Effectiveness and safety of XEN63 in patients with primary-open-angle glaucoma.

This paper evaluates the effectiveness and safety of XEN63 stent, either standalone or in combination with phacoemulsification, in patients with primary open-angle glaucoma (POAG). Eighty eyes from 80 patients with medically uncontrolled POAG were assigned to undergo XEN63 implant. The primary outcome was the surgical success, defined as an intraocular pressure (IOP) lowering from preoperative values ≥ 20% and an IOP absolute value between 6 and 18 mmHg, with or without antiglaucoma medications. Forty-three (53.7%) eyes underwent XEN63-standalone and 37(46.2%) eyes a XEN63 + Phacoemulsification procedure. Success rate was 68.8% (55/80) eyes in the overall study sample, 69.8% (30/43) eyes in the XEN63-standalone group; and 67.6% (25/37) eyes in the XEN63 + Phaco group (p = 0.6133). Preoperative IOP was significantly lowered from 22.1 ± 4.9 mmHg and 19.8 ± 3.7 mmHg to 14.7 ± 5.3 mmHg and 13.8 ± 3.4 mmHg in the XEN63-standalone and XEN63 + Phaco groups, respectively (p < 0.0001 each, respectively); without significant differences between them at any of the time-points measured. Preoperative number of ocular-hypotensive drugs was significantly reduced from 2.3 ± 0.8 to 0.3 ± 0.7 drugs, from 2.5 ± 0.7 to 0.3 ± 0.7 drugs; and from 2.0 ± 0.8 to 0.3 ± 0.7 drugs, in the overall, XEN63-standalone, and XEN63 + Phaco groups, respectively. Regarding safety, 3(42.5%) eyes had transient hypotony at some point during the study, although only in one (1.2%) eye was clinically significant. Four (5.0%) eyes underwent a needling, 4 (5.0%) eyes underwent surgical-bleb-revision, 1 (1.2%) eye required a device replacement and 1 (1.2%) eye a device removal due to maculopathy. XEN63, either alone or in combination with phacoemulsification, significantly lowered IOP and reduced the number of ocular hypotensive medications. The rate of ocular hypotony was relatively high, although it was clinically relevant only in one eye.

Evaluation of multiple sclerosis severity using a new OCT tool.

PURPOSE: To assess the ability of a new posterior pole protocol to detect areas with significant differences in retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness in patients with multiple sclerosis versus healthy control subjects; in addition, to assess the correlation between RNFL and GCL thickness, disease duration, and the Expanded Disability Status Scale (EDSS). METHODS: We analyzed 66 eyes of healthy control subjects and 100 eyes of remitting-relapsing multiple sclerosis (RR-MS) patients. Double analysis based on first clinical symptom onset (CSO) and conversion to clinically definite MS (CDMS) was performed. The RR-MS group was divided into subgroups by CSO and CDMS year: CSO-1 (≤ 5 years) and CSO-2 (≥ 6 years), and CDMS-1 (≤ 5 years) and CDMS-2 (≥ 6 years). RESULTS: Significant differences in RNFL and GCL thickness were found between the RR-MS group and the healthy controls and between the CSO and CDMS subgroups and in both layers. Moderate to strong correlations were found between RNFL and GCL thickness and CSO and CDMS. Furthermore, we observed a strong correlation with EDSS 1 year after the OCT examination. CONCLUSIONS: The posterior pole protocol is a useful tool for assessing MS and can reveal differences even in early stages of the disease. RNFL thickness shows a strong correlation with disability status, while GCL thickness correlates better with disease duration.

Influence of ocular biometric factors on the defocus curve in an enlarged depth-of-focus intraocular lens.

BACKGROUND: To assess the influence of biometric measurements on the defocus curve after the implantation of enlarged depth-of-focus (EDoF) intraocular lens (IOL). METHODS: Patients who underwent cataract surgery with bilateral implantation of Tecnis Symfony IOL were enrolled. Preoperatively, axial length (AL), corneal keratometry (K), pupil size and corneal aberrations were measured. 1 month after surgery, distance, intermediate, and near visual acuities (VA) were recorded. At 3 months, monocular and binocular corrected contrast sensitivities under photopic and mesopic lighting conditions were measured with CSV-1000E test. At 6-months, the defocus curve between -5.00 to + 3.00 diopters (D) was assessed in steps of 0.50 D, and NEI-RQL-42 questionnaire was administered. RESULTS: One hundred thirty one eyes of 66 patients were included. Binocular logMAR VA better than 0.1 for intermediate vision was obtained in 90% of patients, whereas only 17.7% obtained that result in near vision. The rate of satisfaction was high (96%) and most of them (85.5%) had no or little difficulties in near vision. The mean amplitude of the defocus curve was 2.35D ± 0.73D, and smaller AL, smaller pupils, younger age, and male sex were associated with wider range of clear vision. CONCLUSIONS: Tecnis Symfony IOL enables functional vision at all distances, but demographic variables and preoperative biometric measurements like AL and pupil size influence the postoperative amplitude of the defocus curve. These parameters could be used to predict the performance of EDoF IOLs.

Bias of near-infrared light in evaluation of patients implanted with multifocal intraocular lenses.

PURPOSE: To compare visual quality between subjective tests and optical devices using near-infrared (NIR) light in patients implanted with monofocal, multifocal and enlarged depth-of-focus (EDoF) intraocular lenses (IOLs). METHODS: Cross-sectional study enrolling patients aged between 55 and 75 (axial length between 22 and 25 mm) bilaterally implanted with Tecnis IOLs (Johnson & Johnson) four months previously: 40 patients (80 eyes) with monofocal ZCB00, 41 patients (82 eyes) with bifocal diffractive ZMB00 and 48 patients (96 eyes) with EDoF Symfony. They were examined using subjective and objective tests. The subjective tests comprised visual acuity (VA) with ETDRS charts, contrast sensitivity (CS) with Pelli-Robson and CSV-1000E tests, and clear vision range (CVR). The objective tests using NIR light were performed with the KR-1 W wavefront analyzer and the OQAS. RESULTS: In the subjective tests, the monofocal group achieved the best outcomes in some of the VA and CS sections, while the bifocal group obtained the worst outcomes in some of the CS sections. In the objective tests, the bifocal group achieved the best results for VA and CS. Discrepancies between pseudoaccommodation range and CVR were found in the bifocal and EDoF groups. CONCLUSIONS: Assessment of visual quality using NIR light implies greater bias for diffractive lenses than for EDoF lenses. This bias may be even greater with devices using longer light wavelengths or Hartmann-Shack technology. The difference in wavelength between NIR and visible light leads to dimming of near-vision focus and magnification of distance focus.

Angiography with optical coherence tomography as a biomarker in multiple sclerosis.

PURPOSE: To investigate superficial retinal microvascular plexuses detected by optical coherence tomography angiography (OCT-A) in multiple sclerosis (MS) subjects and compare them with healthy controls. METHODS: A total of 92 eyes from 92 patients with relapsing-remitting MS and 149 control eyes were included in this prospective observational study. OCT-A imaging was performed using Triton Swept-Source OCT (Topcon Corporation, Japan). The vessel density (VD) percentage in the superficial retinal plexus and optic disc area (6 x 6 mm grid) was measured and compared between groups. RESULTS: MS patients showed a significant decrease VD in the superior (p = 0.005), nasal (p = 0.029) and inferior (p = 0.040) parafoveal retina compared with healthy subjects. Patients with disease durations of more than 5 years presented lower VD in the superior (p = 0.002), nasal (p = 0.017) and inferior (p = 0.022) parafoveal areas compared with healthy subjects. Patients with past optic neuritis episodes did not show retinal microvasculature alterations, but patients with an EDSS score of less than 3 showed a significant decrease in nasal (p = 0.024) and superior (p = 0.006) perifoveal VD when compared with healthy subjects. CONCLUSIONS: MS produces a decrease in retinal vascularization density in the superficial plexus of the parafoveal retina. Alterations in retinal vascularization observed in MS patients are independent of the presence of optic nerve inflammation. OCT-A has the ability to detect subclinical vascular changes and is a potential biomarker for diagnosing the presence and progression of MS.

Continuous intraocular pressure monitoring in patients with obstructive sleep apnea syndrome using a contact lens sensor.

PURPOSE: To analyse nocturnal intraocular pressure (IOP) fluctuations in patients with obstructive sleep apnea syndrome (OSAS) using a contact lens sensor (CLS) and to identify associations between the OSAS parameters determined by polysomnographic study (PSG) and IOP changes. METHOD: Prospective, observational study. Twenty participants suspected of having OSAS were recruited. During PSG study, IOP was monitored using a CLS placed in the eye of the patient. The patients were classified according to the apnea-hypopnea index (AHI) in two categories, severe (>30) or mild/moderate (<30) OSAS. We evaluated several parameters determined by the IOP curves, including nocturnal elevations (acrophase) and plateau times in acrophase (PTs) defined by mathematical and visual methods. RESULTS: The IOP curves exhibited a nocturnal acrophase followed by PTs of varying extents at which the IOP remained higher than daytime measurement with small variations. We found significant differences in the length of the PTs in patients with severe OSAS compared to those with mild/moderate disease (P = 0.032/P = 0.028). We found a positive correlation between PTs and OSAS severity measured by the total number of apneic events (r = 0.681/0.751 P = 0.004/0.001) and AHI (r = 0.674/0.710, P = 0.004/0.002). Respiratory-related arousal and oxygen saturation also were associated significantly with the IOP PT length. CONCLUSIONS: Periods of nocturnal IOP elevation lasted longer in severe OSAS patients than those with mild/moderate OSAS and correlate with the severity of the disease. The length of the nocturnal PT is also associated to respiratory parameters altered in patients with OSAS.

Clinical Comparison of the Performance of Two Marketed Ophthalmic Viscoelastic Devices (OVDs): The Bacterially Derived Healon PRO OVD and Animal-Derived Healon OVD.

This clinical investigation compared the clinical performance of two marketed ophthalmic viscoelastic devices (OVDs): the bacterially derived Healon PRO OVD (test) and the animal-derived Healon OVD (control) under normal use conditions during cataract removal and lens implantation. This prospective, multicenter, randomized, parallel, participant/evaluator masked, postmarket investigation enrolled 139 subjects (170 eyes), 116 (143 eyes) of which were treated (73 test; 70 control group). Both test and control OVDs were used, at a minimum, to inflate the anterior chamber and protect the endothelium prior to cataract extraction according to the standard procedure. The surgeon completed a postsurgery OVD clinical performance questionnaire, and intraocular pressure (IOP) was measured before surgery and at the 1 day postoperative visit with Goldmann applanation tonometry. Any IOP measurement of 30 mmHg or higher was considered a "spike" and recorded as a study-specific, serious adverse event. The bacterially derived Healon PRO OVD was found to be statistically noninferior to the overall clinical performance of the animal-derived Healon OVD control; thus, the primary hypothesis was satisfied. There were no statistically significant differences between OVD groups for any of the additional endpoints relating to IOP changes or to safety, thus satisfying additional hypotheses. The Healon PRO OVD showed statistically significant improvements in surgeon ratings for ease of injectability, transparency/visibility, and ease of IOL placement. The safety profile was also similar between OVD groups with regards to serious and/or device-related adverse events, as well as medical and lens findings. The results of this clinical investigation support the safety and effectiveness of the bacterially derived, currently marketed Healon PRO OVD and indicate that the intraocular surgical performance was similar between the two OVDs.

Reproducibility and reliability of retinal and optic disc measurements obtained with swept-source optical coherence tomography in a healthy population.

PURPOSE: To analyze the reproducibility of macular and peripapillary thickness measurements, and optic nerve morphometric data obtained with Triton Optical coherence tomography (OCT) in a healthy population. STUDY DESIGN: Observational cross sectional study. MATERIAL AND METHODS: A total of 108 eyes underwent evaluation using the Triton Swept Source-OCT. A wide protocol was used and measurements in each eye were repeated three times. Morphometric data of the optic nerve head, full macular thickness, ganglion cell layer (GCL) and retinal nerve fiber layer thickness (RNFL) were analyzed. For each parameter, the coefficient of variation (COV) and the intra-class (ICC) correlation values were calculated. RESULTS: Measurements were highly reproducible for all morphometric measurements of the optic disc, with a mean COV of 6.36%. Macular full thickness showed good COV and ICC coefficients, with a mean COV value of 1.00%. Macular GCL thickness showed a mean COV value of 3.06%, and ICC higher than 0.787. Peripapillary RNFL thickness showed good COV and ICC coefficients, with a mean COV value of 8.31% and ICC higher than 0.684. The inferotemporal sector showed the lowest ICC (0.685). CONCLUSIONS: Triton OCT presents good reproducibility values in measurements corresponding to retinal parameters, with macular measurements showing the highest reproducibility rates. Peripapillary RNFL measurements should be evaluated with caution.

Ability of Swept-Source Optical Coherence Tomography to Detect Retinal and Choroidal Changes in Patients with Multiple Sclerosis.

PURPOSE: To evaluate the ability of new swept-source (SS) optical coherence tomography (OCT) technology to detect changes in retinal and choroidal thickness in patients with multiple sclerosis (MS). METHODS: A total of 101 healthy and 97 MS eyes underwent retinal and choroidal assessment using SS Triton OCT (Topcon). Macular thickness and peripapillary data (retinal, ganglion cell layer (GCL+, GCL++) and retinal nerve fiber layer (RNFL) thickness) were analyzed, including choroidal thickness evaluation. RESULTS: Significant macular thinning was observed in all ETDRS areas (p < 0.001) in MS patients. Peripapillary retinal, RNFL, and GCL ++ thickness showed a significant reduction in patients in all sectors (p < 0.001) except in the nasal quadrant/sector (p > 0.05). GCL+ measurements were found to be reduced in the nasal (p=0.003), inferonasal (p=0.045), and temporal (p=0.001) sectors and total thickness (p < 0.001). Choroidal thickness was reduced in the outer macular ring in MS patients compared with controls (p=0.038). CONCLUSION: New swept-source technology for OCT devices detects retinal thinning in MS patients, providing increased depth analysis of the choroid in these patients. MS patients present reduced retinal and choroidal thickness in the macular area and reduced peripapillary retinal, RNFL, and GCL thickness.

Visual acuity of pseudophakic patients predicted from in-vitro measurements of intraocular lenses with different design.

The optical quality of a set of IOLs (modeling set: one monofocal and two bifocals) was assessed through focus by the area under the modulation transfer function (MTFa) metric and related to the visual acuity (VA) defocus curves of pseudophakic patients implanted with said IOLs. A non-linear relationship between the MTFa and clinical VA was obtained with an asymptotic limit found to be the best VA achievable by the patients. Two mathematical fitting functions between clinical VA and MTFa were derived with high correlation coefficients (R2≥0.85). They were applied to the MTFa obtained from a different set of IOLs with advanced designs (trial set: one extended range of vision -ERV-, one trifocal ERV and one trifocal apodized) to predict VA versus defocus of patients implanted with these IOLs. Differences between the calculated VA and the clinical VA for both fitting models were within the standard deviation of the clinical measurements in the range of -3.00 D to 0.00 D defocus, thus proving the suitability of the MTFa metric to predict clinical VA performance of new IOL designs.

Peripapillary Choroidal Thickness Analysis Using Swept-Source Optical Coherence Tomography in Glaucoma Patients: A Broader Approach.

AIMS: To evaluate and compare peripapillary choroidal thickness (PPCT) in a wide area around the optic disk and various choroidal established zones in healthy controls and primary open-angle glaucoma (POAG) patients using a new swept-source (SS) optical coherence tomography (OCT) device. METHODS: A total of 246 eyes were finally included in this observational, prospective, cross-sectional study: 111 healthy controls and 135 POAG patients. The healthy subjects were divided into 2 populations: the teaching population (25 used to establish choroidal zones) and the validating population (86 used for comparing choroidal thickness with POAG patients). A 26 × 26 cube grid centered on the optic disk was generated using an SS-OCT to automatically measure choroidal thickness. Four choroidal zones were established and used to compare PPCT between healthy controls and POAG patients. RESULTS: PPCT was significantly thinner in zones 3 and 4 of the POAG group. The choroid exhibited a similar pattern in controls and patients with POAG; it was thickest in the superior region, followed in order by the temporal, nasal, and inferior regions. CONCLUSIONS: Peripapillary choroidal tissue shows a concentric pattern in both groups, and glaucoma patients present with peripapillary choroidal thinning compared with healthy subjects, especially in areas further away from the optic disk.

The use of zonal analysis of peripapillary choroidal thickness in primary open-angle glaucoma.

PURPOSE: To evaluate automatic peripapillary choroidal thickness (PPCT) measurements in a wide area around the optic disc and various established zones in primary open-angle glaucoma (POAG) patients and age- and sex-matched healthy controls using a new swept-source optical coherence tomography (SS-OCT) device. STUDY DESIGN: Single center cross-sectional observational study. METHODS: A total of 135 POAG patients and 86 healthy subjects were consecutively enrolled. An optic disc 6.0 × 6.0 mm three-dimensional scan OD was obtained using the SS-OCT Triton. A 26 × 26 cube-grid centered in the optic disc was generated to automatically measure choroidal thickness. Seven choroidal zones were established (superior temporal, central, and nasal; inferior temporal, central, and nasal, and the optic nerve head) and compared between healthy controls and POAG patients. RESULTS: PPCT was significantly thinner in the central superior, nasal superior, and nasal inferior zones of the POAG subjects. Choroidal thickness in the central superior zone was 124.61 ± 54.95 µm in POAG group vs 156.17 ± 80.89 µm in healthy controls (p = 0.029); in the nasal superior zone, 133.84 ± 58.89 µm in the POAG group vs 168.34 ± 73.45 µm in healthy controls (p = 0.012); and in the nasal inferior zone, 113.45 ± 49.93 µm in the POAG group vs 137.47 ± 65.96 µm in healthy controls (p = 0.049). CONCLUSION: Compared with healthy subjects, glaucoma patients present with peripapillary choroidal thinning, especially in the central superior, nasal superior, and nasal inferior zones. The new SS-OCT could be a useful tool to evaluate choroidal thinning, and it could be an additional support to facilitate glaucoma diagnosis.

Relationship between Visual Dysfunction and Retinal Changes in Patients with Multiple Sclerosis.

AIM: To evaluate structural changes in the retina and their correlation with visual dysfunction in patients with multiple sclerosis. METHODS: Patients with multiple sclerosis (n = 84) and healthy controls (n = 84) underwent structural evaluation of the retinal nerve fiber layer, and macular and ganglion cell layer thicknesses using Spectral domain optical coherence tomography (SD-OCT). All subjects underwent high and low contrast visual acuity, color vision (using the Farnsworth and L´Anthony desaturated D15 color tests), and contrast sensitivity vision using the Pelli Robson chart and CSV 1000E test. RESULTS: Macular, retinal nerve fiber layer, and ganglion cell layer thinning was observed in multiple sclerosis patients compared to healthy controls (p<0.05). High- and low-contrast visual acuity and contrast sensitivity vision at four different spatial frequencies were significantly reduced in comparison with healthy subjects (p<0.05). Macular, retinal nerve fiber layer and ganglion cell layer measurements correlated with high and low contrast visual acuity, and contrast sensitivity vision. Contrast sensitivity vision was the functional parameter that most strongly correlated with the structural measurements in multiple sclerosis and was associated with ganglion cell layer measurements. The L´Anthony color vision score (age-corrected color confusion index) was associated with macular measurements. CONCLUSIONS: Patients with multiple sclerosis had visual dysfunction that correlated with structural changes evaluated by SD-OCT. Macular and ganglion cell layer measurements may be good indicators of visual impairment in multiple sclerosis patients.

A Diagnostic Calculator for Detecting Glaucoma on the Basis of Retinal Nerve Fiber Layer, Optic Disc, and Retinal Ganglion Cell Analysis by Optical Coherence Tomography.

PURPOSE: The purpose of this study was to develop and validate a multivariate predictive model to detect glaucoma by using a combination of retinal nerve fiber layer (RNFL), retinal ganglion cell-inner plexiform (GCIPL), and optic disc parameters measured using spectral-domain optical coherence tomography (OCT). METHODS: Five hundred eyes from 500 participants and 187 eyes of another 187 participants were included in the study and validation groups, respectively. Patients with glaucoma were classified in five groups based on visual field damage. Sensitivity and specificity of all glaucoma OCT parameters were analyzed. Receiver operating characteristic curves (ROC) and areas under the ROC (AUC) were compared. Three predictive multivariate models (quantitative, qualitative, and combined) that used a combination of the best OCT parameters were constructed. A diagnostic calculator was created using the combined multivariate model. RESULTS: The best AUC parameters were: inferior RNFL, average RNFL, vertical cup/disc ratio, minimal GCIPL, and inferior-temporal GCIPL. Comparisons among the parameters did not show that the GCIPL parameters were better than those of the RNFL in early and advanced glaucoma. The highest AUC was in the combined predictive model (0.937; 95% confidence interval, 0.911-0.957) and was significantly (P = 0.0001) higher than the other isolated parameters considered in early and advanced glaucoma. The validation group displayed similar results to those of the study group. CONCLUSIONS: Best GCIPL, RNFL, and optic disc parameters showed a similar ability to detect glaucoma. The combined predictive formula improved the glaucoma detection compared to the best isolated parameters evaluated. The diagnostic calculator obtained good classification from participants in both the study and validation groups.

Measuring hemoglobin levels in the optic disc of Parkinson's disease patients using new colorimetric analysis software.

Objective. To evaluate a new method of measuring hemoglobin (Hb) levels and quantifying the color changes in the optic nerve head of Parkinson's disease (PD) patients. We also compared differences in retinal nerve fiber layer (RNFL) thicknesses obtained using spectral domain optical coherence tomography (OCT) device between PD group and healthy group. Methods. One hundred and fifty-five PD patients and 91 sex- and age-matched healthy subjects were included in this cross-sectional study. OCT examinations and one photograph of the optic disc were performed. The Laguna ONhE ("optic nerve hemoglobin"; Insoft SL, Tenerife, Spain) software was used to analyze the Hb level on the acquired optic disc photographs. Results. PD patients exhibited significantly reduced mean optic disc Hb percentages (57.56% in PD, 67.63% in healthy subjects; P = 0.001) as well as reduced Hb in almost all analyzed sectors, with the largest differences detected in the inferior and nasal sectors. RNFL parameters were significantly reduced in PD patients compared with healthy subjects, especially in the inferior quadrant. Conclusions. Measurements of optic disc Hb levels obtained with the Laguna ONhE software had good ability to detect optic nerve color changes (more papillary paleness and consequently this could suggest optic atrophy and axonal loss) in PD patients.

Retinal segmentation as noninvasive technique to demonstrate hyperplasia in ataxia of Charlevoix-Saguenay.

PURPOSE: To present a new retinal layer segmentation technique for evaluation of nerve fiber hyperplasia in patients with autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS). METHODS: Five patients with a molecular diagnosis of ARSACS and five age- and sex-matched healthy controls underwent a full ophthalmologic examination, which included a new technique to segment the retinal layers using Spectralis optical coherence tomography (OCT). Images and data were correlated with diffusion tensor color-encoded magnetic resonance imaging maps, diffusion tensor tractographies, and retinal anatomopathologic analysis. RESULTS: Optical coherence tomography evaluation revealed increased thickness in the internal layers of the retina (inner limiting membrane, nerve fiber layer, and ganglion cell layer) in each patient with ARSACS compared with controls. These findings suggest that the presence of neurofilamentous hyperplasia in the retinas of patients with ARSACS correlates with the anatomopathologic findings. CONCLUSIONS: We found evidence of ganglion cell and nerve fiber hyperplasia in the retinas of ARSACS patients. The etiopathogenic mechanisms of this disease thus require reconsideration.

Clinical relevance of foveal location on retinal nerve fiber layer thickness using the new FoDi software in spectralis optical coherence tomography.

PURPOSE: To evaluate the effect of improper foveal location on retinal nerve fiber layer (RNFL) thickness measurements by using the new FoDi software in spectral-domain optical coherence tomography (Spectralis SDOCT). METHODS: Cross-sectional study with 126 subjects: 66 healthy, 30 early, and 30 moderate glaucomatous eyes. Fast RNFL scans were performed by using the new FoDi technology. The position of the fovea was manually displaced inferiorly after acquisition (producing clockwise torsion of scan circle) and then superiorly (counterclockwise) to generate study sets of images. Differences in RNFL thickness between foveal-guided and alternative scans were analyzed and color changes in sector charts were evaluated. RESULTS: In healthy eyes, placing the fovea inferiorly led to significant RNFL thickness changes in all sectors. Locating the fovea superiorly seemed to have less impact. Early glaucomatous eyes were more susceptible to quantitative changes, but moderate glaucomatous eyes were more susceptible to qualitative changes. CONCLUSIONS: Improper fovea disc alignment when using the FoDi software in Spectralis OCT significantly affected sectoral RNFL thickness measurements and color chart representation. As final report of FoDi analysis does not show the foveal position used, careful acquisition is encouraged, so that results are reliable. Otherwise, this technique can easily be misinterpreted and patients could be misdiagnosed.

The effect of phacoemulsification cataract surgery on polarimetry and tomography measurements for glaucoma diagnosis.

PURPOSE: To assess whether optical coherence tomography (OCT)Stratus 3000, confocal laser scanning ophthalmoscopy (HRT3), and scanning laser polarimetry (GDx-VCC) results show parameter differences between presurgery and postsurgery in patients with cataracts and suspected glaucoma. SETTING: Glaucoma Service in the Department of Ophthalmology at the Miguel Servet University Hospital, Zaragoza, Spain. METHODS: Forty-six eyes of 46 patients were enrolled in this cross-sectional study and examined with OCT, HRT3, and GDx-VCC before and after phacoemulsification. Differences between presurgery and postoperative measurements were calculated using nonparametric test. RESULTS: The most significant difference between the study groups was in the OCT image quality; the signal-to-noise ratio improved from presurgery to postsurgery. All of the statistically significant sectors reflected measurements in the nasal region and the maximum superior and average nasal retinal nerve fiber layer (thickness (Smax/Navg). Almost all parameters of the HRT area remained unchanged after the surgery, but important differences were observed in cup depth, volume parameters, and image quality. The Glaucoma Progression Score feature may not be helpful in the presence of lens opacity. Temporal incision during the surgery affected most of the nasal GDx-VCC parameters and the image quality. CONCLUSIONS: OCT image quality was reduced preoperatively in the eyes with cataracts and retinal nerve fiber layer thickness in the nasal sectors was increased in these eyes postoperatively. Cup depth, volume parameters, Glaucoma Progression Score, and the image quality of HRT measurements were all influenced by cataract removal. In our study temporal incision during surgery affected the nasal parameters in GDx-VCC. Our results suggest that the examiner should consider obtaining a new baseline measurement after cataract surgery.

Diagnostic ability of the Heidelberg retina tomograph, optical coherence tomograph, and scanning laser polarimeter in open-angle glaucoma.

PURPOSE: To compare the ability to discriminate between healthy and glaucomatous eyes of different criteria based on parameters from 3 optical imaging devices: Heidelberg retina tomograph (HRT-II), optical coherence tomograph (Stratus OCT 3000) and scanning laser polarimeter (GDx VCC). DESIGN: Cross-sectional study. PARTICIPANTS: A total of 139 eyes from 139 subjects were enrolled in this study and classified into 66 healthy subjects and 73 glaucomatous patients according to intraocular pressure and standard automated perimetry. METHODS: All the subjects underwent complete ophthalmic examination, including HRT-II, OCT, and GDx VCC evaluations. MAIN OUTCOME MEASURES: Several parameters were obtained by these techniques and 8 diagnostic criteria were assessed. Receiver operating characteristics curves were plotted and compared among them, and sensitivity for specificity higher than 95% was calculated for every criterion. Agreement among the 3 technologies was assessed by means of Venn diagrams. RESULTS: The best criteria discriminating between healthy and glaucomatous eyes were Moorfields regression analysis out of the 95% confidence interval (HRT-II), OCT retinal nerve fiber layer average thickness <77 microm, and nerve fiber indicator >37 (GDx VCC) with sensitivities of 85%, 66%, and 48%, with specificity higher than 95%. Sixty-six patients out of 73 were correctly identified by at least 1 of the devices and 30 were detected by the 3 of them. CONCLUSIONS: Structural criteria assessed by the optical imaging devices evaluated in this study are useful to discriminate glaucomatous damage.