Longer Axial Length Potentiates Relationship of Intraocular Pressure and Peripapillary Vessel Density in Glaucoma Patients.

Purpose: The purpose of this study was to investigate how axial length (AL) changes the relationship of intraocular pressure (IOP) with peripapillary vessel density (pVD) in glaucoma versus non-glaucomatous eyes. Methods: A population-based, cross-sectional study of 2127 African Americans aged 40 years and older in Inglewood, California, were imaged with 6 × 6-mm optic disc optical coherence tomography angiography scans. There were 1028 healthy subjects (1539 eyes) and 65 subjects with glaucoma (86 eyes) who met inclusion criteria. A multivariable linear mixed effects regression model investigated the relationship of IOP on pVD after controlling for signal strength, retinal nerve fiber layer thickness, and age. These results were stratified by AL groups. Results: Higher IOP was a significant predictor of lower pVD among subjects with glaucoma (P = 0.009), but not among healthy subjects (P = 0.26). After stratifying by the sample median AL (23.46 mm), higher IOP was associated with lower pVD among subjects with glaucoma with longer AL (≥ 23.46 mm, P = 0.005), but not among those in the shorter AL (< 23.46 mm, P = 0.45). IOP was not significantly associated with pVD among healthy subjects in either AL stratum. Conclusions: Among subjects with glaucoma with longer AL, IOP was significantly associated with pVD. This relationship was not seen among subjects with glaucoma with shorter AL or non-glaucomatous subjects in either AL group. These findings support the hypothesis that disturbed retinal autoregulation may be present in subjects with glaucoma with longer AL. Longitudinal studies are needed to further investigate whether axial elongation increases glaucoma risk by compromising retinal autoregulation.

Racial Differences in the Rate of Change in Anterior Lamina Cribrosa Surface Depth in the African Descent and Glaucoma Evaluation Study.

Purpose: The purpose of this study was to determine if the rate of change in the depth of the surface of the lamina cribrosa due to glaucomatous remodeling differs between glaucoma patients of African descent (AD) and European descent (ED). Methods: There were 1122 images taken longitudinally over an average of 3 years (range = 0.9-4.1 years) from 122 patients with glaucoma followed in the African Descent and Glaucoma Evaluation Study (ADAGES) and Diagnostic Intervention and Glaucoma Study (DIGS) were automatically segmented to compute anterior lamina cribrosa surface depth (ALCSD). The rate of ALCSD change was compared across racial groups after adjusting for baseline characteristics known to be associated with ALCSD or disease progression (visual field, ALCSD, corneal thickness, optic disk size, and age). Results: After adjusting for all other covariates, the ED group had significantly greater ALCSD posterior migration (deepening) than the AD group (difference = 2.57 µm/year, P = 0.035). There was a wider range of ALCSD change in the ED compared with the AD group, and more individuals had greater magnitude of both deepening and shallowing. No other covariates measured at baseline had independent effects on the longitudinal changes in ALCSD (baseline visual field severity, baseline ALCSD, corneal thickness, Bruch's membrane opening [BMO] area, or age). Conclusions: Glaucomatous remodeling of the lamina cribrosa differs between AD and ED patients with glaucoma. Unlike the cross-sectional associations seen with aging, in which a deeper ALCSD was seen with age in the ED group, glaucomatous remodeling in this longitudinal study resulted in more posterior migration of ALCSD in ED compared to AD patients.

Adherence to glaucoma medication, illness perceptions, and beliefs about glaucoma: Attitudinal perspectives among Turkish population.

PURPOSE: To evaluate the topical glaucoma eye drops adherence prevalence and its association with beliefs and illness perceptions about glaucoma in Turkey. We also aimed to explore the factors linked to patients' total, voluntary, and involuntary non-adherence to medication in different patient attitudes. MATERIAL AND METHODS: A prospective study with cross-sectional design which included a total of 317 glaucoma patients who completed questionnaires. We assessed the adherence to medication, illness perceptions, and the beliefs about the glaucoma treatment by the "Reported Adherence to Medication scale," "the Brief Illness Perception Questionnaire," and "the Beliefs about Medicine-Specific Questionnaire," respectively. According to the RAM scale, voluntary and involuntary non-adherence scores were also distinguished. Different adherence categories in RAM scale were compared with perception and belief measures. Patient attitudes were assessed from the BMQ. We also performed attitudinal type comparisons with different adherence groups. RESULTS: The full adherence prevelance to glaucoma medication was 40%. The proportion of voluntary and involuntary non-adherence was 26% and 57%, respectively. The adherence groups were similar in terms of belief measures but statistically different according to illness perceptions (consequences (p = 0.002), timeline (p = 0.008), personal control (p = 0.001), identity (p = 0.019), concerns (p = 0.003)), and attitude types (ambivalent (p = 0.030) and accepting (p = 0.029)). CONCLUSION: New strategies are required to improve patient adherence to glaucoma medication in Turkey. The beliefs about the glaucoma treatment and illness perceptions are also needed to be enhanced.

Ethnicity-Specific Database Improves the Diagnostic Ability of Peripapillary Retinal Nerve Fiber Layer Thickness to Detect Glaucoma.

PURPOSE: To determine the changes in optical coherence tomography (OCT) color probability codes and diagnostic ability for peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell complex (GCC) analysis after applying Chinese and white subjects normative databases. DESIGN: Cross-sectional study. METHODS: This study enrolled 219 healthy eyes (108 white and 111 Chinese patients) to construct an ethnicity-specific normative database for pRNFL and macular GCC thickness, which was tested then in 180 eyes with or without glaucoma (102 white and 78 Chinese patients). The percent of change of color probability codes were evaluated after applying the original built-in and the ethnicity-specific normative databases, respectively. Sensitivity and specificity were calculated to evaluate the change in diagnostic ability to detect glaucoma. RESULTS: Healthy white subjects had a thinner pRNFL than Chinese subjects in the overall average thickness as well as the superior, inferior, and temporal quadrants (P < .001). Macular GCC did not differ between ethnicities. After applying an ethnicity-specific normative database, the percent of pRNFL abnormal color code labels decreased significantly for the overall average thickness in the white subjects. This resulted in a significant increase in the specificity to detect glaucoma in the white population (P < .001). No significant changes were seen when applying an ethnicity-specific normative database for macular GCC thickness. CONCLUSIONS: After applying an ethnicity-specific normative database, the percent of pRNFL abnormal color codes decreased significantly, improving the specificity to detect glaucoma in the white population. These findings suggest there may be utility in having ethnicity-specific normative databases for pRNFL thickness.

Increasing Engagement of African American Patients with Glaucoma during Medical Encounters: Creation of a Pre-visit Video.

SIGNIFICANCE: The developed video can be accessed by African American patients with glaucoma from across the United States on YouTube to learn why it is important to ask eye care providers any questions they might have about glaucoma and/or its treatment. PURPOSE: Our objective was to develop an educational video for African Americans with glaucoma to watch before their ophthalmology office visits to help motivate them to be actively involved in their care. METHODS: The Social Cognitive Theory guided the development of the video. We conducted three focus groups with African American patients with glaucoma and three focus groups with providers who care for African American patients with glaucoma. The research team reviewed the transcripts of the focus groups and then developed a plan for video production. RESULTS: The themes that both patients and providers felt should be covered in the video to motivate patient question-asking included the following: what is glaucoma, glaucoma treatment, glaucoma testing, and treatment adherence. Based on focus group results, the resulting video had one male African American physician and four African American patients covering the themes that emerged. CONCLUSIONS: Ophthalmologists and African Americans with glaucoma gave us excellent insight into developing videos to increase patient involvement during their visits.

A multiethnic genome-wide analysis of 44,039 individuals identifies 41 new loci associated with central corneal thickness.

Central corneal thickness (CCT) is one of the most heritable human traits, with broad-sense heritability estimates ranging between 0.68 to 0.95. Despite the high heritability and numerous previous association studies, only 8.5% of CCT variance is currently explained. Here, we report the results of a multiethnic meta-analysis of available genome-wide association studies in which we find association between CCT and 98 genomic loci, of which 41 are novel. Among these loci, 20 were significantly associated with keratoconus, and one (RAPSN rs3740685) was significantly associated with glaucoma after Bonferroni correction. Two-sample Mendelian randomization analysis suggests that thinner CCT does not causally increase the risk of primary open-angle glaucoma. This large CCT study explains up to 14.2% of CCT variance and increases substantially our understanding of the etiology of CCT variation. This may open new avenues of investigation into human ocular traits and their relationship to the risk of vision disorders.

Profiles of Ganglion Cell-Inner Plexiform Layer Thickness in a Multi-Ethnic Asian Population: The Singapore Epidemiology of Eye Diseases Study.

PURPOSE: To examine the normative profile and determinants of macular ganglion cell-inner plexiform layer (GCIPL) thickness based on spectral-domain OCT (SD-OCT) in a nonglaucoma, multi-ethnic Asian population. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: Ethnic Chinese, Malay, and Indian adults aged ≥40 years recruited from the Singapore Epidemiology of Eye Diseases Study. METHODS: All participants underwent standardized examinations. The GCIPL thickness was measured using Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA). Participants with glaucoma or poor-quality scans were excluded. Eye-specific data were used. Associations of ocular and systemic factors with GCIPL thickness parameters were investigated using multivariable linear regression with generalized estimating equation models to account for correlation between both eyes. MAIN OUTCOME MEASURES: GCIPL thickness. RESULTS: A total of 4464 participants (7520 eyes) consisting of 1625 Chinese, 1212 Malay, and 1627 Indian adults contributed to this analysis. Average GCIPL thickness was 82.6±6.1 µm in Chinese, 81.5±6.8 µm in Malays, and 78.0±6.9 µm in Indians (P < 0.001 by analysis of variance). The 5th percentile limit of average GCIPL thickness was 72 µm in Chinese, 70 µm in Malays, and 67 µm in Indians. In multivariable analysis adjusting for age, gender, axial length, presence of cataract, OCT signal strength, disc area, hypertension, diabetes, and hyperlipidemia, eyes of Indians were observed to have 3.43 µm thinner GCIPL on average compared with Chinese (P < 0.001) and 3.36 µm thinner GCIPL compared with Malays (P < 0.001). In addition, older age (per decade; ß = -2.51), female (ß = -1.57), longer axial length (per mm; ß = -1.54), and presence of chronic kidney disease (ß = -1.49) were significantly associated with thinner average GCIPL (all P ≤ 0.008). Larger optic disc area (per mm2; ß = 0.78; P < 0.001) was associated with thicker GCIPL. These factors were consistently observed to be significant for superior and inferior hemisphere GCIPL thickness. CONCLUSIONS: GCIPL thickness profiles were significantly thinner in Indians compared with Chinese and Malays. Our findings further highlight the need of a more refined, ethnic-specific normative database for GCIPL thickness, which in turn may improve the detection and diagnosis of glaucoma in Asians.

The Diagnostic Ability of Ganglion Cell Complex Thickness-to-Total Retinal Thickness Ratio in Glaucoma in a Caucasian Population

Objectives: To evaluate the diagnostic accuracy of the macular ganglion cell complex-to-total retinal thickness (G/T) ratio in a Caucasian population. Materials and Methods: A total of 86 patients were enrolled in this cross-sectional study. Patients were divided into 4 groups: healthy; ocular hypertension; preperimetric glaucoma; and early glaucoma. Macular ganglion cell complex (mGCC) thickness, total retinal thickness, and retinal nerve fiber layer thickness (RNFLT) in one randomly selected eye of each patient were measured with measured with Heidelberg HD spectral domain optical coherence tomography (Heidelberg Engineering, Inc., Heidelberg, Germany). G/T ratio (%) was calculated as (mGCC thickness / total retinal thickness) x100. The ability of each parameter to diagnose glaucoma was examined by area under the receiver operating characteristic curve (AUROC) analysis and sensitivity evaluation at a fixed level of specificity. Unpaired t test was used to compare the measured values between the healthy subjects and the different patient groups. Results: The study included 9 healthy individuals, 18 patients with ocular hypertension, 28 with preperimetric glaucoma, and 31 with early glaucoma. Total retinal thickness, mGCC thickness, RNFLT, and G/T ratio were highest in the healthy group and decreased progressively in patients with ocular hypertension, preperimetric glaucoma, and early glaucoma. All comparisons between the groups were significant for these parameters (p<0.001 for all). Average RNFLT, average GCC, and total retinal thickness showed consistently higher AUROC than G/T ratio in the differentiation between healthy individuals and patients with ocular hypertension, preperimetric glaucoma, and early glaucoma. Conclusion: G/T ratio does not contribute to separation of ocular hypertension, preperimetric glaucoma, and early glaucoma patients from the healthy population. Compared to the other parameters investigated, G/T had lower diagnostic value.

Profile of retinal nerve fibre layer symmetry in a multiethnic Asian population: the Singapore Epidemiology of Eye Diseases study.

BACKGROUND: To examine the normative profile and determinants of retinal nerve fibre layer (RNFL) symmetry in a non-glaucoma, multiethnic Asian population. METHODS: Chinese, Malay and Indian adults aged ≥40 years were recruited from the Singapore Epidemiology of Eye Diseases study. Participants underwent standardised systemic and ocular examinations. RNFL thickness was obtained using a spectral-domain optical coherence tomography (Cirrus HD-OCT). RNFL symmetry (in %) was calculated based on Pearson correlation coefficient between the RNFL thickness profiles of the right and left eyes. Multivariable linear regression analysis was used to investigate the associations between ocular and systemic factors with RNFL symmetry. RESULTS: 4211 participants (1227 Chinese, 1245 Malays, 1739 Indians) were included. The mean RNFL symmetry was 86.7%±8.5% in Chinese, 84.7%±10.2% in Malays and 84.0%±10.7% in Indians. The fifth percentile limit of RNFL symmetry was 71.2% in Chinese, 65.0% in Malays and 62.0% in Indians. In multivariable analysis adjusting for age, gender, ethnicity, hypertension, diabetes, hyperlipidaemia, intereye absolute differences in intraocular pressure (IOP), axial length and disc area, Malays (ß=-0.9; p=0.03) and Indians (ß=-1.76; p<0.001) were found to have lower RNFL symmetry compared with Chinese. Older age, greater intereye differences in IOP, axial length and disc area were significantly associated with lower RNFL symmetry (all p≤0.003). CONCLUSIONS: In non-glaucoma individuals, intereye RNFL profile is less symmetric in Malays and Indians than that in Chinese. This also suggests that current commercial optical coherence tomography's deployment of a single, universal RNFL symmetry cut-off for glaucoma detection is flawed, and ethnic-specific cut-off is warranted.

Associations of nutrient intakes with glaucoma among Japanese Americans.

The aim of this study was to investigate possible associations of nutrient intake on glaucoma in subjects of Japanese descent living in Los Angeles, CA.In this cross-sectional study, 581 Japanese American participants in Los Angeles underwent an interview, fundus photography, comprehensive physical, and blood examinations, along with determining the body mass index status and any confounding factors. CDSketch was used to measure the cup-disc ratio and rim width of each fundus in the retinal photographs. A multivariate logistic regression test with adjustment for confounding factors was used to assess the association between glaucoma and nutrient intake.A total of 61 of 581 participants were diagnosed with glaucoma in this study. Multivariate logistic regression analysis showed that a high intake of iron (odds ratio [OR]: 1.303, P = .004), low intake of vitamin A (OR: 0.365, P = .019), and vegetable fat (OR: 0.957, P = .004) were associated with an increased risk of glaucoma.Current findings showed that high iron intake and low vitamin A and vegetable fat intake appeared to be associated with an increased risk of glaucoma in subjects of Japanese descent living in the Los Angeles populations.

Systemic Determinants of Peripapillary Vessel Density in Healthy African Americans: The African American Eye Disease Study.

PURPOSE: To determine the relationship between systemic factors and radial peripapillary capillary (RPC) vessel density (VD) in healthy African American (AA) participants of the African American Eye Disease Study. DESIGN: A population-based, cross-sectional study. METHODS: A total of 4135 eyes from 2127 AA participants aged 40 years and older in Inglewood, California, were imaged for 6×6-mm optic disc scans on a spectral-domain optical coherence tomography angiography (OCTA) device. Of these, 1029 eyes from 1029 participants who met the inclusion and exclusion criteria were analyzed, including only 1 eye per participant. Custom software was used to quantify RPC VD. Multivariate linear regression was used to identify systemic factors associated with RPC VD with a significance level set at 0.05. The contribution of each variable to the final model was estimated with the magnitude of standardized regression coefficients (SRCs). The fit of the final model was measured by R2. RESULTS: The average RPC VD was 0.346±0.045. Controlling for signal strength, the systemic variables in the final multivariate model associated with reduced RPC VD were older age (ß = -0.0123 per decade; SRC = -0.2733; P < .0001), male sex (ß = -0.0067; SRC = -0.0716; P = .0060), and longer diabetes duration (ß = -0.0022 per 5 years; SRC = -0.0527; P = .0427). The model R2 was 0.3689. CONCLUSIONS: Age, sex, and systemic influences, such as diabetes duration, need to be considered when assessing changes in RPC VD in glaucoma and other ocular diseases. Longitudinal studies are needed to investigate whether reduced RPC VD and the factors that affect it are associated with an increased risk of developing glaucomatous nerve damage.

Comparison of Outcomes of Glaucoma Screening in Primary Care and Community Settings.

Purpose: To compare outcomes of glaucoma screening in primary care and community settings, including the follow-up rates of subjects with positive screening results. Methods: This was a comparative, prospective, non-randomized study. Subjects were recruited by medical students in community-based and primary care settings and screened for glaucoma using the same screening strategy. Results: Two hundred and fifteen total patients were screened, 117 in community settings and 98 in primary care settings. Positive screenings were seen in 34% of patients in the community setting group (n = 40) and 40% of patients in the primary care setting group (n = 39). Of the patients who screened positive, 74% completed their initial follow-up appointment in the primary care setting group compared with 47.5% in the community-based setting group (p = .015). In the primary care setting, 18% were lost to follow up compared with 42.5% in the community-setting (P = .018). African-Americans were more likely to follow-up (P = .025) and less likely to be lost to follow-up (P = .033) in the primary care setting compared with the community-based setting. Conclusion: Patients with a positive glaucoma screening result in a primary care setting are more likely to follow up than those in a community-based setting.

Optic Nerve Tortuosity and Globe Proptosis in Normal and Glaucoma Subjects.

PRéCIS:: Eyes with glaucoma have tauter optic nerves compared with normal eyes, which may exert more force on the optic nerve head tissues during eye movements. PURPOSE: The purpose of this study was to assess the difference in optic nerve tortuosity during eye movements and globe proptosis between primary open angle glaucoma and normal subjects using orbital magnetic resonance imaging (MRI). METHODS: Ten Chinese subjects matched for ethnicity and refractive errors were recruited, including 5 normal controls and 5 patients with primary open angle glaucoma. All subjects underwent MRI to assess their optic nerves and globes for 3 eye positions: primary gaze, adduction, and abduction. Optic nerve tortuosity (optic nerve length divided by the distance between 2 ends) and globe proptosis (maximum distance between the cornea and interzygomatic line) were measured from MRI images. RESULTS: In adduction, the tortuosity of normal eyes was significantly larger than that of the glaucomatous eyes. Optic nerve tortuosity in adduction in the control and glaucoma groups were 1.004±0.003 (mean±SD) and 1.001±0.001, respectively (P=0.037). Globe proptosis (primary gaze) in glaucoma subjects (19.14±2.11 mm) was significantly higher than that in control subjects (15.32±2.79 mm; P=0.046). CONCLUSIONS: In this sample, subjects with glaucoma exhibited tauter optic nerves and more protruding eye globes compared with normal eyes. This may impact optic nerve head deformations in anatomically predisposed patients.

Update: Incidence of Glaucoma Diagnoses, Active Component, U.S. Armed Forces, 2013-2017.

Glaucoma is an eye disease that involves progressive optic nerve damage and vision loss, leading to blindness if undetected or untreated. This report describes an analysis using the Defense Medical Surveillance System to identify all active component service members with an incident diagnosis of glaucoma during the period between 2013 and 2017. The analysis identified 37,718 incident cases of glaucoma and an overall incidence rate of 5.9 cases per 1,000 person-years (p-yrs). The majority of cases (97.6%) were diagnosed at an early stage as borderline glaucoma; of these borderline cases, 2.2% progressed to open-angle glaucoma during the study period. No incident cases of absolute glaucoma, or total blindness, were identified. Rates of glaucoma were higher among non-Hispanic black (11.0 per 1,000 p-yrs), Asian/Pacific Islander (9.5), and Hispanic (6.9) service members, compared with non-Hispanic white (4.0) service members. Rates among female service members (6.6 per 1,000 p-yrs) were higher than those among male service members (5.8). Between 2013 and 2017, incidence rates of glaucoma diagnoses increased by 75.4% among all service members.

Central Corneal Thickness Variances Among Different Asian Ethnicities in Glaucoma and Nonglaucoma Patients.

OBJECTIVE: To compare the central corneal thickness (CCT) between different ethnicities and particularly Asian subethnic groups that may contribute to the different glaucoma diagnoses using the optical low-coherence reflectometry technique. METHODS: A retrospective study of 6 years including 1512 eyes of 929 patients of the Beckman vision center, University of California, San Francisco from 2011 to 2017 had their biometric parameters, including CCT, measured with the Lenstar. Patients were categorized into African Americans, Caucasians, Hispanics, Pacific Islanders, and Asians. Asians were further subcategorized into Chinese, Vietnamese, Koreans, Filipinos, and Japanese. RESULTS: Among 1356 patients who had their CCT measured by Lenstar from 2011 to 2017, 1512 eyes of 929 patients were included. The study population included 462 Caucasians (52.96%), 60 African Americans (6.46%), 92 Hispanics (9.9%), 32 Pacific Islanders (3.44%), 130 Chinese (13.99%), 52 Filipinos (5.6%), 37 Vietnamese (3.98%), 34 Koreans (3.66%), and 30 Japanese (3.23%). African Americans had the thinnest CCT with a mean of 518.62±40.3 followed by Asians with a mean of 539.29±34.1. Among the Asian study sample, the Chinese had the thinnest CCT with a mean of 537.66±32.5. CCT was adjusted for age, sex, glaucoma diagnosis, diabetes status, and prostaglandin analogs use for >12 months. CONCLUSIONS: Optical low-coherence reflectometry is a widely used technology, which can measure CCT. Our study confirms that African Americans have the thinnest corneas followed by Asians. In the latter group, relatively thin CCT may partly explain their high rates of normal-tension glaucoma.

Schlemm's canal measured by optical coherence tomography and correlation study in a healthy Caucasian child population.

PURPOSE: To measure the Schlemm's canal (SC) in vivo by Fourier-domain optical coherence tomography (FD-OCT) in a Caucasian paediatric population. METHODS: Participants of this cross-sectional study were 290 healthy children. In the right eye of each child, SC cross-sectional diameter and area measurements were made with the FD-OCT instrument RTVue® (Optovue Inc, Fremont, CA, USA) in the nasal and temporal quadrants. These SC variables were then assessed for correlation with the factors age, gender, refractive error, anterior chamber angle and trabecular meshwork (TM) metrics. Finally, the reproducibility of the SC measurements was assessed in 30 of the participants. RESULTS: Mean participant age was 10.7 ± 3.4 years (range 3-18). SC diameters could be measured in both quadrants in 70.6% and 70.4% of subjects, respectively. Mean SC diameters were similar (p = 0.125) for the temporal and nasal quadrants: 266.7 ± 84.1 µm (range 131-509) and 273.2 ± 77.3 µm (range 124-486), respectively. Mean SC areas were also similar (p = 0.167) for the two quadrants: 9975 ± 3514 µm2 (range 4000-23 000) versus 9688 ± 3297 µm2 (range 3000-24 000). No differences were detected in SC measurements according to gender, refractive error or angle and TM measurements (R ≤ 0.116; p ≥ 0.125). The exception was age which was directly correlated with SC size (p ≤ 0.041). The reproducibility of the SC measurements was excellent (intraclass correlation coefficients ≥0.936). CONCLUSION: FD-OCT allows the identification of the SC in children. Our data indicate an increase in SC size produced with age.

Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Ocular Findings at Two Health Centers.

Blindness from glaucoma can be prevented by early detection and treatment. Telemedicine improves access to treatment in high-risk populations that face barriers to receiving adequate ophthalmic care. We used a practice-based telemedicine screening model at two health centers. Telemedicine imaging of the fundus and optic nerve, followed by a complete eye exam at the same location for participants with abnormal findings, unreadable images, or ocular hypertension (OHTN), was performed. A total of 182 participants were screened, of whom 108 qualified for a complete eye exam. Of these, 62 (34.1%) had abnormal images, 12 (6.6%) had OHTN, and 34 (18.7%) had unreadable images. Eighty-nine of the 108 (82%) returned for the complete eye exam. Predominantly, participants were African American with glaucoma suspect and cataract. Screening location was an important factor for follow-up. Assessment of the fundus and optic disc using telemedicine resulted in early detection of glaucoma and other ocular pathology.

[Optic disc features on OCT in glaucomatous and normal black Africans]. / Caractéristiques de la papille chez les sujets glaucomateux et normaux à l'OCT dans une population Noire Africaine.

PURPOSE: To determine the correlations between the size of the optic disc and glaucomatous defects in black Africans. DESIGN: Retrospective observational study. METHODS: The study was conducted over a two-year period from November 2014 to October 2016, based on records of black Togolese patients who had undergone optic nerve head (ONH) OCT or ganglion cell complex OCT for assessment of glaucoma. The population was divided into 3 groups (I, II and III) depending on the size of the ONH. The ONH was considered small (Group I) if its size was less than the mean -1 SD, medium (Group II) if its size was within 1 SD of the mean, and large (Group III) if its size was greater than the mean+1 SD. Glaucomatous lesions were qualitatively identified on RNFL and or GCC. The ONH parameters were compared in the 3 groups. The Chi-square test was used to compare the percentages, and the t test to compare the means with statistical significance of 5%. The Pearson correlation coefficient (r2) was used to measure correlations. RESULTS: A total of 586 eyes of 298 patients were examined, 314 glaucomatous eyes and 272 healthy eyes. The mean age was 41.0±15.7 [6; 86] years. There were 159 men vs. 137 women, with a sex ratio of 1.2. The mean surface area of the ONH was 2.80±0.55mm2. Small ONH's (Group I) were defined as a surface area of less than 2.25mm2, medium-sized ONH's (Group II) as an area between 2.25 and 3.35mm2 and large ONH's (Group III) as an area greater than 3.35mm2. Small ONH's represented 14.7%, (86 eyes), medium-sized 68.6% (408 eyes) and large ONH's 16.8% (98 eyes). The mean surface area of the neuroretinal rim, cup, the cup-disc ratio and the RNFL thickness were statistically significant in the 3 groups. Similarly, all these parameters were significant in groups of glaucomatous or non-glaucomatous eyes, except for the surface area of the cup. The RNFL thickness was weakly correlated with the surface area of the ONH (r2=0.39), moderately correlated with the surface area of the neuroretinal rim (r2=0.57). The surface area of the ONH was strongly correlated with the surface area of the cup (r2=0.7). The neuroretinal rim surface area was strongly correlated with the cup-disc ratio (r2=0.66). CONCLUSION: The size of the ONH was correlated with the size of the cup, but it was not correlated to the surface area of the neuroretinal rim or the thickness of the nerve fibers. Analysis of the RNFL and GCC is essential for the diagnosis, especially in the case of large ONH's.

Observational Outcomes of Initial Trabeculectomy With Mitomycin C in Patients of African Descent vs Patients of European Descent: Five-Year Results.

Importance: There is evidence that patients of African descent (AD) experience higher surgical failure rate after trabeculectomy without antimetabolites. Objective: To compare outcomes of initial trabeculectomy with mitomycin C in AD patients with those of patients of European descent (ED) and to identify prognostic factors for failure. Design, Setting, and Participants: In this retrospective matched cohort study, 135 eyes of 105 AD patients were matched with 135 eyes of 117 ED patients by age (within 5 years), surgeon, lens status, and follow-up time (within 1 year) from a single tertiary academic center. Interventions: Initial trabeculectomy with mitomycin C. Main Outcomes and Measures: Criteria A, B, and C defined qualified success rates as final intraocular pressure of 18 mm Hg or less, 15 mm Hg or less, and 12 mm Hg or less, respectively, in addition to 20% or more, 25% or more, and 30% or more reduction of intraocular pressure or reduction of 2 or more medications. Kaplan-Meier survival curves were compared with log-rank test in AD and ED patients, and Cox proportional hazard models were used to estimate the influence of race/ethnicity on surgical success accounting for confounding variables. Results: Of the 105 AD patients, 56 (53.3%) were female, and the mean (SD) age was 67.5 (10.4) years; of the 117 ED patients, 64 (54.7%) were female, and the mean (SD) age was 68.2 (10.0) years. For AD patients compared with ED patients, the qualified success rates at 5 years for criteria A were 61% and 67%, respectively (difference, 7.3%; 95% CI, 4.4-10.4); for criteria B, 43% and 60% (difference, 17.6%; 95% CI, 15.2-20.0); and for criteria C, 25% and 40% (difference, 15.8%; 95% CI, 11.1-20.5). On multivariable Cox regression analyses, AD was associated with higher failure rate with criteria B and C for qualified success and with all criteria for complete success (ie, no need for medications). Incidence of bleb leaks was higher in the AD group (29 vs 11 eyes; P = .002). Additionally, AD patients required additional glaucoma surgeries more often than ED patients (47 vs 26 eyes; P = .004). Conclusions and Relevance: African descent was associated with higher failure rates and higher incidence of bleb leaks after initial trabeculectomy with mitomycin C compared with European descent. If this is subsequently shown to be a cause and effect, the findings need to be considered when surgical treatment of glaucoma is contemplated in AD patients.

Outcomes and Complications of Ahmed Tube Implantation in Asian Eyes.

PURPOSE: There is a lack of long-term Asian studies on the efficacy and safety of Ahmed glaucoma valve (AGV) implantation. This study seeks to determine the outcomes and complications of AGV implantation in Asians. METHODS: A retrospective review of AGV surgeries performed at a single center in Singapore was conducted. A total of 76 patients with primary and secondary glaucoma who underwent their first AGV surgery from January 1, 2010 to December 31, 2012 were considered for our study. Primary outcomes evaluated were as follows: failure, intraocular pressure, best-corrected visual acuity, number of intraocular pressure (IOP)-lowering medications, and complications. Failure was defined by the following: IOP >21 mm Hg on 2 consecutive visits after 3 months, IOP≤5 mm Hg on 2 consecutive visits after 3 months, reoperation for glaucoma, removal of implant, or loss of light perception vision. RESULTS: Mean follow-up duration was 33.2±6.9 months. There was significant reduction in IOP (mean reduction, 25.9%; P<0.001) and number of IOP-lowering medications (mean reduction, 77.8%; P<0.001) at 3 years. Absolute failure rate was 23.9% at 3 years with no difference between eyes with or without previous trabeculectomy and between eyes with primary or secondary glaucoma. Occurrence of postoperative hyphema was a significant risk factor for failure. The commonest postoperative complications were hyphema and tube exposure. CONCLUSIONS: At 3 years after AGV surgery in Asian eyes, less than one-quarter of the eyes fulfilled the criteria for surgical failure.