This retrospective single-center case series evaluated the outcomes of direct selective laser trabeculoplasty (DSLT) in patients with primary angle closure glaucoma (PACG). Twelve eyes of 8 phakic patients with PACG and...This retrospective single-center case series evaluated the outcomes of direct selective laser trabeculoplasty (DSLT) in patients with primary angle closure glaucoma (PACG). Twelve eyes of 8 phakic patients with PACG and patent laser peripheral iridotomy (LPI) underwent DSLT. The primary outcome was the percentage reduction in intraocular pressure (IOP). Secondary outcomes included treatment success, defined as an IOP reduction of ≥20% from baseline or a reduction in glaucoma medications while maintaining baseline IOP and safety parameters. The mean patient age was 71.0±9.3 years. Baseline IOP was 17.0±2.3 mm Hg and decreased significantly to 13.6±3.0 mm Hg at the 2-month follow-up ( P =0.0024), representing an overall mean IOP reduction of 20.3%±11.6%. Treatment success was achieved in 7 eyes (58.3%), with a mean IOP reduction of 27.6%±7.3%. The mean number of glaucoma medications decreased from 3.17±1.47 to 2.75±1.70 ( P =0.0369), and the medications were completely discontinued in 3 eyes. Corrected distance visual acuity remained stable. The most common transient findings were mild anterior chamber reaction and subconjunctival hemorrhage, and no IOP spikes or other complications occurred. These preliminary results suggest that DSLT is a safe, well-tolerated, and potentially effective noncontact laser therapy for phakic patients with PACG and patent LPI. Larger prospective studies with longer follow-up periods are warranted to confirm these findings.
PRÉCIS: We investigated early IOP changes after MPTLT in glaucoma patients. Sixteen percent experienced transient IOP spikes at 1 hour. Alpha-2 adrenergic agonist use was associated with reduced IOP elevation and lower s...PRÉCIS: We investigated early IOP changes after MPTLT in glaucoma patients. Sixteen percent experienced transient IOP spikes at 1 hour. Alpha-2 adrenergic agonist use was associated with reduced IOP elevation and lower spike risk. PURPOSE: To assess the incidence and contributing factors of postoperative intraocular pressure (IOP) spike following micropulse transscleral laser therapy (MPTLT). PATIENTS AND METHODS: This prospective observational study included 80 eyes from 66 glaucoma participants undergoing MPTLT. An IOP spike was defined as an increase of 5 mm Hg or more at 1 hour postlaser compared with baseline. Demographic and clinical factors were assessed, and multivariable backward stepwise regression mixed-effect models were used to identify significant associations. The main outcome measures were the change in IOP at 1 hour (1 h IOP minus baseline IOP) and the occurrence of a 1-hour IOP spike. RESULTS: The mean (SD) IOP change was -0.16 (6.40) mm Hg at 1 hour. Thirteen eyes (16%) met the criteria for the IOP spike, with the average change of 9.73 (5.57) mm Hg. Among these, 5 eyes (6% of all eyes) had an IOP rise of >10 mm Hg. All eyes with an IOP spike had an IOP return to baseline levels or lower at 18 hours. Pre-existing use of alpha-2 adrenergic (AA) agonists (coefficient -4.31, 95% CI: -7.61 to -1.01, P =0.01) and higher baseline IOP (coefficient -0.12, 95% CI: -0.23 to -0.004, P =0.042) were associated with less IOP elevation. Pre-existing use of AA agonists was identified as a protective factor for developing an IOP spike with an odds ratio of 0.20 (95% CI: 0.42 to 0.91, P =0.038). CONCLUSIONS: One sixth of the patients experienced a postoperative IOP spike. Participants with pre-existing use of AA agonists tended to have a lower degree of IOP change and a lower IOP spike.
PRÉCIS: This study investigates the accuracy, readability, utility, and educational value of glaucoma treatment content on social media platforms and explores how large language models assess the quality of social media...PRÉCIS: This study investigates the accuracy, readability, utility, and educational value of glaucoma treatment content on social media platforms and explores how large language models assess the quality of social media posts compared with glaucoma experts. PURPOSE: To assess the quality of information on glaucoma treatment available on social media platforms. METHODS: A 30-question survey consisting of the "top posts" from three social media platforms (X, Instagram, and Reddit) was assessed by 5 board-certified glaucoma experts across four domains (readability, utility, educational value, and accuracy) by using a 5-point Likert scale. The overall quality of each post was calculated as the average of the median score assigned to each of the four domains to create a reference standard. Expert agreement was assessed using Kendall's coefficient of concordance ( W ). A large language model (LLM), GPT-4 (OpenAI), was then prompted to evaluate the same posts with identical instructions. Agreement with expert consensus was compared using Cohen weighted kappa ( κ ), and the difference in favorability of each post assessed using McNemar exact test. RESULTS: Fewer than half of social media posts on glaucoma treatment were judged favorably by glaucoma experts (40%). GPT-4 was less critical of social media content and provided a favorable rating nearly twice as often (77%, P =0.017). Despite this difference, there was moderate agreement between the LLM compared with the glaucoma experts ( κ =0.421, P =0.005). The lack of agreement predominantly stemmed from cases where the experts rated the content unfavorably, with disagreement occurring in 56% of cases, compared with 0% when the content was deemed favorable ( P =0.005). CONCLUSIONS: Although glaucoma experts and artificial intelligence (AI)-based systems were in moderate agreement when evaluating the quality of posts, the LLM was less able to discriminate posts of low quality.
PRÉCIS: This registry-based study estimates the prevalence of glaucoma in Colombia to be 1.94%, with higher rates in women. Significant associations with comorbidities like retinal vascular occlusion, myopia, Raynaud syn...PRÉCIS: This registry-based study estimates the prevalence of glaucoma in Colombia to be 1.94%, with higher rates in women. Significant associations with comorbidities like retinal vascular occlusion, myopia, Raynaud syndrome, and obstructive sleep apnea were found. PURPOSE: To estimate the prevalence of glaucoma in Colombia using data from the Individual Records of Health Services Provision (RIPS) between 2018 and 2022 and determine the prevalence ratios with diagnoses that have been linked to the development and progression of glaucoma. MATERIALS AND METHODS: This observational, retrospective study analyzed secondary data from the RIPS database. The study included individuals diagnosed with glaucoma, categorized by ICD-10 codes, and associated comorbidities. The prevalence was calculated for individuals over 40 years old, and prevalence ratios were determined for comorbid conditions. RESULTS: Between 2018 and 2022, 399,923 patients were diagnosed with glaucoma, with a prevalence of 1.94% in individuals over 40 years old. Primary open angle glaucoma was the most common type, with a prevalence of 1.08%. The study found strong associations between glaucoma and comorbidities such as retinal vascular occlusion (prevalence ratio of 9.1 for glaucoma and 8.8 for primary open angle glaucoma), myopia (3.3 and 3.7), Raynaud syndrome (2.4 and 2.5) and obstructive sleep apnea (2.1 and 2.5). A positive but less significant association with migraine (2.0 and 1.9), hypothyroidism (2.1 and 2.2), asthma (1.7 and 1.7), diabetes (1.5 and 1.7), hypertension (1.4 and 1.4), and chronic obstructive pulmonary disease (1.2 and 1.3) was also found. CONCLUSION: The prevalence of glaucoma in Colombia is consistent with global estimates, but with higher rates in women. The association between glaucoma and several comorbidities underscores the importance of an early detection and comprehensive management of these diseases.
PRÉCIS: An implantable IOP sensor study in glaucoma patients found that 5 evenly spaced daily measurements over 18 waking hours effectively reflect the 24-hour IOP rhythm, with peaks and troughs often occurring outside c...PRÉCIS: An implantable IOP sensor study in glaucoma patients found that 5 evenly spaced daily measurements over 18 waking hours effectively reflect the 24-hour IOP rhythm, with peaks and troughs often occurring outside clinic hours. PURPOSE: The availability of an implantable IOP sensor enables patients to obtain IOP measurements over 24 hours and on demand. The current study assesses the optimal frequency of daily IOP measurements required to reflect the 24-hour IOP rhythm in glaucoma patients. METHODS: Twenty-two patients with primary open angle glaucoma (POAG) who had previously been implanted with a sulcus-based IOP sensor (Eyemate-IO, Implandata, Germany) as part of the prospective multicentric ARGOS-02 study were enrolled. The following parameters were used to characterize the 24-hour IOP rhythm: distribution of IOP measurements and timing of IOP peaks and troughs. To assess the optimal number of IOP values to predict the 24-hour rhythm, the daily count of IOP measurements and the time interval between the first and last daily measurements were used. The correlation with the detection of daily IOP variability was assessed through Student t test and a kernel-density estimate using Gaussian kernels and Earth Movers Distance. RESULTS: Twenty-two patients (8 female and 14 male) with a mean age of 67.8±6.8 years were followed up over 6.6±1.7 years with a total of 80,495 IOP measurements. The percentage of peak IOP values was highest (50.6%) during the early morning hours (4-5 am), while trough measurements occurred predominantly (42.3%) during the late-night hours (between 11 pm and 12 pm). Five IOP measurements equally distributed over an 18-hour period were sufficient to characterize the 24-hour rhythm. Additional measurements did not yield any statistically significant value in the characterization of 24-hour IOP patterns. CONCLUSIONS: Using an implanted telemetric sensor, the results of this study show that 5 daily IOP measurements evenly spread over 18 hours, provide sufficient information for assessment of the diurnal IOP rhythm. However, patients in practice recorded on average 4 measurements over 14 hours, highlighting the gap between the ideal recommendation and real-life adherence.
PRÉCIS: In acute primary angle closure, early cataract extraction is protective against glaucomatous progression through better IOP control, while higher mean IOP and worse baseline visual field defects are associated wi...PRÉCIS: In acute primary angle closure, early cataract extraction is protective against glaucomatous progression through better IOP control, while higher mean IOP and worse baseline visual field defects are associated with increased risk. PURPOSE: To evaluate long-term outcomes and identify risk factors for glaucomatous optic neuropathy (GON) progression after acute primary angle closure (APAC). METHODS: In this multicenter retrospective cohort study, we enrolled 156 eyes from 130 APAC patients with ≥2 years of follow-up. Baseline clinical features, including visual field mean deviation (VFMD) and optical coherence tomography (OCT) parameters, as well as follow-up intraocular pressure (IOP) and interventions, were collected. GON progression was defined by concordant structural and functional changes. Univariate and multivariate logistic regression were used to identify risk factors. RESULTS: The mean age was 63.9±9.6 years, and 71.5% of patients were female. During follow-up, 129 eyes (82.7%) underwent cataract extraction and 49 eyes (31.4%) underwent glaucoma surgery. Visual acuity, IOP, and medication burden improved (all P <0.05), whereas mean VFMD and OCT retinal nerve fiber layer (RNFL) thickness did not show a significant change. Twenty-three eyes (14.7%) were blind; 15 (9.6%) due to glaucoma alone. In multivariable analysis, higher mean follow-up IOP (aOR: 1.14 per mm Hg, P =0.005) and worse baseline VFMD (aOR: 1.07 per 1 dB worsening, P =0.048) independently predicted progression, while early cataract extraction (<3 mo) was protective (aOR: 0.43, P =0.047), an effect partly mediated through IOP reduction (indirect effect β=-0.20, 95% CI: -0.39 to -0.04). CONCLUSIONS: After APAC, higher mean IOP and worse baseline VFMD are associated with GON progression. Early cataract extraction may reduce progression risk, partly through improved IOP control.
PRÉCIS: Discrepancy between objective measures of functioning and self-reported quality of life is predicted by depressive symptoms, females, and advanced field loss, while significant variability between these measures...PRÉCIS: Discrepancy between objective measures of functioning and self-reported quality of life is predicted by depressive symptoms, females, and advanced field loss, while significant variability between these measures remains unexplained. PURPOSE: To determine the degree to which functional metrics and self-reported quality of life agree in glaucoma, and identify factors associated with discrepancies between the two. PATIENTS AND METHODS: Individuals with glaucoma or suspected glaucoma (n=227) were evaluated. Subjective functioning was assessed with the Glaucoma Quality-of-Life-15 (GQL-15) questionnaire. Objective metrics of functioning included balance (total sway), gait (cadence), and reading speed, which were compiled into a z- scored composite measure of function. Discrepancy scores were defined as the difference between composite functioning and GQL-15 z -scores. Linear regression models were computed to identify patient-level and neighborhood-level factors associated with discrepancies between objective functioning and self-reported quality of life. RESULTS: Composite functioning and GQL-15 z -scores were poorly correlated (the Pearson coefficient r =0.15, P =0.024). In multivariable analyses, positive discrepancy (greater function than self-report) was associated with female gender (β=0.53, P <0.001), depressive symptoms (β=0.19, P <0.001), and greater visual field damage (β=0.28, P =0.001). The multivariable model, including gender, depressive symptoms, and visual field sensitivity, accounted for 20% of the variance in discrepancy scores. CONCLUSIONS: Female gender, depressive symptoms, and greater visual field damage are associated with greater subjective vision-related disability than predicted by objective functional impairment. The overall ability of the studied measures to predict agreement between function and self-report was poor, highlighting the complexity of both self-reported impairment and functional evaluation.
PRÉCIS: Disagreement in the angle closure assessment was seen between gonioscopy and ultrasound biomicroscopy (UBM), to which not only anterior, but also posterior chamber configuration UBM parameters were significantly...PRÉCIS: Disagreement in the angle closure assessment was seen between gonioscopy and ultrasound biomicroscopy (UBM), to which not only anterior, but also posterior chamber configuration UBM parameters were significantly related. PURPOSE: To study diagnostic disagreement and its relating factors in assessing the angle classified as "occludable" by gonioscopy and by ultrasound biomicroscopy in eyes with van Herick grade 2 or less (eyes ≤VH2). METHODS: In 93 eyes ≤VH2 (93 subjects) with no peripheral anterior synechia, gonioscopy, UBM, and anterior segment-optical coherence tomography (AS-OCT) were performed in dark, the number of eyes with ≥2 ITC-positive quadrants (contact ≥180 degrees) based on UBM (eyes ≥2-ITC UBM Quad) and that with the angle classified as occludable by gonioscopy (eyes≥2-ITC GONIO Quad) were determined, and the number of eyes not meeting these criteria, that is, eyes <2-ITC UBM Quad (contact <180 degrees) and eyes <2-ITC GONIO Quad, was also determined. Multivariable logistic regression analysis was performed with systemic, ocular, UBM, and AS-OCT parameters as explanatory variables. RESULTS: Out of the 93 eyes, 49 were diagnosed as eyes ≥2-ITC GONIO Quad based on gonioscopy, 63 as eyes ≥2-ITC UBM Quad on UBM, 37 as both eyes ≥2-ITC GONIO Quad and eyes ≥2-ITC UBM Quad (agreement between gonioscopy and UBM), 12 as eyes ≥2-ITC GONIO Quad base on gonioscopy, but as eyes <2-ITC UBM Quad on UBM (UBM under-diagnosing), and 26 as eyes <2-ITC GONIO Quad based on gonioscopy, but as eyes ≥2-ITC UBM Quad on UBM (UBM over-diagnosing), respectively (McNemar test, P =0.0388). Longer axial length ( P =0.0002), deeper anterior chamber depth ( P =0.0121), greater angle-opening distance at 500 μm ( P =0.0159), and smaller iris convexity ( P =0.0031) were related to UBM over-diagnosing, while a greater angle-opening distance at 500 μm ( P =0.0046) and smaller trabecular ciliary angle ( P =0.0158) to UBM under-diagnosing. CONCLUSION: Both anterior and posterior chamber configuration parameters determined based on UBM were significantly related to disagreement between gonioscopy and UBM in assessing the appositional angle closure.
PRÉCIS: Combined phacoemulsification and Kahook Dual Blade goniotomy significantly increased the iridocorneal angle dimensions in POAG/NTG, but postoperative pilocarpine instillation did not further increase the dimensio...PRÉCIS: Combined phacoemulsification and Kahook Dual Blade goniotomy significantly increased the iridocorneal angle dimensions in POAG/NTG, but postoperative pilocarpine instillation did not further increase the dimensions, suggesting that this postoperative therapy offers limited clinical benefit. PURPOSE: Topical pilocarpine is frequently administered for months after Kahook Dual Blade goniotomy combined with phacoemulsification (phaco-KDB) to prevent peripheral anterior synechia formation. To clarify if it offers benefits, we investigated whether iridocorneal angle dimensions after phaco-KDB show further changes after topical pilocarpine instillation in the Japanese primary open angle glaucoma (POAG) or normal tension glaucoma (NTG) eyes. MATERIALS AND METHODS: Thirty eyes of 30 consecutive Japanese POAG or NTG patients (age 69.4±12.4 y) undergoing phaco-KDB were investigated using anterior segment swept-source optical coherence tomography (CASIA2, Tomey). Angle opening distance (AOD) and trabecular-iris space area (TISA) were measured at 5 locations: 250 and 500 µm distance from the scleral spur on both the temporal and nasal sides. Measurements were taken preoperatively and within 1 month postoperatively before and 1 hour after the instillation of 2% pilocarpine. RESULTS: The median spherical equivalent was -2.75 D (range: -18.5 D to +2.25 D). All postoperative AOD and TISA values (before pilocarpine instillation) increased clinically and statistically significantly at all 4 locations compared with the preoperative values ( P <0.001). One hour after pilocarpine instillation TISA in all and AOD in 3 of the 4 measurement locations remained unchanged ( P ≥0.135). AOD at the temporal 500 µm position increased significantly ( P <0.01) but the change was minimal (mean change=0.07 mm). CONCLUSIONS: Phaco-KDB effectively widened the iridocorneal angle in this Japanese POAG and NTG cohort. However, angle widening did not increase further after pilocarpine instillation. This suggests that postoperative pilocarpine therapy after phaco-KDB offers limited benefit.
PRÉCIS: In this systematic review, we find that CW-CPC produces more sustained IOP lowering in children compared with MP-CPC. PURPOSE: Micropulse cyclophotocoagulation (MP-CPC) and continuous cyclophotocoagulation (CW-CP...PRÉCIS: In this systematic review, we find that CW-CPC produces more sustained IOP lowering in children compared with MP-CPC. PURPOSE: Micropulse cyclophotocoagulation (MP-CPC) and continuous cyclophotocoagulation (CW-CPC) are both surgical interventions used to decrease intraocular pressure (IOP) in pediatric glaucoma. Recent publications have shown conflicting results regarding the effectiveness of MP-CPC compared with CW-CPC, which this systematic review and meta-analysis aims to evaluate. METHODS: From inception through March 2025, PubMed, Embase, Scopus, Cochrane Library, and ScienceDirect were searched for studies comparing MP-CPC and CW-CPC in treating pediatric glaucoma, with IOP reported at different time intervals. A random effects model was used across all analyses. RESULTS: At 12 months, CW-CPC showed a significantly greater reduction in IOP compared with MP-CPC (MD: -6.88 mm Hg, 95% CI: -9.46 to -4.30; P < 0.00001). No significant differences in IOP lowering were observed at 1, 3, and 6 months. Overall, CW-CPC was superior in reducing IOP (MD: -4.23 mm Hg, 95% CI: -6.51 to -1.95; P = 0.0003; I² = 80%) at the last follow-up. CONCLUSION: CW-CPC shows a significantly greater reduction in IOP than MP-CPC, particularly at long-term follow-up. These findings highlight the sustained efficacy of CW-CPC compared with MP-CPC in the management of pediatric glaucoma.
PRÉCIS: PreserFlo MicroShunt significantly reduced intraocular pressure and medication burden in Japanese eyes with prior glaucoma surgery, showing a favorable safety profile and offering a viable option for further surg...PRÉCIS: PreserFlo MicroShunt significantly reduced intraocular pressure and medication burden in Japanese eyes with prior glaucoma surgery, showing a favorable safety profile and offering a viable option for further surgical intervention regardless of previous procedure type. PURPOSE: To evaluate the efficacy and safety of the PreserFlo MicroShunt (PMS) in Japanese patients with a history of at least one glaucoma surgery. METHODS: This retrospective study included Japanese glaucoma patients who underwent PMS implantation with adjunctive mitomycin C between October 2022 and July 2023, with or without simultaneous cataract surgery. All eyes had undergone at least one prior glaucoma procedure. On the basis of surgical history, patients were categorized into 2 groups: group 1 (filtration surgery) and group 2 (ab interno reconstruction surgery or laser trabeculoplasty). Primary outcomes included intraocular pressure (IOP), medication score, and logMAR visual acuity (VA) over 12 months, analyzed using a mixed-effects model. Postoperative complications and additional interventions were extracted from medical records. RESULTS: Group 1 included 23 eyes (mean baseline IOP: 23.1 mm Hg, 2.6 medications), and group 2 included 32 eyes (mean baseline IOP: 21.9 mm Hg, 4.2 medications). At 12 months, mean IOP was reduced by 44.6% in group 1 and 37.1% in group 2, with both groups showing significant IOP reductions (P < 0.001). Medication scores were significantly reduced at all time points in both groups (P < 0.001). No significant changes in VA or vision-threatening complications were observed. CONCLUSIONS: PMS implantation significantly lowered IOP and reduced the need for medications in eyes with a history of glaucoma surgery, regardless of prior conjunctival manipulation. These findings support the role of PMS as a safe and effective option for further surgical intervention in this population.
PRÉCIS: No association between physical activity as measured by Fitbit and primary open angle glaucoma diagnosis was observed among adult participants in the All of Us Research Program. PURPOSE: To investigate the associ...PRÉCIS: No association between physical activity as measured by Fitbit and primary open angle glaucoma diagnosis was observed among adult participants in the All of Us Research Program. PURPOSE: To investigate the associations between physical activity and glaucoma diagnosis in the United States. PATIENTS AND METHODS: All subjects were adult participants in the National Institutes of Health All of Us Research Program. We defined a case cohort consisting of participants with Fitbit and electronic health record data with a diagnosis of primary open angle glaucoma (n=266). A control cohort consisted of participants with Fitbit and electronic health record data without primary open angle glaucoma diagnoses (n=7954). Descriptive analyses were performed on glaucoma and non-glaucoma cohorts' demographics including age, gender, race, ethnicity, Charlson Comorbidity Index, and ophthalmic and systemic beta-blocker prescriptions. Univariable and multivariable logistic regression adjusted for demographic factors, Charlson Comorbidity Index, and ophthalmic and systemic beta-blocker prescriptions was conducted for association between odds of glaucoma diagnosis and each physical activity metric. Age-stratified sub-analyses for patients older than 40 and older than 65 were performed. RESULTS: Participants in the glaucoma cohort had a significantly lower step count (6673 vs. 6891, P=0.04) and lower lightly active minutes (180 vs. 193, P<0.001). Step count and lightly active minutes did not remain significant in multivariable models, and all other activity metrics were not significant in multivariable models. These results were recapitulated in age-stratified analyses. CONCLUSIONS: There were no definitive associations between physical activity and primary open angle glaucoma diagnosis among All of Us participants, which was replicated among age-stratified subgroup analyses.
PRÉCIS: This prospective study demonstrates that the PreserFlo MicroShunt effectively reduces IOP and medication burden over 24 months in Asian patients with POAG, although risk of complete success failure was higher in...PRÉCIS: This prospective study demonstrates that the PreserFlo MicroShunt effectively reduces IOP and medication burden over 24 months in Asian patients with POAG, although risk of complete success failure was higher in combined cataract surgery. BACKGROUND: Glaucoma is characterized by progressive and irreversible vision loss due to optic nerve degeneration. Lowering intraocular pressure (IOP) remains the mainstay of glaucoma treatment. The PreserFlo MicroShunt (Santen Pharmaceutical Co.) is a form of minimally invasive bleb surgery. OBJECTIVES: We investigate the efficacy and safety of PreserFlo MicroShunt device in Asian patients with primary open angle glaucoma over a 24-month postoperative period. DESIGN: A prospective, single-arm study of subjects with POAG receiving the PreserFlo MicroShunt surgery with or without concurrent cataract surgery. METHODS: Primary outcome at 2 years was complete success (IOP ≥20% reduction without medications and IOP<22 mm Hg if baseline IOP>21 mm Hg). RESULTS: Ten eyes underwent PreserFlo MicroShunt surgery, and 17 eyes underwent combined phacoemulsification and PreserFlo MicroShunt. Mean baseline IOP was 22.1 mm Hg, and the median baseline medication load was 3.0. At 6, 12, and 24 months, the complete success rate was 55.6%, 48.1%, and 37.0%, respectively. Qualified and complete success at 6, 12, and 24 months was 81.5%, 74.1%, and 63.0%, respectively. Mean reduction in IOP was 7.9, 6.0, 7.1 mm Hg at POM6 (P<0.001), POM12 (P=0.020), and POM24 (P<0.001). Reduction in median number of medications was from 3 to none at 6, 12, and 24 months (P<0.001). The risk of complete success failure was significantly higher in the combined group compared with the standalone (HR: 10.08; 95% CI: 2.26-45.07). One eye required open revision, 2 eyes required trabeculectomy, and 5 eyes had bleb needling or injection with antimetabolite. CONCLUSIONS: Our study demonstrated that the PreserFlo MicroShunt effectively lowered IOP and medication burden in Asian eyes with POAG.
PRÉCIS: Decreased outer nasal macular perfusion density correlates with worsening visual field defects across all glaucoma severity levels-particularly with central 10-2 sensitivity-highlighting its potential as a critic...PRÉCIS: Decreased outer nasal macular perfusion density correlates with worsening visual field defects across all glaucoma severity levels-particularly with central 10-2 sensitivity-highlighting its potential as a critical parameter for monitoring primary open angle glaucoma progression, including advanced stages. PURPOSE: To investigate whether sectoral macular perfusion density (MPD) from optical coherence tomography angiography (OCTA) relates to central visual field (VF) sensitivity (Humphrey 10-2) across mild, moderate, and advanced primary open angle glaucoma (POAG). PATIENTS AND METHODS: In this retrospective, cross-sectional analysis of 196 POAG eyes, OCTA (6×6 mm, superficial plexus) provided sectoral MPD. MPD in each sector was analyzed in relation to the sum of total deviation (TD) of the HFA central 10-2 sectors mapped to OCTA sectors. Glaucoma severity was staged by 30-2 mean deviation (MD) using Hodapp-Parrish-Anderson thresholds: mild (> -6 dB), moderate (-6 to -12 dB), severe (< -12 dB). Study design was clarified as a retrospective analysis of prospectively acquired clinical data. RESULTS: Outer nasal MPD decreased stepwise from mild to moderate to severe (means 46.7%, 42.7%, 39.6%; ANOVA P<0.001, η²=0.135; Cohen f=0.395). Outer nasal MPD correlated with central 10-2 TD sums within strata (moderate r=0.298, P=0.013; severe r=0.286, P=0.022) and overall (r=0.364, P<1×10‒7). In multivariable analysis for MD10-2 (complete cases), outer nasal MPD (β=0.513, P<0.001) and mGCIPL thickness (β=0.288, P<0.001) were independently associated, whereas cpRNFL was not; model R²=0.386. Power analysis based on the observed 1-way ANOVA effect (f=0.395) indicated achieved power≈0.999 at α=0.05. CONCLUSIONS: Outer nasal MPD is strongly associated with central functional loss across severities and adds information complementary to mGCIPL, supporting OCTA as a useful adjunct when structural OCT approaches a floor, including in advanced disease.
PRÉCIS: Higher radial peripapillary capillary density on OCT-A correlates independently with better visual field metrics in primary open-angle glaucoma, with similar diagnostic performance across robotic spectral-domain...PRÉCIS: Higher radial peripapillary capillary density on OCT-A correlates independently with better visual field metrics in primary open-angle glaucoma, with similar diagnostic performance across robotic spectral-domain and swept-source OCT platforms. PURPOSE: To investigate the association between optical coherence tomography angiography (OCT-A) metrics and visual field (VF) mean deviation (MD) using a robotic spectral-domain OCT (SD-OCT) and a swept-source OCT (SS-OCT). METHODS: In this prospective cross-sectional study, participants with primary open-angle glaucoma (POAG) underwent OCT-A imaging with both Topcon Maestro2 (SD-OCT) and Topcon Triton (SS-OCT). Radial peripapillary capillary (RPC) density of the superficial vascular plexus (SVP) was derived from 6×6 mm² scans centered on the optic nerve head (ONH). Associations between OCT-A metrics and VF parameters-including mean deviation (MD), visual field index (VFI), and pattern standard deviation (PSD)-were assessed using linear mixed-effects models, adjusting for scan quality, age, and retinal layer thickness. RESULTS: A total of 28 eyes from 18 patients met study criteria. In a multivariable model, each+1% in RPC density was associated with: a higher +1.09 dB MD on the SD-OCT ( P= 0.0241) and +1.75 dB on the SS-OCT ( P =0.0028); a higher VFI of+3.50% ( P =0.0181) for SD-OCT and+5.13% ( P =0.0019) for SS-OCT; a lower PSD of -0.92 dB ( P =0.0029) with SD-OCT and -1.21 dB ( P =0.0002) with SS-OCT. CONCLUSIONS: OCT-A-derived RPC density is an independent correlate of VF MD across both SD-OCT and SS-OCT platforms. Despite differences in hardware and acquisition methods, both systems demonstrated comparable diagnostic performance. These findings support the integration of OCT-A into glaucoma assessment and highlight the utility of automated SD-OCT platforms in both clinical and screening environments.