Prevalence, Awareness, and Risk Factors of Primary Open-Angle Glaucoma

How is eyeball growth associated with optic nerve head shape and glaucoma? The Lamina cribrosa/Bruch's membrane opening offset theory

The optic nerve head (ONH) is a complex structure wherein the axons of the retinal ganglion cells extrude from the eyeball through three openings: 1) the Bruch's membrane opening (BMO) in the retinal layer, 2) the anterior scleral canal opening in the anterior scleral layer, and 3) the lamina cribrosa (LC). Eyeball expansion during growth induces an offset among openings, since the expansion affects the inner retinal and outer scleral layers differently: the posterior polar retinal structure is preserved by the preferential growth in the equatorial region, whereas no such regional difference is observed in the scleral layer. The various modes and extents of eyeball expansion result in diverse directionality and amount of offset among openings, which causes diverse ONH morphology in adults, especially in myopia. In this review, we summarize the ONH changes that occur during myopic axial elongation. These changes were observed prospectively in our previous studies, wherein LC shift and subsequent offset from the BMO center could be predicted by tracing the central retinal vascular trunk position. This offset induces the formation of γ-zone parapapillary atrophy or externally oblique border tissue. As a presumptive site of glaucomatous damage, the LC/BMO offset may render the LC pores in the opposite direction more vulnerable. To support such speculation, we also summarize the relationship between LC/BMO offset and glaucomatous damage. Indeed, LC/BMO offset is not only the cause of diverse ONH morphology in adults, but is also, potentially, an important clinical marker for assessment of glaucoma.

Prescribing trends of glaucoma medication in Korea from 2007 to 2020: A nationwide population-based study

PURPOSE

Investigating long-term trends in glaucoma medication.

METHODS

All patients diagnosed with glaucoma and prescribed glaucoma eye drops between 2007 and 2020 in Korea's Health Insurance Review and Assessment Service database participated in this study. A weight was assigned to each prescription using the reciprocal of the total number of prescriptions received by the individual in that year. The number of patients who received each type of glaucoma eye drop prescription was calculated by summing the weights for each year.

RESULTS

During the study period, prostaglandin analog eye drop monotherapy was the most frequently given type of glaucoma eye drop prescription. Until 2008, the second most frequently given type of glaucoma eye drop prescription was beta blocker eye drop monotherapy; thereafter, it changed to carbonic anhydrase inhibitor/beta blocker fixed-combination eye drop monotherapy. The prescription proportion of single-ingredient glaucoma eye drops decreased (-1.290%/year, P < 0.001), whereas that of fixed-combination glaucoma eye drops increased (1.291%/year, P < 0.001). The number of glaucoma eye drops prescribed per patient remained constant (-0.00030/year, P = 0.167) with an average of 1.302, while the number of active ingredients prescribed per patient increased (0.01737/year, P < 0.001) from 1.659 in 2007 to 1.896 in 2020.

CONCLUSION

Over 14 years, there was no change in the number of glaucoma eye drops prescribed to individual patients in Korea. However, the number of active ingredients prescribed increased owing to the increased prescription of fixed-combination eye drops. The current trends in glaucoma medication are expected to help establish future treatment strategies.

Trace Element Concentration in the Blood and Aqueous Humor of Subjects with Eye Cataract

Cataract, characterized by the opacification of the lens, is the leading cause of reversible blindness and visual impairment globally. The study aims to investigate the role of trace elements such as Cd, Co, Cr, Cu, Fe, Hg, Mn, Ni, Pb, Se, and Zn in the development and severity of cataract. Elements were quantified by inductively coupled plasma mass spectrometry in blood and aqueous humor of 32 cataract cases and 27 controls living in the Latium region, Italy. The association between element concentration in blood and aqueous humor and cataract severity, gender, and age of subjects were also assessed. Results showed Cr levels significantly elevated in both blood and aqueous humor of cataract cases, with concentrations that increased with cataract severity. In addition, blood Pb levels were significantly higher in older cases and positively correlated with the age of cataract cases, while blood Co and Cu levels negatively correlated with cataract severity, suggesting changes in the levels of these elements. In conclusion, this study provides evidence of the involvement of specific elements in cataract development and severity, and the findings highlighted important avenues for future research. Understanding the biological mechanism underlying element-induced cataract may contribute to preventing cataractogenesis and providing targeted interventions.

Association Between High Blood Folate Levels and Glaucoma in a Representative Korean Population

Purpose

This study aimed to investigate the association between folate levels and the prevalence of glaucoma.

Methods

This nationwide population-based cross-sectional study included 1790 participants aged ≥40 years. We analyzed data regarding the participants obtained in the 2016-2018 Korean National Health and Nutrition Examination Survey. The diagnosis of glaucoma was defined according to the International Society of Geographical and Epidemiological Ophthalmology criteria. Logistic regression analyses were used to investigate the relationship between blood folate levels and glaucoma.

Results

There was a significantly lower prevalence of glaucoma in the highest quartile of blood folate levels than in the lowest quartile, after adjusting for confounding factors such as age, sex, systemic hypertension, diabetes, hypercholesterolemia, and smoking (odds ratio [OR] = 0.470; 95% confidence interval [CI], 0.291-0.759; P for trend = 0.017). There was a significantly lower risk of glaucoma in the highest quartile of blood folate levels than in the lowest quartile among women (OR = 0.188; 95% CI, 0.099-0.357; P for trend <0.001) and younger participants (OR =0.443; 95% CI, 0.229-0.856; P for trend = 0.045).

Conclusions

Our findings indicate a strong inverse correlation between blood folate levels and glaucoma.

Dysregulation of histone deacetylases in ocular diseases

Ocular diseases are a growing global concern and have a significant impact on the quality of life. Cataracts, glaucoma, age-related macular degeneration, and diabetic retinopathy are the most prevalent ocular diseases. Their prevalence and the global market size are also increasing. However, the available pharmacotherapy is currently limited. These diseases share common pathophysiological features, including neovascularization, inflammation, and/or neurodegeneration. Histone deacetylases (HDACs) are a class of enzymes that catalyze the removal of acetyl groups from lysine residues of histone and nonhistone proteins. HDACs are crucial for regulating various cellular processes, such as gene expression, protein stability, localization, and function. They have also been studied in various research fields, including cancer, inflammatory diseases, neurological disorders, and vascular diseases. Our study aimed to investigate the relationship between HDACs and ocular diseases, to identify a new strategy for pharmacotherapy. This review article explores the role of HDACs in ocular diseases, specifically focusing on diabetic retinopathy, age-related macular degeneration, and retinopathy of prematurity, as well as optic nerve disorders, such as glaucoma and optic neuropathy. Additionally, we explore the interplay between HDACs and key regulators of fibrosis and angiogenesis, such as TGF-β and VEGF, highlighting the potential of targeting HDAC as novel therapeutic strategies for ocular diseases.

Increased risk of glaucoma development in patients with central serous chorioretinopathy: results of a 11-year population-based cohort study

PURPOSE

To investigate whether patients with central serous chorioretinopathy (CSC) have increased risk of developing glaucoma.

METHODS

Patients diagnosed with CSC between 1 January 2008 and 31 December 2018 were included in this study using data from the Taiwanese National Health Insurance Research Database (NHIRD). The CSC cohort was matched with a non-CSC cohort using the propensity score matching method, based on sex, age (in 10-year intervals), index date year, comorbidities, and steroid use, resulting in equal numbers of patients in both cohorts. Patients were followed up until 31 December 2019 or until they were withdrawn from the NHIRD. The incidence of glaucoma was compared between the two cohorts using the Cox regression model, and the risk of developing glaucoma was estimated using the Kaplan-Meier method.

RESULTS

After adjusting for sex, age, comorbidities, and steroid use, the CSC cohort showed a significantly higher risk of developing glaucoma compared to those without CSC (adjusted HR = 3.99; 95% CI = 3.44-4.62). The cumulative incidence of glaucoma in the CSC cohort was also significantly higher than in the non-CSC cohort (log-rank test, p < 0.001). Among the glaucoma subtypes, normal tension glaucoma had the highest risk (adjusted HR = 5.79; 95% CI = 3.41-9.85), followed by primary open-angle glaucoma (adjusted HR = 2.77; 95% CI = 2.12-3.62).

CONCLUSIONS

In conclusion, our study shows that CSC patients are at a higher risk of developing glaucoma, especially NTG. Awareness and regular glaucoma screenings are essential for patients with CSC.

Effect of antihypertensive medications on the risk of open-angle glaucoma

The purpose of this study was to identify the effect of antihypertensive medication on risks of open-angle glaucoma (OAG) among patients diagnosed with hypertension (HTN). A total of 5,195 patients, who were diagnosed with HTN between January 1, 2006 and December 31, 2015, and subsequently diagnosed with OAG, were selected for analysis. For each OAG patient, 5 non-glaucomatous, hypertensive controls were matched (n = 25,975) in hypertension diagnosis date, residential area, insurance type and economic status. Antihypertensive medications were stratified into 5 types: angiotensin converting enzyme inhibitor (ACEi), angiotensin receptor blockers (ARB), calcium channel blockers (CCB), β-blockers and diuretics. Relative risks were calculated. After adjusting for age, sex, body mass index, lifestyle, comorbidities, blood pressure (BP), follow-up duration, and use of other types of antihypertensive drugs, ARB and CCB were found to slightly increase OAG risks (RR 1.1087 (95% CI 1.0293-1.1942); 1.0694 (1.0077-1.1349), respectively). Combinations of ARB with diuretics (1.0893 (1.0349-1.1466)) and CCB (1.0548 (1.0122-1.0991)) also increased OAG risks. The risks for OAG were found to increase by antihypertensive medication use, but the effects appeared to be small. Further studies are necessary to identify the associations of increased BP, medication and therapeutic effect with OAG.

Mechanisms of Extraorbital Lacrimal Gland Aging in Mice: An Integrative Analysis of the Temporal Transcriptome

Purpose

This study used high-throughput RNA sequencing (RNA-Seq) and bioinformatics analysis to investigate the altered transcriptome profile of aging lacrimal glands in mice that occurs over the course of a 24-hour cycle.

Methods

Male C57BL/6J mice aged 12 weeks (young) and 20 months (aging) were housed in a pathogen-free setting with a 12-hour light/12-hour dark cycle. Throughout a 24-hour cycle, mouse extraorbital lacrimal glands (ELGs) were collected at eight time points at three-hour intervals. To prepare for the high-throughput RNA-Seq, whole mRNA was extracted. Differentially expressed genes (DEGs) in the young and aging groups were subjected to bioinformatic analysis based on diurnal patterns. Furthermore, the cell populations in which significant DEGs express and signaling pathways occur were validated at the single-cell RNA sequencing (scRNA-seq) level.

Results

The total transcriptome composition was significantly altered in aging ELGs compared with that in young mouse ELGs at eight time points during the 24-hour cycle, with 864 upregulated and 228 downregulated DEGs, which were primarily enriched in inflammatory pathways. Further comparative analysis of the point-to-point transcriptome revealed that aging ELGs underwent alterations in the temporal transcriptome profile in several pathways, including the inflammation-related, metabolism-related, mitochondrial bioenergetic function-associated, synaptome neural activity-associated, cell processes-associated, DNA processing-associated and fibrosis-associated pathways. Most of these pathways occurred separately in distinct cell populations.

Conclusions

Transcriptome profiles of aging lacrimal glands undergo considerable diurnal time-dependent changes; this finding offers a comprehensive source of information to better understand the pathophysiology of lacrimal gland aging and its underlying mechanisms.

Increased Risks of Open-Angle Glaucoma in Untreated Hypertension

PURPOSE

Hypertension (HTN) has been associated with open-angle glaucoma (OAG), but whether elevated blood pressure (BP) alone is associated with OAG is unknown. Whether stage 1 hypertension, as per the 2017 American College of Cardiology/American Heart Association (ACC/AHA) BP guidelines, increases the risk of the disease is uncertain.

DESIGN

Retrospective, observational, cohort study.

METHODS

A total of 360,330 subjects who were ≥40 years of age and not taking antihypertensive or antiglaucoma drugs at the time of health examinations between January 1, 2002, and December 31, 2003, were included. Subjects were categorized based on their untreated BP, into normal BP (systolic BP [SBP] <120 and diastolic BP [DBP] <80 mm Hg; n = 104,304), elevated BP (SBP 120-129 and DBP <80 mm Hg; n = 33,139), stage 1 HTN (SBP 130-139 or DBP 80-89 mm Hg; n = 122,534), or stage 2 HTN (SBP ≥140 or DBP ≥90mm Hg; n = 100,353). Cox regression analysis was performed to calculate hazard ratios (HR) of OAG risk.

RESULTS

The mean age of the subjects was 51.17 ± 8.97 years, and 56.2% were male. During a mean follow-up period of 11.76 ± 1.37 years, 12,841 subjects (3.56%) were diagnosed with OAG. Multivariable-adjusted HRs (95% CIs) were 1.056 (0.985-1.132) for elevated BP, 1.101(1.050-1.155) for stage 1 HTN, and 1.114(1.060-1.170) for stage 2 HTN with normal BP as the reference.

CONCLUSIONS

The risk for OAG becomes greater with increases in untreated BP. Stage 1 HTN per the 2017 ACC/AHA BP guidelines is a significant risk factor for OAG.

Trends in the Prevalence of Blindness and Correlation With Health Status in Korean Adults: A 10-Year Nationwide Population-Based Study

BACKGROUND

Contemporary data on vision impairment form an important basis for public health policies. However, most data on the clinical epidemiology of blindness are limited by small sample sizes and focused not on systemic conditions but ophthalmic diseases only. In this study, we examined the ten-year trends of blindness prevalence and its correlation with systemic health status in Korean adults.

METHODS

This study investigated 10,000,000 participants randomly extracted from the entire Korean population (aged ≥ 20 years) who underwent a National Health Insurance Service health checkup between 2009 and 2018. Participants with blindness, defined as visual acuity in the better-seeing eye of ≤ 20/200, were identified. The prevalence of blindness was assessed, and the systemic health status was compared between participants with blindness and without blindness.

RESULTS

The mean prevalence of blindness was 0.473% (47,115 blindness cases) and tended to decrease over ten years (0.586% in 2009 and 0.348% in 2018; P < 0.001). The following factors were significantly associated with blindness: female sex, underweight (body mass index < 18.5), high serum creatinine (> 1.5 mg/dL), and bilateral hearing loss. In addition, except for those aged 30-39 and 40-49 years, high fasting glucose (≥ 126 mg/dL) and low hemoglobin (male: < 12 g/dL, female: < 10 g/dL) were significantly correlated with prevalent blindness.

CONCLUSION

Our ten-year Korean nationwide population-based study suggested a gradual decrease in the prevalence of blindness and its association with specific systemic health status. These conditions might be the cause or consequence of blindness and can be used as a reference for the prevention and/or rehabilitation of blindness to establish public health policies.

Progress in clinical characteristics of high myopia with primary open-angle glaucoma

High myopia (HM) is a significant risk factor for the occurrence and progression of primary open-angle glaucoma (POAG). Identification with POAG in the HM population is an emergent challenge. Patients with HM have a significantly higher probability of complicating POAG than those without HM. When HM is associated with POAG, the changes to the fundus caused by both of them are confused with each other, making the diagnosis of early glaucoma difficult. This article reviews available researches on HM with POAG, summarizing the characteristics of the fundus structure such as epidemiology, intraocular pressure, optic disc, ganglion cell layer, retinal nerve fiber layer, vascular density, and visual field.

Study of the relationship between serum lipid levels and primary open-angle glaucoma

Purpose

To determine the association between serum lipid levels and primary open-angle glaucoma (POAG).

Methods

In this case-control study, 50 patients with POAG documented by clinical tests using standard ophthalmologic equipment and 50 age-matched controls were investigated. Twelve-hour fasting serum lipid profiles, including total cholesterol, serum triglycerides, low-density lipoproteins (LDLs), and high-density lipoproteins (HDLs), were compared between the cases and controls.

Results

The mean age of cases and controls was 62.84 ± 9.68 and 60.12 ± 8.65, respectively (P = 0.65). High total cholesterol levels (>200 mg/dl) were found in 23 cases (46%) and 8 controls (16%); high serum triglyceride levels (>150 mg/dl) were found in 24 cases (48%) and 7 controls (14%); high LDL levels (130 mg/dl) were found in 28 cases (56%) and 9 controls (18%); and low HDL levels (<40 mg/dl) were found in 38 cases (76%) and 30 controls (60%). The mean total cholesterol levels were 205.24 ± 36.90 mg/dl in cases and 177.68 ± 22.56 mg/dl in controls (P < 0.001); the mean serum triglyceride levels were 150.42 ± 49.55 mg/dl and 130.84 ± 23.16 mg/dl, respectively (P = 0.013); and the mean LDL levels were 139.50 ± 31.03 mg/dl and 114.96 ± 17.73 mg/dl, respectively (P < 0.001). The mean cholesterol, triglyceride, and LDL levels were significantly higher in cases than in controls (P < 0.05).

Conclusion

The present study shows that higher proportion of POAG patients have dyslipidemia compared to age-matched controls. Though these findings need to be replicated by others. This study opens new vistas for further studies, such as lowering dyslipidemia, lowering the intra-ocular pressure and incidence of POAG, and whether the use of statins to reduce dyslipidemia affects the progression of POAG.

The association between obesity and glaucoma in older adults: evidence from the China Health and Retirement Longitudinal Study

OBJECTIVES

This study evaluated the association between obesity and glaucoma in middle-aged and older people. A population-based retrospective cohort study was conducted using data from the China Health and Retirement Longitudinal Study.

METHODS

Glaucoma was assessed via self-reports. Multivariate logistic regression analysis and a Cox proportional hazards model were used to assess the relationship between obesity and glaucoma risk.

RESULTS

Older males living in urban areas who were single, smokers, and non-drinkers were found to have a significantly higher incidence of glaucoma (all p<0.05). Diabetes, hypertension, and kidney disease were also associated with higher glaucoma risk, while dyslipidemia was associated with lower risk (all p<0.05). After the model was adjusted for demographic, socioeconomic, and health-related variables, obesity was significantly associated with a 10.2% decrease in glaucoma risk according to the Cox proportional hazards model (hazard ratio, 0.90; 95% confidence interval [CI], 0.83 to 0.97) and an 11.8% risk reduction in the multivariate logistic regression analysis (odds ratio, 0.88; 95% CI, 0.80 to 0.97). A further subgroup analysis showed that obesity was associated with a reduced risk of glaucoma in people living in rural areas, in smokers, and in those with kidney disease (all p<0.05). Obesity also reduced glaucoma risk in people with diabetes, hypertension, or dyslipidemia more than in healthy controls (all p<0.05).

CONCLUSIONS

This cohort study suggests that obesity was associated with a reduced risk of glaucoma, especially in rural residents, smokers, and people with kidney disease. Obesity exerted a stronger protective effect in people with diabetes, hypertension, or dyslipidemia than in healthy people.

Risk Factors Associated With a Large Vertical Cup-to-Disc Ratio: Korean National Health and Nutritional Examination Survey

PRCIS

Higher intraocular pressure, higher systolic blood pressure, and higher serum aspartate transaminase to alanine aminotransaminase level were risk factors associated with a large vertical cup-to-disk ratio (vCDR).

PURPOSE

To identify risk factors for a large vCDR using data from the Korea National Health and Nutritional Examination Survey (2008-2012).

MATERIALS AND METHODS

Out of the total 29,322 participants aged 20 or older who participated in Korea National Health and Nutrition Survey (KHANES) from the year 2008 to 2012, this study was conducted on 21,780 participants, excluding 1449 of them without fundus photographs and 6093 of them with missing values. To identify the risk factors associated with a large vCDR, the participants were divided into 2 groups: ≥0.6 and <0.6.

RESULTS

Of the 21,780 subjects, 2357 of them had a vCDR ≥0.6 and 19,423 had a vCDR <0.6. There were significant differences in age, sex, and educational levels between the 2 groups. After adjusting age, sex, education level, and survey year by propensity score matching, in the group having vCDR ≥0.6, intraocular pressure (IOP) was high, systolic blood pressure (SBP) was high, and serum aspartate transaminase to alanine aminotransaminase level (AST/ALT ratio) was high ( P <0.001, P <0.001, and P <0.001). The results of multiple logistic regression analyses revealed that high IOP, high SBP, high myopia, and high AST/ALT ratio were risk factors for vCDR ≥0.6 ( P <0.001, P =0.006, P =0.005, P <0.001).

CONCLUSIONS

In this study, risk factors associated with large vCDR were analyzed. Higher IOP, higher SBP, and higher AST/ALT ratio were related to vCDR ≥0.6.

Evidence for Menopause as a Sex-Specific Risk Factor for Glaucoma

Glaucoma is a leading cause of irreversible blindness worldwide and is characterized by progressive loss of visual function and retinal ganglion cells (RGC). Current epidemiological, clinical, and basic science evidence suggest that estrogen plays a role in the aging of the optic nerve. Menopause, a major biological life event affecting all women, coincides with a decrease in circulating sex hormones, such as estrogen. While 59% of the glaucomatous population are females, sex is not considered a risk factor for developing glaucoma. In this review, we explore whether menopause is a sex-specific risk factor for glaucoma. First, we investigate how menopause is defined as a sex-specific risk factor for other pathologies, including cardiovascular disease, osteoarthritis, and bone health. Next, we discuss clinical evidence that highlights the potential role of menopause in glaucoma. We also highlight preclinical studies that demonstrate larger vision and RGC loss following surgical menopause and how estrogen is protective in models of RGC injury. Lastly, we explore how surgical menopause and estrogen signaling are related to risk factors associated with developing glaucoma (e.g., intraocular pressure, aqueous outflow resistance, and ocular biomechanics). We hypothesize that menopause potentially sets the stage to develop glaucoma and therefore is a sex-specific risk factor for this disease.

Relationship between high dose intake of vitamin B12 and glaucoma: Evidence from NHANES 2005-2008 among United States adults

Objective

Glaucoma has currently become the second leading cause of blindness in the world. Serum vitamin B12 level has been found to be involved in the development and progression of glaucoma. We performed the present study to confirm this association.

Methods

This cross-sectional study included 594 participants aged 40 years and older in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2008. Retinal imaging was performed using the Ophthalmic Digital Imaging system (Retinography) to assess the retina for the presence of features of glaucomatous lesions. Logistic regression models were used to assess the association between dietary vitamin intake and glaucoma.

Results

After screening, 594 subjects were finally included. Among all vitamin intakes, we observed significant differences between the two groups for vitamin B12 intake (5.93 vs. 4.77 mg, p = 0.033). According to the logistic regression results, the intake of vitamin B12 was significantly positively associated with glaucoma (model 1: OR = 1.078, 95% CI = 1.019-1.141; model 2: OR = 1.092, 95% CI = 1.031-1.158; model 3: OR = 1.092, 95% CI = 1.029-1.158). After performing a quantile regression, we observed a significant positive association between vitamin B12 intake and incident glaucoma in the fourth quartile (model 1: OR = 1.133, 95% CI = 1.060-1.210; model 2: OR = 1.141, 95% CI = 1.072-1.215; model 3: OR = 1.146, 95% CI = 1.071-1.226).

Conclusions

Therefore, the above results, high-dose intake of vitamin B12 may promote the development of glaucoma.

Increased risk of open-angle glaucoma in non-smoking women with obstructive pattern of spirometric tests

To investigate differences in the prevalence of open-angle glaucoma (OAG) between different pulmonary function types. A population-based, cross-sectional analysis was conducted using Korean National Health and Nutrition Examination Surveys from 2008 to 2011. A total of 8941 subjects  ≥ 40 years of age were analyzed. Chronic obstructive pulmonary disease (COPD) was defined as the ratio between first second of forced expiration (FEV1) and forced vital capacity (FVC) below 70%. The prevalence of glaucoma, as defined by the International Society of Geographical and Epidemiological Ophthalmology, was the main outcome. OAG was more prevalent in women with COPD (8.0% vs. 4.8% normal, P = 0.001) compared to women with normal pulmonary function. Intraocular pressure (IOP) of women with COPD were 13.3 (0.2) mmHg (13.9 (0.1) mmHg for normal function, P = 0.182). Never-smokers were more prevalent in women with COPD and glaucoma (92.9% vs. 52.4% normal function; P < 0.001). COPD was found to increase the risk of glaucoma in women (OR 2.077, P = 0.017) and even further in non-smoking women (OR 2.711, P = 0.003). Women with COPD showed a higher glaucoma prevalence despite similar IOP in comparison to women with normal pulmonary function. Non-smoking COPD is significantly associated with open-angle glaucoma in women.

Meta-Analysis of Dyslipidemia and Blood Lipid Parameters on the Risk of Primary Open-Angle Glaucoma

Objective

We aimed to explore the effect of blood lipid parameters on the risk of primary open-angle glaucoma (POAG) by meta-analysis.

Methods

The databases of PubMed, Scopus, CNKI, and Wanfang were systematically searched from inception to April 2022, and the relevant research literature was obtained, screened, and analyzed.

Results

A total of 15 studies were included in this meta-analysis, including 11 reporting dyslipidemia and risk of POAG and 5 reporting specific lipid level and risk of POAG. Dyslipidemia increased the risk of POAG with an odd ratio (OR) of 1.25 (95% CI: 1.23, 1.26). Total triglyceride and total cholesterol were not related to the prevalence of POAG, but high-density lipoprotein cholesterol was significantly negatively correlated with the risk of POAG with an OR of 0.96 (95% CI: 0.94, 0.99).

Conclusion

Dyslipidemia is a risk factor for POAG. Given the small sample size and significant interstudy heterogeneity, additional studies are needed to establish this conclusion.

Primary Open-angle Glaucoma Prevalence in EUROPE: A Systematic Review and Meta-analysis

PRCIS

Primary open-angle glaucoma is a neurodegenerative disease highly prevalent in the European adult population, with cases expected to increase over the next 30 years.

PURPOSE

This study aimed to evaluate the prevalence of primary open-angle glaucoma (POAG) in Europe.

METHODS

Two authors independently conducted a systematic literature search on PubMed/MedLine, Web of Science, and Google Scholar to identify papers analysing the prevalence of POAG in European countries. After removal of duplicates, title and abstract screening, and full-text analysis, data from selected articles were entered in an Excel spreadsheet. We performed risk of bias assessment using the Joanna Briggs Institute Prevalence Critical Appraisal Tool and conducted a meta-analysis using the R software (version 1.4.1106).

RESULTS

We retrieved 9,348 eligible papers from the initial electronic search and included 10 of them in the qualitative and quantitative analyses. A total of 26,993 patients were included in this meta-analysis (11,927 male and 14,556 female). We identified 755 POAG cases (397 male and 348 female), with a pooled prevalence estimate in Europe of 2.60% (95% confidence interval: 1.90-3.56%). Increasing odds for POAG were related to increasing age and some geographic differences in the disease distribution in the continent were identified. Statistically significant sex-related differences in the prevalence rate of POAG were not observed in this cohort.

CONCLUSION

POAG is a neurodegenerative disease that affects a large proportion of the older European population. In the future, the prevalence of POAG is expected to grow in Europe because of the progressive ageing populations of Western countries. Future high-quality epidemiological studies for the evaluation of POAG prevalence rate are warranted.

Risk factors for glaucoma are reflected in abnormal responses to frequency-doubling technology screening in both normal and glaucoma eyes

The frequency-doubling technology (FDT) screening test (FDT-C-20-1) has adopted in many recent population-based glaucoma surveys, but factors associated with false-positive (FP) responses to FDT-C-20-1 in normal eyes and false-negative (FN) responses in glaucoma eyes were not known. These factors were investigated in a population-based setting using the data from 3805 normal eyes (2381 subjects) and 272 eyes with definite glaucoma (215 subjects) in the Kumejima Study participants with reliable FDT-C-20-1 results. Considering the presence of at least one abnormal test point (P < 0.01) as abnormal, the specificity and sensitivity of FDT-C-20-1 for glaucoma were 91.8% (95% confidence interval, 91.1 ~ 92.5) and 56.3% (47.0 ~ 62.5), respectively. Multivariate linear mixed-model logistic regression analysis showed correlations with older age, worse visual acuity, greater β-peripapillary area (P < 0.001 for all comparisons) and more myopic refraction (P = 0.030) with the FP responses in normal eyes, and normal-tension glaucoma (P = 0.043), a better mean deviation value of Humphrey perimetry (P = 0.001), larger rim area (P = 0.041), and absence of disc hemorrhage (P = 0.015) with the FN responses in glaucoma eyes. In a population-based setting, abnormal responses to FDT-C-20-1 indicate the presence of a risk factor for glaucoma in normal eyes and risk factors for more rapid progression in glaucoma eyes.

The Inferior, Superior, Temporal Rim Width Pattern (IST Rule) Detects Glaucoma in a Japanese Population

PRCIS

The inferior>superior>temporal rim width rate (IST pattern) rather than inferior≥superior≥nasal≥temporal (ISNT) pattern was suited for screening glaucoma in Japanese subjects. Failure of the IST pattern was associated with several important risk factors for glaucoma.

PURPOSE

The purpose of this study was to find a rim width rate pattern to yield the highest positive likelihood ratio (LR+) in detecting glaucoma eyes and to identify risk factors for glaucoma correlating with its failure in a population-based setting.

METHODS

Disc stereophotographs of 2474 eyes of 2474 normal subjects and 237 eyes of 237 glaucoma subjects found in the Kumejima Study were analyzed using computer-assisted planimetry. Among all combinations of the inferior (I), superior (S), nasal (N) and/or temporal (T) rim width rate, a pattern showing the highest LR+ was selected and risk factors for glaucoma correlating with its failure were determined using multiple logistic regression analysis.

RESULTS

The average I, S, N, and T rim widths (SD) were 0.45 (0.10), 0.39 (0.09), 0.47 (0.11), and 0.27 (0.07) mm. Among all combinations, the I>S>T rim width rate pattern (IST pattern) disregarding the N rim width showed the highest LR+ of 2.002 (95% confidence interval, 1.778-2.253). Failure of the IST pattern in normal eyes correlated with a smaller disc area (P<0.001) and disc ovality (P=0.005) and larger β-peripapillary area (P<0.001) and compliance with in glaucoma eyes with a smaller β-PPA area (P=0.027), thicker central corneal thickness (P=0.017), lower intraocular pressure (P=0.019), and higher body mass index (P=0.037).

CONCLUSION

Among all combinations, the I>S>T rim width pattern, the IST pattern, yielded the highest LR+ in detecting glaucoma in Japanese glaucoma eyes and its failure of or compliance with the pattern significantly correlated with several known risk factors for glaucoma.

Degree of Myopia and Glaucoma Risk: A Dose-Response Meta-analysis

PURPOSE

To verify the dose-response relation between the degree of myopia and open-angle glaucoma (OAG) risk DESIGN: Dose-response meta-analysis.

METHODS

We searched the PubMed, EMBASE, and Cochrane Library databases for population-based studies published until November 30, 2020, and reporting on both myopia and OAG. Random-effect models generated pooled odds ratios (OR) and 95% CIs. Results robustness was confirmed by influence and subgroup analyses. A 2-stage dose-response meta-analysis calculated the OAG risk per unit dose of myopia (spherical equivalent [SE] decrease of 1 diopter [D]) and examined the relationship pattern.

RESULTS

The meta-analysis comprised 24 studies in 11 countries (514,265 individuals). The pooled OR of any myopia degree's association with OAG was 1.88 (95% CI, 1.66-2.13; I² = 53%). The OR differences based on ethnicity (Asians vs Westerners) or 5 geographic areas were not statistically significant (P = .80 and P = .06, respectively). The pooled ORs of the associations between low, moderate, moderate-to-high, high myopia, and OAG were 1.50 (95% CI, 1.29-1.76), 1.69 (95% CI, 1.33-2.15), 2.27 (95% CI, 1.74-2.96), and 4.14 (95% CI, 2.57-6.69), respectively. According to the dose-response meta-analysis, the pooled OR (per SE 1-D change) was 1.21 (95% CI, 1.15-1.28). The OAG risk accelerated at approximately -6 D, and further accelerated from -8 D, showing a nonlinear concave upward slope (P = .03).

CONCLUSIONS

For each unit (1-D) increase in myopia, the risk of glaucoma increases by approximately 20%. The risk more steeply increases in high-degree myopia, representing a significant nonlinear relationship.

The Association among Blood Pressure, Blood Pressure Medications, and Glaucoma in a Nationwide Electronic Health Records Database

PURPOSE

To measure the association among blood pressure (BP), BP medications, and glaucoma using the All of Us Research Program database.

DESIGN

A retrospective, longitudinal cohort study leveraging a national electronic health record (EHR) database administered by the National Institutes of Health.

PARTICIPANTS

Eye patients in the All of Us Research Program database with at least 15 months of follow-up and 1 BP measurement.

METHODS

Univariable and multivariable Cox regression models predicted the risk of developing incident open-angle glaucoma (OAG). Mean arterial pressure (MAP) and the number of BP medication classes were entered as time-varying predictors to account for changes over time.

MAIN OUTCOME MEASURES

The risk of developing incident OAG, as defined by billing diagnosis codes.

RESULTS

Of 20 815 eligible eye patients who qualified for this study, 462 developed OAG. Low BP (MAP < 83.0 mmHg) was associated with increased risk of developing OAG (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.04-1.67). High BP (MAP > 101.3 mmHg) and the number of BP medication classes were not associated with OAG after adjustment for covariates. Other risk factors associated with OAG included being Black (HR, 3.31, 95% CI, 2.63-4.17), Hispanic or Latino (HR, 2.53, 95% CI, 1.94-3.28), Asian (HR, 2.22, 95% CI, 1.24-3.97), older in age (80+ years, HR, 20.1, 95% CI, 9.10-44.5), and diabetic (HR, 1.32, 95% CI, 1.04-1.67). Female gender was associated with decreased hazard of developing OAG (HR, 0.66, 95% CI, 0.55-0.80). No significant interaction was observed between MAP and the number of BP medications on the risk of developing OAG.

CONCLUSIONS

We found that low BP is associated with increased risk of developing OAG in a national longitudinal EHR database. We did not find evidence supporting a differential effect of medically treated and untreated low BP. This study adds to the body of literature implicating vascular dysregulation as a potential etiology for the development of OAG, particularly emphasizing the lack of influence of BP medications on this relationship.

Primary glaucomas in adults: Epidemiology and public health-A review

Glaucoma is a mixed group of optic neuropathies that lead to irreversible visual field loss and blindness if left untreated. It is estimated that 3.5% of the global population aged 40 to 80 years have any glaucoma, being the primary open-angle and the primary angle-closure glaucoma the most prevalent forms. Although the age-standardised prevalence of blindness caused by glaucoma has decreased substantially over the last decades, population growth and ageing impose many challenges in preventing glaucoma-related morbidities on a global level. In addition, difficulties in diagnoses and treatment, along with its chronic and irreversible nature, urge the development and implementation of innovative approaches in confronting the disease. This manuscript reviews recent literature related to the epidemiology of primary glaucomas in adults, the risk factors attributed to the development of the disease, and discuss challenges and potential solutions from a public health perspective.

Interim Results of Post-Marketing Observational Study of Omidenepag Isopropyl for Glaucoma and Ocular Hypertension in Japan

Introduction

This post-marketing observational interim analysis evaluated the 12-month effectiveness and safety of omidenepag isopropyl (OMDI) ophthalmic solution in daily clinical settings.

Methods

This was a multicenter, large-scale, non-interventional, prospective, observational study conducted in Japan. The target enrollment was 3900 patients, and the overall observation period was 12 months. Patients with glaucoma and ocular hypertension (OH) with no previous history of OMDI use were enrolled. The key endpoints were change in intraocular pressure (IOP) from baseline and the incidence of adverse reactions (ADRs).

Results

A total of 1862 patients were evaluated in this 12-month interim analysis. Most patients were diagnosed with normal-tension glaucoma (NTG, 62.0%). The treatment patterns with OMDI were naïve monotherapy (48.4%), switching monotherapy (18.4%), and concomitant therapy (31.1%). The overall incidence of ADRs was 24.3%, which was similar between the monotherapy and concomitant therapy groups. Common ADRs were conjunctival hyperemia, refractive disorder, and myopia. Macular edema was observed in four patients. No ADRs categorized as prostaglandin-associated periorbitopathy were observed. There was a significant reduction in mean IOP at 12 months, with a change of − 1.9 ± 2.9 mmHg from baseline (reduction − 10.4 ± 16.5%). The mean IOP change from baseline was − 2.7 ± 2.6 mmHg in the naïve monotherapy group, − 1.1 ± 2.6 mmHg in the switching monotherapy group, and − 1.6 ± 3.1 mmHg in the concomitant therapy group (all P < 0.05). The mean IOP decreased by − 2.5 ± 3.2 mmHg, − 1.5 ± 2.4 mmHg, and − 2.3 ± 4.5 mmHg in the primary open-angle glaucoma (POAG), NTG, and OH groups, respectively. The treatment persistence with OMDI was 82.4%.

Conclusion

This study demonstrated the safety and efficacy of OMDI for glaucoma and OH as monotherapy and concomitant therapy in daily clinical settings. In this interim analysis, OMDI showed a favorable benefit–risk profile, and can be first-line therapy for glaucoma.

Knowledge of glaucoma and associated factors among primary glaucoma patients in Kunming, China

Background

To investigate the level of knowledge, attitude, and practices about glaucoma and associated factors among primary glaucoma patients in Kunming, China.

Methods

A hospital-based study was conducted on 93 patients from the First Affiliated Hospital of Kunming Medical University. Interviewer-administered questionnaires were used to collect data after written informed consent. Data were analyzed by SPSS 19.0. Univariate and multivariate logistic regression models were used to identify factors. A Chi-square test was used to analyze the association between knowledge of glaucoma and medication compliance, Mann–Whitney U test was performed to assess the relationship between knowledge of glaucoma and quality of life in patients with glaucoma. P-value < 0.05 was considered statistically significant.

Results

Among 93 patients, 55 (59.14%) were aware of glaucoma, 48 (51.61%) had good knowledge of glaucoma, while 45 (48.39%) had poor knowledge. Younger age and duration of glaucoma were associated positively with knowledge of glaucoma. 87 (93.54%) patients got knowledge of their disease from doctors. 79.17% of respondents could use all the anti-glaucoma medications on time, out of which 54.17% had good knowledge of glaucoma while 25.00% had poor knowledge of glaucoma. 30.56% of respondents used to stop anti-glaucoma medications on their own out of which only 9.72% had good knowledge of glaucoma while 20.83% had poor knowledge of glaucoma. Patients with good knowledge of glaucoma had lower scores on the Glaucoma Quality of Life-15 questionnaire. Thus, the compliance to anti-glaucoma medications and glaucoma-related quality of life were better in patients with good knowledge.

Conclusions

The level of knowledge of glaucoma among patients in Kunming is relatively low. Improving knowledge with suitable content for patients through effective multiple means such as the mass media rather than relying only on ophthalmologists may be a veritable first step in combating blindness from glaucoma and enhancing patients' quality of life.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-022-02322-0.

The Association between Myopia and Primary Open-Angle Glaucoma: A Systematic Review and Meta-Analysis

BACKGROUND

Previous studies identified myopia as a risk factor for primary open-angle glaucoma (POAG). However, recent studies have shown different results, the definitive relationship between myopia and POAG remains controversial.

OBJECTIVES

To investigate the relationship between myopia and POAG.

METHODS

Published articles were searched from PubMed, Embase, and Scopus databases between 1970 and 2020. A pooled analysis of the ORs was performed using a random-effects model.

RESULTS

Data on the association between myopia and POAG, were obtained from 16 cross sectional studies, and the pooled OR was 2.26 (95% confidence interval [CI], 1.77 - 2.89, P < 0.001) in random effects model (I2 = 86%; P < 0.01). For the relationship of myopia and POAG progression, data from seven longitudinal cohort studies were included and the pooled OR was 0.85 (95% CI, 0.73 - 0.99, P = 0.042) in the random-effects model (I2 = 88%; P < 0.01).

CONCLUSION

Our findings demonstrated that myopia may be a risk factor associated with POAG and a possible protective factor for POAG progression. It may due to myopia with the presence of a lamina cribrosa defect slow down the visual field loss also POAG progression, further research for underlying mechanisms is still needed.

Glaucoma and optical coherence tomography changes in migraine: A comparative cross-sectional study

Purpose

To study the prevalence of glaucoma among adults with migraine and the effect of migraine on peripapillary retinal nerve fiber layer (pRNFL) and central macular thickness (CMT) using optical coherence tomography (OCT) compared to those without migraine headache, i.e. in tension-type headache (TTH) and normal group.

Methods

One hundred and eleven patients (222 eyes) were recruited in three groups. migraine, TTH, and normal subjects visiting hospital outpatient services. After noting demographic details and pertinent history, ophthalmological evaluation including optic disc for glaucomatous changes along with computerized visual field testing and OCT for pRNFL thickness and CMT was performed in all eyes. Continuous variables were compared using ANOVA or Kruskal-Wallis test, while categorical variables including the association of glaucoma with migraine were analyzed using Chi-square or Fisher's exact test.

Results

Prevalence of glaucoma in migraine group (12.2%) was more than in comparison groups (6.8% in TTH, 4.1% in normal) which was however not significant (Fisher's exact P = 0.207). Average pRNFL thickness (103.59 ± 12.82 μm) and thickness in nasal (90.49 ± 19.19 μm) and temporal quadrants (70.58 ± 16.13 μm) and CMT (213.78 ± 19.81 μm) were significantly reduced (ANOVA P < 0.05) in migraine patients when compared to the other groups and this was independent of the presence of glaucoma.

Conclusion

Prevalence of glaucoma is not significantly higher in migraine patients. However, migraine causes thinning of retinal layers on OCT that is statistically significant.

Myopic Open-Angle Glaucoma Prevalence in Northeast Asia: A Systematic Review and Meta-Analysis of Population-Based Studies

Purpose

Investigation of myopic open-angle glaucoma (OAG) prevalence in Northeast Asia by systematic review and meta-analysis.

Methods

Systematic PubMed, EMBASE and Cochrane database searches for Northeast Asian population-based studies published up to 30 November 2020 and reporting on myopia and OAG diagnosis. By random-effect models, pooled OAG prevalence in a myopic population and pooled myopic OAG prevalence in a general population were generated, with 95% confidence intervals (CIs).

Results

The meta-analysis encompassed 5 population-based studies in 4 countries (12,830 individuals, including 7,723 patients with myopia and 1,112 patients with OAG). In a myopic population, OAG prevalence was 4.10% (95% CI, 3.00-5.70; I2 = 93%); in a general population, myopic OAG prevalence was 1.10% (95% CI, 0.60-1.70; I2 = 94%). A visual examination of funnel plot symmetry raised a suspicion of publication bias. Notwithstanding, Begg and Mazumbar's adjusted rank correlation test showed no such evidence (P = 0.6242).

Conclusions

Our systematic review and meta-analysis returned an estimate of OAG prevalence in a myopic Northeast Asian population. Our findings will inform future glaucoma studies as well as public health guidelines for Northeast Asian populations.

Efficacy and safety of newly developed preservative-free latanoprost 0.005% eye drops versus preserved latanoprost 0.005% in open angle glaucoma and ocular hypertension: 12-week results of a randomized, multicenter, controlled phase III trial

AIM

To evaluate the therapeutic efficacy, safety and tolerability of newly developed preservative-free (PF) latanoprost generic [TJO-002] and compare it with benzalkonium chloride (BAK)-preserved latanoprost [Xalatan^®] in patients with primary open angle glaucoma (POAG) and ocular hypertension (OHT).

METHODS

Included patients were aged ≥19y with POAG/OHT. After a washout period, patients with IOP 21-35 mm Hg at 9 a.m. were enrolled. After a full ophthalmic and glaucoma examination, 144 patients with POAG and OHT participated in this study. Subjects were randomly assigned either PF latanoprost (74 eyes) or BAK-preserved latanoprost (70 eyes). All subjects were examined at 4, 8, and 12wk after first administration. At each follow-up visit, IOP was measured at 9 a.m. and 5 p.m. and compliance was assessed. Throughout the study, all adverse events were recorded and monitored by the masked investigators who measured IOP.

RESULTS

Both groups showed a statistically significant decrease of average diurnal IOP at 12wk compared to baseline (-7.21±3.10 mm Hg in the PF latanoprost group and -7.02±3.17 mm Hg in the BAK latanoprost group, both P<0.0001). There was no statistically significant diurnal IOP variation between the groups. In terms of tolerability, pruritus, burning/stinging, and sticky eye sensation, severity was significantly lower in the PF latanoprost group than in the BAK latanoprost group (P<0.05).

CONCLUSION

PF latanoprost has at least similar efficacy in terms of IOP reduction and better tolerability compared with BAK latanoprost.

Role of hypertension as a risk factor for open-angle glaucoma: a systematic review and meta-analysis

Glaucoma is the leading cause of irreversible blindness. It is estimated that as many as 3.2 million people worldwide experience blindness due to glaucoma, including open-angle glaucoma (OAG). Until now, there is no definite mechanism related to the incidence of OAG. However, increased intraocular pressure (IOP) is considered to be the most important risk factor. Several current studies show that there is a significant relationship between hypertension (HTN) and IOP. In particular, several epidemiological studies have shown that an increase in systemic blood pressure (BP) is associated with an increase in IOP. However, several studies report that high BP provides a protective effect at a young age against the incidence of OAG. Therefore, this literature aims to explore the effect of HTN on the incidence of OAG. In this review, search for the literature using keywords that match the topic, then a gradual screening was carried out with the predetermined eligibility criteria. From 3711 studies, 16 studies matched the criteria having a total sample size of 72 212 and then a quantitative meta-analysis was conducted. The results showed a risk ratio of 1.69 (95% CI 1.50 to 1.90) in the HTN group. However, from our qualitative synthesis, we found that people who have an unstable diastolic blood pressure (DBP), either high or low, are both able to increase the risk of OAG events. In conclusion, we found that HTN was able to increase the risk of OAG and DBP instability, whether high or low, can also increase the risk of OAG incidence.

High-Density Lipoprotein 3 Cholesterol and Primary Open-Angle Glaucoma: Metabolomics and Mendelian Randomization Analyses

PURPOSE

We hypothesized that the effect of blood lipid-related metabolites on primary open-angle glaucoma (POAG) would differ according to specific lipoprotein particles and lipid sub-fractions. We investigated the associations of blood levels of lipoprotein particles and lipid sub-fractions with POAG.

DESIGN

Cross-sectional study.

PARTICIPANTS

Individuals recruited for the baseline visit of the population-based Singapore Epidemiology of Eye Disease study (n = 8503).

METHODS

All participants underwent detailed standardized ocular and systemic examinations. A total of 130 blood lipid-related metabolites were quantified using a nuclear magnetic resonance metabolomics platform. The analyses were conducted in 2 stages. First, we investigated whether and which lipid-related metabolites were directly associated with POAG using regression analyses followed by Bayesian network modeling. Second, we investigated if any causal relationship exists between the identified lipid-related metabolites, if any, and POAG using 2-sample Mendelian randomization (MR) analysis. We performed genome-wide association studies (GWAS) on high-density lipoprotein (HDL) 3 cholesterol (after inverse normal transformation) and used the top variants associated with HLD3 cholesterol as instrumental variables (IVs) in the MR analysis.

MAIN OUTCOME MEASURE

Primary open-angle glaucoma.

RESULTS

Of the participants, 175 (2.1%) had POAG. First, a logistic regression model showed that total HDL3 cholesterol (negatively) and phospholipids in very large HDL (positively) were associated with POAG. Further analyses using a Bayesian network analysis showed that only total HDL3 cholesterol was directly associated with POAG (odds ratio [OR], 0.72 per 1 standard deviation increase in HDL3 cholesterol; 95% confidence interval [CI], 0.61-0.84), independently of age, gender, intraocular pressure (IOP), body mass index (BMI), education level, systolic blood pressure, axial length, and statin medication. Using 5 IVs identified from the GWAS and with the inverse variance weighted MR method, we found that higher levels of HDL3 cholesterol were associated with a decreased odds of POAG (OR, 0.91; 95% CI, 0.84-0.99, P = 0.021). Other MR methods, including weighted median, mode-based estimator, and contamination mixture methods, derived consistent OR estimates. None of the routine lipids (blood total, HDL, or low-density lipoprotein [LDL] cholesterol) were associated with POAG.

CONCLUSIONS

Overall, these results suggest that the relationship between HDL3 cholesterol and POAG might be causal and specific, and that dysregulation of cholesterol transport may play a role in the pathogenesis of POAG.

Changes in the Glaucoma Diagnosis during the Last 10 years: Health Insurance Review and Assessment Service Data 2010-2019

Purpose: We determined the current status of glaucoma diagnoses in Korea and trends in the change over the past 10 years using data from the Health Insurance Review and Assessment Service. Methods: The glaucoma diagnostic code was collected from the disease subclass statistics of the medical statistical information disclosed in the Healthcare Bigdata open system, and the number of health insurance patients who were billed for medical care benefit costs from 2010 to 2019 with the glaucoma diagnosis code was collected. Data were collected for each diagnostic code by dividing it by year, age group, and gender, and then changes in the current status of glaucoma diagnosis per 100,000 people were analyzed by age group. A joinpoint regression analysis was used to determine the increasing and decreasing trends for each diagnostic code and whether the trend changed during the study period. Results: The number of health insurance patients who received treatment with the glaucoma diagnostic code in 2019 compared to 2010 increased by 120.3% and 109.5% per 100,000 people covered by medical care. This increasing trend has slowed as of 2015. Suspected glaucoma, primary open-angle glaucoma, and primary angle-closure glaucoma showed an increasing trend, while glaucoma secondary to eye trauma and glaucoma secondary to drugs declined markedly. No significant trend in glaucoma secondary to eye inflammation was detected, and glaucoma secondary to other eye disorders and unspecified glaucoma tended to increase. Other glaucoma diagnoses decreased from 2010 to 2012 and then increased. Conclusions: The number of patients who underwent glaucoma treatment among all health insurance patients increased significantly from 2010 to 2019. Despite the overall increasing trend, eye trauma and drug-induced secondary glaucoma have markedly decreased.

Is Obesity a Risk or Protective Factor for Open-Angle Glaucoma in Adults? A Two-Database, Asian, Matched-Cohort Study

Obesity contributes to multiple systemic disorders; however, extensive discussion regarding obesity and open-angle glaucoma (OAG) remains limited, and conclusions in the existing literature diverge. This study aims to analyze the risk of OAG among obese adults in Taiwan. In this study, adults (aged ≥18 years) with a diagnostic code of obesity or morbid obesity registered in the Longitudinal Health Insurance Database (LHID) 2000 and LHID2005 from 1 January 2001 to 31 December 2010 were included. All adults were traced until the diagnosis of OAG, the occurrence of death, or 31 December 2013. Risk of OAG was significantly higher in obese adults than in non-obese adults after multivariable adjustment (adjusted hazard ratio (aHR): 1.43 (95% confidence interval (CI) 1.11-1.84)/aHR: 1.54 (95% CI 1.23-1.94) in the LHID2000/LHID2005). Both databases demonstrated that young obese adults (aged ≤40 years) had a remarkably increased risk of OAG compared with young non-obese adults (aHR 3.08 (95% CI 1.82-5.21)/aHR 3.81 (95% CI 2.26-6.42) in the LHID2000/LHID2005). This two-database matched-cohort study suggests that obese adults have an increased risk of OAG. In young adults, in particular, obesity could be a potential risk factor of OAG.

Risk factors associated with progression of diabetic retinopathy in eyes treated with panretinal photocoagulation

Uncontrolled diabetes has been associated with progression of diabetic retinopathy (DR) in several studies. Therefore, we aimed to investigate systemic and ophthalmic factors related to worsening of DR even after completion of panretinal photocoagulation (PRP). We retrospectively reviewed DR patients who had completed PRP in at least one eye with a 3-year follow-up. A total of 243 eyes of 243 subjects (mean age 52.6 ± 11.6 years) were enrolled. Among them, 52 patients (21.4%) showed progression of DR after PRP (progression group), and the other 191 (78.6%) patients had stable DR (non-progression group). The progression group had higher proportion of proliferative DR (P = 0.019); lower baseline visual acuity (P < 0.001); and higher platelet count (P = 0.048), hemoglobin (P = 0.044), and hematocrit, (P = 0.042) than the non-progression group. In the multivariate logistic regression analysis for progression of DR, baseline visual acuity (HR: 0.053, P < 0.001) and platelet count (HR: 1.215, P = 0.031) were identified as risk factors for progression. Consequently, we propose that patients with low visual acuity or high platelet count are more likely to have progressive DR despite PRP and require careful observation. Also, the evaluation of hemorheological factors including platelet counts before PRP can be considered useful in predicting the prognosis of DR.

Prevalence of primary open angle glaucoma in the last 20 years: a meta-analysis and systematic review

Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness in the world and is influenced by various sociodemographic factors. This meta-analysis aims to determine the worldwide prevalence of POAG in the adult general population for the last 20 years, and explore variation in prevalence by age, gender and geographical location. An electronic literature search was performed using the PubMed, Embase, and Web of Science databases. Population-based cross-sectional or cohort studies published in the last 20 years (2000–2020) that reported prevalence of POAG were recruited. Relevant studies meeting defined eligibility criteria were selected and reviewed systematically by meta-analysis. The prevalence of POAG was analyzed according to various risk factors. A random effect model was used for the meta-analysis. Fifty publications with a total of 198,259 subjects were included in this meta-analysis. The worldwide overall prevalence of POAG was 2.4% (95% CI 2.0 ~ 2.8%). The prevalence increases with age. Men are found to be more susceptible to POAG than women (RR 1.28, p < 0.01). Africa is found to have the highest prevalence of POAG (4.0%) among all continents. The current estimated global population of POAG is 68.56 million (95% CI 59.99 ~ 79.98). POAG is a worldwide vision threatening disease with high prevalence for the last 20 years. The population-based prevalence of POAG varies widely across individual studies, due to variations in risk factors of age, gender, and population geographic location.

Psychopharmacological Treatment, Intraocular Pressure and the Risk of Glaucoma: A Review of Literature

Through the years, the available psychopharmacological treatments have expanded with numerous new drugs. Besides weight gain, gastro-intestinal problems or Parkinson-like symptoms, ocular adverse effects of psychiatric drugs have been reported. These adverse effects are not common, but can be dangerous for the patient. This review summarises the current knowledge on the risk of raised intraocular pressure and glaucoma entailed by psychopharmacological treatment. Also, it provides updated data for clinicians involved in the treatment of patients with glaucoma or glaucoma risk factors. For this purpose, we performed an extensive literature search in the PubMed database using specific terms. Selective serotonin and noradrenaline reuptake inhibitors are the best evidenced as having no association with glaucoma. Antipsychotics, and especially first generation, seem to have no correlation with an increased intraocular pressure and therefore possibly with a risk of glaucoma, although a special attention should be paid when using ziprasidone. Tricyclic antidepressants, benzodiazepines and topiramate should be avoided in patients diagnosed with glaucoma or at risk. Clinicians should be aware of the possible psychotropic drug induced glaucoma and monitor at risk patients closely in order to prevent this condition. Irrespective of the psychopharmacological regimen taken into consideration, the glaucoma patient should be under the strict supervision of the ophthalmologist.

Methodology and Rationale for Ophthalmic Examinations in the Seventh and Eighth Korea National Health and Nutrition Examination Surveys (2017-2021)

This report provides a detailed description of the methodology for ophthalmic examinations according to the Korea National Health and Nutrition Examination Survey (KNHANES) VII and VIII (from 2017 to 2021). The KNHANES is a nationwide survey which has been performed since 1998 in representatives of whole Korean population. During the KNHANES VII and VIII, in addition to the ophthalmic questionnaire, intraocular pressure measurement, visual field test, auto refractometry, axial length and optical coherence tomography measurements were included. This new survey will provide not only provide normative and pathologic ophthalmic data including intraocular pressure, refractive error, axial length, visual field and precise measurement of anterior segment, macula and optic nerve with optical coherence tomography, but also a more accurate diagnosis for major adult blindness diseases, including age-related macular degeneration, diabetic retinopathy, glaucoma, and other ocular diseases, for the national Korean population.

Long-Term Effectiveness and Safety of Tafluprost, Travoprost, and Latanoprost in Korean Patients with Primary Open-Angle Glaucoma or Normal-Tension Glaucoma: A Multicenter Retrospective Cohort Study (LOTUS Study)

This multicenter retrospective cohort study compared the effectiveness and safety of long-term tafluprost, travoprost, or latanoprost in patients with primary open-angle glaucoma (POAG) or normal-tension glaucoma (NTG). Data were extracted from electronic medical records of 300 patients treated with tafluprost, travoprost, or latanoprost for >6 months. Propensity matching for age and sex was used for effectiveness and safety comparisons. The primary endpoint was visual field (VF) progression via mean deviation (MD) slope. Secondary endpoints were change of MD, intraocular pressure, pattern standard deviation, VF index, and advanced glaucoma intervention study score. Treatment-related adverse events (AEs) were also compared between groups. Overall, 216 POAG or NTG patients were matched into Match Set 1 (72 patients/group), and 177 NTG-only patients in Match Set 2 (59 patients/group) according to: age (mean: 61, 62 years) and sex (male: 53, 56%). There were no statistically significant between-group differences regarding MD slope (p = 0.413, p = 0.374 in Match Sets 1 and 2, respectively). There were no significant between-group differences/tendencies regarding secondary endpoints. No AEs were serious, and there were no significant between-group differences regarding reported AEs. In patients with POAG or NTG, long-term tafluprost, travoprost, or latanoprost showed similar effects. All three prostaglandin analogs had good long-term safety profiles.

Efficacy and Safety of Preservative-free Latanoprost Eyedrops Compared with Preserved Prostaglandin Analogues in Patients with Open-angle Glaucoma

Purpose

To evaluate the safety and efficacy of preservative-free (PF) latanoprost in glaucoma patients.

Methods

In this prospective, open-label, observational study, a total of 27 primary open-angle glaucoma patients who used benzalkonium chloride-preserved prostaglandin analogues for at least 6 months were enrolled. After changing the eye drops to PF lataprost, the intraocular pressure (IOP) and ocular surface symptoms and signs were evaluated in all patients on days 0 (first visit, D0), 45 (D45), and 90 (D90).

Results

Mean IOP remained stable during the study period (14.0 ± 2.4 mmHg at D0, 13.9 ± 2.0 mmHg at D45, 13.7 ± 2.2 mmHg at D90; p = 0.603). Mean deviation, pattern standard deviation, and best-corrected visual acuity were similar before and after eye drops replacement. Bulbar conjunctival hyperemia, corneal staining, and conjunctival staining were significantly decreased over 90 days (p = 0.025, p < 0.001, p = 0.020, respectively). The ocular surface disease index score showed a statistically significant improvement from 26.4 ± 18.5 at D0 to 19.8 ± 17.0 at D45 and 15.7 ± 15.6 at D90 (p < 0.001). In the evaluation of ocular tolerability, burning symptoms and dryness were significantly decreased (p = 0.001, p = 0.040).

Conclusions

The effects of PF latanoprost on reducing IOP were comparable with those of benzalkonium chloride-preserved prostaglandin analogues, but side effects on the ocular surface were much less pronounced when PF latanoprost was used. With this efficacy, PF latanoprost could slow the progression of glaucoma by increasing patient compliance.

Agreement of Optic Nerve Head Evaluation of Primary Open-Angle Glaucoma Between General Ophthalmologists and Glaucoma Specialists

Purpose

To investigate the agreement of optic nerve head evaluations and initial diagnoses of primary open-angle glaucoma (POAG) by general ophthalmologists and glaucoma specialists in Shanghai, China.

Methods

This multicenter, cross-sectional study involved the outpatients from the general ophthalmology departments of four top eye hospitals in Shanghai. The participants underwent ocular examinations, including intraocular pressure, fundus photography, corneal thickness, refractometry, visual acuity, visual field and gonioscopy. General ophthalmologists and glaucoma specialists performed the diagnoses and classified them as non-glaucoma, POAG suspects, and POAG. The consistency of initial diagnosis between general ophthalmologists and glaucoma specialists was measured using the weighted kappa coefficient. Logistic regression analysis was used to detect the risk factors for the reliability of POAG diagnosis.

Results

In 922 participants, the initial diagnosis rates of POAG and non-glaucoma were much higher in the glaucoma specialist group than in the general ophthalmologist group, while the initial diagnosis rates of POAG suspects were higher in the general ophthalmologist group. The weighted kappa coefficient between the two groups was 0.831±0.027 (95% confidence interval, 0.779–0.884). Logistic regression analysis of the risk factors for the reliability of POAG diagnosis showed that the independent risk factors were intraocular pressure (OR 8.363, 95% CI: 4.27–16.37) and vertical cup-to-disc ratio (OR 3.459, 95% CI: 1.54–7.76).

Conclusion

The diagnosis consistency between the general ophthalmologists and the glaucoma specialists was similar among outpatients in the area of Shanghai. However, general ophthalmologists tended to classify the indefinite subjects as POAG suspects, and their accuracy in diagnosing POAG was low. By paying more attention to the risk factors of POAG diagnosis, general ophthalmologists could improve the diagnosis accuracy.

The Global Extent of Undetected Glaucoma in Adults: A Systematic Review and Meta-analysis

TOPIC

Glaucoma is the leading cause of irreversible blindness, despite having good prognosis with early treatment. We evaluated the global extent of undetected glaucoma and the factors associated with it in this systematic review and meta-analysis.

CLINICAL RELEVANCE

Undetected glaucoma increases the risk of vision impairment, which leads to detrimental effects on the quality-of-life and socioeconomic well-being of those affected. Detailed information on the extent and factors associated with undetected glaucoma aid in the development of public health interventions.

METHODS

We conducted a systematic review and meta-analysis of population-based studies published between January 1, 1990, and June 1, 2020. Article search was conducted in online databases (PubMED, Web-of-Science), grey literatures (OpenGrey), and nongovernment organization reports. Our outcome measure was the proportion of glaucoma cases that were undetected previously. Manifest glaucoma included any form of glaucoma reported in the original studies and may include primary open-angle glaucoma (POAG), primary angle-closure-glaucoma, secondary glaucoma, or a combination thereof. Undetected glaucoma was defined as glaucoma cases that were undetected prior to diagnosis in the respective study. Random-effect meta-analysis was used to estimate the pooled proportion of undetected glaucoma. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Meta-analysis of Observational Studies in Epidemiology guidelines in our study.

RESULTS

We identified 61 articles from 55 population-based studies (n = 189 359 participants; n = 6949 manifest glaucoma). Globally, more than half of all glaucoma cases were undetected previously on average in each geographical region. Africa (odds ratio [OR], 12.70; 95% confidence interval [CI], 4.91-32.86) and Asia (OR, 3.41; 95% CI, 1.63-7.16) showed higher odds of undetected glaucoma as compared with Europe. Countries with low Human Development Index (HDI; <0.55) showed a higher proportion of undetected manifest glaucoma as compared with countries of medium to very high HDI (≥0.55; all P < 0.001). In 2020, 43.78 million POAG cases were projected to be undetected, of which 76.7% were in Africa and Asia.

DISCUSSION

Undetected glaucoma is highly prevalent across diverse communities worldwide and more common in Africa and Asia. Strategies to improve detection are needed to prevent excess visual disability and blindness resulting from glaucoma.

Longitudinal Observation of Border Tissue Configuration During Axial Elongation in Childhood

Purpose

To investigate the change of border tissue configuration during axial elongation in childhood.

Methods

Fifty-four subjects (108 eyes; age range, 29.3–132.5 months) who had undergone a series of swept-source optical coherence tomography scans at intervals of 6 months or longer were classified into stable axial length (AXL) eyes (n = 55; AXL change of ≤0.36 mm) and elongating AXL eyes (n = 53; AXL change of >0.36 mm). The angle between the Bruch's membrane opening (BMO) reference plane and the border tissue of Elschnig was defined as the border tissue angle (BTA). The border tissue angle, BMO distance (BMOD) and minimum rim width (MRW) were measured in the temporal and nasal regions.

Results

During 15.6 ± 7.2 months of follow-up, the AXL significantly increased from 22.8 ± 1.3 mm to 23.3 ± 1.4 mm (P < 0.001). Changes of border tissue angle and AXL showed a significant correlation only in the temporal region of elongating AXL eyes (r = –0.409; P = 0.002), but not in stable AXL eyes. Both BMOD and nasal MRW significantly increased from 1482.5 ± 153.0 to 1506.1 ± 154.6 µm and from 310.6 ± 83.2 to 324.6 ± 95.6 µm, respectively (all Ps < 0.001). The changes of BMOD and nasal MRW showed a significant positive correlation with changes of AXL in elongating AXL eyes but not in stable AXL eyes.

Conclusions

During the axial elongation in childhood, temporal border tissue configuration change, BMO enlargement, and nasal peripapillary tissue elevation showed a significant correlation with changes in the AXL.

Laser flare and cell photometry to measure inflammation after cataract surgery: a tool to predict the risk of cystoid macular edema

PURPOSE

To review the current adoption of laser flare and cell photometry (LFCP) in the setting of modern cataract surgery to analyze inflammation aiming to identify evidence of a correlation between LFCP values and the risk of cystoid macular edema (CME) development.

METHODS

An extensive PubMed literature search was performed to review all the published studies investigating inflammation by LFCP after uncomplicated phacoemulsification. The following keywords were used: cataract surgery, cystoid macular edema, anterior chamber inflammation, laser flare, and cell photometry.

RESULTS

Seventy-eight original articles investigating inflammation by LFCP were selected. Macula alterations were searched in 12 (15%) trials, by optical coherence tomography or fluorescein angiography in 11 (14%) and 1 (1%) studies, respectively. Among them, 9 (12%) papers investigated the correlation between LFCP values and cystic changes to the macula: 7 (9%) and 2 (3%) studies identified a positive and negative correlation, respectively. Three (4%) papers did not perform any correlation analysis.

CONCLUSION

CME, as a consequence of uncontrolled postoperative inflammation, is a common cause for unfavorable visual outcomes following uncomplicated phacoemulsification with IOL implantation. After surgery, intraocular inflammation is generally assessed by qualitative methods. Although well-established and practical in uveitis, they are inadequate to detect the modest inflammatory response that usually occurs after uneventful phacoemulsification. LFCP correlate with the chance of macula alteration after surgery and higher the values higher the risk of CME. The quantitative analysis of intraocular inflammation by LFCP after cataract surgery might be a tool to predict the risk of pseudophakic CME.

Investigating the Relationship between Glaucoma Prevalence and Trabecular Meshwork Length

Glaucoma is one of the most common causes of blindness worldwide, but the risk factors of glaucoma are yet to be fully understood. We investigated the relationship between the prevalence of glaucoma and trabecular meshwork (TM) length by comparing the mean TM length of a South Korean population with that of another ethnic population. We included 250 eyes of 125 patients who underwent anterior segment optical coherence tomography at Yonsei University Gangnam Severance Hospital between January 2015 and December 2017. We measured the distance from the scleral spur to Schwalbe’s line in patients with open and closed angles and calculated the TM length using the open- and closed-angle ratios in the general population. The mean TM length of the patients in our study was 752 ± 116 μm. Considering the compensated data, the estimated true mean TM length in the Korean population was 793 ± 76 μm, which was similar to the mean TM length of a previously evaluated Hispanic population, but differed significantly from those of previously evaluated Asian (Chinese), Caucasian, and African-American populations (p < 0.05). Our results support the hypothesis that the development of glaucoma would be affected by TM length.

Health screening program revealed risk factors associated with development and progression of papillomacular bundle defect

BACKGROUND/AIMS

The papillomacular bundle (PMB) area is an important anatomical site associated with central vision. As preventive medicine and health screening examinations are now becoming commonplace, the incidental detection of papillomacular bundle defect (PMBD) on fundus photography has been increasing. However, clinical significance of incidental PMBD has not been well documented to date. Thus, through long-term and longitudinal observation, we aimed to investigate the risk factors for the development and progression of PMBD and its predictive role associated with systemic diseases and glaucoma.

METHODS

This longitudinal study included subjects who had undergone standardized health screening. We retrospectively reviewed patients for whom PMBD had been detected in fundus photography and followed up for more than 5 years. For a comparative analysis, non-PMBD groups of age- and gender-matched healthy controls were selected.

RESULTS

A total of about 67,000 fundus photographs were analyzed for 8.0 years, and 587 PMBD eyes were found. Among them, 234 eyes of 234 patients who had had fundus photographs taken for more than 5 years were finally included. A total of 216 eyes (92.3%) did not progress during the 8.1 ± 2.7 years, whereas 18 eyes (7.7%) showed progression at 7.6 ± 2.9 years after initial detection. A multivariate logistic regression analysis using 224 non-PMBD healthy controls revealed low body mass index (BMI < 20 kg/m2), systemic hypertension, and sclerotic changes of retinal artery as the significant risk factors for the development of PMBD. Regarding PMBD progression, low BMI, concomitant retinal nerve fiber layer defect (RNFLD) at non-PMB sites, optic disc hemorrhage, and higher vertical cup/disc ratio were individual significant risk factors.

CONCLUSION

PMBD is associated with ischemic effects. Although the majority of PMBD do not progress, some of cases are associated with glaucomatous damage in a long-term way. PMBD might be a personalized indicator representing ischemia-associated diseases and a predictive factor for diagnosis and preventive management of glaucoma.

Development of Decision Support Software for Deep Learning-Based Automated Retinal Disease Screening Using Relatively Limited Fundus Photograph Data

Purpose—This study was conducted to develop an automated detection algorithm for screening fundus abnormalities, including age-related macular degeneration (AMD), diabetic retinopathy (DR), epiretinal membrane (ERM), retinal vascular occlusion (RVO), and suspected glaucoma among health screening program participants. Methods—The development dataset consisted of 43,221 retinal fundus photographs (from 25,564 participants, mean age 53.38 ± 10.97 years, female 39.0%) from a health screening program and patients of the Kangbuk Samsung Hospital Ophthalmology Department from 2006 to 2017. We evaluated our screening algorithm on independent validation datasets. Five separate one-versus-rest (OVR) classification algorithms based on deep convolutional neural networks (CNNs) were trained to detect AMD, ERM, DR, RVO, and suspected glaucoma. The ground truth for both development and validation datasets was graded at least two times by three ophthalmologists. The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated for each disease, as well as their macro-averages. Results—For the internal validation dataset, the average sensitivity was 0.9098 (95% confidence interval (CI), 0.8660–0.9536), the average specificity was 0.9079 (95% CI, 0.8576–0.9582), and the overall accuracy was 0.9092 (95% CI, 0.8769–0.9415). For the external validation dataset consisting of 1698 images, the average of the AUCs was 0.9025 (95% CI, 0.8671–0.9379). Conclusions—Our algorithm had high sensitivity and specificity for detecting major fundus abnormalities. Our study will facilitate expansion of the applications of deep learning-based computer-aided diagnostic decision support tools in actual clinical settings. Further research is needed to improved generalization for this algorithm.