The 5-year incidence of bleb-related infection and its risk factors after filtering surgeries with adjunctive mitomycin C: collaborative bleb-related infection incidence and treatment study 2.

PURPOSE: To report the 5-year incidence of bleb-related infection after mitomycin C-augmented glaucoma filtering surgery and to investigate the risk factors for infections. DESIGN: Prospective, observational cohort study. PARTICIPANTS: A total of 1098 eyes of 1098 glaucoma patients who had undergone mitomycin C-augmented trabeculectomy or trabeculectomy combined with phacoemulsification and intraocular lens implantation performed at 34 clinical centers. METHODS: Patients were followed up at 6-month intervals for 5 years, with special attention given to bleb-related infections. The follow-up data were analyzed via Kaplan-Meier survival analysis and the Cox proportional hazards model. MAIN OUTCOME MEASURES: Incidence of bleb-related infection over 5 years and risk factors for infections. RESULTS: Of the 1098 eyes, a bleb-related infection developed in 21 eyes. Kaplan-Meier survival analysis revealed that the incidence of bleb-related infection was 2.2±0.5% (cumulative incidence ± standard error) at the 5-year follow-up for all cases, whereas it was 7.9±3.1% and 1.7±0.4% for cases with and without a history of bleb leakage, respectively (P = 0.000, log-rank test). When only eyes with a well-functioning bleb were counted, it was 3.9±1.0%. No differences were found between the trabeculectomy cases and the combined surgery cases (P = 0.398, log-rank test) or between cases with a fornix-based flap and those with a limbal-based flap (P = 0.651, log-rank test). The Cox model revealed that a history of bleb leakage and younger age were risk factors for infections. CONCLUSIONS: The 5-year cumulative incidence of bleb-related infection was 2.2±0.5% in eyes treated with mitomycin C-augmented trabeculectomy or trabeculectomy combined with phacoemulsification and intraocular lens implantation in our prospective, multicenter study. Bleb leakage and younger age were the main risk factors for infections.

Induction of amyloid-ß(1-42) in the retina and optic nerve head of chronic ocular hypertensive monkeys.

PURPOSE: Recent studies have indicated that accumulation of amyloid ß(1-42) (Aß(1-42)), which is associated with the progression of Alzheimer disease, may also be responsible for retinal ganglion cell death in glaucoma. The purpose of this study was to investigate the expression and localization of Aß(1-42) in the retina and the optic nerve head (ONH) of monkeys with experimental glaucoma. METHODS: Five cynomolgus monkeys with a glaucomatous left eye at 4, 9, 11, 15, and 24 weeks after laser photocoagulation treatment were studied by immunohistochemical methods. Another two cynomolgus monkeys with a glaucomatous left eye at 133 weeks after laser photocoagulation treatment were used to measure Aß(1-42) concentrations in the retina by enzyme-linked immunosorbent assay. RESULTS: At 11 to 24 weeks after the laser photocoagulation treatment, Aß(1-42) was upregulated in the nerve fiber layer (NFL) and the ganglion cell layer (GCL) of the retina and the ONH, but the expression of amyloid precursor protein decreased in the NFL and ONH from levels at 9 weeks. The localizations of Aß(1-42) were merged in glial fibrillary acidic protein-positive astroglial cells but not phosphorylated neurofilament heavy- or nonphosphorylated neurofilament heavy-positive axons in the retina and the ONH. Likewise, Aß(1-42) concentrations in the retina of monkeys increased in the chronic stage of glaucoma. CONCLUSIONS: These findings indicate that the upregulation of Aß(1-42) after an intraocular pressure elevation could apply to monkeys since the structure of the ONH is more similar to humans than that of rodents.

Shortening of interpupillary distance after topical prostaglandin analog eye drop application in an ophthalmic surgeon: A case report.

Purpose: This study reports a case of interpupillary distance (IPD) shortening after instillation of topical prostaglandin analog (PGA) eye drops. Observations: The patient was a 36-year-old ophthalmic vitreoretinal surgeon from Tochigi, Japan, with primary open-angle glaucoma and bilaterally instilled PGA eye drops to decrease intraocular pressure. His IPD had been recorded closely based on surgical microscope settings. The patient had a stable IPD for over five years before the use of PGA drops. The patient noticed IPD shortening associated with latanoprost usage since four years. The IPD shortened further twice with temporal switching to bimatoprost. However, the IPD partially recovered both the times on discontinuing the medication over the course of several months. Conclusions and Importance: Fluctuations in IPD with visible cosmetic changes occur in association with the use of topical PGA eye drops. There might be effects of PGA drops on binocular vision, which are possibly unaddressed and warrant further study.

Shortening of Interpupillary Distance after Instillation of Topical Prostaglandin Analog Eye Drops.

PURPOSE: To investigate changes in the interpupillary distance (IPD) after continual instillation of topical prostaglandin analogs (PGAs) in glaucoma patients as an objective indicator of prostaglandin-associated periorbitopathy (PAP). DESIGN: Retrospective, comparative case series. METHODS: A total of 152 institutional patients with glaucoma were enrolled in this study. Inclusion criteria were visual acuities exceeding 10/20 bilaterally and no intraocular surgery during observation. Intervention/observation procedures: First-time bilateral instillation of bimatoprost, travoprost, latanoprost, or tafluprost and IPDs measured by automatic refractometry. IPDs, intraocular pressures (IOPs), and refractive errors were measured before and after continual drug administration (treatment, 2-24 months). MAIN OUTCOME MEASUREMENTS: Post-treatment changes in IPDs. A total of 61 untreated patients served as controls. RESULTS: The IPDs shortened significantly (P < 0.001) after treatment (-0.80 ± 2.1 mm); the IPDs of control subjects remained unchanged (0.05 ± 0.96 mm; P = 0.69). The IPD change after bimatoprost instillation (-2.20 ± 0.97 mm) was significantly (P < 0.001) greater than with other PGAs (-0.65 ± 2.09 mm). The IOPs decreased significantly (P < 0.001) (-3.7 ± 4.3 mm Hg); the refractive errors did not change significantly (P < 0.099) (-0.07 ± 0.69 diopter) post-treatment. The percentages of subjects with 2-mm or greater decreases in IPD after bimatoprost, travoprost, latanoprost, or tafluprost were 85.7%, 20.0%, 18.2%, and 17.2%, respectively, and with 3-mm or greater decreases in IPD 35.7%, 12.0%, 14.5%, and 12.1%, respectively. The specificities were 93.4% and 100% in the control group, respectively, with IPD threshold changes of 2 and 3 mm or more, respectively. CONCLUSIONS: The IPD decreased significantly after topical PGAs within 24 months. The effect was significantly greater with bimatoprost than with other PGAs. The noninvasive, immediate automatic refractometry measurement may be an objective numerical indicator of PAP.

Local effect of topical FP-receptor agonists on retinal vessels of the ipsilateral posterior retina in normal rabbit eyes.

PURPOSE: To determine whether a topically instilled prostaglandin analogue inhibits endothelin-1 (ET-1)-induced vasoconstrictive effects in the posterior retina by its local effects, and the duration of the effect in normal rabbit eyes. METHODS: Travoprost, a potent selective FP-agonist, or unoprostone, a prostone that also has a weak non-selective FP-agonistic activity, solution was instilled once, or once daily (travoprost) or twice daily (unoprostone) for 7 days in one randomly chosen Dutch rabbit eye, and vehicle in the contralateral eye. ET-1 was intravitreously injected in both eyes 30 min after a single instillation of a test drug or its vehicle, or just after, 30, 60, 90 or 180 min after the final instillation of a 7-day instillation, and fundus photographed before, 30 and 60 min after the injection to study whether difference was seen in the ET-1-induced constriction of retinal vessels between the drug- and vehicle-instilled eyes. The same experimental procedures were conducted with indomethacin pretreatment. RESULTS: In the rabbit eyes where travoprost was instilled for 7 days, the ET-1-induced constriction of retinal vessels was significantly inhibited only on the drug-treated side, when ET-1 was injected 30 or 60 min after the final instillation (P = 0.026-0.005), which was abolished by indomethacin pretreatment. A single instillation of travoprost or unoprostone and 7-day instillation of unoprostone showed no effect. CONCLUSIONS: After a 7-day instillation in normal rabbit eyes, topical travoprost suppressed ET-1-induced vasoconstrictive effects only in the ipsilateral posterior retina by its local effect; this effect was maintained at least for 30 min and mediated by endogenous prostaglandins.

Effects of topical travoprost and unoprostone on optic nerve head circulation in normal rabbits.

PURPOSE: To evaluate the effect, and the duration of the effect, of topically administrated travoprost and unoprostone on optic nerve head (ONH) circulation in Dutch rabbits. METHODS: First, travoprost (0.004% solution) or unoprostone (0.12% solution) was unilaterally instilled once, or once daily (travoprost) or twice daily (unoprostone) for 7 days in Dutch rabbits. The ONH tissue blood velocity (NB(ONH)) was measured using the laser speckle method at 30 and 60 min after a single instillation of travoprost or unoprostone, and before and at 1, 6, and 12 hr (travoprost or unoprostone) and 24 hr (travoprost only) after the last instillation of the aforementioned 7-day instillation regimen. Second, similar experiments were conducted with indomethacin (5 mg/kg) pretreatment. RESULTS: Both travoprost and unoprostone significantly increased NB(ONH) only in the treated eyes after a single instillation (p = 0.011 to 0.038); this effect was abolished by indomethacin pretreatment. In the 7-day instillation regimen, NB(ONH) was increased by 11%, 40%, 17%, 16%, and 12% only in the treated eyes just before and at 1, 6, 12, and 24 hr after the final instillation of travoprost, respectively, and increased by 10%, 25%, 13%, and 14% only in the treated eyes just before and at 1, 6, 12 hr after the final instillation of the unoprostone, respectively. CONCLUSIONS: Topical travoprost or unoprostone significantly increased the ONH blood velocity with a single instillation and the effect persisted for 24 hr after a 7-day instillation. The effects of these drugs against retinal and ONH circulation are probably associated with the production of endogenous prostaglandins.

Applying "Lasso" Regression to Predict Future Glaucomatous Visual Field Progression in the Central 10 Degrees.

PURPOSE OF THE STUDY: We recently reported that it is beneficial to apply least absolute shrinkage and selection operator (Lasso) regression to predict future 24-2 visual field (VF) progression. The purpose of the current study was to investigate the usefulness of Lasso regression to predict VF progression in the central 10 degrees (10-2) in glaucoma patients. METHODS: Series of 10 VFs (Humphrey Field Analyzer 10-2 SITA-standard) from each of 149 eyes in 110 open angle glaucoma patients, obtained over 5.7±1.4 years (mean±SD) were investigated. Mean deviation values of the 10th VF were predicted using varying numbers of VFs (ranging from the first to third VFs to the first to ninth VFs), applying ordinary least square regression (OLSLR) and Lasso regression. Absolute prediction errors were then compared. RESULTS: With OLSLR, prediction error varied between 5.4±5.0 (using first to third VFs) and 1.1±1.6 dB (using first to ninth VFs). Significantly smaller prediction errors were obtained with Lasso regression, in particular with small numbers of VFs (from 2.1±2.8: first to third VFs, to 1.0±1.6 dB: first to ninth VFs). A large λ value, which is an index showing the degree of penalty in Lasso regression, was observed when a small number of VFs were used for prediction. CONCLUSION: Mean deviation prediction using OLSLR with a small number of VFs resulted in large prediction errors. It was useful to apply Lasso regression when predicting future progression of the central 10 degrees, compared to OLSLR.

Developing an Item Bank to Measure Quality of Life in Individuals With Glaucoma, and the Results of the Interview With Patients: The Effect of Visual Function, Visual Field Progression Rate, Medical, and Surgical Treatments on Quality of Life.

PURPOSE: To construct a new item bank to measure quality of life (QOL) in glaucoma patients and to evaluate glaucoma patients' QOL using the item bank. METHODS: An item bank of questions was generated through a literature review of QOL instruments useful for glaucoma patients. Using this item bank, a cognitive survey was performed on 203 patients with glaucoma (112 males and 91 females, 61.9±11.9 y old; mean±SD). The results were then analyzed using the Rasch analysis, and the Rasch-derived disability scores were predicted using linear modelling and the following clinical parameters: age, mean total deviation (mTD) in superior and inferior visual field (mTDsup/mTDinf), mTD progression rate, better visual acuity, worse visual acuity, number of eye drops administered per day, number of trabeculectomy procedures experienced in both eyes. RESULTS: A total of 23 questionnaires of QOL in glaucoma patients were identified resulting in an item bank of 187 questions related to the following tasks: reading/writing, walking, going out, eating and driving (direct disability) as well as questions concerned with worry/anxiety, social participation, and physical symptoms (indirect disability). In the optimal model for direct disability, age and mTDinf were identified as significant predictors, whereas number of eye drops administered per day and number of trabeculectomy experienced were included in the optimal model for indirect disability. CONCLUSIONS: A new item bank to measure QOL in glaucoma patients was developed and evaluated. Age and mTDinf were found to be related to direct disability while medical and surgical treatments were related to indirect disability.

Correlation between hemifield visual field damage and corresponding parapapillary atrophy in normal-tension glaucoma.

PURPOSE: To evaluate the correlation between the superior or inferior half area of parapapillary atrophy (PPA) and the corresponding hemifield visual field damage (VFD) in normal-tension glaucoma. DESIGN: Cross-sectional study. METHODS: patients: One hundred nine eyes of 109 consecutive patients with normal-tension glaucoma. observation procedures: Topography parameters of the optic nerve head and PPA (zone beta) area were obtained with the Heidelberg Retina Tomograph (HRT), and VFD was evaluated with the 30 to 2 program of Humphrey Field Analyzer. The HRT parameters and PPA area were determined separately in superior and inferior half regions. main outcome measures: Partial correlation coefficients of the superior and inferior areas of PPA with refractive error, axial length, HRT parameters, and corresponding hemifield VFD. RESULTS: In simple correlation analyses, significant correlation was found between the inferior PPA area and the superior hemifield VFD (Spearman rank correlation coefficient; Rs = -0.32; P < .001) but not between the superior PPA area and the inferior hemifield VFD (Rs = 0.05; P = .6). Age, refractive error, axial length, and height variation contour were associated significantly with the total, superior, and inferior areas of PPA, respectively (P < .01). Multiple regression analyses showed that the superior PPA area was associated significantly with only axial length (P < .001), and the inferior PPA area was associated significantly with the axial length and the superior hemifield VFD (P < .001). CONCLUSIONS: In patients with normal-tension glaucoma, only the inferior half area of PPA correlated significantly with glaucomatous VFD. Axial length and myopia were associated with both the superior and inferior half areas of PPA.

Plasma endothelin-1 level in Japanese normal tension glaucoma patients.

PURPOSE: To compare the plasma concentration of endothelin-1 (ET-1) among patients < 60 years of age with normal-tension glaucoma (NTG), primary open-angle glaucoma (POAG), and in age-matched normal participants. METHODS: Plasma concentration of ET-1 was determined in 30 NTG 18 POAG patients, and 19 age-matched normal participants using an enzyme immunoassay. RESULTS: The ET-1 level was 1.49 +/- 0.51 pg/ml in the NTG patients (49.4 +/- 8.8 years), 1.58 +/- 0.64 pg/ml in the POAG patients (44.7 +/- 10.7 years), and 1.33 +/- 0.50 pg/ml in the normal participants (49.9 +/- 5.6 years). The ET-1 levels were not significantly different among the three groups, and no significant correlation with the extent of visual field damage, intraocular pressure (IOP), refraction, or age was seen in the glaucoma patients. CONCLUSIONS: The plasma ET-1 level showed no difference among NTG patients, POAG patients, and normal participants < 60 years of age in the Japanese population.

No apparent association between ocular perfusion pressure and visual field damage in normal-tension glaucoma patients.

PURPOSE: To investigate the correlation of ocular perfusion pressure (OPP) with general and localized visual field damage in normal-tension glaucoma (NTG) patients. METHODS: Correlations between OPP, blood pressure, age, intraocular pressure, refractive error, and extent of visual field damage in the eye with the worst mean deviation (MD) were investigated retrospectively in 94 eyes of 94 NTG patients. Visual fields were analyzed statistically with respect to 15 sectors between two age-matched groups of subjects with high or low OPP. RESULTS: Significant positive correlations were found between OPP and age (P < 0.001), blood pressure and age (P < 0.05), and MD and refractive error (P < 0.01). OPP had no significant correlation with MD or mean sensitivity in the visual field in any of the visual field sectors. CONCLUSION: OPP and systemic blood pressure have no evident effect on the extent or pattern of visual field damage in NTG.

Estimating the Binocular Visual Field of Glaucoma Patients With an Adjustment for Ocular Dominance.

PURPOSE: To investigate whether it is possible to improve estimation of the binocular visual field (VF) using monocular sensitivities on a linear scale adjusted for ocular dominance. METHODS: Monocular and binocular VF measurements were evaluated using the Humphrey Field Analyzer (HFA; 24-2 Swedish Interactive Threshold Algorithm standard program) in 60 eyes of 30 patients with open angle glaucoma. Ocular dominance was measured twice in each patient and the average value was used. Measured binocular sensitivity was then predicted based on monocular measurements using the "better sensitivity" integrated visual field (IVF) method, monocular sensitivity summation methods on the dB scale, linear scale (1/Lambert), and finally monocular sensitivity summation methods on the linear scale adjusted for the ocular dominance. RESULTS: The absolute prediction error with the linear scale summation method (mean ± SD: 3.11 ± 4.00) was significantly smaller than the IVF method (3.15 ± 4.09; P = 0.014). Further, the absolute prediction error for the ocular dominance adjusted method (3.10 ± 3.99) was significantly smaller than the nonadjusted linear scale summation method (P = 0.014). The absolute prediction error associated with the dB scale summation method was significantly larger than any other method (8.15 ± 5.06; P < 0.0001). CONCLUSIONS: The most accurate estimation of binocular sensitivity was achieved using the linear monocular sensitivity summation model adjusted for ocular dominance.

Applying "Lasso" Regression to Predict Future Visual Field Progression in Glaucoma Patients.

PURPOSE: We evaluated the usefulness of various regression models, including least absolute shrinkage and selection operator (Lasso) regression, to predict future visual field (VF) progression in glaucoma patients. METHODS: Series of 10 VFs (Humphrey Field Analyzer 24-2 SITA-standard) from each of 513 eyes in 324 open-angle glaucoma patients, obtained in 4.9 ± 1.3 years (mean ± SD), were investigated. For each patient, the mean of all total deviation values (mTD) in the 10th VF was predicted using varying numbers of prior VFs (ranging from the first three VFs to all previous VFs) by applying ordinary least squares linear regression (OLSLR), M-estimator robust regression (M-robust), MM-estimator robust regression (MM-robust), skipped regression (Skipped), deepest regression (Deepest), and Lasso regression. Absolute prediction errors then were compared. RESULTS: With OLSLR, prediction error varied between 5.7 ± 6.1 (using the first three VFs) and 1.2 ± 1.1 dB (using all nine previous VFs). Prediction accuracy was not significantly improved with M-robust, MM-robust, Skipped, or Deepest regression in almost all VF series; however, a significantly smaller prediction error was obtained with Lasso regression even with a small number of VFs (using first 3 VFs, 2.0 ± 2.2; using all nine previous VFs, 1.2 ± 1.1 dB). CONCLUSIONS: Prediction errors using OLSLR are large when only a small number of VFs are included in the regression. Lasso regression offers much more accurate predictions, especially in short VF series.

Outcomes of Late-Onset Bleb-Related Endophthalmitis Treated with Pars Plana Vitrectomy.

Purpose. To investigate clinical results on bleb-related endophthalmitis (BRE) after trabeculectomy treated with pars plana vitrectomy (PPV) and to evaluate influence factors for visual prognosis. Methods. Investigating medical records retrospectively, BRE was defined as an endophthalmitis induced by bleb infection. A total of 2018 eyes of 1225 patients who had trabeculectomy between December 2000 and July 2013 were included in this study. Eleven eyes of 11 patients with BRE were performed with PPV. Results. The mean age was 56.6 years. The mean period between trabeculectomy and BRE onset was 7.4 years. The mean period from starting symptom to initiation of treatment for endophthalmitis (PSITE) was 2.3 days. Bleb leakages were observed in 7 eyes (64%). On culture examinations, highly pathogenic bacteria (HPB) were identified in 6 cases (55%). HPB infection was influence factors on visual disturbance (P = .0337). Number of HPB infections is significantly higher in poor visual outcome than without poor visual outcome (P = .0310). Conclusion. Visual prognosis of BRE treated by PPV is significantly better when the pathogenic bacteria are not HPB. Severe visual loss occurred with HPB infection even though patients had appropriate treatments. Physicians need to have careful consideration to prevent bleb infection after trabeculectomy with MMC.

How Many Visual Fields Are Required to Precisely Predict Future Test Results in Glaucoma Patients When Using Different Trend Analyses?

PURPOSE: To evaluate the minimum number of visual field (VF) tests required to precisely predict future VF results using ordinary least squares linear regression (OLSLR), quadratic regression, exponential regression, logistic regression, and M-estimator robust regression model. METHODS: Series of 15 VFs (Humphrey Field Analyzer 24-2 SITA standard) were analyzed from 247 eyes of 155 open-angle glaucoma patients. Future point-wise (PW) VF results and mean VF sensitivities were predicted with varying numbers of VFs in each regression method. RESULTS: In PW-OLSLR, as expected, the minimum absolute prediction error was obtained using the maximum number of VFs in the regression (14 VFs); mean absolute prediction error was equal to 2.4 ± 0.9 dB. Ten VFs were required to reach the 95% confidence interval (CI) of the minimum absolute prediction error. Prediction errors associated with the exponential and quadratic regression models were significantly larger than those from PW-OLSLR, whereas errors from logistic regression were not significantly smaller than those from PW-OLSLR; however, the absolute prediction error from the M-estimator robust regression model was significantly smaller than those associated with PW-OLSLR (P < 0.01, paired Wilcoxon test). Like PW-OLSLR, 10 VFs were needed to obtain the minimum absolute prediction error of mean VF sensitivity, but there were no significant differences in errors using the different regression methods. CONCLUSIONS: Approximately 10 VFs, are needed to achieve an accurate prediction of PW VF sensitivity and mean sensitivity. Prediction error of PW VF sensitivity can be significantly minimized using the M-estimator robust regression model compared with conventional OLSLR.

Transient but significant visual field defects after robot-assisted laparoscopic radical prostatectomy in deep tRendelenburg position.

BACKGROUND: Robot-assisted laparoscopic radical prostatectomy (RALP) is a minimally invasive surgical procedure for prostate cancer. During RALP, the patient must be in a steep Trendelenburg (head-down) position, which leads to a significant increase in intraocular pressure (IOP). The association of RALP with visual field sensitivity, however, has not been prospectively studied. The purpose of this study was to evaluate prospectively the visual field, retinal nerve fiber layer (RNFL) thickness, and optic disc morphology in 50 normal eyes of 25 male patients that underwent RALP. METHODS: The subjects were 25 males among 33 consecutive patients who underwent uneventful RALP under general anesthesia in our hospital. Visual field tests using the Humphrey visual field analyzer 30-2 SITA-standard program were performed before, 7 days after, and 1-3 months after RALP. IOP was measured before, during, and after RALP; and ophthalmologic examinations, including slit-lamp, fundus examination, and optical coherence tomography (OCT), were scheduled before and 7 days after surgery. RESULTS: IOP was significantly increased during RALP up to 29.4 mmHg (P<0.01). Postoperative local visual field defects were detected in 7 eyes of 7 subjects dominantly in the lower hemifield without abnormal findings in the optic nerve head or retina, and the visual field recovered to normal within 3 months after surgery. General factors associated with RALP, IOP, RNFL thickness, or optic disc parameters did not differ significantly between eyes with and without postoperative visual field defects, and parameters of OCT measurements were not altered after surgery. CONCLUSION: Transient but significant unilateral visual field defects were found in 28% of the subjects examined. The probable cause are the increased IOP and altered perfusion during surgery and ophthalmologic examinations are therefore suggested before and after RALP.

Do pattern deviation values accurately estimate glaucomatous visual field damage in eyes with glaucoma and cataract?

BACKGROUND/AIMS: To study the efficacy of pattern deviation (PD) values in the estimation of visual field compensating the influence of cataract in eyes with glaucoma. METHODS: The study subjects comprised of 48 eyes of 37 glaucoma patients. Mean total deviation value (mTDs) on Humphrey Field Analyzer after cataract surgery was compared with mean PD (mPD) before the surgery. Visual field measurements were carried out ≤6 months before (VF(pre)) and following (VF(post)) successful cataract surgery. The difference between the mPD or mTD values in the VF(pre) and mTD values in the VF(post) (denoted as εmPD/ΔmTD) was calculated, and the influence of the extent of 'true' glaucomatous visual field damage or cataract (as represented by εmPD and ΔmTD, respectively) on this difference was also investigated. RESULTS: There was a significant difference between mTD in the VF(pre) and mTD in the VF(post) (p<0.001, repeated measures analysis of variance). There was not a significant difference between mPD in the VF(pre) and mTD in the VF(post) (p=0.06); however, εmPD was significantly correlated with the mTD in VF(post) and also ΔmTD (R(2)=0.56 and 0.27, p<0.001, Pearson's correlation). The accurate prediction of the mTD in the VF(post) can be achieved using the pattern standard deviation (PSD), mTD and also visual acuity before surgery. CONCLUSIONS: Clinicians should be very careful when reviewing the VF of a patient with glaucoma and cataract since PD values may underestimate glaucomatous VF damage in patients with advanced disease and also overestimate glaucomatous VF damage in patients with early to moderate cataract.

Diagnostic performance and reproducibility of circumpapillary retinal nerve fiber layer thickness measurement in 10-degree sectors in early stage glaucoma.

PURPOSE: To study the circumpapillary retinal nerve fiber layer thickness (cpRNFLT) in a 10°-wide sector using spectral-domain optical coherence tomography for diagnostic ability in early stage open-angle glaucoma (OAG). METHODS: cpRNFLT measurements (3.4-mm diameter centered on the disc) were obtained from 89 eyes with early stage OAG (mean deviation, -2.5 ± 1.8 decibels) and 89 age-matched normal eyes. The ability of 180°-, 90°-, 30°-, and 10°-wide cpRNFLT sectors in discriminating early stage OAG eyes was evaluated by calculating the area under the receiver-operating characteristic curves (AUCs) and sensitivity/specificity per diagnostic criteria with varying sector widths, normative data-based cpRNFLT cutoff levels and numbers of abnormal sectors. The intra- and inter-visit reproducibilities of the cpRNFLT 10°-sector measurements were studied in a separate group of eyes with normal and early stage OAG. RESULTS: The greatest AUC obtained using the cpRNFLT 10° sector, 0.924 (confidence interval, 0.875-0.958), did not differ significantly from those obtained with the 180°, 90°, and 30° sectors. Only calculations using the 10° sectors had sensitivities and specificities of 0.90 or higher with the best performance of the sensitivity/specificity of 0.92/0.94. These values tended to be better (P = 0.070) than with the 30° sectors, 0.85/0.94, which were also selected with several combinations of various cutoff levels and the number of abnormal sectors. The coefficients of variation for the intra- and inter-visit reproducibility of the 10°-sector measurements were 10 % or less in 32 and 24 of the 36 sectors. CONCLUSION: The cpRNFLT 10°-sector measurements showed reasonable reproducibility and identified eyes with early stage OAG with a sensitivity and specificity of 0.92/0.94.

Diagnosis of Early-Stage Glaucoma by Grid-Wise Macular Inner Retinal Layer Thickness Measurement and Effect of Compensation of Disc-Fovea Inclination.

PURPOSE: To evaluate grid-wise analyses of macular inner retinal layer thicknesses and effect of compensation of disc-fovea inclination for diagnosing early-stage glaucoma. METHODS: Spectral-domain optical coherence tomography measurements over a 6.0 × 6.0-mm macular area were prospectively obtained in 104 eyes of 104 patients with early-stage glaucoma with a mean deviation of -1.8 ± 1.9 dB and 104 eyes of 104 age- and refraction-matched normal subjects. Macular retinal nerve fiber layer (mRNFL), ganglion cell-inner plexiform layer (GCIPL) combined, and ganglion cell complex (GCC) thickness of the entire area and each subdivided macular grid were determined to compare diagnostic capability for glaucoma using receiver operating characteristic curves and various normal cutoff values for each layer thickness and number of grids flagged as abnormal. Diagnostic capability was then compared with that of circumpapillary RNFL (cpRNFL) measurements. Effects of compensation of inclination of disc-fovea line by reconfiguration of the macular grid were also studied. RESULTS: Macular inner retinal layer analyses using 8 × 8 grids generally yielded higher diagnostic capability. Only the 8 × 8 grid GCC analyses using the various normal cutoff values yielded a sensitivity ≥ 0.90 with specificity ≥ 0.95 under several conditions in discriminating the glaucoma eyes. In glaucoma and normal eyes with both reliable cpRNFL and macular measurements, the best sensitivity/specificity were 0.98/0.95 for the 8 × 8 grid-mRNFL analysis and 0.93/0.96 for the 8 × 8 grid GCC analysis using various normal cutoff values, which were better than that (0.78/0.95) for clock-hour cpRNFL analysis (P = 0.001). Compensation of the disc-fovea inclination did not improve the diagnostic capability. CONCLUSIONS: Grid-wise analysis of macular GCC--especially using 8 × 8 grids and normative data-based cutoff values--was very useful for diagnosing early-stage glaucoma, though compensation of the disc-fovea inclination had little effect.