Method to Quickly Map Multifocal Pupillary Response Fields (mPRF) Using Frequency Tagging.

We present a method for mapping multifocal Pupillary Response Fields in a short amount of time using a visual stimulus covering 40° of the visual angle divided into nine contiguous sectors simultaneously modulated in luminance at specific, incommensurate, temporal frequencies. We test this multifocal Pupillary Frequency Tagging (mPFT) approach with young healthy participants (N = 36) and show that the spectral power of the sustained pupillary response elicited by 45 s of fixation of this multipartite stimulus reflects the relative contribution of each sector/frequency to the overall pupillary response. We further analyze the phase lag for each temporal frequency as well as several global features related to pupil state. Test/retest performed on a subset of participants indicates good repeatability. We also investigate the existence of structural (RNFL)/functional (mPFT) relationships. We then summarize the results of clinical studies conducted with mPFT on patients with neuropathies and retinopathies and show that the features derived from pupillary signal analyses, the distribution of spectral power in particular, are homologous to disease characteristics and allow for sorting patients from healthy participants with excellent sensitivity and specificity. This method thus appears as a convenient, objective, and fast tool for assessing the integrity of retino-pupillary circuits as well as idiosyncrasies and permits to objectively assess and follow-up retinopathies or neuropathies in a short amount of time.

Spatial attention and central crowding in primary open angle glaucoma.

CLINICAL RELEVANCE: Measuring the impact of spatial attention on signal detection in damaged parts of the visual field can be a useful tool for eye care practitioners. BACKGROUND: Studies on letter perception have shown that glaucoma exacerbates difficulties to detect a target within flankers (crowding) in parafoveal vision. A target can be missed because it is not seen or because attention was not focused at that location. This prospective study evaluates the contribution of spatial pre-cueing on target detection. METHOD: Fifteen patients and 15 age-matched controls were presented with letters displayed for 200 ms. Participants were asked to identify the orientation of the target letter T in two conditions: an isolated letter (uncrowded condition) and a letter with two flankers (crowded condition). The spacing between target and flankers was manipulated. The stimuli were randomly displayed at the fovea and at the parafovea at 5° left or right of fixation. A spatial cue preceded the stimuli in 50% of the trials. When present, the cue always signalled the correct location of the target. RESULTS: Pre-cueing the spatial location of the target significantly improved performance for both foveal and parafoveal presentations in patients but not in controls who were at ceiling level. Unlike controls, patients exhibited an effect of crowding at the fovea with a higher accuracy for the isolated target than for the target flanked by two letters with no spacing between the elements. CONCLUSION: Higher susceptibility to central crowding supports data showing abnormal foveal vision in glaucoma. Exogenous orienting of attention facilitates perception in parts of the visual field with reduced sensitivity.

Glaucoma-associated abnormalities in cortical activity during a visuocognitive task.

OBJECTIVE: To investigate neurophysiological dynamics during a visuocognitive task in glaucoma patients vs. healthy controls. METHODS: Fifteen patients with early-stage primary open-angle glaucoma (POAG) and fifteen age-matched healthy participants underwent a "go/no-go" task, monitored with EEG. Participants had to semantically categorize visual objects in central vision, with animal or furniture as targets according to the experimental block. RESULTS: Early visual processing was delayed by 50 ms in patients with POAG compared to controls. The patients displayed a smaller difference between animal and furniture categorization during higher-level cognitive processing (at 400-600 ms). Regarding behavioral data, the groups differed in accuracy performance and decision criterion. As opposed to the control group, patients did not display facilitation and a higher accuracy rate for animal stimuli. However, patients maintained a consistent decision criterion throughout the experiment, whereas controls displayed a shift towards worse decision criteria in furniture trials, with higher error rate. CONCLUSIONS: The comparative analysis of behavioral and neurophysiological data revealed in POAG patients a delay in early visual processing, and potential high-level cognitive compensation during late, task-dependent activations. SIGNIFICANCE: To our knowledge, our findings provide the first evidence of modification in cognitive brain dynamics associated with POAG.

Central Visual Attention in Primary Open-angle Glaucoma.

SIGNIFICANCE: To better understand the implication of a potential cognitive change in glaucoma, patients were stimulated in central visual areas considered functionally normal to discard an effect due to the loss of vision during an attentional task. The outcome might improve the follow-up on the impact of the pathology. PURPOSE: This study aimed to evaluate the effect of primary open-angle glaucoma on the visual attention system by recording responses of behavioral and oculomotor strategies. METHODS: We included 20 individuals with primary open-angle glaucoma (62.1 ± 7.2 years old), 18 age-matched control subjects (58.4 ± 7.2 years old), and 20 young control subjects (25.7 ± 3.5 years old). The procedure consisted of visual (eye-tracking recordings) and manual detection of a target. All participants had to detect a square with a vertical bar within distractors (squares, triangles, and circles with a horizontal or vertical bar) of identical size of 1.6 × 1.6° visual angle. The shapes were displayed concentrically on a radius of 5° of visual angle. All participants were tested to ensure that their visual field sensitivity was normal within ±5° central vision. RESULTS: In responding manually, glaucoma participants were slower than age-matched control subjects (1723 ± 488 vs. 1263 ± 385 milliseconds; P < .01). Eye-tracking recordings showed that glaucoma participants found the target within the same time frame as age-matched control subjects. Compared with the young group, the scanpath length and average fixation duration on distractors were significantly longer for the glaucoma patients (+235 pixels, +104 milliseconds) and the age-matched control participants (+120 pixels, +39 milliseconds). Impaired contrast sensitivity was correlated with longer response time, longer scanpath, and longer fixation on distractors. CONCLUSIONS: Glaucoma affects the manual response times in a visual attention task, but patients can visually detect the target as quickly as age-matched control subjects. Different clinical factors predicted the performances. The age of the patients was associated with longer scanpath. The visual field loss (mean deviation) was linked with longer visual response time. The loss of contrast sensitivity predicted the behavioral change on fixation duration to the distractors, global response time, visual response time, and scanpath length.

Severe macular complications in glaucoma: high-resolution multimodal imaging characteristics and review of the literature.

PURPOSE: To describe imaging characteristics of severe macular complications occurring in glaucoma and discuss available treatments. METHODS: Retrospective case series of glaucomatous patients with macular retinoschisis (MR) and/or serous retinal detachment (SRD). Patients underwent a complete ophthalmological examination and multimodal imaging including retinography, SD-OCT, fluorescein and indocyanine green angiography (FA & ICGA) and adaptive optics (AO). RESULTS: Ten eyes (8 patients) were included. Initial BCVA was 1.04 ± 1.12 logMAR and IOP was 24.0 ± 9.3mmHg. All eyes presented with MR while SRD was present in 5 eyes (5 patients), with a central macular thickness of 573 ± 152 µm. FA and ICGA allowed to exclude leakage in all cases. A focal lamina cribrosa defect (LCD) was found in four eyes (4 patients) using OCT, with AO providing en-face visualization of the defect in one eye. Outer retinal hole was present in 3 eyes (3 patients). No visual improvement or resolution of the macular retinoschisis was observed in eyes with medical or surgical IOP control (N = 9). Vitrectomy with internal membrane limiting peeling and gas tamponade was performed in one eye with good visual results. CONCLUSIONS: Multimodal high-resolution imaging is essential to diagnose severe macular complications associated with advanced glaucoma.

Impact of glaucoma on the spatial frequency processing of scenes in central vision.

Glaucoma is an eye disease characterized by a progressive vision loss usually starting in peripheral vision. However, a deficit for scene categorization is observed even in the preserved central vision of patients with glaucoma. We assessed the processing and integration of spatial frequencies in the central vision of patients with glaucoma during scene categorization, considering the severity of the disease, in comparison to age-matched controls. In the first session, participants had to categorize scenes filtered in low-spatial frequencies (LSFs) and high-spatial frequencies (HSFs) as a natural or an artificial scene. Results showed that the processing of spatial frequencies was impaired only for patients with severe glaucoma, in particular for HFS scenes. In the light of proactive models of visual perception, we investigated how LSF could guide the processing of HSF in a second session. We presented hybrid scenes (combining LSF and HSF from two scenes belonging to the same or different semantic category). Participants had to categorize the scene filtered in HSF while ignoring the scene filtered in LSF. Surprisingly, results showed that the semantic influence of LSF on HSF was greater for patients with early glaucoma than controls, and then disappeared for the severe cases. This study shows that a progressive destruction of retinal ganglion cells affects the spatial frequency processing in central vision. This deficit may, however, be compensated by increased reliance on predictive mechanisms at early stages of the disease which would however decline in more severe cases.

Higher susceptibility to central crowding in glaucoma.

CLINICAL RELEVANCE: Crowding limits many daily life activities, such as reading and the visual search for objects in cluttered environments. Excessive sensitivity to crowding, especially in central vision, may amplify the difficulties of patients with ocular pathologies. It is thus important to investigate what limits visual activities and how to improve it. BACKGROUND: Numerous studies have reported reduced contrast sensitivity in central vision in patients with glaucoma. However, deficits have also been observed for letter recognition at high contrast, suggesting that contrast alone cannot completely account for impaired central perception. METHOD: Seventeen patients and fifteen age-matched controls were randomly presented with letters in central or parafoveal vision at 5° eccentricity for 200 ms. They were asked to decide whether the central T was upright or inverted. The T was either presented in isolation (uncrowded) or flanked by two Hs (crowded) at various spacings. Contrast was manipulated: 60% and 5%. RESULTS: Compared to controls, patients exhibited a significant effect of crowding in central vision, with higher accuracy for the isolated T than for HTH only at low contrast. In parafoveal vision, an effect of crowding was also observed only in patients. The spacing to escape crowding varied as a function of contrast. Larger spacing was required at low contrast than at high contrast. Susceptibility to crowding was related to central visual field defect for central presentations and to contrast sensitivity for parafoveal presentations, only at low contrast. Controls were at ceiling level both for central and parafoveal presentations. CONCLUSION: Crowding limits visual perception, impeding reading and object recognition in cluttered environments. Visual field defects and lower contrast sensitivity in glaucoma can increase susceptibility to central and parafoveal crowding, the deleterious effect of which can be improved by manipulating contrast and spacing between elements.

Reduced peripheral vision in glaucoma and boundary extension.

CLINICAL RELEVANCE: Peripheral vision is known to be critical for spatial navigation. However, visual cognition, which impacts peripheral vision, has not been studied extensively in glaucoma. BACKGROUND: Spatial memory was assessed with a known to induce a robust memory distortion called "boundary extension" in which participants erroneously remember seeing more of a scene than was present in the sensory input. METHODS: Fifteen patients with glaucoma and 15 age-matched normally sighted controls participated in the experiment. Participants were shown 10 photographs of natural scenes randomly displayed for 0.5 s or 10 s. Following each scene, the participant was asked to draw it from memory. RESULTS: On average, boundary extension was larger, by 12%, for patients than for controls, but the difference was significant for 4 photographs. Patients tended to add more space between the object and the edges than there was between the objects and the border of the photograph. A control experiment in which participants were asked to draw isolated objects without scene context resulted in a significant reduction of the memory distortion in both groups, but patients still drew the objects smaller than controls. CONCLUSION: The reduced field of view in glaucoma has an impact on spatial memory for scenes and on perception of size.

Efficacy and Safety of Ultrasound Cycloplasty for Refractory Glaucoma: A 3-Year Study.

PRECIS: Ultrasound cycloplasty (UCP) treatment using high-intensity focused ultrasound is an effective and safe therapy to reduce intraocular pressure (IOP) in patients with refractory glaucoma over a 3-year period. PURPOSE: The purpose of this study was to evaluate the 3-year efficacy and safety of UCP in patients with refractory glaucoma. PATIENTS AND METHODS: In all, 104 patients with refractory glaucoma recruited from 2 university hospitals underwent UCP. Examinations were performed 7 days, 1 week, 1, 3, 6, 12, 24, and 36 months after the UCP procedure. Primary outcomes were therapeutic success at 3 years (IOP reduction from baseline ≥20% and IOP >5 mm Hg without other surgical procedures) and vision-threatening complications. Secondary outcomes included mean IOP change from baseline at each follow-up visit, medication use, complications, and subsequent UCP and/or other postsurgical interventions. RESULTS: At 3 years post-UCP, the therapeutic success rate was 55%. For 75% of the patients, results were obtained with only one procedure. For the overall study population, IOP was reduced significantly (P<0.005) from 27.6±8.9 mm Hg (n=3.0 topical hypotensive medication) to 17.0±6.8 mm Hg at 36 months (n=2.8 topical hypotensive medication) (33% reduction). For the success patients, the IOP was initially 29.3±8.8 mm Hg (n=3.0 topical hypotensive medication) and 15.6±4.3 mm Hg at 36 months (n=2.8 topical hypotensive medication) (43% reduction). The rate of complications was low and there were no cases of phthisis. CONCLUSION: The UCP procedure was efficacious with few complications and should be considered as an alternative to other IOP-lowering therapies including laser cyclocoagulation in patients with refractory glaucoma.

Preserved Versus Preservative-Free Latanoprost for the Treatment of Glaucoma and Ocular Hypertension: A Post Hoc Pooled Analysis.

INTRODUCTION: To compare the tolerability and efficacy of a preservative-containing latanoprost (PCL) to a preservative-free formulation of latanoprost (PFL) in patients with open-angle glaucoma or ocular hypertension. METHODS: A pooled analysis was performed of data from five published studies. The primary outcome was tolerability as evaluated by the severity of hyperemia. The secondary objectives were patient tolerance based on a composite ocular surface disease (OSD) score arising from ocular signs and symptoms, patient and investigator satisfaction, and a comparison of IOP-lowering efficacy. RESULTS: There were three randomized controlled trials and two observational studies included in the analysis. Conjunctival hyperemia improved significantly in 25.6% (388) of patients switched to the PFL group versus 11.7% (117) of patients switched to the PCL group (p < 0.001). PFL was two times superior to PCL in reducing ocular hyperemia (odds ratio = 1.96; p < 0.001). The mean OSD composite score decreased by 32.2% in patients switched to the PFL group and 14.1% in the PCL group (p < 0.001). At 3 months, the mean IOP was similar between groups (p = 0.312). CONCLUSION: This post hoc pooled analysis confirmed the findings of the individual studies that PFL is as efficacious at reducing IOP as PCL but better tolerated. After switching to PFL, there was twice the improvement in the OSD composite score. PFL was twice as effective at reducing ocular hyperemia and other ocular signs. These findings suggest that PFL has features that may improve patient compliance, thereby potentially improving the IOP-lowering efficacy on a long-term basis.

Preservatives in eye drops for glaucoma can cause side effects such as stinging and eye redness. These side effects can cause some patients to reduce the frequency of the drops as prescribed or stop using the drops. One of the most common drops for glaucoma is latanoprost. This study evaluated whether a preservative-free latanoprost (PFL) is as effective as preservative-containing latanoprost (PCL) for reducing eye pressure and whether PFL is better tolerated in patients with glaucoma. The results of the study indicated that PFL was as effective as PCL for reducing eye pressure. The results also indicated PFL was much better at reducing the side effects related to PCL. For example PFL reduces eye redness up to twofold compared to PCL. By reducing the side effects associated with PCL patients may continue to take their glaucoma drops as directed and thereby reduce the risk of vision loss from glaucoma.

Glaucoma and Computer Use: Do Contrast and Color Enhancements Improve Visual Comfort in Patients?

PURPOSE: To estimate the impact of glaucoma on computer use and to assess specific adaptations of the graphical interface to this form of visual impairment. DESIGN: Prospective, experimental cohort study. PARTICIPANTS: Forty-nine participants were recruited: 16 patients with primary open-angle glaucoma (mean ± SD, 62.7 ± 5.6 years of age), 17 age-matched participants (mean ± SD, 59.1 ± 8.3 years of age), and 16 young control participants (mean ± SD, 23.3 ± 2.1 years of age). METHODS: An ophthalmologic examination before the study evaluated the level of visual loss (mean deviation), visual acuity (logarithm of the minimum angle of resolution units), and contrast sensitivity (CS) of the primary open-angle glaucoma patients. Each participant underwent the following measurements: an information technology (IT) experience questionnaire, a preference task monitored by eye tracking, and a feedback session. The experimental task was based on ecological computer scenes with 3 enhancement levels (low, medium, and high), determined by gradual modulation of contrast, luminance, and color. Participants were asked to select the most readable and comfortable stimulus among 4 images displayed on the screen: the original computer scene and 3 enhanced versions. MAIN OUTCOME MEASURES: Clinical, oculomotor, and subjective data were computed together in a multivariate model by using a principal component analysis (PCA). RESULTS: The PCA revealed 3 principal components accounting for 72% of the total variance of the data and showed a greater need for enhanced computer scenes in glaucoma patients, an equal preference for low and medium enhancement within the 3 groups, and significantly longer oculomotor behavior in the patient groups. Subjective reports of difficulty using IT because of vision were correlated with visual impairment and high enhancement preference. Contrast sensitivity was critical to explaining the main variations of the data. A reduced CS had a significant effect on the preference for enhanced computer scenes (r = -0.43; P < 0.002) and a less effective exploration velocity (r = 0.43; P < 0.002). CONCLUSIONS: Glaucoma alters the global exploration of computer scenes. High enhancement of the graphical interface could improve visual comfort during computer use. Subjective patients' reports underline the importance of including IT questions in visual-related quality-of-life questionnaires.

Acute angle-closure glaucoma with choroidal effusion revealing a hantavirus infection: Description of ultrasound biomicroscopy imagery and optical coherence tomography Visante.

PURPOSE: To report a case of bilateral angle-closure associated with systemic hantavirus infection. MATERIALS AND METHODS: A 32-year-old Caucasian man was referred with blurred vision, fever, cough, dyspnea and thrombocytopenia. Ophthalmologic examination revealed myopic shift, elevated intraocular pressure (30 mmHg right eye and 24 mmHg left eye), corneal edema, iridocorneal angle closure and shallow anterior chamber. Ciliochoroidal effusion was detected on anterior segment optical coherence tomography and ultrasound biomicroscopy. Serologic test and polymerase chain reaction confirmed the diagnosis of hantavirus infection and the serotype Puumala. On the sixth day after he started topical anti-glaucoma and cycloplegic medications, the anterior chamber and iridocorneal angles were normalized with disappearance of ciliochoroidal effusion. CONCLUSION: Puumala hantavirus infection is an exceptional cause of acute bilateral angle-closure combined with ciliochoroidal effusion.

A Saccadic Choice Task for Target Face Detection at Large Visual Eccentricities in Patients with Glaucoma.

SIGNIFICANCE: Little is known about the perception of glaucomatous patients at large visual eccentricities. We show that the patients' performance drops beyond 40° eccentricity even for large images of scenes, suggesting that clinical tests should assess the patients' vision at larger eccentricities than 24 or 30°. PURPOSE: Daily activities such as visual search, spatial navigation, and hazard detection require rapid scene recognition on a wide field of view. We examined whether participants with visual field loss at standard automated perimetry 30-2 were able to detect target faces at large visual eccentricities. METHODS: Twelve patients with glaucoma and 14 control subjects were asked to detect a face in a two-alternative saccadic forced choice task. Pairs of scenes, one containing a face, were randomly displayed at 10, 20, 40, 60, or 80° eccentricity on a panoramic screen covering 180° horizontally. Participants were asked to detect and to saccade toward the scene containing a face. RESULTS: Saccade latencies were significantly slower in patients (264 milliseconds; confidence interval [CI], 222 to 306 milliseconds) than in control subjects (207 milliseconds; CI, 190 to 226 milliseconds), and accuracy was significantly lower in patients (70% CI, 65 to 85%) than in control subjects (75.7% CI, 71.5 to 79.5%). Although still significantly above chance at 60°, the patients' performance dropped beyond 40° eccentricity. The control subjects' performance was still above chance at 80° eccentricity. CONCLUSIONS: In patients with various degrees of peripheral visual field defect, performance dropped beyond 40° eccentricity for large images at a high contrast. This result could reflect reduced spread of exploration in glaucoma.

What is the Nature of the Reach-and-Grasp Deficit in Glaucoma?

PRéCIS:: In a reach-and-grasp task, patients with glaucoma exhibited a motor disorder, even when they had time to explore their environment. The motor performance of glaucoma patients should be taken into account in rehabilitation. PURPOSE: Vision plays an important role in planning and executing manual prehension (reaching and grasping). We assess the impact of glaucoma on motor production, as a function of the visual exploration time available to the patients. METHODS: We compared performance in 2 reach-and-grasp tasks determined by whether or not the participants (16 glaucoma patients, 14 age-matched and 18 young controls) had time to explore the objects before reaching and grasping a target object defined by its color. RESULTS: Differences were observed between glaucoma patients and age-matched controls on movement duration and peak velocity (reaching phase) only when participants were not provided time to look at the objects before the movement (immediate condition). CONCLUSIONS: Glaucoma patients exhibited a motor disorder (grasping phase) only when they had no time to explore their environment before performing the reach-and-grasp task. The motor abnormalities in reaching phase observed in glaucoma patients in previous studies seem to result from difficulties in target identification rather than from visuomotor deficits. From a clinical point of view, motor performances of glaucoma patients could be modulated by task, especially by temporal constraints of task.

Perception of Gaze Direction in Glaucoma: A Study on Social Cognition.

SIGNIFICANCE: Discriminating quickly where another person's gaze is directed is a key component of social interaction, as gaze direction conveys information about others' intentions (approach or avoidance) and shift in gaze is used in group conversation. This study shows that patients with glaucoma are delayed in their discrimination of gaze direction. PURPOSE: The purpose of this study was to investigate whether glaucoma affects the perception of gaze direction. METHODS: Twenty-four patients with open-angle glaucoma, 24 age-matched controls, and 20 young normally sighted controls were presented with faces displayed centrally for 200 milliseconds. The gaze could either be direct or averted, and the head could be a frontal view or a rotated view. Half of the participants in each group were asked to press a key only for faces with a direct gaze. The other half responded for a face with an averted gaze. The orientation of the head had to be ignored. RESULTS: Accuracy was greater than 90% correct for all three groups. We found no difference in performance between young and older controls, except for shorter response times for the frontal view than for the rotated face in young participants. Patients with glaucoma needed on average 140 milliseconds longer to decide if the gaze was averted than for the direct gaze, and they were less accurate than controls in perceiving the gaze as direct when the head was rotated. CONCLUSIONS: Patients with glaucoma often experience impaired vision due to a reduced sensitivity in central vision. Although lower central sensitivity had little effect on their ability to discriminate gaze orientation, they required on average 140 milliseconds longer than age-matched controls to perceive an averted gaze.

Efficacy and Safety of Repeated Ultrasound Cycloplasty Procedures in Patients With Early or Delayed Failure After a First Procedure.

PRECIS: Repeated ultrasound cycloplasty (UCP) procedures are valuable options in patients with early or delayed intraocular pressure (IOP) increase after a first procedure. The safety of a second procedure is similar to that of the first one. PURPOSE: The purpose of this study was to evaluate the efficacy and safety of repeated UCPs in patients with early or delayed IOP increase after a first procedure. PATIENTS AND METHODS: Thirty-one eyes with open-angle glaucoma, with an IOP decrease,>20% after a first UCP procedure (1 and/or 2 mo visit), and with an early or delayed IOP increase (IOP decrease<20% compared with baseline before or after the first 6 mo, respectively), underwent a second UCP procedure. Examinations were performed at 1 day, 1 week, 1, 2, 3, 6, and 12 months. Primary outcomes were surgical success (IOP reduction≥20% and IOP>5 mm Hg) at the last follow-up and vision-threatening complications. Secondary outcomes were mean IOP at each visit, medication use, and other surgical interventions. RESULTS: In the group with early IOP increase, IOP was reduced (P<0.05) from a mean value of 29.8±8.2 mm Hg before retreatment (n=3.3 medications) to 18.5±7.4 mm Hg at the last follow-up (n=3.5 medications) (-34%). Success was achieved in 52.6% of eyes (10/19) at the last follow-up visit. In the late IOP increase group, IOP was reduced (P<0.05) from a mean value of 31.9±6.6 mm Hg before retreatment (n=4.0 medications) to 16.2±5.2 mm Hg at the last follow-up (n=4.0 medications) (-43%). Success was achieved in 55.5% of eyes (5/9) at the last follow-up visit. No major intraoperative or postoperative complications occurred. CONCLUSION: A second UCP procedure could be considered in subjects with early or delayed failure after a first procedure.

Context Association in Glaucoma Patients Using a Touch Screen.

PRECIS: The results showed that people with glaucoma are able to perform with high accuracy a context-association task on a touch screen. This device could be a new possibility for communication and for clinical assessment. BACKGROUND: The present study was designed to investigate the ability of patients with glaucoma to use a touch screen to find and associate pictures with limited text. METHODS: Eighty-four volunteers were recruited in 3 groups and tested binocularly or monocularly. Twenty-eight patients with binocular glaucoma (M=68.5 y) were selected with a visual acuity of 0.4 log MAR or better in each eye and visual field defects, with a mean deviation equal to or less than -6 dB in each eye. Twenty-eight age-matched controls (M=68.8 y) and 28 young controls (M=22.1 y) were also recruited (normal acuity; exclusion of ocular disease). The participants had to associate, by moving their index on a 22″ touch screen, a target on the unique scene (between 3 other distractor images) with a consistent background related to the target (eg, to match a fish with the sea). RESULTS: The performances of the glaucomatous patients were significantly (P<0.01) impaired in monocular vision compared with binocular vision with regard to the exploration duration (+2 s), accuracy (-3% of correct response), and peak speed (-10 cm/s). However, with binocular vision, representing daily life conditions, exploration duration, deviation, movement duration, peak speed, and accuracy were not affected by glaucoma, as demonstrated by comparison with the age-matched group. CONCLUSIONS: People with glaucoma are able to perform with high accuracy a context-association task on a touch screen. Many applications involving touch screen devices should provide new tools with limited text to help patients with visual disabilities.

Better tolerance of preservative-free latanoprost compared to preserved glaucoma eye drops: the 12-month real-life FREE study.

BACKGROUND: Lack of efficacy due to bad compliance caused by intolerance issues is the main reason for a change to a better tolerated ocular treatment, such as using preservative-free (PF) eye drops. AIM: To assess the efficacy and local tolerance after 12 months and patient satisfaction regarding local treatment tolerance and handling at inclusion and after 6 months of PF latanoprost compared to preserved glaucoma eye drops. METHODS: This was an international, prospective, and observational real-life study. Up to three visits, one at inclusion and two follow-up visits (one after 6 and one after 12 months) were planned. Efficacy, local tolerance, and patient satisfaction were the main evaluation criteria. RESULTS: Data from 721 patients were available for the statistical analysis. Overall, 64.8% (467/721) of patients switched treatment before inclusion: 62.2% in the preserved and 68.9% in the PF latanoprost group. IOP values were similar between PF latanoprost and preserved eye drops and remained stable at all visits. Ocular signs and symptoms improved after switching to PF latanoprost; the prevalence of conjunctival hyperemia was significantly lower (P=0.0015) at both follow-up visits. At follow-up visit 1, 49.5% of the patients who switched to PF latanoprost decreased or stopped the use of artificial tears. Satisfaction regarding tolerance in patients using PF latanoprost improved significantly after the switch from preserved eye drops to PF latanoprost (88.9% and 42.5%, respectively, P<0.0001). CONCLUSION: This first real-life study showed that PF latanoprost was as efficacious but better tolerated than preserved eye drops over a sustained period of 12 months, while providing a significantly higher patient satisfaction and potentially allowing improvement in the patient's daily life.

Glaucoma Affects Viewing Distance for Recognition of Sex and Facial Expression.

Purpose: To measure the distance for sex and facial expression recognition in patients with glaucoma. Methods: Sixteen patients with open-angle glaucoma, 16 age-matched controls, and 12 young controls participated. During each trial, a face covering 0.36° × 0.5°, simulating the angular size of a face viewed at 20 m, was presented centrally. The angular size increased automatically by steps of 5 cm, simulating the face moving progressively closer. The participants were asked to stop the progression with a keypress, first, when they were able to recognize the sex, and second, when they were able to recognize the facial expression (angry, happy, neutral). We measured the threshold equivalent viewing distance to recognize the sex and the facial expression. Results: Participants with glaucoma, both those with and without reduced central acuity, required a shorter viewing distance (i.e., a larger face) than did controls to recognize both the sex (by 2.59 m, F1,30 = 8.7, P < 0.006) and the facial expression (by 3.64 m, F1,30 = 14, P < 0.001). No significant difference was found between younger and older controls. Conclusions: Face perception is a skill that is reliant on central vision. Our behavioral results are consistent with the hypothesis of reduced central sensitivity in glaucoma. We suggest that the necessity to view larger faces in patients might result from a higher sensitivity to crowding that increases the difficulty to perceive the relevant features for recognition of both sex and facial expressions, akin to normal peripheral vision.

Multicenter clinical trial of high-intensity focused ultrasound treatment in glaucoma patients without previous filtering surgery.

PURPOSE: To evaluate the efficacy and safety of the ultrasonic circular cyclocoagulation procedure in patients with open-angle glaucoma naïve of previous filtering surgery. METHODS: Prospective non-comparative interventional clinical study conducted in five French University Hospitals. Thirty eyes of 30 patients with open-angle glaucoma, intra-ocular pressure (IOP) > 21 mmHg and with no previous filtering glaucoma surgeries were sonicated with a probe comprising six piezoelectric transducers. The six transducers were activated with a 6-s exposure time. Complete ophthalmic examinations were performed before the procedure and at 1 day, 1 week, 1, 2, 3, 6 and 12 months after the procedure. Primary outcomes were qualified surgical success (defined as IOP reduction from baseline ≥20% and IOP > 5 mmHg with possible re-intervention and without hypotensive medication adjunction) and complete surgical success (defined as IOP reduction from baseline ≥20%, IOP > 5 mmHg and IOP < 21 mmHg with possible re-intervention and without hypotensive medication adjunction) at the last follow-up visit and vision-threatening complications. Secondary outcomes were mean IOP at each follow-up visit compared with baseline, medication use, complications and re-interventions. RESULTS: Intra-ocular pressure was significantly reduced (p < 0.05) from a mean pre-operative value of 28.2 ± 7.2 mmHg (n = 3.6 hypotensive medications) to 19.6 ± 7.9 mmHg at 12 months (n = 3.1 hypotensive medications and n = 1.1 procedures) (mean IOP reduction of 30%). Qualified success was achieved in 63% of eyes (19/30) (mean IOP reduction of 37% in these eyes) and complete success in 46.7% of eyes (14/30) (mean IOP reduction of 37% in these eyes) at the last follow-up. No major intra- or post-operative complications occurred. CONCLUSIONS: The UC(3) procedure seems to be an effective and well-tolerated method to reduce IOP in patients with open-angle glaucoma without previous filtering surgery.