Pub Date : 2025-11-01DOI: 10.1016/j.ogla.2025.06.012
Daniel L. Liebman MD, MBA , Grace E. Johnson BA , Anthony Marte MD , David S. Friedman MD, PhD , Michael V. Boland MD, PhD , Tobias Elze PhD , Luo Song PhD , Mengyu Wang PhD , Lucy Q. Shen MD
{"title":"Accuracy of ICD-10 Glaucoma Codes in a Large Academic Practice","authors":"Daniel L. Liebman MD, MBA , Grace E. Johnson BA , Anthony Marte MD , David S. Friedman MD, PhD , Michael V. Boland MD, PhD , Tobias Elze PhD , Luo Song PhD , Mengyu Wang PhD , Lucy Q. Shen MD","doi":"10.1016/j.ogla.2025.06.012","DOIUrl":"10.1016/j.ogla.2025.06.012","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 6","pages":"Pages 643-645"},"PeriodicalIF":3.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study investigated the incidence rates and risk factors for bleb-related infections (BRIs) following mitomycin C (MMC)–augmented filtration surgeries, including trabeculectomy and Ex-Press implantation, in Japanese patients with glaucoma.
Design
Retrospective cohort study.
Subjects
Two thousand ninety-seven eyes from 1508 patients who underwent MMC-augmented filtration surgery between 2008 and 2022.
Methods
We reviewed and extracted the medical records of baseline characteristics, surgical details, and follow-up data. Patients were categorized by surgery type and glaucoma diagnosis. Bleb-related infection cases were categorized by severity and analyzed in terms of demographic and surgical variables. Kaplan–Meier survival analysis was used to estimate the BRI incidence rate, and a Cox proportional hazards model was used to identify influencing factors.
Main Outcome Measures
The cumulative incidence of BRI in all patients who underwent filtration surgery.
Results
In total, 50 eyes with BRI (49 patients; mean age: 52.6 years; 21 eyes from females) were identified, yielding an overall incidence rate of 2.38%. Stage I to III infections were observed in 27, 15, and 8 eyes, respectively. The cumulative incidence of BRI increased over time, with estimated rates of 1.5 ± 0.3% (standard error) at 5 years, 3.8 ± 0.7% at 10 years, and 6.4 ± 1.4% at 14 years. Furthermore, 33 eyes out of 1460 eyes with primary open-angle glaucoma limited to primary surgeries developed BRI. Younger age at surgery was identified as a significant risk factor for BRI (hazard ratio: 0.969 per 1 year; P < 0.001).
Conclusions
This study is the first to show that the risk of BRI continues to increase 10 years after MMC-augmented filtration surgery. When considering filtration surgery, it is important to take into account the patient's age and inform them of the benefits of the procedure and the long-term risk of infection.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
{"title":"Cumulative Incidence of Bleb-Related Infections after Mitomycin C–Augmented Filtration Surgery over 10 Years in Japanese Patients with Glaucoma","authors":"Mitsuki Kambayashi MD , Rei Sakata MD , Asahi Fujita MD , Makoto Aihara MD , Yuko Ohno PhD , Shiroaki Shirato MD","doi":"10.1016/j.ogla.2025.07.001","DOIUrl":"10.1016/j.ogla.2025.07.001","url":null,"abstract":"<div><h3>Purpose</h3><div>This study investigated the incidence rates and risk factors for bleb-related infections (BRIs) following mitomycin C (MMC)–augmented filtration surgeries, including trabeculectomy and Ex-Press implantation, in Japanese patients with glaucoma.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Subjects</h3><div>Two thousand ninety-seven eyes from 1508 patients who underwent MMC-augmented filtration surgery between 2008 and 2022.</div></div><div><h3>Methods</h3><div>We reviewed and extracted the medical records of baseline characteristics, surgical details, and follow-up data. Patients were categorized by surgery type and glaucoma diagnosis. Bleb-related infection cases were categorized by severity and analyzed in terms of demographic and surgical variables. Kaplan–Meier survival analysis was used to estimate the BRI incidence rate, and a Cox proportional hazards model was used to identify influencing factors.</div></div><div><h3>Main Outcome Measures</h3><div>The cumulative incidence of BRI in all patients who underwent filtration surgery.</div></div><div><h3>Results</h3><div>In total, 50 eyes with BRI (49 patients; mean age: 52.6 years; 21 eyes from females) were identified, yielding an overall incidence rate of 2.38%. Stage I to III infections were observed in 27, 15, and 8 eyes, respectively. The cumulative incidence of BRI increased over time, with estimated rates of 1.5 ± 0.3% (standard error) at 5 years, 3.8 ± 0.7% at 10 years, and 6.4 ± 1.4% at 14 years. Furthermore, 33 eyes out of 1460 eyes with primary open-angle glaucoma limited to primary surgeries developed BRI. Younger age at surgery was identified as a significant risk factor for BRI (hazard ratio: 0.969 per 1 year; <em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>This study is the first to show that the risk of BRI continues to increase 10 years after MMC-augmented filtration surgery. When considering filtration surgery, it is important to take into account the patient's age and inform them of the benefits of the procedure and the long-term risk of infection.</div></div><div><h3>Financial Disclosure(s)</h3><div>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 6","pages":"Pages 599-608"},"PeriodicalIF":3.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.ogla.2025.08.005
Aakriti Garg Shukla MD, MSc, Vishwanath H. Prathikanti MS, Henry D. Jampel MD, MHS
{"title":"GLAUrious but Not Entirely Noninferior: A Critical Review of Clinical Trial Design","authors":"Aakriti Garg Shukla MD, MSc, Vishwanath H. Prathikanti MS, Henry D. Jampel MD, MHS","doi":"10.1016/j.ogla.2025.08.005","DOIUrl":"10.1016/j.ogla.2025.08.005","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 6","pages":"Pages 541-543"},"PeriodicalIF":3.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.ogla.2025.05.006
Mohsen Adelpour MD , Sasan Moghimi MD , Takashi Nishida MD, PhD , Leo Meller BS , Kelvin H. Du BS , Alireza Kamalipour MD, MPH , Natchada Tansuebchueasai MD , Golnoush Mahmoudinezhad MD, MPH , Linda M. Zangwill PhD , Robert N. Weinreb MD
Purpose
To explore the prognostic significance of short-term rates of visual field (VF) mean deviation (MD) change in predicting progression across various levels of glaucoma severity.
Design
Observational cohort.
Participants
A total of 349 eyes from 254 patients followed up to 5 years.
Methods
Primary open-angle glaucoma eyes were included with ≥ 5 24-2 VFs tests during the initial 2 years over a period of up to 5 years. Two assessment methods, Guided Progression Analysis (GPA) and a United States Food and Drug Administration (FDA)–consistent end point, were utilized to identify progression events. Rates of change in VF MD during the initial 2 years were calculated, and survival models were employed to evaluate the risk of faster initial VF MD loss on the development of GPA and FDA-consistent end points.
Main Outcome Measures
Risk of progression based on initial MD change rates.
Results
Over a mean follow-up of 4.3 years, progression was observed in 17.2% (GPA end point) and 24.9% (FDA-consistent end point) of eyes. Faster initial rates of VF MD loss significantly increased the progression risk (hazard ratio [HR] per 0.1 dB/year faster for GPA: 1.16, 95% confidence interval [CI]: 1.12–1.20; HR for FDA: 1.16, 95% confidence interval: 1.12–1.21; both P < 0.001) with survival-adjusted R2 values of 0.67 for GPA and 0.75 for FDA-consistent end points. Global initial 2-year slopes showed the highest predictive accuracy for FDA progression events, with adjusted R2 values of 0.75 overall, 0.71 for early glaucoma, and 0.42 for moderate-to-advanced glaucoma. Superior and inferior sectoral slopes demonstrated lower abilities to explain the variability across all severity groups. The model's predictive accuracy was higher in early glaucoma (R2, 0.71) compared to moderate-advanced stages (R2, 0.42) for both criteria.
Conclusions
The initial 2-year rate of VF MD change predicts subsequent progression events based on FDA-consistent criteria in both early and moderate-to-advanced glaucoma eyes. These findings suggest initial VF MD change rates identify patients at higher risk of future progression, enabling timely management decisions and, also, potentially serving as a progression end point in clinical trials.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Short-Term Rates of Visual Field Change Predict Glaucoma Progression","authors":"Mohsen Adelpour MD , Sasan Moghimi MD , Takashi Nishida MD, PhD , Leo Meller BS , Kelvin H. Du BS , Alireza Kamalipour MD, MPH , Natchada Tansuebchueasai MD , Golnoush Mahmoudinezhad MD, MPH , Linda M. Zangwill PhD , Robert N. Weinreb MD","doi":"10.1016/j.ogla.2025.05.006","DOIUrl":"10.1016/j.ogla.2025.05.006","url":null,"abstract":"<div><h3>Purpose</h3><div>To explore the prognostic significance of short-term rates of visual field (VF) mean deviation (MD) change in predicting progression across various levels of glaucoma severity.</div></div><div><h3>Design</h3><div>Observational cohort.</div></div><div><h3>Participants</h3><div>A total of 349 eyes from 254 patients followed up to 5 years.</div></div><div><h3>Methods</h3><div>Primary open-angle glaucoma eyes were included with ≥ 5 24-2 VFs tests during the initial 2 years over a period of up to 5 years. Two assessment methods, Guided Progression Analysis (GPA) and a United States Food and Drug Administration (FDA)–consistent end point, were utilized to identify progression events. Rates of change in VF MD during the initial 2 years were calculated, and survival models were employed to evaluate the risk of faster initial VF MD loss on the development of GPA and FDA-consistent end points.</div></div><div><h3>Main Outcome Measures</h3><div>Risk of progression based on initial MD change rates.</div></div><div><h3>Results</h3><div>Over a mean follow-up of 4.3 years, progression was observed in 17.2% (GPA end point) and 24.9% (FDA-consistent end point) of eyes. Faster initial rates of VF MD loss significantly increased the progression risk (hazard ratio [HR] per 0.1 dB/year faster for GPA: 1.16, 95% confidence interval [CI]: 1.12–1.20; HR for FDA: 1.16, 95% confidence interval: 1.12–1.21; both <em>P</em> < 0.001) with survival-adjusted R<sup>2</sup> values of 0.67 for GPA and 0.75 for FDA-consistent end points. Global initial 2-year slopes showed the highest predictive accuracy for FDA progression events, with adjusted R<sup>2</sup> values of 0.75 overall, 0.71 for early glaucoma, and 0.42 for moderate-to-advanced glaucoma. Superior and inferior sectoral slopes demonstrated lower abilities to explain the variability across all severity groups. The model's predictive accuracy was higher in early glaucoma (R<sup>2</sup>, 0.71) compared to moderate-advanced stages (R<sup>2</sup>, 0.42) for both criteria.</div></div><div><h3>Conclusions</h3><div>The initial 2-year rate of VF MD change predicts subsequent progression events based on FDA-consistent criteria in both early and moderate-to-advanced glaucoma eyes. These findings suggest initial VF MD change rates identify patients at higher risk of future progression, enabling timely management decisions and, also, potentially serving as a progression end point in clinical trials.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 6","pages":"Pages 560-568"},"PeriodicalIF":3.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.ogla.2025.04.010
Olusola Olawoye MBBS, PhD , Brian P. Young BS , Angela W. Nyunt BS , Oluwatoyin F. Fafowora MD, PhD , Magdalene Ajani MBBS, FWACS , Tarela Sarimiye MBBS, FWACS , Brendan A. Creemer BS , Ben R. Roos BS , Anne L. Coleman MD, PhD , Michael B. Gorin MD, PhD , Michael A. Hauser PhD , Todd E. Scheetz PhD , Adeyinka Ashaye MBBS, FWACS , John H. Fingert MD, PhD
Purpose
Determine the prevalence and the role of myocilin (MYOC) gene mutations in a sub-Saharan population of patients with juvenile open-angle glaucoma (JOAG).
Design
Prospective case-control.
Participants
Forty-five patients with JOAG and 41 normal control subjects from the ophthalmology clinics of the University College Hospital Ibadan, Nigeria.
Methods
DNA was tested for MYOC coding sequence mutations using Sanger sequencing. Identified mutations were evaluated for pathogenicity using ClinGen scoring; assessing prevalence in large public databases of patients with African ancestry (gnomAD and 1000 Genomes); and mutation analysis algorithms: PolyPhen, Sorting Intolerant from Tolerant (SIFT), BLOSUM62, MutationTaster, Combined Annotation Dependent Depletion (CADD), and AlphaMissense. The prevalence of variants was compared between patients with JOAG and normal controls from Ibadan using a mutation burden analysis using Sequence Kernel Association Test (SKAT-O).
Main Outcome Measures
Sanger DNA sequencing data indicating the presence or absence of glaucoma-causing mutations in the MYOC gene.
Results
A total of 10 instances of 4 MYOC variants were detected. A p.Pro370Leu variant, which has been previously categorized by the ClinGen as pathogenic, was detected in 3 (6.7%) of 45 JOAG probands. A p.Arg470Cys MYOC variant, previously categorized a variant of unknown significance, was identified in 1 (2.2%) of 45 JOAG probands. A p.Glu352Lys variant, previously categorized as benign, was detected in 2 (4.4%) of JOAG probands. Both the p.Pro370Leu and p.Arg470Cys variants were absent from control subjects and large public databases, whereas p.Glu352Lys was present at a frequency > 1%, which is inconsistent with pathogenicity. Finally, synonymous missense variant, p.Glu396Glu, was also detected. A total of 5 of 6 mutation analysis algorithms supported the pathogenicity of the p.Pro370Leu and p.Arg470Cys variants, whereas slightly fewer (4 of 6) suggested that p.Glu352Lys is pathogenic.
Conclusions
Myocilin mutations are the most common known cause of JOAG in populations of European ancestry. Our case-control study estimated the prevalence of pathogenic MYOC mutations to be 8.9% in an African population from Nigeria. Myocilin mutations are the most common known cause of JOAG in sub-Saharan Africa; however, they account for a minority of cases.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Prevalence of Myocilin Mutations in a Cohort of Patients with Juvenile Open-Angle Glaucoma from sub-Saharan Africa","authors":"Olusola Olawoye MBBS, PhD , Brian P. Young BS , Angela W. Nyunt BS , Oluwatoyin F. Fafowora MD, PhD , Magdalene Ajani MBBS, FWACS , Tarela Sarimiye MBBS, FWACS , Brendan A. Creemer BS , Ben R. Roos BS , Anne L. Coleman MD, PhD , Michael B. Gorin MD, PhD , Michael A. Hauser PhD , Todd E. Scheetz PhD , Adeyinka Ashaye MBBS, FWACS , John H. Fingert MD, PhD","doi":"10.1016/j.ogla.2025.04.010","DOIUrl":"10.1016/j.ogla.2025.04.010","url":null,"abstract":"<div><h3>Purpose</h3><div><span>Determine the prevalence and the role of myocilin (</span><em>MYOC</em><span>) gene mutations in a sub-Saharan population of patients with juvenile open-angle glaucoma (JOAG).</span></div></div><div><h3>Design</h3><div>Prospective case-control.</div></div><div><h3>Participants</h3><div>Forty-five patients with JOAG and 41 normal control subjects from the ophthalmology clinics of the University College Hospital Ibadan, Nigeria.</div></div><div><h3>Methods</h3><div>DNA was tested for <em>MYOC</em><span><span> coding sequence mutations using Sanger sequencing. Identified mutations were evaluated for </span>pathogenicity using ClinGen scoring; assessing prevalence in large public databases of patients with African ancestry (gnomAD and 1000 Genomes); and mutation analysis algorithms: PolyPhen, Sorting Intolerant from Tolerant (SIFT), BLOSUM62, MutationTaster, Combined Annotation Dependent Depletion (CADD), and AlphaMissense. The prevalence of variants was compared between patients with JOAG and normal controls from Ibadan using a mutation burden analysis using Sequence Kernel Association Test (SKAT-O).</span></div></div><div><h3>Main Outcome Measures</h3><div><span>Sanger DNA sequencing data indicating the presence or absence of glaucoma-causing mutations in the </span><em>MYOC</em> gene.</div></div><div><h3>Results</h3><div>A total of 10 instances of 4 <em>MYOC</em><span> variants were detected. A p.Pro370Leu variant, which has been previously categorized by the ClinGen as pathogenic, was detected in 3 (6.7%) of 45 JOAG probands. A p.Arg470Cys </span><em>MYOC</em><span><span> variant, previously categorized a variant of unknown significance, was identified in 1 (2.2%) of 45 JOAG probands. A p.Glu352Lys variant, previously categorized as benign, was detected in 2 (4.4%) of JOAG probands. Both the p.Pro370Leu and p.Arg470Cys variants were absent from control subjects and large public databases, whereas p.Glu352Lys was present at a frequency > 1%, which is inconsistent with pathogenicity. Finally, synonymous </span>missense variant, p.Glu396Glu, was also detected. A total of 5 of 6 mutation analysis algorithms supported the pathogenicity of the p.Pro370Leu and p.Arg470Cys variants, whereas slightly fewer (4 of 6) suggested that p.Glu352Lys is pathogenic.</span></div></div><div><h3>Conclusions</h3><div>Myocilin mutations are the most common known cause of JOAG in populations of European ancestry. Our case-control study estimated the prevalence of pathogenic <em>MYOC</em> mutations to be 8.9% in an African population from Nigeria. Myocilin mutations are the most common known cause of JOAG in sub-Saharan Africa; however, they account for a minority of cases.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 5","pages":"Pages 450-456"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.ogla.2025.05.003
Lauren S. Blieden MD , Peter T. Chang MD
{"title":"Sulcus Tube in a Patient with Axenfeld-Rieger Syndrome","authors":"Lauren S. Blieden MD , Peter T. Chang MD","doi":"10.1016/j.ogla.2025.05.003","DOIUrl":"10.1016/j.ogla.2025.05.003","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 5","pages":"Page e15"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.ogla.2025.04.003
Henrietta Wang MPH , Katherine Masselos MBBS, FRANZCO , Jeremy C.K. Tan MD, FRANZCO , Nimesh B. Patel PhD , Ashish Agar MBBS, PhD , Michael Kalloniatis PhD , Jack Phu PhD
Purpose
To measure the time and clinical resources taken to obtain 6 reliable visual field (VF) tests for glaucoma in a glaucoma clinic.
Design
Longitudinal, prospective study in a glaucoma clinic.
Subjects
Ten thousand and ten SITA-Faster VF tests of 535 clinical subjects.
Methods
The cumulative number of VF tests with false-positive rates ≤15% for each eye of each subject was counted over time, and from there, the time to achieve 6 VF tests was determined and compared under frontloaded (2 VFs per eye per visit) and non-frontloaded (first VF within the frontloaded set) conditions. Costs to attain 6 VF tests were modeled.
Main Outcome Measures
Visual field counts and costs for attainment.
Results
Eight thousand nine hundred thirty-one of the 10 010 VF results had a false-positive rate of ≤15%. Approximately 90% of subjects had early or moderate open-angle glaucoma. When using the frontloading protocol, it took an average of 1.4 years to attain 6 reliable VFs for right and left eyes, respectively. For the non-frontloaded protocol, the average times were 2.6 and 2.5 years for the right and left eyes, respectively; 82.5% of right eyes and 85.4% of left eyes achieved 6 reliable VFs within 2 years when frontloaded, but the proportion was only 15.8% and 18.8% when non-frontloaded for right and left eyes, respectively. There was a significantly lower cost for obtaining 6 reliable VFs with frontloading than non-frontloading, due to fewer office visits.
Conclusions
A frontloading approach and SITA-Faster paradigm led to patients attaining 6 reliable VFs over 14 months sooner than non-frontloaded, with >84% receiving the recommended number of 6 tests in the first 2 years. The frontloading approach overall leads to savings in time and cost in comparison to non-frontloading for achieving 6 reliable VFs and thus potentially provides an avenue for earlier detection of glaucomatous change.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"The Frontloading Approach to Meet Guideline-Recommended Visual Field Testing for Glaucoma","authors":"Henrietta Wang MPH , Katherine Masselos MBBS, FRANZCO , Jeremy C.K. Tan MD, FRANZCO , Nimesh B. Patel PhD , Ashish Agar MBBS, PhD , Michael Kalloniatis PhD , Jack Phu PhD","doi":"10.1016/j.ogla.2025.04.003","DOIUrl":"10.1016/j.ogla.2025.04.003","url":null,"abstract":"<div><h3>Purpose</h3><div>To measure the time and clinical resources taken to obtain 6 reliable visual field (VF) tests for glaucoma in a glaucoma clinic.</div></div><div><h3>Design</h3><div>Longitudinal, prospective study in a glaucoma clinic.</div></div><div><h3>Subjects</h3><div>Ten thousand and ten SITA-Faster VF tests of 535 clinical subjects.</div></div><div><h3>Methods</h3><div>The cumulative number of VF tests with false-positive rates ≤15% for each eye of each subject was counted over time, and from there, the time to achieve 6 VF tests was determined and compared under frontloaded (2 VFs per eye per visit) and non-frontloaded (first VF within the frontloaded set) conditions. Costs to attain 6 VF tests were modeled.</div></div><div><h3>Main Outcome Measures</h3><div>Visual field counts and costs for attainment.</div></div><div><h3>Results</h3><div>Eight thousand nine hundred thirty-one of the 10 010 VF results had a false-positive rate of ≤15%. Approximately 90% of subjects had early or moderate open-angle glaucoma. When using the frontloading protocol, it took an average of 1.4 years to attain 6 reliable VFs for right and left eyes, respectively. For the non-frontloaded protocol, the average times were 2.6 and 2.5 years for the right and left eyes, respectively; 82.5% of right eyes and 85.4% of left eyes achieved 6 reliable VFs within 2 years when frontloaded, but the proportion was only 15.8% and 18.8% when non-frontloaded for right and left eyes, respectively. There was a significantly lower cost for obtaining 6 reliable VFs with frontloading than non-frontloading, due to fewer office visits.</div></div><div><h3>Conclusions</h3><div>A frontloading approach and SITA-Faster paradigm led to patients attaining 6 reliable VFs over 14 months sooner than non-frontloaded, with >84% receiving the recommended number of 6 tests in the first 2 years. The frontloading approach overall leads to savings in time and cost in comparison to non-frontloading for achieving 6 reliable VFs and thus potentially provides an avenue for earlier detection of glaucomatous change.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 5","pages":"Pages 515-527"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.ogla.2025.06.014
Joel S. Schuman MD , Gadi Wollstein MD
The diagnosis and monitoring of glaucoma require precise evaluation of ocular structural features. The advent of ocular imaging has revolutionized both the clinical management and research of glaucoma, establishing itself as a cornerstone of contemporary practice. In this review, we summarize the major advances in ocular imaging technologies and their contributions to the understanding, diagnosis, and monitoring of glaucoma over the past 2 centuries.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Optic Nerve Imaging—From Disc Photos to OCT","authors":"Joel S. Schuman MD , Gadi Wollstein MD","doi":"10.1016/j.ogla.2025.06.014","DOIUrl":"10.1016/j.ogla.2025.06.014","url":null,"abstract":"<div><div>The diagnosis and monitoring of glaucoma require precise evaluation of ocular structural features. The advent of ocular imaging has revolutionized both the clinical management and research of glaucoma, establishing itself as a cornerstone of contemporary practice. In this review, we summarize the major advances in ocular imaging technologies and their contributions to the understanding, diagnosis, and monitoring of glaucoma over the past 2 centuries.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 5","pages":"Pages S14-S19"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.ogla.2025.06.004
Zefeng Yang MD, Fei Li MD, PhD, Xiulan Zhang MD, PhD
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Pub Date : 2025-09-01DOI: 10.1016/j.ogla.2025.07.006
David Steven Friedman MD, PhD , Tin Aung PhD , Mingguang He PhD , Paul J. Foster PhD
Primary angle-closure disease (PACD) remains a significant cause of visual morbidity globally, particularly in Asia, where >18.5 million will have primary angle-closure glaucoma (PACG) by 2050. Although glaucomatous optic neuropathy is the most widely recognized cause of visual loss, PACD significantly impacts a range of anterior and posterior segment structures and physiological processes, such as corneal endothelial cell loss, trabecular meshwork structural changes and functional derangement, lens opacities, iris ischemia causing a dilated pupil and consequent degradation in vision, retinal vein occlusions, rapidly evolving pressure-related retinal ischemia, and increased surgical morbidity including aqueous misdirection and zonulopathy. In many cases, the management of the condition will draw on cornea, cataract, refractive, glaucoma, medical, and surgical retina expertise and techniques. Collaboration between the authors and their research networks has led to a series of seminal studies that have redefined the management of angle-closure, with a reduction in the scope of prophylactic laser iridotomy for asymptomatic angle-closure and the emergence of clear lens extraction as the central therapeutic intervention in PACD. Demographic and ocular risk factors are well documented, and the understanding of the molecular genetic mechanisms influencing the risk of PACD is advancing rapidly, offering the prospect of more individualized risk stratification in the near future through the use of polygenic risk scores. These offer clinicians a range of potent tools to deliver improved outcomes for their patients with and persons at risk for PACD.
Financial Disclosure(s)
The author has no/the authors have no proprietary or commercial interest in any materials discussed in this article.
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