Glaucoma

Impact of Systemic Comorbidities on Ocular Hypertension and Open-Angle Glaucoma, in a Population from Spain and Portugal

Open-angle glaucoma (OAG), the most prevalent clinical type of glaucoma, is still the main cause of irreversible blindness worldwide. OAG is a neurodegenerative illness for which the most important risk factor is elevated intraocular pressure (IOP). Many questions remain unanswered about OAG, such as whether nutritional or toxic habits, other personal characteristics, and/or systemic diseases influence the course of glaucoma. As such, in this study, we performed a multicenter analytical, observational, case–control study of 412 participants of both sexes, aged 40–80 years, that were classified as having ocular hypertension (OHT) or OAG. Our primary endpoint was to investigate the relationship between specific lifestyle habits; anthropometric and endocrine–metabolic, cardiovascular, and respiratory events; and commonly used psychochemicals, with the presence of OHT or OAG in an ophthalmologic population from Spain and Portugal. Demographic, epidemiological, and ocular/systemic clinical data were recorded from all participants. Data were analyzed using the R Statistics v4.1.2 and RStudio v2021.09.1 programs. The mean age was 62 ± 15 years, with 67–80 years old comprising the largest subgroup sample of participants in both study groups. The central corneal thickness (ultrasound pachymetry)-adjusted IOP (Goldman tonometry) in each eye was 20.46 ± 2.35 and 20.1 ± 2.73 mmHg for the OHT individuals, and 15.8 ± 3.83 and 16.94 ± 3.86 mmHg for the OAG patients, with significant differences between groups (both p = 0.001). The highest prevalence of the surveyed characteristics in both groups was for overweight/obesity and daily coffee consumption, followed by psychochemical drug intake, migraine, and peripheral vasospasm. Our data show that overweight/obesity, migraine, asthma, and smoking are major risk factors for conversion from OHT to OAG in this Spanish and Portuguese population.

A ZFP42/MARK2 regulatory network reduces the damage of retinal ganglion cells in glaucoma: a study based on GEO dataset and in vitro experiments

Glaucoma is a common disorder in which the death of retinal ganglion cells (RGCs) results in a progressive loss of sight, even blindness. This study was performed to reveal the key molecular mechanism of RGC damage in glaucoma based on the Gene Expression Omnibus database. Glaucoma-related microarray datasets were identified, followed by collection of differentially expressed genes (DEGs) with the key genes discovered by weighted gene co-expression network analysis. Through LASSO regression analysis, candidate genes involved in the pathogenesis of glaucoma were identified with their accuracy evaluated by receiver operating characteristic curve analysis. The glaucoma-specific transcriptional regulatory network was constructed to determine the key transcription factor regulatory axis. Then, in vitro cell models were established using H₂O₂ for further verifying the regulatory role of identified ZFP42/MARK2 axis in RGC damage in glaucoma. Differential analysis of GSE27276, GSE45570, and GSE101727 microarray datasets yielded 165 DEGs, and 22 key genes were identified following. Then, 9 candidate genes involved in the pathogenesis of glaucoma was collected and the key ZFP42/MARK2 regulatory axis was found. In vitro cell experiments further confirmed that ZFP42 and MARK2 were down-regulated in RGCs treated with H₂O₂. In addition, overexpression of ZFP42 increased the expression of MARK2 to increase RGC cell viability, and reduce cell apoptosis and ROS levels, while silencing MARK2 could reverse the protective effect of ZFP42. We confirmed that ZFP42 reduced the damage of RGCs in glaucoma by up-regulating the expression of MARK2.

Acute exposure to air pollutants increase the risk of acute glaucoma

Background

Ambient air pollution is related to the onset and progression of ocular disease. However, the effect of air pollutants on the acute glaucoma remains unclear.

Objective

To investigate the effect of air pollutants on the incidence of acute glaucoma (acute angle closure glaucoma and glaucomatocyclitic crisis) among adults.

Methods

We conducted a time-stratified case-crossover study based on the data of glaucoma outpatients from January, 2015 to Dec, 2021 in Shanghai, China. A conditional logistic regression model combined with a polynomial distributed lag model was applied for the statistical analysis. Each case serves as its own referent by comparing exposures on the day of the outpatient visit to the exposures on the other 3–4 control days on the same week, month and year. To fully capture the delayed effect of air pollution, we used a maximum lag of 7 days in main model.

Results

A total of 14,385 acute glaucoma outpatients were included in this study. We found exposure to PM_2.5, PM₁₀, nitrogen dioxide (NO₂) and carbon monoxide (CO) significantly increased the odds of outpatient visit for acute glaucoma. Wherein the odds of acute glaucoma related to PM_2.5 and NO₂ were higher and more sustained, with OR of 1.07 (95%CI: 1.03–1.11) and 1.12 (95% CI: 1.08–1.17) for an IQR increase over lag 0–3 days, than PM₁₀ and CO over lag 0–1 days (OR:1.03; 95% CI: 1.01–1.05; OR: 1.04; 95% CI: 1.01–1.07).

Conclusions

This case-crossover study provided first-hand evidence that air pollutants, especially PM_2.5 and NO₂, significantly increased risk of acute glaucoma.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14078-9.

A Review on Glaucoma Drainage Devices and its Complications

Glaucoma is one of the leading causes of blindness in the world. It is an ocular disorder that may have multiple etiologies and which can present as optic neuropathy and increased intraocular pressure (IOP), but in some cases like normotensive glaucoma, the IOP may remain normal. Its gradually progressive nature makes it important for early diagnosis; although the loss of vision is slow, lost vision can't be restored. Glaucoma drainage implant surgeries are an increasingly popular option in recent days in complicated cases of glaucoma where the previous trabeculectomy had failed and medical management was not responsive. Glaucoma drainage devices (GDD) are of various designs; they are implanted according to the patient condition and surgeons' preference. There are complications after the implantation of a GDD like hypotony, endophthalmitis, migration of the plate, extrusion, erosion of the mucous membrane, etc. In the market, there are various drainage devices present, but some of them are frequently used and popular.

In this article, we will discuss some most commonly used GDDs and their complications. Among these, four are the most popular: Molteno, Baerveldt, Krupin, and Ahmed. The failure rate of the GDD is low. In many studies, it has been noted that only half of the GDD remains functional after five years. Therefore, further studies are still being conducted to refine the biomaterials, techniques, and shape of the GDD. The technique of surgery is also very much crucial in the success of GDD implantation. The glaucoma type is an essential factor in deciding the treatment, and the outcome of the surgery also depends on it.

Rho Kinase Inhibitors as a Neuroprotective Pharmacological Intervention for the Treatment of Glaucoma

Glaucoma is a leading cause of irreversible blindness, and its prevalence has led to research into treatment modalities for glaucoma to prevent the progression of the disease. The primary treatment for glaucoma that has been extensively used is ocular hypotensives to reduce raised intraocular pressure. This treatment has its drawbacks due to the existence of other variants of glaucoma, such as normal-tension glaucoma, where the intraocular pressure is measured to be within regular levels. Hence, there is a need for new treatment interventions which can deliver a better prognosis for glaucoma. Neuroprotection is a new concept studied recently, and neuroprotective agents are being developed for glaucoma therapy. Rho kinase inhibitors are one such neuroprotective agent, and the most recent addition to the class of ocular hypotensives, where they function by reducing raised intraocular pressure. Its neuroprotective capabilities, such as cell survival and axon regeneration, are yet to be determined in detail. This literature review article aims to look into the need for new treatments such as neuroprotection to prevent the progression of glaucoma and the efficacy of rho kinase inhibitors in the treatment of glaucoma, with particular emphasis on its neuroprotective abilities. It also aims to identify the limitations that can occur while approaching neuroprotective therapy, as well as how it can enable future treatment modalities. By exploring this field, blindness caused by progressive glaucoma can be halted and managed by glaucoma therapy.

Study to Identify and Evaluate Predictor Factors for Primary Open-Angle Glaucoma in Tertiary Prophylactic Actions

The aim of this study is to develop a predictive model with several explanatory variables that can guide ophthalmologists to make a more objective assessment of the evolution of open-angle glaucoma (OAG) during tertiary prevention. Objectives: The evaluation of risk factors and different predictors of symptom progression between patients with POAG and non-glaucoma patients (NG), as well as between primary open-angle glaucoma with high intraocular pressure (POAG) and primary open-angle glaucoma with normal intraocular pressure (NTG), in tertiary prophylactic activities. Methods: This research is an analytical epidemiological study of a prospective cohort. For the study, we took into account personal medical history, physical ophthalmological examination, intraocular pressure (IOP) values, and visual field (VF) parameters, examined with the Opto AP-300 Automated Perimeter using the “fast threshold” strategy. The results of gonioscopy were inconsistently recorded; they were not considered in the study due to missing values, the processing of which would have seriously distorted the statistical analysis. Ophthalmological examination was completed with a dichotomous questionnaire entitled “Symptom Inventory”, made according to the accusations of patients resulting from a “focus group” study. The study was carried out in the ophthalmology office within the Integrated Outpatient Clinic of the Emergency Clinical Hospital of Oradea, Bihor County (IOCECHO) between January−December 2021. The threshold of statistical significance was defined for p value < 0.05. The obtained results were statistically processed with specialized software SPSS 22. Results: The study included 110 people, of which 71 (64.54%) had POAG (IOP > 21 mmHg) and 39 people (35.46%) had NTG (IOP < 21 mmHg), the two groups being statistically significantly different (χ2 = 9.309, df = 1, p = 0.002). For the POAG group, glaucomatous loss was early, AD < −6 dB, according to the staging of glaucomatous disease, HODAPP classification. In addition, the groups of POAG and NTG patients was compared with a group of 110 NG patients, these three groups being statistically significantly different (χ2 = 34.482, df = 2, p = 0.000). Analysis of confounding factors (age, sex, residence, marital status) shows a statistically significant relationship only for age (F = 2.381, df = 40, p = 0.000). Sex ratio for the study groups = 5.11 for OAG and =5.87 for NG. After treatment (prostaglandin analogues and neuroprotective drugs) IOP decreased statistically significantly for both POAG and NTG. Conclusions: this study identified possible predictors of OAG, at the 5% level (risk factors and symptoms as independent variables) using a dichotomous questionnaire tool with a complementary role in tertiary prophylactic activities. The implementation of the focus group interview results as a socio-human research technique will be supportive to clinicians.

Screening of primary open-angle glaucoma diagnostic markers based on immune-related genes and immune infiltration

Purpose

Primary open-angle glaucoma (POAG) continues to be a poorly understood disease. Although there were multiple researches on the identification of POAG biomarkers, few studies systematically revealed the immune-related cells and immune infiltration of POAG. Bioinformatics analyses of optic nerve (ON) and trabecular meshwork (TM) gene expression data were performed to further elucidate the immune-related genes of POAG and identify candidate target genes for treatment.

Methods

We performed a gene analysis of publicly available microarray data, namely, the GSE27276-GPL2507, GSE2378-GPL8300, GSE9944-GPL8300, and GSE9944-GPL571 datasets from the Gene Expression Omnibus database. The obtained datasets were used as input for parallel pathway analyses. Based on random forest and support vector machine (SVM) analysis to screen the key genes, significantly changed pathways were clustered into functional categories, and the results were further investigated. CIBERSORT was used to evaluate the infiltration of immune cells in POAG tissues. A network visualizing the differences between the data in the POAG and normal groups was created. GO and KEGG enrichment analyses were performed using the Metascape database. We divided the differentially expressed mRNAs into upregulated and downregulated groups and predicted the drug targets of the differentially expressed genes through the Connectivity Map (CMap) database.

Results

A total of 49 differentially expressed genes, including 19 downregulated genes and 30 upregulated genes, were detected. Five genes ((Keratin 14) KRT14, (Hemoglobin subunit beta) HBB, (Acyl-CoA Oxidase 2) ACOX2, (Hephaestin) HEPH and Keratin 13 (KRT13)) were significantly changed. The results showed that the expression profiles of drug disturbances, including those for avrainvillamide-analysis-3, cytochalasin-D, NPI-2358, oxymethylone and vinorelbine, were negatively correlated with the expression profiles of disease disturbances. This finding indicated that these drugs may reduce or even reverse the POAG disease state.

Conclusion

This study provides an overview of the processes involved in the molecular pathogenesis of POAG in the ON and TM. The findings provide a new understanding of the molecular mechanism of POAG from the perspective of immunology.

The Actions of Lithium on Glaucoma and Other Senile Neurodegenerative Diseases Through GSK-3 Inhibition: A Narrative Review

Glaucoma can be described as a set of progressive optic neuropathies. They cause a gradual, irreversible loss of the field of view, which concludes in complete blindness. Evidence suggests that patients who have glaucoma face a greater risk of suffering from senile dementia. Dementia is a group of conditions that occur in old age individuals. Neurodegeneration is a characteristic pathological feature of dementia, the progression of which causes a decline in cognition, which may be accompanied by memory loss. Severe dementia in old individuals usually presents as Alzheimer’s disease, which significantly contributes to a load of dementia in India. Parkinsonism is another common neurodegenerative disease that is known to occur in the elderly.

The WNT (Wingless-related integration site)/β-catenin pathway is a multistep process that is responsible for the regulation of various cellular functions. Lithium can up-regulate this pathway by disrupting Glycogen synthase kinase-3β (GSK-3β). This action of Lithium can effectively counteract neuroinflammation and neurodegeneration. The current use of Lithium remains majorly confined to its use for episodes of mania in bipolar disorder (BD). However, recent literature gives insight into how Lithium can improve the visual field in glaucomatous eyes. Symptomatic improvement after lithium administration is seen as it has neuroprotective actions on the retinal ganglion cells (RGCs). Prolonged lithium use improves axonal regeneration and neuronal survival. Lithium also improves the worsening of symptoms in other dementia-related neurodegenerative diseases like Alzheimer’s and Parkinsonism. The physiological actions of Lithium can be utilized in providing effective, holistic therapy options in pathologically related senile degenerative disorders. Significantly better results can be obtained if Lithium therapy is given in conjunction with the drugs used to manage these disorders.

Meta-Analysis of the Comprehensive Efficacy of Intraocular Lens Implantation in Glaucoma Patients

This study is aimed at investigating the efficacy of intraocular lens (IOL) implantation in patients suffering from glaucoma through meta-analysis of the previously published research. For this purpose, different literature databases were searched for identification of clinical studies published between January 2000 and January 2022 on evaluating IOL's efficacy in treating glaucoma. RevMan 5.3 was used to conduct a meta-analysis of the pertinent data. The central anterior chamber depth (ACD), corneal endothelial cell counts, best-corrected visual acuity (BCVA), intraocular pressure (IOP), anti-glaucoma medications (AGM), and axial length (AL) changes were compared, and the incidence of postoperative complications was thoroughly evaluated. The Cochran chi-square test was used to examine the heterogeneity of the evaluation results. According to the inclusion and exclusion criteria, 20 studies included 948 glaucomatous eyes. IOP was significantly lower than before treatment (MD = 8.64, 95 CI: 5.75-11.53; Z = 5.86, P < 0.0001), while ACD increased significantly (MD = -1.38, 95 percent CI: -1.74-1.02; Z = 7.49, P < 0.0001). The corneal endothelial cell counts were homogeneous (MD = 225.08, 95% CI: -64.17 to -514.33; Z = 1.53, P = 0.20). AGM utilisation decreased (MD = 1.43, 95% CI: 0.752.12, Z = 4.09, P < 0.0001). AL decreased significantly (MD = 0.31; 95% CI: 0.09-0.54; Z = 2.71; P = 0.007). The incidence of complications remained insignificant after IOL treatment (OR = 1.05, 95% CI: 0.42 to 2.60; Z = 0.10, P = 0.92; P = 0.92). These findings indicate that IOL treatment can significantly reduce intraocular pressure, glaucoma drug use, and aqueous level (AL) in glaucoma patients while increasing the depth of the central anterior chamber. This study offers a theoretical foundation for selecting glaucoma treatment methods.

A Narrative Review of Ocular Surface Disease Related to Anti-Glaucomatous Medications

Topical anti-glaucomatous medications are still the most important measure to lower intraocular pressure. Large number of studies have confirmed that long-term use of anti-glaucomatous eye drops, especially containing benzalkonium chloride, a preservative, can cause or aggravate ocular surface injury. Ocular surface diseases damage the ocular microenvironmental health status, reduce the patients’ compliance with the treatment, and finally affect the treatment result. Therefore, the ocular surface management of patients with glaucoma is very important. This includes the selection of drugs that are better tolerated according to individual conditions, preservative-free formulations, drugs that protect against ocular surface disease, or selecting surgery and laser treatment, to prevent the damage to the ocular surface by topical anti-glaucomatous drugs.

Comparison of the Effect on Vessel Density and RNFL between Carteolol and Latanoprost

The aim of the study was to compare the treatment of hypertensive glaucoma (HTG) in the early stages with carteolol and latanoprost by assessing the change in vessel density (VD) and retinal nerve fibre layer (RNFL). Methods: The first group with diagnosed HTG consisted of 46 eyes treated with carteolol; the second group consisted of 52 eyes treated with latanoprost. The following examinations were evaluated in all patients: intraocular pressure (IOP), retinal nerve fibre layer (RNFL), vessel density (VD) and visual field examination (glaucoma fast threshold test). The results were compared before treatment and 3 months after treatment. Results: There was no difference in the overall visual field defect (OD) between groups before treatment. After treatment, there was a decrease in IOP in both groups (carteolol-treated group had a mean decrease of 5.8 mmHg and latanoprost-treated eyes had a mean decrease of 7 mmHg). This difference was not statistically significant (p = 0.133). No similar difference was observed for RNFL (p = 0.161). In contrast, the change in the VD parameter was statistically significant between groups (p < 0.05), with a greater difference observed in the carteolol-treated group of eyes. Carteolol had a better effect on the VD.

Spotlight on iPad Visual Field Tests Efficacy

Tablet based perimetry has the potential to be used as a low-cost, portable method for glaucoma screening. With the advent of tablets with large dynamic luminance range and high spatial resolution, perimetry applications can test visual field locations within the central 30 degrees, just like bowl perimetry. Tablet perimetry has garnered interest in this COVID era as it can be promptly done in the waiting room or even from the comfort of home. The current review focuses on evaluating glaucoma detection sensitivities, diagnostic abilities and correlation of each parameter and examination time of the iPad based perimetry applications with those of HFA.

COMPARISON OF THE EFFICIENCY OF NON-PENETRATING DEEP SCLERECTOMY AS A STANDALONE SURGERY AND MODIFIED NON-PENETRATING DEEP SCLERECTOMY IN COMBINATION WITH AB INTERNO ENDOTRABECULECTOMY

Aim. To compare the hypotensive effect of non-penetrating deep sclerectomy (NPDS) as a standalone surgery and non-penetrating deep sclerectomy in combination with dosed endotrabeculectomy in patients with primary open-angle glaucoma. Materials and Methods. 27 patients (27 eyes) with primary open-angle glaucoma were under our follow-up. In the first group (15 patients) we performed a non-penetrating deep sclerectomy, in the second group (12 patients) - a combined surgery. Results and Discussion. When comparing values, we found that the difference between the preoperative and postoperative IOP, as well as the preoperative and postoperative amount of topical antihypertensives used, was significant up to the 12th month inclusive in both groups (p<0.05). No significant difference was found when comparing IOP values between two groups in the same follow-up periods. However, there was a difference in the amount of topical intraocular pressure-lowering agents used by two groups in the 12th month of follow-up. Conclusions. Non-penetrating deep sclerectomy, both standalone and in combination with endotrabeculectomy, has a significant hypotensive effect in patients with primary open-angle glaucoma during 12 months of follow-up, however, patients of the first group instilled a higher amount of topical antihypertensives in the 12th month of follow-up, which makes us consider the hypotensive effect of the combined surgery to be higher.

Application Progress of High-Throughput Sequencing in Ocular Diseases

Ocular diseases affect multiple eye parts and can be caused by pathogenic infections, complications of systemic diseases, genetics, environment, and old age. Understanding the etiology and pathogenesis of eye diseases and improving their diagnosis and treatment are critical for preventing any adverse consequences of these diseases. Recently, the advancement of high-throughput sequencing (HTS) technology has paved wide prospects for identifying the pathogenesis, signaling pathways, and biomarkers involved in eye diseases. Due to the advantages of HTS in nucleic acid sequence recognition, HTS has not only identified several normal ocular surface microorganisms but has also discovered many pathogenic bacteria, fungi, parasites, and viruses associated with eye diseases, including rare pathogens that were previously difficult to identify. At present, HTS can directly sequence RNA, which will promote research on the occurrence, development, and underlying mechanism of eye diseases. Although HTS has certain limitations, including low effectiveness, contamination, and high cost, it is still superior to traditional diagnostic methods for its efficient and comprehensive diagnosis of ocular diseases. This review summarizes the progress of the application of HTS in ocular diseases, intending to explore the pathogenesis of eye diseases and improve their diagnosis.

Advances in Excimer Laser Trabeculostomy within the Landscape of Minimally-Invasive Glaucoma Surgery

Primary open-angle glaucoma (POAG) is currently treated with a variety of surgical and non-surgical approaches. Minimally invasive glaucoma surgery (MIGS) involves several devices and procedures that lower intraocular pressure (IOP) by increasing aqueous outflow. The first laser-based MIGS procedure, Excimer Laser Trabeculostomy (ELT), has emerged as a safe and effective treatment option. This article reviews ELT within the context of alternative MIGS procedures and focuses on the historical development of ELT, principles and techniques of the ELT procedure, safety and efficacy data, comparison to other outflow procedures, and future augmentations to expand the use of ELT. Performed alone or as an adjunct to cataract surgery, ELT has minimal complications and has shown long-term effectiveness in lowering intraocular pressure in thousands of patients. The non-thermal laser-tissue interactions of excimer lasers minimize peripheral tissue damage and ensure outflow channel patency without requiring foreign body implants or creating blebs. The development of 2D optical and 3D optical coherence tomography (OCT) guidance systems will eliminate the need for a goniolens to visualize angle structures and enable thousands more surgeons to perform ELT in the future.

Particle Swarm Optimization-Based Approach for Optic Disc Segmentation

Fundus segmentation is an important step in the diagnosis of ophthalmic diseases, especially glaucoma. A modified particle swarm optimization algorithm for optic disc segmentation is proposed, considering the fact that the current public fundus datasets do not have enough images and are unevenly distributed. The particle swarm optimization algorithm has been proved to be a good tool to deal with various extreme value problems, which requires little data and does not require pre-training. In this paper, the segmentation problem is converted to a set of extreme value problems. The scheme performs data preprocessing based on the features of the fundus map, reduces noise on the picture, and simplifies the search space for particles. The search space is divided into multiple sub-search spaces according to the number of subgroups, and the particles inside the subgroups search for the optimal solution in their respective sub-search spaces. The gradient values are used to calculate the fitness of particles and contours. The entire group is divided into some subgroups. Every particle flies in their exploration for the best solution. During the iteration, particles are not only influenced by local and global optimal solutions but also additionally attracted by particles between adjacent subgroups. By collaboration and information sharing, the particles are capable of obtaining accurate disc segmentation. This method has been tested with the Drishti-GS and RIM-ONE V3 dataset. Compared to several state-of-the-art methods, the proposed method substantially improves the optic disc segmentation results on the tested datasets, which demonstrates the superiority of the proposed work.

Detection of Intraocular Hypertension during Opportunity Screening (Check-Up Medical Inspections)

The aim of the study is the early detection of OHT (Ocular hypertension) in patients, in the activity of secondary prophylaxis (opportunity screening-medical check-up), to prevent blindness caused by POAG (Primary Open Angle Glaucoma). In Romania, medical examination of personnel with responsibilities in Transport Safety (TS) is legally regulated, being mandatory as a result of the internal transposition of European legislation in the field. The addressability of the patients for examination was determined by personal choice, depending on the accessibility of the medical service on the profile market (availability and price). The design of the study is epidemiological, observational, descriptive and retrospective. The standardized medical protocol included: personal medical history (anamnesis), physical ophthalmological examination, Intraocular pressure (IOP) measurement and Visual Field (VF) performance, with Automated Perimeter “Optopol PTS 910” through “Fast Threshold” strategy. The specialized medical research was completed with a dichotomous questionnaire entitled “Symptom Inventory”, made according to the recommendations of patients resulting from “Focus group” research. The study was carried out within the “Check-up” type medical controls upon request, only for personnel with positions in Transport Safety (TS), during January−December 2021 at S.C. ARTIMED S.R.L. Oradea, Bihor County. Health analysis was performed for 820 people, of whom 71 people (8.65%) tested positive for IOP > 21 mmHg, (suspected OHT) compared to 749 (91.35%) with normal values (Normal intraocular pressure-NIOP); the two lots being statistically significantly different (x2 = 560.590, df = 1, p = 0.000). The study involved 754 men (92.0%) and 66 women (8.0%), the sex ratio is 11.42 (Exp (B) = 0.782, Sig = 0.558, 95% CI = 0.343−1783; sex is not a significant predictor at the 5% level). The prevalence of OHT was 8.66% for the whole group, 8.48% for men and 10.60% for women. In the screening action for the whole group of patients the following was determined: IOP reference = 20.85 mmHg, Sensitivity (Se) = 91.5% and 1-Specificity (Sp) = 0.073, (Sp = 92.7%). The predictive value of the screening test was: Positive Predictive Value (PPV) = 90.1% and Negative Predictive Value (NPV) = 91.7%; Area under the ROC Curve (Receiver Operating Characteristic) = 0.986, Sig. = 0.000, CI95% = 0.979−0.993. A binary logistical model of a questionnaire was developed to determine the screening parameters which significantly predicted OHT: IOP (OR = 4.154, 95% CI: 3.155−5.469), Age < 40 years (OR = 0.408, 95% CI: 0.239−0.698) and Pattern Defect (PD) (OR = 1.475% CI: 1.130−1.925). The results of this study assess health status through regular medical examinations, and highlight their importance and usefulness in secondary prevention activity. The particularity of this “check-up” type for personnel with attributions in transport safety is based on two essential aspects: the legal obligation to perform it and the fact it is financed by the beneficiary (the employer). In patients suspected of OHT after antiglaucoma treatment, IOP statistically significantly decreased.

Structural and functional differentiation between compressive and glaucomatous optic neuropathy

Clinical diagnoses of slow, progressive, painless visual losses with various degrees of visual field (VF) losses and disc atrophy are often confused between suprasellar compressive optic neuropathy (CON) and open-angle glaucomatous optic neuropathy (GON). We plotted the thickness of the peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL) against the mean deviation (MD) of the VF of 34 eyes of CON at diagnosis, 30 eyes of CON after therapy, 29 eyes of GON, and 60 eyes of healthy controls in a cross-sectional investigation. At diagnosis, a disproportionally early pattern of structural thinning compared with the corresponding VF losses was unique to CON. GON- and CON-specific thinning parameters were generally useful in differentiating GON and CON from moderate to severe MD losses, but early MD losses (0 to - 6 dB) overlapped with GON in a CON-stage specific manner. GON-specific thinning parameters, RNFL in the inferior sector, and inferior to temporal macular GCIPL ratio showed overlap with posttreatment CON in the early MD losses with AUCs of 0.916 (95% CI 0.860-0.971; P < 0.001) and 0.890 (95% CI 0.811-0.968; P < 0.001), respectively. In comparison, CON-specific thinning parameters, superonasal, and inferonasal GCIPL showed overlap with CON at diagnosis for early MD losses. Overall, the nasal-to-temporal macular GCIPL ratio showed good discrimination between CON and GON throughout the MD range, with an AUC of 0.923 (95% CI 0.870-0.976; P < 0.001). Comparing GON with all stages of CON, the cut-point of 0.95 showed the lower nasal-to-temporal GCIPL ratio had a sensitivity of 72% and specificity of 90% for CON. However, the cut-point of 1.10 showed the superior-to-inferior GCIPL ratio had a sensitivity of 60% and specificity of 98% for GON.

Measurement of intraocular temperature in glaucoma: week-day and seasonal fluctuations

PURPOSE

To evaluate long-term intraocular temperature (IOT) variations in eyes with primary open-angle glaucoma (POAG) using an intraocular telemetric sensor.

METHODS

This prospective, open-label, multicentre observational study analysed the IOT variations in 22 eyes of 22 patients with POAG. All enrolled patients underwent implantation of an intraocular pressure (IOP) sensor during cataract surgery. The telemetric system uses a built-in temperature sensor to control measured IOP for temperature. Each time a patient measures their IOP, both the IOP and IOT are recorded in the reader device. Patients were instructed to self-measure their IOP as often as desired, but at least four times daily. Recorded readings were retrieved and analysed using mixed effect models and pairwise comparisons using Bonferroni correction to assess the statistical significance of average IOT variations between each individual weekday and calendar month.

RESULTS

The mean age of patients was 67.8±6.8 years and 36.4% were women. A total of 132 745 readings over 21 102 measurement-days were obtained. On average, IOT was significantly higher on Sundays (34.57°C; 95% CI 34.37 to 34.78) than on any other day of the week (p<0.001). Mean IOT on other weekdays ranged from 34.48°C to 34.51°C. Over the year, IOT followed a clear seasonal pattern, reaching its maximum in July (34.8°C; 95% CI 34.56 to 34.97) and its minimum in January (34.4°C; 95% CI 34.15 to 34.56; p<0.001).

CONCLUSIONS

This study demonstrates the feasibility of continual and long-term measurement of IOT using intraocular sensors. The results show significant short-term and long-term fluctuations of IOT. Research is warranted to understand the impact of IOT variations on IOP, ocular perfusion and glaucoma progression.

The Role of Metalloproteinases and Their Tissue Inhibitors on Ocular Diseases: Focusing on Potential Mechanisms

Eye diseases are associated with visual impairment, reduced quality of life, and may even lead to vision loss. The efficacy of available treatment of eye diseases is not satisfactory. The unique environment of the eye related to anatomical and physiological barriers and constraints limits the bioavailability of existing agents. In turn, complex ethiopathogenesis of ocular disorders that used drugs generally are non-disease specific and do not act causally. Therefore, there is a need for the development of a new therapeutic and preventive approach. It seems that matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) have a significant role in the development and progression of eye diseases and could be used in the therapy of these disorders as pharmacological targets. MMPs and TIMPs play an important role in the angiogenesis, epithelial-mesenchymal transition, cell invasion, and migration, which occur in ocular diseases. In this review, we aim to describe the participation of MMPs and TIMPs in the eye diseases, such as age-related macular degeneration, cataract, diabetic retinopathy, dry eye syndrome, glaucoma, and ocular cancers, posterior capsule opacification focusing on potential mechanisms.

The Role of Axonal Transport in Glaucoma

Glaucoma is a neurodegenerative disease that affects the retinal ganglion cells (RGCs) and leads to progressive vision loss. The first pathological signs can be seen at the optic nerve head (ONH), the structure where RGC axons leave the retina to compose the optic nerve. Besides damage of the axonal cytoskeleton, axonal transport deficits at the ONH have been described as an important feature of glaucoma. Axonal transport is essential for proper neuronal function, including transport of organelles, synaptic components, vesicles, and neurotrophic factors. Impairment of axonal transport has been related to several neurodegenerative conditions. Studies on axonal transport in glaucoma include analysis in different animal models and in humans, and indicate that its failure happens mainly in the ONH and early in disease progression, preceding axonal and somal degeneration. Thus, a better understanding of the role of axonal transport in glaucoma is not only pivotal to decipher disease mechanisms but could also enable early therapies that might prevent irreversible neuronal damage at an early time point. In this review we present the current evidence of axonal transport impairment in glaucomatous neurodegeneration and summarize the methods employed to evaluate transport in this disease.

There’s Danger in the Drops: Systemic Effects of Ophthalmic Drops Used to Treat Glaucoma

Glaucoma is a common eye disorder and an irreversible cause of blindness worldwide. There are several treatment options for this condition, with the traditional first-line treatment being ophthalmologic drops. Although administered topically, it is associated with inadvertent systemic absorption leading to a potential for both local and systemic side effects. We discuss the case of a 71-year-old male who presented with a complaint of recurring episodes of distressing sensations including lightheadedness, dyspnea, chest pressure, and faintness. His past medical history included congestive heart failure, hypertension, hyperlipidemia, Barrett’s esophagus, and glaucoma. Upon a thorough review of the patient’s medications, it was discovered that he had recently been started on timolol ophthalmic drops. The patient then noted that his symptoms had begun after he started using the eye drops. After we recommended that the patient hold the use of the eye drops, these episodes stopped. When prescribing topical ophthalmologic drops, providers must educate patients on common systemic side effects of such drugs.

The cornea and methods for measuring intraocular pressure

Introduction: The study aimed to assert the relationship between central corneal thickness (CCT) and intraocular pressure (IOP) measured by: Goldmann applanation tonometry (GAT) and Dynamic contour tonometry (DCT). Materials and Methods: The study included 150 patients with a mean age of 59.39 ± 13.12 years. Patients were divided into three groups: 50 primary open-angle glaucoma (POAG) patients, 50 ocular hypertension (OHT) patients, and 50 normal tension glaucoma (NTG) patients. IOP was determined using GAT and DCT. CCT was measured by ultrasound pachymetry. Results: IOP measured with DCT was higher than IOP measured with GAT (19.80 ± 3.67 mmHg vs 17.71 ± 3.35 mmHg). A significant positive association between IOP measured with GAT and IOP measured with DCT was found in all patients (r = 0.867, p < 0.01). A significantly positive association between IOP measured with GAT and IOP measured with DCT in POAG (r = 0.855, p <0.01), OHT (r = 0.826, p < 0.01), and NTG patients (r = 0.832, p < 0.01) were found. A significant positive correlation between CCT and IOP measured with GAT (r = 0.198, p < 0.01), as well as a significant positive correlation between CCT and IOP measured with DCT was found (r = 0.198, p < 0.01) in all patients. There was no correlation between CCT and IOP measured neither with GAT nor with DCT separately in three patient groups (p > 0.05). Conclusion: CCT-influenced IOP was measured by both methods, GAT and DCT. DCT can not replace GAT, but it is very useful, especially in cases where errors are in the IOP GAT measurement.

Ambulatory and hospital care of glaucoma in Spain and associated medical costs

OBJECTIVES

This study aimed to analyze the impact of glaucoma in ambulatory centers and hospitals in Spain over the past decade, in terms of incidence and medical costs.

METHODS

Administrative data of glaucoma patients from ambulatory centers and hospitals in Spain and registered between 2011 and 2020 was obtained from a Spanish National discharge database. Medical costs obtained were based on the diagnosis-related group-based hospital payment systems, determined by the Spanish Ministry of Health.

RESULTS

Data from 100,734 ambulatory care visits and 11,408 hospital admissions related to glaucoma were obtained from the database. Most of the cases were registered in patients over 65 years of age. The incidence of glaucoma in ambulatory centers was 2.2 per 10,000 persons over the study period; in hospitals, the incidence was 0.2 per 10,000 persons. The incidence of glaucoma in ambulatory settings increased significantly over the study period, while the incidence in hospitals decreased over the same period. Most ambulatory visits and hospital admissions were programmed or non-urgent. The mean cost per ambulatory visit was €954, €5.5 million in total annually; the mean cost per hospital admission was €3,727, €4.1 million in total annually. The annual cost of ambulatory care increased significantly over the study period, while the annual cost of hospital care decreased significantly.

CONCLUSIONS

The medical costs of glaucoma in Spanish hospitals decreased over the study period, while the costs of ambulatory care increased. This shift in the management of glaucoma should be considered in future resource allocation decisions.

Current situation and progress of drugs for reducing intraocular pressure

Glaucoma, the most common cause of irreversible blindness worldwide, usually causes characteristic optic nerve damage. Pathological intraocular pressure (IOP) elevation is a major risk factor. Drug reduction of IOP is the preferred treatment for clinicians because it can delay the progression of disease. However, the traditional IOP-lowering drugs currently used by patients may be poorly tolerated. Therefore, in recent years, some new drugs have been put into clinical application or in clinical phase I–III studies. They have a better IOP-lowering effect and fewer adverse reactions. Because glaucoma is a chronic disease, drugs need to be administered continuously for a long time. For patients, good compliance and high drug bioavailability have a positive effect on the prognosis of the disease. Therefore, clinicians and scientists have developed drug delivery systems to solve this complex problem. In addition, natural compounds and dietary supplements have a good effect of reducing IOP, and they can also protect the optic nerve through antioxidant action. We summarize the current traditional drugs, new drugs, sustained-release drug delivery systems, and complementary drugs and outline the mechanism of action and clinical effects of these drugs on glaucoma and their recent advances.

Cost effectiveness analysis associated to the treatment of primary open-angle glaucoma according to disease severity

Introduction/Objective. POAG treatment should be individually tailored to the disease severity and type, effectiveness and secondary side effects of the medications used. This research aimed to assess the direct medical costs and the cost effectiveness associated with pharmacotherapy in visually impaired people with primary open-angle glaucoma according to disease severity. Methods. This scientific study is designed as an observational cross-sectional study with a quantitative analytical approach and was conducted in the period from July 2020 to June 2021 on the territory of North Macedonia. The study included 157 patients with binocular POAG in the early, moderate and advanced clinical stage, up to the age of 67, with changes in visual acuity and work ability. During the assessment of the effects of pharmacotherapy were analyzed the types, mutual correlations and effectiveness of the most commonly prescribed antiglaucomatous medications and the cost benefit from their administration. Direct medical costs are calculated according to disease severity in the last 12 months using real-time data of public interest. Results. The beta blockers due to their affordable price and availability are the dominant option with high-cost benefit for primary treatment of POAG. Antiglaucoma medications and diagnostic procedures are major components of direct medical treatment costs. Conclusion. Pharmacotherapy is the dominant alternative compared to other types of treatment because it is safer and is associated with greater effictiveness and lower direct medical costs.