Journal of Glaucoma最新文献

Prcis: A higher screening tool for obstructive sleep apnea risk (STOP-BANG) score and loud snoring observed breathing interruptions during sleep, hypertension, and wide neck circumference (NC) were individually and in combination associated with high intraocular pressure (IOP) in Koreans aged 40 years and older.

Objective: To evaluate the relationship between IOP and the risk of obstructive sleep apnea (OSA).

Methods: In this population-based, cross-sectional study, we included Korean adults aged 40 years or above recruited between 2019 and 2021. A total of 6315 subjects were included in the Korea National Health and Nutrition Examination Survey Ⅷ database. The risk of OSA was measured by the STOP-BANG questionnaire. The IOPs were measured using a rebound tonometer. Logistic regression was used to analyze the association between IOP quartiles (highest quartile vs lower first to third quartiles) with OSA risk after adjusting for sociodemographic characteristics, lifestyle, and diabetes.

Results: The adjusted odds ratio for high IOP was 1.27 (95% CI: 1.12-1.43) for participants with a STOP-BANG score of 3-8 compared with those with a score of 0-2. Participants with loud snoring observed breathing interruptions during sleep, hypertension, or wide NC had 24%-40% higher odds of high IOP than those without these components. The odds ratio for high IOP in the group with all 4 factors was 2.09 times higher (95% CI: 1.26-3.46) than in the group without these factors.

Conclusions: A higher STOP-BANG score was associated with an increased risk of high IOP in Koreans aged 40 years and older. Furthermore, among the STOP-BANG components, loud snoring observed breathing interruptions during sleep, hypertension, and wide NC were individually and in combination associated with high IOP.

Prcis: The study documents the ability of Elisar-Fast to successfully assess visual field in patients with glaucoma.

Purpose: To compare 2 fast threshold strategies of visual field assessment: SITA-Fast (SF; Humphrey field analyser) and Elisar-Fast (EF; advanced vision analyser) in patients with glaucoma.

Methods: In this cross-sectional observational study, of total 192 subjects, 138 subjects (150 eyes, 80 glaucoma subjects [91 eyes] and 58 healthy controls [59 eyes]) were analysed and included. Each subject underwent 24-2 EF and SF in randomized order with a minimum time interval of 1 hour between tests.

Main outcome measures: Mean test-time, pointwise and sectoral sensitivity, significance of values of mean sensitivity (MS) and global indices (mean deviation [MD] and pattern SD [PSD]) and their correlation.

Results: The mean test-time was 2.59±0.25 and 3.38±0.28 minutes ( P = 0.001) with SF and EF, respectively. Correlation coefficient for pointwise threshold values correlated strongly for both devices (range, 0.70-0.92). The intraclass correlation value of ≥0.8 was observed across all sectors, indicating good reliability. Bland-Altman plot denoted 95% of the data for MS values within limit of agreement. The intraclass correlation values for overall MS, MD, and PSD were 0.916, 0.913, and 0.872, respectively, indicating good reliability. High degree of correlation was observed for MD (r=0.912, P =0.00) and PSD values (r=0.732, P =0.00). Comparison of values indicated a difference of 1.09 dB for MD and 0.06 dB for PSD between both strategies.

Conclusions: A high degree of correlation existed between the global indices and pointwise threshold values. The study documents the ability of EF to successfully assess visual field in patients with glaucoma.

Prcis: Treatment with LBN ophthalmic solution 0.024% reduced IOP by an average of 29.9% and 31.8% in patients with POAG and PXG, respectively, and improved VD in different quadrants in all slabs. Therefore, the importance of LBN in the treatment of glaucoma is likely to be that it increases macular microcirculation, possibly through NO, independent of its IOP-reducing effect.

Purpose: The aim of this study was to investigate the effect of topical latanoprostene bunod 0.024% applied once daily on intraocular pressure and macular vessel density in newly diagnosed primary and pseudoexfoliative open angle glaucoma patients.

Methods: A total of 66 patients with newly diagnosed open angle glaucoma were included in this study (group 1). Thirty-four patients had primary (POAG, group 1A) and 32 patients had secondary (pseudoexfoliative glaucoma, PXG, group 1B) open angle glaucoma. Thirty-two healthy participants (group 2) were included in this single-center, prospective study.

Results: In group 1, the mean IOP decrease in first month of treatment with LBN was 7.7 mm  Hg and IOP change was -30.8%. In the superficial slab, the vessel density (VD) in the superior and nasal quadrants was lower in group 1B compared with group 1A in the first month of treatment ( P =0.038, 0.019, respectively). In the choriocapillaris slab, the VD in the superior quadrant at baseline (before treatment) was statistically lower in both groups compared with the VD in the superior quadrant in the first month of treatment ( P <0.001, for both).

Conclusion: In conclusion, treatment with LBN ophthalmic solution 0.024% reduced IOP by an average of 29.9% and 31.8% in patients with POAG and PXG, respectively, and improved VD in different quadrants in all slabs. Therefore, the importance of LBN in the treatment of glaucoma is likely to be that it increases macular microcirculation, possibly through NO, independent of its IOP-reducing effect.

Prcis: Community-based eye health screenings that incorporated fundus photography and optometric exams in a high-risk NYC population effectively identified a higher than average number of participants that required an in-office glaucoma evaluation.

Purpose: To report glaucoma screening rates and risk factors associated with referral for in-office glaucoma evaluation in the Manhattan Vision Screening and Follow-up Study (NYC-SIGHT).

Methods: In this 5-year, cluster-randomized clinical trial, eligible individuals aged 40 and older were recruited from affordable housing developments and senior centers. Visual acuity with correction, intraocular pressure (IOP) measurements, and nonmydriatic fundus photography were conducted. Images were graded by a glaucoma specialist; those with an abnormal image were referred; those who failed the screening or had an unreadable fundus image were examined by the study optometrist. χ 2 tests and stepwise multivariate logistic regression analyses were conducted to determine factors associated with glaucoma referral.

Results: Totally, 708 participants were screened; 189 (26.6%) were referred for an in-office glaucoma evaluation due to an abnormal optic disc image (n=138) or abnormal optometric exam (n=51). Those referred had a mean age 68.5±11.7 years and were 60% female, 57% Black, and 37% Hispanic. Stepwise multivariate logistic regression showed participants with self-reported glaucoma (OR: 8.096, 95% CI: 4.706-13.928, P =0.000), IOP > 23 mm Hg at the screening (OR: 3.944, 95% CI: 1.704-9.128, P =0.001), or wore prescription eyeglasses (OR: 1.601, 95% CI: 1.034-2.48, P =0.035) had higher odds of being referred for an in-office glaucoma evaluation. Of those referred, 106 (56%) attended, 36 participants (34%) were diagnosed with glaucoma and 38 participants (35.8%) as glaucoma suspects.

Conclusion: Our findings support public health approaches that focus on community-based eye health screenings in high-risk populations and prioritize underserved communities.

Prcis: Automated optic nerve head hemoglobin measurements through change over time in the Globin Individual Pointer (GIP) index, provided by the Laguna ONhE software, can be useful to evaluate structural progression in glaucoma.

Purpose: To assess the performance of automated optic nerve head hemoglobin measurements (ONH Hb) for detection of structural progression in glaucoma patients using event analysis.

Patients and methods: Treated glaucoma patients were included in this cross-sectional study. Two experienced examiners classified patients into progressors and non-progressors (controls) based on serial color retinographies (CR). Progressors were then subdivided in structural changes of the neuroretinal rim (NR) or retinal nerve fiber layer (RNFL). Globin individual pointer (GIP) index, derived from ONH Hb measurements, was calculated for each CR using the Laguna ONhE software. Differences in GIP values, ​​between baseline and last visit CRs, were used to assess structural progression. Sensitivity at a fixed specificity (50%; median GIP difference in controls) and areas under receiver operating characteristic curves (AUROC) were calculated.

Results: Eight-seven eyes (35 progressors and 52 controls) from 64 patients were enrolled. Mean GIP reduction over time was greater in progressors (-13.0±18.6) than controls (-2.9±10.4; P =0.001). In progressors, mean GIP reduction was greater in patients with NR changes (-19.6±19.5) than RNFL changes (-3.1±12.1; P =0.008). GIP difference correctly identified 69% of the progressors (AUROC: 0.66), being 76% of these progressions related to NR changes (AUROC: 0.76) and 57% to RNFL changes (AUROC: 0.52).

Conclusions: The GIP index, based on automated ONH Hb measurements demonstrated good sensitivity to differentiate progressors from controls, especially in cases in which progression was documented through structural NR changes. Using only 2 CRs and event analysis, GIP changes over time can be a useful screening tool to evaluate structural progression.

Prcis: In this meta-analysis, Kahook dual blade (KDB) goniotomy achieved higher rates of surgical success compared with iStent/iStent inject implantation combined with phacoemulsification. KDB goniotomy demonstrated better intraocular pressure (IOP) reduction at month 6 compared with the stent group.

Objective: To compare the outcomes of phacoemulsification combined with either KDB goniotomy (phaco-KDB) or trabecular microbypass stent (iStent and iStent inject) implantation (phaco-Stent).

Methods: A literature search was performed on PubMed, Embase, Web of Science, and Cochrane Library from inception to April 2024. Randomized clinical trials and observational studies that compared KDB goniotomy to the first or second-generation iStent combined with phacoemulsification were included. The main outcome measures were surgical success, mean change in IOP and medication number, and complication rates. Mean differences (MDs) and pooled odds ratios were used to analyze continuous and binary outcomes, respectively.

Results: Fourteen studies were included with a total of 1959 eyes (958 phaco-KDB, and 1000 phaco-Stent including 753 phaco-iStent and 207 phaco-iStent inject). The combined findings showed significantly higher rates of surgical success in the phaco-KDB group versus the phaco-Stent group (odds ratio: 0.68; 95% CI: 0.50 to 0.92; P = 0.01; I2 = 40%), and greater IOP reduction in the phaco-KDB group versus the phaco-Stent group at month 6 (MD: 1.13 mm Hg; 95% CI: 0.43 to 1.83; P = 0.002; I2 = 51%). By month 12, both groups demonstrated similar IOP reduction. Subgroup analysis at month 12 showed greater IOP reduction in the phaco-KDB group versus the phaco-iStent group (MD: 1.69 mm Hg; 95% CI: 0.44 to 2.95; P = 0.008; I2 = 74%). However, compared with the phaco-iStent inject group, there was no significant difference in IOP reduction (MD: -0.72 mm Hg; 95% CI: -3.69 to 2.24; P = 0.63; I2 = 64%). Medication reduction and the incidence of adverse events were comparable between groups.

Conclusion: KDB goniotomy may offer better surgical success compared with Stent implantation when used in combination with phacoemulsification. KDB goniotomy demonstrated better IOP reduction at month 12 compared with iStent. However, iStent inject showed a similar IOP reduction to KDB.

Prcis: Socioeconomic status is a potentially significant, although difficult to isolate, factor in determining glaucoma severity.

Purpose: To analyze the level of glaucoma severity (mild, moderate, or severe) based on demographic factors, including age, gender, ethnicity, insurance profile, and zip code, and to use this data to extrapolate the effect of socioeconomic status (SES) and race on glaucoma severity at the community level in Memphis, TN.

Patients and methods: Totally, 2913 patients from a tertiary care center with 3 clinic locations in Memphis, TN who had been given the diagnosis of primary open angle glaucoma (POAG) through use of the ICD-10 codes for mild (H40.1111, H40.1121, H40.1131), moderate (H40.1112, H40.1122, H40.1132), and severe (H40.1113, H40.1123, H40.1133) POAG between January 2016 and July 2021 were included in this study. Diagnoses were made after a complete glaucoma workup consisting of Snellen visual acuity, applanation IOP measurement, gonioscopy, automated Humphreys visual fields (10-2 and 24-2), and optic nerve OCT. Demographic information, including age, gender, ethnicity, insurance profile, and zip code, was also collected with disease severity for each patient. SES was approximated using zip code-level census poverty data and insurance profiles. Statistical analyses were performed, including descriptive, multivariable ordinal logistic modeling, and stepwise multivariable linear modeling.

Results: Glaucoma severity was shown to increase with poverty rate (OR=1.089, P <0.0071), age (OR=1.030, P <0.0001), male sex (OR=1.374, P <0.0001), and Black race (OR=1.896, P <0.0001). Severity was shown to be decreased in patients with private insurance compared with Medicare (OR=0.895, P <0.093) and those from Shelby County compared with other counties (OR=0.703, P <0.0001).

Conclusions: Our findings indicate that worsening glaucoma severity was associated with higher poverty rates in our patient population. However, isolating socioeconomic status (SES) as an independent factor influencing the incidence and severity of glaucoma remains challenging, given the strong correlation between race and SES.

Prcis: 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.

Purpose: To compare PCMD among normal tension glaucoma (NTG), primary open angle glaucoma (POAG), and healthy controls using optical coherence tomography (OCT) angiography (OCTA).

Materials and methods: The study included 40 POAG, 25 NTG, and 33 healthy controls. All subjects underwent OCT and OCTA testing. The inner annulus and outer annulus PCMD, as well as peripapillary vessel density (VD), were calculated. One-way analysis of variance was used to compare the vascular parameters of the 3 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.

Results: The average and 4 quadrants of the inner annulus PCMD and peripapillary VD in the 2 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 and 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 and 0.622, respectively). Inner inferior PCMD exhibited a moderate correlation with VF MD in both POAG and NTG patients ( r =0.487 and 0.440, respectively).

Conclusion: 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.

Prcis: Guardian education level and frequency of surgical interventions are key determinants of knowledge in primary congenital glaucoma, highlighting the need for targeted educational strategies.

Objective: Management of congenital glaucoma poses unique challenges, particularly concerning the patient guardians' understanding of the condition, which is crucial for treatment adherence and follow-up compliance. This study aimed to assess guardians' knowledge levels and identify the influencing factors.

Methods: This cross-sectional study included 103 guardians of pediatric patients with primary congenital glaucoma. Participants with missing data were excluded from the study. The participants were assessed using a 20-question survey covering various aspects of glaucoma. Descriptive and inferential statistics were used for analysis.

Results: The sample included 96 guardians, primarily females (80.2%). The children's ages varied significantly, averaging ∼44 months (SD = 39.8). The guardians predominantly had secondary education (34.4%) and most were housewives (77.1%). There was a positive correlation between higher education levels and the overall knowledge score of guardians ( P = 0.006). Similarly, the guardian's locality showed a positive correlation with knowledge scores, with urban guardians having higher scores than rural guardians. In addition, there was a positive correlation between the number of surgical operations performed on the child and the guardians' knowledge. For the subtotals, variables such as the child order among siblings and the age of the child showed significant positive correlations, emphasizing the multifaceted influences on guardians' understanding. In the multivariate analysis, the guardian's education level showed a significant positive correlation with the overall score, as did the number of operations performed on the patient.

Conclusions: The study revealed gaps in guardian knowledge, irrespective of educational level or other demographic factors. Guardians' education level and the number of operations performed on the child are critical determinants of guardians' understanding of congenital glaucoma. Traditional approaches to educational interventions may require reevaluation, and there is a pressing need for targeted educational interventions.

Prcis: Younger patient age (coefficient: 0.10, P =0.04) and greater peak IOP during follow-up (coefficient: -0.14, P =0.03), but not baseline optical microangiography parameters, were significantly associated with a faster rate of RNFL loss in mild-moderate PACG.

Purpose: To evaluate the association between optical microangiography (OMAG) measurements and progressive retinal nerve fiber layer (RNFL) loss in primary angle closure glaucoma (PACG).

Methods: In a prospective study, 45 eyes of 30 PACG patients (86 hemifields) with mild to moderate functional damage were longitudinally studied for at least 2 years and with a minimum of 3 optical coherence tomography (OCT) examinations. OMAG imaging was performed at the baseline visit. Effect of clinical parameters (age, sex, presence of systemic diseases, central corneal thickness, mean, peak, and fluctuation of intraocular pressure during follow-up), baseline hemifield mean deviation (MD) and baseline OMAG [quadrant peripapillary and macular perfusion density(PD)] on the rate of RNFL change was evaluated using linear mixed models.

Results: The average (±SD) hemifield MD, RNFL thickness, peripapillary PD and macular PD of the analyzed quadrants at baseline were -6.0±3.4 dB, 89±21 µm, 40.1±3.5%, and 29.6±10.3%, respectively. The rate of quadrant RNFL change was -2.5±1.7 µm/year. Multivariate mixed models showed that younger patient age (coefficient: 0.10, P =0.04) and higher peak IOP during follow-up (coefficient: -0.14, P =0.03) were significantly associated with a faster rate of RNFL loss.

Conclusions: Younger patient age and greater peak IOP during follow-up were significantly associated with a faster rate of RNFL loss in PACG patients with mild to moderate severity of functional damage. None of the OMAG parameters at baseline were associated with RNFL thinning suggesting a limited role of OCTA imaging in predicting structural progression in mild-moderate PACG.