Journal of Glaucoma最新文献

Abstract: There are several ongoing, worldwide clinical trials with a cumulative target enrollment of over 1300 participants on the role of nicotinamide (a specific form of vitamin B3) as a therapeutic neuroprotective treatment for glaucoma. We describe a serious adverse event of drug-induced liver injury (DILI) likely related to the use of 3 g/day nicotinamide in a glaucoma clinical trial (clinicaltrials.gov identifier: NCT05695027) based in the United States. This report is important to share with the medical community, as other participants in glaucoma nicotinamide trials globally may have similar adverse events and many patients are using nicotinamide as a health supplement without medical supervision. We recommend that investigators, physicians, and patients remain vigilant about DILI as they seek novel vision-preserving neuroprotective therapies.

Prcis: Intraluminal 3-0 Supramid stent placement can be an effective long-term solution for hypotony after glaucoma drainage device surgery. This procedure may obviate the need for conjunctival dissection. In some cases, additional procedures are required.

Purpose: To describe the utility of implantation of a multifilament polyamide suture (Supramid) in the tube lumen to reverse hypotony after glaucoma drainage device (GDD) surgery.

Patients: Patients who underwent tube revision with intraluminal placement of a 3-0 Supramid stent, with or without external ligature, to manage hypotony following GDD surgery between January 2010 and October 2020.

Methods: Resolution of hypotony was defined as IOP >5 mm Hg and the absence of hypotony-related structural abnormalities. Overall success was the absence of failure criteria (IOP ≤5 mm Hg, >21 mm Hg, or <20% reduction below baseline IOP after 3 months for 2 consecutive study visits; additional glaucoma surgery; or loss of light perception), with or without adjunctive ocular hypotensive therapy.

Results: Nine eyes of 9 patients underwent placement of a 3-0 Supramid stent with a resolution of hypotony in all eyes with a mean follow-up duration of 33.3 ±24.0 months. Overall success was achieved in 7 of 9 eyes. Four eyes required intervention after stent placement: 1 eye required selective laser trabeculoplasty followed by replacement of the original stent with a shorter 3-0 Supramid suture and external ligature; 1 eye underwent revision for tube exposure; and 2 eyes underwent laser suture lysis to release an external suture ligature.

Conclusions: In cases of hypotony after GDD, particularly when it is desirable to reduce the extent of additional conjunctival dissection, intraluminal placement of a 3-0 Supramid stent via an intracameral approach can be an effective long-term solution. Postoperative adjustments were required in many cases.

Precise: Glaucoma patients who had previously been evaluated by eye care professionals at lower-level facilities possessed limited awareness and knowledge about their condition upon presentation to a tertiary care ophthalmic hospital, highlighting the need for improved patient education throughout the health care system.

Purpose: To investigate the depth of knowledge about glaucoma among patients who were referred to a tertiary eye hospital for their first visit.

Material and methods: An internally-designed questionnaire (scored 0-15) assessing patients' knowledge about glaucoma was administered at a glaucoma outpatient service. Patients were divided into normal, high-risk, and glaucoma groups based on comprehensive eye evaluation. Scores were analyzed by regression models. The relationship between glaucoma awareness and the stage of disease at presentation was explored.

Results: One hundred and thirty patients were enrolled and divided into three groups. The group with definitive diagnosis of glaucoma had the most prior medical visits but scored the lowest, with the primary source of information being previous health care providers. The high-risk group possessed more knowledge about glaucoma than the other groups and tended to acquire knowledge from the media and sought tertiary care earlier. Significant differences were observed between the glaucoma and the high-risk groups in all aspects of glaucoma knowledge (P < 0.05). Additionally, the average scores of all participants who had visited lower-level facilities were low. Education, economic status, presence of risk factors for glaucoma positively correlated with awareness and knowledge, whereas age had an inverse relationship (all P < 0.05). Ophthalmic visit frequency had no impact (P > 0.05). Doctors were the primary source of information for all groups, but social media users were better informed.

Conclusions: Patients at tertiary eye care centers lack glaucoma knowledge, despite experience with eye care providers previously. Implementing health education at all levels is crucial in preventing glaucoma-related visual impairment.

Purpose: Glaucoma is a leading public health concern globally. This summary discusses barriers to glaucoma screening and novel strategies for a cost-effective glaucoma screening.

Methods/results: We discuss barriers to glaucoma screening and recent advancements in glaucoma detection and care, including targeted screening approach as well as telemedicine, genetic testing, and artificial intelligence (AI). A major barrier to glaucoma screening is the cost-effectiveness of case finding resulting from the low prevalence of the disease and the complexity of the diagnosis. Targeted-screening, as well as multi-level screening, can reduce the false positive rate and increase the cost-effectiveness of the program. Telemedicine, availability of genetic testing and polygenic risk scores, and AI provide the opportunity for novel glaucoma screening programs in primary care, portable, and home-based settings and will be helpful for lowering the costs, identifying patients in need of urgent treatment and enabling timely diagnosis and early intervention.

Conclusions: Screening of glaucoma is challenging and changing. Recent advancements in digital technology and genetics have led to the development of tools that are promising for novel screening methodologies. Clinical trials are needed to demonstrate the long-term effect of targeted screening on the burden of glaucoma worldwide.

Prcis: This systematic review and meta-analysis found that 360-degree selective laser trabeculoplasty (SLT) is significantly more effective than 180-degree SLT at reducing intraocular pressure at 1-month and 1-year follow-ups without increased serious adverse event risk.

Purpose: To determine the efficacy of 180- versus 360-degree selective laser trabeculoplasty (SLT) in adults with open angle glaucoma (OAG) and ocular hypertension (OHT).

Methods: A systematic review was performed using PubMed, Embase, and Scopus databases, from 1995 to December 30, 2023, for studies comparing 180 and 360-degree SLT in adults with OAG and OHT (PROSPERO ID: CRD42024497832). Meta-analyses were performed to calculate nominal percent and raw reductions in intraocular pressure (IOP) between treatment groups at 1-month, 1-year, and 2-year follow-ups, as well as success rates, defined as a 20% or greater IOP reduction.

Results: Nine studies with 1044 eyes were included; 491 received 180-degree SLT, and 553 received 360-degree SLT. At the 1-month follow-up, 360-degree SLT reduced IOP by 3.45% more (WMD=3.45; 95% CI: 2.02-4.88; P <0.00001) and 0.87 mm Hg more (WMD=0.87; 95% CI: 0.35-1.38; P =0.0010). At the 1-year follow-up, 360-degree SLT reduced IOP by 4.33% more (WMD=4.33; 95% CI: 2.35-6.32; P <0.0001) and 1.15 mm Hg more (WMD=1.15; 95% CI: 0.25-2.04; P =0.01). At 2 years of follow-up, 360-degree SLT reduced IOP by 4.86% more (WMD=4.86; 95% CI: -0.32, 10.0; P =0.07) and 1.25 mm Hg more (WMD=1.25; 95% CI: -0.29, 2.79; P =0.11); however, the difference was not statistically significant. Compared with 360-degree SLT, 180-degree SLT had a significantly lower success rate (OR=0.50; 95% CI: 0.35-0.72; P =0.0002). There was no difference in serious complications between interventions.

Conclusions: 360-degree SLT is more effective than 180-degree SLT at lowering IOP at 1-month and 1-year follow-ups as well as achieving successful IOP control without increased risk of serious complications.

Purpose: To provide an overview of novel technologies in telemedicine and artificial intelligence (AI) approaches for cost-effective glaucoma screening.

Methods/results: A narrative review was performed by summarizing research results, recent developments in glaucoma detection and care, and considerations related to telemedicine and AI in glaucoma screening. Telemedicine and AI approaches provide the opportunity for novel glaucoma screening programs in primary care, optometry, portable, and home-based settings. These approaches offer several advantages for glaucoma screening, including increasing access to care, lowering costs, identifying patients in need of urgent treatment, and enabling timely diagnosis and early intervention. However, challenges remain in implementing these systems, including integration into existing clinical workflows, ensuring equity for patients, and meeting ethical and regulatory requirements. Leveraging recent work towards standardized data acquisition as well as tools and techniques developed for automated diabetic retinopathy screening programs may provide a model for a cost-effective approach to glaucoma screening.

Conclusion: Leveraging novel technologies and advances in telemedicine and AI-based approaches to glaucoma detection show promise for improving our ability to detect moderate and advanced glaucoma in primary care settings and target higher individuals at high risk for having the disease.

Prcis: A large disk, a large parapapillary delta zone and a long axial length may be used as screening criteria to detect glaucomatous optic neuropathy in highly myopic eyes.

Purpose: To describe aspects for screening of glaucomatous optic neuropathy in dependence of refractive error, under special consideration of high myopia.

Methods/results: Studies on the anatomy of the myopic optic nerve head and results of investigations on the relationship between glaucomatous optic neuropathy and axial myopia were included.

Conclusions: In the range from hyperopia to moderate myopia, refractive error is not a strong glaucoma risk factor and may not be included in glaucoma screening strategies. Care should be taken, that in moderate myopia, a shift of Bruch´s membrane opening usually into the temporal direction leads to parapapillary gamma zone and a corresponding shortening of the horizontal disk diameter. In these moderately myopic eyes, a secondarily small optic disk with a correspondingly small optic cup should not lead to an overlooking of intrapapillary glaucomatous changes. Prevalence of glaucomatous or glaucoma-like optic nerve atrophy (GOA) steeply increases with longer axial length in highly myopic eyes (cutoff approximately -8 diopters/axial length 26.5 mm), with prevalences higher than 50% in extremely high myopia. Besides longer axial length, morphological parameters associated with GOA in highly myopic eyes are a secondarily enlarged disk and large parapapillary delta zone. Both parameters, together with long axial length, may be used as screening criteria in high myopia for GOA. The latter is characterized by an abnormal neuroretinal rim shape, that is, vessel kinking close to the intrapapillary disk border. Factors associated with nonglaucomatous optic neuropathy are larger gamma zone and longer axial length, potentially due to an axial elongation-related retinal nerve fiber stretching.

Intraocular pressure is currently the only known reliable, modifiable risk factor for the development and progression of glaucoma. Other risk factors for glaucoma include increasing age, myopia, decreased central corneal thickness, and low corneal hysteresis (CH) measurements. Photoablative keratorefractive surgery including laser assisted in situ keratomileusis (LASIK) has become a common way to treat refractive error, with over 25 million procedures performed in the United States alone. Though myopic LASIK has been associated with a decrease in CH measurements, relatively little is known about the risk of LASIK on glaucoma onset and progression. Here we present an observational study of 4 consecutive relatively young and otherwise healthy glaucoma patients with a history of myopic LASIK who showed progression of paracentral visual field deficits at intraocular pressures of 12 mm Hg or less while being carefully monitored. Therefore, these patients required lower targets of intraocular pressure, in the single-digit range, to slow or halt progression. In this cohort, the average corneal hysteresis was more than 2 standard deviations below normal values. This series suggests that additional study into the association of LASIK and glaucoma is warranted, including the potential risk contribution of diminished CH. These studies may be particularly relevant as patients who underwent LASIK procedures in the early 2000s may now be at increased risk of glaucoma due to the risk factor of age.

Prcis: Machine learning classifiers are an effective approach to detecting glaucomatous fundus images based on optic disc topographic features making it a straightforward and effective approach.

Study design: Retrospective case-control study.

Objective: The aim was to compare the effectiveness of clinical discriminant rules and machine learning classifiers in identifying glaucomatous fundus images based on optic disc topographic features.

Methods: The study used a total of 800 fundus images, half of which were glaucomatous cases and the other half non-glaucomatous cases obtained from an open database and clinical work. The images were randomly divided into training and testing sets with equal numbers of glaucomatous and non-glaucomatous images. An ophthalmologist framed the edge of the optic cup and disc, and the program calculated five features, including the vertical cup-to-disc ratio and the width of the optic rim in four quadrants in pixels, used to create machine learning classifiers. The discriminative ability of these classifiers was compared with clinical discriminant rules.

Results: The machine learning classifiers outperformed clinical discriminant rules, with the extreme gradient boosting method showing the best performance in identifying glaucomatous fundus images. Decision tree analysis revealed that the cup-to-disc ratio was the most important feature for identifying glaucoma fundus images. At the same time, the temporal width of the optic rim was the least important feature.

Conclusions: Machine learning classifiers are an effective approach to detecting glaucomatous fundus images based on optic disc topographic features and integration with an automated program for framing and calculating the required parameters would make it a straightforward and effective approach.