Ophthalmology. Glaucoma最新文献

{"title":"Comparison of a Novel Head-mounted Perimeter vs. the Humphrey Field Analyzer","authors":"Wisam O. Najdawi BS ,&nbsp;Fangfang Jiang MSc ,&nbsp;Gideon K.D. Zamba PhD ,&nbsp;Chris A. Johnson PhD ,&nbsp;Andrew E. Pouw MD","doi":"10.1016/j.ogla.2024.11.007","DOIUrl":"10.1016/j.ogla.2024.11.007","url":null,"abstract":"<div><h3>Purpose</h3><div>Perimetry is a critical tool for the diagnosis and monitoring of glaucomatous visual field defects. The Humphrey Field Analyzer (HFA) is a large, relatively expensive device that does not normally allow for examination outside of the clinic, and it can be ergonomically difficult to tolerate for some patients. The present study compared the novel Smart System Virtual Reality (SSVR) perimetric headset test to that of the HFA in a group of patients with glaucoma.</div></div><div><h3>Design</h3><div>Prospective comparative study.</div></div><div><h3>Subjects</h3><div>Seventy-two eyes from 36 patients with glaucoma recruited at the University of Iowa Hospitals and Clinics.</div></div><div><h3>Methods</h3><div>Patients completed both HFA and SSVR visual field tests on the same day, with the order of tests randomized. After completing both visual field tests, subjects completed a survey regarding their subjective experience using each perimeter. Visual fields were analyzed using a linear mixed model to assess differences between devices accounting for intereye correlation and Bland–Altman analysis.</div></div><div><h3>Main Outcome Measures</h3><div>Primary outcome measures included mean deviation (MD), pattern standard deviation (PSD), and test duration.</div></div><div><h3>Results</h3><div>No statistically significant difference in MD was observed between the SSVR (−7.17 ± 6.36 dB) and HFA (−6.88 ± 6.78 dB; <em>P</em> = 0.859). Statistically significant differences in PSD were observed between the SSVR (4.26 ± 2.37 dB) and HFA (6.38 ± 4.51 dB; <em>P</em> &lt; 0.001) and test duration (323.44 ± 72.27 seconds and 372.20 ± 61.44 seconds, respectively; <em>P</em> &lt; 0.001). Subjectively, the SSVR was the preferred perimeter by 88.5% of patients.</div></div><div><h3>Conclusions</h3><div>The SSVR headset is a novel visual field testing device that produces similar results to the HFA with a shorter testing duration. The SSVR was the preferred perimeter by the majority of patients. Future study is required to determine if the SSVR can identify visual field progression.</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 3","pages":"Pages 213-226"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740485","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}

{"title":"Protection from Steroid-Induced Glaucoma via iStent Inject in a Patient with Behçet’s Disease","authors":"Milton Louca MD ,&nbsp;David Z. Wechsler MBBS (Hons), FRANZCO","doi":"10.1016/j.ogla.2024.12.001","DOIUrl":"10.1016/j.ogla.2024.12.001","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 3","pages":"Pages 323-325"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824959","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}

{"title":"Minimally Invasive Glaucoma Surgery and the Distal Aqueous Outflow System: The Final Frontier?","authors":"Clemens A. Strohmaier MD, PhD,&nbsp;Martin Kallab MD, PhD,&nbsp;Saige Oechsli BSc,&nbsp;Alex S. Huang MD, PhD,&nbsp;Osamah J. Saeedi MD, MS","doi":"10.1016/j.ogla.2024.11.006","DOIUrl":"10.1016/j.ogla.2024.11.006","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 3","pages":"Pages 209-212"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017049","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}

{"title":"Agreement and Reliability of Transpalpebral Tonometers with Goldmann Applanation Tonometer","authors":"Selvaraj Jerrome MSc, MPhil ,&nbsp;Sanil Joseph MHA, MSc ,&nbsp;Balasubramaniam Niranjana MS ,&nbsp;Majumdar Arkaprava MSc ,&nbsp;Pooludaiyar Lakshmanan MSc ,&nbsp;Sundar Balagiri MSc ,&nbsp;Thandavarayan Kumaragurupari PhD ,&nbsp;S. Vidya DO ,&nbsp;Vijayalakshmi A. Senthilkumar MS ,&nbsp;Subbaiah R. Krishnadas DO, DNB","doi":"10.1016/j.ogla.2024.11.001","DOIUrl":"10.1016/j.ogla.2024.11.001","url":null,"abstract":"<div><h3>Topic</h3><div>The systematic review and meta-analysis consolidates the extant body of evidence comparing reliability and agreement between transpalpebral tonometers (TTs) and Goldmann applanation tonometer (GAT).</div></div><div><h3>Clinical Relevance</h3><div>With a global prevalence of 3.54 percent, glaucoma stands as the second leading cause of preventable blindness. Projections indicate a rise to 111 million cases by 2040. Existing literature presents inconsistent findings while comparing TT and GAT. The derivation of summary estimates assessing their agreement holds significance, given TT’s multifaceted applicability in clinical, community, and home settings.</div></div><div><h3>Methods</h3><div>Systematic review was conducted using PubMed, Cochrane Library, and Google Scholar from January 2000 to December 2022. Two reviewers independently evaluated, enumerated, and extracted studies and data based on eligibility criteria. The Quality Assessment for Diagnostic Accuracy Studies checklist was used to assess study quality. The summary measures were pooled using the random-effects model as mean difference (MD), and 95% limits of agreement (LoA). We assessed heterogeneity using the I² statistic. The study protocol was registered with the International Prospective Register of Systematic Reviews (CRD42022321693).</div></div><div><h3>Results</h3><div>A total of 26 methods comparison studies (3577 eyes) were included in the meta-analysis. The overall random-effects MD (TT – GAT) and standard deviation (SD) for intraocular pressure (IOP) were −0.70 ± 4.32 mmHg (95% LoA: −8.74 to 7.33 mmHg). In the subgroup analysis based on index test devices used, Easyton showed the lowest MD, SD, (−0.29 ± 2.35 mmHg), and 95% LoA (−4.90 to 4.32 mmHg). In the univariate meta-regression model, we found that, on average, studies examining normal eyes reported a statistically significant lower MD of 2.67 mmHg (95% confidence interval: 0.27–5.07 mmHg; <em>P</em> = 0.03) between TT and GAT, compared to studies that assessed eyes with mixed ocular condition.</div></div><div><h3>Conclusion</h3><div>In the current meta-analysis, we found a small MD in the measured IOP between the 2 tonometers. However, given the high heterogeneity and a wider LoA, it is not advisable to use TT interchangeably with GAT.</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 3","pages":"Pages 242-256"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633590","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}

{"title":"Influence of Social Determinants of Health on Presentation and Outcomes of Primary Congenital Glaucoma","authors":"David A. Ramirez MD ,&nbsp;Blair Shaman MA ,&nbsp;Jennifer L. Rossen MD ,&nbsp;Adam Jacobson MD ,&nbsp;Brenda L. Bohnsack MD, PhD","doi":"10.1016/j.ogla.2025.02.001","DOIUrl":"10.1016/j.ogla.2025.02.001","url":null,"abstract":"<div><h3>Purpose</h3><div>Assess the effect of social determinants of health on presentation and outcomes in primary congenital glaucoma (PCG).</div></div><div><h3>Design</h3><div>Retrospective case series.</div></div><div><h3>Subjects</h3><div>Patients with PCG presenting between 2011 and 2023 with &gt; 3 months follow-up.</div></div><div><h3>Methods</h3><div>The percentage of households with 0, 1–2, or &gt; 3 community resilience estimates (CREs) risk factors and median income for the census tract of residence for each patient were collected. Initial details and final outcomes were correlated with race, ethnicity, insurance type, and census tract data.</div></div><div><h3>Main Outcome Measures</h3><div>Final best-corrected visual acuity (BCVA).</div></div><div><h3>Results</h3><div>Of 59 patients (105 eyes, 68% male), the presenting average age was 294 ± 365 days. Black patients (n = 16) were younger (<em>P</em> &lt; 0.001) than White (n = 31) or other race patients (n = 12). Although there was no racial or ethnic differences in initial intraocular pressure (IOP), IOP &gt; 30 mmHg was associated with worse final BCVA. Patients with Medicaid (n = 31) required more glaucoma surgeries compared with those with commercial insurances (n = 28, <em>P</em> = 0.0305), respectively. Linear regression analysis demonstrated that census tracts with higher percentage of households with &gt; 3 CRE risk factors correlated with worse visual acuity (ß = 0.02, <em>P</em> = 0.0028, <em>R</em>^<em>2</em> = 0.2). There were no racial, ethnic, insurance type, tract median income, or CRE risk factor differences in IOP, number of glaucoma medications, spherical equivalent, or cup-to-disc ratio at final follow-up.</div></div><div><h3>Conclusions</h3><div>Type of insurance and census data as markers for social determinants of health demonstrated increased risk factors can be associated with worse visual outcomes in PCG.</div></div><div><h3>Financial Disclosure(s)</h3><div>The authors have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 3","pages":"Pages 312-322"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460950","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}

{"title":"Eye Drop Instillation Success and Hand Function in Adults with Glaucoma","authors":"Madeline K. Weber BS ,&nbsp;Gül G. Kabil BS ,&nbsp;Leslie M. Niziol MS ,&nbsp;Daniel Duque Urrego BSE ,&nbsp;Cameron Haire BSE ,&nbsp;Stephen M. Cain PhD ,&nbsp;Alanson P. Sample PhD ,&nbsp;David T. Burke PhD ,&nbsp;Susan H. Brown PhD ,&nbsp;Paula Anne Newman-Casey MD","doi":"10.1016/j.ogla.2024.12.008","DOIUrl":"10.1016/j.ogla.2024.12.008","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;To investigate hand function and eye drop instillation success in adults with and without glaucoma.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Cross-sectional pilot study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Subjects&lt;/h3&gt;&lt;div&gt;Adults aged ≥ 65 years with glaucoma who use eye drops daily and adults aged 65+ without glaucoma who do not regularly use eye drops.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Hand function was evaluated using the Saehan Hydraulic Pinch Gauge, Jamar Hand Dynamometer, Grooved Pegboard Test (GPT), Arthritis Hand Function Tests (AHFT), Semmes-Weinstein Monofilament Test, and a tactile pattern recognition device. Eye drop instillation success was analyzed through videography.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Proportion of successful eye drop instillation trials assessed by (1) overall success in getting at least one drop in the eye; (2) average number of drops dispensed; and (3) bottle tip contact with the eye, eyelashes, or skin. Hand function measures: mean pinch and grip strength, GPT and AHFT completion times, smallest detected monofilament, tactile pattern identification time, and accuracy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 25 participants with glaucoma and 79 participants without glaucoma were included. There was no difference in the proportion of trials where at least one drop was successfully instilled, disregarding bottle tip contact (glaucoma: 0.95, nonglaucoma: 0.91; &lt;em&gt;P&lt;/em&gt; = 0.88). Participants with glaucoma were more likely to make contact between the bottle tip and the eye, eyelashes, or skin compared with those without (glaucoma: 0.49, nonglaucoma: 0.28; &lt;em&gt;P&lt;/em&gt; = 0.01). Participants with glaucoma dispensed a similar number of drops as those without (glaucoma: 1.37, nonglaucoma: 1.46; &lt;em&gt;P&lt;/em&gt; = 0.47). Participants with glaucoma had significantly reduced pinch strength (glaucoma: 4.8 kg, nonglaucoma 6.1 kg, &lt;em&gt;P&lt;/em&gt; = 0.01), grip strength (glaucoma: 23.4 kg, nonglaucoma: 27.7 kg, &lt;em&gt;P&lt;/em&gt; = 0.02), longer completion times for the GPT (glaucoma: 113.5 seconds, nonglaucoma: 85.5 seconds, &lt;em&gt;P&lt;/em&gt; = 0.02), and specific AHFT tasks of fastening/unfastening buttons (glaucoma: 36.6 seconds, nonglaucoma: 27.7 seconds, &lt;em&gt;P&lt;/em&gt; = 0.03) and pinning/unpinning safety pins (glaucoma: 35.4 seconds, nonglaucoma: 27.3 seconds, &lt;em&gt;P&lt;/em&gt; = 0.02), and worse tactile acuity on monofilament (&lt;em&gt;P&lt;/em&gt; = 0.04) compared with participants without glaucoma.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Despite hand function deficits, in this exploratory pilot study, adults with glaucoma demonstrated eye drop instillation success comparable to those without glaucoma, though with higher rates of bottle tip contact with the eye, skin, or eyelashes, suggesting an increased risk of potential eye drop bottle contamination. These findings suggest that though regular practice may help mitigate the effects of hand function deficits on the targeted activity of getting the eye drop in the eye, the deficits ","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 3","pages":"Pages 275-284"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089668","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}

{"title":"Agreement between the ICare HOME Tonometer and the Goldmann Applanation Tonometer in the Assessment of the Peak Intraocular Pressure in the Water-Drinking Test","authors":"Carolina N. Susanna MD ,&nbsp;Fernanda N. Susanna MD ,&nbsp;Laura Goldfarb Cyrino MD ,&nbsp;Renato Antunes Schiave Germano MD, PhD ,&nbsp;Remo Susanna Jr. MD, PhD ,&nbsp;Pradeep Y. Ramulu MD, PhD ,&nbsp;Marcelo Hatanaka MD, PhD","doi":"10.1016/j.ogla.2024.11.008","DOIUrl":"10.1016/j.ogla.2024.11.008","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the agreement between the ICare HOME tonometer and the Goldmann Applanation Tonometer (GAT) in assessing the peak intraocular pressure (IOP) during the water-drinking test (WDT).</div></div><div><h3>Design</h3><div>Prospective cross-sectional study.</div></div><div><h3>Subjects</h3><div>Seventy-nine eyes of 41 open-angle glaucoma patients were included in the study.</div></div><div><h3>Methods</h3><div>All of the included patients underwent a training session provided by ophthalmologist specialists to use the ICare HOME tonometer. Then the IOP was first measured with the GAT (AT900; Haag-Streit) by a trained physician, immediately followed by ICare HOME tonometer (TA022, ICare Oy) measurement by the patient. Four measurements were taken with each device with 15-minute differences as established by the WDT.</div></div><div><h3>Main Outcome Measures</h3><div>The agreement and degree of correlation of the peak IOP by both tonometers were assessed.</div></div><div><h3>Results</h3><div>The agreement between the ICare HOME and GAT was high during the WDT: the intraclass correlation coefficient (<em>r</em>) between the 2 methods from basal to 45 minutes: 0.94 (<em>P</em> &lt; 0.001), at basal: 0.91 (<em>P</em> &lt; 0.001), at 15 minutes: 0.94 (<em>P</em> &lt; 0.001), at 30 minutes: 0.94 (<em>P</em> &lt; 0.001), at 45 minutes: 0.95 (<em>P</em> &lt; 0.001), and for peak IOP: 0.94 (<em>P</em> &lt; 0.001). There was no significant difference between peak IOP with the GAT and ICare HOME (18.3 ± 4.6 [10–33] and 18.5 ± 5.0 [0–33], respectively, <em>P</em> = 0.533), nor between the delta of fluctuation between basal and peak IOP with the GAT and ICare HOME (3.96 ± 3.22 and 4.54 ± 3.92, <em>P</em> = 0.054).</div></div><div><h3>Conclusions</h3><div>Our study demonstrated a high agreement between the ICare HOME and the GAT during the WDT in a clinical environment with supervision.</div></div><div><h3>Financial Disclosure(s)</h3><div>The authors have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 3","pages":"Pages 235-241"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775008","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}

{"title":"Re: Lee et al.: Associations between statin use and glaucoma in the All of Us Research Program (Ophthalmol Glaucoma. 2024;7:563–571)","authors":"Ayushi S. Shah BS ,&nbsp;Pranav Vasu MPH","doi":"10.1016/j.ogla.2025.01.005","DOIUrl":"10.1016/j.ogla.2025.01.005","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 3","pages":"Page e5"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588468","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}

{"title":"Effect of Blood Pressure on Rates of Progression in Focal Ischemic vs. Generalized Cup Enlargement Glaucoma Phenotypes","authors":"Marcus Guerreiro-Filho MD ,&nbsp;Alessandro A. Jammal MD, PhD ,&nbsp;Rohit Muralidhar BA ,&nbsp;Rafael Scherer MD, PhD ,&nbsp;Luiz F. Beniz MD ,&nbsp;Douglas R. da Costa MD ,&nbsp;Ivan M. Tavares MD, PhD ,&nbsp;Felipe A. Medeiros MD, PhD","doi":"10.1016/j.ogla.2025.01.001","DOIUrl":"10.1016/j.ogla.2025.01.001","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the impact of blood pressure (BP) on rates of retinal nerve fiber layer (RNFL) thinning in glaucomatous eyes with focal ischemic (FI) vs. generalized cup enlargement (GE) optic disc phenotypes.</div></div><div><h3>Design</h3><div>Prospective cohort study.</div></div><div><h3>Participants</h3><div>The study included 122 eyes from 101 patients diagnosed with primary open-angle glaucoma. Eyes were classified as FI (n = 31, 25%) or GE (n = 91, 75%) based on masked grading of stereophotographs at baseline.</div></div><div><h3>Methods</h3><div>Subjects underwent comprehensive ophthalmic examinations, including intraocular pressure (IOP) measurement and spectral-domain OCT scans, every 6 months for an overall mean follow-up of 4.2 years ± 1.5 years. Brachial artery BP was measured concurrently, and mean arterial pressure (MAP), systolic arterial pressure (SAP), and diastolic arterial pressure (DAP) were calculated. Rates of global RNFL thickness change over time were assessed using linear mixed models, evaluating the impact of BP parameters in each optic disc phenotype, adjusting for IOP and other confounders. Interaction terms were used to test for differences in the effects of BP and IOP between the FI and GE phenotypes.</div></div><div><h3>Main Outcome Measures</h3><div>Effect of MAP, SAP, and DAP on rates of RNFL loss over time in FI and GE optic disc phenotypes.</div></div><div><h3>Results</h3><div>In the adjusted FI group models, each 10 mmHg decrease in MAP, SAP, and DAP was associated with −0.397 μm/year (<em>P</em> = 0.006), −0.211 μm/year (<em>P</em> = 0.029), and −0.471 μm/year (<em>P</em> = 0.005) faster RNFL thinning, respectively. In contrast, BP parameters were not significantly associated with RNFL loss in the GE group. In the multivariable model with interaction terms, the interaction between DAP and phenotype was statistically significant (<em>P</em> = 0.019), indicating the FI phenotype exhibited greater sensitivity to lower diastolic pressure compared to GE eyes. In contrast, interaction terms between IOP and optic disc phenotype were not significant in any of the models, suggesting a similar effect of IOP in both phenotypes.</div></div><div><h3>Conclusions</h3><div>Lower systemic BP levels were associated with faster RNFL thinning in the FI optic disc phenotype but not in the GE phenotype. These findings highlight the importance of considering both IOP and systemic BP when managing patients with the FI optic disc phenotype.</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 3","pages":"Pages 293-301"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973497","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}

{"title":"Risk Factors for Diagnostic Change from Glaucoma Suspect to Primary Open-Angle Glaucoma and Vice Versa Over 2 Years","authors":"Lillian K. To MD, MS ,&nbsp;Nicole V. Carrabba MD ,&nbsp;Chaitanya G. Kalathuru MD ,&nbsp;Alice Z. Chuang PhD ,&nbsp;Logan Smith MD ,&nbsp;Robert M. Feldman MD","doi":"10.1016/j.ogla.2024.12.006","DOIUrl":"10.1016/j.ogla.2024.12.006","url":null,"abstract":"<div><h3>Objective</h3><div>This study investigates the incidence and causes of diagnostic changes from primary open-angle glaucoma suspect (POAGS) to primary open-angle glaucoma (POAG), and vice versa, in clinical practice.</div></div><div><h3>Design</h3><div>This is a retrospective, single-site, case-control study.</div></div><div><h3>Participants</h3><div>It includes patients &gt; 40 years of age diagnosed with either POAG or POAGS between 2013 and 2020. Controls had a minimum of 24 months of follow-up without a diagnostic change, whereas cases underwent a diagnostic change from glaucoma to suspect (POAG to POAGS) or from suspect to glaucoma (POAGS to POAG) within 2 years.</div></div><div><h3>Methods</h3><div>At initial and follow-up visits, diagnosis, treatment, type of ophthalmic provider, and performance of pachymetry, visual fields (VFs), OCT, disc examination, and gonioscopy were recorded.</div></div><div><h3>Main Outcome Measures</h3><div>Data were then analyzed to determine if baseline characteristics, type of provider seen, or ophthalmic testing performed were protective or risk factors in regards to diagnostic change.</div></div><div><h3>Results</h3><div>Nine hundred twenty-two subjects were included, and the incidence of diagnostic changes was 13.8% (127/922), of which 99 (78%) were upstaged from POAGS to POAG and 28 (22%) changed from POAG to POAGS. Pre-existing nonglaucomatous VF defect (<em>P</em> &lt; 0.001) was significantly higher in cases than controls. Cases were significantly less likely to be seen by a glaucoma specialist at the initial visit compared with controls (<em>P</em> &lt; 0.001), and less cases underwent VF testing (<em>P</em> &lt; 0.001), OCT testing (<em>P</em> = 0.017), or gonioscopy (<em>P</em> = 0.013) at the initial visit. On multivariate analysis, performing VFs or OCT at both visits reduced the odds of short-term diagnostic change, whereas changing providers from a nonglaucoma specialist to a glaucoma specialist between visits increased the odds of diagnostic change. In the POAG-to-POAGS cases, 39% (11/28) were treated with either medications or laser trabeculoplasty, whereas 72% (71/99) of the POAGS-to-POAG cases were left untreated between visits.</div></div><div><h3>Conclusions</h3><div>It is important to understand risk factors for diagnostic changes in glaucoma, in order to prevent undertreatment of disease and overtreatment of suspects. Here we find specialist type and adherence to American Academy of Ophthalmology (AAO) recommended testing to be important factors in preventing short term diagnostic changes.</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 3","pages":"Pages 257-265"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878691","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}