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PURPOSE: To evaluate the association between contrast sensitivity (CS), vessel density (VD), and functional parameters in patients with glaucoma of varying severity. METHODS: Ninety-four eyes of 94 patients (57 men and 37 women, aged 56.52 ± 11.28 years) were divided into mild and moderate to advanced glaucoma groups. The mild glaucoma group was further subdivided based on the presence of central visual field defect (CVFD). Pearson's correlations were used to evaluate the associations between area under the log CS function (AULCSF), best-corrected visual acuity (BCVA), 10 - 2 visual field (VF), and structural parameters, including VD. The area under the receiver operating characteristic (AUROC) curve was calculated to detect abnormal CS (AULCSF < 1.2). RESULTS: In mild glaucoma without CVFD, AULCSF was associated with radial peripapillary capillary VD (γ = 0.597, P = 0.001), with an AUROC of 0.840 (P = 0.006) for detecting abnormal CS. In mild glaucoma with CVFD, AULCSF worsened and was associated with superficial parafoveal VD (γ = 0.569, P = 0.017) and macular whole image VD (γ = 0.632, P = 0.007), with AUROCs of 0.833 (P = 0.021) and 0.792 (P = 0.043), respectively. In moderate to advanced glaucoma, the relationship between AULCSF and the mean deviation of 10 - 2 VF and BCVA was more robust than that observed in structural measures. CONCLUSIONS: Decreased VD is linked to early CS impairment. Radial peripapillary capillary and macular VD can serve as indicators of CS function in the early stages of glaucoma. KEY MESSAGES: What is known Contrast sensitivity loss has been reported in glaucoma patients but its relationship with glaucoma-related structural and functional changes in different glaucoma severity and central visual field defect (CVFD) remains elusive. What is new Decline in RPC peripapillary vessel density was associated with early impairment of contrast sensitivity in mild glaucoma without CVFD. Decline in macular vessel density and central 16 points of 10-2 visual field damage were associated with contrast sensitivity reduction in mild glaucoma with CVFD. Microvasculature change can serve as an indicator for abnormal contrast sensitivity.
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PURPOSE: This study aimed to investigate the factors associated with disability glare in patients with advanced glaucoma and evaluate the impact of disability glare on the vision-related quality of life. METHODS: We prospectively studied 225 eyes (225 patients) with advanced glaucoma. The visual function was evaluated using the 10-2 and 24-2 Humphrey visual field (VF) (Dublin, California) and contrast sensitivity test. Structural parameters were obtained using RTVue optical coherence tomography and angiography (Fremont, California). Significant loss of macular vessel density (mVD) was defined as VD < 30%. Each participant completed the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) and questions regarding subjective symptoms of glare. RESULTS: Fifty-six patients (24.9%) experienced glare and had a lower NEI-VFQ-25 composite score (P = 0.017). The average retinal nerve fiber layer and ganglion cell complex thickness and mean deviation (MD) in the 24-2 VF test were not associated with glare. Significant superior or inferior mVD loss (P < 0.001; odds ratio [OR], 3.45; and 95% confidence interval [CI], 1.83-6.55), lower logarithmic contrast sensitivity at 0.75 cycles/degree (P < 0.001; OR, 0.27; and 95% CI, 0.13-0.56), and worse MD in the 10-2 VF test (P < 0.001; OR, 0.93; and 95% CI, 0.89-0.97) showed an association with glare. CONCLUSION: In advanced glaucoma, central VF defect and mVD loss are associated with disability glare, which negatively impacts vision-related quality of life.
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Ofuscação , Glaucoma , Humanos , Pressão Intraocular , Qualidade de Vida , Tomografia de Coerência Óptica , Testes de Campo Visual , Campos VisuaisRESUMO
PURPOSE: Corneal biomechanics, reflecting structural vulnerabilities of the eyeball, may participate in the pathogenesis of unilateral normal-tension glaucoma. This study investigated the pathophysiology of unilateral normal-tension glaucoma using Corvis ST (OCULUS Optikgeräte GmbH) and other ocular characteristics. METHODS: Eighty-three patients with normal-tension glaucoma with unilateral visual field loss and structurally unaffected fellow eyes and 111 healthy controls were included in this prospective study. Dynamic corneal response parameters, intraocular pressure measured by rebound tonometry, central corneal thickness, and axial length were assessed on the same day. Measurements were compared between affected eyes, unaffected fellow eyes, and control eyes. Risk factors for normal-tension glaucoma and unilateral involvement were the main outcome measures. RESULTS: A shorter first applanation time (adjusted odds ratio, 0.061; 95% confidence interval, 0.018-0.215) and a larger peak distance (adjusted odds ratio, 4.935; 95% confidence interval, 1.547-15.739) were significant risk factors for normal-tension glaucoma and were associated with greater glaucoma severity (both P < 0.001). Axial length (adjusted odds ratio, 29.015; 95% confidence interval, 4.452-189.083) was the predominant risk factor for unilateral involvement in patients with normal-tension glaucoma. CONCLUSION: The eyes with normal-tension glaucoma were more compliant than healthy eyes. Axial elongation-associated optic nerve strain may play an important role in unilateral normal-tension glaucoma with similar corneal and scleral biomechanics in both eyes.
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Glaucoma , Glaucoma de Baixa Tensão , Fenômenos Biomecânicos , Córnea , Humanos , Pressão Intraocular , Glaucoma de Baixa Tensão/diagnóstico , Estudos Prospectivos , Tonometria OcularRESUMO
PURPOSE: To investigate the clinical characteristics and long-term outcomes of primary congenital glaucoma (PCG) patients. METHODS: In this retrospective, longitudinal, cohort study, PCG patients with reliable visual field (VF) tests and optical coherence tomography (OCT) were included. Disease progression was detected using guided progression analysis with OCT and the change analysis of mean deviation (MD) slope with VF tests. Factors associated with the disease progression and visual prognosis were analyzed. RESULTS: Twenty-nine eyes from 11 bilateral and 7 unilateral PCG patients were enrolled. LogMAR visual acuity declined (0.15 vs. 0.40, P < 0.001). The change rate of the average retinal nerve fiber layer thickness was - 0.83 ± 1.45 µm/year, and 28% of eyes showed glaucoma progression on OCT. The median of the MD slope was 0.16 (- 1.19 to 1.07) dB/year, and 14% of eyes showed glaucoma progression on the VF test. Higher average intraocular pressure (IOP) (P = 0.046) and IOP fluctuation (P = 0.031) predicted disease progression. None of the fellow eyes of unilateral PCG patients developed glaucoma during the follow-up. At last, 59% of eyes had visual acuity > 20/70, and 31% had MD > - 6 dB. Patients with worse baseline visual acuity (P = 0.027), worse baseline MD (P < 0.001), and smaller neuroretinal rim area (P < 0.001) showed worse final MD values. CONCLUSIONS: Aggressive IOP control is necessary to prevent structural and functional decline in PCG patients. Their fellow eyes are not at risk of glaucoma. Baseline neuroretinal rim area can predict the functional outcome.
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Glaucoma , Campos Visuais , Estudos de Coortes , Progressão da Doença , Glaucoma/diagnóstico , Humanos , Pressão Intraocular , Estudos Retrospectivos , Tomografia de Coerência Óptica , Transtornos da Visão , Testes de Campo VisualRESUMO
BACKGROUND: Cataract surgery in combination with or after trabeculectomy is often required for improving vision in glaucoma patients. Intraocular pressure (IOP) changes may influence refractive outcomes after cataract surgery. We compared refractive outcomes of the combined and sequential approaches in managing glaucoma and cataract. METHODS: This retrospective case-control study included 52 patients (57 eyes) who underwent phacotrabeculectomy (combined group) and 39 patients (42 eyes) who underwent phacoemulsification at least three months post-trabeculectomy (sequential group). The IOP and refraction prediction error were compared at three months after cataract surgery. Univariate regression analyses were used to assess risk factors for the postoperative refraction prediction error. RESULTS: Anti-glaucomatous medications were not administered to either group. The mean postoperative IOP (12.96 vs. 13.80 mmHg; P = .392), refraction prediction error (-0.32 ± 1.53 vs. -0.47 ± 1.14 D, P = .594), mean absolute error (1.02 ± 1.18 vs. 0.8 ± 0.93 D, P = .320), and surgically induced astigmatism (1.85 ± 1.40 vs. 2.16 ± 1.16 D, P = .161) did not differ significantly between the combined and sequential groups. In the sequential group, the refraction prediction error correlated to the IOP change, with a 1-mm Hg rise resulting in a -0.07-diopter shift between the expected and observed refraction (r = -0.380, R2 = 0.144, P = .013); no such correlation was observed in the combined group. CONCLUSION: Both approaches resulted in similar effective IOP control and accurate intraocular lens predictability. The IOP change affected the postoperative refraction prediction error only in the sequential approach.
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Extração de Catarata , Catarata , Trabeculectomia , Humanos , Facoemulsificação , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: To compare the clinical characteristics and outcomes of eyes with unilateral disc hemorrhage (DH) in different locations. METHODS: This was a retrospective cohort study. DHs were classified by locations: the superior, superotemporal, inferotemporal, or inferior sectors of optic disc were classified as the susceptible area, while other sectors were defined as the less susceptible area. Structural and functional outcomes were analyzed by the Humphrey field analyzer and spectral domain optical coherence tomography. RESULTS: Forty-three eyes with DHs in the susceptible area were less myopic and had more peripapillary-type DH, larger cup-to-disc ratio, cup volume, and disc area. Thirty-three eyes with DHs in the less susceptible area had less association with RNFL defects, greater tilted ratio, and less torsion of the disc. Follow-up revealed that the change in sectoral RNFL (µm) thickness was significantly greater for DHs in the susceptible area within one year (- 6.0 ± 14.0 vs. 0.7 ± 13.0, p = 0.035) and two years (- 10.0 ± 17.4 vs. - 1.1 ± 7.6, p = 0.012), while the change in average RNFL thickness was not different. Eyes with DHs in the susceptible area had faster MD deterioration (dB/year) than those in the less susceptible area within four years (- 0.32 ± 0.51 vs. - 0.05 ± 0.45, p = 0.047). A total of 16.9% of eyes, all in the susceptible area, had localized VF progression at DH corresponding area. CONCLUSION: Disc hemorrhage in the superotemporal and inferotemporal regions had more subsequent structural and functional deterioration compared with the eyes with DHs in the temporal quadrant and nasal area.
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Glaucoma/complicações , Disco Óptico/irrigação sanguínea , Doenças do Nervo Óptico/diagnóstico , Células Ganglionares da Retina/patologia , Hemorragia Retiniana/diagnóstico , Tomografia de Coerência Óptica/métodos , Campos Visuais/fisiologia , Feminino , Seguimentos , Glaucoma/diagnóstico , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Doenças do Nervo Óptico/etiologia , Hemorragia Retiniana/etiologia , Estudos Retrospectivos , Acuidade VisualRESUMO
BACKGROUND: Migraine is linked to endothelial dysfunction and is considered to be a systemic vasculopathy. Interestingly, systemic vascular diseases also occur in glaucoma patients and are considered to be vascular risk factors. Whether migraine is simply a concomitant condition in glaucoma patients or a risk factor per se for glaucoma remains unknown. Thus, in the present study, we investigated the risk for open angle glaucoma (OAG) in migraineurs using a 10-year follow-up study that employed a nationwide population-based dataset in Taiwan. METHODS: This retrospective matched-cohort study used data sourced from the Longitudinal Health Insurance Database 2000. We included 17,283 subjects with migraine in the study cohort and randomly selected 69,132 subjects from the database for the comparison group. Each subject in this study was individually traced for a 10-year period to identify those subjects who subsequently received a diagnosis of OAG. The age-adjusted Charlson's comorbidity index (ACCI) score was utilized to compute the burden of comorbidity in each subject. Multivariate regression analysis was used to assess risk factors for OAG in migraineurs. Cox proportional hazards regression was performed to compare the 10-year risk of OAG between the migraineurs and the comparison cohort. RESULTS: Migraineurs had more vascular comorbidities than the comparison cohort. The overall incidence of OAG (per 1000 person-years) was 1.29 and 1.02, respectively, for migraineurs and the comparison cohort during the 10-year follow-up period. Age, hyperlipidemia, and diabetes mellitus were three significant risk factors for OAG in migraineurs. After adjusting for patients' age and vascular comorbidities, migraineurs were found to have a 1.68-fold (95% confidence interval [CI], 1.20-2.36) greater risk of developing OAG than the comparison cohort, in subjects with an ACCI score of 0. This association became statistically nonsignificant in subjects with ACCI scores of 1-2 or ≥ 3. CONCLUSION: Migraine is associated with a higher risk of OAG for patients with no comorbidity who are aged under 50 years.
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Glaucoma de Ângulo Aberto/epidemiologia , Transtornos de Enxaqueca/epidemiologia , Adulto , Estudos de Coortes , Bases de Dados Factuais , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/diagnóstico , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Programas Nacionais de Saúde/estatística & dados numéricos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologiaRESUMO
PURPOSE: To investigate the structural and functional characteristics and change of the retinal nerve fiber layer cleavages (RNFLCs) in glaucoma patients and suspects in long-term follow-up. METHODS: This is a retrospective longitudinal study. Within 43 eyes of 30 subjects, 62 RNFLC locations were detected on color fundus photography. Basic ophthalmic examinations, color fundus photography, optical coherence tomography (OCT), and visual field (VF) test were performed in 6-month intervals. Clinical characteristics and the structural and functional changes of the cleaved areas were analyzed. RESULTS: RNFLC and localized vitreoretinal traction occurred most commonly along the superotemporal retinal vessel arcade. Nine locations had corresponding defects on OCT deviation map, while 31 locations were associated with defects on OCT deviation map. Three locations had corresponding VF defects. More of the non-highly myopic eyes had lamellar hole than the highly myopes (p = 0.038). The RNFLC lesions in glaucomatous eyes were more frequently associated with OCT defects on deviation map (p = 0.021). There was no difference in the presence of lamellar hole or the number of RNFLCs between the glaucomatous and non-glaucomatous eyes. During a 66.8 ± 37.8-month follow-up, there was no structural or functional progression of the RNFLCs as determined by color fundus photography, VF test, and GPA of OCT interpreted by three ophthalmologists. There was no statistically significant change of RNFLC area (p = 0.268). CONCLUSIONS: RNFLC did not show detectable functional or structural change in early glaucoma patients and suspects after long-term follow-up.
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Glaucoma/diagnóstico , Pressão Intraocular , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos , Campos Visuais , Adolescente , Adulto , Idoso , Progressão da Doença , Seguimentos , Glaucoma/fisiopatologia , Humanos , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Disco Óptico/patologia , Estudos Retrospectivos , Fatores de Tempo , Acuidade Visual , Adulto JovemRESUMO
BACKGROUND: In randomized, controlled trials of open-angle glaucoma (OAG) or ocular hypertension (OHT), bimatoprost 0.01 % improved tolerability while retaining the intraocular pressure (IOP)-lowering efficacy of bimatoprost 0.03 %. Given geographic/racial differences in glaucoma presentation, the APPEAL study assessed the occurrence and severity of hyperemia produced by bimatoprost 0.01 %, and its efficacy, in the Taiwanese clinical setting. METHODS: In this multicenter, open-label, observational study, treatment-naïve and previously treated patients with OHT or OAG received once-daily bimatoprost 0.01 % for 12 weeks. Hyperemia (primary endpoint) was graded at baseline, week 6, and week 12 using a photonumeric scale (0, +0.5, +1, +2, +3), grouped (≤ +1, none to mild; ≥ +2, moderate to severe), and reported as unchanged from baseline, improved, or worsened. IOP assessments followed the same schedule. Supplemental efficacy analyses were conducted based on previous therapies. RESULTS: The intent-to-treat population (N = 312) included treatment-naïve (13.5 %) and previously treated (86.5 %) patients; mean age was 53.3 years. At baseline, 46.3 % of previously treated patients were receiving prostaglandin analog (PGA) monotherapy. At week 12, 91.2 %, 5.9 %, and 2.9 % of treatment-naïve patients exhibited unchanged, worsened, and improved hyperemia from baseline, respectively; 77.9 %, 12.9 %, and 9.2 % of previously treated patients showed no change, worsening, and improvement, respectively. There were no statistically significant shifts in hyperemia severity in either group, or in subgroups based on previous use of any PGA, any non-PGA, latanoprost, or travoprost monotherapies. In treatment-naïve patients, mean IOP reduction from baseline (18.0 ± 3.8 mm Hg) was 3.6 mm Hg at week 12 (P < 0.0001); 83.3 % had baseline IOP ≤ 21 mm Hg. In previously treated patients, mean additional IOP reduction from baseline (17.8 ± 3.9 mm Hg) was 2.6 mm Hg (P < 0.0001); similar results were observed in patient subgroups based on previous therapies. CONCLUSIONS: In the Taiwanese clinical setting, bimatoprost 0.01 % provided significant IOP lowering in treatment-naïve patients (regardless of baseline IOP) and previously treated patients (even those with relatively low IOP on other therapies), while causing no significant changes in hyperemia from baseline. TRIAL REGISTRATION: Clinicaltrials.gov NCT01814761 . Registered 18 March 2013.
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Anti-Hipertensivos/uso terapêutico , Bimatoprost/uso terapêutico , Glaucoma de Ângulo Aberto/tratamento farmacológico , Hipertensão Ocular/tratamento farmacológico , Adulto , Idoso , Anti-Hipertensivos/efeitos adversos , Bimatoprost/efeitos adversos , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Hiperemia/etiologia , Análise de Intenção de Tratamento , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/fisiopatologiaRESUMO
PURPOSE: The purpose was to investigate the risk factors for depressive symptoms in glaucoma patients. METHODS: From the Longitudinal Health Insurance Database in Taiwan, we included 1190 glaucoma patients with subsequent depression diagnoses in the case group and randomly selected 4673 glaucoma patients without depression diagnoses as the control group, matched by age, sex, and time of glaucoma diagnosis. The age-adjusted Charlson comorbidity index (ACCI) score was used to compute the burden of comorbidity for each patient. Current use (past 6 months) of topical antiglaucoma medications and systemic medications was identified. Multivariate regression was used to analyze the risk factors for depression. RESULTS: The mean age for glaucoma patients was 61.88 years. Patients with depressive symptoms had significantly higher ACCI scores (P < .0001). The current use of any topical antiglaucoma medications was not associated with an increased risk for depression. However, higher ACCI scores (P < .0001), cerebrovascular diseases (odds ratio [OR] = 1.324, 95 % confidence interval [CI] = 1.118--1.568), dementia (OR = 2.647, 95 % CI = 2.142-3.270), thyroid diseases (OR = 1.720, 95 % CI = 1.366-2.165), headaches (OR = 1.299, 95 % CI = 1.112-1.518), and current use of systemic ß-blockers (OR = 1.782, 95 % CI = 1.538-2.065) and calcium channel blockers (OR = 1.396, 95 % CI, 1.197-1.629) were found to increase the risk of depression in glaucoma patients. CONCLUSIONS: In this study, a comorbidity burden was a significant risk factor for depression in glaucoma patients, particularly for those currently using systemic ß-blockers and calcium channel blockers.
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Transtorno Depressivo/epidemiologia , Glaucoma/epidemiologia , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Transtornos Cerebrovasculares/epidemiologia , Comorbidade , Bases de Dados Factuais , Transtorno Depressivo/diagnóstico , Complicações do Diabetes/epidemiologia , Feminino , Glaucoma/diagnóstico , Glaucoma/tratamento farmacológico , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Doenças Vasculares Periféricas/epidemiologia , Fatores de Risco , Taiwan/epidemiologiaRESUMO
OBJECTIVES: This cross-sectional study aimed to investigate the relationship between visual function and staircase use in glaucoma. METHODS: Overall, 181 patients with glaucoma with a best-corrected visual acuity ≥20/400 were classified into mild to moderate (mean deviation [MD] ≥ -12 dB) and advanced (MD < -12 dB) groups, according to 24-2 VF of the worse eye. Staircase use evaluation included stair descent and ascent time (SDT/SAT) and self-reported stair difficulty. Correlations between staircase use and visual function were analysed, including binocular visual acuity, integrated visual field (IVF), and binocular contrast sensitivity (CS). Linear and logistic regression adjusted by age, sex, and comorbidities inspected the effect of visual parameters on SDT/ SAT and stair difficulty. RESULTS: Visual function best correlated with SDT among staircase use. In mild to moderate glaucoma, area under the log CS function (AULCSF) (ß = -1.648, P = 0.031) was the only visual factor significant for SDT (adjusted R2 = 0.106), whereas AULCSF (ß = -1.641, P = 0.048) and MD of IVFINF0-24 (ß = -0.089, P = 0.013) were associated with SDT in advanced glaucoma (adjusted R2 = 0.589). The AULCSF was the only significant visual parameter related to SAT (ß = -1.125, P = 0.019) and stair difficulty (adjusted odds ratio = 0.003; 95% confidence interval, 0-0.302; P = 0.013). CONCLUSIONS: SDT provides a higher correlation with visual function than self-reported stair difficulty. Patients with impaired CS or inferior IVF defects should be advised on stair safety and referred to low-vision services.
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Glaucoma , Pressão Intraocular , Humanos , Estudos Transversais , Inquéritos e Questionários , Visão Ocular , Testes de Campo Visual , Transtornos da Visão , Qualidade de VidaRESUMO
Topical atropine has been widely used for controlling myopia progression in children, yet its long-term efficacy and safety, including potential intraocular pressure (IOP) elevation, are still being studied. The mydriasis and cyclopegia induced by atropine may reduce traction on the trabecular meshwork, together with pigment released into anterior chamber due to the friction between the iris and lens during pupil dilation, may obstruct and reduce the trabecular outflow. This review first explores postdilation IOP changes across different groups - healthy individuals, glaucoma patients, and children. The response to pupil dilation varies widely, with IOP potentially increasing or decreasing. Glaucoma patients, whether with open or closed-angle glaucoma, may experience more significant IOP rises postdilation. The second section examines IOP effects in children using topical atropine for myopia, where most of the 25 reviewed studies showed nonsignificant IOP changes, although slight increases were observed in a few. In addition, no alterations in the retinal nerve fiber layer thickness were found. However, the research on children's IOP under topical atropine is constrained by small sample sizes, cross-sectional studies, brief follow-ups, and often lacks control groups or pretreatment IOP measurements. Given the extended atropine use for myopia and the significant individual variation in IOP response, we recommend routine IOP monitoring for children receiving topical atropine.
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Purpose: To compare the efficacy and safety of omidenepag isopropyl (OMDI) 0.002% with latanoprost 0.005% once daily in Asian subjects with open-angle glaucoma (OAG)/ocular hypertension (OHT). Methods: In this Phase III randomized, observer-masked, active-controlled, multinational trial (NCT02981446), subjects aged ≥18 years with OAG/OHT in both eyes and baseline intraocular pressure (IOP) ≥22 mmHg and ≤34 mmHg were randomized 1:1 to OMDI or latanoprost. IOP was measured at 9AM, 1PM, and 5PM at baseline, 1 week, 6 weeks, and 3 months. Adverse events (AEs) were recorded. Non-inferiority of OMDI to latanoprost was tested for primary and key secondary endpoints. Results: Each group included 185 subjects. Mean diurnal IOP from baseline to month 3 was reduced 7.1 mmHg (28.8%) with OMDI and 7.8 mmHg (31.3%) with latanoprost, with the least-squares mean difference (OMDI minus latanoprost) being 0.6 mmHg (95% CI: 0.0, 1.2 mmHg; p = 0.0366), indicating non-inferiority. Mean IOP reductions at the nine timepoints were -5.8 to -7.3 mmHg (23.5-29.5%) for OMDI and -6.1 to -7.9 mmHg (24.3-31.7%) for latanoprost. Non-inferiority per FDA criteria was also met. Rates of all AEs, ocular AEs, and ocular AEs associated with treatment were 40.0%, 36.8%, and 23.2%, respectively, for OMDI and 29.7%, 21.1%, and 11.9%, respectively, for latanoprost. Conjunctival hyperemia rates were higher with OMDI than latanoprost (11.9% vs 5.4%). Most AEs were mild, with no serious ocular AEs. Conclusion: OMDI safely and effectively reduces IOP in Asian subjects with OAG/OHT, with mean diurnal IOP at Month 3 and per-timepoint IOP reductions non-inferior to those of latanoprost.
PEONY Study: Testing How Well and How Safely Omidenepag Isopropyl Eye Drops Treat People with Glaucoma or Ocular Hypertension Compared with Latanoprost. Who took part in the study? Three hundred and seventy participants average age of 57 years, from 34 centers across four Asian countries who had glaucoma or high pressure in both eyes were randomly divided into two groups. One group (185 people; 50%) was given OMDI, and the other group (185 people; 50%) latanoprost for 3 months. The intraocular pressure of both eyes was measured in all participants at three time points (9 AM, 1 PM, and 5 PM) after 1 week, 6 weeks, and 3 months of treatment. The primary endpoint was the average of the daily eye pressure after 3 months of treatment. The safety of OMDI was also assessed. Study results. After 3 months of treatment, OMDI decreased the eye pressure by 29%. This was similar to latanoprost, which decreased the eye pressure by 31% over the same time period. OMDI was safe and well tolerated by those participants who received it. The most common side-effect in people receiving OMDI or latanoprost was conjunctival hyperemia (red eye) (experienced by 22 people receiving OMDI, and 10 people receiving latanoprost). Conclusions After 3 months of use, OMDI was found to safely reduce high eye pressure to a similar level as latanoprost in Asian people with glaucoma or high eye pressure.
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PURPOSE: To evaluate the relationship between central visual field sensitivity (cVFS) and the structural parameters in patients with advanced glaucoma. DESIGN: Cross-sectional study. METHODS: In total, 226 eyes of 226 patients with advanced glaucoma were classified into the "minor central defect" (mean deviation on 10-2 visual field test [MD10] > -10 dB) and "significant central defect" (MD10 ≤ -10 dB) groups. We examined the structural parameters using RTVue OCT and angiography, including the retinal nerve fiber layer, ganglion cell complex, peripapillary vessel density (VD), and superficial and deep macular VD (mVD). The assessment of cVFS included MD10 and the mean deviation of the central 16 points on the 10-2 VF test (MD16). We used Pearson correlation and segmented regression to assess the global and regional relationships between the structural parameters and cVFS. MAIN OUTCOME MEASURES: Correlation between structural parameters and cVFS. RESULTS: In the minor central defect group, the best global correlations existed between the superficial macular and parafoveal mVD and MD16 (r = 0.52 and 0.54, P < 0.001). In the significant central defect group, superficial mVD best correlated with MD10 (r = 0.47, P < 0.001). Segmented regression between superficial mVD and cVFS revealed no breakpoint was found as MD10 declined, but a breakpoint was identified at -5.95 dB for MD16, which was statistically significant (P < 0.001). The regional correlations between the grid VD and sectors of the central 16 points were significant (r = 0.20-0.53, P= 0.010 â¼P < 0.001). CONCLUSIONS: The fair global and regional relationships between mVD and cVFS suggest that mVD may be beneficial for monitoring cVFS in patients with advanced glaucoma. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Glaucoma de Ângulo Aberto , Glaucoma , Disco Óptico , Humanos , Campos Visuais , Disco Óptico/irrigação sanguínea , Estudos Transversais , Testes de Campo Visual , Vasos Retinianos , Pressão Intraocular , Células Ganglionares da Retina , Glaucoma/complicações , Glaucoma/diagnóstico , MicrovasosRESUMO
PURPOSE: To evaluate the correlation between structural parameters and visual acuity (VA) in advanced glaucoma. DESIGN: Prospective, cross-sectional study. METHODS: A total of 238 eyes from 238 patients (82 were men and mean ± SD age was 59.9 ± 13.8 years) from a tertiary center were divided into an advanced (mean deviation of 24-2 visual field tests from -12.01 to -20.0 dB) and severe (< -20 dB) glaucoma group. Structural parameters were obtained by RTVue (Optovue Inc) optical coherence tomography and angiography. Pearson correlation, partial correlation adjusted for age and axial length, and receiver operating characteristic curves to detect decreased VA (<20/25) were performed. RESULTS: In the advanced glaucoma group (133 eyes), superficial (Pearson correlation coefficient, r = -0.46, P < .001; partial correlation coefficient, r' = -0.30, P < .001) and deep macular vessel densities (VDs) (r = -0.47, P < .001; r' = -0.30, P < .001) showed highest correlation with VA. The area under the receiver operating characteristic curves of the superficial parafoveal/macular VDs were 0.816 (95% CI, 0.735-0.897) and 0.808 (95% CI, 0.725-0.891), respectively. In the severe glaucoma group (105 eyes), deep nasal grid VD (r = -0.31, P = 0.002; r' = -0.35, P < .001) showed highest correlation with VA. Deep macular VD showed better correlation with VA than other structural parameters. The area under the receiver operating characteristic curves of deep macular VD and deep nasal grid VD were 0.740 (95% CI, 0.632-0.849) and 0.748 (95% CI, 0.640-0.857), respectively. CONCLUSIONS: Macular VD showed better correlation with VA in advanced glaucoma. Deep macular VD, especially nasal grid, may be a promising structural parameter in severe glaucoma.
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Glaucoma de Ângulo Aberto , Glaucoma , Idoso , Estudos Transversais , Angiofluoresceinografia/métodos , Glaucoma/diagnóstico , Glaucoma de Ângulo Aberto/diagnóstico , Humanos , Masculino , Microvasos , Pessoa de Meia-Idade , Estudos Prospectivos , Vasos Retinianos , Tomografia de Coerência Óptica/métodos , Acuidade VisualRESUMO
BACKGROUND: Topical prostaglandin analogs (PGAs) are widely approved and preferred first-line options for glaucoma and elevated intraocular pressure (IOP). However, prostaglandin-associated periorbitopathy syndrome (PAPS) is now a well-recognized clinical and cosmetic concern for patients receiving PGAs, especially during long-term and unilateral therapy. PGA-associated periocular changes occur in a substantial proportion of patients, with older patients (>60 years) at greater risk of clinical presentation. PAPS may hinder long-term management of glaucoma, including treatment adherence, ophthalmic surgery outcomes, and reliable IOP measurements. RECOMMENDATION: New therapeutic approaches may address this unmet clinical need. Omidenepag isopropyl (OMDI) is a novel, non-prostaglandin, selective EP2 receptor agonist in ongoing development, which provides a unique pharmacological mechanism of action. OMDI appears to provide IOP reductions comparable to PGAs, but without PAPS-related undesirable effects. OMDI may offer a suitable long-term option for patients who demonstrate decreased efficacy, or failure, of PGAs, plus patients with significant PAPS, while fulfilling international guidelines.
Assuntos
Glaucoma , Pressão Intraocular , Anti-Hipertensivos/efeitos adversos , Glaucoma/tratamento farmacológico , Humanos , Prostaglandinas/uso terapêuticoRESUMO
Purpose: To evaluate the posture-related change in intraocular pressure (IOP) of eyes with angle-closure disease and the associated factors. Methods: Eyes were prospectively enrolled and divided into three groups: eyes with acute primary angle-closure (APAC), fellow eyes of acute primary angle-closure (FAPAC), and eyes with nonacute primary angle-closure disease (PACD). All of them had been treated with laser peripheral iridotomy. IOP was measured in the sitting, supine, and lateral decubitus positions (LDP) five minutes after posture change. Anterior chamber angle parameters and angle-closure mechanism were evaluated by anterior segment optical coherence tomography. Results: Forty-four eyes were enrolled into each group. APAC eyes showed more LDP-Sitting IOP increase than fellow eyes (5.7 ± 2.7 vs. 2.2 ± 1.4 mm Hg, P < 0.001) and nonacute PACD eyes (3.6 ± 2.0 mm Hg, P < 0.001). LDP-sitting IOP change was higher in eyes with exaggerated lens vault (having shallow anterior chamber and volcano-like iris-lens configuration) than in those without it (APAC: 6.3 ± 2.6 vs. 3.9 ± 2.1 mm Hg, P = 0.011). Linear regression revealed that LDP-sitting IOP change in the APAC group was negatively associated with angle opening distance (AOD), trabecular iris space area, scleral spur angle, and anterior chamber depth (ACD1000). With multivariable stepwise regression analysis, AOD750 remained statistically significant (beta-coefficient = -8.36, P = 0.014). Conclusions: APAC eyes had significant posture-related IOP changes, associated with narrower angle structures and exaggerated lens vault.
Assuntos
Glaucoma de Ângulo Fechado/fisiopatologia , Pressão Intraocular/fisiologia , Postura/fisiologia , Doença Aguda , Idoso , Feminino , Seguimentos , Gonioscopia , Humanos , Masculino , Estudos Prospectivos , Tomografia de Coerência Óptica/métodosRESUMO
Purpose: To investigate the influence of benzalkonium chloride (BAK) on ocular surface disease (OSD) in glaucoma patients receiving ocular-hypotensive agent. Methods: Patients were randomized to receive BAK-containing latanoprost (Xalatan) or preservative-free bimatoprost (Lumigan PF). Intraocular pressure (IOP), basal Schirmer's test, noninvasive keratograph tear-breakup time (TBUT), conjunctival redness score (R score), OSD index (OSDI), and corneal Oxford staining were recorded and compared between the 2 groups at 1-month and 4-month visits. The influence of BAK was analyzed by a generalized estimating equation model. Results: We enrolled 74 and 76 eyes treated with latanoprost and bimatoprost, respectively. The IOP decreased in both groups, although greater reduction was observed for latanoprost (13.95 vs. 15.42 mmHg, P = 0.0264). There was a significantly negative association between tear flow and latanoprost use (ß = -0.763, P = 0.0243). The first and average TBUT did not show intergroup differences, but the area with unstable tear film increased with latanoprost use and showed marginal significance at 4-month visit (9.33% vs. 5.94% P = 0.055). In both groups, OSDI decreased, whereas Oxford stain increased over time, and R scores showed improvement after transient increase in the first month. The bimatoprost group had significantly worse conjunctival hyperemia, whereas a negative association with conjunctival hyperemia was revealed for latanoprost use (R score-bulbar nasal: ß = -0.045, P = 0.0423). Conclusions: BAK-containing latanoprost was associated with decreased tear secretion and may be associated with tear-film instability, whereas bimatoprost was associated with worse conjunctival hyperemia. Ocular surface side effects should be considered when prescribing BAK-containing medication to glaucoma patients.
Assuntos
Compostos de Benzalcônio/uso terapêutico , Bimatoprost/uso terapêutico , Glaucoma/tratamento farmacológico , Latanoprosta/uso terapêutico , Soluções Oftálmicas/uso terapêutico , Conservantes Farmacêuticos/uso terapêutico , Adulto , Idoso , Compostos de Benzalcônio/efeitos adversos , Bimatoprost/efeitos adversos , Comorbidade , Conjuntivite/induzido quimicamente , Feminino , Humanos , Pressão Intraocular/efeitos dos fármacos , Latanoprosta/efeitos adversos , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas/efeitos adversos , Conservantes Farmacêuticos/efeitos adversos , Estudos Prospectivos , Lágrimas/efeitos dos fármacosRESUMO
BACKGROUND/PURPOSE: Taiwan has a very high prevalence rate of myopia. We retrospectively studied the influence of myopia on the progression of visual field (VF) loss in primary open-angle glaucoma (POAG) patients. METHODS: We studied 515 POAG patients for a minimum follow-up period of 5 years. VF examination was performed with Humphrey perimeter, 30-2 SITA standard program, every 6 months. A point-wise numerical comparison was applied to judge the VF changes. Test points showing more than 1.0 dB of sensitivity loss in mean defect were identified. A location was considered to have progression if it was detected on two consecutive visits. Progression of VF loss was confirmed if three or more test points deteriorated. Multivariate logistic regression was used to evaluate the association between progression of VF loss and various risk factors. RESULTS: There were 262 cases. Progression of VF loss occurred in 57 eyes (21.8%) during the 5-year follow-up period. Logistic regression revealed that the deterioration was associated with older age, higher mean intraocular pressure, larger vertical cup-to-disc ratio, and greater myopic refraction status. The incidence of VF loss progression was 15.1% in the group of eyes with myopia less than -3 D, 10.5% in the group with -3 D to -6 D, 34.4% in the group with -6 D to -9 D, and 38.9% in the group with myopia greater than -9 D. CONCLUSION: POAG patients with myopia greater than -6 D had a greater progression of VF loss.
Assuntos
Glaucoma de Ângulo Aberto/complicações , Miopia/complicações , Baixa Visão/etiologia , Campos Visuais/fisiologia , Adolescente , Adulto , Idoso , Progressão da Doença , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Miopia/epidemiologia , Miopia/fisiopatologia , Prevalência , Prognóstico , Refração Ocular , Estudos Retrospectivos , Taiwan/epidemiologia , Fatores de Tempo , Baixa Visão/fisiopatologia , Acuidade Visual , Testes de Campo Visual , Adulto JovemRESUMO
PURPOSE: To study the relationships between single nucleotide polymorphisms (SNPs) of extracellular matrix, matrix metalloproteases (MMPs), tissue inhibitors of MMPs, and other glaucoma-associated genes and acute primary angle closure glaucoma (PACG). METHODS: We extracted DNA samples from 78 adult patients with acute PACG and 86 control subjects to study the relationships between these specific genes and acute PACG. Genotyping was performed for 35 genes by the GenomeLab SNPstream genotyping system after PCR amplification of chromosomal DNA. The association between these genetic polymorphisms and risk of primary PACG was estimated by chi2 and logistic regression. RESULTS: The genotyping success rate was 99%. Genotyping for the MMP9 site (rs2664538) was significantly different between the two groups (p=0.000001) and the odds ratio was 2.586 (95% CI: 1.715-3.898, p<0.00001). However, there were no associations of SNPs to other genes in patients with acute PACG. CONCLUSIONS: Our results reveal that SNP rs2664538, which is located at the MMP9 gene, is likely to be associated with acute PACG.