Diagnostic ability of superficial vascular density measured by optical coherence tomography angiography to differentiate high myopic eyes from eyes with primary open angle glaucoma.

Purpose: To determine if high myopia and glaucoma can be differentiated based on the measurement of superficial vascular density in the peripapillary and macular areas by using Optical Coherence Tomography Angiography (OCTA). Methods: This prospective, observational, cross-sectional, comparative study was conducted on patients between 40 and 60 years of age diagnosed as primary open-angle glaucoma (POAG) or high myopia and compared with age-matched controls. The main outcome measures were the difference in SVD% in peripapillary and macular areas in POAG and high myopic eyes. Detailed ophthalmic examination and OCTA of the disc and peripapillary area and macula were performed. The SVD in each zone was calculated using ImageJ software and their difference were analyzed. Results: In total, 128 eyes of 70 patients were enrolled. Peripapillary SVD% in controls was 45.07 ± 3.44, 40.36 ± 8.27 in high myopia, and 31.80 ± 9.008 in POAG. The mean difference in peripapillary SVD% of POAG to control was - 13.479, of POAG to high myopia was -8.777 (both P < 0.001), and of high myopia to controls was -4.701 (P = 0.012). Macular SVD% in controls was 27.30 ± 3.438, 22.33 ± 6.011 in high myopia, and 21.21 ± 5.598 in POAG. The mean difference in macular SVD% of POAG to controls was -6.088, of high myopia to controls was -4.965 (both P < 0.001), and of POAG to high myopia was -1.122 (P = 0.984; not statistically significant). Conclusion: OCTA is a useful diagnostic tool in distinguishing glaucomatous and myopic eyes. The measurement of peripapillary SVD has a greater discriminatory ability than that of the macular area.

Outcomes of neovascular glaucoma in eyes presenting with moderate to good visual potential.

PURPOSE: To compare the disease characteristics and treatment outcomes of patients with neovascular glaucoma (NVG) presenting with visual acuity (VA) 6/60 or better in two different health systems. METHODS: Retrospective chart review of consecutive patients with NVG who presented between January 2016 to January 2018 in 5 tertiary-centres in India and one eye-specialist centre in London (UK) was performed. The baseline characteristics, treatment provisions, and visual outcomes in the India and UK cohorts were compared. RESULTS: At presentation, 18% (83 of 451) and 22% (59 of 270) of patients with NVG had VA 6/60 or better in India and the UK cohorts, respectively. The aetiologies of NVG were similar with proliferative diabetic retinopathy being the most common cause (60.9%, India; 64.4%, UK; p = 0.38). Previous panretinal photocoagulation was more prevalent in the UK cohort compared to the India cohort (94.9% versus 66.3%, respectively; p < 0.001). The mean number of intravitreal anti-VEGF injections per eye was higher in the Indian cohort (1.65 ± 0.97 versus 1.14 ± 1.02 injections; p < 0.001). The number of eyes with closed angles (36.9% India versus 30.5% UK; p = 0.45) and the number of eyes needing glaucoma interventions (52.1% India; 62.7% UK; p = 0.82) were similar in two cohorts. Among glaucoma surgeries, trabeculectomies were more commonly performed in the Indian cohort (23 vs 4; p < 0.001),while glaucoma drainage device surgeries were more prevalent in the UK cohort (18 vs 4 p < 0.001). After a median follow-up of 21 months (IQR 8.4-34.8 India; 24-36 months UK), favourable visual outcomes (vision stable or improved) were similar in both health systems (52.5% in the Indian cohort vs 43.4% in the UK cohort; p = 0.28). On multivariate regression analysis, the need for trans-scleral cyclophotocoagulation was associated with worse visual outcomes in both cohorts. CONCLUSIONS: The causes and clinical profile of neovascular glaucoma with presenting visual acuity 6/60 or better in India and the UK were similar. Only up to 50% of eyes achieved favourable visual outcomes with current management protocols in both health systems.