Impact of glaucoma on vision-specific quality of life in monocular glaucoma patients using the Indian vision function questionnaire.

Purpose: To evaluate the determinants affecting the quality of life in monocular glaucoma patients using the Indian vision function questionnaire. Methods: In this prospective cross-sectional study,: total of 196 patients were divided into two groups: cases and controls. Indian Vision Function Questionnaire (IND-VFQ) was administered and analyzed. One hundred twenty-nine (58.6%) patients who had lost their vision in one eye due to glaucoma were included as cases and 67 (30.4%) patients who had lost their vision due to other causes were taken as controls. Results: Median composite score of subscales was 54.62 (29.7-74.7) in group 1 and 45.38 (23.7-76.7) in group 2. The psychosocial impact scale was the most affected scale, the median scores were 33.02 (0 to 60.0) and 19.07 (0 to 53.0) in groups 1 and 2, respectively. Among all dimensions of IND-VFQ, the highest score was for color vision 100.0 (0-100.0) and 100.0 (0-100.0), and the lowest median score was found in mental health and dependency in both the groups. Multiple linear regression analysis demonstrated that visual acuity was associated with a low score (P < 0.001). Female gender was significantly associated with the overall score in the univariate model (P = 0.006). Conclusion: Monocular glaucoma patients have a poor general and vision-related quality of life. Depression associated with monocularity and the perception of dependency and being a burden on their family members greatly impacted the mental health of the participants.

Pars plana Aurolab aqueous drainage implantation for refractory glaucoma: Outcome of a new modified technique.

PURPOSE: To report the outcomes of pars plana insertion of Aurolab aqueous drainage implant (AADI) in adults with refractory glaucoma by the novel technique of making scleral tunnel instead of patch graft to cover the tube to prevent its migration. METHODS: A retrospective study was done between April 2016 and April 2018 on patients with ≥12 months of follow-up. The main outcome measure was a surgical failure at 12 months. The failure was defined as intraocular pressure (IOP) >18 mmHg or IOP ≤5 mmHg on two consecutive follow-up visits after 3 months, reoperation for glaucoma, loss of light perception vision, or implant explantation. Alternate definitions of failure including IOP >21 and IOP >15 mmHg were also considered. RESULTS: : The study included 32 eyes of 32 patients. The mean age was 46.2 ± 17.5 years. The most common etiology is traumatic glaucoma (12 eyes, 37.5%). The mean preoperative IOP and anti-glaucoma medications were 43.3 ± 10.3 and 3.4 ± 0.5 mmHg, respectively; both the parameters at the final follow-up were reduced to 15.2 ± 8.1 and 1.6 ± 0.5 mmHg. The Kaplan-Meier survival estimates demonstrated that the cumulative probability of failure was 15.6% (95% CI; 6.8-33.5%) at 3 months, 18.7% (95% CI; 8.9-37.0%) at 6 months, and 25.0% (95% CI; 13.4-43.8%) at 12 months. CONCLUSION: Pars plana AADI implantation with a newer modification technique is a useful procedure in reducing IOP and the number of anti-glaucoma medications in the eyes with refractory glaucoma. The visual acuity may be stabilized with the concurrent treatment of posterior segment pathology.

Evaluation of Angle Closure as a Risk Factor for Reduced Corneal Endothelial Cell Density.

PURPOSE: Acute angle closure attacks are frequently accompanied by corneal edema. However, little is known about corneal endothelial cell status at different stages of angle closure. Here, we compared endothelial cell density (ECD) in unoperated eyes with that in eyes with open angles (OAs) and various stages of angle closure disease. MATERIALS AND METHODS: The study was conducted at Aravind Eye Hospitals in India. Masked examiners performed gonioscopy to classify each eye as follows: (1) OA, (2) primary angle closure suspect, or (3) primary angle closure (PAC)/primary angle closure glaucoma (PACG). Specular microscopy was performed and differences in ECD were analyzed using hierarchical models. RESULTS: A total of 407 patients and 814 eyes were studied, including 127 (15.6%), 466 (57.3%), and 221 (27.1%) with PAC/PACG, primary angle closure suspect, and OA, respectively. Participants were predominantly female (69.8%) and the mean age was 49.2 (SD: 8.6) years. Lower ECD was observed with increasing age [ß=-6.3 cells/mm; 95% confidence interval (CI), -9.3 to -3.3, per year; P<0.001], greater iridotrabecular contact [ß=-15.6 cells/mm; 95% CI, -28.3 to -2.9, per quadrant of contact; P=0.016), and shallow (<2.5 mm) anterior chamber depth (ß=-40 cells/mm; compared to deeper AC's (≥2.5 mm), 95% CI, 78.9-1.1; P=0.044). In age-adjusted analyses, angle closure suspects had lower ECD than OA eyes (ß=-54.7 cells/mm; 95% CI, -47.8 to -85.3; P=0.018), although PAC/PACG eyes were not significantly different from OA eyes (ß=-18.6 cells/mm; 95% CI, -85.9 to 2.5; P=0.058). CONCLUSION: In untreated eyes, only mild, clinically insignificant decrement in ECD was noted with angle closure.

Retinal nerve fibre layer thickness measurements in normal Indian population by optical coherence tomography.

PURPOSE: To obtain retinal nerve fibre layer thickness measurements by optical coherence tomography (OCT) in normal Indian population. MATERIALS AND METHODS: Total of 118 randomly selected eyes of 118 normal Indian subjects of both sex and various age groups underwent retinal nerve fiber layer thickness analysis by Stratus OCT 3000 V 4.0.1. The results were evaluated and compared to determine the normal retinal nerve fiber layer thickness measurements and its variations with sex and age. RESULTS: Mean +/- standard deviation retinal nerve fiber layer thickness for various quadrants of superior, inferior, nasal, temporal and along the entire circumference around the optic nerve head were 138.2 +/- 21.74, 129.1 +/- 25.67, 85.71 +/- 21, 66.38 +/- 17.37 and 104.8 +/- 38.81 microm, respectively. There was no significant difference in the measurements between males and females and no significant correlation with respect to age. CONCLUSION: Our results provide the normal retinal nerve fiber layer thickness measurements and its variations with age and sex in Indian population.