical coherence tomography. Mean age of the glaucoma suspects was 54.35 ± 10.6 years. Women were having higher (58.7%) mean age as compared to men (41.3%). Mean IOP in glaucoma suspects was 17.97 mmHg. The mean CD ratio was measured as 0.66 ± 0.11 and with significant negative correlation between the mean MD and CD ratio values (p&amp;#60;0.05) and similarly between MD and Vertical CDR. PSD showed significant positive correlation with CDR and also with Vertical CDR. Correlation is noted between MD and average RNFL, with significant positive correlation between MD and superior RNFL. Spectral domain OCT, when used in combination with automated perimetry helps in early diagnosis of glaucoma.SD OCT of Optic disc alone can detect changes of RNFL in patients with normal discs and visual fields. Optic Disc OCT plays a vital role in diagnosing preperimetric glaucoma patients.

Analysis of factors affecting the progression of visual field defects in patients with myopia and primary open-angle glaucoma

Objective: To investigate the factors affecting the progression of visual field defects in patients with myopia and primary open-angle glaucoma (POAG), and to clarify whether the factors vary in patients with different degrees of myopia. Method: An ambispective cohort study was conducted among patients diagnosed with myopia and POAG from the glaucoma outpatient department at the Zhongshan Ophthalmic Center of Sun Yat-sen University between January 2006 and January 2024. Based on the criteria of functional visual field progression, patients were divided into the progression group and non-progression group, and further divided into the low to moderate myopia subgroup and high myopia subgroup according to the degree of myopia. The patient age, gender, type of glaucoma (high tension glaucoma and normal tension glaucoma), spherical equivalent refraction, best corrected visual acuity (BCVA, recorded as the logarithm of the minimum angle of resolution), intraocular pressure (IOP), central corneal thickness, baseline visual field, history of ophthalmic surgery (corneal refractive surgery and glaucoma surgery), and number of anti-glaucoma medications were summarized. The generalized estimation equation was used for comparison between groups, and the Cox proportional hazards model was used to analyze the factors affecting the progression of visual field defects. Results: A total of 182 eyes from 106 patients were included in this study. There were 57 eyes in the progression group and 125 eyes in the non-progression group. Compared with the non-progression group, the progression group had the older age [43 (29, 53) years old], worse BCVA [0.05 (0.00, 0.17)], greater IOP fluctuation [1.8 (1.3, 2.9)mmHg(1 mmHg=0.133 kPa)], more common baseline central defects [52.6%(30/57)], higher visual field pattern standard deviations [8.92 (5.32, 12.00)dB], lower visual field index [77% (67%, 88%)], and more anti-glaucoma medications [35.1% (20/57) patients used three medications] (all P<0.05). The Cox proportional hazards models showed that the baseline moderate visual field defects [hazard ratio (HR)=2.33, 95% confidence interval (CI): 1.25 to 4.36, P=0.008], baseline central defects (HR=2.09, 95%CI: 1.11 to 3.93, P=0.022), older age (Model A, HR=1.03, 95%CI: 1.00 to 1.05, P=0.017; Model B, HR=1.02, 95%CI: 1.00 to 1.05, P=0.019), and greater IOP fluctuation (Model A, HR=1.54, 95%CI: 1.32 to 1.81, P<0.001; Model B, HR=1.49, 95%CI: 1.26 to 1.75, P<0.001) were risk factors for visual field progression. In the low to moderate myopia subgroup, the increased risk of progression was associated with baseline central defects (HR=5.74, 95%CI: 1.72 to 19.20, P=0.005), worse BCVA (Model A, HR=15.80, 95%CI: 2.07 to 121.00, P=0.008; Model B, HR=12.50, 95%CI: 2.65 to 58.70, P=0.001), and older age (Model A, HR=1.05, 95%CI: 1.02 to 1.08, P=0.002; Model B, HR=1.07, 95%CI: 1.03 to 1.11, P<0.001). In the high myopia subgroup, the increased risk of progression was associated with baseline moderate visual field defects (HR=2.35, 95%CI: 1.12 to 4.92, P=0.024) and greater IOP fluctuation (Model A, HR=1.50, 95%CI: 1.24 to 1.82, P<0.001; Model B, HR=1.52, 95%CI: 1.26 to 1.83, P<0.001). Conclusions: Age, IOP fluctuation, baseline moderate visual field defects, and baseline central defects were the factors affecting the progression of visual field defects in patients with myopia and POAG. There were differences in the influencing factors of visual field progression in patients with different degrees of myopia.

To identify risk factors for central visual field progression in moderate to advanced glaucoma.

To identify the risk factors for central visual field progression in moderate to advanced glaucoma. We included patients with moderate to advanced primary glaucoma who had undergone at least five reliable Humphrey visual field (HVF) 10-2 tests with follow-up of at least 2 years. Regression slopes for each threshold location on the 10-2 plot were calculated. A test location with a regression slope worsening more than -1 dB/year with P < 0.01 was labeled as a progressing point on point-wise linear regression (PLR) analysis. We compared point-wise progression with progression on the 10-2 mean deviation (defined as a negative MD slope P < 0.05). Ninety-six eyes of 74 patients with a median follow-up of 4 years (±1.97) were included. The median mean deviation 10-2 (MD) at inclusion was -19.01 dB (interquartile range [IQR] -13.2 to -24.14). Eighteen eyes (18.75%) had moderate glaucoma and 78 eyes (81.25%) had advanced glaucoma. The baseline median 24-2 MD in moderate glaucoma was -10.35 dB (IQR -11.35 to -9.25) and in advanced glaucoma was -24.96 dB (IQR -28.48 to -18.26). Based on 10-2 PLR, 27 eyes (28%) showed progression. On multivariate logistics regression analysis, the rate of change for 10-2 MD was a risk factor for progression based on 10-2 PLR analysis: odds ratio (OR) 0.04 (95% confidence interval [CI]: 0.006-0.323), P = 0.002, and for progression based on 10-2 MD analysis: OR 0.03 (95% CI: 0.002-0.602), P = 0.02. In addition, average MD 24-2 (OR 1.343 [95% CI: 1.006-1.793], P = 0.04) and visual field index (OR 0.787 [95% CI: 0.649-0.954], P = 0.01) were found to be risk factors based on 10-2 PLR. Rate of change for 10-2 mean deviation and baseline damage were predictors of point-wise progression.

Patient Experience and Barriers to the Visual Field Test for Glaucoma.

There are significant mental, physical, and perceptual challenges in patients undergoing visual field testing, particularly in the elderly population with glaucoma. To quantitatively and qualitatively investigate patient experiences of undergoing visual field testing. This cross-sectional, mixed-methods study involves adult patients attending a private outpatient ophthalmology clinic in Brisbane, Australia. Participant experiences of visual field testing were assessed using a 100mm visual analog scale (VAS), followed by face-to-face semi-structured interviews. Outcome data comprised of VAS scores (1-100) and thematically analyzed verbatim notes. Out of the 152 participants (M:F 79 (52.0%):73 (48.0%)) the age group with the highest proportion of participants was 71-80 years 56 (36.8%), and most had a primary ocular diagnosis of glaucoma 107 (70.4%). The mean VAS score for visual field testing experience was (60.45 [SD=30.38]). The mean VAS score of participants with glaucoma was significantly lower than that of participants without glaucoma (55.34 [31.13] vs 72.67 [25.04]; P<0.05). Prevalent themes regarding participant experiences of visual field testing consisted of concentration difficulties, intra-test and peri-test anxiety, skepticism in the testing process, and physical discomfort. Age, gender and mean visual field index did not influence the participant's experience of visual field testing. Mental and physical barriers to visual field testing tolerability were identified in a predominantly elderly population with glaucoma. Our findings highlight the importance of addressing patient concerns and apprehensions regarding visual field testing and emphasize the value of patient-initiated breaks, particularly for individuals experiencing concentration difficulties and physical discomfort.

Assessing Glaucoma Severity and Progression in Individuals with Asymmetric Axial Length: An Intrapatient Comparative Study

PurposeTo investigate whether there is a difference in inter-eye glaucoma severity and progression in patients with asymmetric axial length DesignLong-term observational study ParticipantsPatients over 20 years of age who had been diagnosed with glaucoma at Seoul National University Hospital, Seoul, Korea, between 2010 and 2020. MethodsPatients diagnosed with glaucoma in both eyes with an axial length difference of more than 1.0 mm were included. Each individual’s eyes were classified into “longer eye” and “shorter eye,” and the baseline and follow-up clinical data were analyzed using the paired test. Main Outcome MeasuresDifferences in clinical characteristics in patients with asymmetric axial length ResultsA total of 190 eyes of 95 glaucoma patients with asymmetric axial length were included in the study. The patients’ mean age was 51.2 ± 12.3 years, and the mean follow-up period was 10.1 ± 3.9 years. There was no difference in the baseline intraocular pressure (IOP) or central corneal thickness (CCT) between longer eyes and shorter eyes. Among the baseline disc parameters, ovality index, beta-zone and gamma-zone parapapillary atrophy (PPA) area were larger in the longer eyes. In the baseline OCT data, the retinal nerve fiber layer (RNFL) thickness and ganglion cell-inner plexiform layer (GCIPL) thickness were thinner in the longer eyes. According to a baseline visual field (VF) test, the mean deviation (MD) and visual field index (VFI) values were significantly lower in the longer eyes. Based on an analysis of glaucoma progression, the rate of change of superior GCIPL (longer eyes : -0.65 μm/yr, shorter eyes : -0.40 μm/yr) , MD (longer eyes : -0.40 dB/yr, shorter eyes : -0.21 dB/yr) , and VFI (longer eyes : -0.92 %/yr, shorter eyes : -0.46 %/yr) were larger in the longer eyes. The greater the difference between the mean IOP and beta-zone PPA area between inter-eyes, the greater the difference in the rate of change of RNFL and GCIPL. Additionally, the greater the difference in IOP fluctuation, the greater the difference in the rate of change between MD and VFI. ConclusionsWhen there was an axial length difference of more than 1.0 mm, glaucoma tended to be more severe and to progress faster in the longer eyes. The inter-eye difference in glaucoma progression rate is related to both mean IOP and IOP fluctuation.

Evaluation of lamina cribrosa curvature index in different types of glaucoma.

The aim of this study was to evaluate the lamina cribrosa curvature index in different types of glaucoma in comparison with clinical findings and conventional measurement methods. Patients older than 18years who were followed up in Glaucoma Unit of Department of Ophthalmology at Fırat University Faculty of Medicine, whose disease had been under control at least for 1year, who had at least three reliable visual fields, whose refractive error was between - 6 and + 5 diopter and who did not have any disease other than glaucoma that would affect the visual field, were included in the study. Clinical and demographic characteristics, visual field, optical coherence tomography and lamina cribrosa curvature index (LCCI) results were evaluated. The study patients were divided into six groups: early-stage primary open-angle glaucoma (POAG) as group 1 and intermediate-advanced stage POAG as group 2, pseudo-exfoliation glaucoma (PEXG) as group 3, normal tension glaucoma (NTG) as group 4, ocular hypertension patients whom subsequently developed POAG as group 5 and healthy control as group 6. A total of 189 eyes of 101 patients were included in our study. Forty-seven patients were male (46.5%) and 54 were female (53.5%). The mean age was 62.43 ± 1.49years. LCCI, mean deviation (MD), visual field index (VFI), pattern standard deviation (PSD) and retinal nerve fiber layer thickness (RNFL) values were analyzed in all groups and Pearson correlation analysis showed statistically significant correlation between PSD and RNFL measurements with LCCI values in all groups. MD value was correlated with LCCI in groups 2, 3 and 4, while VFI value was correlated with LCCI in all groups except group 5. When the groups were compared with each other according to the Post-Hoc Tamhane test, LCCI measurement showed statistically significant results in accordance with MD, VFI, PSD and RNFL values. The LCCI assessment is mostly consistent with conventional tests. In this study, in which different types of glaucoma and healthy subjects were examined simultaneously, LCCI shows promise as a detailed and reliable assessment method.

The Glaucoma Intensive Treatment Study (GITS): A Randomized Controlled Trial Comparing Intensive and Standard Treatment on 5 Years Visual Field Development

PurposeTo assess the effect of an intensive initial IOP lowering treatment strategy on the progression of visual field damage. DesignA randomized, controlled, open-labelled two-center clinical trial. MethodsA total of 242 patients with newly detected early or moderate untreated open-angle glaucoma were enrolled at two university hospitals in Sweden. Participants were randomly allocated (1:1) to either initial treatment with intensive IOP-lowering medications followed by 360° laser trabeculoplasty (LTP), or to traditional mono-therapy, which was increased when deemed necessary. The primary study outcome of interest was the predicted remaining visual field, as measured by the visual field index (VFI) at projected end of life. ResultsThe median untreated IOP was 24 mmHg in both treatment groups. During follow-up, median and mode IOP was 17 mmHg in the mono- and 14 mmHg in the multi-treated group. In the mono-treated group the median VFI at projected end of life was 79.3%, and in the multi-treated group 87.1%, p=0.15. Annual rate of progression of visual field damage was faster in mono-treated than in multi-treated participants; median losses per year were 0.65 and 0.25 percentage units respectively, p=0.09. Progression events occurred in 21% of the mono- and in 11% of the multi-treated participants, p=0.03. Adverse events, mostly mild, were reported in 25% of the mono-, and in 36% of the multi-treated participants. Differences in visual field outcomes between treatment groups were more pronounced in participants having higher baseline IOP defined by median split of untreated IOP values. ConclusionIn the overall analysis the visual field outcomes were not overwhelming better in the multi-treated group, but post-hoc analysis showed definite benefit in patients with higher untreated IOP. Based upon the results of this study, initial intensive treatment may be considered in glaucoma patients with high untreated IOP at diagnosis, while we found no evidence that multi-therapy should be given routinely to all glaucoma patients.

Establishing target intraocular pressure in newly diagnosed exfoliation glaucoma patients

ABSTRACT Background This study aimed to determine the appropriate target intraocular pressure (IOP) for patients newly diagnosed with exfoliation glaucoma. Research design and methods The study followed a prospective cohort of newly diagnosed exfoliation patients for three years. The target IOP was defined using three methods to measure visual field deterioration, mean deviation (MD), visual field index (VFI), and guided progression analysis (GPA). Results Over the three years, the mean deviation (MD) values declined by an average of −3.84 (±2.61) dB, while the visual field index (VFI) values dropped by an average of 9.66 (±6.25) %. The untreated IOP at inclusion was 32.52 ± 5.54 mmHg. At the end of the study (due to treatment), it was 17.94 ± 1.82 mmHg, resulting in a reduction of 14.58 mmHg (45% reduction). Based on the MD and VFI methods, the target IOP for the whole cohort was around 14–15 mmHg, while the target IOP based on GPA was around 15 mmHg. For advanced glaucoma cases, the target IOP was around 13 mmHg. Conclusions The study concludes that the traditional reported IOP reduction of 20% and/or IOP 18–20 mmHg may not be sufficient for patients newly diagnosed with exfoliation glaucoma. Instead, the study recommends a target IOP of 14–15 mmHg for these patients. Clinical Trial Registration The study was registered in the www.clinicaltrials.gov website with the number NCT06237764.

Exploring the Association Between Visual Field Testing and CERAD Neuropsychological Battery in Idiopathic Normal Pressure Hydrocephalus Patients

Background: Association between visual field test indices and The Consortium to Establish a Registry for Alzheimer’s Disease Neuropsychological Battery (CERAD-NB) is unknown. Idiopathic normal pressure hydrocephalus (iNPH) patients provide a unique set of patient data for analysis. Objective: To assess the reliability of visual field testing using the CERAD-NB in patients with iNPH and to investigate the association between visual field test results and cognitive function. Methods: 62 probable iNPH patients were subjected to comprehensive ophthalmological examination, ophthalmological optical coherence tomography imaging studies, visual field testing, and CERAD-NB. Based on visual field indices, the patients were divided into two groups: unreliable (n = 19) and reliable (n = 43). Independent T-test analysis was performed to examine the relationship between visual field test results and cognitive function. Pearson Chi-square test was used for non-continuous variables. Results: The unreliable group performed worse in CERAD-NB subtests compared to the reliable group. Statistically significant differences were observed in nine out of ten subtests, with only Clock Drawing showing no statistical significance. Pairwise comparison of the groups showed no statistical significance between amyloid-β (Aβ) biopsy, hyperphosphorylated tau biopsy, apolipoprotein E allele or the ophthalmological status of the patient. But there was a statistically significant difference in cerebrospinal fluid Aβ42 and age between the groups. Conclusions: Patients with unreliable visual field tests performed worse on CERAD-NB subtests. CERAD-NB subtests do not provide a specific cut-off value to refrain patients from visual field testing. Should patients with unreliable visual field tests be screened for cognitive impairment?

Adding Genetics to the Risk Factors Model Improved Accuracy for Detecting Visual Field Progression in Newly Diagnosed Exfoliation Glaucoma Patients.

This study aims to determine whether including genetics as a risk factor for progression will improve the accuracy of the models used in newly diagnosed exfoliation glaucoma patients. This was a prospective cohort study. This study included only patients who were newly diagnosed with exfoliation glaucoma and received treatment upon inclusion. Blood samples were taken from all patients at inclusion to test for the single nucleotide polymorphisms (SNPs) LOXL-1 rs2165241 and rs1048661. This study found that the frequency of SNPs, as well as intraocular pressure (IOP), mean deviation (MD), and visual field index (VFI) values at diagnosis, were significant predictors of visual field deterioration (p ≤ 0.001). This study showed that interaction terms, including SNPs, were highly significant (p ≤ 0.001). Furthermore, logistic regression analysis also showed highly significant results for interaction terms when SNPs were included (p ≤ 0.001). Finally, the area under the curve (AUC) analysis showed an increased value of around 10-20% when SNPs were included. Adding genetic factors to the well-known clinical risk factors can increase the accuracy of models for predicting visual field deterioration in exfoliation glaucoma patients. However, further studies are needed to investigate the role of other genes in this process.

Quantitative Assessment of Visual Field Recovery Following Transspheniodal Pituitary Adenoma Excision and its Time Course

Background: Pituitary adenomas are a significant subset of intracranial tumors, constituting approximately 10-15% of all primary brain tumors. These benign tumors often lead to various clinical symptoms, including hormonal imbalances and visual field defects due to optic chiasm compression. The transsphenoidal approach for pituitary adenoma excision is favored for its minimal invasiveness and favorable outcomes. However, the timeline and extent of visual field recovery post-surgery remain areas of active research. Objective: This study aimed to quantitatively assess and track visual field recovery in patients following transsphenoidal pituitary adenoma excision and to identify factors influencing the recovery process. Methods: This descriptive observational study was conducted at the Department of Neurosurgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from June 16, 2023, to March 31, 2024. Forty-six consecutive patients, aged 18-70 years, who underwent transsphenoidal pituitary adenoma excision and had documented visual field impairments, were included. Exclusion criteria were previous pituitary surgery, pre-existing visual field abnormalities not attributable to pituitary adenoma, and inability to perform visual field testing. Preoperative visual field measurements were taken within two weeks before surgery using Humphrey visual field testing. Postoperative evaluations were performed immediately after surgery (within 48 hours), and at one month, two months, and three months. Visual field indices, including mean deviation (MD) and pattern standard deviation (PSD), were recorded. Data were analyzed using SPSS version 25, with descriptive statistics for patient demographics and tumor characteristics, and inferential statistics (Student's t-test and chi-square test) for comparing visual field indices. Results: The study included 23 male and 23 female patients, with a mean age of 52.3 years (SD ± 8.7). Tumor size averaged 2.7 cm (SD ± 0.9). Non-functioning tumors comprised 65.2% of cases. Preoperative hormonal dysfunction was present in 39.1% of patients. Preoperative visual field indices showed a mean MD of -5.2 dB (SD ± 2.1). Visual field improvement was noted postoperatively, with mean MD values of -4.0 dB (SD ± 1.8) at 48 hours, -3.5 dB (SD ± 1.7) at one month, -2.8 dB (SD ± 1.5) at two months, and -2.2 dB (SD ± 1.3) at three months. Endoscopic surgery was performed in 82.6% of cases, with a gross total resection rate of 69.6%. Postoperative complications included CSF leaks (13%) and hypopituitarism (26.1%). Conclusion: The study demonstrated significant visual field recovery in patients following transsphenoidal pituitary adenoma excision, with notable improvements observed within the first three months post-surgery. These findings support the efficacy of the transsphenoidal approach in improving visual outcomes and highlight the importance of early intervention and comprehensive postoperative monitoring.

Assessment of glaucoma severity and deterioration by using Spaeth/Richman contrast sensitivity (SPARCS) and its correlation with retinal nerve fiber layer thickness and perimetry.

To assess the severity of glaucoma and its worsening using Spaeth/Richman contrast sensitivity (SPARCS). To evaluate its correlation with retinal nerve fiber layer thickness (RNFL) and perimetry. In this prospective observational study, 90 eyes of primary open-angle glaucoma were categorized into mild, moderate, and severe glaucoma (30 each). All eyes were subjected to contrast sensitivity measurements by using the Pelli-Robson (PR) chart and SPARCS, Humphrey automated perimetry, and optical coherence tomography (OCT) RNFL, along with routine ophthalmological evaluation at baseline. Contrast sensitivity was repeated at 1, 3, and 6 months. Other investigations were repeated at 6 months. The correlation between contrast sensitivity and other parameters was analyzed at baseline and 6 months. Total SPARCS showed a significant positive correlation with visual field index, pattern standard deviation, mean deviation, OCT RNFL, and a negative correlation with best corrected visual acuity. Central SPARCS and PR scores exhibited strong positive correlations. Both total and quadrantic SPARCS significantly reduced from mild to moderate to severe glaucoma. The quadrant-wise SPARCS also correlated well with opposite-side RNFL thickness. At 6 months, SPARCS showed a significant reduction along with RNFL measurements preceding any significant changes in visual field parameters. This study establishes SPARCS as a reliable and reproducible tool in assessing the deterioration of visual function in glaucoma patients even before significant perimetric changes. The specific relationship of quadrantic SPARCS with opposite-side RNFL is a novel yet expected finding. The findings advocate integrating SPARCS into routine glaucoma assessment for timely detection of any worsening and prompt intervention, improving the visual outcomes in these patients.

Phacoemulsification in angle-closure glaucoma: A 360° evaluation.

To evaluate the effect of phacoemulsification on intraocular pressure (IOP) and anterior chamber angle (ACA) morphology in primary angle-closure glaucoma (PACG). A hospital-based, prospective pre- and post-interventional study was carried out in 40 PAC and PACG eyes post patent PI with visually significant cataracts. All patients underwent phacoemulsification and were evaluated for IOP control, ACA widening, and disease progression for a minimum of 6 months. Failure was defined as an IOP of >21 mmHg necessitating another intervention, including trabeculectomy and/or an increase in the required number of antiglaucoma medications (AGMs) by >1. A highly statistically significant reduction of IOP ( P < 0.0001) was seen with an overall reduction of 42.2% over 6 months and a mean reduction of 8.9 ± 3.59 mmHg, with the requirement of AGMs reducing from 39/40 patients preoperatively to 1/38 postoperatively. Success was seen in 95% of cases, with two patients not achieving target IOP and requiring trabeculectomy. Angle widening was documented in all cases by both gonioscopy and AS-OCT, and none of the patients showed any progression in disc damage and visual field changes. Early cataract surgery in ACG not only helps to control IOP and disease progression by widening angles and improving aqueous outflow but also improves visual acuity and reduces the economic burden of AGMs. It also helps in better evaluation of disease progression by both structural and functional analysis, as was documented by the improved and more reliable visual field indices.

High-intensity interval training in patients with glaucoma (HIT-GLAUCOMA): protocol for a multicenter randomized controlled exercise trial.

Glaucoma stands as a prominent global cause of irreversible blindness and the primary treatment approach involves reducing intraocular pressure (IOP). However, around one-third of patients exhibit disease progression despite effective IOP reduction. Microvascular endothelial function, chronic inflammation, and oxidative stress are known to affect retinal neuronal networks and have been associated with disease severity and progression. Exercise training has the potential to counteract these mechanisms as add-on treatment to usual care. The HIT-GLAUCOMA study will investigate the effects of a 6-month high-intensity interval training (HIIT) on intermediate endpoints such as local retinal microvascular and systemic large artery function, inflammation, and oxidative stress as well as clinical endpoints such as visual field indices, optic nerve rim assessment, retinal nerve fiber layer thickness, IOP, number of eye drops, vision-related quality of life and ocular surface disease symptomatology. The study is a multi-center randomized controlled clinical trial in patients with both normal tension and high-tension primary open angle glaucoma. Across two study centers, 128 patients will be enrolled and randomized on a 1:1 basis into an exercise intervention group and a usual care control group. The primary microvascular endpoints are retinal arteriolar and venular flicker light-induced dilation at 6months. The primary endpoint in the systemic circulation is brachial artery flow-mediated dilation at 6months. We hypothesize that exercise therapy will improve retinal microvascular function and thus ocular blood flow in patients with glaucoma. As clinical outcomes, we will investigate the effect of exercise on visual field indices, optic nerve rim assessment, retinal nerve fiber layer thickness, IOP, number of eye drops, vision-related quality of life and ocular surface disease symptomatology. HIT-GLAUCOMA is a blueprint trial design to study the effect of exercise training on neurodegenerative and cardiovascular diseases. Importantly, patients are also expected to benefit from improvements in general health and cardiovascular co-morbidities. If proven effective, exercise may offer a new add-on treatment strategy to slow glaucoma progression. The trial is registered at Clinicaltrials.gov under the identifier NCT06058598 and is currently in the recruitment stage.

Preliminary clinical observation and analysis of structural changes of optic nerve head in glaucoma patients after visual training

Objective: To investigate the effect of virtual reality visual training on remodeling optic nerve structures of glaucoma patients and analyze the influencing factors of visual training effect. Methods: A prospective non-randomized controlled trial was conducted. Glaucoma patients who presented to the Department of Ophthalmology, Beijing Shijitan Hospital between October 2021 and October 2022 were collected and divided into the training group or the control group according to their intentions. The training group accepted 3 months of visual training, while the control group did not. Optical coherence tomography was used to examine the disc edge area, cup volume, disc area, cup-to-disc ratio, and other parameters of the optic disc of both eyes of the patients at enrollment and after 3 months, and the changes of each parameter in the two groups were analyzed. Multivariate analysis was performed in the training group to investigate the effects of sex, age, visual field index, and mean defect on visual disc structure changes during visual training. Results: A total of 53 glaucoma patients (101 eyes) were included in the final analysis, among which the training group consisted of 27 cases (51 eyes), with 19 males and 8 females, and the age range was 48.0 (40.0, 61.0) years old. The control group comprised 26 cases (50 eyes), with 26 males and 11 females, and the age range was 54.0 (38.0, 63.0) years old. Compared with the control group, the deviation of cup volume was -0.006(-0.050, 0.015)mm3 (P<0.05), and the deviation of disc edge area was 0.00(-0.04, 0.05)mm2 (P<0. 05)in the visual training group after 3 months of visual training. The gender (OR=4.217, 95%CI=1.188-14.966) may be the influence factor of rim area. While,the mean defect (OR=1.526, 95%CI=0.245-9.491) was not that influential on rim area change. Conclusions: Visual training can increase the disc area and decrease the optic cup volume of the optic nerve in glaucoma patients. The rim area may be increased more easily after visual training in male glaucoma patients.

Clinical efficacy of dexamethasone parabulbar injection in patients with Nonarteritic anterior ischemic optic neuropathy

BackgroundNonarteritic anterior ischemic optic neuropathy (NAAION) is a common optic neuropathy that often leads to significant visual acuity loss in patients. The present study evaluated the effects of parabulbar dexamethasone injection on visual outcomes in patients with NAAION. MethodsThis retrospective case-control study included patients diagnosed with NAAION between January 2019 and December 2022. Thirty-four patients with NAAION (34 eyes) received dexamethasone parabulbar injections, while 39 patients with NAAION (39 eyes) received oral corticosteroid treatment (control group). Best-corrected visual acuity (BCVA), visual field (VF) defect, and retinal nerve fiber layer (RNFL) thickness of the affected eye were compared between groups at baseline and 2, 6, and 12 weeks post-treatment. ResultsMean BCVA significantly improved after 6 and 12 weeks in the injection groups compared with the control group (all P < 0.01). The visual field indices, mean deviation and pattern standard deviation significantly improved in the injection group compared with the control group after 2, 6, and 12 weeks (all P < 0.01). The RNFL showed a remarkable decrease in edema after 6 weeks (superior and nasal P values 0.005 and 0.013, respectively) in the injection group compared with the control group. Significant RNFL thinning was also observed in superior, inferior, temporal, and nasal quadrants in the control group after 12 weeks (all P values < 0.01). Also, fewer side effects were observed in the injection group compared to the control group. ConclusionsThe results of this study suggested that dexamethasone parabulbar injection might be a safe and effective intervention for relieving visual acuity and VF in patients with NAAION.