Journal Of Glaucoma[JOURNAL]
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200 papers
Letter to the Editor: "Aqueous Angiography-Guided Bent Ab Interno Needle Goniectomy in High Versus Low Aqueous Humor Outflow Regions in Primary Open Angle Glaucoma": A Pilot Randomized Controlled Trial.
Kulkarni N, Pegu J, Khan M … +1 more , Dubey S
J Glaucoma · 2026 May · PMID 41284924 · Publisher ↗
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One-Year Outcomes of Hydrus Microstent Combined With Cataract Surgery: Efficacy Across Glaucoma Severity Levels.
Bachour K, Dahoud A, Berkache M … +3 more , Chow DR, Yuan PHS, Durr G
J Glaucoma · 2026 Jan · PMID 41284607 · Publisher ↗
PRÉCIS: The Hydrus Microstent combined cataract surgery reduces IOP and medication use in mild-to-moderate glaucoma. For severe open angle glaucoma, it reduces medication use while maintaining a favorable safety profile....
PRÉCIS: The Hydrus Microstent combined cataract surgery reduces IOP and medication use in mild-to-moderate glaucoma. For severe open angle glaucoma, it reduces medication use while maintaining a favorable safety profile. PURPOSE: This study evaluates the 12-month clinical outcomes of Hydrus Microstent combined with cataract surgery in eyes with open angle glaucoma stratified by disease severity. MATERIALS AND METHODS: Retrospective, single-surgeon cohort study. Eyes with mild-to-moderate and severe glaucoma undergoing Hydrus implantation combined with cataract surgery were included. Primary outcomes were complete (no medication) and qualified (with medication) success (6-21 mm Hg) at 1 year. Secondary outcomes included IOP, number of glaucoma medications, complications, failure, and success rates for 6-18 and 6-15 mm Hg IOP thresholds. RESULTS: A total of 147 eyes from 100 patients with a median baseline IOP of 16.0 [IQR: 14.0-20.0] on 2.0 [1.0-3.0] medications were included. Complete success was achieved in 78% and qualified success in 93% of eyes, with mild-to-moderate glaucoma achieving 77% and 92%, and severe glaucoma achieving 84% and 96%, respectively. In the mild-to-moderate group, mean IOP decreased from 17.1±3.8 mm Hg (SD) to 15.5±2.7 mm Hg ( P <0.0003), and medications were reduced from 2.2±1.1 to 0.6±1.1 ( P <0.0001). In the severe group, mean IOP was not significantly changed, and medications were reduced from 2.6±1.3 to 1.2±1.3 ( P =0.0008). At 12 months, 64% of eyes were medication-free, and 67% of severe cases required one or fewer medications. Focal peripheral anterior synechiae (35%) was the most common complication. CONCLUSION: The Hydrus Microstent lowered medication use across all glaucoma severities. Further studies with larger sample sizes are warranted to support these findings.
Systematic Review of Clinical Practice Guidelines for the Diagnosis and Management of Open Angle Glaucoma.
Galvez-Olortegui J, Jarroudi RB, Silva-Ocas I … +4 more , Bernales-Urbina S, Mollo-Bautista R, Burgueño-Montañes C, Galvez-Olortegui T
J Glaucoma · 2026 Feb · PMID 41283759 · Publisher ↗
PRÉCIS: Clinical Practice Guidelines for Open Angle Glaucoma (OAG) have evolved through the years and differ in their methodological quality. British, Peruvian, and Spanish guidelines have a high methodological quality....
PRÉCIS: Clinical Practice Guidelines for Open Angle Glaucoma (OAG) have evolved through the years and differ in their methodological quality. British, Peruvian, and Spanish guidelines have a high methodological quality. TOPIC: To assess the methodological quality of Clinical Practice Guidelines for the diagnosis and management of open angle glaucoma (OAG). CLINICAL RELEVANCE: An assessment of the methodological quality of Clinical Practice Guidelines for the diagnosis and management of open angle glaucoma (OAG) is reported. METHODS: A systematic review of Clinical Practice Guidelines for the diagnosis and management of OAG, published between January 2017 and November 2024, was carried out with a search in databases, meta-search engines, guidelines development institutions, ophthalmology associations and guidelines repositories (CRD42024510656). Guidelines were selected if they were published in English/Spanish during the last 7 years. Five authors evaluated them independently, using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) instrument. An individual assessment by domain (AGREE-II), an overall assessment of the guide, and its use with or without modifications was performed. High-quality guideline was considered with at least 3/6 domains >60% including domain 3. In addition, a meta-synthesis of the recommendations for the most relevant outcomes of each guideline was performed. RESULTS: Eleven guidelines (20% of the 55 guidelines retrieved) published in English/Spanish, between 2017 and 2024 were selected. The lowest mean scores were in applicability and rigour of development (mean 43% and 46%, respectively). The highest score (mean 73%) was for domain 4 "clarity of presentation." British (92%), Peruvian (77%), and Spanish (75%) guidelines presented the best score in domain 3 "Rigour of development." When applying AGREE-II criteria for the overall guideline assessment, British and Spanish guidelines have the highest overall quality (6 and 5 scores, respectively). Most of the guidelines used GRADE approach for making recommendations. In the meta-synthesis, the guidelines show similar recommendations; however, we found variability in indications for selective laser trabeculoplasty (SLT) and minimally invasive glaucoma surgery (MIGS). CONCLUSIONS: British, Peruvian, and Spanish guidelines for the diagnosis and management of OAG have a high methodological quality, and high scores in applicability. In contrast, European guideline have high scores in applicability and moderate quality.
Quantitative Assessment of Functional Aqueous Humor Outflow by Aqueous Angiography.
Beri N, Patil A, Midha N … +4 more , Angmo D, Bari A, Sharma N, Dada T
J Glaucoma · 2025 Nov · PMID 41183392 · Publisher ↗
PRÉCIS: Evaluation of aqueous humor outflow (AHO) pathways shows a segmental pattern with the nasal quadrant having the maximum and the temporal quadrant having the least AHO pathways in nonglaucomatous subjects. AIM: To...
PRÉCIS: Evaluation of aqueous humor outflow (AHO) pathways shows a segmental pattern with the nasal quadrant having the maximum and the temporal quadrant having the least AHO pathways in nonglaucomatous subjects. AIM: To evaluate circumferential aqueous humor outflow (AHO) pathways in nonglaucomatous subjects using aqueous angiography (AA). METHODS: A cross-sectional, observational, single-center study recruited 30 subjects with visually significant age-related cataract planned for phacoemulsification. AA was performed using indocyanine green (ICG) dye 0.1% just before phacoemulsification. Images were analyzed at 60 seconds from the injection of ICG dye for angiographic signal intensity in 4 quadrants and 8 sectors, circumferentially (360 degrees) along the limbus. Signal intensities were evaluated and compared between quadrants and sectors as the primary outcome measure. Signal intensities between males and females, right and left eyes were assessed as secondary outcome measures, using appropriate statistical tests. RESULTS: The mean age of the patients was 61.53±5.5 years (range: 49-68 y) with 16 males and 14 females; 16 right eyes and 14 left eyes. Segmental AHO was noted in all patients. The median signal intensity was highest in the nasal quadrant [45.95(35.59-54.34)] followed by the inferior [31.56 (24.82-41.71)], superior [30.16 (28.2-37.43)], and temporal [26.66 (22.92-34.33)] quadrants, and their difference was statistically significant (P<0.0001). Median signal intensity among 8 sectors was highest in the nasosuperior sector [23.05 (17.14-29.20)] and least in the temporoinferior sector [12.98 (10.82-17.51)] (P<0.0001). No significant difference was observed in median signal intensities between males [132.83 (115.82-174.18)] and females [143.74 (122.43-166.00)] (P=0.771) and right eyes [143.74 (118.53-170.6)] and left eyes [133.51 (122.43-153.86)] (P=0.967). Anterior capsule rupture and vitreous staining were noted in one patient each. CONCLUSION: Nonuniform, segmental AHO pathways were seen in nonglaucomatous subjects using AA. The nasal quadrant had the maximum AHO functional channels, followed by the inferior, superior, and least in the temporal quadrant. Within the sectors, the nasosuperior sector had the highest signal intensity.
The Postoperative Hyperopic Shift Risk Prediction Model for Primary Angle Closure Glaucoma Patients Based on Machine Learning.
Gong D, Liu Y, Dang K … +5 more , Huang Y, Deng S, Guo J, Shen X, Wang J
J Glaucoma · 2025 Dec · PMID 41182183 · Publisher ↗
PRÉCIS: This study developed and validated a machine learning-based risk prediction model to estimate the likelihood of postoperative hyperopic shift in patients with primary angle closure glaucoma after IOL implantation...
PRÉCIS: This study developed and validated a machine learning-based risk prediction model to estimate the likelihood of postoperative hyperopic shift in patients with primary angle closure glaucoma after IOL implantation, which may help guide individualized surgical decision-making. OBJECTIVE: This study aims to construct a predictive model for the risk of hyperopic shift (HS) after phacoemulsification combined with intraocular lens (PE+IOL) surgery in patients with primary angle closure glaucoma (PACG), with the goal of providing scientific evidence for personalized treatment and early warning. MATERIALS AND METHODS: This is a retrospective cohort study that included PACG patients who underwent PE+IOL surgery between June 2019 and June 2024, according to predefined inclusion and exclusion criteria. We collected patients' demographic information, preoperative ocular examination data, and refractive changes 3-6 months postsurgery. The Boruta algorithm was used for feature selection of all clinical variables, and various machine learning models, including logistic regression (LR), random forest, support vector machine (SVM), k-nearest neighbors (KNN), and XGBoost, were developed. Model performance was assessed using receiver operating characteristic (ROC) curves and the area under the curve (AUC). The best-performing model was selected for visualization and interpretability analysis. Data processing and analysis were performed using R version 4.2.3. All statistical tests were 2-sided, with a P -value <0.05 considered statistically significant. RESULTS: A total of 423 eyes were included, with n=267 in the non-HS group and n=156 in the HS group. Key predictive variables identified by the Boruta algorithm included target refraction, preoperative best-corrected visual acuity (BCVA), axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), white-to-white distance (W2W), and pupil diameter (P). Both the SVM and LR models exhibited the best predictive accuracy, with AUCs of 0.704 and 0.696, respectively, demonstrating moderate classification ability. CONCLUSION: This study successfully developed a risk prediction model for HS after PE+IOL surgery in PACG patients based on various clinical features. The SVM and LR models show promising clinical application in predicting HS risk and can provide personalized postoperative management strategies for glaucoma surgery patients.
Myopic Shift Induced By Omidenepag Isopropyl 0.002% in Patients With Primary Open Angle Glaucoma.
Lee YJ, Choe S, Kim JS
J Glaucoma · 2026 Jan · PMID 41182070 · Publisher ↗
PRÉCIS: Among POAG patients, 13.6% experienced a myopic shift of 0.75 D or more at 1 month following OMDI administration. Ciliary spasm may be the underlying mechanism. PURPOSE: To evaluate the incidence, pathophysiology...
PRÉCIS: Among POAG patients, 13.6% experienced a myopic shift of 0.75 D or more at 1 month following OMDI administration. Ciliary spasm may be the underlying mechanism. PURPOSE: To evaluate the incidence, pathophysiology and risk factors for myopic shift following omidenepag isopropyl (OMDI) 0.002% administration in patients with primary open angle glaucoma (POAG). METHODS: This prospective, observational study included adult patients aged 20 years or older who visited the clinic between February and December 2022 and were diagnosed with POAG (treatment-naive). Participants were prescribed OMDI 0.002% eyedrops at the baseline visit. Comprehensive ophthalmic examinations, including measurements of refractive error (RE), keratometry, corneal topography, optical biometry, visual acuity (VA), and intraocular pressure (IOP) were performed at the baseline and 1 month after OMDI instillation. Main outcome measures were changes in ocular parameters, including RE, corneal curvature (CC), central corneal thickness (CCT), anterior chamber depth (ACD), axial length, lens thickness (LT), white-to-white, VA and IOP. RESULTS: A total of 44 eyes of 44 subjects were included. 13.6% of patients experienced a myopic shift of 0.75 D or more 1 month after OMDI instillation. Other ocular parameter changes included increased CC, CCT, and LT, along with decreased ACD. In the correlation analysis, CC change was associated with the myopic shift. Multiple linear regression analysis further revealed that changes in both CC and VA were significantly associated with the myopic shift, though no specific risk factor was identified. CONCLUSIONS: OMDI 0.002% eyedrops were associated with a notable incidence of myopic shift in patients with POAG. Ciliary muscle spasm is a possible underlying mechanism of myopic shift.
Association Between Adiposity Indicators and Intraocular Pressure.
Kim JL, Lee K
J Glaucoma · 2026 Feb · PMID 41182045 · Publisher ↗
PRÉCIS: In a nationally representative sample, intraocular pressure was linked to multiple adiposity indicators in men but only select measures in women, with ocular hypertension significantly associated with obesity and...
PRÉCIS: In a nationally representative sample, intraocular pressure was linked to multiple adiposity indicators in men but only select measures in women, with ocular hypertension significantly associated with obesity and abdominal obesity in men. PURPOSE: To evaluate the association between intraocular pressure (IOP) and adipose indicators and to investigate sex differences in these associations. METHODS: A population-based cross-sectional study. A total of 7407 Korean adults from the 2019 to 2021 Korea National Health and Nutrition Examination Survey VIII database. Body mass index (BMI), waist circumference (WC), visceral adiposity index (VAI), lipid accumulation product (LAP), and cardiometabolic index (CMI) were evaluated as adiposity indicators. The IOPs in both eyes were measured using rebound tonometer. Complex sample general linear models and logistic regression analyses were performed to assess associations between adiposity indicators and IOP or ocular hypertension, adjusting for demographic, health behaviors, and clinical covariates. IOP and ocular hypertension. RESULTS: IOP was positively associated with all adiposity indicators (BMI, waist circumference, LAP, VAI, and CMI) in men, whereas only BMI, WC, and LAP were associated with IOP in women. For ocular hypertension, BMI, WC, and LAP were significantly associated with increased odds in men. Notably, men with both obesity and abdominal obesity had higher odds of ocular hypertension (OR 3.24, 95% CI, 1.47-7.13), and those with abdominal obesity alone also showed elevated risk (OR 3.35, 95% CI, 1.58-7.11). In women, none of the adiposity indicators or obesity categories were significantly associated with ocular hypertension. CONCLUSIONS: In this Korean population, adiposity indicators were more strongly associated with IOP and ocular hypertension in men than in women. Abdominal adiposity appeared to play a particularly important role, suggesting sex-specific pathways in IOP regulation.
Long-Term Outcomes of Gonioscopy-Assisted Transluminal Trabeculotomy in Open Angle Glaucoma.
Bektas C, Ozmen MC, Acar B … +2 more , Uysal BS, Aktas Z
J Glaucoma · 2026 Feb · PMID 41182003 · Publisher ↗
PRÉCIS: GATT significantly reduced intraocular pressure and reduced medication use in POAG and PXG patients over 5 years, with high success rates. Previous glaucoma surgeries and early intraocular pressure spikes were ri...
PRÉCIS: GATT significantly reduced intraocular pressure and reduced medication use in POAG and PXG patients over 5 years, with high success rates. Previous glaucoma surgeries and early intraocular pressure spikes were risk factors for failure. PURPOSE: To evaluate the long-term outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in managing primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG) over 5 years. PATIENTS AND METHODS: This retrospective study involved 51 eyes of 42 patients who underwent GATT using prolene suture by a single surgeon with a follow-up duration of at least 5 years. RESULTS: Mean follow-up duration was 69.0±12.1 months. Mean intraocular pressure (IOP) significantly reduced in POAG patients (n=26), from 27.4±5.6 mmHg to 14.5±1.9 mm Hg ( P <0.001), and in PXG patients (n=25), from 26.4 ± 6.6 mm Hg to 13.3±2.1 mm Hg ( P <0.001) at the final visit. Correspondingly, the average number of antiglaucomatous medications decreased from 3.2±0.7 to 2.1±1.5 in POAG ( P =0.019) and from 3.5±0.7 to 1.5±1.4 in PXG ( P <0.001). The qualified cumulative surgical success rates at a target IOP ≤18 mm Hg were 83.1% (95% CI: 72.5%-93.7%) for POAG and 91.2% (95% CI: 84.7%-97.7%) for PXG, and at a target IOP ≤15 mm Hg were 68.2% (95% CI: 55.0%-81.4%) and 83.5% (95% CI: 74.4%-92.7%), respectively. Factors such as prior incisional glaucoma surgery and higher IOP levels during the first postoperative week were identified as risks for surgical failure. CONCLUSION: GATT showed promising long-term efficacy and safety in POAG and PXG patients followed for 5 years, achieving significant reductions in IOP and medication dependence. Prior incisional glaucoma surgery and early postoperative IOP elevations were identified as risk factors for failure.
Outcomes of Ahmed and Baerveldt Glaucoma Drainage Devices in Japanese Patients.
Hara T, Ikeda HO, Numa S … +5 more , Miyake M, Suda K, Kameda T, Akagi T, Tsujikawa A
J Glaucoma · 2025 Dec · PMID 41181987 · Publisher ↗
PRÉCIS: Preoperative conditions and outcomes of the Ahmed glaucoma valve and Baerveldt glaucoma implant were assessed. Differences were observed in disease type and surgical history between the 2 groups. Comparatively, t...
PRÉCIS: Preoperative conditions and outcomes of the Ahmed glaucoma valve and Baerveldt glaucoma implant were assessed. Differences were observed in disease type and surgical history between the 2 groups. Comparatively, the Baerveldt glaucoma implant had more complications. PURPOSE: To evaluate the preoperative conditions and surgical outcomes of the Ahmed glaucoma valve and the Baerveldt glaucoma implant in clinical practice. PATIENTS AND METHODS: Patients who underwent glaucoma tube-shunt surgery using the Ahmed glaucoma valve or Baerveldt glaucoma implant at Kyoto University Hospital between January 1, 2015, and December 31, 2021, were included. Patients with previous glaucoma tube shunt surgeries were excluded. Data on preoperative conditions, intraocular pressure, glaucoma medication scores, visual acuity, and complications were retrospectively obtained from medical records. RESULTS: We analyzed 154 eyes (Ahmed glaucoma valve, 102 eyes; Baerveldt glaucoma implant, 52 eyes) in total. No significant differences were observed between the groups except for disease type and surgical history-neovascular glaucoma and no prior glaucoma surgery were more common in the Ahmed glaucoma valve group, whereas exfoliation glaucoma, primary open angle glaucoma, and history of glaucoma surgery were more frequent in the Baerveldt glaucoma implant group. At 36 months, mean intraocular pressure and medication scores were 14.2±4.0 mm Hg and 2.1±1.5 for Ahmed glaucoma valve, and 13.0±4.6 mm Hg and 1.7±1.7 for Baerveldt glaucoma implant, respectively, with no significant differences. The 60-month cumulative success rates were 58.1% for Ahmed glaucoma valve and 60.6% for Baerveldt glaucoma implant under Definition A (intraocular pressure range: 6-21 mm Hg) and 57.5% for Ahmed glaucoma valve and 57.5% for Baerveldt glaucoma implant under Definition B (intraocular pressure range: 6-18 mm Hg). The Baerveldt Glaucoma Implant group revealed a higher incidence of postoperative complications, with hypotony being the most common complication. CONCLUSION: In this large-scale real-world study, no significant differences in surgical outcomes were observed between the Ahmed glaucoma valve and the Baerveldt glaucoma implant. However, it should be noted that the implant choice tended to be influenced by glaucoma type and surgical history, reflecting differences in disease background between the treatment groups.
Comparative Evaluation of Peripapillary Retinal Nerve Fiber Layer Thickness in Myopes and Emmetropes in a Tertiary Hospital in Nigeria.
Ibiyemi AA, Olawoye OO, Olusanya BA
J Glaucoma · 2026 Feb · PMID 41002220 · Publisher ↗
PRÉCIS: This comparative cross-sectional study in an indigenous black population demonstrated that high myopic eyes have a significantly thinner retinal nerve fiber layer when compared with emmetropic and other myopic su...
PRÉCIS: This comparative cross-sectional study in an indigenous black population demonstrated that high myopic eyes have a significantly thinner retinal nerve fiber layer when compared with emmetropic and other myopic subgroups. PURPOSE: To compare the peripapillary retinal nerve fiber layer (RNFL) thickness in myopes and emmetropes and determine the relationship between age and sex and RNFL thickness in myopes and emmetropes in an African population. METHODS: This was a hospital-based observational cross-sectional study in which both myopic and emmetropic subjects were recruited. Myopic subjects were classified into low [-0.5D to -3.0 diopters (D)], moderate (>-3.0D to -5.0D), and high myopia (>-5.0D) based on spherical equivalent. Myopic and emmetropic groups were further subdivided into subgroups based on age as follows: 20-29, 30-39, 40-49, and 50-59 to recruit subjects across the age groups. Consecutive subjects presenting to the eye clinic that met the eligibility criteria were recruited into the study until the sample size in each group was completed. All participants underwent full ophthalmic examination, refraction, visual fields analysis, and A-scan biometry. The peripapillary RNFL thickness of the retina was measured using the Optovue iScan Spectral Domain Optical Coherence Tomography (SD-OCT). Measurements from one eye (right) of participants were used for analysis. Quantitative data were descriptively summarized and compared using t test, ANOVA, and ANCOVA. RESULTS: A total of 116 participants were recruited, 28 (24.1%) subjects were emmetropes, while 33 (28.5%) had low myopia, 27 (23.3%) moderate myopia, and 28 (24.1%) high myopia. The mean age of all subjects was 36.0±11.4 years. All subgroups of myopia had thinner RNFL [Low=103.8±8.6 µm ( P =0.582); Moderate=101±6.5 µm ( P =0.171); High=94.4±7.9 µm ( P =<0.001)] compared with emmetropes (105.2±10.7 µm). There was a decrease in the mean global RNFL thickness with increasing myopia. RNFL thickness was negatively correlated with age ( r = -0.303). The rate of reduction per year was higher in emmetropes (0.66 µm) compared with myopes (0.25 µm). The rate of decline of RNFL per year is associated with thicker mean global RNFL thickness seen in emmetropes as compared with myopes. CONCLUSION: High myopes in this population have thinner peripapillary RNFL values compared with emmetropes, low and moderate myopes. RNFL thickness was negatively correlated with age in both emmetropes and myopes.
A Model to Estimate the Unmedicated Intraocular Pressure of Patients on Glaucoma Medications.
Benoit O, Jumelle C, Meunier E … +3 more , Sourdille P, Baudouin C, Labbe A
J Glaucoma · 2025 Nov · PMID 40985756 · Publisher ↗
PRÉCIS: This report presents a model that can be used to determine the IOP-lowering effect of a glaucoma procedure or treatment when a medication washout is not ethical or not possible to be performed. BACKGROUND: The ef...
PRÉCIS: This report presents a model that can be used to determine the IOP-lowering effect of a glaucoma procedure or treatment when a medication washout is not ethical or not possible to be performed. BACKGROUND: The effect of individual (or certain predefined combinations of) glaucoma medications on intraocular pressure (IOP) has been well documented in various clinical trials. Conversely, the cumulative effect of several glaucoma medications, let alone their discontinuation (ie, washout), on IOP is still relatively unknown. This is why it is generally recommended to perform a medications' washout to analyze the effect of the glaucoma procedure without confounding factors. However, a washout is not always possible or ethical for some patients and can also increase the costs and complexity of clinical trials. AIMS: To build and validate a mathematical model of the IOP change after glaucoma medications washout. METHOD: A literature search was conducted to identify studies reporting IOP values before and after washout, as well as the number of glaucoma medications used. On the basis of this, a quadratic equation was fitted to estimate the IOP change after washout, using the mean medicated IOP and the mean number of medications as input parameters. FINDINGS: A total of 31 groups (each group having a precise mean medicated IOP, mean number of medications, and mean postwashout IOP) from 15 studies were selected to build and validate the model. Overall, over 90% of the variability of IOP change reported in the studies was explained by the model ( R2 =0.9007). The mean difference between the IOP changes estimated by the model and the IOP changes reported in the studies was <1 mm Hg. CONCLUSION: Estimating the IOP change using this model may represent an useful tool to determine the IOP-lowering effect of a glaucoma procedure or treatment when the washout is not ethical or not possible to be performed on patients. More studies need to be conducted to validate the practical robustness of this formula.
Impact of Different Intraocular Pressure and Medication Endpoint Criteria on Success Rates in Subconjunctival Minimally Invasive Glaucoma Surgery.
Tan JCK, Kong G, Louis A … +5 more , Lee V, Clement C, Cheng J, Gazzard G, Lawlor M
J Glaucoma · 2025 Nov · PMID 40985753 · Publisher ↗
PRÉCIS: Applying different combinations of intraocular pressure and medication endpoint criteria recommended by the World Glaucoma Association can have a significant influence on the risk of failure following glaucoma su...
PRÉCIS: Applying different combinations of intraocular pressure and medication endpoint criteria recommended by the World Glaucoma Association can have a significant influence on the risk of failure following glaucoma surgery, which hinders the comparison of outcomes. PURPOSE: The definition of success in glaucoma surgical trials lacks standardization, leading to difficulty comparing outcomes across studies. This study evaluates how different intraocular pressure (IOP) and medication criteria affect success in a representative subconjunctival minimally invasive glaucoma surgery (MIGS) dataset. METHODS: A literature review identified the range of criteria used to define surgical success in studies of Xen gel stent, which were summarized into 4 definitions: (A) final IOP within upper and lower thresholds only, (B) criteria A plus ≥20% decrease in IOP verssus baseline, (C) ≥20% IOP decrease plus no increase in medications versus baseline, (D) all 3 criteria combined. These definitions were then applied to a cohort of 308 eyes that underwent Xen surgery to compare the apparent risks of failure. RESULTS: Success rates at 12 months across studies reviewed ranged from 18.5% to 33.4% for complete and 22.4% to 64.6% for qualified success. In our cohort, the hazard ratios of failure ranged from 0.27 to 5.87 (95% CI: 0.21-7.63, P <0.001) across the 4 definitions. The greatest degree of difference in apparent failure rates was observed at the upper IOP threshold of 21 mm Hg, and when evaluating qualified success. CONCLUSION: Using different IOP and medication criteria to define success can have a significant influence on the apparent risk of failure, particularly at the 21 mm Hg threshold and when incorporating a minimum 20% IOP reduction from baseline. Reporting success using guidelines-recommended criteria-and at multiple upper IOP thresholds may enable better comparison of outcomes between studies.
Predictors of Long-Term Visual Acuity and Intraocular Pressure Outcomes in Childhood Glaucoma: A Multicenter Study By the Childhood Glaucoma Research Network.
Sheheitli H, Brandt J, Grajewski A … +10 more , Cooper C, Edmunds B, Kaushik S, Bouhenni R, Al-Haddad C, Munshi H, Jiang Z, Marka N, Reiser BJ, Chang TC
J Glaucoma · 2025 Nov · PMID 40982256 · Publisher ↗
PRÉCIS: This study identifies visual acuity and intraocular pressure at 3-year and 5-year follow-ups, along with other variables such as media opacity and nystagmus, as key predictors of long-term outcomes in childhood g...
PRÉCIS: This study identifies visual acuity and intraocular pressure at 3-year and 5-year follow-ups, along with other variables such as media opacity and nystagmus, as key predictors of long-term outcomes in childhood glaucoma, aiding better management and prognostication. PURPOSE: This study aims to identify key predictive variables of visual acuity (VA) and intraocular pressure (IOP) outcomes in childhood glaucoma. By understanding these factors, the study seeks to improve prognostication and management strategies for pediatric patients. METHODS: A retrospective analysis was conducted on pediatric glaucoma patients across multiple centers within the Childhood Glaucoma Research Network (CGRN). The study included patients with at least 5 years of follow-up. Variables such as sex, race, ethnicity, age of onset, laterality, and clinical measures including VA and IOP at various stages (initial visit, 3 y, 5 y, and final visits) were evaluated. Additional factors considered were anisometropia, media opacities, nystagmus, anterior segment dysgenesis (ASD), strabismus, and angle closure. RESULTS: The study included 396 eyes from 243 patients, with a mean age at presentation of 1.5 months. Several variables showed statistically and clinically significant correlations with final outcomes including IOP and VA at both 3-year and 5-year visits, as well as the presence of media opacities, unilateral glaucoma, nystagmus, and ASD. On the basis of multivariable prediction model analysis the 2 statistically significant predictors for visual acuity (n=31) were VA at 5-year visit and presence of angle closure. As for IOP outcomes (n=31), significant predictors included were IOP at 5-year visit and presence of nystagmus. CONCLUSIONS: This multicenter study highlights that VA and IOP measurements at 3 and 5 years postdiagnosis, along with the presence of specific ocular conditions such as media opacity and nystagmus, are crucial in predicting long-term outcomes in childhood glaucoma.
The Effect of Glaucomatous Visual Field Defects on Driving: A Systematic Review.
Toh ZH, Koh SYN, Yang WYL … +2 more , Munro YL, Ang BCH
J Glaucoma · 2025 Nov · PMID 40960416 · Publisher ↗
PRÉCIS: Glaucoma patients with significant visual field defects show poorer driving performance, higher collision risks, and a greater likelihood of driving cessation. They face difficulties with lane maintenance, slower...
PRÉCIS: Glaucoma patients with significant visual field defects show poorer driving performance, higher collision risks, and a greater likelihood of driving cessation. They face difficulties with lane maintenance, slower hazard responses, and self-regulation while driving. PURPOSE: Glaucoma is a chronic, progressive optic neuropathy associated with visual field (VF) defects, which in advanced disease has been shown to affect patients' activities of daily living. This systematic review qualitatively analyzes existing literature that explores the impact of glaucomatous VF loss on the driving performance of glaucoma patients, the extent of driving limitation and cessation, as well as the risk of motor vehicle collisions (MVCs). METHODS: A literature search of MEDLINE and Embase (via Ovid), PubMed, Cochrane Library, and Web of Science databases was performed for studies published from 2003 to 2023, with the terms "glaucoma," "visual field defect/disorder," and "driving," followed by selective vetting based on inclusion criteria. Within studies, data pertaining to study design, subject demographics, VF defect characteristics, driving performance and related outcomes were extracted. RESULTS: Initial search yielded 835 studies, with 20 studies selected. Three more studies were included through hand-searching, with a total of 23 studies included for final review. Moderate to severe VF defects resulted in poorer driving performance, with slower response times to road hazards, decreased ability for lane maintenance, and increased difficulty driving at night. Patients with more severe VF defects and with bilateral glaucoma were more likely to limit or cease driving compared with those with milder and unilateral glaucoma. A greater severity of VF loss was associated with a higher risk of MVCs. CONCLUSION: More severe glaucomatous VF and bilateral glaucoma is associated with worse driving performances and a higher risk of MVCs, in both simulator and real-world settings.
Comparing Online Circular Contrast Perimetry and the Esterman Visual Field Test in Glaucoma for Driving-relevant Vision.
Klejn A, Gong A, Skalicky SE
J Glaucoma · 2025 Dec · PMID 40960412 · Publisher ↗
PRÉCIS: Online binocular perimetry showed moderate to strong agreement with Esterman visual field testing in glaucoma patients and controls, with high correlation coefficients and predictive capability. This tool may off...
PRÉCIS: Online binocular perimetry showed moderate to strong agreement with Esterman visual field testing in glaucoma patients and controls, with high correlation coefficients and predictive capability. This tool may offer a viable, accessible alternative to machine perimeters for driving licence assessment. PURPOSE: To assess the feasibility of an online computer-based binocular driving perimetry assessment (OBDP) based on online circular contrast perimetry, and agreement with binocular static Esterman visual field testing (EVFT). METHODS: A prospective comparative cohort study was conducted on patients with or without open angle glaucoma, recruited from a single-site glaucoma subspecialty practice. Eligible subjects underwent 2 visual field tests using OBDP and this was compared with the results of a single EVFT. RESULTS: Eighty patients were enrolled in the study, with a mean age of 69 years (+/- 13.4 SD). Of these, 49% were female, 18 were healthy controls, while 20, 18 and 24 had mild, moderate and severe glaucoma, respectively. Pearson and intraclass correlation between the 2 perimetry methods for percentage of points not seen (PNS) was 0.85 and 0.86 (95% CI: 0.78-0.9), respectively, for the overall binocular visual field. When the binocular field was subdivided into 8 sectors, intraclass coefficients (ICCs) ranged from 0.76 to 0.93 for each sector. Bland-Altman analysis revealed a difference of 1.24% (95% CI: -16.93% to 19.30%) between the 2 methods for the overall field, ranging from 0.04% to 4.17% for each sector. On the basis of the Austroads fitness to drive guidelines, OBDP demonstrated a sensitivity of 96.97% and specificity of 78.57% when compared with the EVFT. ICCs evaluating the repeatability of OBDP testing for the percentage of PNS were excellent overall (0.97) and ranged from moderate to excellent for each of the 8 sectors (0.67-0.98). CONCLUSION: OBDP showed strong agreement with EVFT. As an online application that easily runs on any computer, it could expand the scope of binocular perimetry screening for licence assessment. With modifications, integration into modern clinical licensing procedures could be considered.
Relationships of Paracentral Scotoma With Structural and Vascular Parameters in Highly Myopic Eyes With Early Open Angle Glaucoma.
Huang J, Ye L, Luo N … +4 more , Cheng L, Xiang Y, Han Y, Huang J
J Glaucoma · 2025 Nov · PMID 40960410 · Publisher ↗
PRÉCIS: This study revealed the prevalence of paracentral scotoma in highly myopic eyes with early open angle glaucoma, and highlighted structural and vascular parameters associated with paracentral scotoma, which may fa...
PRÉCIS: This study revealed the prevalence of paracentral scotoma in highly myopic eyes with early open angle glaucoma, and highlighted structural and vascular parameters associated with paracentral scotoma, which may facilitate the assessment of central visual function. PURPOSE: To investigate the prevalence and associated factors of paracentral scotoma in patients with high myopia and early open angle glaucoma (OAG). METHODS: In this cross-sectional study, myopic eyes with early OAG (mean deviation of visual field > -6 dB) were categorized into the high myopia group and the low-to-moderate myopia group. Paracentral scotoma was defined as a visual field defect in one hemifield within 10 degrees of fixation. The prevalence of paracentral scotoma was compared between the 2 groups. Association between structural and vascular factors and paracentral scotoma was investigated by logistic regression analysis. RESULTS: A total of 220 myopic eyes with early OAG were enrolled, including 136 highly myopic eyes, and 84 low-to-moderate myopic eyes. Paracentral scotoma was more prevalent in the high myopia group (39.7% vs. 22.6%, P = 0.012). Multivariate logistic regression analysis showed that thinner circumpapillary retinal nerve fiber layer (cpRNFL) thickness in inferior-temporal and temporal-upper sectors, thinner inferior ganglion cell complex (GCC) thickness, lower radial peripapillary capillary (RPC) vessel density in inferior-temporal and temporal-lower sectors, and lower inferior perifoveal vessel density were significantly associated with paracentral scotoma in highly myopic eyes with early OAG (all P < 0.05). CONCLUSIONS: Compared with low-to-moderate myopia, highly myopic eyes with early OAG were more likely to develop paracentral scotoma. The measurement of cpRNFL thickness and RPC vessel density in the temporal and inferior-temporal sectors, GCC thickness, and perifoveal vessel density in the inferior sector may help assessment of central visual function in highly myopic eyes with early OAG.
Augmentation of Aqueous Outflow After Trabecular MIGS in Primary Angle Closure Glaucoma Demonstrated by Aqueous Angiography.
Dada T, Beri N, Patil A … +2 more , Shaw E, Angmo D
J Glaucoma · 2026 Feb · PMID 40960408 · Publisher ↗
Minimally invasive glaucoma surgeries (MIGS) targeting the trabecular meshwork are emerging as a new modality in the management of primary angle closure glaucoma (PACG). Aqueous angiography (AA) allows in vivo, real-time...
Minimally invasive glaucoma surgeries (MIGS) targeting the trabecular meshwork are emerging as a new modality in the management of primary angle closure glaucoma (PACG). Aqueous angiography (AA) allows in vivo, real-time assessment of conventional aqueous humor outflow (AHO) using tracer dyes. Herein, we discuss a novel case of AA demonstrating changes seen in AHO post-trabecular MIGS in a PACG patient. This case provides evidence that supports the hypothesis of using trabecular MIGS in treating PACG patients and encourages further research to innovate and study the efficacy of trabecular MIGS in the management of primary angle closure disease.
Online Circular Contrast Perimetry: Validity and Repeatability of Home Performance.
Chen YX, Corbett J, Gale J … +4 more , Meyerov J, Gong A, Cheng J, Skalicky SE
J Glaucoma · 2025 Nov · PMID 40960404 · Publisher ↗
PRECIS: Online Circular Contrast Perimetry (OCCP) offers clinically validated threshold perimetry to patients via a web application from their own devices. This study evaluates the feasibility, repeatability, and reliabi...
PRECIS: Online Circular Contrast Perimetry (OCCP) offers clinically validated threshold perimetry to patients via a web application from their own devices. This study evaluates the feasibility, repeatability, and reliability of OCCP when performed in unsupervised home environments. PURPOSE: To evaluate the feasibility, repeatability, and reliability of online circular contrast perimetry (OCCP) when performed in unsupervised home environments on personal devices. PATIENTS AND METHODS: A total of 55 participants (20 control and 35 open angle glaucoma patients) were recruited. Participants underwent baseline visual field testing using OCCP in a clinical setting, followed by weekly unsupervised home tests over 6 weeks on their personal computers. An online survey was completed afterwards. Global perimetric indices and reliability indices were compared between clinic-based and home-based tests and analyzed to assess the repeatability and reliability of OCCP at home. Rasch analysis assessed the psychometric properties of the survey and intergroup variability. RESULTS: No statistically significant differences were found in mean deviation (MD), pattern standard deviation (PSD), or visual index values between home and clinic tests ( P >0.05), and these values did not significantly alter over the 6 weekly at-home tests. OCCP false positive and fixation loss responses were statistically higher at home compared with baseline ( P =0.002 and P =0.001). Test-retest intraclass correlation coefficients for OCCP home use compared with in-clinic for MD ranged from 0.90 to 0.93, and for PSD ranged from 0.81 to 0.85. Bland-Altman analysis for MD revealed zero test-retest bias with limits of agreement ranging from ±5.28 to ±5.83 dB across the 6 weeks. The survey indicated high user satisfaction; however, Rasch analysis revealed suboptimal precision and targeting. CONCLUSIONS: OCCP retains a similar diagnostic accuracy and repeatability in home environments on personal devices compared with clinic-based environments and has the potential to be utilized as a remote tool for glaucoma screening and surveillance.
Surgical Efficacy After Viscogonioplasty in Primary Angle Closure Disease With Different Mechanisms.
Wang J, Wang Y, Zhang Y … +4 more , Tang X, Wang D, Wang N, Mou D
J Glaucoma · 2026 May · PMID 40952508 · Publisher ↗
PRCIS: Nonpupillary block mechanisms are associated with larger postoperative peripheral anterior synechiae (PAS) extent at 1-year follow-up compared with pupillary block mechanisms in primary angle-closure disease (PACD...
PRCIS: Nonpupillary block mechanisms are associated with larger postoperative peripheral anterior synechiae (PAS) extent at 1-year follow-up compared with pupillary block mechanisms in primary angle-closure disease (PACD). PURPOSE: To evaluate the impact of preoperative angle closure mechanisms on the surgical outcomes of phacoemulsification and intraocular lens implantation (PEI) combined with VGP in PACD patients with cataracts. PATIENTS AND METHODS: This prospective cohort study enrolled 56 patients (68 eyes) with PACD and cataracts. Participants were classified into pupillary block (PB) and nonpupillary block (Non-PB) groups based on the anatomic characteristics of angle closure shown in preoperative ultrasound biomicroscopy imaging. Primary outcomes included peripheral anterior synechiae (PAS) extent, intraocular pressure (IOP), and number of IOP-lowering medications over a 12-month follow-up period. RESULTS: Both groups showed significant reductions in PAS extent at the end of surgery compared with the baseline. At 6 and 12 months postoperatively, the Non-PB group exhibited significantly larger PAS extent compared with the PB group ( P =0.025 and 0.017, respectively). Both groups demonstrated significant IOP reduction and decreased use of IOP-lowering medications postoperatively, with no significant differences between groups. The overall complete and qualified success rates at 12 months were 71.6% and 98.5%, respectively, with no significant difference between groups. CONCLUSIONS: Non-PB mechanisms are associated with larger postoperative PAS extent at 1-year follow-up compared with PB mechanisms, emphasizing the importance of comprehensive preoperative angle closure mechanisms assessment in predicting and potentially minimizing PAS progression for enhanced long-term surgical efficacy in PACD treatment.
Safety and Efficacy of a Preservative-Free Bimatoprost 0.01% Ophthalmic Gel: Results From a Phase III Controlled Trial.
Miller-Ellis E, Peace JH, Day DG … +4 more , El-Harazi SM, Nissle S, Wirta D, Bacharach J
J Glaucoma · 2025 Nov · PMID 40952469 · Publisher ↗
PRÉCIS: Noninferiority on intraocular pressure (IOP)-lowering efficacy was demonstrated for a preservative-free (PF) bimatoprost 0.01% ophthalmic gel compared with a preserved formulation following a 3-month treatment in...
PRÉCIS: Noninferiority on intraocular pressure (IOP)-lowering efficacy was demonstrated for a preservative-free (PF) bimatoprost 0.01% ophthalmic gel compared with a preserved formulation following a 3-month treatment in patients with open angle glaucoma (OAG) or ocular hypertension (OHT). PURPOSE: To compare the safety and IOP-lowering efficacy of a preservative-free bimatoprost 0.01% ophthalmic gel (PFB 0.01% gel) with a preserved bimatoprost 0.01% ophthalmic solution (PB 0.01%) in patients with OAG or OHT. METHODS: This prospective, phase III, multicenter, randomized, parallel group, investigator-masked, 3-month study included patients with OAG or OHT, previously treated with monotherapy, who underwent a maximum 7-week washout period. At day 1, patients were randomized to receive either PFB 0.01% gel (n=232) or PB 0.01% (n=234) dosed once daily from day 1 to day 85. The primary efficacy endpoint was the change from baseline in IOP across 9 timepoints (8 am , 10 am , and 4 pm ) at weeks 2, 6 and 12. Safety measures included adverse events (AEs) and conjunctival hyperemia. RESULTS: Change in IOP from baseline was consistent across timepoints and was similar between treatment groups. Noninferiority of PFB 0.01% gel to PB 0.01% on IOP-lowering over a 12-week treatment period was demonstrated based on predetermined noninferiority margins [below 1.5 mm Hg at all timepoints (9/9) and below 1 mm Hg at the majority of time points (6/9)]. Tolerability and safety were comparable with fewer treatment-related ocular AEs in the PFB 0.01% gel group compared with the PB 0.01% group (28.1% vs. 34.8%, respectively), and conjunctival hyperemia at Week 2 (54.8% vs. 63.2%, respectively). CONCLUSIONS: PF bimatoprost 0.01% ophthalmic gel was noninferior to the preserved bimatoprost 0.01% ophthalmic solution, with similar safety and tolerability over 3 months.
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