Advanced glaucoma at diagnosis: current perspectives

Kastner, Alan; King, Anthony J

doi:10.1038/s41433-019-0637-2

Cited by 46 publications

(33 citation statements)

References 145 publications

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“…16 This grouping was adopted to evaluate the performance of HCP in patients with less perceptible VF loss (early-moderate) and patients with severe glaucoma who are at highest risk for rapid worsening of the disease, lifetime blindness and deterioration of quality of life. 17 Were also excluded patients with: (1) an unconfirmed glaucoma diagnosis or any associated ophthalmic conditions such as other causes of optic neuropathy, retinopathies and/or ocular motor disorders; (2) clinically significant pupillary abnormalities except for relative afferent pupillary defects (RAPD) in the glaucoma group; (3) clinically diagnosed psychiatric or neurological disorders, including dementia and (4) patients who had undergone intraocular surgery within the past 6 months, had severe ocular trauma or were using psychotropic or other medications known to affect the pupillary control pathways. Written informed consent was obtained from all participants.…”

Section: Clinical Sciencementioning

confidence: 99%

Handheld chromatic pupillometry can accurately and rapidly reveal functional loss in glaucoma

et al. 2021

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Background/aimsEarly detection and treatment of glaucoma can delay vision loss. In this study, we evaluate the performance of handheld chromatic pupillometry (HCP) for the objective and rapid detection of functional loss in glaucoma.MethodsIn this clinic-based, prospective study, we enrolled 149 patients (median (IQR) years: 68.5 (13.6) years) with confirmed glaucoma and 173 healthy controls (55.2 (26.7) years). Changes in pupil size in response to 9 s of exponentially increasing blue (469 nm) and red (640 nm) light-stimuli were assessed monocularly using a custom-built handheld pupillometer. Pupillometric features were extracted from individual traces and compared between groups. Features with the highest classification potential, selected using a gradient boosting machine technique, were incorporated into a generalised linear model for glaucoma classification. Receiver operating characteristic curve analyses (ROC) were used to compare the performance of HCP, optical coherence tomography (OCT) and Humphrey Visual Field (HVF).ResultsPupillary light responses were altered in glaucoma compared with controls. For glaucoma classification, HCP yielded an area under the ROC curve (AUC) of 0.94 (95% CI 0.91 to 0.96), a sensitivity of 87.9% and specificity of 88.4%. The classification performance of HCP in early-moderate glaucoma (visual field mean deviation (VFMD) > -12 dB; AUC=0.91 (95% CI 0.87 to 0.95)) was similar to HVF (AUC=0.91) and reduced compared with OCT (AUC=0.97; p=0.01). For severe glaucoma (VFMD ≤ -12 dB), HCP had an excellent classification performance (AUC=0.98, 95% CI 0.97 to 1) that was similar to HVF and OCT.ConclusionHCP allows for an accurate, objective and rapid detection of functional loss in glaucomatous eyes of different severities.

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Section: Clinical Sciencementioning

confidence: 99%

Handheld chromatic pupillometry can accurately and rapidly reveal functional loss in glaucoma

et al. 2021

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“…Glaucoma is a blinding disease representing the most common neurodegenerative pathology as it is expected to affect about 111 million people worldwide by 2040 [2]. Although the pathogenesis of glaucoma is not fully understood, the increase in IOP is a major risk factor for the disease, ultimately leading to compression and degeneration of the optic nerve [3]. The main approved treatments for glaucoma rely on the use of drugs that are able to reduce IOP, including prostaglandin analogs, β-adrenergic blockers, α-adrenergic agonists, carbonic anhydrase inhibitors, Rho kinase inhibitors, and cholinergic agonists, either as monotherapy or combination therapy [4].…”

Section: Introductionmentioning

confidence: 99%

Hypotensive Effect of Nanomicellar Formulation of Melatonin and Agomelatine in a Rat Model: Significance for Glaucoma Therapy

Monte

Cammalleri

Pezzino³

et al. 2020

Diagnostics

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Background: Melatoninergic agents are known to reduce intraocular pressure (IOP). The present study was performed to evaluate the effect of nanomicellar formulations of melatoninergic agents on IOP in the rat. Methods: Tonometry was used to measure IOP in eyes instilled with melatonin or agomelatine. Ocular hypertension was induced by the injection of methylcellulose in the anterior chamber. Results: Melatonin formulated in nanomicelles had a longer lasting hypotonizing effect on IOP with respect to melatonin in saline. Nanomicellar formulations of melatonin and agomelatine, either alone or in combination, had lowering effects that did not depend on their concentration or their combination, which, however, resulted in an increased duration of the hypotonizing effect. The duration of the lowering effect was further increased by the addition of lipoic acid. Conclusions: We demonstrated the effective hypotonizing activity of melatonin and agomelatine in combination with lipoic acid. Although results in animals cannot be directly translated to humans, the possibility of developing novel therapeutical approaches for patients suffering from hypertensive glaucoma should be considered.

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“…3 In another report it was 50.4%. 14 Cataract is a common cause of decreased visual equity in the elderly and it is a common reversible cause of decreased visual acuity in glaucoma patients. 15 Uveitis, pseudo exfoliation, acute angle-closure glaucoma, trabeculectomy, laser treatment, and steroids in any form can accelerate cataract formation.…”

Section: Discussionmentioning

confidence: 99%

Non-Glaucomatous Causes of Decreased Vision in Glaucoma

Fasih¹,

Shahid²,

Shaikh³

2021

pak J Ophthalmol

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Purpose: To determine the non-glaucomatous causes of decreased visual acuity in glaucoma patients presenting in the eye OPD of a tertiary care hospital. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Abbasi Shaheed Hospital from July 2019 to September 2020. Methods: Patients above 18 years of age, visual acuity of less than 6/6 and diagnosed case of glaucoma were included in this study. Patients with congenital glaucoma and patients not willing to participate in the study were excluded. Detailed history was taken and ocular examination of the patient was done. Causes of decreased visual acuity were determined. Data was collected and analyzed on SPSS version 20. Results: There were 369 glaucoma patients with a mean age of 58.2 ± 11.54 SD years. Males were 224 (60.4%), with mean duration of glaucoma as 5.4 ± 5.2 years. Primary open-angle glaucoma was seen in 209 (56.6%) and primary angle-closure glaucoma was in 96 (26%) of patients. Treatable causes were 119 (32.2%) and non-glaucomatous causes of decrease vision were 221 (59.9%). Glaucomatous optic atrophy was seen in 182 (49.3%) patients followed by cataract in 96 (26%). Patients with corneal pathologies were 38 (10.2%) and ARMD were 26 (7%). Conclusion: The commonest cause of decreased visual acuity in glaucoma patients is irreversible glaucomatous optic atrophy. Age-related macular degeneration, corneal pathologies, and amblyopia also contribute to irreversibly decreased visual acuity in glaucoma patients. Reversible causes include cataract, refractive errors, cystoid macular edema and diabetic macular edema. Key Words: Cataract, Glaucoma, Glaucomatous Optic Atrophy, Vision.

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Advanced glaucoma at diagnosis: current perspectives

Cited by 46 publications

References 145 publications

Handheld chromatic pupillometry can accurately and rapidly reveal functional loss in glaucoma

Handheld chromatic pupillometry can accurately and rapidly reveal functional loss in glaucoma

Hypotensive Effect of Nanomicellar Formulation of Melatonin and Agomelatine in a Rat Model: Significance for Glaucoma Therapy

Non-Glaucomatous Causes of Decreased Vision in Glaucoma

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