Characterization of laser speckle flowgraphy pulse waveform parameters for the evaluation of the optic nerve head and retinal circulation.

To characterize laser speckle flowgraphy (LSFG) pulse waveform parameters for ocular circulation evaluation, a multicenter, prospective, cross-sectional study was conducted in 111 eyes of 86 healthy Japanese individuals. Optic nerve head (ONH) tissue-area, vessel-area mean blur rate (MT and MV, respectively), and MT and MV pulse waveform parameters were obtained using LSFG and ONH structural parameters using planimetry. Multivariate linear mixed-effects modeled regression analysis identified factors contributing to MT- or MV-waveforms using age, gender, smoking history, body mass index, systolic and diastolic blood pressure, heart rate, intraocular pressure, axial length, disc, rim, and ß-peripapillary atrophy areas, MT or MV, central retinal artery, and vein equivalents (CRAE and CRVE) as explanatory variables. MT- and MV-waveforms significantly correlated with one or more systemic factors, consistent with previous studies. Following confounding factor adjustment, MT-Skew significantly negatively correlated with ß-PPA area (P = 0.026); MT- and MV-flow acceleration index positively correlated with CRAE, MT, and MV (P = 0.041-< 0.001), compatible with these parameters' observed correlations to systemic factors. Significantly negative correlations of the blowout score and acceleration time index to CRAE partly conflicted with their correlations to systemic factors, and other waveform parameters showed little correlation to ocular factors. Thus, Skew and flow acceleration index assisted the in vivo ocular circulation characterization.

Ocular and Systemic Factors Affecting Laser Speckle Flowgraphy Measurements in the Optic Nerve Head.

Purpose: To investigate the ocular and systemic factors related to glaucoma and to be adjusted for interindividual comparison of ocular blood flow measurement results by laser speckle flowgraphy (LSFG) obtained from the optic nerve head (ONH) in normal Japanese individuals. Methods: A multicenter, prospective cross-sectional study was conducted. The ONH tissue-area and vessel-area mean blur rate (MT and MV) were evaluated using LSFG and ONH structural parameters using planimetric methods. Multivariate linear mixed-effects modeled regression analysis was used to identify the contributing factors to the MT and MV. The explanatory variables were age; gender; smoking history; body mass index; mean arterial pressure (MAP); heart rate; intraocular pressure; axial length (AL); disc, rim, cup, and ß-peripapillary atrophy (ß-PPA) areas; and central retinal artery and vein equivalents. Results: In total, 195 eyes of 126 healthy individuals with an average age of 48.1 years were included. Multivariate analysis showed that MAP and disc area had a negative (P < 0.001) correlation, whereas ß-PPA area had a positive correlation with MT (P = 0.010). Age and AL had a negative correlation (P = 0.001 and P = 0.011, respectively), whereas cup area had a positive correlation (P = 0.012) with MV. Conclusions: Interindividual comparison of MT or MV must be adjusted for both systemic factors (blood pressure or age) and local ocular factors (AL and disc, cup, or ß-PPA area). Translational Relevance: Our results provided reference data on the LSFG measurement and are important in comparing ocular blood flow between individuals using LSFG.

One-Year Efficacy and Safety Assessment of Ripasudil, a Rho Kinase Inhibitor, in an Addition to or Replacing Existing Treatment Regimens: A Retrospective Study.

Purpose: To evaluate efficacy and safety of ripasudil for 1 year in addition to or replacing existing treatment regimens. Methods: We retrospectively reviewed the medical records for 128 eyes of 128 glaucoma patients who were prescribed ripasudil as an addition to or a switch from their preexisting antiglaucoma instillations. We investigated the rate and factors for discontinuation and intraocular pressure (IOP) reduction. Results: Almost half of the patients (60 eyes) discontinued ripasudil treatment before the 1 year mark, while remaining patients completed the treatment. The lack of efficacy and development of adverse effects were significantly correlated with discontinuation (P < 0.001) in the Cox proportional hazards model. In the Kaplan-Meier curve, adverse effects occurred in earlier phase and almost 60% dropped out within 3 months after ripasudil administration. However, adverse effects also occurred randomly throughout the study period. In patients who continued ripasudil, the mean IOPs (mmHg) at baseline, 6 and 12 months after treatment were 17.7 ± 5.1, 14.6 ± 5.0, and 14.8 ± 3.8 in the Addition group, and 17.8 ± 4.1, 15.4 ± 3.2, and 15.4 ± 5.0 in the Switch group, respectively (all P values <0.05). Conclusions: Almost half of the patients discontinued ripasudil owing to the lack of efficacy and the generation of adverse effects within the 1 year. In the remaining half, the addition and switching of ripasudil to the existing glaucoma treatment effectively reduced IOP for 1 year.

Pulse Waveform Analysis of the Ocular Blood Flow Using Laser Speckle Flowgraphy before and after Glaucoma Treatment.

Although reduction in intraocular pressure (IOP) is the principle of glaucoma treatment, impaired ocular blood flow is believed to play a role in the progression of glaucoma. This study evaluated the effect of glaucoma treatment on pulse waveforms for optic nerve head (ONH) microcirculation in patients with glaucoma. Fifty-one subjects were included on the basis of the glaucoma treatment administered, which involved instillation of prostaglandin (PG) analogs (PG group; n = 28) or trabeculectomy (trabeculectomy group; n = 23). ONH blood flow, represented by the mean blur rate (MBRT) and pulse waveforms, was measured using laser speckle flowgraphy before and 1 and 3 months after treatment. Three months after treatment, IOP exhibited a significant decrease (p < 0.05). Although there was no significant change in MBRT after treatment, the acceleration time index (ATI) significantly decreased (p=0.034) in the PG group. In the trabeculectomy group, there was no significant change in the MBRT after treatment, while fluctuation (p=0.019) and blowout score (BOS) (p=0.036) exhibited significant decrease and increase, respectively. Multiple regression analysis showed that mean deviation was significantly associated with the rate of change in the BOS (p=0.013), age was a significant contributing factor for the rate of change in fluctuation in the trabeculectomy group, reflection was significantly associated with the ATI (p=0.037) in the in the PG group. Both glaucoma treatments can change the pulse waveforms, with MBRT remaining unchanged, and IOP reduction owing to the treatment may contribute to stable blood flow in the tissue area of the ONH. As impaired ocular blood flow plays a role in the progression of glaucomatous damage, it would be beneficial if glaucoma treatment could improve the stability of ONH microcirculation.

Macular vessel density in untreated normal tension glaucoma with a hemifield defect.

PURPOSE: To investigate macular vessel density (MVD) and structural alterations in untreated normal tension glaucoma (NTG) with a hemifield defect (HFD) and to compare these with the findings in healthy eyes. STUDY DESIGN: Case series with a healthy group for comparison. METHODS: Thirty-four eyes of 34 untreated NTG patients with HFD and 28 eyes of 28 healthy subjects were enrolled. RTVue-XR AvantiTM (Optovue, Inc.), a combined OCT-A and SD-OCT system, was used to determine MVD and inner macular thickness (IMT) measurements. Mean circumpapillary retinal nerve fiber (cpRNFL) and macular ganglion cell complex (mGCC) thicknesses were measured with the RTVue-100TM (Optovue, Inc.). Wilcoxon signed-rank test was used to evaluate differences between defective and normal hemifields in NTG eyes and Mann-Whitney U test to evaluate differences between normal hemifields in NTG eyes and healthy eyes. RESULTS: In comparison with healthy eyes, the normal hemifields of NTG eyes showed significantly reduced MVD, as well as cpRNFL and mGCC thicknesses, although IMT did not differ between the two groups. The defective hemifield in NTG eyes showed significantly reduced IMT, as well as cpRNFL and mGCC thicknesses, compared with the normal hemifield, although MVD did not differ between the two hemifields. CONCLUSION: Hemodynamic deficiencies and structural damage might have already begun in the perimetrically normal hemifields of NTG eyes. Further studies are needed to elucidate whether the reduction in MVD may precede structural changes or the reduction in vasculature and structural loss may vary with disease severity in at least in some cases.

Factors Related to Superior and Inferior Hemifield Defects in Primary Open-Angle Glaucoma.

PURPOSE: We aimed to investigate factors related to superior and inferior hemifield defects in primary open-angle glaucoma (POAG). METHODS: Sixty-seven subjects with newly diagnosed, untreated POAG underwent optical coherence tomography (OCT) of the disc area, macular ganglion cell complex (mGCC), and circumpapillary retinal nerve fiber layer (cpRNFL) thickness within 6 months of the visual field (VF) test. Based on the VF and OCT results, 40 subjects had a superior and 27 an inferior hemifield defect. Clinical data including visual acuity, refractive error, disc hemorrhage, VF indexes, and medical history were recorded. RESULTS: Average mGCC thickness corresponding to the defective hemifields was thinner in the superior VF defect group than in the inferior VF defect group (P=0.003). Average total deviation (TD) was comparable between the two groups. However, the superior VF defect group had a higher prevalence of defects (P=0.001) and lower TD (P=0.002) within central 5 degrees of VF than the inferior VF defect group. In multivariate regression analyses, the temporal-lower and inferior-temporal cpRNFL thicknesses were significant contributing factors to the inferior mGCC thickness in the superior VF defect group. In the inferior VF defect group, the disc area, family history of glaucoma, and temporal-upper cpRNFL thickness contributed to the superior mGCC thickness. CONCLUSION: The inferior mGCC thickness corresponding to the superior hemifield defect group was significantly thinner than the superior mGCC thickness corresponding to the inferior hemifield defect group. The factors related to the reduction of the corresponding mGCC thickness may differ between superior VF defect and inferior VF defect groups.

Relationship between Macular Vessel Density and Focal Electroretinograms in Early Normal Tension Glaucoma.

Purpose: To evaluate the relationship between the macular vessel density and photopic negative response (PhNR) amplitude of focal electroretinograms (ERGs) in patients with early-stage normal tension glaucoma (NTG). Materials and Methods: This prospective cross-sectional study included a total of 42 subjects with early-stage NTG. Optical coherence tomography angiography was used to measure macular vessel density, and focal ERGs were elicited by a white light stimulus (30 cd/m2) with background light (1.5 cd/m2). The amplitude of the PhNR was measured from the peak of the b-wave to the PhNR trough. Mean visual field sensitivity was measured by the Humphrey Field Analyzer (HFA) program central 10-2. Spearman's coefficients were used to evaluate the correlation between the macular vessel density, PhNR amplitude, mean deviation (MD) of the HFA 10-2, retinal nerve fiber layer (RNFL) thickness, and ganglion cell complex (GCC) thickness measured by spectral domain-optical coherence tomography. Results: The mean MD of the HFA 10-2 was -2.0 ± 3.2 dB. The PhNR amplitude significantly correlated with the macular vessel density (r = 0.420, P = 0.006), but not with the MD, GCC thickness, or RNFL thickness. The macular vessel density significantly correlated with the MD (r = 0.364, P = 0.018) and RNFL thickness (r = 0.369, P = 0.016), but not with GCC thickness (r = 0.266, P = 0.089). Conclusions: Macular vessel density significantly correlated with PhNR amplitude in patients with early-stage NTG, suggesting that microvascular alterations are associated with functional changes recorded by focal ERG in very early-stage glaucoma.

Comparison of Optical Coherence Tomography Angiography and Laser Speckle Flowgraphy for the Diagnosis of Normal-Tension Glaucoma.

PURPOSE: To compare optical coherence tomography angiography (OCT-A) and laser speckle flowgraphy (LSFG) for the diagnosis of normal-tension glaucoma (NTG). METHODS: Twenty-eight eyes of 28 patients with NTG and 25 eyes of 25 normal subjects matched for age, refractive errors, systemic blood pressure, and central corneal thickness were evaluated. OCT-A was used to measure whole image vessel density, inside disc vessel density, and peripapillary vessel density; using LSFG, mean blur rate (MBR) inside the whole optic nerve head (ONH) area (MBRA), and MBR of the vessel area (MBRV) and tissue area (MBRT) inside the ONH, were determined. Receiver operating characteristic (ROC) curves and areas under the ROC (AUROC) were used to assess the diagnostic ability of each variable. RESULTS: The AUROC for OCT-A whole image vessel density (0.950) was significantly greater than that for OCT-A peripapillary vessel density (0.830) and for all LSFG parameters (MBRA = 0.793, MBRV = 0.601, and MBRT = 0.61) (P < 0.001). The AUROC for OCT-A inside disc vessel density (0.931) was significantly greater than that for all LSFG parameters (P < 0.005). CONCLUSIONS: OCT-A vessel density had a higher glaucoma diagnostic ability compared to all LSFG parameters in patients with NTG.

Factors Related to a Right-Left Difference in Visual Field Defect in the Eyes with Untreated Normal Tension Glaucoma.

PURPOSE: To investigate factors related to a right-left difference in visual field defect in untreated normal tension glaucoma (NTG). METHODS: The medical records of 92 patients with untreated NTG were reviewed. Ocular blood flow was evaluated with laser speckle flowgraphy, and the mean blur rate (MBR) at the optic nerve head was analyzed. Relationships between right-left differences in mean deviation (MD), intraocular pressure, MBR, spherical equivalent, central corneal thickness, and mean ocular perfusion pressure were evaluated using Spearman's rank correlation coefficient. Multiple regression analysis was used to detect factors contributing to a right-left difference in MD. RESULTS: The right-left difference in MD was correlated with differences in intraocular pressure (r = -0.263, P = 0.011), MBR (r = 0.417, P < 0.001), and spherical equivalent (r = 0.213, P = 0.042), but not with central corneal thickness or mean ocular perfusion pressure. Multiple regression analysis showed that a difference in MBR was the only significant contributor to a right-left difference in MD (slope 0.047, 95% confidence interval 0.025-0.069; P < 0.001). CONCLUSION: In untreated NTG, a difference in blood flow at the optic nerve head was a significant contributor to a right-left difference in visual field defect.

Association between Optic Nerve Head Microcirculation and Macular Ganglion Cell Complex Thickness in Eyes with Untreated Normal Tension Glaucoma and a Hemifield Defect.

Purpose. We evaluated the association between optic nerve head (ONH) microcirculation and macular ganglion cell complex (mGCC) thickness in patients with untreated normal tension glaucoma (NTG) and a hemifield defect. Methods. The medical records of 47 patients with untreated NTG were retrospectively reviewed. Laser speckle flowgraphy was used to obtain mean blur rate (MBR), a relative measure of blood flow. Average total deviation (TD), mGCC, and the circumpapillary retinal nerve fiber layer (cpRNFL) thickness were also analyzed. Results. All parameters corresponding to the defective hemifield were significantly lower than those corresponding to the normal hemifield. In the defective hemifield, MBR was correlated with TD, mGCC, and cpRNFL thickness. In the normal hemifield, MBR was only correlated with mGCC thickness, and multiple regression analysis showed that mGCC thickness was a significant contributing factor of the MBR. Conclusion. MBR was well correlated with mGCC thickness in eyes with untreated NTG and a hemifield defect. In the normal hemifield, mGCC thickness was a contributing factor of the MBR indicating that ONH circulatory dysfunction may be associated with retinal structural changes in the early stages of glaucoma. A reduction in ONH microcirculation may be an early indicator of the presence and progression of glaucoma.

The clinical utility of measuring the macular outer retinal thickness in patients with glaucoma.

PURPOSE: Few optical coherence tomography (OCT) studies have investigated outer retinal thickness including the photoreceptor layer in glaucoma. We measured changes in the macular outer retinal thicknesses using OCT in patients with glaucoma with an average follow-up of 2.9 ± 0.8 years. METHODS: A total of 39 eyes of 39 patients with primary open-angle glaucoma were analyzed. The RTVue-100 was used to measure the macular outer retinal, macular ganglion cell complex, and circumpapillary retinal nerve fiber layer thicknesses, global loss volume, and focal loss volume. Using the paired t test, baseline parameters were compared with those at the last follow-up. RESULTS: The average baseline mean deviation value in the Humphrey Field Analyzer was -2.13 dB. The ganglion cell complex thickness significantly decreased over the follow-up period (baseline thickness, 79.66 ± 7.71 µm; final thickness, 76.79 ± 7.39 µm; p<0.001). There were significant differences between baseline and final visit measurements for circumpapillary retinal nerve fiber layer thickness, global loss volume, and focal loss volume (p<0.001, p<0.001, and p = 0.004, respectively). However, there was no significant change in outer retinal thickness (baseline thickness, 167.56 ± 7.26 µm; final thickness, 167.25 ± 7.93 µm; p = 0.540). CONCLUSIONS: Outer retinal thickness was not altered during the follow-up period. The stability of outer retinal thickness may indicate the reliability of OCT analysis for glaucoma follow-up.

Erratum to "Size of the Optic Nerve Head and Its Relationship with the Thickness of the Macular Ganglion Cell Complex and Peripapillary Retinal Nerve Fiber Layer in Patients with Primary Open Angle Glaucoma".

[This corrects the article DOI: 10.1155/2015/186249.].

Size of the Optic Nerve Head and Its Relationship with the Thickness of the Macular Ganglion Cell Complex and Peripapillary Retinal Nerve Fiber Layer in Patients with Primary Open Angle Glaucoma.

Purpose. To evaluate the relationships among the optic nerve head (ONH) area, macular ganglion cell complex (mGCC) thickness, circumpapillary retinal nerve fiber layer (cpRNFL) thickness, and visual field defects in patients with primary open angle glaucoma (POAG). Methods. This retrospective study included 90 eyes of 90 patients with POAG. The ONH area, rim area, mGCC thickness, and cpRNFL thickness were measured using optical coherence tomography. Mean deviation (MD) was measured using standard automated perimetry. The relationships among clinical factors including age, refraction, the ONH area, the rim area, the mGCC thickness, the cpRNFL thickness, and MD were evaluated using correlation coefficients and multiple regression analyses. Results. The significant correlation of the ONH area with refraction (r = 0.362, P < 0.001), the mGCC thickness (r = 0.225, P = 0.033), and the cpRNFL thickness (r = 0.253, P = 0.016) was found. Multiple regression analysis showed that the ONH area, rim area, and MD were selected as significant contributing factors to explain the mGCC thickness and cpRNFL thickness. No factor was selected to explain MD. Conclusions. The ONH area, in other words, the disc size itself may affect the mGCC thickness and cpRNFL thickness in POAG patients.

Conjunctival complications related to Ahmed glaucoma valve insertion.

PURPOSE: Conjunctival complications may occur after glaucoma drainage device surgery. We analyzed the frequency, risk factors, management and outcomes of Ahmed glaucoma valve (AGV)-related conjunctival complications. METHODS: Retrospective review of postoperative conjunctival complications in patients undergoing AGV insertion. Only subjects with ≥1-year follow-up were included. RESULTS: The charts of 158 subjects with a median age of 64±16.2 years were reviewed. Median follow-up was 43.5 months (range, 12 to 103 mo). Fifty-three (33.5%) wound dehiscences and 14 (8.9%) device exposures were diagnosed 31.6±35.7 and 996±735 days after procedure, respectively (P<0.001). Ninety-one subjects (57.6%) had no conjunctival complications. This uncomplicated group used 3.3 (±1.1) [95% confidence interval (CI): 3.07, 3.51] hypotensive medications before surgery as compared with 3.8 (±1.1) (95% CI: 3.48, 4.10) and 3.9 (±0.9) (95% CI: 3.36, 4.36) for dehiscence and exposure groups, respectively (P=0.01). The inferonasal quadrant was associated with the highest rate of dehiscences (4/7, 57.1%) (95% CI: 18.4, 90.1), followed by the inferotemporal quadrant (30/65, 46.2%) (95% CI: 33.1, 58.2), the superotemporal (15/61, 24.6%) (95% CI: 12.9, 33.8), and the superonasal (4/25, 16%) (95% CI: 10.9-52.0; P<0.0073). There were no differences in dehiscence and exposure rates between limbal versus fornix-based approaches (P=0.54; 95% CI: 24.8-44.9, 24.4-45.7, 5.9-19.6, 3-45.1, respectively). Forty-eight (90.6%) dehiscent wounds resolved with conservative management and 5 were resutured, whereas all exposed devices were managed surgically. CONCLUSIONS: Conjunctival dehiscence is usually a benign, common complication after AGV insertion. It does not need repair as long as the tube is well covered. AGV tube or plate exposures are less common, occur later and were promptly repaired as per current practice. Important factors predisposing to these problems include a greater number of preoperative hypotensive medications and the implantation quadrant.

Baseline thickness of macular ganglion cell complex predicts progression of visual field loss.

BACKGROUND: Previous studies reported that the thickness of the macular ganglion cell complex (mGCC) showed good diagnostic ability for detecting glaucoma. However, its impact on the progression of visual field loss in primary open angle glaucoma (POAG) is unknown. The purpose of this study was to assess whether baseline mGCC thickness is associated with the progression of visual field loss in POAG. METHODS: Fifty-six patients with POAG were included in the study. All patients were followed for more than 2 years after baseline optical coherence tomography (OCT) measurements. They had at least five reliable Humphrey visual field tests with 30-2 Swedish Interactive Threshold Algorithm standard tests during the follow-up period. The subjects were divided into two groups according to the slope of the mean deviation (MD): the fast progression group (MD slope < -0.4 dB/y) and the slow progression group (MD slope ≥ -0.4 dB/y). Factors compared between the groups were as follows: age, baseline intraocular pressure (IOP), mean IOP during the follow-up, refraction, baseline MD, pattern standard deviation (PSD), and baseline OCT measurements. RESULTS: There were no significant differences between the two groups in age, baseline IOP, mean IOP during the follow-up, refraction, baseline MD or PSD, average thickness of retinal nerve fiber layer (RNFL), or disc parameters. However, the baseline mGCC thickness (average and inferior hemifield) was significantly thinner in the fast progression group than in the slow progression group (74.0 ± 7.2 µm vs. 80.3 ± 8.6 µm; 68.0 ± 6.6 µm vs. 78.2 ± 11.6 µm, respectively). Moreover, global loss volume and focal loss volume, which are parameters of mGCC, showed significantly higher rates in the fast progression group than in the slow progression group. In multivariate analysis, only mGCC thickness of the inferior hemifield was associated with disease progression (P = 0.007). CONCLUSIONS: Baseline mGCC thickness can be predictive of progressive visual field loss in patients with POAG.

Relationship between macular ganglion cell complex thickness and macular outer retinal thickness: a spectral-domain optical coherence tomography study.

BACKGROUND: To assess the relationship between macular ganglion cell complex and macular outer retinal thicknesses. DESIGN: Case-control study. PARTICIPANTS: Forty-two normal eyes and 91 eyes with primary open-angle glaucoma were studied. METHODS: Spectral-domain optical coherence tomography (RTVue-100) was used to measure the macular ganglion cell complex and macular outer retinal thickness. Ganglion cell complex to outer retinal thickness ratio was also calculated. MAIN OUTCOME MEASURES: The relationships between the ganglion cell complex and outer retinal thicknesses and between the ganglion cell complex to outer retinal thickness ratio and outer retinal thickness were evaluated. RESULTS: There was a positive correlation between ganglion cell complex and outer retinal thicknesses in the normal group and the glaucoma group (r = 0.53, P < 0.001 and r = 0.42, P < 0.001, respectively). In that respect, there was no correlation between ganglion cell complex to outer retinal thickness ratio and outer retinal thickness in the both groups (r = -0.07, P = 0.657, and r = 0.04, P = 0.677, respectively). The ganglion cell complex to outer retinal thickness ratio was 55.65% in the normal group, 45.07% in the glaucoma group. This difference was statistically significant. CONCLUSIONS: The ganglion cell complex thickness may be affected by outer retinal thickness, and there is individual variation in the outer retinal thickness. Therefore, when determining the ganglion cell complex, it seems necessary to consider the outer retinal thickness as well. We propose the ratio as a suitable parameter to account for individual variations in outer retinal thickness.

Evaluation of investigator bias in industry-funded clinical trials of latanoprost.

OBJECTIVE: To determine whether sponsorship of prostaglandin analogue (PGA) clinical trials results in investigator bias in outcomes when studying intraocular pressure (IOP). DESIGN: Retrospective, observational cohort study. METHODS: A PubMed search was performed for latanoprost or Xalatan, bimatoprost or Lumigan, and travoprost or Travatan, with limits to humans, clinical trials, and English language. Inclusion criteria included randomized controlled trials, open-angle glaucoma, monotherapy with a PGA, baseline IOP ≥ 21 mm Hg, washout period, and minimum 1-month follow-up. Each article was reviewed by 2 independent reviewers. The results of IOP for each PGA were categorized as being sponsored by the parent company (the company manufacturing the PGA); by the competing company (the company manufacturing competing glaucoma therapy); or by a nonindustry source. The mean IOP and changes in IOP from baseline were compared among the 3 categories of sponsorship. RESULTS: Only studies involving latanoprost were analyzed because of the low number of studies meeting the inclusion criteria for bimatoprost and travoprost. We found 29 and 13 studies that provided 1- and 3-month data, respectively, for analysis. The mean baseline IOPs in the 3 groups (parent company, competing company, nonindustry) were not significantly different (p = 0.47). The mean IOP at 1 (p = 0.72) and 3 months (p = 0.59) and the change in IOP from baseline (p = 0.83 and 0.90, respectively) were not significantly different in the 3 groups. A random-effects metaregression controlling for the covariates of blinding, naïveté to PGAs, and baseline IOP < 24 mm Hg or ≥ 24 mm Hg did not change the findings. CONCLUSION: There was no evidence of investigator bias in determining outcomes for IOP in these clinical trials of latanoprost.

The Toronto epidemiology glaucoma survey: a pilot study.

OBJECTIVE: To evaluate the prevalence of undetected glaucoma in a Toronto population. DESIGN: A cross-sectional survey. PARTICIPANTS: Toronto residents aged 50 years or older. METHODS: Telephone calls were randomly made to Toronto residents. Those who indicated they did not have glaucoma were invited to the Toronto Western Hospital for a comprehensive ophthalmic assessment, including best corrected visual acuity testing, applanation tonometry, pachymetry, gonioscopy, disc assessment, frequency doubling technology, and Heidelberg retinal tomography. Patient suspected to have glaucoma were asked to return for further evaluation, including a 24-2 Humphrey automated visual field test, repeat Heidelberg retinal tomography, repeat disc assessment, and possibly a diurnal tension curve. The diagnosis of glaucoma was made based on standardized criteria modified from those used by the Rotterdam Study and Foster and associates. RESULTS: Among 975 eligible respondents, 73 (7.5%) stated that they had glaucoma. Of the remaining 902 negative respondents, 271 booked clinical appointments, and 180 completed the clinical assessment; their mean age was 61.6 years. Of the participants, 7 (3.9%) were diagnosed with glaucoma: 5 (2.8%) had primary open-angle glaucoma (3 with low-pressure and 2 with high-pressure glaucoma); 1 had (0.6%) chronic angle-closure glaucoma; and 1 (0.6%) had pseudoexfoliation glaucoma. A further 8 (4.4%) participants were classified as probably having open-angle glaucoma and 33 (18.3%) as being suspected to have glaucoma. Narrow angles were found in 27 participants (15%), and 37 (20.6%) had family histories of glaucoma. CONCLUSION: The prevalence of undetected glaucoma appears to be high in Toronto. Further studies involving larger numbers of participants are required to confirm this finding.

Survey of conflict-of-interest disclosure policies of ophthalmology journals.

PURPOSE: To survey the disclosure policy for authors, peer reviewers, and editors in English-language ophthalmology journals. DESIGN: Cross-sectional survey. PARTICIPANTS: English-language ophthalmology journals. METHODS: All indexed English-language ophthalmology journals were identified. The journals' websites were reviewed for published conflict-of-interest disclosure policies for authors, peer reviewers, and editors. In cases where no policy was found, the journal's editor was contacted directly to confirm if a policy existed. MAIN OUTCOME MEASURES: The existence of conflict-of-interest policy for authors, peer reviewers, and editors. RESULTS: Forty-two English-language ophthalmology journals were identified. Web-based published conflict-of-interest policies were found for authors in 33 (79%), for peer reviewers in 3 (7%), and for editors in 2 (5%) of the 42 journals. After contacting those journals with no published policies, these numbers increased to 37 (100%) of 37 for authors, 18 (60%) of 30 for peer reviewers, and 10 (33%) of 30 for editors. Seven journals with published disclosure policies for authors, but not for peer reviewers or editors, did not respond to the survey, and a further 5 journals without any published disclosure policy did not respond to the survey. Journals with a higher impact factor were more likely to have a web-based published disclosure policy for peer reviewers and a disclosure policy for editors. CONCLUSIONS: Most English-language ophthalmology journals have a conflict-of-interest policy for authors; however, they are not publicly available in 21% of journals. Conflict-of-interest policies for peer reviewers and editors are less common and are more likely not to be published compared with those for authors. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.