Journal Of Glaucoma[JOURNAL]
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200 papers
Tonographic outflow facility and intraocular pressure after standalone OMNI surgery.
Swampillai AJ, Sherman T, Ranjit A … +4 more , Patel B, Madekurozwa M, Overby DR, Lim KS
J Glaucoma · 2026 Jun · PMID 42397848 · Publisher ↗
PRECIS: The OMNI surgical device produces a statistically significant reduction in intraocular pressure and a significant increase in tonographic outflow facility at 3 months, which is found to be non-significant at 12 m...
PRECIS: The OMNI surgical device produces a statistically significant reduction in intraocular pressure and a significant increase in tonographic outflow facility at 3 months, which is found to be non-significant at 12 months for both parameters. PURPOSE: OMNI is a minimally invasive glaucoma surgical device designed to address all three points of conventional outflow resistance (juxtacanalicular trabecular meshwork, inner wall of Schlemm's canal and resistance distal to canal). This study assessed its effects on intraocular pressure (IOP) and tonographic outflow facility (TOF) changes after medication washout. METHODS: Thirty eyes of 30 patients with uncontrolled open angle glaucoma or ocular hypertension were prospectively recruited. Each patient underwent a 4-week washout baseline IOP measurement and TOF recording via digital Schiøtz tonography. Patients received standalone 360 degrees canaloplasty and 160-180 degrees trabeculotomy. Measurements were repeated at 3 and 12 months post treatment (with further washout). RESULTS: At 3 months, a mean IOP reduction by 3.26 mmHg from baseline (27.25±9.0 vs. 23.99±10.84 mmHg, P=0.03) was achieved, with a statistically significant increase in TOF (0.068±0.045 vs. 0.14±0.090 µL/min/mmHg, P=0.0002). At 12 months, a mean IOP reduction of 1.57 mmHg was achieved (27.25±9.0 vs. 25.68±12.04 mmHg, P=0.6) with no significant TOF change (0.068±0.045 vs. 0.10± 0.09 µL/min/mmHg, P=0.07). Thirty-two percent experienced a > 20% IOP reduction (n=9) with 25% experiencing an IOP < 18 mmHg (n=7) at 12 months. CONCLUSIONS: This is the first study assessing the standalone effect of the OMNI device on both IOP and TOF change pre and post treatment. While an IOP reduction and increase in TOF was noted at 3 months, this was not statistically significant at 12 months.
Factors Associated With Retinal Nerve Fiber Layer Asymmetry in Primary Open-Angle Glaucoma Among Individuals of African Ancestry.
Zhao AT, Di Rosa I, Salowe R … +7 more , Jin F, Lee R, Aibo MI, Ying GS, Addis V, Sankar P, O'Brien JM
J Glaucoma · 2026 Jun · PMID 42384867 · Publisher ↗
PRCIS: This study investigated RNFL asymmetry in 834 African ancestry patients with primary open-angle glaucoma. Associated with optic disc and visual field differences, RNFL asymmetry may signal early glaucomatous damag...
PRCIS: This study investigated RNFL asymmetry in 834 African ancestry patients with primary open-angle glaucoma. Associated with optic disc and visual field differences, RNFL asymmetry may signal early glaucomatous damage. PURPOSE: Primary open-angle glaucoma (POAG) disproportionately affects individuals of African ancestry, with retinal nerve fiber layer (RNFL) asymmetry being a potential early marker of glaucomatous damage. This study aimed to determine the prevalence of RNFL asymmetry and to identify associated demographic, clinical, and ocular factors in individuals of African ancestry with POAG. PATIENTS AND METHODS: This cross-sectional study included 834 POAG cases from the Primary Open-Angle African American Glaucoma Genetics study who had bilateral RNFL thickness measurements. RNFL asymmetry was defined as an interocular RNFL thickness difference of >9 µm. Demographic, clinical, and ocular characteristics were compared between individuals with and without RNFL asymmetry using univariable and multivariable logistic regression. RESULTS: Among 834 POAG cases, 32.09% (95% CI: 28.93-35.38%) had RNFL asymmetry. In univariate analysis, compared to patients without RNFL asymmetry, patients with asymmetry exhibited significantly larger differences in the following: average and vertical cup-to-disc ratio (CDR), visual field (VF) mean deviation (MD), and pattern standard deviation (PSD), rim area, and cup volume (P<0.001). In their worse eye, patients with RNFL asymmetry had a smaller rim area (P<0.001) and a larger average and vertical CDR (P=0.002, P<0.001, respectively). In multivariate analysis, greater rim area difference (OR: 1.92, P<0.001) and a more negative PSD difference (OR: 0.69, P<0.001) were significantly associated with risk of RNFL asymmetry. CONCLUSIONS: In POAG patients of African ancestry, RNFL asymmetry is linked to optic disc structural asymmetries and-in a subset with available visual field data-functional asymmetries. These findings suggest RNFL asymmetry may indicate asymmetric glaucomatous damage, though prospective validation with comprehensive functional testing is needed to establish clinical utility.
Haploinsufficiency of PITX2 in Four Chinese Families with Axenfeld-Rieger Syndrome.
Liu C, Zhou Z, Xu L … +9 more , Liu G, Liu N, Hu L, Tan J, Chen Z, Hommodova M, Fan N, Hu J, Liu X
J Glaucoma · 2026 Jun · PMID 42384866 · Publisher ↗
PRCIS: Axenfeld-Rieger syndrome (ARS) is a rare genetic disorder characterized by anterior segment dysgenesis and secondary glaucoma, often accompanied by systemic defects. This study investigated the clinical and geneti...
PRCIS: Axenfeld-Rieger syndrome (ARS) is a rare genetic disorder characterized by anterior segment dysgenesis and secondary glaucoma, often accompanied by systemic defects. This study investigated the clinical and genetic features in four Chinese families with ARS. PURPOSE: To characterize the clinical phenotypes and identify the causative genetic mutations in four unrelated Chinese families with ARS. METHODS: Affected individuals from four Han Chinese families underwent comprehensive clinical and ophthalmological examinations. Genetic analysis was performed using whole-exome sequencing (WES) and validated by copy number variation sequencing (CNV-seq) and qPCR. RESULTS: All affected individuals exhibited anterior segment dysgenesis. Secondary glaucoma was present in seven of them. Systemic manifestations, including dental and umbilical abnormalities, were observed in all affected individuals. Genetic analysis identified novel heterozygous PITX2 mutations in all four families: three distinct microdeletions (ranging from 206 bp to 449.97 kb) and one nonsense mutation (p.Phe140*) , with all predicted to cause haploinsufficiency. CONCLUSIONS: Four novel PITX2 mutations, including microdeletions, were identified in Chinese ARS families. The 206-bp genomic DNA deletion appeared to be an essential region (chr4: 111543411-111543616) for PITX2 function in ocular and systemic development, underscoring the necessity of full gene dosage.
Intraocular Pressure-Lowering Effect of Omidenepag Isopropyl as a Predictor for the Efficacy of Laser Trabeculoplasty.
Ryu HK, Shin HJ, Park CK … +1 more , Park HL
J Glaucoma · 2026 Jun · PMID 42384864 · Publisher ↗
PRCIS: A strong intraocular pressure reduction with omidenepag isopropyl predicts greater efficacy of patterned laser trabeculoplasty in primary open-angle glaucoma, while prior omidenepag use does not diminish laser tre...
PRCIS: A strong intraocular pressure reduction with omidenepag isopropyl predicts greater efficacy of patterned laser trabeculoplasty in primary open-angle glaucoma, while prior omidenepag use does not diminish laser treatment outcomes. OBJECTIVES: To determine whether the intraocular pressure (IOP)-lowering response to omidenepag isopropyl (OMDI) predicts the efficacy of patterned laser trabeculoplasty (PLT) in primary open-angle glaucoma (POAG) patients, and to assess any interaction between OMDI and PLT when used in combination. METHODS: This retrospective propensity score-matched study included 63 eyes treated with OMDI followed by PLT and 63 matched eyes treated with PLT alone, matched by baseline IOP and age. IOP reduction with OMDI was assessed prior to PLT, and the IOP-lowering outcomes of PLT were evaluated one month after the procedure. Statistical analyses were performed to identify predictors of PLT response within each group and to compare PLT efficacy between the groups. RESULTS: Baseline characteristics were comparable between the groups. The IOP reduction rate after PLT did not differ significantly between the OMDI + PLT and PLT-only groups. In the OMDI+PLT group, PLT responders had greater IOP reductions from OMDI than non-responders (31.52±13.03% vs. 15.62±17.43%; P<0.001). Linear regression identified the IOP-lowering rate from the OMDI as the sole significant predictor of PLT response in the OMDI+PLT group (B=0.792, P<0.001). In the PLT-only group, only baseline IOP predicted the PLT response. CONCLUSIONS: A greater IOP-lowering response to OMDI predicts a larger IOP reduction with PLT, supporting the use of OMDI responsiveness as a potential indicator of PLT efficacy in POAG. OMDI administration did not alter the IOP-lowering effects of PLT.
Comparative Outcomes Between Micropulse and Slow-Coagulation Transscleral Cyclophotocoagulation in Eyes With Good Visual Acuity.
Chaves MRR, Costa VP, Almeida INF … +6 more , Maestrini HA, Magacho L, Kanadani FN, Prata TS, Neto CL, Abe RY
J Glaucoma · 2026 Jun · PMID 42384861 · Publisher ↗
PRECIS: Despite both CW TSCPC and MP-TSCPC are effective in reducing IOP, with low rates of complications, MP-TSCPC seems to achieve higher success rates with less significant visual acuity loss compared to CW TSCPC. PUR...
PRECIS: Despite both CW TSCPC and MP-TSCPC are effective in reducing IOP, with low rates of complications, MP-TSCPC seems to achieve higher success rates with less significant visual acuity loss compared to CW TSCPC. PURPOSE: To compare the efficacy and safety of continuous wave transscleral cyclophotocoagulation (CW TSCPC) using slow-coagulation technique versus micropulse (MP) TSCPC in patients with glaucoma and good visual acuity. PATIENT AND METHODS: Retrospective multicenter study including patients with logMAR visual acuity (VA) of <0.5 and at least 6 months of follow-up. Surgical success was defined as IOP ≤ 18 mm Hg and at least 30% reduction from baseline IOP with or without glaucoma medication, without loss of >2 lines of vision. For criterion A, patients that required a new CPC session during follow-up were considered as failure. For criterion B, the additional need for CPC was not considered as failure. RESULTS: We included a total of 200 eyes from 200 glaucoma patients (110 eyes in CW TSCPC and 90 in MP-TSCPC groups). There was a significant reduction of IOP levels and number of medications after CPC in both groups (P<0.001). Considering criterion, A, success rates at 12 months were 61% and 76% in the CW TSCPC and MP-TSCPC groups, respectively (P=0.087). Considering criterion B, success rates were 75% and 87% in the CW TSCPC and MP-TSCPC groups, respectively (P=0.289). Significant VA loss was observed in 20% of the eyes in the CW TSCPC group and 10% of the eyes in the MP-TSCPC group (P=0.016). CONCLUSION: Both CW TSCPC and MP-TSCPC are safe and effective in reducing IOP, with low rates of complications or serious adverse events.
Machine Learning With Optical Coherence Tomography for Glaucoma Diagnosis.
Costa VP, Zangalli C, Gomi ES … +1 more , Jammal AA
J Glaucoma · 2026 May · PMID 42384738 · Publisher ↗
PRCIS: Machine learning classifiers combining OCT-derived minimum rim width and retinal nerve fiber layer thickness achieved high diagnostic accuracy for mild to moderate glaucoma, with combined parameters outperforming...
PRCIS: Machine learning classifiers combining OCT-derived minimum rim width and retinal nerve fiber layer thickness achieved high diagnostic accuracy for mild to moderate glaucoma, with combined parameters outperforming RNFL alone. PURPOSE: To investigate the diagnostic performance of different machine learning classifiers (MLC) trained with retinal nerve fiber layer thickness (RNFLT) and minimum rim width (MRW) measurements obtained from spectral-domain optical coherence tomography (OCT). METHODS: 113 eyes with mild to moderate glaucoma and 154 healthy eyes were included. The global average of the MRW and RNFLT measurements were obtained from OCT scans of the optic nerve and peripapillary region. Ten MLCs algorithms were compared when trained with MRW data only, RNFLT data only, and both MRW and RNFLT parameters. Receiver operating characteristic (ROC) curves were built for each MLC in training set. The highest AUC in each training group were compared using the De Long method. RESULTS: The Random Forest MLC presented the highest diagnostic performance when trained with both RNFLT and MRW data (AUC=0.979, 95% confidence interval [CI]: 0.959-0.995), with a sensitivity of 98% at 80% specificity and 96% at 90% specificity. When using the RNFLT data only, the Multilayer Perceptron presented the highest performance among MLCs (AUC=0.942, 95%CI: 0.887-0.974, and a sensitivity of 93% at 90% specificity), and the Random Forest had the highest AUC value when trained with the MRW data only (AUC=0.967, 95%CI: 0.937-0.985, sensitivity of 94% at 90% specificity). The AUC from MLC trained with both RNFLT and MRW parameters was significantly higher than that obtained with RNFLT alone (P=0.029). CONCLUSION: MLC combining RNFLT and MRW data can provide high diagnostic accuracy for glaucoma.
GATT-First Surgical Sequence Reduces Complications in Combined Phacoemulsification-GATT Surgery for Glaucoma.
Yüksel E, Yozgat Z, Durmuş Ece BŞ … +3 more , Dumlupınar Gİ, Işık MU, Özkan K
J Glaucoma · 2026 Jun · PMID 42384723 · Publisher ↗
PRCIS: This study highlights the importance of surgical sequencing in combined procedures, suggesting that the GATT-first sequence is safer and more reliable, especially for less experienced surgeons. PURPOSE: To evaluat...
PRCIS: This study highlights the importance of surgical sequencing in combined procedures, suggesting that the GATT-first sequence is safer and more reliable, especially for less experienced surgeons. PURPOSE: To evaluate the impact of the surgical sequence in combined phacoemulsification (PHACO) and gonioscopy-assisted transluminal trabeculotomy (GATT) on intraocular pressure (IOP), medication use, glaucoma progression, and complication rates in patients with moderate-to-severe open-angle glaucoma and cataract. METHODS: This retrospective comparative study included 73 eyes of 73 patients who underwent combined PHACO and GATT surgery. Patients were divided into two groups based on the surgical sequence: PHACO performed first (Group 1, n=37) or GATT performed initially (Group 2, n=36). IOP, anti-glaucoma medications use, retinal nerve fiber layer (RNFL) thickness, and intraoperative and postoperative complications were evaluated over 12 months. RESULTS: Preoperative IOP decreased from 26.6±7.9 mmHg to 10.9±2.8 mmHg and from 28±6.3 mmHg to 12.8±2.8 mmHg in Group 1 and Group 2 (P<0.001 in both groups), respectively, at 12 months. The number of anti-glaucoma medications reduced from 2.83± 0.5 to 1.22± 0.8, and from 2.47± 0.7 to 1.17± 0.7 in Group 1 and Group 2, respectively. No significant differences in IOP or medication reduction were observed between the two groups. Complication-free outcomes were significantly higher in Group 2 (63.8%) compared to Group 1 (13.5%) (P<0.001). Both groups achieved 100% surgical success. CONCLUSIONS: The surgical sequence in combined PHACO-GATT does not affect IOP reduction or medication number but significantly impacts complication rates. Performing GATT first minimizes intraoperative complications and results in a higher rate of complication-free outcomes, suggesting it as a safer approach for combined surgeries, especially for beginners.
Geriatric Assessment and Risk Prediction of Severe Complications in Glaucoma Surgery.
Sugihara K, Ida C, Ohtani H … +5 more , Murakami K, Iida M, Harano A, Ichioka S, Tanito M
J Glaucoma · 2026 Jun · PMID 42384722 · Publisher ↗
PRCIS: Geriatric assessment scores including Mini-Cog, G8, and age-adjusted Charlson Comorbidity Index improve the prediction of severe hemorrhagic complications after glaucoma surgery, enabling more individualized risk...
PRCIS: Geriatric assessment scores including Mini-Cog, G8, and age-adjusted Charlson Comorbidity Index improve the prediction of severe hemorrhagic complications after glaucoma surgery, enabling more individualized risk stratification in glaucoma patients. PURPOSE: To investigate the associations between various postoperative complications and background factors-including geriatric assessment (GA) scores-and to evaluate the predictive value of GA-based risk stratification for severe hemorrhagic complications following glaucoma surgery. SUBJECTS AND METHODS: Retrospective observational case series. A total of 729 eyes from 464 Japanese patients (mean age±SD, 70.2±12.4 y) who underwent glaucoma surgery with perioperative GA assessment at Shimane University Hospital. Geriatric assessments, including Mini-Cog, G8, and age-adjusted Charlson Comorbidity Index (ACCI), were conducted preoperatively. Surgical complications and interventions were comprehensively collected and analyzed in relation to multiple background factors using both univariate and multivariate statistical models. Predictive performance for severe hemorrhagic complications (vitreous hemorrhage and hemorrhagic choroidal detachment) was assessed via machine learning algorithms. RESULTS: Postoperative complications occurred in 37% of eyes, with 8% experiencing severe hemorrhagic complications. Multivariate analysis identified low Mini-Cog scores (P<0.0001) and high ACCI scores (P=0.003) as independent risk factors for severe hemorrhagic events. The inclusion of GA scores with age enhanced predictive performance, achieving an area under the curve (AUC) of up to 0.96. Optimal thresholds for high-risk identification were age ≥80 years, Mini-Cog score ≤4, G8 score ≤14, and ACCI score ≥5. CONCLUSION: GA scores are significantly associated with the risk of severe hemorrhagic complications after glaucoma surgery. Integrating GA-based risk stratification with traditional background factors enhances prediction of high-risk cases, facilitating more individualized and safer surgical planning for elderly patients with glaucoma.
Effect of Optic Disc Size on Retinal Nerve Fiber Layer Thickness and Peripapillary Vascular Density in Advanced Primary Open-Angle Glaucoma.
Uzel MM, Yiğit Y, Girgin Y … +1 more , Şahin Vural G
J Glaucoma · 2026 May · PMID 42384721 · Publisher ↗
PRECIS: In advanced primary open-angle glaucoma, larger optic discs were associated with thicker retinal nerve fiber layers, while peripapillary vascular density remained unaffected by disc size, indicating structural bu...
PRECIS: In advanced primary open-angle glaucoma, larger optic discs were associated with thicker retinal nerve fiber layers, while peripapillary vascular density remained unaffected by disc size, indicating structural but not microvascular dependence. PURPOSE: To evaluate the effect of optic disc size on peripapillary retinal nerve fiber layer thickness and peripapillary vascular density in patients with advanced primary open-angle glaucoma. METHODS: This retrospective, observational study included 50 eyes from 50 patients with advanced primary open-angle glaucoma and similar cup-to-disc ratios (0.7-0.8). Participants were divided into two groups according to optic disc area: <2.1 mm² (small-disc group, n=29) and ≥2.1 mm² (large-disc group, n=21). All subjects underwent spectral-domain optic coherence tomography angiography to measure retinal nerve fiber layer thickness and peripapillary vascular density. Structural and vascular parameters were compared between groups, and multiple linear regression analysis was performed to identify factors associated with retinal nerve fiber layer thickness and peripapillary vascular density. RESULTS: Baseline demographic and ocular characteristics were comparable between groups. Eyes with larger optic discs exhibited significantly greater retinal nerve fiber layer thickness in the superior (P=0.001), inferior (P=0.001), and nasal (P=0.032) quadrants, while temporal thickness and pVD showed no significant differences (P>0.05). Multivariate regression revealed that optic disc area (β=0.31, P<0.001), mean deviation (β=0.35, P=0.010), and pattern deviation (β=-0.26, P=0.038) were independent predictors of retinal nerve fiber layer thickness. In contrast, mean deviation (β=0.36, P=0.039) and axial length (β=-0.24, P=0.023) independently influenced peripapillary vascular density, while optic disc area did not. CONCLUSIONS: Peripapillary vascular density appears to be less influenced by optic disc morphology compared to RNFL thickness and may serve as a complementary parameter, particularly in eyes with atypical optic disc anatomy.
The Future of Glaucoma: Data, AI, and Precision Medicine for Patient-Centered Care.
Verticchio Vercellin A, Wood K, Pasquale LR … +1 more , Harris A
J Glaucoma · 2026 Jun · PMID 42384719 · Publisher ↗
PURPOSE: To summarize the main topics discussed during the 29th Annual Optic Nerve Rescue and Restoration Think Tank Meeting "THE FUTURE OF GLAUCOMA: HARNESSING DATA, AI, AND PRECISION MEDICINE FOR PATIENT-CENTERED CARE"...
PURPOSE: To summarize the main topics discussed during the 29th Annual Optic Nerve Rescue and Restoration Think Tank Meeting "THE FUTURE OF GLAUCOMA: HARNESSING DATA, AI, AND PRECISION MEDICINE FOR PATIENT-CENTERED CARE" held in New York on June 20th and 21st 2025. METHODS: The main findings from presentations focusing on data integration and the application of artificial intelligence (AI) to advance the understanding of primary open-angle glaucoma pathogenesis, as well as to improve disease diagnosis and management, are summarized. RESULTS: The researchers discussed the importance of data integration for AI development, highlighting the specific challenges in the field of glaucoma, including data standardization and sharing, and the initiatives of the National Institutes of Health (NIH) and National Eye Institute (NEI) in this context. Specific examples of the use of AI tools for advancing the knowledge in glaucoma pathophysiology, diagnosis and management are showcased. CONCLUSIONS: AI is improving the understanding of glaucoma and enhancing its diagnosis and management. The NEI and NIH are spearheading several initiatives in AI, Ophthalmology, and Glaucoma; yet glaucoma as a disease entity remains without a unified definition. There is also a need to measure critical glaucoma endophenotypes with devices that possess uniform standards. For imaging devices, interoperability across platforms and data unfettered access could improve patient care and advance our understanding of glaucoma. With its rich data resources, the glaucoma community is uniquely positioned to lead a cultural shift, enabling larger datasets, stronger collaboration, and future studies that would help translate AI advances into clinical care.
Corneal Biomechanics and Aberrometry After Phacoemulsification Combined with Gonioscopy-Assisted Transluminal Trabeculotomy.
Azimi A, Fathian A, Meshksar A … +3 more , Attar A, Bostanian P, Hassanipour H
J Glaucoma · 2026 Jun · PMID 42384718 · Publisher ↗
PRECIS: Combined Phaco+GATT surgery significantly alters corneal biomechanics and aberrometry, increasing deformability and affecting postoperative IOP interpretation in patients with POAG or PEXG. PURPOSE: To evaluate t...
PRECIS: Combined Phaco+GATT surgery significantly alters corneal biomechanics and aberrometry, increasing deformability and affecting postoperative IOP interpretation in patients with POAG or PEXG. PURPOSE: To evaluate the changes in corneal biomechanical properties and corneal aberrometry following combined phacoemulsification and Gonioscopy-Assisted Transluminal Trabeculotomy (Phaco+GATT) in patients with primary open-angle glaucoma (POAG) or pseudoexfoliative glaucoma (PEXG). PATIENTS AND METHODS: In this prospective comparative study, 28 eyes of 26 patients with visually significant cataracts and either POAG or PEXG underwent combined Phaco+GATT surgery. Corneal biomechanical parameters were assessed using the Corvis ST, and corneal aberrometry was evaluated using the Pentacam AXL, both preoperatively and 3 months postoperatively. Statistical analyses included paired t-tests, Wilcoxon signed-rank tests, and linear regression modeling. RESULTS: Significant postoperative reductions in Goldmann applanation tonometry intraocular pressure (IOP) and biomechanically corrected IOP were observed. Parameters such as A1 time, A2 velocity, SP-A1, and SSI significantly decreased, indicating increased corneal deformability. Conversely, deflection amplitude max, peak distance, and corneal biomechanical index (CBI) significantly increased. Higher-order aberrations (HOAs) from the corneal back also showed significant elevation. Regression analysis revealed that preoperative IOP was the most significant predictor of changes in several biomechanical parameters, while central corneal thickness (CCT) was significantly associated with changes in astigmatism. CONCLUSION: Combined phacoemulsification and gonioscopy-assisted transluminal trabeculotomy was associated with measurable changes in corneal biomechanics and aberrometry at 3 months postoperatively. These changes may affect postoperative IOP interpretation, including the potential for IOP underestimation, and should be considered when evaluating visual and pressure outcomes. Longer-term studies are needed to determine the durability and clinical significance of these findings.
Optical Coherence Tomography-Derived Excavation Index and Structure-Function Damage in Glaucoma.
Canleblebici M, Erdağ M, Dal A
J Glaucoma · 2026 May · PMID 42384717 · Publisher ↗
PRCIS: The Excavation Index is a novel OCT-based parameter quantifying optic nerve head excavation, showing independent associations with RNFL thickness and lamina cribrosa curvature index, and demonstrating sensitivity...
PRCIS: The Excavation Index is a novel OCT-based parameter quantifying optic nerve head excavation, showing independent associations with RNFL thickness and lamina cribrosa curvature index, and demonstrating sensitivity to early structural changes in glaucoma. PURPOSE: Glaucomatous optic neuropathy is characterized by progressive deformation of the lamina cribrosa (LC) and scleral canal, leading to optic disc (OD) excavation and visual field (VF)loss. This study proposes the Excavation Index (EI), a novel optical coherence tomography-based parameter designed to quantify the OD excavation. METHODS: A total of 107 eyes (23 controls, 84 with primary open-angle glaucoma of varying severity) underwent OCT and VF testing. The EI was defined as the ratio of excavation width (Ew) to peripheral LC depth (PLCD), multiplied by 100 (EI=Ew/PLCD×100). Correlations with LC curvature index (LCCI), retinal nerve fiber layer (RNFL)thickness, and visual field indices were analyzed using univariate and multivariate models. RESULTS: EI values increased progressively from control to advanced glaucoma (14.72±2.79 to 31.00±10.21; P<0.001) and showed strong correlations with RNFL thickness (r=-0.749), MD (r=-0.696), PSD (r=0.570), VFI (r=-0.701) and LCCI (r=0.710), (all P<0.001). In multivariate analysis, intraocular pressure, RNFL thickness and LCCI were independently associated with EI (P<0.05). ROC analysis showed that AUC of EI was 0.860, comparable to LCCI (AUC=0.864,P=0.923). EI significantly differentiated control from all disease stages (all P<0.01). CONCLUSIONS: The EI provides a reliable measurement of glaucomatous OD excavation. Its structural-functional correlations suggest potential utility as a complementary biomarker for disease staging and monitoring of OD excavation in glaucoma. EI may represent a promising parameter for the detection of early-stage glaucoma, suggesting sensitivity to glaucomatous changes; however, further studies are needed to confirm its diagnostic role.
Comments on: Refractive Outcomes of Toric Intraocular Lenses in Combined Phacoemulsification and Trabeculectomy Surgery.
Thulasidas M
J Glaucoma · 2026 May · PMID 42384711 · Publisher ↗
Abstract loading — click title to view on PubMed.
Efficacy and Safety of the Susanna Glaucoma Drainage Device - 5 Years Follow-up Study.
Susanna F, Godoy J, Cavalcanti H … +5 more , Rebouças-Santos V, Susanna BN, Germano R, Susanna CN, Susanna R
J Glaucoma · 2026 Jun · PMID 42384673 · Publisher ↗
PRCIS: The Susanna Glaucoma Drainage Device achieved sustained 5-year IOP and medication reduction, with a 80.9% success rate and favorable safety profile, supporting its effectiveness for long-term management of refract...
PRCIS: The Susanna Glaucoma Drainage Device achieved sustained 5-year IOP and medication reduction, with a 80.9% success rate and favorable safety profile, supporting its effectiveness for long-term management of refractory glaucoma. PURPOSE: To evaluate the 5-year outcomes of the Susanna Glaucoma Drainage Device for the treatment of glaucoma. PATIENTS AND METHODS: Medical records from consecutive patients aged 18 years or older with glaucoma who underwent implant surgery with the Susanna Glaucoma Drainage Device from January 2017 to january 2020 were included. The primary outcome was success, defined as IOP ≥6 and <18 mmHg for and absence of loss of light perception or additional glaucoma surgery. Secondary outcomes included IOP, hypotensive therapy, adverse events, and surgical interventions. RESULTS: A total of 104 patients were included, mean patient age was 60.8±17.6 years. Mean preoperative IOP was 29.9±11.6 mmHg under 2.8±0.9 glaucoma medications. At 5 years, the cumulative success rate was 80.9%. IOP and medication use were significantly reduced at all postoperative visits. At 5 years, mean IOP was 13.4±3.6 mmHg (55.2% reduction, P<0.001), and mean medication use was 1.9±1.4 (32.1% reduction, P<0.001). The primary reason for failure was elevated IOP (38.9%). Five patients underwent glaucoma reoperation to lower IOP; two cases were treated with cyclophotocoagulation, while three underwent a second SGDD inferiorly. Hypotony-related failure was observed in one case. Among the failures, five patients developed significant vision loss (27.8%). CONCLUSIONS: The Susanna implant effectively reduced IOP and medication dependence over 5 years. It demonstrated a high success rate (80.9%) and sustained pressure control. These findings support the long-term efficacy of the Susanna implant in managing refractory glaucoma.
Perimetric Outcomes of Melbourne Rapid Field Perimetry in Patients With Glaucoma: A Systematic Review and Meta-Analysis.
Inzunza A, Moreno-Diaz EA, Goss D … +1 more , Friedman DS
J Glaucoma · 2026 Jul · PMID 42340749 · Publisher ↗
PRCIS: Melbourne Rapid Fields (MRF) had shorter test durations than HFA, high agreement with HFA global indices, modest bias in MD and PSD measurements, and comparable concordance and repeatability. MRF had poorer reliab...
PRCIS: Melbourne Rapid Fields (MRF) had shorter test durations than HFA, high agreement with HFA global indices, modest bias in MD and PSD measurements, and comparable concordance and repeatability. MRF had poorer reliability indices, while maintaining good diagnostic performance. PURPOSE: The Humphrey Field Analyzer (HFA) is the most widely used perimeter in glaucoma, but its cost and low portability limit its use in resource-constrained settings. Melbourne Rapid Fields (MRF) is a low-cost, tablet-based perimeter system that enables at-home and low-resource testing. Despite growing evidence that the MRF can obtain reliable estimates of the visual field, no study has synthesized its perimetric performance through meta-analysis and compared it with HFA. METHODS: Following PROSPERO registration, we conducted a systematic review to compare MRF with HFA in patients with glaucoma. Searches were performed using controlled vocabulary related to perimetry assessment with these devices. Meta-analyses and narrative synthesis were conducted to summarize their performance. RESULTS: Of 290 studies screened, 9 were included, totaling 777 eyes. Pooled data comparing MRF to HFA, MRF had faster testing (-1.33 min), less-negative MD (+2.08 dB), and higher PSD (+0.77 dB). Global agreement with HFA was high (MD ICC=0.94; MD R2=0.85; PSD ICC=0.85). Test-retest reliability was similar between devices (MRF ICC=0.96; HFA ICC=0.95). AUCs were comparable for MD (0.84 vs. 0.85) but lower for PSD (0.81 vs. 0.93). MRF had higher fixation losses, false positives, and false negatives. CONCLUSION: Melbourne Rapid Fields (MRF) had shorter test durations, high global agreement with HFA, excellent repeatability, and a bias toward less-negative global results. MRF showed greater pointwise variability at certain thresholds and worse reliability measures. Despite these differences, MRF provided diagnostic information comparable to that of HFA.
Rethinking Dry Eye and Ocular Surface Disease in Glaucoma: Pathophysiology, Diagnosis, and Management.
Kolko M
J Glaucoma · 2026 Jul · PMID 42340748 · Publisher ↗
PURPOSE: To highlight the overlooked role of ocular surface disease (OSD) in glaucoma, explore its pathophysiological links to treatment, and propose integrated strategies to improve patient care. METHODS: A narrative re...
PURPOSE: To highlight the overlooked role of ocular surface disease (OSD) in glaucoma, explore its pathophysiological links to treatment, and propose integrated strategies to improve patient care. METHODS: A narrative review of current literature on the relationship between glaucoma therapies and ocular surface health was conducted. Evidence on prevalence, mechanisms, diagnostic approaches, and management strategies for OSD in glaucoma patients was reviewed. RESULTS: Glaucoma remains the leading cause of irreversible blindness worldwide, with treatment adherence being a critical determinant of long-term outcomes. Chronic use of topical intraocular pressure (IOP)-lowering eye drops, particularly those containing benzalkonium chloride (BAK), induces epithelial and goblet cell toxicity, tear film instability, and ocular inflammation. The prevalence of OSD in glaucoma patients is markedly higher than in the general population, affecting up to 60%. Symptoms such as dryness, burning, and blurred vision significantly reduce quality of life and compromise adherence to treatment. Emerging alternatives, including preservative-free formulations, selective laser trabeculoplasty, and minimally invasive glaucoma surgery, provide opportunities to reduce ocular surface burden. Structured evaluation using questionnaires, slit-lamp examination, and diagnostic tests can facilitate early detection and tailored management. CONCLUSIONS: The ocular surface, long considered secondary in glaucoma care, is central to optimizing both adherence and visual outcomes. Protecting ocular surface health through preservative-sparing regimens, procedural interventions, and patient-centered strategies is essential. Reframing OSD as an integral component of glaucoma management may improve long-term quality of life and enhance treatment success.
Outcome of Gonioscopy-Assisted Transluminal Trabeculotomy in Uveitic Glaucoma.
El Sayed YM, Abdelwareth Mohammed A, Gerges TK … +3 more , Gamal-Eldin MM, Aboulhassan RM, Taher El-Zanaty R
J Glaucoma · 2026 May · PMID 42340247 · Publisher ↗
PRECIS: GATT was effective in decreasing the IOP and number of glaucoma medications significantly in patients with UG. Active uveitis at the time of surgery was associated with higher likelihood of requiring glaucoma med...
PRECIS: GATT was effective in decreasing the IOP and number of glaucoma medications significantly in patients with UG. Active uveitis at the time of surgery was associated with higher likelihood of requiring glaucoma medications. PURPOSE: To study the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in uveitic glaucoma (UG). METHODS: This was a prospective interventional case series that included 42 eyes of 35 patients with open angle UG who required glaucoma surgery. Cases requiring combined GATT and cataract surgery were excluded. Surgical success was defined as achieving an IOP≤21 mmHg and ≥30% IOP reduction on the same or fewer medications, without additional glaucoma interventions. The primary outcomes were changes in IOP and number of glaucoma medications. Secondary outcomes included success rate and complications. RESULTS: After a 12-month follow-up period, the IOP was reduced from 31 ±10.6 mmHg to 12.5 ±2.5 mmHg (P <0.001, representing a 62.11% ±25.09% reduction). The number of glaucoma medications decreased from 3.67±1.18 to 0.97±1.12 (P <0.001). Mean BCVA (log MAR) improved from 0.62±0.79 preoperatively to 0.51±0.72 at 12 months (P= 0.054). At the final follow up, complete success was achieved in 21 eyes (50%), qualified success in 16 eyes (38.1%) and failure in fives eyes (11.9%). No serious complications were encountered. The only significant adverse prognostic factor was uveitis activity at the time of surgery which was associated with higher likelihood of requiring glaucoma medications (P-value= 0.04- OR=4.85). CONCLUSION: GATT is a safe and effective procedure for UG. The outcome is influenced by the uveitis activity at the time of surgery, which can result in the need for more antiglaucoma medications postoperatively.
"Letter to the Editor: Myopic Shift Induced By Omidenepag Isopropyl 0.002% in Patients With Primary Open-Angle Glaucoma, Jan 2026.
Baishyakh P, Tayab S, Tara T
J Glaucoma · 2026 May · PMID 42340244 · Publisher ↗
Abstract loading — click title to view on PubMed.
Comparative Evaluation of Functional Aqueous Humor Outflow in Primary Open Angle Glaucoma versus Primary Angle Closure Glaucoma using Aqueous Angiography.
Beri N, Patil A, Sharma A … +5 more , Bari A, Sharma N, Weinreb RN, Huang AS, Dada T
J Glaucoma · 2026 May · PMID 42340241 · Publisher ↗
PRCIS: Aqueous humor outflow (AHO) is significantly lower in primary angle closure glaucoma (PACG) compared to primary open angle glaucoma (POAG). AIM: To quantitatively compare circumferential,perilimbal aqueous humor o...
PRCIS: Aqueous humor outflow (AHO) is significantly lower in primary angle closure glaucoma (PACG) compared to primary open angle glaucoma (POAG). AIM: To quantitatively compare circumferential,perilimbal aqueous humor outflow(AHO) pathways in patients of primary open angle glaucoma(POAG) and primary angle closure glaucoma(PACG) using Aqueous Angiography(AA). METHODS: Thirty-two eyes of 32 patients were included with 16 patients of POAG and 16 age-matched PACG patients presenting with age-related cataract and planned phacoemulsification surgery.IOP and the number of antiglaucoma medications(AGMs) were noted. All patients underwent AA with 0.1% indocyanine green dye injected into the anterior chamber prior to the capsulorrhexis step, followed by capture of images up to 60 seconds. Images at 60 seconds were exported for image analysis, where mean gray value was assessed to calculate angiographic signal intensity(ASI) along the limbus into eight sectors(45° each),four quadrants(90° each) and overall flow(360°) for POAG & PACG.Statistical tests for relationship of age and severity of disease with overall flow were performed. RESULTS: The mean age(years) was 58.8±5.8(POAG) and 59.8±8.6(PACG)[P=0.704]. The mean preoperative IOP[POAG(16.5±2.48 mmHg) & PACG(18.44±4.03 mmHg)] and median number of AGMs[POAG{3 (1.75-3.25)} & PACG{3 (2.75-4)}] between the two groups were comparable(P>0.05).There was no significant difference in the severity of baseline disease for POAG(MD= -16.79±8.73) and PACG(MD= -16.39±9.57),P=0.904.The overall flow was lower in PACG[123.72(105.18-205.68)] compared to POAG[188.32(163.58-234.40)],P=0.029. In multivariate linear regression analysis, higher overall flow in POAG compared to PACG(β=56.705,P=0.010)was noted.The correlation with age[POAG(r= -0.267,P=0.316); PACG(r= -0.301, P=0.256)] and MD[POAG (r=0.106, P=0.697);PACG (r=0.515, P=0.044)]was documented. CONCLUSION: Both POAG and PACG had segmental AHO. PACG eyes had lower functional AHO compared to POAG in phakic, dilated patients. With increasing disease severity, a decrease in overall flow was noted in PACG.
Patient and Neighborhood Factors Influencing Glaucoma Medication Adherence.
Hicks PM, Dobson JN, Mitchell J … +4 more , Darnley-Fisch D, Heisler M, Imami NR, Newman-Casey PA
J Glaucoma · 2026 May · PMID 42340228 · Publisher ↗
PRECIS: This study identified patient-level factors as key barriers and facilitators to glaucoma medication adherence, varying by sex and neighborhood disadvantage (ADI), suggesting targeted interventions could improve g...
PRECIS: This study identified patient-level factors as key barriers and facilitators to glaucoma medication adherence, varying by sex and neighborhood disadvantage (ADI), suggesting targeted interventions could improve glaucoma medication adherence outcomes. PURPOSE: To identify the barriers and facilitators to glaucoma medication adherence for participants in the Support, Educate, Empower Personalized Glaucoma Coaching Program Pilot Study and assess any differences by demographics. MATERIALS AND METHODS: This was a mixed-methods study of participants that reported glaucoma medication adherence of ≤80.00%. Patient (age, sex, and race) and neighborhood (area deprivation index (ADI)) factors were obtained, and participants completed a semi-structured interview. Patient interviews were transcribed and analyzed with the modified Penchansky and Thomas framework to assess barriers and facilitators to glaucoma medication adherence, and participant numbers were computed for each theme. RESULTS: Of the 44 participants, 52% were ≥65 years old, 45% female, 45.5% Black race, and 34% lived in high ADI neighborhoods. The most cited theme by participants for barriers and facilitators to medication adherence were patient-level factors (52% and 48%, respectively). Difficulty with the medication schedule was a leading barrier (48%), while location of eye drops in the home (25%) was a leading facilitator. Patient-level barriers and facilitators differed by sex and ADI. CONCLUSION: Patient-level barriers and facilitators to glaucoma medication adherence were most frequently mentioned. Patient-level facilitators differed by sex and ADI, thus patient and neighborhood factors should be considered when assessing glaucoma medication adherence as it may differ by these factors. In this cohort of glaucoma patients with poor medication adherence, patient-level factors served as more significant barriers compared to those related to health care in the US. Consequently, targeted interventions addressing these individual barriers could potentially improve medication adherence outcomes.
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