Eyes with Suspicious Appearance of the Optic Disc and Normal Intraocular Pressure: Using Clinical and Epidemiological Characteristics to Differentiate Those with and without Glaucoma

<p>Retinal Sensitivity Thresholds Obtained Through Easyfield and Humphrey Perimeters in Eyes with Glaucoma: A Cross-Sectional Comparative Study</p>

Objective

To compare global retinal sensitivity thresholds obtained through the Easyfield perimeter (EF) and Humphrey visual field analyzer (HFA).

Design

Observational cross-sectional study.

Participants

Glaucomatous patients and glaucoma suspects enrolled between October 2018 and April 2019.

Materials and Methods

All participants underwent EF (SPARK Precision) and HFA perimetry (SITA-Standard). After inclusion, demographic and ocular data were collected, including measurements of retinal nerve fiber layer (RNFL) thickness obtained from spectral-domain optical coherence tomography (SD-OCT). Global indices (mean deviation, MD; pattern standard deviation, PSD) values were compared between perimeters, and their correlation and agreement were evaluated. We used regression analysis to investigate structure-functional correlations between SD-OCT measurements and MD index of each perimeter.

Results

We investigated 111 eyes from 69 patients. Mean MD (mean difference=1.49dB) and PSD values (mean difference=0.42dB) from the HFA were significantly larger than those from the EF perimeter (p<0.001). There were significant linear correlations between EF-MD and HFA-MD (r=0.56), and EF-PSD and HFA-PSD (r=0.38; p<0.001). We found significant non-linear associations between average RNFL thickness and MD values derived from both EF (R²=0.41) and HFA (R²=0.17) perimeters (p≤0.012). A difference <2dB between EF-MD and HFA-MD was found in 53% of the eyes, while 71% of them had a difference <1dB between EF-PSD and HFA-PSD.

Conclusion

While we found a moderate correlation and a small mean sensitivity difference between test results, EF’s correlation with structural measurements was at least comparable to that of the HFA. Our findings suggest that although these tests should not be used interchangeably, EF SPARK Precision could be used as an alternative for functional assessment in eyes with mild glaucoma.

A comprehensive map of disease networks and molecular drug discoveries for glaucoma

Glaucoma is the leading cause of irreversible blindness worldwide. The molecular etiology of glaucoma is complex and unclear. At present, there are few drugs available for glaucoma treatment. The aim of the present study was to perform a systematic analysis of glaucoma candidate drugs/chemicals based on glaucoma genes, including genetic factors and differentially expressed (DE) genes. In total, 401 genes from the genetic databases and 1656 genes from the DE gene analysis were included in further analyses. In terms of glaucoma-related genetic factors, 54 pathways were significantly enriched (FDR < 0.05), and 96 pathways for DE genes were significantly enriched (FDR < 0.05). A search of the PheWAS database for diseases associated with glaucoma-related genes returned 1,289 diseases, and a search for diseases associated with DE glaucoma-related genes returned 1,356 diseases. Cardiovascular diseases, neurodegenerative diseases, cancer, and ophthalmic diseases were highly related to glaucoma genes. A search of the DGIdb, KEGG, and CLUE databases revealed a set of drugs/chemicals targeting glaucoma genes. A subsequent analysis of the electronic medical records (EMRs) of 136,128 patients treated in Sichuan Provincial People’s Hospital for candidate drug usage and the onset of glaucoma revealed nine candidate drugs. Among these drugs, individuals treated with nicardipine had the lowest incidence of glaucoma. Taken together with the information from the drug databases, the 40 most likely candidate drugs for glaucoma treatment were highlighted. Based on these findings, we concluded that the molecular mechanism of glaucoma is complex and may be a reflection of systemic diseases. A set of ready-to-use candidate drugs targeting glaucoma genes may be developed for glaucoma clinical drug treatments. Our results provide a systematic interpretation of glaucoma genes, interactions with other systemic diseases, and candidate drugs/chemicals.