Visual Field Mean Deviation Research Articles

Long-Term Blood Pressure Variability and Visual Field Progression in Glaucoma.

Long-term variability of blood pressure may be associated with visual field (VF) progression in patients with glaucoma. To investigate the association between blood pressure parameters and VF progression over time in patients with glaucoma. This retrospective cohort study of longitudinal data included patients with suspected or confirmed glaucoma who were selected from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Patients underwent blood pressure and VF testing from November 2000 to December 2022, and data were analyzed in October 2023. Suspected or confirmed glaucoma. Mean and SD values of blood pressure variables were calculated for systolic and diastolic arterial pressures. These parameters were incorporated into multivariable mixed-effect models to investigate the association between blood pressure parameters and mean intraocular pressure with rates of VF mean deviation loss. Interaction terms between blood pressure parameters and mean intraocular pressure were also included in the models. A total of 1674 eyes from 985 patients were assessed (mean [SD] age, 61.2 [0.4] years; 563 female [57.2%]). The mean rate of VF mean deviation change was -0.13 (95% CI, -0.16 to -0.10) dB/y over a mean follow-up of 8.0 (95% CI, 7.7-8.2) years. The interaction terms of higher mean blood pressure and higher SD of blood pressure were associated with faster annual mean deviation changes for both mean arterial pressure (0.02 [95% CI, 0.01-0.04] dB/y per 1-mm Hg higher; P = .001) and diastolic arterial pressure (0.02 [95% CI, 0.01-0.03] dB/y per 1-mm Hg higher; P < .001). The interaction term of higher SD of blood pressure and higher mean intraocular pressure was associated with faster annual mean deviation changes for both mean arterial pressure (0.01 [95% CI, 0.00-0.02] μm per 1-mm Hg higher; P = .003) and diastolic arterial pressure (0.01 [95% CI, 0.00-0.01] μm per 1-mm Hg higher; P = .001). In this cohort study, higher mean blood pressure and higher SD of blood pressure were associated with faster VF progression. These findings suggest that long-term variability of blood pressure may be a modifier of the association between intraocular pressure and VF progression in glaucoma.

Enhancing Detection of Glaucoma Progression: Utility of 24-2 Visual Field Central Points vs. 10-2 Visual Fields

PurposeTo test the hypothesis that a summary index derived from the central 12 points of the 24-2 visual field (MD12) could provide complementary information to that provided by the 24-2 visual field (VF) mean deviation (24-2 MD). DesignLongitudinal observational study Participants125 eyes (125 patients) with central damage or moderate to severe glaucoma from the Advanced Glaucoma Progression Study with four or more pairs of 10-2 and 24-2 SITA standard VFs. MethodsBaseline 10-2 and 24-2 VF dates were within six months, and the remaining pairs of VF tests were done in the same session. The MD12 index was calculated by averaging total deviation (TD) values from the central 12 points of 24-2 VF. Simple linear regression of MD against time was used to estimate 24-2 MD, 10-2 MD, and MD12 rates of change (RoC). Progression at the final follow-up visit was defined as a RoC <0 dB/year with p<0.05 for any summary index with confirmation. Main Outcome MeasuresProportion of progressing eyes based on 24-2 MD, 10-2 MD, and MD12 rates of change. ResultsThe average (SD) baseline 24-2 and 10-2 MD were –9.0 ± 6.2 and –8.5 ± 5.4 dB, respectively. The mean follow-up time was 5.7 (±1.6) years. The 3 summary indices were highly correlated at baseline: r (95% CI) =0.62 (0.52-0.74) between 10-2 MD and 24-2 MD, 0.84 (0.78-0.90) between MD12 and 24-2 MD, and 0.86 (0.80-0.92) between 10-2 MD and MD12. The corresponding correlations between RoC were weaker: r=0.41 (0.37-0.45), 0.80 (0.78-0.82), and 0.49 (0.45-0.53). Glaucoma progression was detected in 29 (23.2%), 22 (17.6%), and 23 eyes (18.4%) based on the 24-2, 10-2, and MD12 RoC, respectively; 7 eyes (9.6%) exhibited progression based on MD12 RoC and not with 24-2 MD; only 3 of these eyes progressed according to 10-2. ConclusionsMD12 rates of change and detection rates have a low level of agreement with those of 10-2 and hence do not replace the need for 10-2 VF MD to monitor central damage.

Visual recovery following pituitary adenoma surgery: prognostic value of optical coherence tomography and suprasellar tumour volume

ObjectiveThe aim of this study is to investigate the effects of preoperative parameters such as retinal nerve fiber layer (RNFL) thickness, visual acuity (VA), visual field (VF), and tumour volume on postoperative outcomes in patients with pituitary adenoma. DesignRetrospective study. ParticipantsTwo-hundred and seventy-six eyes from 142 patients were included. MethodsAll patients underwent a comprehensive ophthalmological evaluation both before and 12 months after the surgery. RNFL thickness was analyzed using optical coherence tomography. VF testing was carried out using the automated Humphrey Visual Field Analyzer 3. Two primary visual field (VF) parameters, mean deviation (MD), and pattern standard deviation (PSD), were recorded. Patients were categorized into 2 groups based on their visual field outcomes: the MD recovery group and the nonrecovery group. MD recovery was defined as an MD value greater than −2 dB at the 12-month postoperative follow-up visit. ResultsThe mean BCVA was significantly improved postoperatively compared with the preoperative values (P = 0.001). Preoperatively, the upper, temporal, and inferior RNFL values were significantly higher in patients with normal visual fields compared to those with abnormal visual fields (P = 0.001 for upper and temporal, P = 0.008 for inferior). Preoperative suprasellar tumour volume was found to be lower in the MD recovery group (P = 0.001). Multivariate logistic regression analyses revealed that preoperative inferior RNFL thickness were significantly associated with MD recovery (P = 0.023), and preoperative temporal RNFL thickness were significantly associated with VA recovery (P = 0.047). ConclusionRNFL thickness, VF parameters, and suprasellar tumour volume can serve as important prognostic indicators in patients with pituitary adenoma.

Asymmetric Glaucoma and Corresponding Hearing Impairment.

Background/Objectives: This study aims to explore the potential relationship between unilateral or asymmetric glaucoma and ipsilateral hearing impairment. Methods: In this retrospective study, visual and hearing functions were assessed in patients with unilateral or asymmetric glaucoma. Correlations between retinal nerve fiber layer (RNFL) thickness, visual field mean deviation (MD) values, and pure tone audiometry (PTA) measurements across various frequencies were analyzed to explore potential associations between visual and ipsilateral hearing functions. Differences in PTA values between ears ipsilateral to the more affected glaucomatous eyes and the contralateral ears were studied for statistical significance. Results: Twenty-six patients with unilateral or asymmetric glaucoma were included in the study. Significant differences in hearing thresholds between the ears corresponding to the more severely glaucomatous eyes and the contralateral ears were found at 0.7, 1, 1.5, and 3 kHz (p < 0.05). Additionally, a statistically significant difference was observed in the speech frequencies (0.5, 0.7, 1, 1.5, 2, 3, and 4 kHz) between ears corresponding to glaucomatous or more affected glaucomatous eyes and the contralateral ears (p = 0.016). Furthermore, a moderately positive correlation was found between differences in MD and PTA values at 0.125 kHz (r = 0.50; p = 0.01). Conclusions: This study highlights a potential association between unilateral or asymmetric glaucoma and ipsilateral hearing impairment, particularly at speech-relevant frequencies. These findings underscore the importance of integrated sensory assessment in the management of glaucoma patients, suggesting that early detection and intervention for concurrent hearing loss could enhance overall quality of life.

Longitudinal OCTA vessel density loss in macula and optic nerve head in healthy, glaucoma suspect and established glaucoma eyes.

To examine longitudinal optical coherence tomography angiography (OCTA) changes in macula and optic nerve head (ONH) in healthy, glaucoma suspect (GS) and primary open-angle glaucoma (POAG) eyes. Healthy, GS and POAG eyes from Diagnostic Innovations in Glaucoma Study with ≥2 years follow-up and four visits of macular/ONH OCTA imaging were included. Rates of macular wiVD (whole-image vessel density) and ONH wiCD (whole-image capillary density) changes were calculated for each diagnosis group using join mixed-effect modelling. Differences in wiVD/wiCD change rates across diagnoses were examined through pairwise comparison. Relationships of baseline 24-2 visual field (VF) mean deviation (MD) with wiVD/wiCD change rates were evaluated for POAG eyes. There were 36, 57 and 79 eyes (25, 38 and 50 subjects) in healthy, GS and POAG groups, respectively. Rates of wiVD (range:-0.72 to -0.92 %/year) and wiCD (range:-0.28 to -0.66 %/year) loss were different from zero in all groups (p<0.05). The rates of wiCD loss differed across all diagnosis groups (p<0.001), while wiVD change rates did not increase when comparing healthy to GS eyes (p=0.167). Baseline VF MD showed a significant but modest correlation with the rates of both wiVD and wiCD loss (p<0.05), and the correlation with wiCD change rate was slightly stronger (R2=0.27 vs 0.16). In glaucoma, there is earlier microvasculature loss in the ONH than in the macula. Moreover, ONH VD loss shows a slightly stronger association with baseline VF than macular VD. Observing ONH VD loss with OCTA may help to monitor early glaucoma, which should be confirmed by future larger studies.

Sodium bicarbonate use in the treatment of idiopathic intracranial hypertension.

This retrospective case-control study from 2008 to 2022 aimed to determine the effect of adjunctive sodium bicarbonate (NaHCO3) on treatment outcomes of and side effects of acetazolamide (ACZ) for the treatment of idiopathic intracranial hypertension (IIH). Retrospective data was collected via chart review. 288 eyes of 144 patients with IIH, including those taking ACZ alone (control group, n = 89) vs. ACZ and NaHCO3 (treatment group, n = 56). The primary outcome measure was time to IIH resolution. Secondary outcomes included retinal nerve fibre layer thickness (RNFL), visual field mean deviation (VFMD), visual acuity (VA), discontinuation ACZ, and patient-reported side effects of ACZ. Cox proportional hazards model for the primary outcome yielded a hazard ratio of 0.800, which was statistically insignificant (95% CI, 0.57-1.13; p = 0.200). There was no significant difference between groups when comparing RNFL, VFMD, VA, surgical intervention, or discontinuation of ACZ. The treatment group was more likely to experience side effects from ACZ prior to starting sodium bicarbonate therapy (p < 0.001). Among the treatment group, 92.7% remained on NaHCO3 until IIH resolution, and 9 of 12 (75%) subjects reported significant improvement in ACZ-related side effects. Sodium bicarbonate does not appear to impact treatment outcomes in patients taking acetazolamide for IIH. Sodium bicarbonate may represent a reasonable adjunctive medication to help mitigate acetazolamide-related side effects in this group of patients.

Detecting Glaucoma Worsening Using Optical Coherence Tomography Derived Visual Field Estimates.

Multiple studies have attempted to generate visual field (VF) mean deviation (MD) estimates using cross-sectional optical coherence tomography (OCT) data. However, whether such models offer any value in detecting longitudinal VF progression is unclear. We address this by developing a machine learning (ML) model to convert OCT data to MD and assessing its ability to detect longitudinal worsening. Retrospective, longitudinal study. A model dataset of 70,575 paired OCT/VFs to train an ML model converting OCT to VF-MD. A separate progression dataset of 4,044 eyes with ≥ 5 paired OCT/VFs to assess the ability of OCT-derived MD to detect worsening. Progression dataset eyes had two additional unpaired VFs (≥ 7 total) to establish a "ground truth" rate of progression defined by MD slope. We trained an ML model using paired VF/OCT data to estimate MD measurements for each OCT scan (OCT-MD). We used this ML model to generate longitudinal OCT-MD estimates for progression dataset eyes. We calculated MD slopes after substituting/supplementing VF-MD with OCT-MD and measured the ability to detect progression. We labeled true progressors using a ground truth MD slope <0.5 dB/year calculated from ≥ 7 VF-MD measurements. We compared the area under the curve (AUC) of MD slopes calculated using both VF-MD (with <7 measurements) and OCT-MD. Because we found OCT-MD substitution had a statistically inferior AUC to VF-MD, we simulated the effect of reducing OCT-MD mean absolute error (MAE) on the ability to detect worsening. AUC. OCT-MD estimates had an MAE of 1.62 dB. AUC of MD slopes with partial OCT-MD substitution was significantly worse than the VF-MD slope. Supplementing VF-MD with OCT-MD also did not improve AUC, regardless of MAE. OCT-MD estimates needed an MAE ≤ 1.00 dB before AUC was statistically similar to VF-MD alone. ML models converting OCT data to VF-MD with error levels lower than published in prior work (MAE: 1.62 dB) were inferior to VF-MD data for detecting trend-based VF progression. Models converting OCT data to VF-MD must achieve better prediction errors (MAE ≤ 1 dB) to be clinically valuable at detecting VF worsening.

Two-Year Retrospective Study of Cataract Surgery and Schlemm Canal Hydrus Microstent in Black and Afro-Latino Patients.

The Hydrus Microstent has been shown to be efficacious in the treatment of Open-angle Glaucoma. We previously reported 1-year results of the Hydrus Microstent in Black and Afro-Latino patients. Here we report two-year results of the Hydrus Microstent in Black and Afro-Latino patients with mild to moderate open-angle glaucoma. This was a retrospective, nonrandomized study that was carried out at two private practices in Harlem, NY and Queens, NY. This study consisted of Black and Afro Latino patients who had a Hydrus Microstent implanted for the treatment of glaucoma. The evaluated parameters were intraocular pressure (IOP), reductions in the number of medications, mean deviation on visual field test and visual acuity. We excluded persons with advanced glaucoma and incomplete data. We included those with mild to moderate glaucoma and had complete two-year follow-up data. The study consisted of 86 patients and 86 eyes. The mean age was 69.The mean pre-op IOP was 14.1 on 2.17 medications. At two years the mean IOP was 14 (p = 0.651) on 0.42 medications (p = 0.000003); 88% of patients were medication free (p = 0.651), The MD on the visual field changed little from -5.73 preoperatively to -5.21 at two years. There were 3 intraocular pressure spikes and 1 case of hyphema that were treated and had complete resolution. No patients required secondary surgery. Our results show that at two years the Hydrus Microstent can maintain low intraocular pressures, reduce medication burden and, in aggregate, experienced little change in visual field Mean Deviation in Black and Afro Latino patients with mild to moderate glaucoma.

Optical Coherence Tomography Angiography Analysis of Peripapillary Choroidal Microvascular Density in normal-tension Glaucoma and Primary open-angle Glaucoma.

Glaucoma patients had a reduction in the inner annulus peripapillary choroidal microvascular density (PCMD) that became worse as the glaucoma severity progressed, which might provide new evidence supporting the vascular theory. To compare PCMD among normal-tension glaucoma (NTG), primary open-angle glaucoma (POAG), and healthy controls using optical coherence tomography (OCT) angiography (OCTA). The study included 40 POAG, 25 NTG, and 33 healthy controls. All subjects underwent OCT and OCTA testing. Inner annulus and outer annulus PCMD, as well as peripapillary vessel density (VD), was calculated. One-way analysis of variance was used to compare the vascular parameters of the three groups. Pearson correlation analysis or Spearman correlation test was used to evaluate the correlation between PCMD and glaucomatous severity factors. The spatial positional relationship between PCMD and corresponding peripapillary retinal nerve fiber layer (RNFL) thickness and visual field (VF) mean deviation (MD) was also assessed. The average and four quadrants of the inner annulus PCMD and peripapillary VD in the two glaucomatous groups were significantly lower than in normal eyes (P<0.05). Strong correlations were found between inner annulus PCMD and VF MD, peripapillary VD, and RNFL in POAG patients. Similarly, the inner annulus PCMD in NTG patients was strongly correlated with peripapillary VD and RNFL (all r>0.5). Strong positional correlations were found between inner superior quadrantal PCMD and RNFL thickness in both POAG and NTG patients (r=0.566, r=0.731, respectively). Likewise, inner inferior quadrantal PCMD exhibited a strong correlation with RNFL thickness in POAG patients (r=0.608). Strong positional correlations were also found between inner superior PCMD and VF MD in both POAG and NTG patients (r=0.589, r=0.622, respectively). Inner inferior PCMD exhibited a moderate correlation with VF MD in both POAG and NTG patients (r=0.487, r=0.440, respectively). The study found that the inner annulus PCMD decreased to varying degrees in NTG and POAG patients. The inner annulus PCMD was closely related to the structural and visual function parameters of glaucoma in both NTG and POAG. Furthermore, inner PCMD demonstrated a spatial correlation with corresponding RNFL thickness and VF MD.

Structural Features of Optic Nerve Head in Glaucoma with Single-hemispheric and Bi-hemispheric Visual Field Defects

Purpose: To compare the structural features of the optic nerve head (ONH) in moderate glaucoma patients with single-hemispheric and bi-hemispheric visual field (VF) defects.Methods: Patients with open-angle glaucoma (OAG) and a VF mean deviation between -6 and -12 dB were retrospectively enrolled. Based on VF defect patterns, eyes were classified into two groups: those with single-hemispheric VF defects and those with bi-hemispheric VF defects. Structural features analyzed included Bruch’s membrane opening area, lamina cribrosa (LC) thickness, temporal β-zone parapapillary atrophy with and without Bruch's membrane (βPPA&lt;sub&gt;+BM&lt;/sub&gt;, βPPA&lt;sub&gt;-BM&lt;/sub&gt;, respectively), and peripapillary retinal nerve fiber layer thickness using spectral-domain optical coherence tomography.Results: Out of 137 eyes from 124 patients, 80 eyes had single-hemispheric VF defects and 57 eyes had bi-hemispheric VF defects. The bi-hemispheric group exhibited longer axial length (&lt;i&gt;p&lt;/i&gt; = 0.038), thinner central corneal thickness (&lt;i&gt;p&lt;/i&gt; = 0.003), thinner LC (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), and larger temporal βPPA&lt;sub&gt;+BM&lt;/sub&gt; (&lt;i&gt;p&lt;/i&gt; = 0.002) compared to the single-hemispheric group.Conclusions: Among Korean OAG patients with moderate VF defects, those with bi-hemispheric VF defects showed more structurally vulnerable optic discs characterized by longer axial lengths, thinner central corneal thickness, thinner LC, and larger β PPA+BM compared to those with single-hemispheric VF defects. These findings underline the importance of evaluating ONH structures in monitoring glaucoma progression particularly in patients with extensive VF damage.

Abnormal dynamic features of spontaneous brain activity and their concordance in neuromyelitis optica spectrum disorder related optic neuritis: A resting-state fMRI study

ObjectiveCharacterizing the neuropathological features of neuromyelitis optica spectrum disorder-related optic neuritis (NMOSD-ON) is crucial for understanding its mechanisms. Given the important role of dynamic features in the brain’s functional architecture, we aim to investigate the dynamic features of spontaneous brain activity and their concordance using resting-state functional magnetic resonance imaging (rs-fMRI) in NMOSD-ON. MethodsFourteen NMOSD-ON patients and 21 healthy controls (HCs) underwent rs-fMRI and ophthalmological examinations. Five dynamic indices depicting different aspects of functional characteristics were calculated using a sliding window method based on rs-fMRI data. Kendall’s coefficient was utilized to measure concordance among these indices at each time point. The differences of dynamic features between two groups were evaluated using two-sample t-tests, with correlations explored between altered dynamics and clinical parameters. ResultsCompared to HCs, NMOSD-ON patients exhibited significant decreases in dynamic regional homogeneity (dReHo) and dynamic degree centrality (dDC) in visual regions, including bilateral cuneus, lingual gyrus, calcarine sulcus, and occipital gyrus. Conversely, increases were observed in left insula, left thalamus, and bilateral caudate. The concordance of NMOSD-ON patients was significantly lower than HCs. The dReHo of right cuneus negatively correlated with mean deviation of visual field (r = -0.591, p = 0.026) and the dReHo of left cuneus negatively correlated with disease duration (r = -0.588, p = 0.030). ConclusionThe evidence suggests that regional dynamic functional alterations involving vision, emotional processing, and cognitive control may provide a new understanding of brain changes in the progression of NMOSD-ON.

Are Peripapillary Hyperreflective Ovoid Mass-like Structures with an Elevated Optic Disc Still a Diagnosis Dilemma?

ObjectiveTo identify clinical characteristics that would help make or rule out the diagnosis of Idiopathic intracranial hypertension (IIH) in patients referred for papilledema (PE) with peripapillary hyperreflective ovoid mass-like structures (PHOMS) DesignA retrospective cohort study SubjectsAll patient referred for PE excluding PE with Frisén grade ≥ 3, optic neuritis, ischemic optic neuropathy, compressive optic neuropathy. Patients were divided into 2 groups:Group1= isolated PHOMSGroup2= PHOMS associated with IIH MethodsWe analyzed the location of PHOMS based on OCT-EDI and calculated their volume Main outcome MeasuresP RNFL,GCC, PHOMS’ volume Results154 patients (308 eyes) were included, mean age was 29 with female predominance (78%). PHOMS were associated to these etiologies : IIH(38.3%) isolated (35.7%), posterior uveitis (11%),optic disc drusen (ODD)(10%), and tilted optic disc (5%). An MRI was obtained in 83.1% of cases. More than half of the MRIs were interpreted as consistent with IIH. However, only 39.7% of these patients had confirmed IIH with 44.5% of sensitivity and 55.5% of sensibility. PHOMS were overrepresented in the nasal region (95.5%).The location of PHOMS in the superior and/ or inferior quadrant was significantly associated to IIH or optic dusc drusen, while their presence in the temporal or nasal sector was strongly associated to isolated lesions. PHOMS mean and median volume were 1.66 μm3 and 1.50 μm3 respectively. There was a significant difference in PHOMS volume with higher volume in IIH patients (p=0.0037). Follow up of these patients at 3 and 6 months demonstrated no significant changes in visual function, as per visual field mean deviation, and visual acuity measurements as well as Ganglion cell layer (GCL).Mean pRNFL, showed a decrease of -4.225 μm at 3 months and of –6.489 μm at 6 months, when compared to initial measurement independing of the etiology. ConclusionIsolated PHOMS should be considered as a distinct entity. In asymptomatic patients, PHOMS should be carefully studied. Nasal or temporal location, small volume, stable aspect over the course of weeks or months, are so suggestive of this entity. This strategy would considerably reduce the impact on patients’ anxiety and morbidity.

Emotional State Evaluation of Retinitis Pigmentosa Patients with the Beck Depression Inventory.

To evaluate the incidence and severity of depression in patients with retinitis pigmentosa (RP). The Beck Depression Inventory (BDI) was administered to 74 patients with RP and 60 healthy controls. Biomicroscopic anterior segment and fundus examination, visual field, optical coherence tomography, and full-field electroretinography tests were performed in all cases. Variables were evaluated with bivariate, multiple linear, and ordinal logistic regression analyses. The RP group included 40 (54%) male and 34 (46%) female patients, while the control group included 23 (38%) male and 37 (62%) female subjects. The patient group had a mean age of 39.20±12.4 years, median best corrected visual acuity (BCVA) of 0.10 decimal (1.0 logarithm of the minimum angle of resolution [logMAR]; range, 1.3-0.7 logMAR), and median visual field mean deviation (MD) score of -28.00 decibels (dB) (range, -1.00 to -34.00 dB). The median BDI score was statistically significantly higher in the patient group (19 points) than in the control group (12 points) (p<0.001). Moderate to severe depression (BDI ≥20) was detected in 61% of patients, while this rate was 25% in healthy controls. BCVA and visual field MD values were identified as predictors of depression score and severity level. The patients' age and gender did not affect total depression score or severity. The prevalence and severity of depression were found to be higher in RP patients than in healthy controls. There was a significant relationship between the patient's functional vision tests and the frequency and severity of depression. Depression reduces the reliability of visual function tests and impairs patients' quality of life. Therefore, assessing mental health as well as functional tests is important in patients with RP.

Does the Visual Field Improve After Initiation of Intraocular Pressure Lowering in the United Kingdom Glaucoma Treatment Study?

PurposeEvidence to support the hypothesis that visual field (VF) status can improve after initiation of intraocular pressure (IOP) reducing treatment is controversial. We take advantage of participant eligibility data from the United Kingdom Glaucoma Treatment Study (UKGTS) to test this hypothesis in newly diagnosed glaucomatous patients randomised to IOP lowering therapy or placebo. DesignMulticentre, randomised, triple-masked, placebo-controlled trial. ParticipantsNewly diagnosed open-angle glaucoma patients in the UKGTS with eligibility and baseline data (n = 202 and n = 205 participants from the treatment and placebo groups, respectively). MethodsUKGTS eligibility data, including two reliable VFs (Humphrey 24-2 SITA Standard) and IOP measurements were compared to UKGTS trial baseline data acquired after allocation to treatment (topical prostaglandin analog) or placebo eye drops. Mean change in VF mean deviation (MD) and proportion of eyes that improved MD by more than different thresholds were compared across this interval in the treatment and placebo groups. Secondary analyses included stratifying the groups by level of IOP, level of VF loss and age along with pointwise analyses including change in subsets of VF locations. Main outcome measureMean change in VF MD. ResultsMean (standard deviation [SD]) time between eligibility/baseline visits and reduction in IOP was 12 (3) weeks and 4.8 (4.2) and 1.0 (3.6) mmHg for the treated and placebo eyes, respectively. Mean (SD) change in MD was almost the same for the treated (-0.03 (1.45) dB) and placebo groups (+0.08 (1.72) dB) (P=0.47). Proportion of participants with an MD improvement of 1 dB or more were similar for both groups (P=0.25). No association was found between MD improvement and magnitude of IOP lowering. Stratifying data by IOP, level of VF loss and age did not reveal any differences between the treated and placebo groups and neither did any of the pointwise VF analyses. ConclusionInitial short-term VF changes in the treatment and placebo arms of UKGTS were the same. In these newly diagnosed patients (non-advanced glaucoma) we found no evidence to support the hypothesis that VF status improves after initial lowering of IOP by medical therapy.

Evaluation of Macular Thickness in Glaucoma Patients Using Prostaglandin Analog Eye Drops Undergoing Trabeculectomy with Mitomycin C: Prospective, Comparative, Randomized, Masked Examiner Study

Introduction: The aim of the study was to evaluate the macular thickness of glaucomatous patients undergoing trabeculectomy (TREC) with mitomycin C (MMC) with or without the use of prostaglandin analog (PA) eye drops. Methods: In this prospective, comparative clinical trial, patients with glaucoma and indications for TREC with MMC using PA and without previous macular changes were randomized into 2 groups: the study group (SG) and the control group (CG). In the CG, PA was suspended between 30 and 60 days after the preoperative exams. The subjects were evaluated, including optical coherence tomography (OCT) with the Cirrus 4000 macular protocol preoperatively and in the postoperative period on 3 occasions: 1–3 days (“PO1”), 6–9 days (“PO7”), and 27–30 days (“PO30”) after surgery. The results were compared between groups. Results: Thirty-five eyes of 35 patients were included (17 in the CG and 18 in the SG). There was no statistically significant difference in age (p = 0.2), the preoperative visual field mean deviation (p = 0.08), or the preoperative intraocular pressure (SG: 24.8 ± 7.8 mm Hg vs. CG: 22.8 ± 6.0 mm Hg, p = 0.4). The preoperative macular OCT parameters were equivalent between the groups (p > 0.05). When comparing the variation of parameters between the groups between preop and PO30 there was equivalence in all of the comparisons evaluated. The presence (or absence) of the lens did not affect the results. Conclusion: PA eye drops did not affect macular thickness after TREC with MMC in glaucomatous patients.

Clinical outcomes of radial optic neurotomy versus pars plana vitrectomy in recent onset non-arteritic anterior ischemic optic neuropathy.

This study investigated the effect of pars plana vitrectomy (VIT) versus pars plana vitrectomy combined with radial optic neurotomy (RON) on recent onset non-arteritic anterior ischemic optic neuropathy (NAION). In this prospective interventional case series, individuals with recent-onset NAION, lower than one month and low vision (lower than 20/200) were recruited. Patients randomly underwent either VIT, or RON. 34 eyes of 34 patients were included in this study. 10, 9, and 15 eyes were randomly included in VIT, RON, and control groups, respectively. The BCVA of the VIT group improved significantly from 1.84 ± 0.5 logMAR at baseline to 1.29 ± 0.67, 0.93 ± 0.53, and 0.77 ± 0.47 logMAR at 1, 3, and 6 months, respectively (Ps < 0.05). The corresponding values for RON group were 1.73 ± 0.53 logMAR at baseline, which improved to 1.04 ± 0.65, 0.64 ± 0.28, and 0.61 ± 0.26 logMAR at the same follow-up visit times (P < 0.05).The corresponding values for the control group were 1.6 ± 0.58 log MAR at baseline, which improved to 1.03 ± 0.29, 1.00 ± 0.32, and 0.32 ± 0.83 log MAR at the same follow-up visit times. There was no significant statistical difference in BCVA between the three groups. However, both interventions resulted in statistically significant improvement in mean deviation (MD) of visual field (VF) compared with the control group at the end of 6 months (VIT P = 0.006, RON P = 0.043). RNFLT decreased from baseline 235.3 ± 44.01 to 75.6 ± 17.68 at 1 month in the VIT group (P < 0.001), from baseline 268.22 ± 65.9 to 76.67 ± 10.59 at 1 month in RON (P < 0.001), while it decreased from baseline 179.48 ± 39.02 to 112.92 ± 44.51 at 1 month in the control group. VIT and RON showed promising results in terms of MD of VF, and optic disc edema resolved faster in these groups compared to the control group in recent onset NAION. A larger sample size study is deemed necessary to generalize the results of this study.

Drug-Induced Intracranial Hypertension: The Adverse Effects of Acne Medications and Topical Retinoids.

Tetracyclines and vitamin A derivatives, major components in acne care and antiaging products, have been associated with the development of drug-induced intracranial hypertension (DIIH). Treatment practices and longitudinal visual outcomes have been highly understudied in DIIH. The purpose of this study was to provide management guidelines for DIIH and report visual outcomes of patients with DIIH. This was a single institute ophthalmology center case-control study where patients were seen between June 1, 2012, and September 1, 2023, in the United States. Patients with an International Classification of Disease (ICD) code for IIH and meeting the IIH diagnostic criteria who were taking a tetracycline or a vitamin A derivative during their diagnosis were included in this study. Patients were stratified into the following 3 categories: tetracyclines only, vitamin A derivatives only, or both, and compared with Kruskal-Wallis rank-sum tests. Poor visual outcomes were evaluated for and defined as a visual field mean deviation (peripheral visual measure) of -7 dB or greater. Individuals were followed for up to 1.5 years after diagnosis. Among patients with IIH (n = 839), DIIH occurred in 8.10% of them (n = 68) with 83% taking the medication for acne. 88% of cases were female, and patients had a mean age of 24.96 years. DIIH medications were taken for an average length of 25.79 weeks before diagnosis of IIH. 20.5% of patients with DIIH were not treated with any IIH medication and were discontinued from the inducing drug. 3 patients had a poor visual outcome on follow-up with all of them taking a vitamin A derivative (P < 0.05). Patients identified as having a poor visual outcome did not report discontinuing the DIIH drug (P < 0.05). We propose treatment guidelines highlighting that patients taking a DIIH medication who develop headaches or visual changes should be immediately referred to ophthalmology, removal of the offending agent, and close monitoring by ophthalmology for vision loss. Importantly, vitamin A DIIH may have more severe visual outcomes, but further research is needed to corroborate this finding.

Detection of glaucoma progression on longitudinal series of en-face macular optical coherence tomography angiography images with a deep learning model

Background/aimsTo design a deep learning (DL) model for the detection of glaucoma progression with a longitudinal series of macular optical coherence tomography angiography (OCTA) images.Methods202 eyes of 134 patients with...

Comparison of Retinal Nerve Fiber Layer and Ganglion Cell Complex Rates of Change in Patients With Moderate to Advanced Glaucoma

PurposeTo compare ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL) rates of change (RoC) in eyes with central or moderate to advanced glaucoma. DesignProspective cohort study. Participants918 matched macular and RNFL OCT scan pairs from 109 eyes (109 patients) enrolled in the Advanced Glaucoma Progression Study with ≥2 years of follow-up and ≥4 OCT scans. MethodsWe exported GCC and RNFL thickness measurements in 49 central macular superpixels and 12 RNFL clock-hour sectors, respectively. We applied our latest Bayesian hierarchical longitudinal model to estimate population and subject-specific baseline thickness (intercepts) and rates of change (RoC) in macular superpixels and RNFL sectors. Global RNFL and GCC RoC were analyzed in a single bivariate longitudinal model to properly compare them accounting for the correlation between their RoC. Main Outcome MeasuresProportion of significant negative (deteriorating) and positive (improving) RoC expressed in μm/year. Standardized RoC were calculated by dividing RoC by the corresponding population SD. Analyses were repeated in eyes with visual field mean deviation (MD) ≤–6 and >–6 dB. ResultsAverage (SD) 24-2 visual field MD and follow-up length were –8.6 (6.3) dB and 4.2 (0.5) years, respectively. Global RNFL RoC (–0.70 µm/year) were faster than GCC (–0.44 µm/year) (p<.001); corresponding normalized RoC were not significantly different (p=0.052). In bivariate analysis, patients with a significant negative global RNFL RoC (n=63, 57%) or GCC (n=56, 51%) frequently did so for both outcomes (n=49, 45%). The average proportion of significantly decreasing RNFL sectors within an eye was 30.7% in eyes with MD >–6 dB compared to 20.5% in those with MD ≤–6 dB (p=0.014); the proportions for GCC superpixels were 21.1% vs. 18.7%, respectively (p=0.63). ConclusionsBoth GCC and RNFL measures can detect structural progression in glaucoma patients with central damage or moderate to advanced glaucoma. The clinical utility of RNFL imaging decreases with worsening severity of glaucoma.

Radiologic Predictors of Visual Outcome in Myelin Oligodendrocyte Glycoprotein-Related Optic Neuritis

This study aimed to determine whether magnetic resonance imaging (MRI) biomarkers are associated with visual prognosis in myelin oligodendrocyte protein (MOG)-associated optic neuritis (ON). Cross-sectional analysis. Patients meeting 2023 international diagnostic criteria for MOG antibody-associated disease who were seen for first episodes of MOG-associated ON at 3 tertiary neuro-ophthalmology practices between January 2017 and July 2023 were enrolled. Patients who received < 3 months of neuro-ophthalmic follow-up and did not demonstrate visual recovery (visual acuity [VA] ≥ 20/20 and visual field mean deviation [VFMD] > -5.0 dB) during this time were excluded. Patients underwent contrast-enhanced, fat-suppressed MRI of the brain and orbits within 1 month of symptom onset. The associations between radiologic biomarkers and poor VA outcome (<20/40), incomplete VA recovery (< 20/20), and poor VFMD outcome (VFMD < -5.0 dB) were assessed using multivariable logistic regression adjusting for time from symptom onset to treatment and nadir VA or VFMD. Radiologic biomarkers included length of optic nerve enhancement (> 25% vs. < 25%; > 50%vs.<50%; and >75%vs.< 75%); degree of orbital, canalicular, and intracranial or chiasmal optic nerve enhancement (mild vs. moderate to severe compared with the lacrimal gland); and absence versus presence of optic nerve sheath enhancement on baseline T1-weighted MRI. A total of 129 eyes of 92 patients (median age, 37.0 years [interquartile range, 20.8-51.3 years]; 65.2% female) were included. Poor VA outcome was seen in 6.2% of patients, incomplete VA recovery was seen in 19.4% of patients, and poor VFMD outcome was seen in 16.9% of patients. Compared with eyes with moderate to severe enhancement, eyes with mild orbital optic nerve enhancement were more likely to have poor VA outcome (odds ratio [OR], 8.57; 95% confidence interval [CI], 1.85-51.14; P= 0.009), incomplete VA recovery (OR, 7.31, 95% CI, 2.42-25.47; P= 0.001), and poor VFMD outcome (adjusting for time to treatment: OR, 6.81; 95% CI, 1.85-28.98; P= 0.005; adjusting for nadir VFMD: OR, 11.65; 95% CI, 1.60-240.09; P= 0.04). Lack of optic nerve sheath enhancement additionally was associated with incomplete VA recovery (OR, 3.86; 95% CI, 1.19-12.85; P= 0.02) compared with the presence of enhancement. These associations remained consistent in subgroup logistic regression analysis of MRIs performed before initiation of treatment but were not seen in pairwise analysis of MRIs performed after treatment. In eyes with first MOG-associated ON episodes, milder enhancement in the orbital optic nerve was associated with poorer VA and visual field recovery. Prospective and mechanistic studies are needed to confirm the prognostic usefulness of MRI in MOG-associated ON. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.