Journal of Glaucoma最新文献

Prcis: This case-control study investigated the effect of atrial fibrillation (AF) on the progression of glaucoma. The presence of AF and related microvascular damage was associated with a slightly faster visual field loss in glaucoma patients.

Purpose: To investigate the effect of atrial fibrillation (AF) on glaucoma progression.

Methods: In this longitudinal case-control study, a total of 144 eyes from 105 patients with primary open angle glaucoma were included. Forty-eight eyes of case developed AF during the follow-up followed for 15.6 years. Ninety-six eyes of control that did not have AF at baseline or during follow-up matched for age, baseline glaucoma severity, and follow-up period were followed for an average of 14.7 years. Mixed-effects linear models were used to calculate the difference in the VF MD slopes before and after the AF. CHADS 2 and CHA 2 DS 2 -VASc scores were used to evaluate the risk of thrombosis event, and related microvascular damage was assessed based on these scores.

Results: The rate of VF MD change was -0.20 (-0.42 to 0.02) dB/y before AF and -0.28 (-0.47 to -0.09) dB/y after AF for the patients with AF, and -0.21 (-0.25 to -0.17) dB/y for the control. In the multivariable models, the VF slope difference before and after the onset of AF [-0.10 (-0.14 to -0.05) dB/y, P <0.001], higher CHADS 2 score [-0.07 (-0.13 to 0.00) dB/y per 1 unit, P =0.040], and higher CHA 2 DS 2 -VASc score [-0.05 (-0.10 to 0.00) dB/y per 1 unit, P =0.039] were associated with faster VF MD loss.

Conclusions: The presence of atrial fibrillation and related microvascular damage might accelerate visual field loss. This underscores the need for a comprehensive medical history and management of cardiovascular risk factors to mitigate increased VF loss in glaucoma.

Prcis: An objective perimetry method provides four 30-2 style reports in 8 minutes. These comprise sensitivity and delay reports for both eyes. A combined report format shows comparable diagnostic power to 2 forms of automated perimetry.

Purpose: To compare objective perimetry with 2 forms of standard automated perimetry (SAP) in glaucoma.

Methods: The study cohort contained 40 persons with glaucoma (PwG) and 94 normal control subjects. The PwG had both perimetric and preperimetric eyes. Multifocal pupillographic objective perimetry was performed with the objectiveField Analyser (OFA), which independently assesses the visual fields of both eyes concurrently. Its OFA30 test assessed the central ±30 degrees, and the OFA15 test assessed the central ±15 degrees, both providing 30-2 style reports. The OFA tests were repeated 2 weeks apart to assess test-retest variability (TRV). OFA was compared with Matrix and HFA-SITA fast 24-2 threshold testing. Diagnostic power was quantified as the area under the receiver operating characteristic curves (AUROC). Test durations, mean defects, and pattern standard deviations of the 4 tests were compared.

Results: At a median of 4.09±0.02 minutes/eye the OFA tests were quicker than SAP (all P ≤0.0001), 2 minutes/eye if OFA per-region sensitivities and delays are considered separately. The %AUROCs for OFA, Matrix, and HFA were not significantly different, averaging 93±3% (mean±SD) in perimetric eyes, and 73±6% in preperimetric eyes. For moderate to severe fields, OFA TRV was less than the published results for SAP. OFA30 mean defects were significantly correlated between repeats ( r =0.91) and with OFA15 ( r =0.93, both P <0.0001).

Conclusions: OFA provides extra functional measures in the form of per-region delays and between-eye asymmetries. Both the OFA wide-field and macular tests provided comparable diagnostic power to SAP and better TRV in damaged eyes.

Prcis: Peripapillary retinoschisis (PPRS) may bias optical coherence tomography's (OCT) monitoring of glaucoma progression. Its impact on glaucoma still remains uncertain. Only 2 out of the 10 included studies illustrated a correlation between PPRS and glaucoma progression.

Objectives: The frequent use of OCT increased the detection of PPRS, which poses challenges in the follow-up of patients with glaucoma. This systematic review aims to summarize the literature regarding PPRS in glaucoma, exploring its prevalence, impact on disease, and clinical management implications.

Methods: We searched PubMed, Embase, Web of Science, and Scopus with tailored search queries for each platform. All studies had to report PPRS in patients with glaucoma. Exclusion criteria included studies with <10 eyes, studies focusing on schisis outside the disc area, with concomitant retinal or optic nerve lesions, with animals, reviews, studies written in non-English language, and congress abstracts.

Results: Ten studies were included, of which 7 were case-control, one was a cohort study, and 2 were case series.Six studies showed that PPRS often overlapped preexisting retinal nerve fiber layer defects. One study reported that the de novo development of PPRS was more frequent in eyes with glaucoma progression than in eyes without progression.Visual field findings were inconsistent, with just one study (out of 6) showing that patients with glaucoma with PPRS experienced faster visual field deterioration than those without it. Overall, solely 2 studies (out of 7) associated PPRS with faster glaucoma progression.

Conclusions: PPRS biases OCT analysis in glaucoma. Caution is needed against overestimation of retinal nerve fiber layer thickness when PPRS develops and misinterpretation of its resolution as rapid progression. PPRS' exact impact on glaucoma progression remains unclear.

Prcis: In primary open angle glaucoma, the rate of retinal nerve fiber layer thickness decrease was negatively correlated with lamina cribrosa strain, which was associated with intraocular pressure and optic nerve head geometric factors.

Purpose: We hypothesized that the biomechanical deformation of the optic nerve head (ONH) contributes to the progression of primary open angle glaucoma (POAG). This study investigated the biomechanical stress and strain on the ONH in patients with POAG using computer simulations based on finite element analysis and analyzed its association with disease progression.

Methods: We conducted a retrospective analysis that included patients diagnosed with early-to-moderate stage POAG. The strains and stresses on the retinal nerve fiber layer (RNFL) surface, prelaminar region, and lamina cribrosa (LC) were calculated using computer simulations based on finite element analysis. The correlations between the rate of RNFL thickness decrease and biomechanical stress and strain were investigated in both the progression and nonprogression groups.

Results: The study included 71 and 47 patients in the progression and nonprogression groups, respectively. In the progression group, the factors exhibiting negative correlations with the RNFL thickness decrease rate included the maximum and mean strain on the LC. In multivariate analysis, the mean strain on the LC was associated with optic disc radius, optic cup deepening, axial length, and mean intraocular pressure (IOP), whereas the maximum strain was only associated with mean IOP.

Conclusions: In early-to-moderate stage POAG, the rate of RNFL thickness decrease was influenced by both the mean and maximum strain on the LC. Strains on the LC were associated with mean IOP, optic disc radius, axial length, and optic cup deepening. These results suggest that not only IOP but also ONH geometric factors are important in the progression of glaucoma.

Prcis: The microvasculature of the optic disc and macula in eyes with acute primary angle closure and primary angle closure glaucoma was lower across the disease spectrum, but the significant difference was only observed in primary angle closure glaucoma.

Purpose: To assess the microvasculature in the optic nerve head (ONH) and macula across the primary angle closure disease (PACD) spectrum using optical coherence tomography angiography (OCTA).

Materials and methods: OCTA (AngioVue, Fremont, CA) imaging was performed on 122 PACD subjects. Flow area (FA) and vessel density (VD) in the ONH, radial peripapillary capillary (RPC) network, and superficial and deep capillary plexuses of the macula were calculated and compared across the PACD spectrum using linear regression models with generalized estimating equations adjusted for inter-eye correlation.

Results: A total of 234 eyes including 44 primary angle closure suspects (PACS), 93 primary angle closure (PAC), 79 primary angle closure glaucoma (PACG), and 18 PAC with a history of previous acute primary angle closure (APAC) were included in the analysis. Compared with other groups, PACG eyes showed smaller FA in the ONH (1.35±0.02 mm 2 ), RPC (0.78±0.03 mm 2 ), and the superficial retinal layer (1.08±0.03 mm 2 ) (all P <0.05). Lower VD was also observed in the "whole image," "inside disc," and "peripapillary" regions of the ONH and RPC, and the "whole image" and "parafoveal" regions of the retinal layer in the PACG group when compared with other groups (all P <0.05). No significant differences were found for the other groups (all P >0.05). Lower VD in the ONH, RPC, and superficial retinal layer significantly correlated with worse visual field loss in PACG eyes (all P <0.05).

Conclusions: Significant reduction in the microvasculature of the optic disc and macula in PACG suggests that glaucoma development may contribute to lower VD in these regions.

Prcis: Selective laser trabeculoplasty (SLT) and medical therapy groups displayed comparable intraocular pressure (IOP) at most follow-ups. SLT was associated with significantly decreased rates of glaucoma surgeries, antiglaucomatous medications, and ocular adverse effects.

Purpose: To evaluate the efficacy and safety of SLT compared with medical therapy in the treatment of open angle glaucoma (OAG) or ocular hypertension (OHT).

Methods: A systematic search was performed in PubMed, Embase, Cochrane Library and Web of Science databases. Randomized controlled trials (RCTs) comparing SLT with medical therapy were included. We computed mean differences (MDs) or standardized mean differences (STDs) for continuous endpoints and risk ratios (RRs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed with I2 statistics. Software R, version 4.2.1, was used for statistical analyses. Subgroup analyses were performed on treatment-naive patients and on the class of drugs in the medical therapy group.

Results: Fourteen RCTs comprising 1706 patients were included, of whom 936 were submitted to SLT. Medical therapy was associated with a significantly improved IOP at 1 month and a higher proportion of patients achieving ≥20% IOP reduction. There were no significant differences between groups in IOP at 2, 3, 6, and 12 months, IOP fluctuation, rate of eyes at target IOP, visual field, and quality of life. The SLT group exhibited significantly decreased rates of glaucoma surgeries, antiglaucoma medications, and ocular adverse effects.

Conclusions: SLT demonstrated comparable efficacy to medical therapy in IOP control at most follow-ups, along with favorable impacts on critical treatment-related factors. Our findings support SLT as a safe and effective treatment for OAG or OHT.

Prcis: The lamina cribrosa (LC) pores of patients with high-tension glaucoma (HTG) appear to take a more tortuous pathway than the LC pores of patients with non-glaucomatous (NG).

Objective: To compare the LC pore microarchitecture in patients with HTG, normal tension glaucoma (NTG), and NG, by reconstructions of the LC made from tomographic images.

Patients and methods: Spectral domain-optical coherence tomography images of 52 eyes (18 NG, 18 HTG, and 16 NTG) of 29 patients were analyzed. Pores were traced using segmentation software. Pore length, tortuosity, and verticality were the 3 quantitative parameters compared among the 3 groups. Correlation analyses were performed to determine the effects of covariates on the 3 quantitative parameters.

Results: Pore tortuosity in HTG (1.419 ± 0.093) was significantly higher ( P = 0.011) than in NG (1.347 ± 0,034) but did not differ from that of NTG eyes ( P = 0.251). In addition, NTG had significantly shorter pores ( P = 0.005) than NG. No difference in pore tortuosity or verticality was found between NG and NTG ( P = 0.587 and P = 0.120, respectively). Pore verticality and length in HTG eyes did not significantly differ from that of NG eyes ( P = 0.049 and P = 0.033, respectively) and NTG eyes ( P = 0.827 and P = 0.968, respectively). All of the quantitative parameters measured were not correlated with age but were associated with glaucoma severity (Visual Field Index, mean deviation, retinal nerve fiber layer, and ganglion cell complex), except for pore verticality, which was not correlated with retinal nerve fiber layer.

Conclusion: The LC pores of patients with HTG appear to be more tortuous than the pores of patients with NG, and the pores of patients with NTG are shorter than those of patients with NG. Changes in pore parameters appear to be associated with the severity of glaucomatous optic neuropathy.

Prcis: Patients' acceptance of glaucoma therapy was high overall in this study, but lower for surgery than for laser or medical therapy. Fear and cost were the leading reasons why patients declined recommended therapy and they were treatment-specific. Cost was the primary reason for declining medical and laser therapy, while fear was the most common reason for declining surgical therapy.

Purpose: To determine the frequency at which patients newly diagnosed with glaucoma in sub-Saharan Africa (SSA) decline recommended therapy and to characterize the reasons for declining therapy.

Methods: This was a multicenter, cross-sectional study conducted on adult patients at the time of glaucoma diagnosis at 27 centers in 10 countries in SSA. Data collected from the diagnostic encounter included demographics, clinical glaucoma characteristics, treatment recommendations, patient acceptance of therapy, and reasons for declining therapy.

Results: Among 2282 eyes of 1198 patients offered treatment for glaucoma, initially recommended treatment was accepted in 2126 eyes (93.2%). Acceptance of therapy varied with the nature of treatment offered, with medical therapy accepted in 99.2% of eyes, laser therapy in 88.3%, and surgical therapy in 69.3%. The most common reasons cited for declining therapy were fear (42.9%) and cost (41.7%); cost was the primary reason for declining medical and laser therapy, while fear was the most common reason for declining surgical therapy. Most patients declining laser or surgical therapy accepted medical therapy as an alternate therapy (98.1%).

Conclusions: Patients' acceptance of glaucoma therapy was high overall, but lower for surgery than for laser or medical therapy. Most patients who declined laser or surgical therapy accepted medical therapy as an alternate therapy when offered. Educational interventions, sustainable incentives, and other approaches are needed to enhance patient acceptance of glaucoma therapy in this setting, particularly surgery, when needed.

Prcis: We quantified and compared the gaze metrics during target-oriented visual search tasks between glaucoma and healthy controls. On the basis of a mathematical concept we showed that due to glaucoma, focal search becomes prominent over global search.

Purpose: Visual search (VS) which is essential for target identification and navigation is significantly impacted by glaucoma. VS metrics can be influenced by differences in cultural exposure or coping strategies, leading to varying VS patterns. This study aimed to explore and label the pattern of VS based on gaze metrics quantified using eye-tracking technology.

Methods: Twenty-seven glaucoma subjects and 30 healthy controls [median age 51 (14) and 54 (19) y, respectively] underwent a VS experiment during which they had to identify specific targets from real-world images. Eye movements were recorded using a remote eye-tracker and gaze metrics-fixation count (FC), fixation duration (FD), saccade amplitude (SA), and VS time (VST) were computed and compared between the study groups. A Z -score-based coefficient " K " was derived to label the search patterns as global ( K ≤ - 0.1: short FD with long SA), focal ( K ≥+0.1: long FD with short SA), or a combination ( K between ±0.1).

Results: Similar to other ethnicities, Indian glaucoma subjects also exhibited statistically significantly increased FC, FD, and VST ( P =0.01). Healthy controls presented a comparable proportion of focal (47%) and global (42%) search patterns while glaucoma subjects exhibited predominantly focal (56%) than global search patterns (26%, P =0.008).

Conclusions: This study suggests that glaucoma subjects perform more focal searches during active gaze scanning. This change in viewing behavior reflects underlying compensatory strategies adapted for coping with their visual impairments. These search patterns can be influenced by factors such as saliency which requires further investigation.

Prcis: In early pseudoexfoliation glaucoma (PXG), radial peripapillary capillary vessel density (RPC-VD) was reduced nasally, while the retinal nerve fiber layer (RNFL) thinned from the nasal to temporal sectors. Nonglaucomatous fellow eyes demonstrated no RPC-VD or RNFL loss in comparison to the controls.

Purpose: To evaluate peripapillary and macular vessel density (VD) in unilateral early PXG and unaffected fellow eyes compared with healthy controls.

Methods: This cross-sectional study included 28 eyes with PXG and 28 nonglaucomatous, pseudoexfoliation-free fellow eyes of 28 patients, and 28 eyes of 28 healthy participants. All subjects underwent optical coherence tomography angiography (OCTA) imaging. RPC-VD, macular VD, retinal nerve fiber layer (RNFL) thickness, and ganglion cell complex (GCC) thickness were compared among the groups.

Results: The average RPC-VD and RNFL thickness were significantly reduced in PXG eyes compared with both fellow eyes and the control group ( P <0.001-0.002). In fellow eyes, neither RNFL thickness nor RPC-VD parameters differed from controls. In sector-based analysis, RPC-VD loss in the PXG eyes was significant in the nasal-superior, nasal-inferior, superonasal, and inferonasal sectors ( P =0.005-0.031), while RNFL thinning extended from the nasal sectors toward the superotemporal and temporal-superior sectors ( P <0.001-0.014). RPC-VD was strongly correlated with average and all sector RNFL thicknesses ( r =0.402-0.759, P <0.001-0.034). While perifoveal GCC differed from both fellow and control eyes ( P <0.001), there was no significant difference in macular VD parameters among the groups. RPC-VD and RNFL had comparable area under receiver operating curve (AUROC) values in the average and nasal sectors, while RPC-VD had no ability to distinguish PXG from controls in the superotemporal and inferotemporal sectors.

Conclusion: In the early stages of PXG, RNFL parameters mostly appear to have better diagnostic ability than RPC-VD parameters. Fellow eyes in the preclinical stage may not exhibit any RPC-VD and RNFL loss detectable by current OCTA technology.