Predictors of Glaucomatous Progression in Individuals with Small and Large Optic Discs.

PURPOSE: To identify factors associated with glaucomatous progression in individuals with small and large optic discs. DESIGN: Retrospective review. SUBJECTS: 4505 individuals with glaucoma at UCLA; 233 (59.7%) with small discs, 157 (40.3%) with large discs. METHODS: Small and large disc sizes were defined by OCT or Heidelberg Retinal Tomography as disc area ≤ 5% (≤ 1.3 mm2) and ≥ 95% (≥ 2.9 mm2), respectively. Medical records were reviewed for demographics, systemic comorbidities, glaucoma type, ocular comorbidities, and ocular surgery. Logistic regression was used to identify predictors of visual field (VF) progression in individuals with small and large discs and predictors of large versus small discs. MAIN OUTCOME MEASURES: The VF deterioration with mean deviation, pointwise linear regression, and glaucoma rate index (GRI); large vs. small disc. RESULTS: In individuals with small discs, Asian versus non-Hispanic White ethnicity was associated with increased progression (adjusted odds ratio [aOR] = 4.05; 95% confidence interval [CI] = 1.12-14.59 for GRI). Higher intraocular pressure (IOP) range and peak were associated with increased progression in individuals with both small discs (aOR = 1.12; 95% CI = 1.00-1.27 and aOR = 1.05; 95% CI = 1.00-1.10 per 1 mmHg for range and peak with GRI) and large discs (aOR = 1.35; 95% CI = 1.12-1.66 and aOR = 1.11; 95% CI = 1.03-1.20 per 1 mmHg for range and peak with GRI). Multivariable predictors of having large vs. small discs included vasospastic phenotype (aOR = 2.58; 95% CI = 1.35-5.19) and Black (aOR = 20.46; 95% CI = 8.33-61.84), Hispanic/Latino (aOR = 9.65; 95% CI = 4.14-25.39), Asian (aOR = 4.87; 95% CI = 2.96-8.1), and other (aOR = 2.79; 95% CI = 1.69-4.63) versus non-Hispanic White ethnicity. CONCLUSIONS: Increased odds of glaucomatous progression were associated with Asian vs. non-Hispanic White ethnicity in glaucoma patients with small optic discs, as well as with increased IOP range and peak in those with small and large discs. Individuals with a vasospastic phenotype and those from racial and ethnic minority backgrounds had increased odds of having large vs. small optic discs. Further characterization of discernible phenotypes would improve disease prognostication and help individualize glaucoma treatment. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Clinical Performance of a New Trifocal IOL with a 7.0 mm Optical Zone.

Purpose: To evaluate the refractive and visual outcomes following cataract surgery and implantation of a diffractive trifocal intraocular lens (IOL) with a 7.0 mm optical zone. Methods: A total of 23 patients who underwent bilateral implantation with the Triva-aXAY IOL were analyzed at 6 months post-surgery. The main outcome measures were refractive error, monocular and binocular uncorrected and corrected-distance visual acuity (UDVA, CDVA), uncorrected and corrected-distance intermediate visual acuity (UIVA, CDIVA) at 60 cm, uncorrected and corrected-distance near visual acuity (UNVA, CDNVA) at 40 cm, and binocular defocus curve. Patients also completed the Catquest-9SF questionnaire. Results: All eyes were within ±1.00D, and 91.30% of eyes within ±0.50D, with a mean postoperative spherical equivalent of -0.14±0.29D. Similarly, 95.65% of patients showed a binocular UDVA ≥20/25, compared to 100% for CDVA, and the mean binocular UDVA and CDVA were 0.02±0.06 and 0.00±0.05 logMAR, respectively. At intermediate vision, 65.22% of patients showed a binocular UIVA ≥20/25, compared to 86.96% for CDIVA, and the mean binocular UIVA and CDIVA were 0.07±0.06 and 0.06±0.06 logMAR, respectively. At near, 95.65% of patients showed a binocular UNVA and CDNVA ≥20/25, with a mean binocular UDNVA and CDNVA of 0.04±0.07 and 0.02±0.05 logMAR, respectively. Finally, 95.65% of patients reported being quite satisfied to very satisfied with their vision and about 74% did not report any difficulty with their vision in their everyday life. Between 65.22% and 100% of patients reported no difficulty performing different tasks. Conclusion: Our study shows good visual and refractive outcomes with high satisfaction in patients implanted with the Triva-aXAY IOL with a 7.0 mm optical zone.

Efficacy of Large Optic Intraocular Lenses in Myopic Eyes with Posterior Segment Pathology.

We report a case series of patients with high myopia (axial length 25.04-27.59 mm) diagnosed with cataract and maculopathy who underwent a combined procedure of phacoemulsification with implantation of a large optic intraocular lens (IOL) and intravitreal injection. Six patients with a mean (± standard deviation) age of 73.20 ± 7.19 years received the 7.0-mm optic ASPIRA-aXA IOL (HumanOptics AG, Erlangen, Germany) and intravitreal injection of aflibercept at the end of the surgery. The corrected distance visual acuity (CDVA) improved significantly (p = 0.001) from a preoperative logMAR of 0.87 ± 0.28 logMAR to 0.49 ± 0.18 logMAR at 10 weeks postoperatively. Even though all patients had a persisting central scotoma due to their maculopathy, there was a significant improvement in their subjective quality of life and self-autonomy. Patients reported no postoperative dysphotopsia. During surgery and postoperative examinations, the wide IOL optic permitted an enhanced view of the fundus. The IOLs remained stable after implantation, especially during the intravitreal injection at the end of the surgery. No IOL displacement or shift of the lens was observed. Retinal diseases are sight-threatening and diminish the patient's quality of life due to reduced visual acuity and visual field defects. When cataract surgery is performed in this patient group, a reduced prognosis can be assumed. Our results show that implantation of the large optic IOL enables a wide view of the fundus during and after surgery without any additional risks or negative effects. It may also reduce the risk of dysphotopsia in cases of IOL decentration in large capsular bags, but comparative studies with a higher number of cases are needed to confirm this. A large rhexis and large IOL optic seem to be advantageous for the retinal surgeon in follow-up surgeries on the posterior segment of the eye.

Rotational Stability, Tilt and Decentration of a New IOL with a 7.0 mm Optic.

Purpose: To evaluate rotational stability, tilt and decentration of a new monofocal IOL with a 7.0 mm optic and frame haptics.Methods: Prospective post-market clinical follow-up study at the Kepler University Hospital Linz, Austria. An Aspira-aXA (HumanOptics, Germany) was implanted in 74 eyes of 42 cataract patients. The lens was manufactured with toric markings. IOL rotational stability was evaluated by comparing its position at the end of surgery (EoS) versus 1 day, 1 week, 1 month and 4 months postoperatively. IOL tilt and decentration were measured using a Scheimpflug camera at 1 week, 1 month and 4 months.Results: Median absolute IOL rotation was 1.42 degrees (n = 52; mean = 2.18 ± 2.23°) within 1 day after surgery and was significantly higher compared to all later intervals (median <1.0 degree; P = .001). At the 4 months follow-up, IOL rotation was within 5.0 degrees in 85% of the eyes (n = 40) and within 10.0 degrees in 98% (n = 46) of the eyes. The only eye with an IOL rotation of ≥ 10.ty0 degrees (EoS vs. 1 day) had an AL of 26.45 mm. At the last follow-up, the IOL vertical and horizontal tilt referenced to the pupillary axis was in average less than 1.5 degrees in both eyes (n = 54; maximum 5.85°). Decentration in both meridians was on average less than 0.10 mm in both eyes (maximum 0.30 mm).Conclusion: The one-piece Aspira-aXA IOL showed good and stable positioning within the capsular bag over a 4 months period.

Nasalised distribution of peripapillary retinal nerve fibre layers in large discs.

BACKGROUND: To describe the distribution pattern of the peripapillary retinal nerve fibre layer (RNFL) and major retinal vessel positions in patients with a large disc. METHODS: The medical records of patients with a large disc and those of normal controls were reviewed retrospectively. Comprehensive ophthalmic examinations including Cirrus HD-optical coherence tomography (OCT) and Heidelberg Retinal Tomography III (HRT III) were performed. We divided patients into two groups (large disc group and control group) using an HRT-measured disc size of 2.5 mm2 as a reference point. We extracted RNFL thicknesses at 256 points with OCT, measured major retinal vessel positions and compared them between the two groups. RESULTS: In total, 97 eyes of 97 patients were included, with 60 patients in the large disc group and 37 patients in the control group. All patients were free of any glaucomatous change. We observed nasal shifting of the second superior and inferior peaks in the large disc group compared with the controls. The superior major temporal retinal arteries in patients with large disc also showed significant nasal displacement. CONCLUSIONS: We could observe nasalisation of the peripapillary RNFL and superior retinal artery in patients with a large disc. As this phenomenon may lead to false positive results in OCT-based RNFL thickness maps, results from our study may help prevent misdiagnosis of glaucoma and improve the sensitivity and specificity of glaucoma detection.