Pub Date : 2025-09-01DOI: 10.1016/j.ogla.2025.08.001
Anfei Li MD, PhD , C. Gustavo De Moraes MD, PhD
The assessment of the human visual field, a concept explored since ancient Greece, underwent a critical transformation in the 19th century with the advent of objective measurement techniques. Early methodologies concentrated on mapping the outer limits of vision, a practice known as perimetry. However, the focus soon shifted toward campimetry (although the name perimetry remained), which involves assessing defects within the central/paracentral visual field—a crucial development for diagnosing diseases such as glaucoma. Although historical methods such as Bjerrum tangent screen and Goldmann kinetic perimetry were foundational, the last 4 decades have been defined by the rise of static automated perimetry (SAP). Coinciding with the inception of the American Glaucoma Society, the 1980s marked a pivotal transition from manual techniques to computerized, automated testing. Static automated perimetry, exemplified by the Humphrey Field Analyzer (HFA), has since become the clinical standard, offering a precise and reproducible method for quantifying visual field sensitivities, which is indispensable for the detection and management of glaucoma. This review examines the evolution of modern visual field testing over the past 40 years, focusing on the technological advancements in hardware, software algorithms, and novel testing paradigms that have reshaped our approach to glaucoma care.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
人类视野的评估是一个自古希腊以来就被探索的概念，随着客观测量技术的出现，在19世纪经历了一个关键的转变。早期的方法集中于绘制视觉的外部界限，这种做法被称为视野测量。然而，焦点很快转向了视野测量（尽管名称仍然保留），它涉及评估中央/副中央视野内的缺陷——这是诊断青光眼等疾病的关键发展。虽然Bjerrum切线筛和Goldmann动力学视野测量等历史方法是基础，但在过去的40年里，静态自动视野测量（SAP）的兴起定义了这一方法。20世纪80年代恰逢美国青光眼协会成立，标志着从手工技术到计算机化、自动化测试的关键转变。以汉弗莱视场分析仪（Humphrey Field Analyzer， HFA）为代表的静态自动视场测量从此成为临床标准，提供了一种精确、可重复的量化视野灵敏度的方法，这对于青光眼的检测和治疗是不可或缺的。本文回顾了过去40年来现代视野检测的发展，重点介绍了硬件、软件算法和新的检测范式方面的技术进步，这些技术进步重塑了我们对青光眼的治疗方法。财务披露：专有或商业披露可在本文末尾的脚注和披露中找到。
{"title":"The Evolution of Visual Field Testing","authors":"Anfei Li MD, PhD , C. Gustavo De Moraes MD, PhD","doi":"10.1016/j.ogla.2025.08.001","DOIUrl":"10.1016/j.ogla.2025.08.001","url":null,"abstract":"<div><div>The assessment of the human visual field, a concept explored since ancient Greece, underwent a critical transformation in the 19th century with the advent of objective measurement techniques. Early methodologies concentrated on mapping the outer limits of vision, a practice known as perimetry. However, the focus soon shifted toward campimetry (although the name <em>perimetry</em> remained), which involves assessing defects within the central/paracentral visual field—a crucial development for diagnosing diseases such as glaucoma. Although historical methods such as Bjerrum tangent screen and Goldmann kinetic perimetry were foundational, the last 4 decades have been defined by the rise of static automated perimetry (SAP). Coinciding with the inception of the American Glaucoma Society, the 1980s marked a pivotal transition from manual techniques to computerized, automated testing. Static automated perimetry, exemplified by the Humphrey Field Analyzer (HFA), has since become the clinical standard, offering a precise and reproducible method for quantifying visual field sensitivities, which is indispensable for the detection and management of glaucoma. This review examines the evolution of modern visual field testing over the past 40 years, focusing on the technological advancements in hardware, software algorithms, and novel testing paradigms that have reshaped our approach to glaucoma care.</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 S20-S26"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994451","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.2025.08.007
Carla J. Siegfried MD, Gregory L. Skuta MD
{"title":"American Glaucoma Society 40th Anniversary","authors":"Carla J. Siegfried MD, Gregory L. Skuta MD","doi":"10.1016/j.ogla.2025.08.007","DOIUrl":"10.1016/j.ogla.2025.08.007","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 5","pages":"Page S1"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994405","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.2025.04.001
Tianyi Wang BA , Hong Su An PhD , Jaqueline Stoutin MD , Alexander D. Valentine MD , Leah K. Depperschmidt RN , Matthew Callewaert OD , Michael Goldstein MD , Joshua D. Stein MD, MS
Objective
Eye drops are often first-line treatment for glaucoma and dry eye disease (DED). Unfortunately, proper eye drop self-administration is difficult, and this is likely magnified in persons with comorbid rheumatological, neurological, or cognitive disorders. This study investigates the association between ocular conditions often treated with eye drops (glaucoma and DED) and medical conditions that may impair proper eye drop self-administration.
Design
A retrospective database study.
Participants
From 6 health systems, 1 446 229 patients participated in the Sight Outcomes Research Collaborative between January 2012 and December 2021.
Methods
We determined the proportion of patients with glaucoma or DED with medical conditions that may limit proper eye drop self-administration and created multivariable logistic regression models assessing associations between glaucoma or DED and comorbid conditions.
Main Outcome Measures
Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of glaucoma or DED.
Results
Among 247 899 patients with glaucoma (mean [standard deviation] age: 60.1 [15.1] years, 56.2% female, 19.5% Black), 106 927 (43%) had ≥ 1 comorbid condition that could affect eye drop self-administration. Among 321 941 patients with DED (mean [standard deviation] age: 55.9 [16.1] years, 66.4% female, 12.6% Black), 156 811 (49%) had ≥ 1 such condition. Patients with ≥ 1 impairment affecting eye drop self-administration had 17% greater odds of glaucoma (aOR: 1.17, CI: 1.16–1.18) and 66% greater odds of DED (aOR: 1.66, CI: 1.65–1.68), compared with other patients. Persons with 2, 3, and ≥ 4 conditions that may affect eye drop administration had 27%, 39%, and 53% higher odds of glaucoma, respectively, compared with persons without such conditions (P < 0.0001). Persons with 2, 3, and ≥ 4 health conditions that may impair eye drop administration had 76%, 121%, and 156% higher odds of DED, respectively (P < 0.0001).
Conclusions
Nearly half of all patients with glaucoma or DED have ≥ 1 medical condition that may impair eye drop self-administration. Clinicians should assess patients' physical and mental capacity to self-administer topical ocular therapy. Some patients may benefit from alternative therapies that reduce or eliminate the need for eye drops.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的：青光眼和干眼病（DED）的一线治疗通常是滴眼液。不幸的是，适当的滴眼液自我给药是困难的，这在患有风湿病、神经或认知障碍的患者中可能会更加严重。本研究调查了经常用眼药水治疗的眼部疾病（青光眼和DED）与可能损害适当滴眼液自我给药的医疗状况之间的关系。设计：回顾性数据库研究参与者：2012年1月至2021年12月期间参加视力结局研究合作（SOURCE）的6个卫生系统的1,446,229名患者。方法：我们确定了青光眼或DED患者中存在可能限制适当滴眼液自我使用的医疗条件的比例，并创建了多变量logistic回归模型，评估青光眼或DED与合并症之间的关系。结果：在247899例青光眼患者（平均（SD）年龄：60.1（15.1）岁，56.2%为女性，19.5%为黑人）中，106927例（43%）患者存在≥1种影响滴眼液自我给药的合并症。在321,941例DED患者中（平均（SD）年龄：55.9（16.1）岁，女性66.4%，黑人12.6%），156,811例（49%）有≥1种可能妨碍滴眼液自我给药的情况。与无上述情况的患者相比，有≥1种损害影响滴眼液自我给药的患者发生青光眼的几率（aOR）高17% (1.17，CI（1.16-1.18))，发生DED的几率高66% (aOR 1.66, CI 1.65-1.68)）。患有2、3、4+种可能影响滴眼液给药的疾病的患者患青光眼的几率分别比没有这些疾病的患者高27%、39%和53%（结论：近一半的青光眼或DED患者患有≥1种可能影响滴眼液自我给药的疾病）。这突出了临床医生评估患者的重要性，以确保他们在身体和精神上能够自我使用眼药水。其中一些患者可能会受益于替代疗法，减少或消除对滴眼液的需求。
{"title":"Association of Eye Drop–Treated Diseases and Conditions That Can Impair Eye Drop Self-Administration","authors":"Tianyi Wang BA , Hong Su An PhD , Jaqueline Stoutin MD , Alexander D. Valentine MD , Leah K. Depperschmidt RN , Matthew Callewaert OD , Michael Goldstein MD , Joshua D. Stein MD, MS","doi":"10.1016/j.ogla.2025.04.001","DOIUrl":"10.1016/j.ogla.2025.04.001","url":null,"abstract":"<div><h3>Objective</h3><div>Eye drops are often first-line treatment for glaucoma and dry eye disease (DED). Unfortunately, proper eye drop self-administration is difficult, and this is likely magnified in persons with comorbid rheumatological, neurological, or cognitive disorders. This study investigates the association between ocular conditions often treated with eye drops (glaucoma and DED) and medical conditions that may impair proper eye drop self-administration.</div></div><div><h3>Design</h3><div>A retrospective database study.</div></div><div><h3>Participants</h3><div>From 6 health systems, 1 446 229 patients participated in the Sight Outcomes Research Collaborative between January 2012 and December 2021.</div></div><div><h3>Methods</h3><div>We determined the proportion of patients with glaucoma or DED with medical conditions that may limit proper eye drop self-administration and created multivariable logistic regression models assessing associations between glaucoma or DED and comorbid conditions.</div></div><div><h3>Main Outcome Measures</h3><div>Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of glaucoma or DED.</div></div><div><h3>Results</h3><div>Among 247 899 patients with glaucoma (mean [standard deviation] age: 60.1 [15.1] years, 56.2% female, 19.5% Black), 106 927 (43%) had ≥ 1 comorbid condition that could affect eye drop self-administration. Among 321 941 patients with DED (mean [standard deviation] age: 55.9 [16.1] years, 66.4% female, 12.6% Black), 156 811 (49%) had ≥ 1 such condition. Patients with ≥ 1 impairment affecting eye drop self-administration had 17% greater odds of glaucoma (aOR: 1.17, CI: 1.16–1.18) and 66% greater odds of DED (aOR: 1.66, CI: 1.65–1.68), compared with other patients. Persons with 2, 3, and ≥ 4 conditions that may affect eye drop administration had 27%, 39%, and 53% higher odds of glaucoma, respectively, compared with persons without such conditions (<em>P</em> < 0.0001). Persons with 2, 3, and ≥ 4 health conditions that may impair eye drop administration had 76%, 121%, and 156% higher odds of DED, respectively (<em>P</em> < 0.0001).</div></div><div><h3>Conclusions</h3><div>Nearly half of all patients with glaucoma or DED have ≥ 1 medical condition that may impair eye drop self-administration. Clinicians should assess patients' physical and mental capacity to self-administer topical ocular therapy. Some patients may benefit from alternative therapies that reduce or eliminate the need for eye drops.</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 431-439"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059668","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.2025.06.011
James D. Brandt MD , Lauren S. Blieden MD , Alana L. Grajewski MD
The glaucomas arising in children comprise a diverse group of developmental and secondary disorders. Until the mid-20th century, childhood glaucoma was a uniformly blinding disease. The development of surgical approaches like goniotomy ab interno (1940s) and trabeculotomy ab externo (1960s) provided the first effective treatments for this group of uncommon disorders. Since then, additional progress in the management of adult glaucoma has quickly found its way to childhood glaucoma—including the use of antimetabolites, modern glaucoma drainage devices, and techniques of circumferential ab interno and ab externo trabeculotomy using sutures or an illuminated microcatheter. Each of these techniques requires modifications to be safely used in infants and young children. The nomenclature and classification of the pediatric glaucomas were standardized in 2013 with the Childhood Glaucoma Research Network classification system which was a foundational step in developing registries and coordinated research in the field. Modern tools of molecular genetics have begun to elucidate the underlying molecular pathophysiology and inheritance of some forms of childhood glaucoma. Single-gene, Mendelian-inherited forms of childhood glaucoma may be ideal targets for clustered regularly interspaced short palindromic repeats (CRISPR) gene-editing technologies to correct the disorder locally in the anterior chamber angle. All these advances greatly improved visual outcomes in childhood glaucoma. However, with the greatly improved visual prognosis in childhood glaucoma come unique considerations in how we care for these patients over a very long lifespan.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Childhood Glaucoma","authors":"James D. Brandt MD , Lauren S. Blieden MD , Alana L. Grajewski MD","doi":"10.1016/j.ogla.2025.06.011","DOIUrl":"10.1016/j.ogla.2025.06.011","url":null,"abstract":"<div><div>The glaucomas arising in children comprise a diverse group of developmental and secondary disorders. Until the mid-20th century, childhood glaucoma was a uniformly blinding disease. The development of surgical approaches like goniotomy ab interno (1940s) and trabeculotomy ab externo (1960s) provided the first effective treatments for this group of uncommon disorders. Since then, additional progress in the management of adult glaucoma has quickly found its way to childhood glaucoma—including the use of antimetabolites, modern glaucoma drainage devices, and techniques of circumferential ab interno and ab externo trabeculotomy using sutures or an illuminated microcatheter. Each of these techniques requires modifications to be safely used in infants and young children. The nomenclature and classification of the pediatric glaucomas were standardized in 2013 with the Childhood Glaucoma Research Network classification system which was a foundational step in developing registries and coordinated research in the field. Modern tools of molecular genetics have begun to elucidate the underlying molecular pathophysiology and inheritance of some forms of childhood glaucoma. Single-gene, Mendelian-inherited forms of childhood glaucoma may be ideal targets for clustered regularly interspaced short palindromic repeats (CRISPR) gene-editing technologies to correct the disorder locally in the anterior chamber angle. All these advances greatly improved visual outcomes in childhood glaucoma. However, with the greatly improved visual prognosis in childhood glaucoma come unique considerations in how we care for these patients over a very long lifespan.</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 S58-S63"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790809","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.2025.04.013
Reem M. Aboulhassan MSc, Yasmine M. ElSayed MD, Amanne Esmael MD, Ghada Gawdat MD, Ahmed ElKateb MD, Hala ElHilali MD
Purpose
The aim of this study was to compare the outcomes of 2-site rigid probe trabeculotomy (RPT) compared to gonioscopy-assisted transluminal trabeculotomy (GATT) in the treatment of primary congenital glaucoma (PCG).
Design
A prospective randomized controlled study
Subjects
The study included 77 eyes of 60 patients with PCG with clear corneas all aged < 5 years.
Methods
Patients were randomized to undergo either 2-site trabeculotomy using a RPT or GATT using a 5/0 polypropylene suture. Success was defined as achieving a final intraocular pressure (IOP) < 18 mmHg without (complete) or with medications (qualified).
Main Outcome Measures
Primary outcomes were reduction of IOP and medications. Secondary outcomes were complications and success rates. Anterior segment OCT (AS-OCT) was performed to compare changes in angle morphology.
Results
The two-site RPT group included 39 eyes, and the GATT group included 38 eyes. There was a significant reduction in IOP and glaucoma medications at 1, 3, 6, 9, and 12 months postoperatively in both groups (P < 0.001) with no significant difference in IOP or IOP-lowering medications between both groups at any follow-up (FU). At the final FU, there was a 49% ± 13% IOP reduction in the 2-site RPT trabeculotomy group compared to 44% ± 25% in the GATT group (P = 0.2). Success was achieved in all eyes in the RPT group and in 95% in the GATT group. Hyphema was the most frequently observed complication; with no vision-threatening complications in either group. Postoperative AS-OCT findings included angle widening, trabecular shelf, and peripheral anterior synechia.
Conclusions
Circumferential trabeculotomy using ab interno GATT or ab externo 2-site trabeculotomy yielded comparable results in terms of safety and efficacy. Gonioscopy-assisted transluminal trabeculotomy has the advantage of sparing the conjunctiva which may be needed for future interventions.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
{"title":"Two-Site Trabeculotomy vs. Gonioscopy-Assisted Transluminal Trabeculotomy in the Treatment of Primary Congenital Glaucoma","authors":"Reem M. Aboulhassan MSc, Yasmine M. ElSayed MD, Amanne Esmael MD, Ghada Gawdat MD, Ahmed ElKateb MD, Hala ElHilali MD","doi":"10.1016/j.ogla.2025.04.013","DOIUrl":"10.1016/j.ogla.2025.04.013","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to compare the outcomes of 2-site rigid probe trabeculotomy (RPT) compared to gonioscopy-assisted transluminal trabeculotomy (GATT) in the treatment of primary congenital glaucoma (PCG).</div></div><div><h3>Design</h3><div>A prospective randomized controlled study</div></div><div><h3>Subjects</h3><div>The study included 77 eyes of 60 patients with PCG with clear corneas all aged < 5 years.</div></div><div><h3>Methods</h3><div>Patients were randomized to undergo either 2-site trabeculotomy using a RPT or GATT using a 5/0 polypropylene suture. Success was defined as achieving a final intraocular pressure (IOP) < 18 mmHg without (complete) or with medications (qualified).</div></div><div><h3>Main Outcome Measures</h3><div>Primary outcomes were reduction of IOP and medications. Secondary outcomes were complications and success rates. Anterior segment OCT (AS-OCT) was performed to compare changes in angle morphology.</div></div><div><h3>Results</h3><div>The two-site RPT group included 39 eyes, and the GATT group included 38 eyes. There was a significant reduction in IOP and glaucoma medications at 1, 3, 6, 9, and 12 months postoperatively in both groups (<em>P</em> < 0.001) with no significant difference in IOP or IOP-lowering medications between both groups at any follow-up (FU). At the final FU, there was a 49% ± 13% IOP reduction in the 2-site RPT trabeculotomy group compared to 44% ± 25% in the GATT group (<em>P</em> = 0.2). Success was achieved in all eyes in the RPT group and in 95% in the GATT group. Hyphema was the most frequently observed complication; with no vision-threatening complications in either group. Postoperative AS-OCT findings included angle widening, trabecular shelf, and peripheral anterior synechia.</div></div><div><h3>Conclusions</h3><div>Circumferential trabeculotomy using ab interno GATT or ab externo 2-site trabeculotomy yielded comparable results in terms of safety and efficacy. Gonioscopy-assisted transluminal trabeculotomy has the advantage of sparing the conjunctiva which may be needed for future interventions.</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 5","pages":"Pages 484-494"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043051","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号