Glaucoma progression due to refraining examination amid the pandemic of COVID-19.

PURPOSE: Some patients refrained from seeking an ophthalmologist due to the anxiety and morbidity associated with the coronavirus disease (COVID-19) pandemic. We investigated progressive visual field defects in patients with glaucoma who refrained from ophthalmological examinations. METHODS: This was a retrospective study. We analyzed data from 886 patients with glaucoma who visited Inouye Eye Hospital in June 2022 and were followed-up prior to January 2020. We examined the number of times patients canceled visits between January 2020 and May 2022 due to coronavirus concerns. We assessed the mean deviation (MD) values of the Humphrey Visual Field Assessment (HFA) program 30-2 SITA Standard values after visit interruptions for worsening beyond the MD values predicted by the MD slope. Factors influencing this difference were analyzed using logistic regression analysis. RESULTS: The study included 374 men and 512 women. The mean age was 68.7 ± 12.0 years. Visit interruptions occurred in 146 patients (16.5%), with 95 (65.1%) rescheduling once, 27 (18.5%) twice, and 24 (16.4%) three or more times. Among 90 patients who underwent HFA regularly, 50 (55.6%) experienced worse-than-expected MD values and 12 (13.3%) deteriorated by 2 dB or more. Longer interruptions and high intraocular pressure before interruption worsened the MD values by 2 dB or more. CONCLUSION: Patients with glaucoma with visit interruptions due to the pandemic should be monitored for the progression of visual field impairment.

Switching to Brimonidine/Ripasudil Fixed Combination from Brimonidine + Ripasudil.

Purpose: A fixed-combination eye drop has several advantages over combination therapy, however, the intraocular pressure (IOP)-lowering efficacy and safety of the newly available brimonidine + ripasudil fixed-combination (BRFC) eye drops after switching from brimonidine + ripasudil is yet to be established. Therefore, this study aimed to retrospectively investigate the 6-month safety, usability, and IOP-lowering efficacy of BRFC switched from brimonidine and ripasudil. Patients and Methods: Overall, 69 patients with primary open-angle glaucoma (69 eyes) receiving brimonidine + ripasudil were enrolled in this study. Brimonidine + ripasudil was discontinued, and treatment was switched to BRFC without a washout period. The IOP was compared before and at 3 and 6 months after switching to BRFC. The side effects, discontinued cases, and usability (a questionnaire survey) were also investigated. Results: The IOP was not significantly different after switching to BRFC (15.1 ± 3.3 mmHg at baseline, 15.9 ± 3.6 mmHg after 3 months, and 14.6 ± 3.3 mmHg after 6 months). Adverse reactions occurred in four patients (5.8%): allergic conjunctivitis, two patients; irritation, one patient; and blurred vision, one patient. Treatment was discontinued in five (7.2%) patients owing to allergic conjunctivitis, two patients; increased IOP, two patients; and blurred vision, one patient. In the questionnaire survey, 68 patients with eye pain, 67 with itching, 64 with conjunctival hyperemia, 64 with irritation, and 62 with blurred vision reported no change or improved conditions. Additionally, in response to the question regarding preferences for pre-treatment and fixed combinations, 14 participants (20.2%) favored pre-treatment, while 53 (76.8%) preferred fixed combinations. Conclusion: The IOP was maintained for 6 months, with satisfactory safety and comfort of use, with BRFC switched from brimonidine and ripasudil.

Three-year efficacy and safety of omidenepag isopropyl in patients with normal tension glaucoma.

PURPOSE: To retrospectively evaluate the 3-year efficacy and safety of single-agent omidenepag isopropyl in patients with normal tension glaucoma (NTG). STUDY DESIGN: Retrospective. METHODS: One hundred patients (100 eyes) who had newly been administered omidenepag isopropyl were enrolled in this study. Intraocular pressure (IOP) was compared at baseline and 6, 9, 12, 18, 24, 30, and 36 months after administration. The mean deviation values at baseline and 12, 24, and 36 months measured using the Humphrey visual field test (30-2 Swedish Interactive Threshold Algorithm standard) were compared. Adverse reactions and dropouts were assessed. RESULTS: IOP significantly decreased from 15.5±2.7 mmHg at baseline to 13.8 ±2.3 mmHg after 6 months, 13.9± 2.3 mmHg after 12 months, 13.9±2.3 mmHg after 18 months, 13.8±2.1 mmHg after 24 months, 13.9±2.0 mmHg after 30 months, and 13.6±1.7 mmHg after 36 months (P < 0.0001). There was no significant difference in the mean deviation values at baseline (-3.66±3.49 dB), 12 months (-3.41±3.80 dB), 24 months (-3.13±3.81 dB), and 36 months (-3.06±3.30 dB). Adverse reactions occurred in 11 patients (11.0%), including conjunctival hyperemia in 6 patients. Fifty-two patients (52.0%) were excluded from the analysis because they discontinued treatment either due to IOP measurement by NCT or the use of additional drugs. CONCLUSION: After the administration of omidenepag isopropyl, IOP in patients with NTG decreased within 3 years, visual fields were maintained, and safety was satisfactory. Thus, omidenepag isopropyl can be used as the first-line treatment for patients with NTG.

Intraocular pressure-lowering effects and safety of brimonidine/brinzolamide fixed combination after switching from other medications.

PURPOSE: To investigate the effects of switching to brimonidine/brinzolamide fixed combination (BBFC) eye drops on intraocular pressure (IOP) and safety. STUDY DESIGN: A retrospective observational study. METHODS: We enrolled 238 patients with primary open-angle glaucoma or ocular hypertension who were switched to BBFC eye drops, from June 2020 to March 2021 from their previous medications without a washout period. Patients were divided into 3 groups based on previous medications: Group A, brimonidine and brinzolamide concomitantly; Group B, brinzolamide; and Group C, brimonidine. IOP at baseline, after 3 months, and after 6 months in each group were compared. RESULTS: In Group A (n = 102), there was no difference in IOP at baseline (14.4 ± 3.0 mmHg), 3 months (14.1 ± 3.1 mmHg), and 6 months (13.9 ± 2.8 mmHg). In Group B (n = 104), IOP significantly decreased at 3 months and 6 months (baseline, 14.8 ± 3.0 mmHg; 3 months, 13.1±2.6 mmHg; 6 months 13.8±2.9 mmHg; P < 0.0001). In Group C (n = 32), IOP significantly decreased at 3 months and 6 months (baseline, 16.2 ± 3.5 mmHg; 3 months, 15.2 ± 3.5 mmHg; 6 months, 14.6 ± 3.2 mmHg; P < 0.01). Adverse reactions occurred in 6.9%, 18.3%, and 15.6% in Groups A, B, and C, respectively. The frequent adverse reactions in all patients were conjunctival hyperemia (3.4%), conjunctivitis (2.9%), blepharitis (2.9%), and itching (2.5%). CONCLUSION: BBFC had satisfactory IOP-lowering effects without serious adverse reactions in patients who switched medications.

Frequency of Use of Fixed-Combination Eye Drops by Patients with Glaucoma at Multiple Private Practices in Japan.

Purpose: To investigate the current use of fixed-combination eye drops by patients with glaucoma in Japan. Patients and Methods: A total of 5303 outpatients (5303 eyes) with glaucoma or ocular hypertension were enrolled in the survey at 78 private practices from March 8 to 14, 2020. The medications they used were investigated. The use of fixed-combination medications was analyzed, stratified by the number of medications used. The results were compared to those of the survey performed in 2016 via χ 2 tests. Results: Fixed-combination medications were used by 55.6%, 79.8%, 84.9%, 91.3%, and 94.1% of patients in the two-, three-, four-, five, and six-medications groups. The use of prostaglandin analog/ß-blocker (PG/ß), carbonic anhydrase inhibitor/ß-blocker (CAI/ß), and α-2-adrenergic agonist/ß-blocker (α2/ß) fixed-combination medications were 42.8%, 12.0%, and 0.8% in the two-medications group; 36.2%, 41.6%, and 2.0% in the three-medications group; and 23.5%, 60.1%, and 1.3% in the four-medications group, respectively. The most commonly used fixed-combination medications were PG/ß in the two-medications group and CAI/ß in the groups using three or more medications. Compared to those in the survey performed in 2016, there were increases (both P < 0.0001) in the use of PG/ß fixed-combination medication in the two- (28.7% to 42.8%) and three-medications (21.7% to 36.2%) groups, and none in the use of CAI/ß fixed-combination medication. There was little use of α2/ß fixed-combination medication, probably because it was launched only three months before the survey. Conclusion: The proportion of fixed-combination medications increased as the number of medications per patient increased.

Acute Primary Angle Closure Caused by Plateau Iris After Ritodrine Use in a Primigravid Woman Successfully Treated With Clear-Lens Extraction: A Case Report.

Acute primary angle closure (APAC) is rare in young adults (those under approximately 40 years old) and pregnant women. Here, we report the case of a 37-year-old primigravid woman with APAC caused by plateau iris after the use of ritodrine (a ß2 stimulator) that was successfully resolved by clear-lens extraction five months after delivery. The patient presented with pain in her right eye after ritodrine infusion for threatened premature labor at 23 weeks of gestation. Her visual acuity was 20/40, and her intraocular pressure (IOP) was 31 mmHg in her right eye. The patient was diagnosed as having APAC with plateau iris based on ultrasound biomicroscopy (UBM) findings of irido-angle touch, anterior dislocation of the ciliary process, and an absent ciliary sulcus. The effectiveness of treatment with pilocarpine eyedrops was limited, and argon laser peripheral iridoplasty did not succeed in reducing IOP. An immediate resolution was achieved with clear-lens extraction. IOP has since stayed within 14-16 mmHg without any medication for seven years. This is the first reported case of APAC complicated with plateau iris after ritodrine use in a pregnant woman. This condition is rare in young adults, making it difficult to diagnose; however, UBM can be of great help. In this case, clear-lens extraction led to a successful outcome. Our case suggests that attention should be paid to drug associations when APAC occurs with plateau iris.

One-Year Efficacy and Safety of Omidenepag Isopropyl in Patients with Normal-Tension Glaucoma.

Purpose: To retrospectively evaluate the 1-year efficacy and safety of single-agent of omidenepag isopropyl in patients with normal-tension glaucoma (NTG). Methods: One hundred patients (100 eyes) newly administered omidenepag isopropyl were enrolled. Intraocular pressure (IOP) was compared at baseline and 3, 6, 9, and 12 months after administration. The mean deviation values at baseline and 12 months measured using the Humphrey visual field test (30-2 Swedish Interactive Threshold Algorithm standard) were compared. Adverse reactions and dropouts were observed. Results: IOP significantly decreased from 15.5 ± 2.7 mmHg at baseline to 13.3 ± 2.5 mmHg after 3 months, 13.7 ± 2.3 mmHg after 6 months, 13.9 ± 2.4 mmHg after 9 months, and 13.7 ± 2.3 mmHg after 12 months (P < 0.0001). There was no significant difference in the mean deviation values at baseline (-3.66 ± 3.49 dB) and after 12 months (-3.41 ± 3.80 dB). Adverse reactions occurred in 9 patients (9.0%): conjunctival hyperemia (n = 6), eye pain (n = 1), iritis (n = 1), and blepharitis (n = 1). Twenty-one patients (21.0%) discontinued administration because of changes in medication (n = 7), interruption of visits (n = 5), adverse reactions (n = 4), and others. Conclusions: After administering omidenepag isopropyl, the IOP in patients with NTG decreased within 1 year, visual fields were maintained, and safety was satisfactory. Omidenepag isopropyl can be used as the first-line medication for patients with NTG.

Periocular Adverse Reactions to Omidenepag Isopropyl.

PURPOSE: To investigate the periocular adverse reactions to omidenepag isopropyl (OMDI). DESIGN: Nonrandomized comparative clinical study. METHODS: We enrolled 100 patients (100 eyes) with primary open-angle glaucoma or ocular hypertension who received initial treatment with OMDI or tafluprost in only 1 eye for ≥6 months. Photographs of the eyelids were taken on the day of the participants' visit after ≥6 months of prescription. Subsequently, 3 ophthalmologists individually determined the occurrence of eyelid pigmentation, eyelash growth, and deepening of the upper eyelid sulcus (DUES). Additionally, a questionnaire on the subjective symptoms was administered. Multivariate analysis of baseline data was performed to investigate the factors involved in adverse reactions. RESULTS: The mean duration of drug administration was 10.2 ± 3.8 and 10.8 ± 4.1 months in the OMDI and tafluprost groups, respectively. The frequencies of eyelid pigmentation, eyelash growth, and DUES were 0.0%, 0.0%, and 2.0%, respectively, in the OMDI group, whereas the corresponding values in the tafluprost group were 4.0%, 32.0%, and 12.0%. The only significant difference was that the OMDI group showed fewer patients with eyelash growth than in the tafluprost group (P < .0001). In the questionnaire, the subjective symptoms of eyelid pigmentation, eyelash growth, and DUES were 8.0%, 2.0%, and 4.0%, respectively, in the OMDI group, whereas the corresponding values in the tafluprost group were 12.0%, 40.0%, and 4.0%, respectively. Multivariate analysis revealed a correlation between the type of drug administered and these adverse reactions (R = 0.38, P = .005). CONCLUSIONS: The frequencies of periocular adverse reactions to OMDI, ranging from 0% to 2.0%, were lower than those to tafluprost.

Short-Term Efficacy and Safety of Omidenepag Isopropyl in Patients with Normal-Tension Glaucoma.

PURPOSE: To retrospectively evaluate the short-term efficacy of omidenepag isopropyl (EYBELIS 0.002%) by assessing its intraocular pressure (IOP)-lowering capability and safety in patients with normal-tension glaucoma (NTG). PATIENTS AND METHODS: Fifty-four NTG patients (54 eyes) who were newly administrated with omidenepag isopropyl were enrolled in the study. The subjects comprised 22 men and 32 women, and the mean age of the subjects was 55.0 ± 14.1 years. The mean deviation value using the Humphrey visual field test program (30-2 SITA Standard) was -5.03 ± 3.38 dB. The following data were retrieved from the medical records and used for retrospective analyses: IOP at baseline 1-2 months and 3-4 months after administration. The frequency of non-responder patients who had less than 10% IOP reduction was evaluated. Patients were observed for adverse reactions and dropouts at each time point. RESULTS: IOP at baseline, after 1-2 months and after 3-4 months was 15.7 ± 2.6 mmHg, 13.5 ± 2.3 mmHg, and 13.6 ± 2.4 mmHg, respectively. There was a significant decrease in IOP after administration (p<0.0001). Eleven patients (22.4%) were non-responders. Adverse reactions occurred in 4 patients (7.4%), including conjunctival hyperemia in 3 patients (after 1 week, 2 weeks, and 1 month, respectively) and eye pain in 1 patient (after 1 month). Five patients (9.3%) dropped out of the study because of an adverse reaction in 3 patients, insufficient IOP reduction in 1 patient, and discontinuation of follow-up of 1 patient at our institution. CONCLUSION: After administration of omidenepag isopropyl, IOP in patients with NTG was significantly decreased. However, adverse reactions occurred in 7.4% of patients.

Efficacy of 27-Gauge Vitrectomy with Internal Limiting Membrane Peeling for Epiretinal Membrane in Glaucoma Patients.

PURPOSE: To evaluate the efficacy of epiretinal membrane (ERM) surgery for patients with ERM and glaucoma. METHODS: We reviewed the medical records of 20 consecutive ERM patients with glaucoma, who underwent 27-gauge microincision vitrectomy surgery (27GMIVS) with internal limiting membrane (ILM) peeling. The preoperative and 6-month postoperative visual field was tested with the Humphrey Field Analyzer (HFA) 24-2 program. Changes in threshold sensitivity in the HFA test points were analyzed point-by-point, with points classified into groups based on sensitivity as abnormal (less than 5th percentile in pattern deviation) or normal (all other points) and based on location as central (12 central points) or peripheral (all other points) with a linear mixed-effects model. RESULTS: Visual acuity and mean deviation improved postoperatively (P < 0.001 for both) in all patients. Threshold sensitivity in central or peripheral points that were abnormal preoperatively improved postoperatively (P=0.006 or P < 0.001, respectively). Threshold sensitivity also improved in the central normal test points (P=0.03), but not in the peripheral normal points (P=0.12). CONCLUSION: Visual acuity improved, and there was no visual field progression, after ERM surgery in glaucomatous eyes during a 6-month postoperative follow-up, suggesting that ERM and ILM removal using 27GMIVS may be effective even in glaucomatous eyes.

Optical Coherence Tomography Assessment of Risk Factors for Visual Acuity Decline After Trabeculectomy in Patients With Advanced Open-Angle Glaucoma.

PRéCIS:: Thinning of the macular retinal nerve fiber layer (mRNFL) and ganglion cell complex in the papillomacular bundle area contributed significantly to visual acuity (VA) decline in advanced glaucoma patients after trabeculectomy. PURPOSE: To identify structural parameters that could predict VA decline after trabeculectomy in patients with advanced open-angle glaucoma. PATIENTS AND METHODS: Retrospective review of 74 eyes of 74 patients with advanced glaucoma (defined as mean deviation -12 dB or worse) and best-corrected VA (BCVA) of ≥40/200. All patients underwent trabeculectomy between 2013 and 2016. Measurements included intraocular pressure, BCVA, visual field parameters, and optical coherence tomography-derived parameters [(in both the overall macula and within the papillomacular bundle (PMB)], including mRNFL thickness (mRNFLT), ganglion cell layer/inner plexiform layer thickness, and ganglion cell complex thickness. Measurements were obtained before and after surgery, and follow-up was at least 6 months. We grouped the patients according to whether they underwent VA decline of >3 lines of BCVA after 6 months. We then compared the VA-decline group and the stable-VA group and performed a receiver operating characteristic analysis to determine optimal cut-off values for predicting VA decline. RESULTS: The VA-decline group comprised 7 eyes (9.5%) and had lower preoperative mean deviation (P=0.021) and thinner mRNFL, ganglion cell layer/inner plexiform layer, and ganglion cell complex in the PMB (P=0.003, 0.135, and 0.023, respectively) than the stable-VA group. The cut-off values for predicting VA decline were 9.5 µm for mRNFLT in the PMB. CONCLUSIONS: This study found that thin mRNFLT in the PMB were risk factors for VA decline after trabeculectomy.

Predicting the Integrated Visual Field with Wide-Scan Optical Coherence Tomography in Glaucoma Patients.

PURPOSE: This study aimed to calculate a predicted integrated visual field (IVF) based on predicted monocular visual fields (MVFs) derived, with a new method, from wide-scan optical coherence tomography (OCT) data. MATERIALS AND METHODS: Visual field testing used the central (6 × 4) 24 points of the Humphrey Field Analyzer 24-2 program. OCT scans of a corresponding retinal area, centered on the fovea, were divided into a 6 × 4 grid. The thickness of the macular retinal nerve fiber layer (mRNFL), ganglion cell layer + inner plexiform layer (GCIPL), and mRNFL + GCIPL (GCC) was measured in each grid area. Next, a support vector machine was used to create a MVF prediction model, with training data from 101 eyes of 60 glaucoma patients. Then, the prediction model was validated with data from 108 eyes of 54 glaucoma patients, for MVF and IVF. A simulated IVF was created by merging bilateral simulated MVFs. RESULTS: The overall average of the median 95% prediction interval length for the MVF prediction model (measured in dB) was 10.0, 18.3, and 11.3 for the mRNFL, GCIPL, and GCC, respectively. In the validation data, the overall average root mean squared error (dB) between actual and predicted sensitivity for the IVF was 9.6, 10.5, and 9.5 for the mRNFL, GCIPL, and GCC, respectively, in the 24 grid areas. The intraclass correlation coefficient between average actual and predicted IVF was 0.61, 0.44, and 0.59 in the mRNFL, GCIPL, and GCC, respectively, in the 24 grid areas. CONCLUSIONS: We calculated a predicted IVF based on predicted MVFs that were derived, with a new method, from OCT data and validated the accuracy of the calculated IVF. This technique should improve glaucoma management in cases when standard visual field testing is difficult.

Prediction of Surgical Outcome After Trabeculectomy for Neovascular Glaucoma With Anterior-segment Optical Coherence Tomography.

PURPOSE: To determine the potential of anterior-segment optical coherence tomography (AS-OCT) to predict posttrabeculectomy outcomes in neovascular glaucoma (NVG). PATIENTS AND METHODS: We recruited 45 eyes of 40 NVG patients who underwent trabeculectomy. The patients were divided into success and failure groups based on the posttrabeculectomy outcome after 12 months. AS-OCT findings were compared in the success and failure groups at 1 and 2 weeks and 1, 3, 6, and 12 months. We also analyzed early posttrabeculectomy bleb parameters with multiple logistic regression, stepwise multiple regression, and the receiver operating characteristic curve to evaluate the power of these parameters to predict long-term outcomes. RESULTS: Intraocular pressure at 6 and 12 months was lower in the success group than the failure group (P<0.0016=0.0048). Reflectivity of the bleb wall was higher in the failure group than the success group throughout the study (all: P<0.0016). Age and reflectivity of the bleb wall at 1 week were risk factors for failure with odds ratios for failure of 0.91 and 1.67. The area under the receiver operating characteristic curve for reflectivity of the bleb wall at 1 week was 0.943 with the cutoff set at 128.9 (sensitivity: 85.7%; specificity: 100.0%). Stepwise multiple regression analysis showed that reflectivity of the bleb wall at 1 week independently indicated the bleb survival period (ß=-0.84; P<0.001). CONCLUSIONS: AS-OCT-measured reflectivity of the bleb wall, measured at 1 week of trabeculectomy for NVG, might be able to predict of the final status of the bleb.

Anterior-Segment Optical Coherence Tomography for Predicting Postoperative Outcomes After Trabeculectomy.

PURPOSE: To determine whether anterior-segment optical coherence tomography (AS-OCT) can be used to predict post-trabeculectomy bleb outcomes. MATERIALS AND METHODS: We divided 58 eyes of 47 trabeculectomy patients into success or failure groups based on their status at 12 months after surgery. We then compared various AS-OCT measurement parameters between the two groups at 1 and 2 weeks and 1, 3, 6, and 12 months. We also analyzed the early post-trabeculectomy bleb parameters with multiple logistic regression, stepwise multiple regression, and the receiver operating characteristic (ROC) curve, to evaluate the power of these parameters to predict long-term outcomes. RESULTS: Intraocular pressure 3 or more months after trabeculectomy was significantly lower in the success group than the failure group (all: P < 0.0016). Cleft volume was significantly higher 6 or more months after trabeculectomy in the success group than the failure group (P = 0.0027 and <0.0016). Reflectivity of the bleb wall was significantly higher in the failure group than the success group at 2 weeks and all later time points (all: P < 0.0016). Reflectivity of the bleb wall at 2 weeks after trabeculectomy was a risk factor for failure, with an odds ratio (OR) for failure of 2.48 (95% confidence interval, 1.31-4.68, increasing per 10 AU). The area under the ROC curve for reflectivity of the bleb wall at 2 weeks after trabeculectomy was 0.775 when the cutoff value was set at 122.8, with sensitivity, specificity, and OR of 78.3%, 80.0%, and 14.4, respectively. A stepwise multiple regression analysis showed that reflectivity of the bleb wall at 2 weeks was an independent factor indicating postoperative bleb survival period (ß = -0.39, P = 0.007). CONCLUSIONS: Reflectivity of the bleb wall, measured by AS-OCT, may be an early post-trabeculectomy predictor of bleb outcome.

Characteristic Profiles of Inflammatory Cytokines in the Aqueous Humor of Glaucomatous Eyes.

PURPOSE: To analyze cytokine profiles of the aqueous humor of eyes with primary open-angle glaucoma (POAG), neovascular glaucoma (NVG), and cataract (as controls). METHODS: A multiplex bead assay was used to measure concentrations of 27 cytokines in aqueous humor samples from 54 eyes. RESULTS: Detection rates were as follows: IL-7: NVG higher than POAG; IL-10: POAG lower than cataract or NVG; and GM-CSF: cataract higher than POAG or NVG. Concentrations were as follows: IL-8, IP-10, MCP-1, and MIP-1ß: POAG and NVG higher than cataract; IL-9: POAG lower than NVG; IL-12: POAG lower than cataract or NVG; and VEGF: NVG higher than cataract or POAG and POAG lower than cataract. Further analysis showed that IL-8, IP-10, MCP-1, and MIP-1ß were correlated with intraocular pressure and age. CONCLUSIONS: The detection rates and levels of various cytokines had different patterns in POAG and NVG patients, suggesting distinctive alterations in the microenvironment in different types of glaucoma.

The effect of concentric constriction of the visual field to 10 and 15 degrees on simulated motor vehicle accidents.

PURPOSE: Traffic accidents are associated with the visual function of drivers, as well as many other factors. Driving simulator systems have the advantage of controlling for traffic- and automobile-related conditions, and using pinhole glasses can control the degree of concentric concentration of the visual field. We evaluated the effect of concentric constriction of the visual field on automobile driving, using driving simulator tests. METHODS: Subjects meeting criteria for normal eyesight were included in the study. Pinhole glasses with variable aperture sizes were adjusted to mimic the conditions of concentric visual field constrictions of 10° and 15°, using a CLOCK CHART®. The test contained 8 scenarios (2 oncoming right-turning cars and 6 jump-out events from the side). RESULTS: Eighty-eight subjects were included in the study; 37 (mean age = 52.9±15.8 years) subjects were assigned to the 15° group, and 51 (mean = 48.6±15.5 years) were assigned to the 10° group. For all 8 scenarios, the number of accidents was significantly higher among pinhole wearing subjects. The average number of all types of accidents per person was significantly higher in the pinhole 10° group (4.59±1.81) than the pinhole 15° group (3.68±1.49) (P = 0.032). The number of accidents associated with jump-out scenarios, in which a vehicle approaches from the side on a straight road with a good view, was significantly higher in the pinhole 10° group than in the pinhole 15° group. CONCLUSIONS: Concentric constriction of the visual field was associated with increased number of traffic accidents. The simulation findings indicated that a visual field of 10° to 15° may be important for avoiding collisions in places where there is a straight road with a good view.

The role of specific visual subfields in collisions with oncoming cars during simulated driving in patients with advanced glaucoma.

BACKGROUND/AIMS: To assess the role of specific visual subfields in collisions with oncoming cars during simulated driving in patients with advanced glaucoma. METHODS: Normal subjects and patients with glaucoma with mean deviation <-12 dB in both eyes (Humphrey Field Analyzer 24-2 SITA-S program) used a driving simulator (DS; Honda Motor, Tokyo). Two scenarios in which oncoming cars turned right crossing the driver's path were chosen. We compared the binocular integrated visual field (IVF) in the patients who were involved in collisions and those who were not. We performed a multivariate logistic regression analysis; the dependent parameter was collision involvement, and the independent parameters were age, visual acuity and mean sensitivity of the IVF subfields. RESULTS: The study included 43 normal subjects and 100 patients with advanced glaucoma. And, 5 of the 100 patients with advanced glaucoma experienced simulator sickness during the main test and were thus excluded. In total, 95 patients with advanced glaucoma and 43 normal subjects completed the main test of DS. Advanced glaucoma patients had significantly more collisions than normal patients in one or both DS scenarios (p<0.001). The patients with advanced glaucoma who were involved in collisions were older (p=0.050) and had worse visual acuity in the better eye (p<0.001) and had lower mean IVF sensitivity in the inferior hemifield, both 0°-12° and 13°-24° in comparison with who were not involved in collisions (p=0.012 and p=0.034). A logistic regression analysis revealed that collision involvement was significantly associated with decreased inferior IVF mean sensitivity from 13° to 24° (p=0.041), in addition to older age and lower visual acuity (p=0.018 and p<0.001). CONCLUSIONS: Our data suggest that the inferior hemifield was associated with the incidence of motor vehicle collisions with oncoming cars in patients with advanced glaucoma.

Comparing Trabeculectomy Outcomes between First and Second Operated Eyes: A Multicenter Study.

OBJECTIVE: To compare surgical outcomes between the first and second operated eyes in patients who underwent trabeculectomy in both eyes. METHODS: This retrospective clinical cohort study at five clinical centers in Japan included 84 patients with open-angle glaucoma who underwent primary trabeculectomy in both eyes. The primary outcome was surgical success or failure, with failure being defined according to three criteria: <20% reduction of the preoperative intraocular pressure (IOP), or Criterion A, IOP >21 mmHg; Criterion B, IOP >18 mmHg; or Criterion C, IOP >15 mmHg. Cases of reoperation, a loss of light perception vision, or hypotony were also considered as "failures". RESULTS: There were no significant differences in success rate for any of the three criteria between the first and second operated eyes. For patients whose first trabeculectomy was successful, when the second trabeculectomy was performed ≥2 months after the first, the survival curves for all three criteria for the second trabeculectomy were significantly worse than those for patients waiting a shorter interval between trabeculectomies (Criterion A, 52.0% vs 83.6%, P = 0.0031; Criterion B, 51.5% vs 80.4%, P = 0.026; Criterion C, 51.1% vs 80.4%, P = 0.048). In multivariable analyses, a longer interval between trabeculectomies was a significant prognostic factor for surgical failure (Criterion A, P = 0.0055; Criterion B, P = 0.0023; Criterion C, P = 0.027). However, no dependency on the interval between trabeculectomies was found among patients whose first trabeculectomy failed. CONCLUSIONS: If the first trabeculectomy is successful, a long interval before the second trabeculectomy increases the risk of surgical failure in the second eye. This result has clinical implications for developing surgical strategies for patients with bilateral glaucoma.

Erratum: Estimation of Jones matrix, birefringence and entropy using Cloude-Pottier decomposition in polarization-sensitive optical coherence tomography: erratum.

[This corrects the article on p. 3551 in vol. 7, PMID: 27699120.].