Quality of Life in Glaucoma: A Review of the Literature

Seizing the silent vision loss: cost-utility analysis of population-based glaucoma screening in India

OBJECTIVES

Glaucoma is a major cause of irreversible blindness in India; however, if detected early, its progression can be either prevented or stabilised through appropriate medical or surgical treatment. We aim to evaluate the cost-utility of various models for population-based glaucoma screening at primary health centres in India. We also assess the potential impact of the implementation of a population-based screening programme on overall costs of care for glaucoma.

DESIGN

Cost-utility analysis using a mathematical model comprising a decision tree and Markov model was conducted to simulate relevant costs and health outcomes over a lifetime horizon.

SETTING

Screening services were assumed to be delivered at primary health centres in India.

PARTICIPANTS

A hypothetical cohort of different target population groups in terms of age groups and risk of glaucoma (age group 40-75 years, 50-75 years, 40-75 years age group at high risk of glaucoma, 50-75 years age group at high risk of glaucoma) were included in comparative screening strategies.

INTERVENTIONS

The exclusive intervention scenarios were 12 screening strategies based on different target population groups (age group 40-75 years, 50-75 years, 40-75 years age group at high risk of glaucoma, 50-75 years age group at high risk of glaucoma), screening methods (face-to-face screening and artificial intelligence-supported face-to-face screening) and screening frequencies for 40-75 years aged population (annual vs once every 5 years screening), in comparison to usual care scenario. The usual care scenario (current practice) implied opportunistic diagnosis by the ophthalmologists at higher levels of care.

PRIMARY AND SECONDARY OUTCOMES

The primary outcome was the incremental cost-utility ratio for each of the screening strategies in comparison to usual care. The secondary outcomes were per person lifetime costs, lifetime out-of-pocket expenditures, life years and quality-adjusted life-years (QALYs) in all screening scenarios and usual care.

FINDINGS

Depending on the type of screening strategy, the gain in QALY per person ranged from 0.006 to 0.046 relative to usual care. However, the screening strategies, whether adjusted for specific age groups, patient risk profiles, screening methods or frequency, were not found to be cost-effective. Nonetheless, annual face-to-face screening strategies for individuals aged 40-75 years could become cost-effective in a scenario of strengthened public financing and provisioning, such that at least 67% of those seeking care for confirmatory diagnosis and treatment use government-funded facilities, in conjunction with 60% availability of medications at government hospitals.

CONCLUSIONS

Enhancing continuity of care following screening through either strengthening of public provisioning or strategic purchasing of care could make glaucoma screening interventions not only cost-effective, but also potentially cost-saving.

Inhibition of AGTR1 attenuates cell proliferation after glaucoma filtration surgery via NF-κB pathway-mediated G0/G1-phase cell cycle arrest

Fibroblast proliferation after glaucoma filtration surgery (GFS) plays a pivotal role in scar formation. Angiotensin type 1 receptor (AGTR1) is involved in tissue remodeling. Our previous study demonstrated that treatment with an AGTR1 blocker prolonged the survival of filtering blebs following GFS. However, whether AGTR1 participates in fibroblast proliferation after GFS remains unclear. This study examined the mechanisms underlying the involvement of AGTR1 in the activation of cell proliferation following GFS. AGTR1 expression was increased in Tenon capsule tissue of patients with glaucoma. AGTR1 inhibition resulted in a decrease in TGF-β2-induced human Tenon capsule fibroblast (HTF) proliferation and a mitigation of subconjunctival cell proliferation following GFS. Additionally, lower AGTR1 expression led to a higher percentage of HTFs in the G0/G1 phase via the p21Waf1/Cip1/Cyclin D/Cyclin E pathway. Furthermore, the addition of BAY 11-7082, a blocker of the NF-κB pathway, resulted in further inhibition of Ki67, Cyclin D, and Cyclin E expressions and an increase in the percentage of HTFs in the G0/G1 phase. In conclusion, our findings indicate that AGTR1 inhibition can attenuate HTF proliferation by leading to cell cycle arrest in the G0/G1 phase through the NF-κB pathway. Targeting AGTR1 is a feasible strategy for mitigating cell proliferation following GFS.

Current perspectives in tackling glaucoma blindness

As a major reason for irreversible vision loss, glaucoma is a significant public health concern. Its multifactorial nature demands a nuanced understanding of its pathophysiology, risk factors, and management. An understanding, and continuous refinement, of diagnostic and therapeutic modalities, including pharmacological interventions, novel methods of drug delivery, and surgical techniques (including minimally invasive glaucoma surgeries) are critical. The advent of personalized medicine, genetic profiling, and innovative biomarkers for identifying susceptible individuals and tailoring treatment strategies may help prevent blindness and improve patient outcomes. Evaluation of the impact of lifestyle modifications and holistic approaches and integration of telemedicine and artificial intelligence in glaucoma management may revolutionize current glaucoma practice. In addressing the global challenge of glaucoma blindness, this narrative review highlights ongoing initiatives, public health policies, and community-based interventions. This includes raising awareness, enhancing early detection programs, and access to care, particularly in underserved populations.

Open-Angle Glaucoma in Idiopathic Normal Pressure Hydrocephalus Before and After Ventriculo-Peritoneal Shunt Surgery: An Interventional Prospective Study

OBJECTIVE

To assess the frequency of open-angle glaucoma in Caucasian patients affected by idiopathic normal pressure hydrocephalus (iNPH) prior to ventriculo-peritoneal shunt surgery, and to evaluate the progression of optic nerve damage 1-year postsurgery.

METHODS

Thirty-five consecutive patients diagnosed with iNPH were prospectively recruited between November 2021 and June 2023. Assessments included visual acuity, intraocular pressure, macular ganglion cell complex thickness, retinal nerve fiber layer thickness, visual field test, central corneal thickness, axial length, and corneal hysteresis. Patients with newly diagnosed open-angle glaucoma were initiated on intraocular pressure-lowering medications. Eighteen patients were re-evaluated after a mean of 1 year postshunt surgery to assess the progression of optic nerve damage.

RESULTS

A total of 35 eyes of 35 iNPH patients were included. The mean age of participants was 75.75 ± 6.67 years, with 34.3% being females. Primary open-angle glaucoma was identified in 22.8% of nonshunted iNPH patients, including 11.4% who received a new diagnosis. After a mean follow-up of 14.9 ± 4.8 months postsurgery, there were no significant changes in retinal nerve fiber layer and ganglion cell complex thickness, nor were there any observed progressions in visual field defects or significant alterations in corneal biomechanics (P > 0.05).

CONCLUSIONS

Approximately 1 in 5 nonshunted iNPH patients exhibited primary open-angle glaucoma, with 50% being undiagnosed. These findings indicate the importance of conducting ophthalmological evaluations at the time of iNPH diagnosis, as early intervention may mitigate optic nerve damage progression following shunt surgery.

Emerging perspectives in quality of life after trabeculectomy surgery

BACKGROUND/OBJECTIVES

Trabeculectomy is the gold standard surgery in treatment of glaucoma but there is little reported on its early impact in health-related quality of life (HRQoL). Here we characterise HRQoL in the early post-operative period with two generic patient-reported outcome measures tools (PROMs), the EQ-5D and SF-6D, and compare them to visual-related and glaucoma-specific PROMs, the VF-25 and GUI.

SUBJECTS/METHODS

We prospectively enrolled 168 patients with failed medical treatment undergoing trabeculectomy and assessed HRQoL at baseline and in the post-operative period using the PROMs above. Paired t-tests, ANOVA and linear regression tests were used to analyse outcomes.

RESULTS

A significant drop in HRQoL was identified in the first month post-operatively with the SF-6D, the VF-25 and the GUI but not with the EQ-5D. This drop was reversed to pre-operative levels by month 3. Four dimensions of HRQoL, including physical functioning, social functioning and adaptation to physical and to emotional roles had the most impact on the generic HRQoL. Visual acuity dropped one line in the operated eye at month 1 and was the only measurable clinical factor contributing to HRQoL.

CONCLUSIONS

The early post-operative period in trabeculectomy surgery is associated with a reversible loss of HRQoL, which is the result of transient worsening of vision but also physical, emotional and social restrictions caused by the busy medication regimen and drastic lifestyle changes. The SF-6D was better than the EQ-5D at picking up changes in HRQoL.

Combined Microinvasive Glaucoma Surgery With Phacoemulsification in Open-Angle Glaucoma: A Systematic Review and Meta-analysis

PURPOSE

To compare efficacies and safeties of combined phacoemulsification-microinvasive glaucoma surgeries (MIGS) to phacoemulsification only in eyes with open-angle glaucoma.

DESIGN

Systematic review and meta-analysis.

METHODS

A multidatabase literature search was conducted to capture MIGS articles published before April 19, 2024. Key exclusion criteria were inadequate follow-up, significant loss to follow-up, standalone MIGS surgery, or unreported primary outcomes. MIGS were grouped according to mechanisms of action: (1) trabecular meshwork (TM) bypass that improves aqueous drainage into Schlemm's canal, (2) non-gonioscopy-assisted transluminal trabeculotomy (non-GATT) goniotomies that remove TM with varying devices, and (3) GATT that removes TM with a catheter or suture placed into Schlemm's canal. Efficacy was measured by reductions in intraocular pressure (IOP) and medications, whereas safety was compared using incidence of sight-threatening and other adverse events.

RESULTS

A total of 95 studies were included, accounting for 9733 eyes followed up at 1-year. The control group had a baseline IOP of 16.9 (95% CI: 15.9-17.9) mm Hg on 1.43 (1.19-1.68) medications and a postoperative IOP of 15.2 (14.4-15.9) mm Hg on 0.80 (0.54-1.00) medications. The TM bypass baseline IOP was 18.2 (17.6-18.7) mm Hg on 1.89 (1.78-2.01) medications that lowered to an IOP of 14.8 (14.5-15.1) mm Hg on 0.80 (0.65-0.95) medications at 1 year after operation. The non-GATT goniotomy baseline IOP was 20.0 (19.2-20.8) mm Hg on 2.30 (2.09-2.53) medications, and at 1-year follow-up, the IOP was 14.6 (14.3-15.0) mm Hg on 1.41 (1.22-1.62) medications. Lastly, the GATT baseline IOP of 21.8 (19.5-24.1) mm Hg on 2.90 (2.36-3.44) medications was reduced to an IOP of 12.5 (10.0-15.0) mm Hg on 0.73 (0.37-1.09) medications at 1-year after operation. All MIGS groups had equal or lower rates of sight-threatening events and secondary glaucoma surgery when compared with control. GATT had the highest hyphema rate at 27.7% (13.5%-44.5%) followed by non-GATT goniotomy with 15.5% (7.8%-25.0%). These were both significantly higher than TM bypass and control groups, with hyphema rates of 3.5% (1.6%-5.9%) and 4% (only 1 study reporting hyphema rate), respectively.

CONCLUSIONS

Based on current peer-reviewed articles, there is strong evidence that when compared with phacoemulsification alone, combined phacoemulsification-MIGS is beneficial for patients with open-angle glaucoma and does not increase the incidence of vision-threatening events. Key limitations of our review stem from heterogeneities in protocol design or outcome reporting and a limited number of high-quality studies with long-term follow-up.

Evaluation of the nutraceutical Palmitoylethanolamide in reducing intraocular pressure (IOP) in patients with glaucoma or ocular hypertension: a systematic review and meta-analysis

Intraocular pressure (IOP) positively correlates with both normal and high-tension glaucoma. To date, IOP targeting remains the validated pharmacological approach in counteracting glaucoma progression as well as in halting vision loss. Among the different adjuvant compounds, evidence highlighted the potential effectiveness of Palmitoylethanolamide (PEA), an endogenous fatty acid amide. Thus, a systematic review of the literature was conducted, thoroughly evaluating PEA treatment regimen in decreasing IOP in patients with eye disorders. We checked for articles across the scientific databases Pubmed (MEDLINE), Embase (OVID), and Web of Science from the inception to 30 August 2023, and a total of 828 articles were recovered. Six of these studies (199 patients) were included in the systematic review after the study selection process, and three studies for meta-analysia. Overall, PEA showed significant efficacy in reducing IOP in patients, this encourages its clinical use in glaucoma as well as across different forms of eye disorders.

A Randomized Pilot Study of Four Dosing Schemes of Sublingual Methazolamide in Glaucoma Patients

Purpose

To evaluate the safety and efficacy of sublingual methazolamide in patients with open-angle glaucoma (OAG) and inform future trial design.

Methods

Fourteen participants (28 eyes) aged 50 to 90 years with bilateral OAG and intraocular pressure (IOP) between 18 and 35 mmHg after medication washout were included. Participants were randomized to receive either 25 mg or 50 mg of sublingual methazolamide once daily for one week, followed by twice-daily administration during the second week. The primary outcome was change in IOP from baseline to days 7 and 14. Secondary outcomes included changes in serum methazolamide levels, serum electrolytes, urine pH and electrolytes, and side effects.

Results

After randomization, exclusion, and two dropouts, four patients in the 25 mg group and ten in the 50 mg group completed the study in full. Both doses of sublingual methazolamide resulted in significant reductions in IOP from the post-washout baseline at all follow-up points (all p < 0.05). Lowest mean IOPs were recorded 8 hours post-dose; after a week of daily dosing, the 25 mg and 50 mg groups achieved reductions of 6.6 mmHg (-26.5%) and 4.2 mmHg (-19.3%), respectively (both p < 0.001). Twice-daily dosing resulted in significantly lower morning IOPs compared to once-daily in each group (p = 0.05 for 25 mg; p = 0.003 for 50 mg). Serum methazolamide levels correlated with dose amount and frequency. Serum electrolyte levels were stable throughout, while urinary pH and urinary electrolytes fluctuated based on time since last dose. Side effects of mild headaches and/or fatigue were reported by 3 out of 14 (21.4%) participants, with no serious adverse events.

Conclusion

Sublingual methazolamide demonstrated effective IOP reduction with a favorable safety profile. Twice-daily dosing may offer more sustained IOP control. These findings support further investigation into sublingual methazolamide as an alternative glaucoma treatment.

Quality of life and associated factors among patients with glaucoma attending at Boru Meda General Hospital, Northeast Ethiopia

Glaucoma significantly impacts the well-being of millions of people worldwide and contributes to a decline in quality of life. Therefore, this study aimed to evaluate quality of life and identify influencing factors among glaucoma patients receiving care at Boru Meda General Hospital in Northeast Ethiopia in 2022. A hospital-based cross-sectional study was conducted at Boru Meda General Hospital from July 10 to September 10, 2022. A total of 432 glaucoma patients were selected through a simple random sampling technique. The participants were interviewed via a structured questionnaire, including the modified Glaucoma Quality of Life-15 tool. The data collected were processed by cleaning, coding, and entering into EPi-data version 4.6 and then analysed via SPSS version 26. Variables with a p value less than 0.05 at the 95% confidence interval were considered statistically significant. A total of 417 participants participated in the study, resulting in a response rate of 96.4%. Among them, 187 individuals, accounting for 44.2% (95% CI 39.8-49.9%), reported having poor quality of life. Factors such as being diagnosed for more than 6 years, residing in rural areas, having other ocular diseases, having bilateral glaucoma, receiving treatment for 1-5 years, experiencing moderate anxiety, and facing moderate depression were significantly associated with poor quality of life, with adjusted odds ratios ranging from 2.555 to 8.035. Approximately half of the participants experienced a diminished quality of life, and significant associations were found with rural residence, time since diagnosis, treatment duration, the presence of other ocular conditions, bilateral glaucoma, and levels of anxiety and depression. The implementation of community-based glaucoma screening initiatives aimed at early identification and treatment, particularly those focused on rural communities and individuals with bilateral glaucoma, is crucial.

Evidence in Practice: A Review of Real-Life Studies and Clinical Experience with the Preservative-Free Tafluprost (0.0015%) and Timolol (0.5%) Fixed-Dose Combination

The preservative-free fixed-dose combination formulation of 0.0015% tafluprost and 0.5% timolol (PF tafluprost/timolol FC) is among the topical intraocular pressure (IOP)-lowering therapies commonly used second-line for the management of ocular hypertension (OHT) and open-angle glaucoma (OAG), according to recommended treatment pathways. A growing body of evidence has developed in recent years regarding efficacy, safety and tolerability outcomes with PF tafluprost/timolol FC in both randomized controlled trials (RCTs) and real-life studies. This review aims to summarize key evidence from published Phase IV trials and real-life studies to highlight those data that complement RCT findings and support implementation of evidence-informed clinical practice. Real-life efficacy and safety outcomes are discussed through the lens of common clinical scenarios that ophthalmologists may encounter in the management of OHT/OAG. Phase IV studies conducted to date have demonstrated that the majority of OHT/OAG patients insufficiently controlled on topical prostaglandin or beta-blocker monotherapy may achieve IOP reductions of ≥20% following a switch to PF tafluprost/timolol FC therapy. Statistically significant IOP reductions were reported from 4 weeks and maintained through 6 months. Real-life studies and case series data also indicated that patients with poor IOP control on maximal/complex topical regimens benefited from a step down to PF tafluprost/timolol FC therapy, achieving significant and sustained IOP reductions. A number of studies have shown improvements in tolerability and the signs and symptoms of ocular health with PF tafluprost/timolol FC therapy, both in patients stepping up from monotherapy and in those simplifying their topical regimen. Clinicians reported better treatment adherence with PF tafluprost/timolol FC compared with prior treatments, which may have been associated with enhanced patient experience regarding treatment tolerability and is likely to have contributed to the long-term IOP-lowering efficacy outcomes observed. Real-life safety data for PF tafluprost/timolol FC reflect outcomes reported in published RCTs.

Vision-related quality of life in patients with glaucoma before and after trabeculectomy

PURPOSE

To determine vision-related quality of life (VR-QoL) and functional and structural parameters associated with VR-QoL in patients with glaucoma before and 12 months after trabeculectomy.

METHODS

Fifty-eight patients undergoing trabeculectomy were included. Participants completed the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) prior to and 12 months after trabeculectomy. Functional (visual acuity and visual fields) and structural (ganglion cell layer volume) parameters were evaluated for their association with VR-QoL using multiple linear regression of VFQ-25 subscale scores. Intraocular pressure and the number of glaucoma medications were also included in the analyses.

RESULTS

The VFQ-25 composite score did not change after trabeculectomy (before: 74.9; 12 months: 74.0; p = 0.512). The subscale mental health had a significantly higher score 12 months after trabeculectomy (before: 65.6; 12 months: 71.4; p = 0.017). The VFQ-25 scores for general health (before: 68.5; 12 months: 62.5; p = 0.009) and role difficulties (before: 78.9; 12 months: 53.7; p < 0.001) were significantly lower 12 months after trabeculectomy. No functional or structural parameters were associated with VFQ-25 composite score.

CONCLUSION

Overall, VR-QoL in glaucoma patients was similar before and after trabeculectomy, reflecting the procedure's stabilizing effect on both objective and subjective visual function. The absence of correlations between VR-QoL and clinical parameters emphasizes the multifaceted nature of VR-QoL and highlights the limitations of depending solely on objective clinical metrics to evaluate patients' subjective experiences. Using both objective measures and VR-QoL, clinicians can better understand the challenges patients face due to glaucoma and trabeculectomy, potentially leading to better solutions.

Patient Experience and Barriers to the Visual Field Test for Glaucoma

PRCIS

There are significant mental, physical, and perceptual challenges in patients undergoing visual field testing, particularly in the elderly population with glaucoma.

PURPOSE

To quantitatively and qualitatively investigate patient experiences of undergoing visual field testing.

METHODS

This cross-sectional, mixed-methods study involves adult patients attending a private outpatient ophthalmology clinic in Brisbane, Australia. Participant experiences of visual field testing were assessed using a 100 mm visual analog scale (VAS), followed by face-to-face semi-structured interviews. Outcome data comprised of VAS scores (1-100) and thematically analyzed verbatim notes.

RESULTS

Of the 152 participants [M:F 79 (52.0%):73 (48.0%)], the age group with the highest proportion of participants was 71-80 years [n=56 (36.8%)], and most had a primary ocular diagnosis of glaucoma [n=107 (70.4%)]. The mean VAS score for visual field testing experience was 60.45 (SD=30.38). The mean VAS score of participants with glaucoma was significantly lower than that of participants without glaucoma [55.34 (31.13) vs. 72.67 (25.04); P <0.05]. Prevalent themes regarding participant experiences of visual field testing consisted of concentration difficulties, intra-test and peri-test anxiety, skepticism in the testing process, and physical discomfort. Age, sex, and mean visual field index did not influence participant experiences of visual field testing.

CONCLUSIONS

Mental and physical barriers to visual field testing tolerability were identified in a predominantly elderly population with glaucoma. Our findings highlight the importance of addressing patient concerns and apprehensions regarding visual field testing and emphasize the value of patient-initiated breaks, particularly for individuals experiencing concentration difficulties and physical discomfort.

Asymmetric Glaucoma and Corresponding Hearing Impairment

Background/Objectives: This study aims to explore the potential relationship between unilateral or asymmetric glaucoma and ipsilateral hearing impairment. Methods: In this retrospective study, visual and hearing functions were assessed in patients with unilateral or asymmetric glaucoma. Correlations between retinal nerve fiber layer (RNFL) thickness, visual field mean deviation (MD) values, and pure tone audiometry (PTA) measurements across various frequencies were analyzed to explore potential associations between visual and ipsilateral hearing functions. Differences in PTA values between ears ipsilateral to the more affected glaucomatous eyes and the contralateral ears were studied for statistical significance. Results: Twenty-six patients with unilateral or asymmetric glaucoma were included in the study. Significant differences in hearing thresholds between the ears corresponding to the more severely glaucomatous eyes and the contralateral ears were found at 0.7, 1, 1.5, and 3 kHz (p < 0.05). Additionally, a statistically significant difference was observed in the speech frequencies (0.5, 0.7, 1, 1.5, 2, 3, and 4 kHz) between ears corresponding to glaucomatous or more affected glaucomatous eyes and the contralateral ears (p = 0.016). Furthermore, a moderately positive correlation was found between differences in MD and PTA values at 0.125 kHz (r = 0.50; p = 0.01). Conclusions: This study highlights a potential association between unilateral or asymmetric glaucoma and ipsilateral hearing impairment, particularly at speech-relevant frequencies. These findings underscore the importance of integrated sensory assessment in the management of glaucoma patients, suggesting that early detection and intervention for concurrent hearing loss could enhance overall quality of life.

Knowledge, attitude, and practice (KAP) towards glaucoma among new glaucoma patients and their first-degree relatives: A cross-sectional study in a tertiary eye care centre in Riyadh, Saudi Arabia

PURPOSE

Glaucoma, a disease characterized by optic nerve damage and associated visual field defects, is the main cause of irreversible loss of vision, both globally and locally. Appropriate management of glaucoma involves early diagnosis in addition to early and continuous control of the disease to protect the optic nerve from further damage. This study aimed to assess the knowledge, attitude, and practice (KAP) towards glaucoma among patients making their first visit to the glaucoma clinics, at King Khaled Eye Specialist Hospital in Riyadh, and their first-degree relatives.

METHODS

This cross-sectional study used self-administered questionnaires. Informed consent was obtained prior to questionnaire distribution. The questionnaire included four sections on sociodemographic data, and awareness, and KAP towards glaucoma.

RESULTS

Overall, 120 participants were included in our study: 70 (58.3%) were glaucoma patients and 50 (41.7%) were first-degree relatives. Forty-four (62.9%) participants in the patient group and 39 (78%) in the relative group were men. Thirty-four (48.6%) patients were aged 41-65 years, whereas 41 (82%) relatives were aged 18-40 years. Thirty-six patients (52.2%) and 35 relatives (70%) had heard of the term 'glaucoma'. The correct definition of glaucoma was selected by only 12 participants (17.1%) in the patient group and 4 (8.2%) in the relative group. Living outside the central region of Saudi Arabia and having a negative systemic medical history were associated with poorer knowledge of glaucoma definition (p < 0.05). Although 84.8% of patients believed that compliance with anti-glaucoma medications helps in disease control, only 22.7% reported good compliance. The correct method of instilling eye drops was stated by 43.9% of the patients, and good hospital visit habits were reported by 53.03%. Eighty percent of glaucoma patients strongly recommended that their first-degree relatives be screened for glaucoma.

CONCLUSION

Knowledge about glaucoma is still limited, and awareness programs need to be further activated to spread correct knowledge about the nature of glaucoma, the importance of compliance with treatment, the correct method of instilling eye drops, and the significance of screening at-risk individuals. Patient families should also be involved in educational programs.

Quality of life and mental health status of glaucoma patients

Introduction

Glaucoma, a leading cause of irreversible blindness worldwide, poses significant challenges to patients' quality of life (QOL) and mental well-being.

Methods

This study aimed to investigate the complex interplay between clinical, demographic, and psychological factors and their impact on QOL among patients diagnosed with glaucoma. A cohort of 201 glaucoma patients, with a mean age of 70 years, participated in the study.

Results

Descriptive analyses revealed that participants reported living with a glaucoma diagnosis for an average of 13.38 years, highlighting the chronic nature of the disease in the cohort. Comorbidity was shown to be in close relationship with QOL, where with additional health problems have lower QOL scores (M = 34.86, SD = 18.25), as well as higher levels of anxiety (M = 10.64, SD = 5.38) and depression (M = 13.42, SD = 7.37). Correlation analyses further unveiled robust associations between clinical characteristics and psychological outcomes, with lower visual acuity strongly correlated with reduced QOL (rR = -0.74, pR < 0.001; rL = -0.78, pL < 0.001) and higher levels of anxiety and depression. Additionally, longer duration of glaucoma diagnosis was moderately associated with poorer QOL (r = 0.56, p < 0.001) and increased psychological distress, highlighting the cumulative burden of living with the disease over time. Mediation analyses indicated that duration of diagnosis partially mediated the relationship between depression and QOL, as well as anxiety and QOL, suggesting that the prolonged experience of living with glaucoma may exacerbate the impact of psychological distress on QOL.

Discussion

These findings underscore the importance of holistic patient care approaches that address both the physical and psychological aspects of glaucoma to improve patient outcomes and enhance overall well-being.

Preservative-Free Fixed Combination of Tafluprost 0.0015% and Timolol 0.5% for Treatment-Naive Patients with Open-Angle Glaucoma

PURPOSE

To assess efficacy, safety, and tolerability of the preservative-free (PF) fixed-dose combination (FC) of tafluprost 0.0015%/timolol 0.5% (PF tafluprost/timolol FC) in treatments-naive patients with primary open-angle glaucoma (POAG).

METHODS

This was a retrospective, real-world clinical practice setting study that included 107 eyes of 107 subjects with POAG who had never been treated for glaucoma. All subjects were received PF tafluprost/timolol FC once daily. Intraocular pressure (IOP) levels were documented for each eye at the untreated baseline and up to 6 months after the initiation of medical treatment. All adverse events, including ocular and systemic adverse reactions, were recorded. Additionally, the reasons for medication discontinuations were thoroughly documented.

RESULTS

A total of 32 POAG patients with high-baseline IOP (>21 mmHg) and 75 with normal-baseline IOP were included in the study. The subjects' baseline mean age was 62.4 ± 8.7 years (range, 26.0-85.0 years); among them, 42 were female (39.3%). Mean IOP at baseline for all patients was 18.6 ± 4.3 mmHg. The mean IOP at 6 months was 12.6 ± 4.7 mmHg, representing a significant decrease compared to the baseline (-32%, p < 0.001). In POAG patients with high-baseline IOP, mean IOP was significantly lowered from 28.0 ± 5.7 mmHg at baseline to 18.0 ± 5.5 mmHg (-35%, p < 0.001); in patients with normal-baseline IOP, from 14.6 ± 3.4 mmHg at baseline to 10.3 ± 4.1 mmHg (-29%, p < 0.001). PF tafluprost/timolol FC was well-tolerated and safe. After 6 months, 97.2% of all patients remained on therapy.

CONCLUSIONS

In this real-world observational study, once-daily treatment with PF tafluprost/timolol FC demonstrated clinically relevant and statistically significant efficacy, as well as safety and good tolerability, in treatment-naive patients diagnosed with POAG.

Travoprost Intracameral Implant for Open-Angle Glaucoma or Ocular Hypertension: 12-Month Results of a Randomized, Double-Masked Trial

INTRODUCTION

This prospective, multicenter, randomized, double-masked pivotal phase 3 trial evaluated the efficacy and safety of the travoprost intracameral SE-implant (slow-eluting implant, the intended commercial product) and FE-implant (fast-eluting implant, included primarily for masking purposes) compared to twice-daily (BID) timolol ophthalmic solution, 0.5% in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT).

METHODS

The trial enrolled adult patients with OAG or OHT with an unmedicated mean diurnal intraocular pressure (IOP) of ≥ 21 and unmedicated IOP ≤ 36 mmHg at each diurnal timepoint (8 A.M., 10 A.M., and 4 P.M.) at baseline. The eligible eye of each patient was administered an SE-implant, an FE-implant or had a sham administration procedure. Patients who received an implant were provided placebo eye drops to be administered BID and patients who had the sham procedure were provided timolol eye drops to be administered BID. The primary efficacy endpoint, for which the study was powered, was mean change from baseline IOP at 8 A.M. and 10 A.M. at day 10, week 6, and month 3. Non-inferiority was achieved if the upper 95% confidence interval (CI) on the difference in IOP change from baseline (implant minus timolol) was < 1.5 mmHg at all six timepoints and < 1 mmHg at three or more timepoints. The key secondary endpoint was mean change from baseline IOP at 8 A.M. and 10 A.M. at month 12. Non-inferiority at month 12 was achieved if the upper 95% CI was < 1.5 mmHg at both timepoints. Safety outcomes included treatment-emergent adverse events (TEAEs) and ophthalmic assessments.

RESULTS

A total of 590 patients were enrolled at 45 sites and randomized to one of three treatment groups: 197 SE-implant (the intended commercial product), 200 FE-implant, and 193 timolol. The SE-implant was non-inferior to timolol eye drops in IOP lowering over the first 3 months, and was also non-inferior to timolol at months 6, 9, and 12. The FE-implant was non-inferior to timolol over the first 3 months, and also at months 6 and 9. Of those patients who were on glaucoma medication at screening, a significantly greater proportion of patients in the SE- and FE-implant groups (83.5% and 78.7%, respectively) compared to the timolol group (23.9%) were on fewer topical glaucoma medications at month 12 compared to screening (P < 0.0001, chi-square test). TEAEs, mostly mild, were reported in the study eyes of 39.5% of patients in the SE-implant group, 34.0% of patients in the FE-implant group and 20.1% of patients in the timolol group.

CONCLUSIONS

The SE-travoprost intracameral implant demonstrated non-inferiority to timolol over 12 months whereas the FE-implant demonstrated non-inferiority over 9 months. Both implant models were safe and effective in IOP lowering in patients with OAG or OHT.

TRIAL REGISTRATION

ClinicalTrials.gov identifier, NCT03519386.

Efficacy of Smoothing Algorithms to Enhance Detection of Visual Field Progression in Glaucoma

Purpose

To evaluate and compare the effectiveness of nearest neighbor (NN)- and variational autoencoder (VAE)-smoothing algorithms to reduce variability and enhance the performance of glaucoma visual field (VF) progression models.

Design

Longitudinal cohort study.

Subjects

7150 eyes (4232 patients), with ≥ 5 years of follow-up and ≥ 6 visits.

Methods

Vsual field thresholds were smoothed with the NN and VAE algorithms. The mean total deviation (mTD) and VF index rates, pointwise linear regression (PLR), permutation of PLR (PoPLR), and the glaucoma rate index were applied to the unsmoothed and smoothed data.

Main Outcome Measures

The proportion of progressing eyes and the conversion to progression were compared between the smoothed and unsmoothed data. A simulation series of noiseless VFs with various patterns of glaucoma damage was used to evaluate the specificity of the smoothing models.

Results

The mean values of age and follow-up time were 62.8 (standard deviation: 12.6) years and 10.4 (standard deviation: 4.7) years, respectively. The proportion of progression was significantly higher for the NN and VAE smoothed data compared with the unsmoothed data. VF progression occurred significantly earlier with both smoothed data compared with unsmoothed data based on mTD rates, PLR, and PoPLR methods. The ability to detect the progressing eyes was similar for the unsmoothed and smoothed data in the simulation data.

Conclusions

Smoothing VF data with NN and VAE algorithms improves the signal-to-noise ratio for detection of change, results in earlier detection of VF progression, and could help monitor glaucoma progression more effectively in the clinical setting.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

[Life satisfaction in patients with chronic glaucoma-An overview]

How do patients perceive fear and psychological challenges emerging from a chronic disease and how does this influence their commitment to treatment? Treating patients suffering from glaucoma requires not only medical knowledge but also empathy, communication skills and a positive valuing doctor-patient relationship, thus, having a good eye for the challenges in the treatment of patients with glaucoma. Supplementary, a method and a case study for the measurement of satisfaction with life in patients with glaucoma is introduced. The results and the benefits of an individual evaluation and analysis of the results with each patient are discussed in this article. To make the patients aware of possible psychological challenges and to address possible solutions, ophthalmologists should use and analyze questionnaires with their patients individually. The relationship to the patient and a valuing guidance of the patient are essential to the promotion of the effectiveness of treatment and adherence of the patient.

Quality of life and depression among patients with high myopia in Nigeria: a cross sectional study

AIM

To evaluate the quality of life (QOL) and level of depression among participants with high myopia in Nigeria and the demographic factors associated with these outcomes.

METHODS

This cross-sectional study was conducted on 100 adult participants with high myopia (defined as refractive error ≤-5.00 D or worse, and uncorrected visual acuity worse than 6/18 in the better seeing eye) attending ophthalmology centres in Nigeria from 2 October 2021 to 30 August 2022. The means and standard deviations were calculated for each of the four domains of World Health Organization Quality of life scale (WHOQOL-BREF) using the transformed scores. The Beck Depression Inventory (BDI) scale was used to assess the level of depression.

RESULTS

The highest and the lowest mean scores of WHOQOL-BREF domains were found for the psychological and physical health domains (mean percentage scores were 67.0 [95% confidence intervals (CI) 64.1-68.9] and 55.3 (95%CI 51.8-58.8, P<0.001), respectively. One-way analysis of variance (ANOVA) revealed significant differences in physical health with educational status (higher among those with tertiary education: mean difference 0.9, 95%CI -0.2-2.1; P=0.049), differences in psychological health with working status (higher among those who were working 1.2, 95%CI 0.3-2.1; P=0.012). Also, the result showed a statistically significant association between environmental health and marital status (higher among non-married: 1.7, 95%CI -0.9-2.3; P=0.012) while overall health was associated with place of residence (higher in urban areas: 2.3, 95%CI 1.2-3.5; P=0.024). For depression, one in every nine participants reported major depressive symptom, mostly younger people (aged 16-29 vs 30-49y: 17.0% vs 0, P=0.019), and slightly more women than men (14.3% vs 0, P=0.064). There were significant negative correlations between the depression scores and psychological health (r=-0.48, P<0.001), physical health (r=-0.29, P=0.002), social and relationship (r=-0.49, P<0.001), environmental (r=-0.48, P<0.001) and overall health (r=-0.49, P<0.001).

CONCLUSION

People with high myopia have a relatively moderate QOL, but poor physical health, particularly the younger age group, and women who are more likely to experience clinically relevant depression. Eye care professionals should consider possible referrals for counselling for people with high myopia.

Treatment expectations in glaucoma: what matters most to patients?

BACKGROUND/OBJECTIVES

Recent clinical trials in glaucoma have used patient-reported outcome measures (PROMs) of health-related quality of life to evaluate interventions. However, existing PROMs may not be sufficiently sensitive to capture changes in health status. This study aims to determine what really matters to patients by directly exploring their treatment expectations and preferences.

SUBJECTS/METHODS

We conducted a qualitative study using one-to-one semi-structured interviews to elicit patients' preferences. Participants were recruited from two NHS clinics serving urban, suburban and rural populations in the UK. To be relevant across glaucoma patients under NHS care, participants were sampled to include a full range of demographic profiles, disease severities and treatment histories. Interview transcripts were evaluated using thematic analysis until no new themes emerged (saturation). Saturation was established when 25 participants with ocular hypertension, mild, moderate and advanced glaucoma had been interviewed.

RESULTS

Themes identified were: Patients' experiences of living with glaucoma, patients' experiences of having glaucoma treatment, most important outcomes to patients, and COVID-related concerns. Participants specifically expressed their most important concerns, which were (i) disease-related outcomes (intraocular pressure control, maintaining vision, and being independent); and (ii) treatment-related outcomes (treatment that does not change, drop-freedom, and one-time treatment). Both disease-related and treatment-related experiences were covered prominently in interviews with patients across the spectrum of glaucoma severity.

CONCLUSIONS

Outcomes related both to the disease and its treatment are important to patients with different severities of glaucoma. To accurately evaluate quality of life in glaucoma, PROMs may need to assess both disease-related and treatment-related outcomes.

Awareness and Knowledge About Glaucoma in the Western Region of Saudi Arabia: A Population-Based Survey

Background Glaucoma is a leading cause of irreversible blindness worldwide. This study aimed to assess the Saudi population's levels of awareness and knowledge regarding glaucoma risk factors, symptoms, treatment, and outcomes. Methods A cross-sectional study was conducted among the Glaucoma Awareness Campaign attendees during the World Glaucoma Week (2015-2016). A structured questionnaire was used, and a knowledge score (0-25) was calculated as the sum of all correct answers. Sociodemographic factors, personal and family history of glaucoma, and the presence of risk factors were investigated and analyzed as factors affecting knowledge. Results The study included 1751 participants, with a mean age of 40.23 (SD ±13.86) years; 51.5% were males, 3.7% had glaucoma and 22.6% had a family history of glaucoma. The overall awareness rate was 65.6%, which was moderately higher among females (71.6%), older participants (≥40 years, 69.7%), and highly educated participants (70.6%). Concerning knowledge, 15.4% had fair to good knowledge (score 15-25). Participants with a personal history of glaucoma had relatively greater knowledge regarding glaucoma-specific questions, such as optic nerve damage (p=0.001) and the requirement of lifetime treatment (p<0.001). Conclusion Awareness and knowledge about glaucoma are limited among the Saudi population, regardless of socioeconomic class or educational status. Knowledge about glaucoma should be further promoted to enable early screening and prevention.

Outcomes of 60-Degree Nasal Goniotomy for Open Angle Glaucoma

PRCIS

Sixty-degree nasal sectoral juxtacanalicular space goniotomy with the single-use Espaillat juxtacanalicular space slider device significantly reduced intraocular pressure and the number of required glaucoma hypotensive medications, with sustained reductions over 24 months.

PURPOSE

This study analyzed the safety and efficacy of the Espaillat juxtacanalicular space slider during minimally invasive 60-degree nasal sectoral goniotomy for mild-to-moderate open angle glaucoma (OAG).

PATIENTS AND METHODS

This prospective, observational case series performed at a private clinical practice and outpatient surgery center assessed the eyes of patients with mild-to-moderate OAG who underwent phacoemulsification cataract surgery with 60-degree nasal sectoral goniotomy using the Espaillat juxtacanalicular space slider. The same surgeon performed all procedures. Intraocular pressure, intraocular pressure-lowering drugs, and adverse effects were assessed over 24 months, and a regression analysis of intraocular pressure reduction was performed. Success was defined as (1) A reduction in the intraocular pressure of at least 20% for at least 12 months, compared with the baseline value, and (2) a decrease in the number of medications by at least one for at least 12 months.

RESULTS

Among 38 eyes, 27 (72%) had moderate glaucoma, and 11 (28%) had mild glaucoma. Postoperatively, intraocular pressure was decreased by 38% at 12 months (mean 13.7±1.7 mmHg), 35% at 18 months (mean 14.4±1.8 mmHg), and 31% at 24 months (mean 15.2±1.9 mmHg). In addition, the number of topical glaucoma medications used decreased from a mean of 1.6 to 0.4 ( P <0.001). The main adverse event was temporary focal corneal edema (29 patients; 76%).

CONCLUSIONS

Using the Espaillat juxtacanalicular space slider during invasive 60-degree nasal sectoral goniotomy for OAG yielded a significant and sustained reduction in intraocular pressure and reduced the need for glaucoma medications with minimal adverse events.

Ocular Surface Changes in Primary Open Angle Glaucoma Patients Treated With Topical Antihypertensive Drugs

PRCIS

In this study, patients with glaucoma undergoing topical antihypertensive (TAH) drugs had changes in the ocular surface and more dry eye symptoms than controls. Clinicians should recognize the influence of TAH drops on exacerbating ocular surface disease.

PURPOSE

The purpose of this study was to evaluate the ocular surface of eyes with glaucoma treated with TAH drugs.

METHODS

Cross-sectional study that included eyes undergoing TAH drugs due to primary open angle glaucoma and controls. The parameters evaluated were: the basal tear flow (basic secretion test); the tear film osmolarity (TearLab); and the noninvasive break-up time, blink score, lipid layer thickness, tear meniscus height, and loss area of the meibomian glands, measured with the IDRA Ocular Surface Analyser. Presence of symptoms [Ocular Surface Disease Index (OSDI)], dry eye disease (DED, TFOS DEWS II criteria), and corneal fluorescein staining were assessed.

RESULTS

We included 154 eyes (154 patients), 77 undergoing TAH drugs for glaucoma (group 1) and 77 of controls (group 2). The tear film osmolarity ( P =0.003) and the loss area of the meibomian glands ( P =0.004) were higher in group 1. The noninvasive break-up time ( P =0.005), lipid layer thickness ( P =0.006), and tear meniscus height ( P =0.001) were lower in group 1. The global OSDI score ( P <0.001), the proportion of eyes with severe disease ( P =0.002), according to the OSDI, and with DED ( P <0.001), according to the TFOS DEWS II criteria, were higher in group 1. The proportion of patients with corneal fluorescein staining was higher in group 1 ( P <0.001). There were no significant differences in eyes taking TAH drugs with and without preservatives ( P >0.127).

CONCLUSIONS

DED, in patients with glaucoma, is a multifactorial disease, with a strong contribution from TAH drugs. These eyes had changes in almost every measured parameter, translating into the presence of more dry eye symptoms and corneal damage when compared with controls.

Factors associated with 1-year outcomes and transient intraocular pressure elevation in minimally invasive glaucoma surgery using Kahook Dual Blades

In this retrospective case-control study, we aimed to investigate the mid- to long-term outcomes and factors involved in minimally invasive glaucoma surgery using the Kahook Dual Blade. Of the 229 cases since 2018 in which the dual blades were used for glaucoma surgery at the Tenri Hospital, 133 eyes of 98 patients who followed up for more than 3 months were included. Intraocular pressure (IOP), number of drops score, and need for reoperation were evaluated on day 1 and at 1, 3, 6, 9, and 12 months postoperatively. Intraocular pressure spikes occurred in 25 patients postoperatively (18.8%), occurring at approximately 4.5 days (1-10.25). The preoperative number of eye drops used and ocular axial length were found to be associated with the occurrence of spikes (OR = 1.45, 95% CI 1.02-2.06; P = 0.025 and OR = 1.41, 95% CI 0.98-1.25; P = 0.072, respectively). At the 12-month mark, no significant relationship was found between the presence of spikes or incisional extent scores and the amount of change in IOP and number of drops scores. Patients with severe visual field impairment, high preoperative IOP and drop scores, and long ocular axial length may require more frequent follow-ups after surgery to check for spikes.

Emerging Gene Therapy Technologies for Retinal Ganglion Cell Neuroprotection

ABSTRACT

Optic neuropathies encompass a breadth of diseases that ultimately result in dysfunction and/or loss of retinal ganglion cells (RGCs). Although visual impairment from optic neuropathies is common, there is a lack of effective clinical treatments. Addressing a critical need for novel interventions, preclinical studies have been generating a growing body of evidence that identify promising new drug-based and cell-based therapies. Gene therapy is another emerging therapeutic field that offers the potential of specifically and robustly increasing long-term RGC survival in optic neuropathies. Gene therapy offers additional benefits of driving improvements following a single treatment administration, and it can be designed to target a variety of pathways that may be involved in individual optic neuropathies or across multiple etiologies. This review explores the history of gene therapy, the fundamentals of its application, and the emerging development of gene therapy technology as it relates to treatment of optic neuropathies.

Preservative-Free versus Benzalkonium Chloride-Preserved Latanoprost Ophthalmic Solution in Patients with Primary Open-Angle Glaucoma or Ocular Hypertension: A Phase 3 US Clinical Trial

Purpose

To evaluate the safety and efficacy of a preservative-free latanoprost 0.005% formulation (T2345) in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT) compared to benzalkonium chloride-preserved latanoprost 0.005% (BPL) formulation in the United States (US).

Patients and Methods

A prospective, randomized, multicenter, observer-masked, parallel-group study enrolled 335 patients diagnosed with POAG or OHT from 31 US sites who had adequately controlled intraocular pressure (IOP; ≤18 mm Hg) with latanoprost monotherapy. After a ≥72-hour washout period, patients were randomized to T2345 (n=165) or BPL (n=170) groups. Study drugs were dosed once-daily from Day 0 to Day 84 in one or both eyes. The study eye was the eye with lower IOP at baseline. The primary efficacy measure was the between-group comparison of the mean IOP values in the study eye at each time point (8 AM, 10 AM, and 4 PM on Days 15, 42, and 84). Safety measurements included ocular and systemic treatment-emergent adverse events (TEAEs).

Results

Both T2345 and BPL adequately controlled IOP with 95% CIs within 1.5 mm Hg in the study eye at all assessed time points. The percentages of patients with diurnal IOP <18 mm Hg at Day 84 were 73.1% vs 78.7% for the T2345 and BPL groups, respectively. Adverse events were generally mild-to-moderate and primarily ocular. Fewer patients in the T2345 group experienced ocular TEAEs (13.9% vs 22.5%, respectively) and TEAEs with a suspected relationship to the study medication compared with the BPL group (5.5% vs 11.8%, respectively). The most common ocular TEAEs were instillation site pain and conjunctival hyperemia.

Conclusion

In patients with POAG or OHT, both T2345 and BPL maintained IOP at or below clinically meaningful values for the duration of the study. T2345 showed a favorable safety profile, with numerically lower incidences of ocular TEAEs than BPL.

Impact of learning effect on reliability factors and global indices in visual field testing by standard automated perimetry in normal healthy subjects and primary open-angle glaucoma patients to obtain an accurate baseline perimetry chart

Purpose

To record and evaluate the reliability parameters (fixation loss (FL) %, false positive (FP) %) and global indices (mean sensitivity (MS), mean deviation (MD), pattern standard deviation in dB) in three visual field test sessions within two weeks to assess the learning effect in normal healthy subjects and POAG patients and comparison of learning effect gender wise and age wise in primary open-angle glaucoma (POAG) patients.

Methods

This study was a prospective observational study. An oculus visual field testing was done and analyzed in 30 eyes of POAG patients and 30 eyes of normal healthy subjects in three visits.

Results

There were 16 (53.3%) males and 14 (46.6%) females in the POAG group and 16 (53.33%) males and 14 (46.66%) females in the normal healthy subject group. A significant difference in data change between each visit in FL, FP, MD, MS was found though the difference was more pronounced in the second visit than in the third visit. The pattern standard deviation does not change significantly in subsequent visits in both groups. Gender wise and age wise no significant difference was found in the POAG group.

Conclusion

Significant improvement in reliability parameters and global indices with each subsequent visit in both the POAG group and normal patients signifies the importance of learning effect on these parameters and the need to perform at least three tests to get the baseline perimetry chart, especially in POAG patients, while in normal subjects, second perimetric result can be accepted. It was also concluded that the learning effect is not influenced by age and gender.

TYRP1 Protects Against the Apoptosis and Oxidative Stress of Retinal Ganglion Cells by Binding to PMEL

OBJECTIVES

This research aimed to dissect the function of TYRP1 and PMEL in glaucomatous animal and cell models.

METHODS

A chronic ocular hypertension (COH) rat model was induced in the right eyes of rats through the electrocoagulation of superficial iris veins. In addition, an oxygen-glucose deprivation (OGD)-retinal ganglion cell (RGC) model was constructed through OGD. TYRP1 and PMEL expression was altered in the animal and cell models to explore their effects.

RESULTS

TYRP1 and PMEL expression was poor in glaucoma patients, COH rats, and OGD-RGCs. Mechanistically, TYRP1 interacted with PMEL to upregulate PMEL in OGD-RGCs. TYRP1 overexpression enhanced viability and diminished apoptosis and oxidative stress of OGD-RGCs, which was abolished by PMEL knockdown. TYRP1 upregulation reduced intraocular pressure, RGC apoptosis, and oxidative stress in COH rats, which was reversed by PMEL knockdown.

CONCLUSIONS

TYRP1 elevates PMEL expression to reduce RGC apoptosis and oxidative stress in vivo and in vitro.

Assessment of quality of life in glaucoma patients in a tertiary care center in Eastern India

Purpose

The aim of this study is to assess the quality of life (QOL) in glaucoma patients and find out the sociodemographic factors predicting QOL.

Methods

A cross-sectional study was conducted in a tertiary care center from August 2021 to February 2022. Subjects diagnosed with glaucoma for at least 6 months were enrolled. After taking informed consent, demographic details and detailed history were collected for all patients. Comprehensive eye examination (visual acuity, intraocular pressure, gonioscopy, fundoscopy, visual field assessment, ocular coherence tomogram assessment) was done for all and they were asked to fill the WHOQOL-BREF questionnaire. Data were collected and analyzed using SPSS 21.

Results

One hundred and ninety-nine patients were recruited. Mean age of participants was 57.99 ± 10.76 years. Based on various domains and subgroups, QOL values were significant with respect to income (P = 0.016). Gender-wise QOL in females was lower than that of males with respect to all the domains (P = 0.001). While marital status affected both environmental and social domain, literacy affected only the social domain. A variation in intraocular pressure affected the QOL in the psychological domain. QOL was not significantly associated with the severity of the disease. Gender was the most predominant predictor out of all sociodemographic factors.

Conclusion

Chronic diseases affect the QOL of individuals in many ways. Glaucoma being a chronic disease hampers patients' vision irreversibly and by extension the various physical, social, and psychological aspects of the patient's life as well. Hence, knowledge of the change in QOL it brings about can help plan the treatment, counseling, and management of these patients.

A quality management system aiming to ensure regulatory-grade data quality in a glaucoma registry

BACKGROUND

Disease/patient registries are underutilized despite their multiple advantages over clinical trials in the clinical evaluation of drugs, such as the capacity for long-term curation, provision of patient outcome data in routine clinical practice, and provision of benchmark data for comparison. Ensuring the fit-for-purpose quality of data generated from such registries is important to informing regulatory decision making. Here, we report the construction of a quality management system aiming to ensure regulatory-grade data quality for a registry of Japanese patients with glaucoma to evaluate long-term patient outcomes.

METHODS

The quality management system was established by reference to the risk-based approach in the ICH-E6 (R2) recommendations. The following three-component approach was taken: establishment of governance, computerized system validation (CSV), and implementation of risk assessment and control. Compliance of the system with the recommendations of regulatory guidelines relevant to use of the registry was assessed.

RESULTS

Governance by academic collaboration was established. This was followed by the development of a total of 15 standard operating procedures, including CSV, data management, monitoring, audit, and management of imaging data. The data management system was constructed based on a data management plan, which specified data/paper flow and data management procedures. The electronic data capture (EDC) system was audited by an external vendor, and configured and validated using the V-model framework as recommended in the GAMP5 guideline. Informed consent, eligibility assessment and major ophthalmology measurements were determined as Critical to Quality (CTQ) factors. A total of 22 risk items were identified and classified into three categories, and operationalized in the form of a risk control plan, which included training sessions and risk-based monitoring. The glaucoma registry addressed most quality recommendations in official guidelines issued by multiple health authorities, although two recommendations were not met.

CONCLUSIONS

We established and configured a quality management system for a glaucoma registry to ensure fit-for-purpose data quality for regulatory use, and to curate long-term follow-up data of glaucoma patients in a prospective manner.

The effect of citicoline oral solution on quality of life in patients with glaucoma: the results of an international, multicenter, randomized, placebo-controlled cross-over trial

PURPOSE

This study aims to evaluate whether the use of citicoline oral solution could improve quality of life in patients with chronic open-angle glaucoma (OAG).

DESIGN

Randomized, double-masked, placebo-controlled, cross-over study was used. Patients were randomized to one of the two sequences: either citicoline 500 mg/day oral solution-placebo or placebo-citicoline 500 mg/day oral solution. Switch of treatments was done after 3 months; patients were then followed for other 6 months. Follow-up included 3-month, 6-month, and 9-month visits.

OUTCOMES

The primary outcome was the mean change of "intra-patient" composite score of the Visual Function Questionnaire-25 (VFQ-25). after citicoline oral solution vs placebo at 6-month visit as compared with baseline.

METHODS

The trial was multicenter, conducted at 5 European Eye Clinics. OAG patients with bilateral visual field damage, a mean deviation (MD) ranging from - 5 to - 13 dB in the better eye, and controlled IOP were included. VFQ-25 and SF-36 questionnaires were administered at baseline and at 3-, 6-, and 9-month visits. A mixed effect model, with a random effect on the intercept, accounted for correlations among serial measurements on each subject.

RESULTS

The primary pre-specified outcome of the analysis reached statistical significance (p = 0.0413), showing greater improvement after citicoline oral solution. There was an increase in the composite score in both arms compared to baseline, but it was significant only for the placebo-citicoline arm (p = 0.0096, p = 0.0007, and p = 0.0006 for the three time-points compared to baseline). The effect of citicoline was stronger in patients with vision-related quality of life more affected by glaucoma at baseline.

CONCLUSIONS

This is the first placebo-controlled clinical study evaluating the effect of a medical treatment aiming at improving vision-related quality of life in glaucomatous patients.

Determinants of late presentation of glaucoma in Hong Kong

BACKGROUND

Glaucoma is the commonest cause of irreversible blindness worldwide. As it is typically asymptomatic until advanced, the risk of blindness from late presentation is higher than other eye diseases. This study aims to investigate the risk factors for late presentation of primary glaucoma patients.

METHODS

We undertook a hospital-based case-control study of a random sample of glaucoma patients from a hospital in Hong Kong. Structured questionnaires and existing information from the electronic patient record were used, and the odds of presenting late were analysed by logistic regression.

RESULTS

Of 210 recruited participants, 83 (39.5%) presented with advanced glaucoma unilaterally or bilaterally. The mean age of participants was 61.1 ± 11.9 years, with 110 males (52.4%). Univariate analysis revealed that male sex and primary angle-closure glaucoma (PACG) have 3.06 (CI95:1.71-5.48; P < 0.001) and 2.47 (CI95:1.11-5.49; P = 0.03) times higher odds of late presentation, respectively. Multivariate analysis revealed late presenters were 3.54 (CI95:1.35-9.35; P = 0.01) times more likely to have PACG than primary open-angle glaucoma (POAG). Patients with elevated baseline intraocular pressure (IOP) also had 1.06 times higher odds of presenting with advanced glaucoma (CI95:1.02-1.11; P = 0.002). Linear regression revealed that PACG patients present with 7.12 mmHg higher IOP than POAG patients (CI95:4.23-10.0; P < 0.001).

CONCLUSION

In conclusion, a high proportion of glaucoma patients present late in Hong Kong, with gender and type of glaucoma being significant determinants. Our study shows that PACG presents with higher IOP and, along with male gender, are more likely to have advanced disease than POAG.

Cross-cultural adaptation and validation of the Moroccan version of the Glaucoma Quality of Life-15 (GQL-15) questionnaire in patients with glaucoma

BACKGROUND

Glaucoma is the second leading cause of blindness in the world. In addition, visual impairment and psychological strain have been shown to have a significant impact on quality of life (QoL) in glaucoma patients. Maintaining the quality of life of glaucoma patients has become an important component of treatment. The goal of this study is to develop a Moroccan Arabic dialect version of the Glaucoma Quality of Life-15 questionnaire and to examine its psychometric properties.

METHODS

The Glaucoma Quality of Life-15 questionnaire was translated and cross-culturally adapted into Moroccan Arabic dialect and administered to glaucoma patients recruited from the ophthalmology department of the Omar Drissi Hospital, Hassan II University Hospital, Fez. Sociodemographic and other clinical data were collected. Psychometric properties were performed, including internal consistency, which was tested using Cronbach's alpha (α), test-retest reliability using intraclass correlation coefficients (ICC). Construct validity was assessed by examining the convergent and divergent validity of items.

RESULTS

The questionnaire was administered to 148 patients with a mean age of 60.91 ± 15.10 years. Over half of the patients were female (58.1%), patients were married (77.7%), illiterate (62.2%) and unemployed (82.3%). The majority of patients had primary open angle glaucoma (68.9%). The mean time to complete the GQL-15 was 3.26±0.51min. The mean summary score for the GQL-15 was 39.50±16.76. Cronbach's alpha for the entire scale was 0.95 (central and near vision 0.58; peripheral vision 0.94; glare and dark adaptation 0.87).

CONCLUSION

The Moroccan Arabic dialect version of the GQL-15 demonstrates adequate reliability and validity. Therefore, this version could be used as a reliable and valid tool for quality-of-life assessment in Moroccan glaucoma patients.

Longitudinal Analysis of Retinal Ganglion Cell Damage at Individual Axon Bundle Level in Mice Using Visible-Light Optical Coherence Tomography Fibergraphy

Purpose

We developed a new analytic tool based on visible-light optical coherence tomography fibergraphy (vis-OCTF) to longitudinally track individual axon bundle transformation as a new in vivo biomarker for retinal ganglion cell (RGC) damage.

Methods

After acute optic nerve crush injury (ONC) in mice, we analyzed four parameters: lateral bundle width, axial bundle height, cross-sectional area, and the shape of individual bundles. We next correlated the morphological changes in RGC axon bundles with RGC soma loss.

Results

We showed that axon bundles became wider and taller at three days post ONC (pONC), which correlated with about 15% RGC soma loss. At six days pONC, axon bundles showed a significant reduction in lateral width and cross-sectional area, followed by a reduction in bundle height at nine days pONC. Bundle shrinking at nine days pONC correlated with about 68% RGC soma loss. Both experimental and simulated results suggested that the cross-sectional area of individual RGC axon bundles is more sensitive than bundle width and height to indicate RGC soma loss.

Conclusions

This study is the first to track and quantify individual RGC axon bundles in vivo after ONC injury.

Translational Relevance

Recognizing RGC loss at its earliest stage is crucial for disease diagnosis and treatment. However, current clinical methods to detect the functional and structural changes in the inner retina are not sensitive enough to directly assess RGC health. In this study, we developed vis-OCTF-based parameters to track RGC damage, making possible to establishing a quantifiable biomarker for glaucoma.

Diagnostic Accuracy of Imaging Devices in Glaucoma: An Updated Meta-Analysis

Background

Different devices have diverse accuracy in diagnosing glaucoma, and therefore choosing the best device is challenging. Thereby, this study was conducted to evaluate the diagnostic sensitivity and specificity of imaging devices in glaucoma and explore the need for an updated meta-analysis on this issue.

Methods

In this systematic review and meta-analysis, PubMed, Scopus, and Web of Science databases were searched for articles published between January 2004 and 2022. Cross-sectional or diagnostic studies were selected, and sensitivity, specificity, positive predictive value, and negative predictive value were measured.

Results

A total of 28 cross-sectional studies were included for meta-analysis. Devices were divided into 2 groups, based on the optic nerve area and the macular area. For the nerve area, the pooled sensitivity was 77% (CI 95%, 70-83; I2, 90.01%) and the pooled specificity was 89% (CI 95%, 84-92, I2, 93.22%), and for the macular area, the pooled sensitivity was 87% (CI 95%, 80-92, I2, 91.79%), and the pooled specificity was 90% (CI 95%, 84-94; I2, 86.30%). We analyzed each device separately. For optical coherence tomography(OCT), the pooled sensitivity was 85% (CI 95%, 81-89; I2, 87.82%) and the pooled specificity was 89% (CI 95%, 85-92; I2, 84.39%); for Heidelberg retinal tomography (HRT), the pooled sensitivity was 72% (CI 95%, 57-83; I2, 88.94%) and the pooled specificity was 79% (CI 95%, 62-90; I2, 98.61%), and for optical coherence tomography angiography (OCTA), the pooled sensitivity was 82% (CI 95%, 66-91; I2, 93.71%) and the pooled specificity was 93% (CI 95%, 87-96; I2, 64.72%).

Conclusion

The macular area was more sensitive and specific than the optic nerve head. Furthermore, OCT had higher sensitivity, and OCTA had higher specificity when compared with other imaging devices.

Magnitude of Maladaptive Coping Strategy and Its Associated Factors Among Adult Glaucoma Patients Attending Tertiary Eye Care Center in Ethiopia

Introduction

Coping strategy is the mechanism by which patients adjust to the condition they face. It can be adaptive or maladaptive. A maladaptive coping strategy is a harmful and ineffective way of dealing with stress or anxiety. It is common among patients with chronic illnesses. Despite Ethiopia having a greater glaucoma prevalence, there was no evidence of patients with glaucoma using maladaptive coping mechanisms.

Objective

The main goal of this study was to evaluate the magnitude of maladaptive coping strategy use and the factors that associate with it among adult glaucoma patients enrolled in the Tertiary Eye Care and Training Center at the University of Gondar in Northwest Ethiopia in 2022.

Methods and Materials

At the University of Gondar, Tertiary Eye Care and Training Center, a facility-based cross-sectional study was carried out on a sample of 423 glaucoma patients chosen by a systematic random sampling technique from May 15 to June 30, 2022. Optometrists conducted an interview with the study subject and reviewed the medical record, and administered a pretested, structured questionnaire of the brief cope inventory assessment. In the multivariable logistic regression, binary logistic regression was performed to identify the related factors, and significance was taken into account when the p-value was less than 0.05 at the 95% confidence interval.

Results

The study found that among study participants 50.1% (95% CI: 45.1-54.5%) had a maladaptive coping strategy. Female sex (AOR=2.031, 95% CI:1.185-3.480), chronic medical illness (AOR=1.760, 95% CI:1.036-2.989), bilateral glaucoma (AOR=2.321, 95% CI: 1.328-4.055), receiving both drug and surgery treatment (AOR=1.895, 95% CI: 1.002-3.585), severe visual impairment (AOR=2.758, 95% CI:1.110-6.852), absolute glaucoma (AOR=2.543, 95% CI:1.048-6.169), duration of diagnosis >12 months (AOR=3.886, 95% CI: 2.295-6.580) were significantly associated with a maladaptive coping strategy.

Conclusion and Recommendation

Half of the participants had a maladaptive coping strategy. It is better to set and plan strategies that enable the integration of coping strategy care into the current treatment of patients with glaucoma to encourage positive coping strategies instead of maladaptive ones.

Self-reported glaucoma prevalence and related factors, contribution to reported visual impairment, and functional burden in a cross-sectional study in Colombia

PURPOSE

Describe the self-reported prevalence of glaucoma in Colombian older adults, emphasizing the most important risk factors and associated daily-life functional alterations.

METHODS

This a secondary analysis of the Health, Wellness, and Aging survey conducted in the year 2015. Diagnosis of glaucoma was obtained from self-report. Functional variables were assessed through activities of daily living questionnaires. A descriptive analysis followed by bivariate and multivariate regression models adjusting for confounding variables was conducted.

RESULTS

Self-reported prevalence of glaucoma was 5.67%, with higher rate in women, OR 1.22 (1.13-1.40) p = .003, older age OR 1.02 (1.01-1.02) p < .001, and with higher education OR 1.38 (1.28-1.50) p < .001. Glaucoma was independently associated with diabetes OR 1.37 (1.18-1.61) p  < .001 and hypertension 1.26 (1.08-1.46) p = .003. It also showed statistically significant correlations with poor SRH OR 1.15 (1.02-1.32) p < .001, self-reported visual impairment 1.73 (1.50-2.01) p < .001, and impairment in money management OR 1.59 (1.16-2.08) p  = .002, grocery shopping OR 1.57 (1.26-1.96) p < .001 and preparing meals OR 1.31 (1.06-1.63) p  = .013 and having had falls during the last year OR 1.14 (1.01-1.31) p = 0.041.

CONCLUSION

Our findings suggest the self-reported prevalence of glaucoma in older adults in Colombia to be higher than reported data. Glaucoma and visual impairment in older adults represent a public health concern, since glaucoma was associated with adverse outcomes like functional loss and risk of falling, affecting the quality of life and their participation in society.

Teleglaucoma Using a New Smartphone-Based Tool for Visual Field Assessment

PRCIS

COVID-19 underlines the importance of telemedical diagnostics. The smartphone-based campimetry (Sb-C) is a newly developed digital application allowing visual field testing using a head-mounted device and a smartphone. It enables visual field screening remotely from a clinic.

BACKGROUND

Sb-C is a newly developed tool for functional ophthalmic diagnosis. This study aimed to examine the comparability of the Sb-C and Octopus 900 to ensure ophthalmological care in times of social distancing.

METHODS

Total 93 eyes were included in the study. After an ophthalmological examination, the visual field was tested by the Octopus program G1 and by the smartphone-based campimeter. The Sb-C was performed using VR glasses and an iPhone 6. The software Sb-C was downloaded and installed as SmartCampiTracker app and is examining the 30-degree visual field with 59 test positions corresponding to the G pattern of Octopus G1. Sensitivities were recorded and saved on the app. In addition, test-retest reliability was tested on 6 ophthalmologically healthy participants.

RESULTS

The group comprised 48 women and 45 men (mean age: 62.52±12.2 y) including 19 controls, 17 patients with ocular hypertension, 11 preperimetric glaucomas, and 46 perimetric glaucomas. The mean sensitivity (MS) of all points of G1 perimetry was 23.13 dB (95% CI, 22.08-24.18). The MS of the Sb-C was 21.23 dB (95% CI, 20.37-22.08). The correlation between the mean MS measured by G1 perimetry and the Sb-C was strong ( r =0.815, P <0.05). The test-retest reliability showed a correlation of r =0.591 ( P <0.05) .

CONCLUSIONS

With some technical adjustments, the Sb-C shows promise for screening glaucoma and monitoring disease progression remotely from an ophthalmologic clinic.

Vision rehabilitation in glaucoma patients

PURPOSE OF REVIEW

Vision rehabilitation services are important but underutilized resources for patients with glaucoma. Glaucoma and its impact on vision can affect patients' abilities to read and drive, two activities of daily living that are associated with quality of life and functional independence. In this review, we provide an overview of low vision, discuss barriers to vision rehabilitation, and outline various strategies and interventions to optimize visual function and quality of life in patients with glaucoma.

RECENT FINDINGS

Studies have shown that glaucoma negatively impacts reading, driving and overall quality of life. Decreased visual acuity, visual field loss and reduced contrast sensitivity play a role. Low vision services and interventions can help patients maximize visual function and improve their quality of life. Barriers to receiving these services exist at multiple levels and an increased awareness and integration into routine ophthalmic care are needed to deliver comprehensive care.

SUMMARY

Glaucoma is one of the leading causes of low vision. Ophthalmologists who treat glaucoma often tend to focus on objective measures to monitor progression and disease severity, but the functional impact of glaucoma should also be addressed. Low vision services can benefit patients, particularly for reading and driving, and should be considered as an essential component of patient care.

Three-Year Outcomes of a Schlemm Canal Microstent (Hydrus Microstent) with Concomitant Phacoemulsification in Open-Angle Glaucoma

PURPOSE

HORIZON trials have reported the medium- and long-term outcomes of the Hydrus microstent. However, outside of randomized clinical trials, outcomes beyond 24 months have not been previously reported. Here, we examine the 3-year outcomes of the Hydrus microstent with cataract surgery outside of a randomized clinical trial setting.

DESIGN

Single-surgeon consecutive case series.

PARTICIPANTS

Glaucomatous eyes that underwent implantation of a Hydrus microstent with concomitant cataract surgery at a single ophthalmology center in Montreal, Canada.

METHODS

Success was defined according to the absence of specific failure criteria: (A) glaucoma reoperation; (B) selective laser trabeculoplasty; (C) intraocular pressure (IOP) < 5 mmHg, > 18 mmHg, or increase in the number of antiglaucoma medications (AGMs) used (after the first postoperative month), or loss of light perception due to glaucoma; (D) aggregation of criteria A-C. Predictors of treatment failure and postoperative changes in IOP and AGM use were assessed. Safety included best-corrected visual acuity (BCVA), cup-to-disc ratio (CDR), retinal nerve fiber layer (RNFL) thickness, ganglion cell inner plexiform layer (GC-IPL) thickness, visual field mean deviation (VF-MD) and pattern standard deviation (VF-PSD), and adverse events.

MAIN OUTCOME MEASURES

Surgical success, predictors of treatment failure, postoperative changes in IOP and AGM use, and structural and functional markers of disease stability.

RESULTS

One hundred six eyes were included. The 3-year surgical success according to Criteria A to D was 86%, 83%, 91%, and 67%, respectively. Intraocular pressure decreased by 26.5% from 18.9 ± 4.8 to 13.9 ± 2.3 mmHg (P < 0.001) and AGM use reduced by 33% from 3.0 ± 1.2 to 2.0 ± 1.2 medications (P < 0.001). The postoperative improvement in BCVA was preserved (P < 0.001). The structural and functional markers of disease stability, including CDR, RNFL, and GC-IPL thickness, as well as VF-MD and VF-PSD, remained stable (P > 0.05). Postoperative adverse events were few and transient.

CONCLUSIONS

The 36-month results from this study show that the Hydrus microstent with phacoemulsification is safe and effective in reducing the IOP and AGM among patients with mild to severe open-angle glaucoma and can slow down the disease progression by preserving both structural and functional parameters.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

The Japan Glaucoma Society guidelines for glaucoma 5th edition

We are pleased to bring you the 5th edition of the Glaucoma Clinical Practice Guidelines. Clinical practice guidelines are based on evidence (scientific grounds). It is a document that presents the treatment that is the most appropriate for the patient. "Glaucoma Clinical Guidelines" was first published in 2003. This was the first guideline for glaucoma treatment in Japan. The principle of glaucoma treatment is to lower intraocular pressure. Means for lowering intraocular pressure includes drugs, lasers, and surgery; Glaucoma is a disease that should be considered as a complex syndrome rather than a single condition. Therefore, the actual medical treatment is not as simple as one word. This time we set the Clinical Questionnaire with a focus on glaucoma treatment. We hope that you will take advantage of the 5th edition.

Association between sight-threatening eye diseases and death by suicide in South Korea: a nationwide population-based cohort study

PURPOSE

Although associations between visual impairment (VI) and suicide are posited, specific risks across the sight-threatening eye disease (STED) spectrum remain to be assessed. We determined whether individuals with STED die more often by suicide than do other people and assessed the temporal associations.

DESIGN

A nationwide, population-based cohort study.

PARTICIPANTS

All persons aged 40 years or older in South Korea from 2010 to 2020.

METHODS

Persons diagnosed with STEDs (i.e., glaucoma, exudative age-related macular degeneration [AMD], or diabetic retinopathy [DR]) were identified in the Korean National Health Insurance (NHI) service database. Both NHI health checkup records and the National Disability Registration were used for coexisting severe VI. Death by suicide was defined as diagnostic codes as recorded in the Korea National Statistical Office. Incidence rate ratios (IRRs) were estimated by quasi-Poisson regressions and adjusted for sociodemographics, comorbidity, psychiatric diagnoses, and VI. The temporal relationship between time since first STED diagnosis and suicide risk was determined by identifying patients with STED newly diagnosed during the period from 2010 to 2011.

MAIN OUTCOME MEASURES

The IRR of death by suicide in people with STED relative to those without.

RESULTS

Of the 2.8 million people (45% male) observed for 24 300 969 person-years, 13 205 died by suicide. Among them, 34% (n = 4514) had a STED diagnosis, for a suicide rate of 69 per 100 000 person-years (95% confidence interval [CI], 67-72), relative to 51 per 100 000 person-years (95% CI, 50-52) for non-STED individuals. People with STED had an adjusted IRR of 1.33 (95% CI, 1.26-1.41) relative to those without. The largest excess adjusted IRR of suicide mortality was that for DR (1.40, 95% CI, 1.29-1.52). For exudative AMD, the adjusted IRR was 1.20 (95% CI, 1.04-1.39), whereas for glaucoma, the corresponding value was 1.09 (95% CI, 1.02-1.17). With coexisting severe VI, the IRR for any STED was 1.49 (95% CI, 1.29-1.73). The highest suicide hazard ratio was between 3 and 6 months postdiagnosis (5.33; 95% CI, 4.59-6.20).

CONCLUSIONS

In South Korea between 2010 and 2020, a higher suicide rate was evident among those with diagnosed STED than for persons not so diagnosed.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

A latanoprost cationic emulsion (STN1013001) vs. other latanoprost formulations (Latanoprost) in open angle glaucoma/ocular hypertension and ocular surface disease: an Italian cost-utility analysis

BACKGROUND

STN1013001 is an innovative latanoprost cationic emulsion for open-angle glaucoma/ocular hypertension (OAG/OHT) and ocular surface disease (OSD).

METHODS AND FINDINGS

A 5-year, 7 health states, 1-year cycle early Markov model-supported cost-utility analysis (CUA) of STN1013001 vs. other latanoprost formulations (Latanoprost) followed the Italian National Health Service (INHS) perspective.One-way, probabilistic and scenario sensitivity analyses tested the uncertainty of the baseline results. Value of information analysis (VOIA) investigated the potential cost-effectiveness of collecting further evidence.

RESULTS

Over 5 years, the Markov model-supported CUA predicts STN1013001 to be potentially highly cost-effective vs. Latanoprost (+€57.60 cost at €2020 values; +0.089 Quality-Adjusted Life Years).The Incremental Cost-Utility Ratio (€647.65) falls well below the lower limit of the acceptability range proposed for Italy (€25,000-€40,000).Sensitivity analyses confirmed the robustness of the baseline findings. VOIA highlighted that further information might only be cost-effective for OAG/OHT utilities and OSD-related disutility.

CONCLUSION

STN1013001 is potentially highly cost-effective and strongly dominant vs. Latanoprost for OAG/OHT+OSD patients from the INHS perspective. These findings should be re-assessed using the data from the ongoing Phase III trial (NCT04133311) comparing the efficacy and safety of STN1013001 vs. Latanoprost and with future real-world CUAs upon the availability of STN1013001 on the Italian market.

Threat to fixation and vision-related quality of life in early open-angle glaucoma - results from the Glaucoma Intensive Treatment Study

PURPOSE

To determine the effect of glaucomatous visual field (VF) damage close to the point of fixation, called threat-to-fixation (TTF), on vision-related quality of life (VRQoL) in open-angle glaucoma.

METHODS

A total of 239 patients from the Glaucoma Intensive Treatment Study (GITS) were included in this analysis. The second VF of patients with newly diagnosed primarily early glaucoma was evaluated for the presence or absence of TTF. TTF was defined as VF loss including one or more of the four innermost test points depressed at p < 1% in the total deviation probability map of Humphrey 24-2 SITA Standard visual fields. VRQoL was evaluated using Rasch-analysed National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) scores. The correlation between VRQoL and TTF was evaluated using uni- and multivariable regression analyses.

RESULTS

TTF was present in at least one eye in 115 patients (48%); located in the superior hemifield alone in 47% (54 of 115), in the inferior hemifield alone in 23% (27 of 115), and in 30% (34 of 115) in both hemifields. The median Rasch-calibrated NEI VFQ-25 scores were identical when comparing patients with TTF (VRQoL score 66, 95% CI: 23-100) and those with no-TTF (VRQoL score 66, 95% CI: 21-100) (p = 0.925). Neither the presence of TTF (R²  = -0.004, p = 0.968) nor the location of TTF (R²  = 0.023, p = 0.103) was significantly correlated to Rasch-calibrated NEI VFQ-25 scores.

CONCLUSION

The presence of TTF did not influence VRQoL, as measured by the NEI-VFQ-25, in this relatively large group of patients with mainly early glaucoma.

STATIS multivariate three-way method for evaluating quality of life after corneal surgery: Methodology and case study in Costa Rica

Vision-related quality of life (QoL) analyzes the visual function concerning individual well-being based on activity and social participation. Because QoL is a multivariate construct, a multivariate statistical method must be used to analyze this construct. In this paper, we present a methodology based on STATIS multivariate three-way methods to assess the real change in vision-related QoL for myopic patients by comparing their conditions before and after corneal surgery. We conduct a case study in Costa Rica to detect the outcomes of patients referred for myopia that underwent refractive surgery. We consider a descriptive, observational and prospective study. We utilize the NEI VFQ-25 instrument to measure the vision-related QoL in five different stages over three months. After applying this instrument/questionnaire, a statistically significant difference was detected between the perceived QoL levels. In addition, strong correlations were identified with highly similar structures ranging from 0.857 to 0.940. The application of the dual STATIS method found the non-existence of reconceptualization in myopic patients, but a statistically significant recalibration was identified. Furthermore, a real change was observed in all patients after surgery. This finding has not been stated previously due to the limitations of the existing statistical tools. We demonstrated that dual STATIS is a multivariate method capable of evaluating vision-related QoL data and detecting changes in recalibration and reconceptualization.

The Need for Glaucoma Management in Glaucoma Patients with Concurrent Obstructive Sleep Apnea: A Population-Based Cohort Study

We try to evaluate glaucoma management numbers in patients with both glaucoma and obstructive sleep apnea (OSA) using the National Health Insurance Research Database (NHIRD) of Taiwan. A retrospective cohort study was conducted and patients with glaucoma were enrolled and divided into the OSA and non-OSA populations. A total of 11,778 participants were selected in both the OSA and non-OSA groups. The primary outcomes were the number of anti-glaucomatous medications each year and the total number of glaucoma laser and glaucoma surgeries. The Cox proportional hazard regression was utilized to produce the adjusted hazard ratios (AHR) with corresponding 95% confidence intervals (CI) between the two groups. After a study period of 18 years, 286 and 352 events of laser and surgeries for glaucoma were found in the OSA and non-OSA groups, respectively. After considering the effect of potential confounders, no significant difference concerning the numbers of laser trabeculoplasty, trabeculectomy and tube shunt surgery, cyclodestructive procedure and eyeball removal were found between the two groups (all 95% CIs included one). In addition, the multiple anti-glaucomatous medication usages were similar between the two groups (all p > 0.05) In the subgroup analyses, glaucoma patients older than 60 years and with OSA received significantly lesser trabeculectomy and tube shunt surgery compared to glaucoma patients older than 60 years without OSA (AHR: 0.774, 95% CI: 0.611−0.981) while other analyses revealed insignificant results (all 95% CIs included one). In conclusion, the presence of OSA does not increase the need for glaucoma management.

Advanced glaucoma. Clinical practice guideline

OBJECTIVE

To present an update clinical practice guideline that serve as a guide for the detection, evaluation and treatment of adults patients with advanced glaucoma.

METHODS

After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple systematic Rewiews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate methodology. Guideline Network (SIGN).

RESULTS

Recommendations with their corresponding levels of evidence that may be useful in the diagnosis, monitoring and treatment of adults patients with advanced glaucoma.

CONCLUSIONS

Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of advanced glaucoma.

Analysis of the Readability and Accountability of Online Patient Education Materials Related to Glaucoma Diagnosis and Treatment

Purpose

To assess the readability and accountability of online patient education materials related to glaucoma diagnosis and treatment.

Methods

We conducted a Google search for 10 search terms related to glaucoma diagnosis and 10 search terms related to glaucoma treatment. For each search term, the first 10 patient education websites populated after Google search were assessed for readability and accountability. Readability was assessed using five validated measures: Flesch Reading Ease (FRE), Gunning Fog Index (GFI), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and New Dale-Chall (NDC). Accountability was assessed using the Journal of the American Medical Association (JAMA) benchmarks. The source of information for each article analyzed was recorded.

Results

Of the 200 total websites analyzed, only 11% were written at or below the recommended 6th grade reading level. The average FRE and grade level for 100 glaucoma diagnosis-related articles were 42.02 ± 1.08 and 10.53 ± 1.30, respectively. The average FRE and grade level for 100 glaucoma treatment-related articles were 43.86 ± 1.01 and 11.29 ± 1.54, respectively. Crowdsourced articles were written at the highest average grade level (12.32 ± 0.78), followed by articles written by private practice/independent users (11.22 ± 1.74), national organizations (10.92 ± 1.24), and educational institutions (10.33 ± 1.35). Websites averaged 1.12 ± 1.15 of 4 JAMA accountability metrics.

Conclusion

Despite wide variation in the readability and accountability of online patient education materials related to glaucoma diagnosis and treatment, patient education materials are consistently written at levels above the recommended reading level and often lack accountability. Articles from educational institutions and national organizations were often written at lower reading levels but are less frequently encountered after Google search. There is a need for accurate and understandable online information that glaucoma patients can use to inform decisions about their eye health.

The impact of low vision on social function: The potential importance of lost visual social cues

Visual cues usually play a vital role in social interaction. As well as being the primary cue for identifying other people, visual cues also provide crucial non-verbal social information via both facial expressions and body language. One consequence of vision loss is the need to rely on non-visual cues during social interaction. Although verbal cues can carry a significant amount of information, this information is often not available to an untrained listener. Here, we review the current literature examining potential ways that the loss of social information due to vision loss might impact social functioning. A large number of studies suggest that low vision and blindness is a risk factor for anxiety and depression. This relationship has been attributed to multiple factors, including anxiety about disease progression, and impairments to quality of life that include difficulties reading, and a lack of access to work and social activities. However, our review suggests a potential additional contributing factor to reduced quality of life that has been hitherto overlooked: blindness may make it more difficult to effectively engage in social interactions, due to a loss of visual information. The current literature suggests it might be worth considering training in voice discrimination and/or recognition when carrying out rehabilitative training in late blind individuals.