Vision-related Performance and Quality of Life of Patients With Rapid Glaucoma Progression:

Assessment of Structural Progression in Glaucoma Through Automated Optic Nerve Head Hemoglobin Measurements

PRCIS

Automated optic nerve head hemoglobin measurements through change over time in the Globin Individual Pointer (GIP) index, provided by the Laguna ONhE software, can be useful to evaluate structural progression in glaucoma.

PURPOSE

To assess the performance of automated optic nerve head hemoglobin measurements (ONH Hb) for detection of structural progression in glaucoma patients using event analysis.

PATIENTS AND METHODS

Treated glaucoma patients were included in this cross-sectional study. Two experienced examiners classified patients into progressors and non-progressors (controls) based on serial color retinographies (CR). Progressors were then subdivided in structural changes of the neuroretinal rim (NR) or retinal nerve fiber layer (RNFL). Globin individual pointer (GIP) index, derived from ONH Hb measurements, was calculated for each CR using the Laguna ONhE software. Differences in GIP values, ​​between baseline and last visit CRs, were used to assess structural progression. Sensitivity at a fixed specificity (50%; median GIP difference in controls) and areas under receiver operating characteristic curves (AUROC) were calculated.

RESULTS

Eight-seven eyes (35 progressors and 52 controls) from 64 patients were enrolled. Mean GIP reduction over time was greater in progressors (-13.0±18.6) than controls (-2.9±10.4; P =0.001). In progressors, mean GIP reduction was greater in patients with NR changes (-19.6±19.5) than RNFL changes (-3.1±12.1; P =0.008). GIP difference correctly identified 69% of the progressors (AUROC: 0.66), being 76% of these progressions related to NR changes (AUROC: 0.76) and 57% to RNFL changes (AUROC: 0.52).

CONCLUSIONS

The GIP index, based on automated ONH Hb measurements demonstrated good sensitivity to differentiate progressors from controls, especially in cases in which progression was documented through structural NR changes. Using only 2 CRs and event analysis, GIP changes over time can be a useful screening tool to evaluate structural progression.

Correlation between contrast sensitivity and national eye institute visual function questionnaire (NEI VFQ-25) Rasch scores in patients with open-angle glaucoma: A cross-sectional study

BACKGROUND

We examined the relationship between contrast sensitivity (CS) and visual field stage/severity in patients with open-angle glaucoma (OAG), and correlated CS with Quality of Vision (QOV) scores.

METHODS

CS was measured under photopic (100 cd) and mesopic (10 cd) conditions in 218 eyes of 109 patients with OAG aged < 60 years. The glaucoma stages were divided into four groups according to the mean deviation (MD) of the Humphrey Field Analyzer (HFA) 24 - 2 or 10 - 2 Swedish Interactive Thresholding Algorithm (SITA) standard, and their relationship with CS was examined.

RESULTS

The results of the Japanese version of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) in 79 patients were converted into Rasch scores and correlated with CS. Both HFA24-2 and 10 - 2 showed statistically significant improvements in all items except 10.2 cycles per degree (cpd) under mesopic conditions where CS decreased significantly (p < 0.05). Correlations between CS and NEI VFQ-25 Rasch scores were stronger in the worse eye (WE) at HFA24-2, 10 - 2, and foveal sensitivity thresholds. The measurement results strongly correlated under photopic conditions. Comparing the correlations at HFA24-2, 10 - 2, and foveal sensitivity thresholds, the correlation was strongest at the foveal sensitivity threshold.

CONCLUSIONS

CS declines with progression in the visual field stage or severity. QOV score tends to decreases with a decline in CS.

Association between contrast sensitivity function and structural damage in primary open-angle glaucoma

AIMS

To evaluate the association between contrast sensitivity function (CSF) and glaucomatous structural damage in primary open-angle glaucoma (POAG).

METHODS

A cross-sectional study was performed with 103 patients (103 eyes) aged 25-50 years who had POAG without any other ocular disease. CSF measurements were obtained by the quick CSF method, a novel active learning algorithm that covers 19 spatial frequencies and 128 contrast levels. The peripapillary retinal nerve fibre layer (pRNFL), macular ganglion cell complex (mGCC), radial peripapillary capillary (RPC) and macular vasculature were measured by optical coherence tomography and angiography. Correlation and regression analyses were used to assess the association of area under log CSF (AULCSF), CSF acuity and contrast sensitivities at multiple spatial frequencies with structural parameters.

RESULTS

AULCSF and CSF acuity were positively associated with pRNFL thickness, RPC density, mGCC thickness and superficial macular vessel density (p<0.05). Those parameters were also significantly associated with contrast sensitivity at 1, 1.5, 3, 6, 12, 18 cycles per degree spatial frequencies (p<0.05) and, the lower the spatial frequency, the higher the correlation coefficient. RPC density (p=0.035, p=0.023) and mGCC thickness (p=0.002, p=0.011) had significant predictive value for contrast sensitivity at 1 and 1.5 cycles per degree, with adjusted R 2 of 0.346 and 0.343, respectively.

CONCLUSIONS

Full spatial frequency contrast sensitivity impairment, most notably at low spatial frequencies, is a characteristic change in POAG. Contrast sensitivity is a potential functional endpoint for the measurement of glaucoma severity.

Frontloading visual field tests detect earlier mean deviation progression when applied to real-world-derived early-stage glaucoma data

PURPOSE

To examine the diagnostic accuracy of performing two (frontloaded) versus one (clinical standard) visual field (VF) test per visit for detecting the progression of early glaucoma in data derived from clinical populations.

METHODS

A computer simulation model was used to follow the VFs of 10,000 glaucoma patients (derived from two cohorts: Heijl et al., Swedish cohort; and Chauhan et al., Canadian Glaucoma Study [CGS]) over a 10-year period to identify patients whose mean deviation (MD) progression was detected. Core data (baseline MD and progression rates) were extracted from two studies in clinical cohorts of glaucoma, which were modulated using SITA-Faster variability characteristics from previous work. Additional variables included follow-up intervals (six-monthly or yearly) and rates of perimetric data loss for any reason (0%, 15% and 30%). The main outcome measures were the proportions of progressors detected.

RESULTS

When the Swedish cohort was reviewed six-monthly, the frontloaded strategy detected more progressors compared to the non-frontloaded method up to years 8, 9 and 10 of follow-up for 0%, 15% and 30% data loss conditions. The time required to detect 50% of cases was 1.0-1.5 years less for frontloading compared to non-frontloading. At 4 years, frontloading increased detection by 26.7%, 28.7% and 32.4% for 0%, 15% and 30% data loss conditions, respectively. Where both techniques detected progression, frontloading detected progressors earlier compared to the non-frontloaded strategy (78.5%-81.5% and by 1.0-1.3 years when reviewed six-monthly; 81%-82.9% and by 1.2-2.1 years when reviewed yearly). Accordingly, these patients had less severe MD scores (six-monthly review: 0.63-1.67 dB 'saved'; yearly review: 1.10-2.87 dB). The differences increased with higher rates of data loss. Similar tendencies were noted when applied to the CGS cohort.

CONCLUSIONS

Frontloaded VFs applied to clinical distributions of MD and progression led to earlier detection of early glaucoma progression.

Ultrasound cyclo-plasty for moderate glaucoma: Eighteen-month results from a prospective study

Purpose

To evaluate the long-term clinical efficacy of ultrasound cyclo-plasty (UCP) in the treatment of moderate glaucoma and molecular effects in animal experiments.

Methods

An 18-month clinical study was conducted among 32 patients with moderate glaucoma. The primary outcome was surgical success, defined as a reduction in intraocular pressure (IOP) of greater than or equal to 20% from the baseline and an IOP value of greater than 5 mmHg at the last follow-up. The secondary outcomes were related to the quality of life, complications, and mean IOP value at each follow-up. In the animal experiment, 20 New Zealand rabbits were used to establish a high-IOP model and implement UCP. The distribution of aquaporin 4 (AQP4) in the ciliary body and the tissue changes under electron microscopy were observed after surgery.

Results

The mean patient IOP decreased from 34.9 ± 4.9 mmHg before surgery to 23.5 ± 5.2 mmHg at 18 months after UCP. No vision loss occurred in any patient. Some patients had postoperative complications, but the symptoms were mild and disappeared within 3 months after the surgery. Most patients had good postoperative quality of life. Histology showed that AQP4 remained in the ciliary muscle after UCP, and only the bilayered epithelial cells showed coagulative necrosis. Furthermore, electron microscopic observation revealed the destruction of ciliary process cells covered by ultrasound after UCP.

Conclusion

UCP is associated with mild postoperative reactions and the mild treatment of ciliary tissue and is a safe and effective method for reducing IOP in moderate glaucoma.

Predicting a reduction in intraocular pressure in glaucoma patients in the early period after a trabeculectomy: Development and assessment of a new predictive nomogram

Purpose

To identify the factors associated with a reduction in intraocular pressure (IOP) in the early postoperative period after a trabeculectomy and to develop a predictive nomogram to guide clinical care.

Methods

This study included clinical data on 588 glaucoma patients (N = 588 eyes) who underwent a trabeculectomy in our hospital between January 2016 and December 2021. There were 412 eyes in a training cohort and 176 eyes in a validation cohort. We used logistic regression analysis to evaluate whether these factors were related to a decrease in IOP in the early period postsurgery and established a predictive model by combining features selected in a univariate analysis. We used external validation for evaluation. The standard for IOP reduction was that the IOP decreased to the normal range (10-21 mmHg) 1 month after the trabeculectomy.

Results

Among the patients in the training cohort, 82.8% met the standard for IOP lowering. There were 11 meaningful differences among the enrolled predictors, but the logistic regression analysis only showed significant differences with anterior chamber angle closed, age, preoperative IOP, axial length, and visual field mean sensitivity (MS). The C-index of the model was 0.910 (95% confidence interval [CI]: 0.869-0.951). The C-index was 0.956 for external validation of the model.

Conclusion

This new nomogram can be used to predict whether the IOP will reach the standard in the early stages after a trabeculectomy. The anterior chamber angle closed, age, preoperative IOP, axial length, and visual field MS are independent risk factors.

A Comparative Study between Swedish Interactive Thresholding Algorithm Faster and Swedish Interactive Thresholding Algorithm Standard in Glaucoma Patients

Purpose:

To compare the results of the new strategy Swedish Interactive Thresholding Algorithm (SITA) Faster to the results of SITA Standard in patients with glaucoma.

Methods:

This was a cross-sectional study of 49 patients with glaucoma and previous experience with standard automated perimetry. Two consecutive tests were performed in random order, one with SITA Standard and another one with SITA Faster, in the studied eye of each patient. Comparisons were made for test time, mean deviation (MD), visual field index (VFI), and number of depressed points in pattern deviation map and total deviation map for every level of significance.

Results:

The average test time was 56% shorter with SITA Faster (P < 0.001). The intraclass correlation coefficient (ICC) for MD and VFI showed excellent agreement between both strategies, ICC = 0.98 (95% confidence interval [CI]: 0.96, 0.99) and ICC = 0.97 (95% CI: 0.95, 0.99), respectively. For the number of depressed points in total deviation map and pattern deviation map, ICC demonstrated good agreement with values between 0.8 and 0.95.

Conclusions:

Our study shows that SITA Faster is a shorter test with strong agreement with SITA Standard parameters. These results suggest that SITA Faster could replace SITA Standard for glaucoma diagnosis.

Impact of binocular integrated visual field defects on healthy related quality of life in glaucoma

To investigate the impact of different types of binocular integrated visual field defects on the quality of life in glaucoma.Ninety-six patients with primary glaucoma were divided into 5 groups with 25, 24, 11, 15, and 21 patients according to types of the binocular integrated visual field (BVF) defects. The criteria for BVF grouping included mild visual field defect in binocular eyes, mild visual field defect in 1 eye and moderate or advanced defect in the other, moderate and non-overlapping visual field defect in both eyes, overlapping and moderate visual field defect in binocular eyes, and severe defect in both eyes, respectively. The visual field (VF) evaluation was based on H-P-A visual field grading system. Visual acuity, visual field tests and Glaucoma Quality of Life-15 Questionnaire (GQL-15) were performed for enrolled patients, and binocular visual field results were integrated. The changes and correlations of the Visual field index values and quality of life scores were compared among the 5 groups. The main factors affecting the quality of life in glaucoma were analyzed by multiple regression analysis.The best binocular integrated visual field index (BVFI) and optimal quality of life were observed in group A. The BVFI of group B was better than that of group C or group D, but the peripheral vision glare and dark adaptation were worse. No significant difference was noted between group C and group D in terms of BVFI. However, the glare and dark adaptation in group C were better than that in group D. The BVFI was the lowest and the quality of life was the worst in group E. In all, BVFI and decibels (dB) values were negatively correlated with GQL-15 scores and positively correlated with patients' quality of life.Binocular integrated visual field accurately reflects the visual function in glaucoma. Higher binocular integrated visual field indices represent a better quality of life for patients with glaucoma. Mild to moderate synchronous or complementary binocular VF defects had a slight effect on the quality of life, while severe and non-compensated VF loss significantly impacts on quality of life in glaucoma patients.

Contrast Sensitivity and Glaucoma

Spatial contrast sensitivity decline occurs in different types and stages of glaucoma. In this short review we discuss methods of assessing contrast sensitivity, the role of contrast sensitivity in the pathogenesis of glaucoma and its practical application in clinical practice.