Economic cost of management of glaucoma in public and private health facilities in the Tema metropolis in Ghana.

Objectives: This study sought to determine the economic cost of the management of glaucoma among patients seeking care in health facilities in Ghana. Design: A cross-sectional cost-of-illness (COI) study from the perspective of the patients was employed. Setting: The study was conducted in public and private eye care facilities in the Tema Metropolis of Ghana. Participants: About 180 randomly selected glaucoma patients seeking healthcare at two facilities participated in the study. Main outcome measure: Direct cost, including medical and non-medical costs, indirect cost, and intangible burden of management of glaucoma. Results: the cost per patient treated for glaucoma in both facilities was US$60.78 (95% CI: 18.66-107.80), with the cost in the public facilities being slightly higher (US$62.50) than the private facility (US$ 59.3). The largest cost burden in both facilities was from direct cost, which constituted about 94% of the overall cost. Medicines (42%) and laboratory and diagnostics (26%) were the major drivers of the direct cost. The overall cost within the study population was US$10,252.06. Patients paid out of pocket for the frequently used drug- Timolol, although expected to be covered under the National Health Insurance Scheme (NHIS). Patients, however, expressed moderate intangible burdens due to glaucoma. Conclusion: The cost of the management of glaucoma is high from the perspective of patients. The direct costs were high, with the main cost drivers being medicines, laboratory and diagnostics. It is recommended that the National Health Insurance Authority (NHIA) should consider payment for commonly used medications to minimize the burden on patients. Funding: None declared.

Irisin attenuates acute glaucoma-induced neuroinflammation by activating microglia-integrin αVß5/AMPK and promoting autophagy.

Neuroinflammation, characterized by microglial activation and the release of multiple inflammatory mediators, is a key factor in acute glaucomatous injury leading to retinal ganglion cell (RGC) death and ultimately irreversible vision loss. Irisin, a novel exercise-induced myokine, has demonstrated anti-inflammatory activity in ischemia/reperfusion injuries across multiple organs and has displayed a significant neuroprotective role in experimental stroke disease models. This study examined the protective impact of irisin and investigated its potential mechanism involved in this process utilizing an acute ocular hypertension (AOH)-induced retinal injury model in mice and a microglia inflammation model induced by lipopolysaccharide (LPS). There was a transient downregulation of irisin in the retina after AOH injury, with parallel emergence of retinal neuroinflammation and RGC death. Irisin attenuated retinal and optic nerve damage and promotes the phenotypic conversion of microglia from M1 to M2. Mechanistically, irisin significantly upregulated the expression of integrin αVß5, p-AMPK, and autophagy-related markers. Integrin αVß5 was highly expressed on microglia but hardly expressed on RGC. The integrin αVß5 inhibitor cilengitide, the AMPK inhibitor dorsomorphin, and the autophagy inhibitor 3-Methyladenine (3-MA) blocked the neuroprotective effects of irisin. Our results suggest irisin attenuates acute glaucoma-induced neuroinflammation and RGC death by activating integrin αVß5/AMPK in microglia and promoting autophagy. It should be considered a potential neuroprotective therapy for acute glaucoma.

Insulin resistance in the retina: possible implications for certain ocular diseases.

Insulin resistance (IR) is becoming a worldwide medical and public health challenge as an increasing prevalence of obesity and metabolic disorders. Accumulated evidence has demonstrated a strong relationship between IR and a higher incidence of several dramatically vision-threatening retinal diseases, including diabetic retinopathy, age-related macular degeneration, and glaucoma. In this review, we provide a schematic overview of the associations between IR and certain ocular diseases and further explore the possible mechanisms. Although the exact causes explaining these associations have not been fully elucidated, underlying mechanisms of oxidative stress, chronic low-grade inflammation, endothelial dysfunction and vasoconstriction, and neurodegenerative impairments may be involved. Given that IR is a modifiable risk factor, it may be important to identify patients at a high IR level with prompt treatment, which may decrease the risk of developing certain ocular diseases. Additionally, improving IR through the activation of insulin signaling pathways could become a potential therapeutic target.

Influence of Laser Trabeculoplasty on Combined Phacoemulsification/Kahook Dual Blade Goniotomy.

Purpose: To investigate the influence of laser trabeculoplasty (LTP) on subsequent surgery with combined phacoemulsification/Kahook Dual Blade goniotomy (phaco-KDB) in patients with open-angle glaucoma or intraocular hypertension. Patients and Methods: Patients undergoing phaco-KDB between 2019 and 2021 were divided into previously LTP treated and previously non-LTP treated, and LTP-treatment included argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT). The primary goal was to investigate if previous LTP influenced later surgical outcome of phaco-KDB. The secondary goal was to investigate if the outcome of LTP could be predictive of the outcome of subsequent phaco-KDB. We also compared IOP- and medication reductions between LTP and non-LTP treated patients. Results: A total of 111 LTP treated patients were compared to 139 non-LTP treated patients. In LTP treated patients, surgical success of phaco-KDB was 82.9%, compared to 88.5% in non-LTP treated patients (P=0.20). Reductions in IOP and medications were similar between groups. Furthermore, within the LTP group, patients with successful LTP-treatment had a subsequent surgical success of phaco-KDB in 80.7%, compared to 83.0% in patients with unsuccessful LTP-treatment (P=0.765). Conclusion: Previous LTP treatment does not predict the outcome of phaco-KDB. Furthermore, no correlation was found between the LTP effect and a later surgical success of phaco-KDB.

Can Baseline Parapapillary Atrophy Morphology Predict Future Glaucoma Progression?- An OCT Glaucoma Imaging Study.

PURPOSE: To investigate glaucoma progression based on Optical Coherence Tomography (OCT) Guided Progression Analysis (GPA) according to baseline ß-zone parapapillary atrophy (PPA) morphology in glaucoma patients. DESIGN: Retrospective cohort study. METHODS: Patients over 20 years of age who had been diagnosed with primary open-angle glaucoma (POAG) at Seoul National University Hospital, Seoul, Korea between 2010 and 2020. This study included POAG patients with a minimum of 5 years of follow-up. We quantitatively measured the baseline ß-zone PPA parameters, classified ß-zone PPA morphology according to new classification standard we created and analyzed the corresponding GPA progression of the retinal nerve fiber layer (RNFL). RESULTS: A total of 210 patients with POAG (mean age: 53.8 years) were enrolled in the study. The mean follow-up period was 9.8 years. The average value of the baseline mean deviation in visual field perimetry was -2.48 dB. Longer radial extent and larger angular extent of ß-zone PPA were significantly associated with progression on GPA, as was the presence of disc hemorrhage. Among the 4 classified ß-zone PPA morphologies (Crescent type 1 & 2, Solar-eclipse type 1 & 2), the Solar-eclipse type 2 group showed the highest progression. A Kaplan-Meier survival analysis demonstrated significant differences among the 4 types. CONCLUSIONS: The larger the radial and angular extents of ß-zone PPA, the more progression that was shown on OCT GPA. Furthermore, significant differences in progression were noted based on the morphological type of ß-zone PPA. Our findings indicate that baseline ß-zone PPA parameters and morphology are valuable predictors of future glaucoma progression.

Current challenges in accessibility to ophthalmological care in Ukraine.

OBJECTIVE: Aim: The purpose of the study is to identify challenges in the organization and access to ophthalmic services through the analysis of expert opinion of practitioners and government officials. PATIENTS AND METHODS: Materials and Methods: Materials developed during expert interviews with practitioners and government officials were used in the study. We also used materials worked out within the project ID 22120107 supported by Visegrad Fund. CONCLUSION: Conclusions: Despite all the challenges in access to high-quality ophthalmology services, practitioners and government officials have common opinions on how to improve the organization of eye services, how to make care more inclusive and effective, so that the development of blindness and visual impairment does not cause a burden on the state and society.

Evaluation of machine learning approach for surgical results of Ahmed valve implantation in patients with glaucoma.

BACKGROUND: Ahmed valve implantation demonstrated an increasing proportion in glaucoma surgery, but predicting the successful maintenance of target intraocular pressure remains a challenging task. This study aimed to evaluate the performance of machine learning (ML) in predicting surgical outcomes after Ahmed valve implantation and to assess potential risk factors associated with surgical failure to contribute to improving the success rate. METHODS: This study used preoperative data of patients who underwent Ahmed valve implantation from 2017 to 2021 at Ajou University Hospital. These datasets included demographic and ophthalmic parameters (dataset A), systemic medical records excluding psychiatric records (dataset B), and psychiatric medications (dataset C). Logistic regression, extreme gradient boosting (XGBoost), and support vector machines were first evaluated using only dataset A. The algorithm with the best performance was selected based on the area under the receiver operating characteristics curve (AUROC). Finally, three additional prediction models were developed using the best performance algorithm, incorporating combinations of multiple datasets to predict surgical outcomes at 1 year. RESULTS: Among 153 eyes of 133 patients, 131 (85.6%) and 22 (14.4%) eyes were categorized as the success and failure groups, respectively. The XGBoost was shown as the best-performance model with an AUROC value of 0.684, using only dataset A. The final three further prediction models were developed based on the combination of multiple datasets using the XGBoost model. All datasets combinations demonstrated the best performances in terms of AUROC (dataset A + B: 0.782; A + C: 0.773; A + B + C: 0.801). Furthermore, advancing age was a risk factor associated with a higher surgical failure incidence. CONCLUSIONS: ML provides some predictive value in predicting the outcomes of Ahmed valve implantation at 1 year. ML evaluation revealed advancing age as a common risk factor for surgical failure.

Ab Interno Intraluminal Stent Insertion for Prolonged Hypotony After PreserFlo MicroShunt Implantation.

This study aimed to present an effective and minimally invasive method for treating prolonged hypotony after PreserFlo MicroShunt (PMS) implantation, which can cause serious complications. A 79-year-old man with primary open-angle glaucoma of the right eye underwent ab interno intraluminal stent insertion for prolonged hypotony after PMS implantation. After making two corneal incisions at the 5 and 8 o'clock positions in the right eye, a viscoelastic material was injected into the anterior chamber. A 10-0 nylon suture was inserted into the anterior chamber through a corneal incision in the 5 o'clock position. Next, the 10-0 nylon suture was grasped and inserted into the PMS lumen as a stent with forceps, following which it was cut approximately 1 mm from the tip of the PMS using micro-iris scissors. Finally, the viscoelastic material in the anterior chamber was washed with a balanced salt solution, and self-closure of the two corneal incisions was confirmed. After ab interno intraluminal stent insertion, hypotony improved and stabilized at approximately 10 mmHg. The shallow anterior chamber, choroidal detachment, and hypotonic maculopathy improved rapidly. This novel technique demonstrated effectiveness and minimal invasiveness in treating prolonged hypotony after PMS implantation.

[Virtual reality perimetry and home perimetry]. / "Virtual reality perimetry" und "home perimetry".

In this article virtual reality (VR)-based procedures for home perimetry (HP) are described and an overview is given of which procedures can already be used today.

Effect of intraocular pressure reduction on progressive high myopia (PHM study): study protocol of a randomised controlled trial.

BACKGROUND: In adult patients with high myopia (HM), progressive axial elongation poses a significant risk for the development of subsequent ocular complications that may lead to visual impairment. Effective strategies to reduce or prevent further axial elongation in highly myopic adult patients have not been available so far. Recent studies suggested that medically lowering intraocular pressure (IOP) may reduce axial elongation. OBJECTIVE: This clinical randomised controlled trial (RCT) aims to evaluate the efficacy of medical IOP reduction in adult patients with progressive HM (PHM). TRIAL DESIGN: Single-centre, open-label, prospective RCT. METHODS: This RCT will recruit 152 participants with PHM at the Zhongshan Ophthalmic Center (ZOC). Randomised in a ratio of 1:1, participants will receive IOP-lowering eyedrops (intervention group) or will be followed without treatment (control group) for 12 months. Follow-up visits will be conducted at 1, 6 and 12 months after baseline. Only one eye per eligible participant will be included for analysis. The primary outcome is the change in axial length (AL) within the study period of 12 months. Secondary outcomes include the incidence and progression of visual field (VF) defects, changes in optic disc morphology and incidence and progression of myopic maculopathy. Difference in AL changes between the two groups will be analysed using linear regression analysis. For the secondary outcomes, a multifactor Poisson regression within a generalised linear model will be used to estimate the relative risk of progression in VF defects and myopic maculopathy, and the rate of thinning in retinal nerve fibre layer and ganglion cell-inner plexiform will be assessed through Kaplan-Meier curves and log-rank tests. ETHICS AND DISSEMINATION: Full ethics approval for this trial has been obtained from the Ethics Committee of ZOC, Sun Yat-sen University, China (ID: 2023KYPJ110). Results of this trial will be disseminated through peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER: NCT05850936.

A Cross-Sectional Study on Knowledge, Awareness, Self-Care Practices About Glaucoma Among Doctors in South India.

Introduction Glaucoma is the major cause of irreversible blindness worldwide. Glaucoma affects the optic nerve head in the posterior segment of the eye and the defects lead to permanent blindness if left untreated. Poor knowledge about this disease is strongly correlated with delayed diagnosis. This study aimed to evaluate doctors' knowledge and self-care practices about glaucoma at a tertiary care hospital in Chennai, presuming that healthcare professionals constitute an effective conduit between the population at risk and ophthalmologists. Methods We carried out this cross-sectional survey among 252 doctors practicing allopathic medicine in a tertiary care hospital in Chennai from July 2022 to December 2022. We have collected 252 samples by simple random sampling method. We have excluded doctors who have a degree in ophthalmology or practicing it. The data collection was interview-based using a pre-designed, structured questionnaire that contained questions on sociodemographic characteristics age, gender, and specialty in medicine. It also included questions assessing knowledge and self-care practices about glaucoma among doctors of various specialties other than ophthalmology. We entered the collected data into Microsoft Excel (Microsoft Corporation, Redmond, WA), cleaned it, and analyzed it using SPSS version 16. Results The mean age of the doctors was 33.24 ± 10.90 years in this study. About 132 (52.4%) of the study participants were females. Only 91 (36.1%) of respondents knew that glaucoma may permanently impair vision, but nearly 240 (95.2%) believed that it could be treated. Two hundred seventeen (86.1%) participants were aware that glaucoma runs in families. About 218(86.5%) doctors were aware that glaucoma destroys the optic nerve in the eye, and 171 (67.9%) knew that peripheral vision loss happens before central vision loss. Only 146 (57.9%) of physicians had their eye pressure examined. About 232(92.1%) doctors had their eyes checked routinely. Only 42 (16.7%) of physicians took part in glaucoma awareness campaigns. Nearly 199 (79%) of those surveyed thought it was required to check a patient's family members for glaucoma. We note that among doctors, the knowledge and practice score of correct replies was strongly connected with work experience (P value = 0.035). Conclusion The need for extensive eye health education and information distribution for healthcare workers should be stressed. Teaching the hospital staff about the symptoms and prognosis of this "silent thief of sight" might be a crucial first step in providing preventive ophthalmic treatment.

Diagnostic ability of the combination of retinal microvasculature evaluation and static automated perimetry for early primary open-angle glaucoma.

PURPOSE: To investigate the diagnostic ability of retinal superficial vasculature evaluation by optic coherence tomography angiography (OCTA) combined with visual field (VF) testing for early primary open-angle glaucoma (POAG). PATIENTS AND METHODS: In this cross-sectional study, 84 participants were included, including 11 in the ocular hypertension (OHT) group, 11 in the preperimetric POAG (pre-POAG) group, 29 in the early POAG group and 33 in the control group. All participants underwent 6 × 6 mm2 scans of macula and optic nerved head by optic coherence tomography (OCT) and OCTA, along with white-on-white and blue-on-yellow VF testing by static automated perimetry. The ability of diagnosing early glaucoma by either various examinations separately or combination of examinations in both terms of function and structure was studied using the receiver operating characteristic (ROC) curve and the area under the curve (AUC). RESULTS: The superficial retinal vessel densities (VD) in peri-nasal, para-temporal, peri-temporal and peri-inferior regions around the macula, as well as vessel area densities (VAD) in all peripapillary regions, were significantly different among the four groups, with lower VD or VAD in the early POAG patients compared to the normal individuals. The diagnostic ability of peripapillary superficial retinal VAD alone or VF testing alone was limited for early POAG only. However, the combination of these two was more effective in distinguishing normal individuals from OHT subjects or pre-POAG patients without VF defects, with better performance than the combination of peripapillary retinal nerve fiber layer (RNFL) thickness and VF indicators. CONCLUSIONS: Peripapillary retinal vessel densities were generally lower in early POAG patients compared to normal individuals. The combination of peripapillary superficial retinal VAD by OCTA with white-on-white VF testing improved the ability to distinguish POAG patients at early stage without function impairment, which may help in providing reference and guidance for the following-up and treatment of suspected POAG patients.

[Epidemiological and clinical profile of ocular eviscerations in northern Algeria, about 136 cases]. / Profil épidémiologique et clinique des éviscérations oculaires au nord de l'Algérie, à propos de 136 cas.

Introduction: Despite the existence of well codified indications, the performance of mutilating surgery in ophthalmology is not an easy decision to take due to the aesthetic and moral damages that patients may suffer. This surgery should be considered as a last resort in the case of a non-functional, painful and unsightly eye or in the presence of an oncological involvement and after all conservative alternatives have been exhausted. This study aims to define the factors making it possible to favor ocular evisceration, which is the least mutilating of the above-mentioned surgeries, by determining the epidemiological and clinical aspects of the patients. In addition, the results of the study will serve as a starting point for epidemiological surveillance and will guide preventive activities and the fight against blindness. Material & method: We conducted an exhaustive retrospective study of medical records from the archives of the ophthalmology departments of the Dr. Tidjani Damardji University Hospital Center in Tlemcen, the Specialized Hospital Establishment in ophthalmology of Oran Hamou Boutlelis, the Specialized Hospital Establishment in ophthalmology of Oran Front de mer and the University Hospital Center of Bejaia (unit Franz Fanon), in order to specify the epidemiological-clinical profile of patients who have undergone an ocular evisceration in the north of Algeria from January 1, 2008 to December 31, 2014. Results & discussion: We have identified 136 patients, representing an admission rate of 0,13% in all these services. We noted a slight male predominance with an estimated sex-ratio of 1.4. Evisceration was carried out mainly following an ocular trauma in 39% of cases. The surgical technique performed in all patients is a classic non-conservative evisceration of "four quadrants" or "four squares" under general anesthesia in 55.9% of cases. Post-operative complications were found in 19.8% of patients in our series, the main one being exteriorization of the intra-scleral implant in 9.5% of cases. This rate corresponds to the data in the literature, with figures between 0 and 67%. This complication may be in relation with the experience or even the competence of the surgeon. Accessibility to ocularists and the quality of prosthetic equipment were also studied. All the data collected were compared with data from the international medical literature. Our study carried out in the north of Algeria on ocular eviscerations, allowed us to deduce that this surgery is rarely carried out in ophthalmology. Its main indications are post-traumatic and post-infectious. Conclusion: The prevention of mutilating surgeries requires early diagnosis and appropriate treatment of ophthalmological pathologies and trauma. Losing an eye is always experienced as a tragedy and can be devastating at any age, affecting self-image and self-esteem. Psychological support is therefore essential.

Predictive biomarkers of intra-ocular pressure decrease after cataract surgery associated with trabecular washout in patients with pseudo exfoliative glaucoma.

To investigate biomarkers of intra-ocular pressure (IOP) decrease after cataract surgery with trabecular washout in pseudo-exfoliative (PEX) glaucoma. A single-center observational prospective study in PEX glaucoma patients undergoing cataract surgery with trabecular washout (Goniowash) was performed from 2018 to 2021. Age, gender, visual acuity, IOP, endothelial cell count, central corneal thickness, medications, were collected over 16-month follow-up. Multivariable binomial regression models were implemented. 54 eyes (35 subjects) were included. Mean preoperative IOP (IOPBL) was 15.9 ± 3.5 mmHg. Postoperative IOP reduction was significant at 1-month and throughout follow-up (p < 0.01, respectively). IOPBL was a predictive biomarker inversely correlated to IOP decrease throughout follow-up (p < 0.001). At 1 and 12 months of follow-up, IOP decrease concerned 31 (57.4%) and 34 (63.0%) eyes with an average IOP decrease of 17.5% (from 17.6 ± 3.1 to 14.3 ± 2.2 mmHg) and 23.0% (from 17.7 ± 2.8 to 13.5 ± 2.6 mmHg), respectively. Performance (AUC) of IOPBL was 0.85 and 0.94 (p < 0.0001, respectively), with IOPBL threshold ≥ 15 mmHg for 82.1% and 96.8% sensitivity, 84.2% and 75.0% specificity, 1.84 and 3.91 IOP decrease odds-ratio, respectively. All PEX glaucoma patients with IOPBL greater than or equal to the average general population IOP were likely to achieve a significant sustainable postoperative IOP decrease.

The ketogenic diet and hypoxia promote mitophagy in the context of glaucoma.

Mitochondrial homeostasis includes balancing organelle biogenesis with recycling (mitophagy). The ketogenic diet protects retinal ganglion cells (RGCs) from glaucoma-associated neurodegeneration, with a concomitant increase in mitochondrial biogenesis. This study aimed to determine if the ketogenic diet also promoted mitophagy. MitoQC mice that carry a pH-sensitive mCherry-GFP tag on the outer mitochondrial membrane were placed on a ketogenic diet or standard rodent chow for 5 weeks; ocular hypertension (OHT) was induced via magnetic microbead injection in a subset of control or ketogenic diet animals 1 week after the diet began. As a measure of mitophagy, mitolysosomes were quantified in sectioned retina immunolabeled with RBPMS for RGCs or vimentin for Müller glia. Mitolysosomes were significantly increased as a result of OHT and the ketogenic diet (KD) in RGCs. Interestingly, the ketogenic diet increased mitolysosome number significantly higher than OHT alone. In contrast, OHT and the ketogenic diet both increased mitolysosome number in Müller glia to a similar degree. To understand if hypoxia could be a stimulus for mitophagy, we quantified mitolysosomes after acute OHT, finding significantly greater mitolysosome number in cells positive for pimonidazole, an adduct formed in cells exposed to hypoxia. Retinal protein analysis for BNIP3 and NIX showed no differences across groups, suggesting that these receptors were equivocal for mitophagy in this model of OHT. Our data indicate that OHT and hypoxia stimulate mitophagy and that the ketogenic diet is an additive for mitophagy in RGCs. The different response across RGCs and Müller glia to the ketogenic diet may reflect the different metabolic needs of these cell types.

Ocular inflammation in tsutsugamushi disease - a case report.

A 64-year-old male, working at a mountain site in Taitung County, suffered from primary open angle glaucoma (POAG) post trabeculectomy with well-controlled intraocular pressure (IOP) in both eyes (OU). He presented with headache accompanied by red eyes (OU) for 10 days. Physical examination revealed fever up to 38.2°C, neck stiffness, one eschar at the left forearm and another at the left ankle. Abnormal laboratory data indicated bacterial infection with central nervous system involvement. Ophthalmic examination showed elevated IOP, moderate conjunctival congestion, subconjunctival hemorrhage, anterior uveitis, cotton-wool spots on the retina and multiple white dots on the temporal retina (OU). Under the impression of uveitis in tsutsugamushi disease with atypical meningitis, oral doxycycline, anti-glaucoma and anti-inflammation eye drugs were prescribed. IOP returned to 12 mmHg and anterior uveitis subsided. The lesions of cotton-wool spots on the retina disappeared within 2 weeks, but multiple white dots remained persistently on the temporal retina.

Automated Classification of Physiologic, Glaucomatous, and Glaucoma-Suspected Optic Discs Using Machine Learning.

In order to generate a machine learning algorithm (MLA) that can support ophthalmologists with the diagnosis of glaucoma, a carefully selected dataset that is based on clinically confirmed glaucoma patients as well as borderline cases (e.g., patients with suspected glaucoma) is required. The clinical annotation of datasets is usually performed at the expense of the data volume, which results in poorer algorithm performance. This study aimed to evaluate the application of an MLA for the automated classification of physiological optic discs (PODs), glaucomatous optic discs (GODs), and glaucoma-suspected optic discs (GSODs). Annotation of the data to the three groups was based on the diagnosis made in clinical practice by a glaucoma specialist. Color fundus photographs and 14 types of metadata (including visual field testing, retinal nerve fiber layer thickness, and cup-disc ratio) of 1168 eyes from 584 patients (POD = 321, GOD = 336, GSOD = 310) were used for the study. Machine learning (ML) was performed in the first step with the color fundus photographs only and in the second step with the images and metadata. Sensitivity, specificity, and accuracy of the classification of GSOD vs. GOD and POD vs. GOD were evaluated. Classification of GOD vs. GSOD and GOD vs. POD performed in the first step had AUCs of 0.84 and 0.88, respectively. By combining the images and metadata, the AUCs increased to 0.92 and 0.99, respectively. By combining images and metadata, excellent performance of the MLA can be achieved despite having only a small amount of data, thus supporting ophthalmologists with glaucoma diagnosis.

Enhancing Medical Image Classification with an Advanced Feature Selection Algorithm: A Novel Approach to Improving the Cuckoo Search Algorithm by Incorporating Caputo Fractional Order.

Glaucoma is a chronic eye condition that seriously impairs vision and requires early diagnosis and treatment. Automated detection techniques are essential for obtaining a timely diagnosis. In this paper, we propose a novel method for feature selection that integrates the cuckoo search algorithm with Caputo fractional order (CFO-CS) to enhance the performance of glaucoma classification. However, when using the infinite series, the Caputo definition has memory length truncation issues. Therefore, we suggest a fixed memory step and an adjustable term count for optimization. We conducted experiments integrating various feature extraction techniques, including histograms of oriented gradients (HOGs), local binary patterns (LBPs), and deep features from MobileNet and VGG19, to create a unified vector. We evaluate the informative features selected from the proposed method using the k-nearest neighbor. Furthermore, we use data augmentation to enhance the diversity and quantity of the training set. The proposed method enhances convergence speed and the attainment of optimal solutions during training. The results demonstrate superior performance on the test set, achieving 92.62% accuracy, 94.70% precision, 93.52% F1-Score, 92.98% specificity, 92.36% sensitivity, and 85.00% Matthew's correlation coefficient. The results confirm the efficiency of the proposed method, rendering it a generalizable and applicable technique in ophthalmology.

The Ocular Glymphatic System-Current Understanding and Future Perspectives.

The ocular glymphatic system subserves the bidirectional polarized fluid transport in the optic nerve, whereby cerebrospinal fluid from the brain is directed along periarterial spaces towards the eye, and fluid from the retina is directed along perivenous spaces following upon its axonal transport across the glial lamina. Fluid homeostasis and waste removal are vital for retinal function, making the ocular glymphatic fluid pathway a potential route for targeted manipulation to combat blinding ocular diseases such as age-related macular degeneration, diabetic retinopathy, and glaucoma. Several lines of work investigating the bidirectional ocular glymphatic transport with varying methodologies have developed diverging mechanistic models, which has created some confusion about how ocular glymphatic transport should be defined. In this review, we provide a comprehensive summary of the current understanding of the ocular glymphatic system, aiming to address misconceptions and foster a cohesive understanding of the topic.

Advancing Glaucoma Care in Bangladesh With Minimally Invasive Glaucoma Surgery.

Minimally invasive glaucoma surgery (MIGS) is a cutting-edge approach to treating glaucoma that provides a range of techniques and technology to reduce intraocular pressure (IOP). An 80-year-old man with visually significant cataracts and primary open-angle glaucoma (POAG) underwent combined cataract surgery and TrabEx+ (MicroSurgical Technology, Washington, United States) in his left eye, a unique type of MIGS, as we described in this study. Over the one-year follow-up, this patient showed improved visual function with well-controlled IOP without anti-glaucoma medications.