J. Glaucoma [JOURNAL]
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200 papers
Optical Coherence Tomography Alteration of the Choroid and Lamina Cribrosa in Pseudoexfoliation Syndrome and Glaucoma.
Fekrazad S, Gouravani M, Hassanzadeh G … +5 more , Mafhoumi A, Mirzad M, S Vafa S, Xu B, Arevalo JF
J Glaucoma · 2025 Jul · PMID 40131012 · Publisher ↗
PRÉCIS: This meta-analysis demonstrates significant thinning of the choroid and lamina cribrosa in eyes with pseudoexfoliation syndrome and pseudoexfoliative glaucoma compared with healthy controls, emphasizing OCT's pot...
PRÉCIS: This meta-analysis demonstrates significant thinning of the choroid and lamina cribrosa in eyes with pseudoexfoliation syndrome and pseudoexfoliative glaucoma compared with healthy controls, emphasizing OCT's potential utility for early glaucoma detection in these patients. BACKGROUND: Pseudoexfoliation syndrome (PXS) is a significant risk factor for pseudoexfoliative glaucoma (PXG), impacting posterior segment tissues such as the choroid and lamina cribrosa (LC). This research aims to investigate the effects of PXS on these layers compared with healthy controls using optical coherence tomography (OCT). METHODS: Following the PRISMA checklist, this systematic review, registered at PROSPERO (CRD42023415302), examined OCT measurements in PXS and PXG patients. Searches were conducted in PubMed, Scopus, and EMBASE until April 2023. Selection criteria included human observational studies assessing choroid and lamina cribrosa layers with OCT in PXS and PXG patients. Statistical analyses, including meta-analysis, bias detection, subgroup analysis, and metaregression, were performed. RESULTS: A total of 22 studies, comprising 2293 participants (717 PXG patients, 708 PXS patients, and 868 healthy controls), underwent meta-analysis. In PXG cases, subfoveal choroidal thickness (CT), as well as CT at 1500 µm and 3000 µm temporal and nasal to the fovea, were significantly decreased compared with healthy individuals. In addition, average peripapillary CT and average LCT were significantly reduced in PXG eyes compared with healthy controls. Similarly, eyes with PXS exhibited significantly lower values for subfoveal CT, CT at 1500 µm temporal and 3000 µm nasal to the fovea, average peripapillary CT, and average LC thickness compared with healthy controls. CONCLUSION: This meta-analysis confirms previously reported decreases in CT and LC thickness in patients with PXG and PXS. Continuous monitoring of choroid and LC using OCT may facilitate the early detection of glaucoma in patients with PXS, addressing a key concern in their management.
Incidence and Association of Angle Closure Glaucoma in Retinitis Pigmentosa: A Meta-Analysis.
Tao BK, Wong M, Shunmugam M … +6 more , Bhalla M, Ling J, Gill K, Schendel S, Gregory-Evans K, Navajas EV
J Glaucoma · 2025 Jul · PMID 40111380 · Publisher ↗
PRÉCIS: Low certainty evidence suggests elevated angle closure glaucoma incidence [1.30% 95% CI (0.71-2.36)] with retinitis pigmentosa than without [risk ratio: 2.01, 95% CI (1.59-2.53)]. RP patients may benefit from enh...
PRÉCIS: Low certainty evidence suggests elevated angle closure glaucoma incidence [1.30% 95% CI (0.71-2.36)] with retinitis pigmentosa than without [risk ratio: 2.01, 95% CI (1.59-2.53)]. RP patients may benefit from enhanced monitoring for glaucomatous complications. PURPOSE: To determine the literature-pooled rate and association of angle closure glaucoma (ACG) with retinitis pigmentosa (RP). ACG is a potentially sight-threatening cause of optic neuropathy. To date, several reports have documented the potential association between ACG and RP. MATERIALS AND METHODS: Cochrane Library, Embase, and Medline were searched to August 2024. We included all studies that reported the incidence of ACG among patients with RP, or the comparative risk of ACG among patients with or without RP. Two independent reviewers completed study screening, data extraction, and risk of bias assessment using the Cochrane risk of bias (ROB) in nonrandomized studies (exposure) tool. Non-pairwise and pairwise meta-analyses, using random effects and the Mantel-Haenszel method, were conducted to calculate the pooled rate of ACG in RP patients and to determine whether this risk differed significantly from patients without RP. Subgroup analysis excluded "high" ROB studies. RESULTS: Eight observational studies (n=31,501 patients; 456 events) were identified, 3 of which were of comparative design. Of this pooled population, there were 29,363 patients with RP (238 events). Across all studies, the pooled incidence of ACG with RP was 1.30% [95% CI (0.71-2.36), I2 : 97%], although this heterogeneity resolved when subgrouped by studies with low ROB [1.59%, 95% CI (1.31-0.192), I2 : 0%]. In the comparative analysis, patients with RP had a significantly higher risk of developing ACG [RR: 2.02, 95% CI (1.61-2.55), I2 : 0%] compared with patients without RP. For either outcome, there was no significant evidence of publication bias, and the results remained consistent across subgroup and sensitivity analyses. Six of 8 studies were rated as having "high" ROB due to a lack of adjusted analyses. CONCLUSION: Low certainty evidence suggests that RP may confer an increased risk of ACG compared with patients without RP. The results of this study seem to support the view that more extensive clinical monitoring for ACG may be of benefit for patients with RP. Further studies controlling for individual patient-level confounding are needed.
Outcome of Goniotomy Over 120, 240 and 360 Degrees in Juvenile Open Angle Glaucoma: A Multicenter Study.
Yang Z, Wang Z, Fan H … +37 more , Ge Q, Dang G, Yang X, Xie L, Zhu X, Yang Y, Wang Y, Liu J, Zhang H, Feng Y, Qi Y, Ye X, Lai M, Lin P, Wang P, Han S, Xu J, Tao L, Liu H, Nie X, Liao M, Zou K, Jiang Y, Song Y, Lin F, Zhou F, Xiaokaiti D, Liu X, Fang Z, Jin L, Chen Y, Tham CC, Han Y, Pan X, Zeng L, Weinreb RN, Zhang X
J Glaucoma · 2025 Jun · PMID 40105411 · Publisher ↗
PRÉCIS: 240-degree and 360-degree goniotomy (GT) demonstrated similar efficacy in intraocular pressure (IOP) reduction, both outperforming 120-degree GT in patients with juvenile open angle glaucoma (JOAG) at postoperati...
PRÉCIS: 240-degree and 360-degree goniotomy (GT) demonstrated similar efficacy in intraocular pressure (IOP) reduction, both outperforming 120-degree GT in patients with juvenile open angle glaucoma (JOAG) at postoperative 6-month follow-up. OBJECTIVE: To compare the surgical efficacy and safety of 120-degree, 240-degree, and 360-degree GT for patients with JOAG. PATIENTS AND METHODS: This multicenter retrospective study included 102 eyes of 102 patients with JOAG, who underwent GT with a follow-up of at least 6 months. Patients were categorized into 3 groups: (1) 120-degree GT, (2) 240-degree GT, and (3) 360-degree GT. IOP, glaucoma medications, and complications were recorded at baseline and the final visit. Complete success and qualified success were defined as a postoperative IOP ≤21 mm Hg without and with medications, respectively. RESULTS: Mean age of the participants was 24.4 ± 7.9 years. After a mean follow-up of 8.1 ± 2.7 months, complete success rates were similar between the 240-degree GT (45.2%) and the 360-degree GT (63.2%; P = 0.135), and both were superior to 120-degree GT (18.2%; P < 0.05). Qualified success rates among patients in the 120-degree, 240-degree, and 360-degree GT groups were 93.9%, 96.8%, and 100%, respectively, and showed no statistically significant difference ( P = 0.292). 360-degree GT required fewer medications than 240-degree GT and 120-degree GT ( P < 0.05), with no significant difference in medications between 120-degree GT and 240-degree GT ( P > 0.05). Hyphema was the most common postoperative complication, with a significantly higher incidence in the 360-degree GT (68.4%) compared with the 240-degree GT (41.9%) and 120-degree GT (33.3%; P < 0.05). CONCLUSIONS: 240-degree and 360-degree GT showed similar efficacy in IOP reduction and were superior to 120-degree GT. More extensive GT may provide better outcomes in JOAG.
Pattern of Long-Term Intraocular Pressure Variation Following Gonioscopy-Assisted Transluminal Trabeculotomy: Two-Year Outcomes.
Faria BM, Dias DT, Reis MAO … +7 more , Daga FB, Scoralick ALB, Magacho L, Ribeiro Junior PHE, Kanadani FN, Costa VP, Prata TS
J Glaucoma · 2025 Aug · PMID 40071986 · Publisher ↗
PRÉCIS: Patients with clinically uncontrolled open angle glaucoma submitted to isolated gonioscopy-assisted transluminal trabeculotomy or combined with phacoemulsification not only achieved low mean IOPs, but also demons...
PRÉCIS: Patients with clinically uncontrolled open angle glaucoma submitted to isolated gonioscopy-assisted transluminal trabeculotomy or combined with phacoemulsification not only achieved low mean IOPs, but also demonstrated stable IOP patterns during a 24-month follow-up. PURPOSE: To assess the impact of gonioscopy-assisted transluminal trabeculotomy (GATT) on long-term intraocular pressure (IOP) variation. PATIENTS AND METHODS: An unicentric retrospective study including 169 consecutive patients who had undergone standalone GATT or combined with phacoemulsification (PHACOGATT) due to clinically uncontrolled open angle glaucoma, with at least 12 months of follow-up was conducted. Long-term mean IOP, long-term IOP peak, long-term IOP fluctuation, coefficient of variation, mean-positive IOP variation, sustained clinically significant positive IOP variation, and number of follow-up visits with IOP ≥15 mm Hg were investigated. RESULTS: One hundred sixty-nine eyes from 169 patients were included (GATT group=101 patients; PHACOGATT group=68 patients). Mean long term IOP (12.0±1.8 vs. 11.2±2.0 mm Hg), mean long-term IOP peak (12.9±2.6 vs. 11.8±3.5 mm Hg), and mean coefficient of variation (0.07±0.08 vs. 0.05±0.09) were lower in the PHACOGATT group, while mean IOP fluctuation (1.0±3.7 vs. 1.2±1.8 mm Hg) was lower in the GATT group. In addition, the overall mean-positive IOP variation was 0.79±1.64 mm Hg. Finally, only 6.5% of the patients presented sustained clinically significant positive IOP variation and IOP was ≥15 mm Hg in 5.9% of the follow-up visits. CONCLUSIONS: Patients with clinically uncontrolled open angle glaucoma submitted to GATT or PHACOGATT achieved low mean IOPs and demonstrated stable IOP patterns. Our results provide additional evidence supporting GATT and PHACOGATT as viable options for the treatment of medically uncontrolled glaucoma patients requiring low and stable IOPs.
Fractal Dimension Analysis of Peripapillary Microvasculature in Primary Congenital Glaucoma.
Tam EK, Ji MH, Fayed AE … +7 more , Sadek SH, Ahmed N, Dihan Q, Alzein A, Adelpour M, El Sayed YM, Elhusseiny AM
J Glaucoma · 2025 Aug · PMID 40071983 · Publisher ↗
PRÉCIS: In this prospective multicenter study, eyes with primary congenital glaucoma exhibited lower retinal vascular parameters compared to healthy controls, as assessed by optical coherence tomography angiography fract...
PRÉCIS: In this prospective multicenter study, eyes with primary congenital glaucoma exhibited lower retinal vascular parameters compared to healthy controls, as assessed by optical coherence tomography angiography fractal dimension analysis. PURPOSE: To study the retino-choroidal peripapillary microvascular pattern in primary congenital glaucoma (PCG) using fractal dimension (FD) analysis and compare it to healthy controls. METHODS: This was a prospective multicenter comparative study. We obtained peripapillary optical coherence tomography angiography (OCTA) scans (Optovue Inc) and computed FD at the vitreous/retina (large retinal vessels), inner limiting membrane/nerve fiber layer (ILM-NFL) (radial peripapillary capillary plexus, RPC), and the choroid. Other peripapillary OCTA parameters, including the whole image inside the disk and peripapillary superior and inferior vascular density (VD) parameters, were also collected. 1 eye per patient was included in the analysis. RESULTS: We included a total of 17 PCG eyes and 24 control eyes. The mean age at the time of enrollment was 8.24±0.75 years in the PCG group compared to 8.33±1.09 in controls ( P =0.74). Eight patients (47%) in the PCG group and 14 (58.3%) in the control group were male. Among the PCG group, the mean vitreo-retina (large retinal vessels) FD (1.79) and ILM-NFL (RPC) FD (1.75) were significantly reduced compared to controls [vitreo-retina FD (1.85), ILM-NFL FD (1.82), P -value 0.011 and 0.014, respectively]. There was no statistically significant difference in the averaged choroidal FD between both groups (1.89 vs. 1.88, P =0.29). All optic nerve VD parameters (whole image, inside disc, superior, and inferior-hemi) were also significantly reduced in the PCG group. CONCLUSIONS: PCG was associated with lower vascular parameters in the vitreo-retina (large retinal vessels) and ILM-NFL (RPC) layers as detected by OCTA FD.
Visual Field Progression in Glaucoma During COVID-19.
Johri B, Vijaya L, Patil TS … +1 more , George R
J Glaucoma · 2025 Jul · PMID 40071981 · Publisher ↗
PRÉCIS: Visual fields in glaucoma significantly progressed during the COVID-19 pandemic, likely due to reduced compliance and lack of availability of medication. PURPOSE: To study the impact of the COVID-19 pandemic on t...
PRÉCIS: Visual fields in glaucoma significantly progressed during the COVID-19 pandemic, likely due to reduced compliance and lack of availability of medication. PURPOSE: To study the impact of the COVID-19 pandemic on the rate of visual field progression in glaucoma and to validate the factors affecting progression. METHODS: This hospital-based prospective cohort study included patients diagnosed with primary open angle glaucoma, primary angle closure glaucoma, and ocular hypertension who fulfilled the eligibility criteria. We included 234 eyes with at least 5 reliable Humphrey visual fields (24-2 SITA Standard) before March 24, 2020 and 2 or more after. Glaucoma Progression Analysis software was used to carry out both trend and event-based analysis. Rates of progression prepandemic and postpandemic were compared. Univariate and multivariate logistic regression analyses were done to identify factors affecting progression. RESULTS: The rate of visual field progression increased significantly post lockdown, mean deviation (MD) prelockdown -0.1(SD:0.8) (95% CI: -0.196, 0.001) dB/year versus -0.3 (SD:0.6) (95% CI: -0.362, -0.208) dB/year post lockdown ( P <0.001) and Visual Field Index(VFI) pre lockdown -0.001(SD:0.007) (95% CI: -0.002, 0) %/year versus -0.6 (SD:2.2) (95% CI: -0.903, -0.342) %/year post lockdown ( P <0.001). According to either trend or event analysis, of 234 eyes, 45.3% progressed and 37.6% progressed on any progression post-COVID. The MD of the last field pre-COVID was significantly affecting progression post-COVID based on both trend and event analysis or any progression ( P <0.001). CONCLUSION: In patients with glaucoma on follow-up, higher rates and proportions of visual field progression were found post the COVID-19 pandemic compared with prepandemic.
Comparison Between Phacoemulsification-iStent Inject W and Phacoemulsification-Micropulse Transscleral Laser Therapy in Asian Eyes With Mild-Moderate Open Angle Glaucoma.
Figueras MM, Okada N, Tan CK … +7 more , Aquino MC, Tan MCJ, Lun KW, Lim DKA, Loon SC, Chew PTK, Chang Koh VT
J Glaucoma · 2025 Jun · PMID 40071977 · Full text
PRÉCIS: In this retrospective cohort study, the 1-year cumulative probability of failure was comparable, achieving 52.20% in the phacoemulsification-iStent inject W (phaco/iStent) group and 47.80% in the phacoemulsificat...
PRÉCIS: In this retrospective cohort study, the 1-year cumulative probability of failure was comparable, achieving 52.20% in the phacoemulsification-iStent inject W (phaco/iStent) group and 47.80% in the phacoemulsification-micropulse transscleral laser therapy (phaco/MPTLT) group ( P =0.994). PURPOSE: To compare the 1-year efficacy and safety of phacoemulsification combined with iStent Inject W (phaco/iStent) and phacoemulsification combined with micropulse transscleral laser therapy (phaco/MPTLT). METHODS: A retrospective cohort study that included patients with mild-moderate open angle glaucoma (OAG) and cataract who underwent either phaco/iStent or phaco/MPTLT in a tertiary hospital in Singapore between August 1, 2016 and December 31, 2022. The primary outcome measures were cumulative probabilities of failure between the 2 groups, with failure defined as disease progression by ocular coherence tomography (OCT-RNFL) or visual field test (VFT), repeat glaucoma surgery, and inability to maintain intraocular pressure (IOP) lower than preoperative baseline or the use of glaucoma medications for 2 consecutive visits after 1 month postoperatively. In addition, postoperative mean IOP, average number of IOP lowering medications, visual acuity, and complications were analyzed. RESULTS: Forty-six patients were included. Twenty-three eyes underwent phaco/iStent and 23 had phaco/MPTLT. The 2 groups had comparable cumulative probabilities of failure (52.20% phaco/iStent, 47.80% phaco/MPTLT; P =0.994) and mean IOP (15.57±2.95 mm Hg phaco /iStent, 14.39±2.25 mm Hg phaco/MPTLT; P =0.136) after 1 year. The change in IOP before surgery to 12 months is -1.04±3.07 mm Hg in the phaco/iStent group ( P =0.593) and -2.43±4.12 mm Hg in the phaco/MPTLT group ( P =0.022). Both achieved significant medication reduction burdens ( P <0.05). Intraoperative and postoperative complication rates were similar. CONCLUSION: Both groups showed comparable surgical efficacy and safety after 1 year. The phaco/MPTLT group demonstrated sustained IOP reduction 1 year postoperatively.
Social Vulnerability Associated With Frequency of Visual Field and Optical Coherence Tomography Testing in Glaucoma Patients.
Chen DX, Hashimi H, Ding L … +2 more , Bojikian KD, Chen A
J Glaucoma · 2025 May · PMID 40071974 · Publisher ↗
PRECIS: Higher Social Vulnerability Index scores, limited-English proficiency, and retirement/disability status were associated with lower odds of completing one visual field and optical coherence tomography/year in glau...
PRECIS: Higher Social Vulnerability Index scores, limited-English proficiency, and retirement/disability status were associated with lower odds of completing one visual field and optical coherence tomography/year in glaucoma patients. PURPOSE: To assess the correlation between sociodemographic factors and the Social Vulnerability Index to the likelihood of not receiving 1 visual field test and 1 retinal nerve fiber layer optical coherence tomography test per year. METHODS: Patient records with glaucoma living in Washington state from a single academic institution (2014-2021) were reviewed. Those with a single visit, an address with no Social Vulnerability Index score, or a diagnosis relating to pre-glaucoma, glaucoma-suspect, or ocular hypertension were excluded. Demographic data, Social Vulnerability Index scores, and the number of visual fields and optical coherence tomography were collected. Patients were classified as meeting testing criteria if they had at least one visual field and optical coherence tomography per year. Logistic regression was used to assess whether sociodemographic factors and Social Vulnerability Index scores were associated with not meeting testing criteria. RESULTS: Three thousand nine hundred seventy-one patients were included: 1470 (37.0%), 1834 (46.2%), and 1413 (35.6%), had at least 1 visual field/year, at least 1 optical coherence tomography/year, and at least 1 visual field and 1 optical coherence tomography/year, respectively. On average 0.8±0.6 visual field/year and 0.9±0.6 optical coherence tomography/year were performed. Limited English proficiency ( P =0.009), being disabled/retired ( P =0.003), and higher Social Vulnerability Index scores ( P <0.001) were associated with higher odds of not meeting testing criteria. CONCLUSIONS: Although higher Social Vulnerability Index scores were linked to reduced odds of glaucoma testing, specific sociodemographic factors-such as limited English proficiency and retirement/disability-further reduced the odds.
One-Year Outcomes of Gonio Scratch as a Minimally Invasive Glaucoma Surgery With Cataract Removal.
Tokumo K, Yokoyama M, Baba T … +8 more , Okada N, Edo A, Komatsu K, Okumichi H, Mochizuki H, Miyoshi T, Kiuchi Y, Hirooka K
J Glaucoma · 2025 Jun · PMID 40071957 · Publisher ↗
PRÉCIS: This study evaluated the 1-year efficacy and safety of a novel minimally invasive glaucoma surgery, gonio scratch, in reducing intraocular pressure of eyes with open angle glaucoma and cataracts. PURPOSE: To eval...
PRÉCIS: This study evaluated the 1-year efficacy and safety of a novel minimally invasive glaucoma surgery, gonio scratch, in reducing intraocular pressure of eyes with open angle glaucoma and cataracts. PURPOSE: To evaluate the 1-year efficacy and safety of phacoemulsification cataract extraction combined with gonio scratch (GS-Phaco), a novel minimally invasive glaucoma surgery, in patients with open angle glaucoma and cataracts. PATIENTS AND METHODS: This prospective multicenter clinical trial was conducted at Hiroshima University, Yokoyama Retina Clinic, Kusatsu Eye Clinic, and Miyoshi Eye Clinic in Japan. The primary outcome measure was the rate of intraocular pressure (IOP) control. Failure was defined as an IOP of >18 mm Hg or >14 mm Hg, a <20% reduction from baseline IOP on 2 consecutive follow-up visits after 3 months, the need for additional glaucoma surgery, or loss of light perception. Kaplan-Meier analysis was used to assess surgical success rates. RESULTS: Forty-seven eyes of 47 patients who underwent GS-Phaco surgery were included in the analysis. None of the patients had undergone prior ocular surgery. The median baseline IOP was 17 mm Hg. At 12 months postoperatively, there was a significant reduction in IOP to a median of 12 mm Hg ( P <0.01). The number of glaucoma medications also decreased significantly, from a median of 2 to 1 ( P <0.01). The surgical success rate at 12 months was 80.9%. The only complication observed was transient elevation of IOP in 2 (4.3%) eyes. No patients developed anterior chamber hemorrhage or hyphema with niveau formation. CONCLUSION: GS-Phaco achieved sustained IOP reduction and a decrease in medication use at 12 months postoperatively in patients with open angle glaucoma and cataracts.
Transscleral Cyclophotocoagulation for Refractory Intraocular Pressure Elevation After Penetrating Keratoplasty.
Martin Lesan C, Flockerzi E, Löw U … +1 more , Seitz B
J Glaucoma · 2025 Aug · PMID 40071927 · Publisher ↗
PRÉCIS: Transscleral cyclophotocoagulation significantly reduces intraocular pressure and anti-glaucomatous medication use post-penetrating keratoplasty, with low hypotony risk, particularly if delayed. Safe reinterventi...
PRÉCIS: Transscleral cyclophotocoagulation significantly reduces intraocular pressure and anti-glaucomatous medication use post-penetrating keratoplasty, with low hypotony risk, particularly if delayed. Safe reintervention is feasible for intraocular pressure recurrence. PURPOSE: Transscleral cyclophotocoagulation (TSCPC) is an established procedure for lowering intraocular pressure (IOP). We aimed to evaluate the therapeutic efficacy and the safety of TSCPC in patients with refractory IOP elevation after penetrating keratoplasty (PK), as well as to identify risk factors associated with postoperative hypotony. PATIENTS AND METHODS: TSCPC was performed in 52 eyes with inadequate pressure regulation despite maximal conservative therapy after PK. All the patients were reviewed on day 1, 1 month, 6 months, and 1 year after the TSCPC. A diagnosis of hypotony was considered if the IOP was <6 mm Hg at any time postoperatively. Multivariate analysis was applied to identify risk factors for hypotony and elevated IOP recurrence. RESULTS: The IOP value decreased significantly from the median baseline of 29.1±0.7 mm Hg to 15.1±0.8 mm Hg at 1-year follow-up. The number of anti-glaucomatous medications was significantly reduced 1 year after TSCPC (2.9±0.1 vs. 2.4±0.2; P <0.01). Only 6 (11.5%) patients developed transitory hypotony. The mean time between PK and TSCPC was significantly lower ( P <0.01) in patients who developed hypotony (5.8±2.2 vs. 28.9±5.7 mo). A total of 53.8% of cases had a relapse of IOP increase at any time point during the follow-up. Reintervention with TSCPC was performed in 42.4% of patients. CONCLUSIONS: TSCPC after PK significantly reduces IOP and the number of anti-glaucomatous medications. The rate of postoperative hypotony is low. Patients with shorter time intervals between PK and TSCPC are at higher risk of developing hypotony. TSCPC can be safely reperformed in patients after PK.
Associations Between Socioeconomic Factors and Neovascular Glaucoma in a United States Medicare Population.
Tseng VL, Kitayama K, Yu F … +1 more , Coleman AL
J Glaucoma · 2025 Nov · PMID 40052874 · Publisher ↗
PRÉCIS: In 2019 California Medicare beneficiaries with retinal ischemia, poor socioeconomic status was associated with increased prevalence of neovascular glaucoma before adjustment for demographic factors. Investigation...
PRÉCIS: In 2019 California Medicare beneficiaries with retinal ischemia, poor socioeconomic status was associated with increased prevalence of neovascular glaucoma before adjustment for demographic factors. Investigation is needed of demographic differences in management of retinal ischemia. PURPOSE: To examine associations between poor socioeconomic status (SES) and prevalence of neovascular glaucoma (NVG) in at-risk individuals in the California (CA) Medicare population. MATERIALS AND METHODS: The study included 2019 CA Medicare beneficiaries with retinal ischemia (ie, proliferative diabetic retinopathy, retinal vein occlusion, and/or ocular ischemic syndrome). Exposures were Centers for Disease Control and Prevention Social Vulnerability Index socioeconomic status theme (SVI-SES) quartile and dual Medicare/Medicaid eligibility (DMME), and the outcome was NVG diagnosis. Covariates included age, sex, race and ethnicity, and the Charlson Comorbidity Index (CCI) score. Logistic regression modeling was used to examine associations between SVI-SES, DMME, and NVG, adjusting for demographics only, CCI only, and all covariates, overall and stratified by race and ethnicity. RESULTS: There were 41,972 beneficiaries with retinal ischemia, of whom 1842 (4.4%) had NVG. The presence of DMME was associated with increased prevalence of NVG in unadjusted and CCI-adjusted models (unadjusted OR=1.23, 95% CI=1.12-1.35; CCI-adjusted OR=1.18, 95% CI=1.07-1.30), but not in demographic-adjusted or fully adjusted models. In stratified analyses, the fourth versus first SVI-SES quartile was associated with increased prevalence of NVG for beneficiaries of Non-Hispanic White and other race and ethnicity (adjusted OR=1.39, 95% CI=1.10-1.70 for Non-Hispanic White; adjusted OR=2.17, 95% CI=1.08-4.33 for other). CONCLUSIONS AND RELEVANCE: In the 2019 CA Medicare population, associations between high SVI-SES, DMME, and increased prevalence of NVG were weakened after adjustment for demographic factors. Further studies are needed to assess for differential management of retinal ischemia in at-risk individuals based on age, sex, race, and ethnicity, independent of SES.
Reliability of Self-Monitoring of Intraocular Pressure With iCare Home2 Rebound Tonometry.
Romano D, Montesano G, Aminoleslami AA … +2 more , Colizzi B, Rossetti LM
J Glaucoma · 2025 Jun · PMID 40052873 · Full text
PRÉCIS: Using iCare Home2 (iCare, Finland) rebound tonometry, self-measurement of intraocular pressure has demonstrated good reliability and ease of use. PURPOSE: To investigate the reliability and repeatability of self-...
PRÉCIS: Using iCare Home2 (iCare, Finland) rebound tonometry, self-measurement of intraocular pressure has demonstrated good reliability and ease of use. PURPOSE: To investigate the reliability and repeatability of self-measured intraocular pressure (IOP) with rebound tonometry using iCare Home2. PATIENTS AND METHODS: One hundred four patients out of 110 consecutive patients were recruited for this observational cross-sectional study. One randomly selected eye from each patient underwent 6 consecutive IOP measurements with Goldmann applanation tonometry (GAT), iCare IC200, and iCare Home2. Every eye was tested twice with each device, in random order, by an ophthalmologist for GAT and IC200, and by the patient itself for Home2. In addition, central corneal thickness (CCT) has been collected. The reliability of Home2 has been tested by calculating limits of agreement (LoA) between self-measured and physician-measured IOP, using the Bland-Altman analysis. The repeatability of each device has been tested by calculating the limits of repeatability (LoR) with the same method. Pearson correlation coefficient was used to determine the correlation between differences in IOP measurements and CCT. RESULTS: The mean difference between GAT and iCare Home2 was -0.28±1.57 mmHg ( P =0.070), 95%-LoA: (-3.36 to 2.79 mmHg). The mean difference between IC200 and iCare Home2 was 0.92±1.48 mmHg ( P <0.0001), 95%-LoA (-1.98 to 3.82 mmHg). The mean difference between the first and second measurements with GAT, iCare IC200, and iCare Home2 measurements was 0.21±0.98 mmHg ( P =0.03), -0.02±1.11 mmHg ( P =0.88) and -0.23±1.04 mmHg ( P =0.05). CONCLUSIONS: Self-measured IOP with rebound tonometry showed good reliability and repeatability when compared with physician-measured IOP with both standard GAT and rebound tonometry.
Telemedicine in Glaucoma Management: Patient Perspectives.
Oh AJ, Bouris E, Leyva BK … +2 more , Malik M, Caprioli J
J Glaucoma · 2025 May · PMID 40029196 · Publisher ↗
PRÉCIS: Patient satisfaction and perspectives on telemedicine for glaucoma are crucial for validating the efficacy of remote health care. This study underscores its acceptance by patients in a single academic practice. P...
PRÉCIS: Patient satisfaction and perspectives on telemedicine for glaucoma are crucial for validating the efficacy of remote health care. This study underscores its acceptance by patients in a single academic practice. PURPOSE: To evaluate patient satisfaction and preferences with telemedicine visits integrated into a glaucoma practice. METHODS: A prospective observational study of patients of a single glaucoma specialist's telemedicine practice was performed using an online questionnaire. RESULTS: Of the 219 patients contacted, 153 (69%, mean age 67.0 y, 58% women) completed the survey. 68% had glaucoma (43% mild, 44% moderate, and 13% severe) and 32% were glaucoma suspects. Patients had been under the care of the specialist for 10±6.2 years, with 41% having undergone surgery with the specialist. The mean number of prior office visits with the specialist was 9.7±6.3 (range 1-24 y) with an average of 0.8 (range 0-3) prior telemedicine visits at the time of the survey. Ninety-seven percent reported satisfaction with integrated telehealth visits, and 78% would recommend telemedicine visits. Ninety-three percent planned to continue with telemedicine; 5 patients (3%) requested switching to in-person only visits with another provider. Compared with their in-person visits, patients found integrated telemedicine visits less time-consuming and more convenient. CONCLUSIONS: This study demonstrates high satisfaction and support for integrated telemedicine visits among glaucoma patients within a specialized practice setting.
Intraocular Pressure Measurements With the Tono-Vera: A New Handheld Rebound Tonometer.
Beniz LAF, Jammal AA, Malek DA … +2 more , Tseng H, Medeiros FA
J Glaucoma · 2025 May · PMID 40029195 · Publisher ↗
PRÉCIS: In a cross-sectional study comparing the novel Tono-Vera handheld rebound tonometer with the Ocular Response Analyzer, a strong agreement was found between the intraocular pressure measurements of the 2 devices....
PRÉCIS: In a cross-sectional study comparing the novel Tono-Vera handheld rebound tonometer with the Ocular Response Analyzer, a strong agreement was found between the intraocular pressure measurements of the 2 devices. PURPOSE: To compare intraocular pressure (IOP) measurements obtained by the new Tono-Vera (Reichert Technologies), a novel handheld rebound tonometer with a proprietary camera-based positioning system, with those from the Ocular Response Analyzer (ORA, Reichert Technologies) non-contact tonometer. PATIENTS: Fifty-four eyes of normal individuals and open angle glaucoma subjects. METHODS: All subjects had at least 6 reliable measurements with the Tono-Vera and 3 with the ORA, acquired by the same technician in the same visit. The sample was randomly split into calibration and validation samples. An ordinary least squares linear regression model generated a calibration formula for Tono-Vera readings using ORA's Goldmann-correlated IOP (IOPg) as a target. Bland-Altman plots evaluated the agreement between Tono-Vera calibrated IOP (IOPtv) and ORA IOPg in the validation sample. MAIN OUTCOME MEASURES: Agreement between IOPtv and IOPg measurements. RESULTS: Fifty glaucoma and 4 normal eyes were included, mean age 68.3 ± 9.4 years, mean central corneal thickness 535.0 ± 39.6 μm. In the validation sample, mean IOPtv was 14.6 ± 5.2 mmHg (range, 7.4-28.5 mmHg) versus 15.0 ± 5.3 mmHg (range, 6.6-28.6 mmHg) for ORA IOPg ( R ² = 0.782). Bland-Altman plots showed a mean difference of -0.4 ± 2.5 mmHg (95% limits of agreement: -5.4 to 4.5 mmHg). 58.6%, 79.3%, and 96.5% of IOPtv measurements fell within ± 2, ± 3, and ± 5 mmHg of ORA measurements. No fixed or proportional biases were observed ( P = 0.620). CONCLUSION: There was a strong correlation and agreement in IOP measurements between calibrated Tono-Vera IOP and ORA IOPg.
Treatment Outcomes of Micropulse Transscleral Laser Therapy as an Adjunctive Therapy in African American Individuals With Prior Procedural Interventions.
Dickinson A, Leidy L, An J … +3 more , Kaleem M, Mihailovic A, Okeke C
J Glaucoma · 2025 Jun · PMID 40029188 · Publisher ↗
PRÉCIS: Micropulse transscleral laser therapy is a clinically beneficial adjunctive treatment option for African American individuals with severe-stage primary open angle glaucoma who have undergone prior glaucoma proced...
PRÉCIS: Micropulse transscleral laser therapy is a clinically beneficial adjunctive treatment option for African American individuals with severe-stage primary open angle glaucoma who have undergone prior glaucoma procedural interventions. PURPOSE: To assess the safety and efficacy of micropulse transscleral laser therapy as an adjunctive treatment in reducing intraocular pressure and ocular hypotensive medications in African American patients. METHODS: We analyzed 44 eyes of 44 African American individuals with severe-stage primary open angle glaucoma who underwent prior procedural interventions and received a subsequent micropulse treatment. Mean intraocular pressure and ocular hypotensive medications were evaluated at all postoperative visits through 12 months. Main outcome measures included within-group reductions in intraocular pressure and ocular hypotensive medications at 12 months compared with baseline. Univariate and multivariable logistic regression models were used to calculate odds ratios to evaluate characteristics associated with the likelihood of success at 12 months. Success was defined as achieving a target intraocular pressure of ≤12 mm Hg without additional medications and no secondary surgical interventions. RESULTS: Mean intraocular pressure was significantly reduced from 22.9±6.2 mm Hg at baseline to 13.8±4.8 at 12 months following micropulse, a 40% reduction ( P <0.001). The majority of patients were on 4-6 ocular hypotensive medications at baseline. By 12 months, the proportion of patients requiring ≥3 ocular hypotensive medications was significantly reduced compared with baseline ( P =0.03). Univariate analysis revealed that a history of trabeculectomy before micropulse treatment increased the likelihood of successful surgery at 12 months by nearly 5-fold (OR: 4.67; P =0.03). CONCLUSION: Micropulse is an effective adjunctive treatment in African Americans with severe-stage primary open angle glaucoma and a history of prior glaucoma procedures.
Development of a Computerized and Automated Cost-Effectiveness Analysis Application to Aid in Glaucoma Surgical Management.
Prasad J, Sood S, Al-Aswad LA
J Glaucoma · 2025 Jun · PMID 40029187 · Publisher ↗
PRÉCIS: In this article, we describe the development of validated software that automates cost-effectiveness analyses of minimally invasive glaucoma surgeries based on modifications to robust mathematical models of glauc...
PRÉCIS: In this article, we describe the development of validated software that automates cost-effectiveness analyses of minimally invasive glaucoma surgeries based on modifications to robust mathematical models of glaucoma progression and management discussed in previous literature. PURPOSE: To develop a validated application to streamline the use of cost-effectiveness (CE) in clinical management and investigations of minimally invasive glaucoma surgeries (MIGS) in the US. DESIGN: Automated cost-utility analysis adapted from Markov models described in prior literature. PARTICIPANTS: Patients of ages 65 years and older with mild to moderate primary open angle glaucoma irrespective of concurrent visually significant cataract. METHODS: Markov models simulating glaucoma progression through 37 states and death were constructed based on previous CE models of minimally invasive trabecular meshwork stents. These states represent combinations of various glaucoma severity (mild, moderate, advanced, and severe/blind) with differences in clinical management, including the use of up to 4 medications, selective laser trabeculoplasty, or incisional surgery. These are not mutually exclusive and are based on decisions related to the rate of thinning of the retinal nerve fiber layer. Rather than using fixed sets of transition probabilities for specific surgical interventions, new transition probabilities are dynamically derived based on the expected reduction in intraocular pressure related to visual field mean deviation decline. In addition to the generic MIGS arm, 2 comparison arms (cataract-surgery or medications-only) are included. Medication reduction, whole costs, and utilities are modifiable inputs in the model. Optimal and worst-case results are determined by uncomplicated or complicated (secondary surgical intervention required/medication nonadherence) intervention outcomes. The model was entirely re-implemented in R and validated by comparing results to TreeAge data. MAIN OUTCOME MEASURES: Total costs, quality-adjusted life years (QALY), and incremental cost-effectiveness ratio (ICER). RESULTS: An optimal-case 35-year CE-analysis of the implantation of Hydrus and iStent inject devices provided values of costs and QALY that were similar to prior data (R vs. TreeAge): Hydrus (Cost: $50,446.53 vs. $48,026.13; QALY: 12.18 vs. 12.26), iStent inject (Cost: $52,323.43 vs. $49,599.86; QALY: 12.13 vs. 12.21), cataract (Cost: $54,150.56 vs. $54,409.25; QALY: 12.03 vs. 12.04). Trends of ICER over time were also very similar. CONCLUSIONS: Novel software is available to aid in CE analyses of MIGS with modifiable inputs and outcomes of interest. Such a tool makes CE more accessible for use in clinical management decisions and may guide future investigation.
Optical Microangiography and Progressive Retinal Nerve Fiber Layer Loss in Primary Angle Closure Glaucoma.
Rao HL, Dasari S, Puttaiah NK … +5 more , Pradhan ZS, Moghimi S, Mansouri K, Webers CAB, Weinreb RN
J Glaucoma · 2025 Mar · PMID 40009426 · Publisher ↗
PRÉCIS: Younger patient age (coefficient: 0.10, P =0.04) and greater peak IOP during follow-up (coefficient: -0.14, P =0.03), but not baseline optical microangiography parameters, were significantly associated with a fas...
PRÉCIS: Younger patient age (coefficient: 0.10, P =0.04) and greater peak IOP during follow-up (coefficient: -0.14, P =0.03), but not baseline optical microangiography parameters, were significantly associated with a faster rate of RNFL loss in mild-moderate PACG. PURPOSE: To evaluate the association between optical microangiography (OMAG) measurements and progressive retinal nerve fiber layer (RNFL) loss in primary angle closure glaucoma (PACG). METHODS: In a prospective study, 45 eyes of 30 PACG patients (86 hemifields) with mild to moderate functional damage were longitudinally studied for at least 2 years and with a minimum of 3 optical coherence tomography (OCT) examinations. OMAG imaging was performed at the baseline visit. Effect of clinical parameters (age, sex, presence of systemic diseases, central corneal thickness, mean, peak, and fluctuation of intraocular pressure during follow-up), baseline hemifield mean deviation (MD) and baseline OMAG [quadrant peripapillary and macular perfusion density(PD)] on the rate of RNFL change was evaluated using linear mixed models. RESULTS: The average (±SD) hemifield MD, RNFL thickness, peripapillary PD and macular PD of the analyzed quadrants at baseline were -6.0±3.4 dB, 89±21 µm, 40.1±3.5%, and 29.6±10.3%, respectively. The rate of quadrant RNFL change was -2.5±1.7 µm/year. Multivariate mixed models showed that younger patient age (coefficient: 0.10, P =0.04) and higher peak IOP during follow-up (coefficient: -0.14, P =0.03) were significantly associated with a faster rate of RNFL loss. CONCLUSIONS: Younger patient age and greater peak IOP during follow-up were significantly associated with a faster rate of RNFL loss in PACG patients with mild to moderate severity of functional damage. None of the OMAG parameters at baseline were associated with RNFL thinning suggesting a limited role of OCTA imaging in predicting structural progression in mild-moderate PACG.
Effect of Anti-Inflammatory Regimen on Selective Laser Trabeculoplasty Outcomes: A Randomized Controlled Trial.
Miranda JF, Maestrini HA, Barbosa CCP … +6 more , Oltramari L, Guedes GB, Nascimento MM, Prata TS, Urata CN, Abe RY
J Glaucoma · 2025 Jun · PMID 39964343 · Publisher ↗
PRÉCIS: Patients in the prednisolone acetate 1% group post-SLT had higher treatment success rates comparing with other anti-inflammatory drugs. PURPOSE: To investigate the effect of different anti-inflammatory regimens o...
PRÉCIS: Patients in the prednisolone acetate 1% group post-SLT had higher treatment success rates comparing with other anti-inflammatory drugs. PURPOSE: To investigate the effect of different anti-inflammatory regimens on selective laser trabeculoplasty (SLT) outcomes. PATIENTS AND METHODS: A prospective randomized controlled trial. We included newly diagnosed primary open angle glaucoma (POAG) patients that underwent a primary SLT session. Patients were randomly divided into 3 groups (prednisolone acetate 1%, prednisolone acetate 0.12%, and ketorolac tromethamine 0.5%). After SLT, intraocular pressure (IOP) data were collected at different time points: days 7 and 30, and at 3, 6, and 12 months post-SLT. The main outcome measure was the comparison of success rates (Kaplan-Meier survival analysis) between groups (log-rank test). RESULTS: We included a total of 134 eyes from 134 newly diagnosed POAG patients (mean age: 62.64±13.86 y) with a mean follow-up of 287±104 days. We observed a significant IOP reduction following SLT treatment in all groups at 12 months (baseline IOP 19.57±3.78 vs. final IOP: 14.39±2.29 mm Hg, P <0.001). Patients in the acetate prednisolone 1% group presented higher survival rates (83.7%) comparing with the other groups (prednisolone acetate 0.12%=63.9%; ketorolac tromethamine 0.5%=67.0%) at 12 months ( P =0.003). Patients in the acetate prednisolone 1% group had higher chances of treatment success [hazard ratio (HR) 0.30; 95% CI: 0.13-0.68, P =0.004], as well as younger patients (HR: 1.03; 95% CI: 1.00-1.05, P =0.005) and those with higher baseline IOP (HR: 0.78; 95% CI: 0.72-0.85 P <0.001). In the multivariable analysis, patients in the acetate prednisolone 1% group remained with higher chances of treatment success (HR: 0.37; 95% CI: 0.15-0.91, P =0.031). No sight-threatening adverse events was reported during follow-up in all groups. CONCLUSIONS: In summary, when evaluating the effect of different anti-inflammatory regimens on SLT outcomes in newly diagnosed POAG patients, we found higher success rates in patients treated with prednisolone acetate 1% after SLT. In addition, higher baseline IOP appears to positively influence postoperative outcomes.
Characteristics of Eyes With Asymptomatic Primary Angle Closure Glaucoma With Varying Severity of Visual Field Loss at Presentation.
Umapathi RM, Hliang TN, Koh AS … +7 more , Sim C, Perera SA, Husain R, Ho CL, Wong TT, Aung T, Nongpiur ME
J Glaucoma · 2025 May · PMID 39950876 · Publisher ↗
PRÉCIS: Approximately 38% of 467 asymptomatic primary angle closure glaucoma subjects had severe visual field loss (<-20 dB) at first presentation. Sex-based differences in prevalence and biometry suggest the need for an...
PRÉCIS: Approximately 38% of 467 asymptomatic primary angle closure glaucoma subjects had severe visual field loss (<-20 dB) at first presentation. Sex-based differences in prevalence and biometry suggest the need for an integrated approach for assessing risk. PURPOSE: To compare the clinical characteristics of patients with asymptomatic primary angle closure glaucoma (PACG) across varying disease severity at presentation. METHODS: Of 681 PACG patients recruited, 196 were excluded due to acute primary angle closure and 18 due to pretreatment. Clinical data from 467 patients were analysed, including age at presentation, presenting intraocular pressure (IOP), pre-intervention gonioscopy, vertical cup-to-disc ratio, biometry, pre-surgery refractive data, and visual field (VF) mean deviation (MD) at presentation (excluding the first VF). Disease severity was classified based on the VF MD as early-to-moderate (≥-12 dB), advanced (-12.01 to -20 dB), and severe (<-20 dB). RESULTS: Of the 467 patients, 304 had reliable VFs within 1.5 years of presentation and were categorized as early-to-moderate (n=129; 42.4%), advanced (n=57; 18.8%), and severe PACG (n=118; 38.8%). The mean age at presentation was 64.7±8.6 years and 52.6% were male. Patients with severe PACG were more likely to be male (61.9%), with the highest presenting IOP ( P <0.001), and narrowest anterior chamber angle ( P <0.001). Significantly smaller anterior chamber depth and shorter axial length across worsening disease severity were only observed in female but not in male subjects. There was no significant difference in mean age at presentation across groups ( P =0.12). Presenting IOP of ≤21 mm Hg was observed in 49.1% (n=28) advanced and 29.7% (n=35) severe PACG. CONCLUSIONS: Similar age at presentation of severe PACG and those with less severe disease suggests that the severe group either developed PACG at an earlier age or underwent rapid disease progression. Sex-based differences of prevalence and biometry may also impact disease risk.
Clinical Insights Into a Large Cohort of Phakomatosis Pigmentovascularis.
Kolipaka GP, Molleti D, Krishnamurthy R … +3 more , Rao A, Mandal AK, Senthil S
J Glaucoma · 2025 Jun · PMID 39950872 · Publisher ↗
PRÉCIS: Phakomatosis pigmentovascularis, a multisystem disorder, exhibited male predominance, with Phakomatosis cesioflammea as the most prevalent type. Glaucoma affected 88% of eyes, with three-quarters requiring surger...
PRÉCIS: Phakomatosis pigmentovascularis, a multisystem disorder, exhibited male predominance, with Phakomatosis cesioflammea as the most prevalent type. Glaucoma affected 88% of eyes, with three-quarters requiring surgery. Systemic issues, notably epilepsy and anemia, were prevalent in over half of all subjects. PURPOSE: To report the clinical profile and demographic characteristics of a large cohort with Phakomatosis pigmentovascularis (PPV). PARTICIPANTS: Included 119 eyes of 60 patients with PPV between January 1996 and January 2023 (27 y). METHODS: This is a retrospective multicentric study involving 4 tertiary network institutes in India. The diagnosis of PPV was established based on the concurrent presence of pigmentary nevi and capillary malformation, with classification conducted according to the Happle classification system. Demographic information, clinical features at the time of diagnosis (both ocular and systemic), the prevalence of glaucoma, details of management strategies used, and the subsequent outcomes were meticulously documented. MAIN OUTCOME MEASURES: Key outcome measures included the prevalence of glaucoma among patients, the frequency of systemic abnormalities noted, and the various surgical interventions performed along with their respective success rates. RESULTS: The cohort had male preponderance (male: female ratio of 67%:33%), with median age of presentation at 0.48 (range=0.12, 7.77) years. Glaucoma was observed in 105 eyes (88.2%), with bilateral involvement present in 75% of cases. The most prevalent phenotype observed within the cohort was Phakomatosis cesioflammea (Type iib), affecting 65% of patients. Systemic abnormalities were noted in 51.6% of cases, with epilepsy (45%) and anemia (36%) being the most frequently documented conditions. Surgical intervention was required for 64.7% of eyes for intraocular pressure control, with combined trabeculotomy and trabeculectomy being the predominant procedure used. Surgical success was noted in 87% of eyes, and 19.4% eyes had complications. CONCLUSION: Phakomatosis cesioflammea (Type iib) was the most common subgroup noted. The majority of patients had glaucoma, often bilateral, with two-thirds requiring surgical intervention for IOP control. Systemic abnormalities were common, emphasizing the need for comprehensive multisystem evaluation in these patients.
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