Aim: To investigate the need among future doctors of various specialties (medical university students) to study the fundamentals of the organization of diagnosis, treatment and prevention of glaucoma. Materials and Methods: A custom-designed questionnaire was used as the research tool. The study materials consisted of data obtained from a survey of senior students at three medical universities in Ukraine. Bibliographic, statistical, and analytical methods were employed in the study. Results: Overall, 80% of medical students believe that knowledge of the discipline "Ophthalmology" is necessary for future physicians of all specialties. 75% of respondents rated the scope and quality of ophthalmology knowledge received during the pre-graduation stage at 3-5 points on a 5-point scale. One-third of students rated their knowledge of the organization of ophthalmologic care and the prevention of eye diseases at 3 points. More than 80% of students highly valued the importance of future physicians of all specialties being knowledgeable about modern approaches to glaucoma prevention and the factors influencing its development. However, while there is general understanding among future physicians about the need to know the current algorithm of actions when glaucoma or pseudoexfoliation syndrome is suspected, knowledge of modern treatment approaches for glaucoma patients is not deemed necessary by all. 75% of students plan to apply their knowledge of glaucoma prevention in their future practice, but they do not intend to carry out preventive activities aimed at preventing the development of glaucoma. Conclusions: Overall, 70-80% of the surveyed medical students recognize the importance of ophthalmology knowledge. However, their assessment of the volume and quality of their own knowledge was not sufficiently high. Future physicians understand the importance of being informed about risk factors for glaucoma and its prevention. Evaluations of the need for in-depth knowledge of modern treatment approaches for glaucoma patients or the organization of glaucoma prevention were more reserved. Sixth-year students and medical interns feel uncertain about their theoretical and practical knowledge of ophthal-mology. Educators teaching the "Ophthalmology" discipline should clearly demonstrate the relevance and value of ophthalmological knowledge for various medical specialties, especially for family physicians.
Early diagnosis of glaucoma is one of the most crucial strategies to tackle the huge burden of glaucoma and associated blindness. Early diagnosis, though, will not cure the disease but prevent the progression of glaucoma, leading to a reduction in ocular morbidity. This study aimed to estimate the proportion of the population with knowledge of glaucoma and their attitude and practices related to the disease. We conducted this community-based cross-sectional study in Mendhasala, a rural block of Odisha, a state in eastern India. We chose two of the five sectors in the block using simple random sampling. We employed a 30 × 30 cluster sampling method, selecting 30 participants from each village. Households with at least one member over 18 were identified using systematic random sampling. The data were collected using a prestructured and validated questionnaire and analyzed using Microsoft Excel 2021. We gathered data from 899 participants, containing sociodemographic information and information about their knowledge, attitudes, and practices concerning glaucoma. The mean age of the participants was 45.7 years (SD 14.43), with an almost equal number of males and females. Only 4.23% (95% CI: 3.01%-5.8%) had ever heard of glaucoma, of whom three were unaware of the eye changes associated with the condition. Education and employment status were significant predictors of knowledge related to glaucoma. Health education campaigns should be reinforced at the community level to increase the knowledge related to glaucoma. This may increase the care-seeking attitude towards glaucoma in the community. Taywade M, Nayak B, Pal D, et al. Knowledge, Attitude, and Practices Related to Glaucoma in a Rural Population of Eastern India: A Cross-sectional Study. J Curr Glaucoma Pract 2025;19(3):119-124.
Glaucoma is a major cause of irreversible blindness in India; however, if detected early, its progression can be either prevented or stabilised through appropriate medical or surgical treatment. We aim to evaluate the cost-utility of various models for population-based glaucoma screening at primary health centres in India. We also assess the potential impact of the implementation of a population-based screening programme on overall costs of care for glaucoma. Cost-utility analysis using a mathematical model comprising a decision tree and Markov model was conducted to simulate relevant costs and health outcomes over a lifetime horizon. Screening services were assumed to be delivered at primary health centres in India. A hypothetical cohort of different target population groups in terms of age groups and risk of glaucoma (age group 40-75 years, 50-75 years, 40-75 years age group at high risk of glaucoma, 50-75 years age group at high risk of glaucoma) were included in comparative screening strategies. The exclusive intervention scenarios were 12 screening strategies based on different target population groups (age group 40-75 years, 50-75 years, 40-75 years age group at high risk of glaucoma, 50-75 years age group at high risk of glaucoma), screening methods (face-to-face screening and artificial intelligence-supported face-to-face screening) and screening frequencies for 40-75 years aged population (annual vs once every 5 years screening), in comparison to usual care scenario. The usual care scenario (current practice) implied opportunistic diagnosis by the ophthalmologists at higher levels of care. The primary outcome was the incremental cost-utility ratio for each of the screening strategies in comparison to usual care. The secondary outcomes were per person lifetime costs, lifetime out-of-pocket expenditures, life years and quality-adjusted life-years (QALYs) in all screening scenarios and usual care. Depending on the type of screening strategy, the gain in QALY per person ranged from 0.006 to 0.046 relative to usual care. However, the screening strategies, whether adjusted for specific age groups, patient risk profiles, screening methods or frequency, were not found to be cost-effective. Nonetheless, annual face-to-face screening strategies for individuals aged 40-75 years could become cost-effective in a scenario of strengthened public financing and provisioning, such that at least 67% of those seeking care for confirmatory diagnosis and treatment use government-funded facilities, in conjunction with 60% availability of medications at government hospitals. Enhancing continuity of care following screening through either strengthening of public provisioning or strategic purchasing of care could make glaucoma screening interventions not only cost-effective, but also potentially cost-saving.
Myopic glaucoma is a distinct subtype of glaucomatous optic neuropathy that is often underrecognized or misdiagnosed, particularly in younger patients whose intraocular pressures (IOP) fall within statistically normal ranges. High myopia presents complex structural, functional, and biomechanical challenges that hinder both early detection and effective disease management.This review summarizes current evidence on the pathophysiology, clinical presentation, diagnostic limitations, and tailored therapeutic strategies for myopic glaucoma, providing a practical clinical framework for improved management. This narrative review synthesizes current evidence from peer-reviewed clinical and basic science studies on myopic glaucoma. Drawing on a comprehensive literature search, it addresses the pathophysiology, clinical presentation, diagnostic limitations, and tailored therapeutic strategies for myopic glaucoma, with the aim of establishing a clinically relevant framework to inform optimized management. The global prevalence of myopia is increasing, with high myopia substantially elevating the risk of glaucoma, particularly among Asian populations. Structural alterations-including axial elongation, scleral thinning, lamina cribrosa deformation, and optic nerve head tilting-augment biomechanical vulnerability to glaucomatous damage, even when IOP remains within normal limits.Myopic glaucoma is often characterized by tilted optic discs, peripapillary atrophy, and early paracentral visual field defects, which may not be detected by standard perimetric methods. Diagnosis is complicated by the limitations of optical coherence tomography (OCT), including segmentation errors and the lack of normative databases specific to myopic eyes. Moreover, disease progression may occur even with low IOP, and distinguishing glaucomatous damage from myopia-induced structural changes remains a significant challenge. Recent advances, such as the identification of the crescent moon sign, implementation of 10-2 visual field testing, and use of biomechanically compensated tonometry, have improved diagnostic accuracy.Management requires lower IOP targets due to increased structural fragility, often necessitating combined medical therapy or early surgical intervention. However, surgery in young highly myopic patients carries a heightened risk of hypotony maculopathy.Emerging technologies, including artificial intelligence (AI)-based algorithms and widefield optical coherence tomography angiography (WF-OCTA), enhance diagnostic precision by addressing anatomical distortions and facilitating the early detection of glaucomatous changes. Early identification and tailored management of myopic glaucoma are crucial to mitigate vision loss in this high-risk population. Awareness of the unique challenges posed by high myopia, combined with emerging diagnostic and therapeutic approaches, can improve patient outcome and reduce the burden of undiagnosed disease. Diniz CK, Meira MA, Gondim LAVAS, et al. Managing Myopic Glaucoma-Beyond Structural Fragility and Diagnostic Challenges: Review Article. J Curr Glaucoma Pract 2026;20(1):20-25.
Glaucoma is one of the most common causes of blindness and affects more than 70 million people worldwide. The disease is characterised by the loss of retinal ganglion cells associated with a progressive optic neuropathy, resulting in an impairment of visual functions, for example, visual field loss. Nowadays, the only modifiable risk factor is the increase in intraocular pressure, and its treatment is to lower this pressure by medication, laser treatment or surgery to avoid disease progression. New methods for preventing and reversing vision loss are thus urgently needed. Several small and two multicentre studies have presented evidence that repetitive transorbital alternating current stimulation (rtACS) can lead to long-lasting visual field improvement. This could open a new and inexpensive therapeutic option for optic atrophy. However, the level of evidence for this method is still fairly rather poor, and further trials are needed. Therefore, this clinical trial aims to prove the effectiveness of rtACS compared with sham stimulation in patients with primary open-angle glaucoma (POAG). VIRON (Vision Restoration in Optic Neuropathy) is a national, multicentre, prospective, randomised, placebo-controlled, double-blind trial with three arms. The primary objective is to assess the effectiveness of rtACS in patients with POAG compared with sham stimulation. The primary outcome is the change in mean defect (MD) in the visual field immediately after 10 sessions of rtACS (days 9, 16 and 23) compared with the values of initial perimetry (days -21 to -14 and 0) after applying electrical stimulation with a classical montage, compared with sham and electrical stimulation using individualised montage. Secondary outcome measures comprise a long-term effect with changes in MD at 24 weeks after stimulation, and data from the National Eye Institute Visual Function-25 and quality of life (Short Form 36) questionnaires. The target population are patients with glaucomatous optic atrophy and significant glaucomatous visual field defects (MD of 5-22 dB) due to POAG.After randomisation, patients received either classical rtACS (group 1), individual rtACS (group 2) or sham stimulation (group 3) in daily 25 min stimulation sessions in two series of five consecutive days separated by a weekend interval. In group 1, active stimulation will be via the routinely applied montage using two electrodes affixed on the right and left side of the head, next to the eyes, with straightforward fixation. In group 2, the current flow will be individually modelled (MRI-based) to target areas of partial visual field defects by optimising electrode positions in conjunction with an optimised visual fixation direction. Group 3 with sham stimulation will serve as control.The calculated sample size required to achieve a statistical power of 80% for a relevant effect size and allow for dropouts was 300 (100 per group). The trial has already begun with the first patient in July 2023. The planned recruitment period is 24 months with an estimated end of the study in November 2025 (last patient out). An adjusted extension of the study period is planned. VIRON was approved by the Central Ethics Committee of the University Medical Center Göttingen (19 October 2022) and those of the individual participating centres (Bonn: 446/23-EP, Hamburg: 2023-200889-BO-bet, Cologne: 23-1487 and Mainz: 2023-17399-§23b). The study protocol complies with the Declaration of Helsinki, the national medicine device regulation (MDR) laws and the international standards of good clinical practice (GCP).The study protocol (V.5, 24 November 2023) was designed following the Standard Protocol Items: Recommendations for Interventional Trials guidelines and is registered on https://drks.de/search/de/trial/DRKS00029129.As study initiatior the University Medical Center Göttingen (UMG) is responsible for data ownership and data management of the VIRON study. The study data will be published within 6 months of the study being completed. After the publication of the primary results, all data are anonymised and published in an open-access journal to ensure access to the data for third parties. https://drks.de/search/de/trial/DRKS00029129.
Glaucoma is a leading cause of irreversible blindness worldwide. Its global prevalence is projected to exceed 110 million individuals by 2040 (Tham et al., 2014). In 2020, the disease accounted for an estimated 3.6 million cases of blindness and 4 million cases of moderate to severe visual impairment. Between 3 and 17% of patients develop refractory glaucoma, in which progression continues despite maximal medical and surgical treatment (Saunders et al., 2016). Optimizing management of these patients is essential to reduce the global burden of visual disability. This was a single-center, observational, retrospective cohort study conducted at York and Scarborough Teaching Hospitals. We included patients with refractory glaucoma treated with a single session of transscleral cyclodiode laser between 2019 and 2023. Baseline demographics, intraocular pressure (IOP), and medication use were recorded. Treatment success was defined as ≥20% reduction in IOP and a final IOP ≤ 21 mm Hg at 12 months posttreatment or cessation of oral antihypotensive medication and/or reduction in the number of topical antiglaucoma drops. A total of 108 patients had cyclodiode laser treatment between 2019 and 2023. A total of 62 eyes from 57 patients were included. The average age of the patient was 71.5 ± 15.8 years. The mean baseline IOP was 36.4 ± 12.4 mm Hg, which significantly reduced to 19.0 ± 9.0 mm Hg at 12 months (p < 0.001). There was no significant correlation between baseline and posttreatment IOP. The average number of topical medications decreased from 3.4 ± 1.2 to 2.5 ± 1.4 (p < 0.001). Transscleral cyclodiode laser achieved a 77.4% success rate in reducing IOP ≤ 21 mm Hg and ≥20% reduction. It was an effective and well-tolerated option for managing refractory glaucoma. This study supports the use of a single session of transscleral cyclodiode laser as a viable standalone treatment for patients with advanced, treatment-resistant glaucoma. Its ability to significantly lower IOP and reduce the need for systemic medications, with a favorable safety profile, makes it especially valuable for elderly and frail patients who are poor candidates for further surgery. Salari Y, Venugopal D, Sohail T, et al. Safety and Efficacy of Transscleral Cyclodiode Laser in Advanced Glaucoma: A Retrospective, Single-center Observational Cohort Study. J Curr Glaucoma Pract 2025;19(4):175-181.
We aimed to compare the effects of ab externo trabeculotomy (AbE-TLO), gonioscopy-assisted transluminal trabeculotomy (GATT), and Ahmed glaucoma valve (AGV) implantation on intraocular pressure (IOP) and the number of antiglaucomatous medications used in pediatric aphakic glaucoma (AG). Between 2017 and 2022, 27 eyes of 24 children who underwent AbE-TLO, GATT, and AGV in our clinic for pediatric AG were retrospectively analyzed. Corneal dimensions, corneal thickness, axial length, and surgical technique were recorded. Baseline and postoperative follow-up IOP measurements and antiglaucomatous drops used were analyzed. AbE-TLO was performed in 37% (n = 9), GATT in 30% (n = 7), and AGV implantation in 33% (n = 8) of the patients included in our study. The mean follow-up period was 39.12 ± 3.19 months. In the 2nd postoperative year, IOP decreased significantly from 33.9 to 17.7 mm Hg with AbE-TLO (p = 0.014), from 34.3 to 18.3 mm Hg with GATT (p = 0.033), and from 34.5 to 16.4 mm Hg with AGV (p = 0.002). When all three surgical methods were compared, no significant difference was observed in IOP reduction at 1 and 2 years (p > 0.05). The number of antiglaucomatous medications decreased from 2.3 to 0.8 (p = 0.005) in AbE-TLO, from 2.4 to 0.5 (p = 0.008) in GATT, and from 2.3 to 0.6 (p = 0.005) in AGV at 2 years after surgery. There was a significant decrease in IOP, along with a significant reduction in the usage of antiglaucomatous drugs, across all three primary surgical methods. No significant difference was detected regarding the reduction in IOP and the usage of antiglaucomatous medications. Approximately, half of the patients with pediatric AG undergo surgery. However, the most appropriate surgical technique for AG remains unclear. Minimally invasive glaucoma surgeries, increasingly performed in recent years, now constitute a pivotal aspect of glaucoma surgical treatment. Thus, the main objective of the current research is to compare the impacts of AbE-TLO, GATT, and AGV implantation on IOP as the primary surgical method in pediatric AG. Toptan M. Comparison of the Intraocular Pressure-lowering Effects of Three Primary Surgical Procedures in Pediatric Aphakic Glaucoma. J Curr Glaucoma Pract 2025;19(1):50-54.
To assess the perception and knowledge that Spanish ophthalmologists have of overdiagnosis (OD) and overtreatment (OT) in the field of glaucoma. An anonymous, 26-item online survey was submitted to members of the Spanish Glaucoma Society and the Spanish Ophthalmology Society. Approximately 55% out of the 195 respondents were aware of the current definition of OD/OT. Only 13 (6.7%) believe OD/OT is not a clinically significant problem. There were no significant differences in terms of demographics, type of practice and treatment preferences between ophthalmologists who considered OD/OT important and those who considered OD/OT unimportant, except for a higher proportion of PhDs among the "not clinically relevant" group. No differences were found either across groups considering clinical findings/real-world scenarios. "Peace of mind" was considered a principal driver of OD/OT by both groups. Moderate OHT was considered the most common clinical scenario for OD/OT, which was estimated to affect 20% of medically treated patients and only 5% of those undergoing surgical procedures. Spanish ophthalmologists reported being aware of the importance of OD and OT. However, only half were aware of the current definition of OD and OT. Most participants believe a White Paper should be produced to reduce the prevalence of OD/OT. The low participation rate and the non-response bias may limit the generalization of the results.
This study aims to systematically evaluate and synthesize current evidence on the environmental risk factors and genetic markers associated with the development and progression of glaucoma, with a focus on primary open-angle (POAG), normal-tension glaucoma (NTG) and angle-closure glaucoma (ACG), in order to clarify their interplay, clinical implications, and potential avenues for personalized risk assessment and therapeutic intervention. Being one of the major causes of irreversible blindness in the world, glaucoma is a multifactorial optic neuropathy that has a complex interaction between clinical, environmental, and genetic factors. In this literature review, existing evidence on the risk factors and the genetic markers of glaucoma, induced by primary open-angle glaucoma (POAG), NTG, and primary angle-closure glaucoma (PACG), are synthesized. PubMed, Scopus, Web of Science, DOAJ, and Google Scholar have been searched by using key terms ('Glaucoma,' 'POAG,' 'ACG,' 'Risk Factors,' 'Genetic Markers,' etc.) for peer-reviewed articles, clinical trials, GWAS, and meta-analyses to meet up the study's aim. Epidemiologic studies reveal significant demographic variations, with POAG prevalent in African populations and PACG in East Asians. Key nonmodifiable risks include age, family history and ethnicity, while modifiable factors comprise elevated IOP, vascular dysregulation and lifestyle. Genetic studies implicate MYOC, OPTN and TBK1 mutations, along with emerging polygenic risk scores, underscoring the importance of personalized management considering gene-environment interactions. In this review, early screening, genetic screening, and specific interventions have been highlighted to combat the menace of glaucoma that results in a high global burden. This comprehensive review enhances clinical practice by identifying high-risk populations for targeted screening and highlighting key genetic markers (e.g., MYOC, OPTN) that enable personalized glaucoma management. It improves diagnostic accuracy by clarifying modifiable (IOP, smoking) and nonmodifiable (age, family history) risk factors while informing therapeutic strategies through mechanistic insights into autophagy and vascular regulation. Additionally, the study addresses healthcare disparities by emphasizing ethnic-specific risk patterns and supports genetic counseling for familial cases, ultimately guiding more effective prevention and treatment approaches to preserve vision. Hamid SAT, Abdulmajeed SM, Chowdhury IH, et al. Risk Factors and Genetic Markers Associated with the Development and Progression of Glaucoma: A Review. J Curr Glaucoma Pract 2025;19(4):216-222.
Glaucoma is a leading cause of blindness in India, and treatment adherence is essential to prevent vision loss. However, studies have shown that treatment adherence rates among glaucoma patients in India are low. It is important to identify the factors determining treatment adherence in order to improve compliance with the treatment, thereby preventing worsening vision. The current study was conducted with an objective to assess the treatment adherence among glaucoma patients using the Morisky Medication Adherence Scale (MMAS-8) and to assess determinants of treatment adherence among the study participants. A drop instillation technique among the glaucoma patients was also evaluated. A cross-sectional study was conducted among primary open-angle glaucoma (POAG) patients at a selected tertiary care institute in Ahmedabad city. The calculated sample size was 100. Glaucoma patients receiving treatment for at least 3 months were enrolled. Systematic sampling was applied, wherein every alternate patient fulfilling the inclusion criteria was selected. After obtaining informed consent, interviews were conducted using a pretested and predesigned pro forma including MMAS-8. Participants were instructed to use sterile artificial tears, which were evaluated by the investigator for precision. The mean age of study participants was 62.0 ± 6.28 years. Among the participants, 54% were female. The study revealed that 82% of participants had poor adherence to glaucoma medication. Factors such as education, regular follow-up, and having received prior instruction were significantly associated with adherence to medications. Only 43% of the patients were able to instill the eye drops correctly. Low adherence to medication was found among 82% of cases. Factors significantly associated with adherence were gender, education, duration of treatment, and having received prior instruction. Forgetfulness and the cost of treatment were the most common factors leading to low treatment adherence. Among 79 participants who were observed for the drop instillation technique, 43% were found to have instilled it properly. Shah V, Shah D, Desai HP, et al. A Cross-sectional Study on Adherence to Topical Glaucoma Medication and its Determinants among Patients Attending Glaucoma Clinics of a Tertiary Care Institute of Ahmedabad City, Gujarat, India. J Curr Glaucoma Pract 2025;19(3):107-111.
A review of the published literature was done to understand the role of endocannabinoids in glaucoma. As evidence mounts that intraocular pressure (IOP) is not the only factor in the pathogenesis and progression of glaucoma, a look into other aspects is the need of the hour. From the first instance of a drop in IOP linked to marijuana in the 1970s to the present, research has been ongoing, mostly in animals and in vitro models, with a scarcity of human studies, to delve into the world of the endocannabinoid system (ECS). PubMed, ScienceDirect, and Google Scholar were searched for studies relating to endocannabinoids and their role in glaucoma. The ECS comprises ligands, receptors, and the synthesizing and degrading enzymes and is ubiquitous throughout the human body, including the visual system, from the eye to the occipital lobe. Apart from the IOP-lowering effect of the system, another property being investigated and implicated as an attribute of its receptors is neuroprotection. This neuroprotection seems to be mediated by excitotoxicity reduction and changes in vascular tone by acting on cannabinoid receptors. The possibilities are indeed immense, and further research into the complex relationship between ECS and glaucoma is imperative to enable us to develop therapies for this otherwise chronic, progressive neuropathy, where the only armament in our hands is early diagnosis and maintenance therapy. We still do not have drugs for the prevention of retinal ganglion cell loss and for neuroprotection in glaucoma. Drugs that target cannabinoid receptors can revolutionize glaucoma management owing to their IOP-lowering action and neuroprotective effects. Based on the findings, we argue that further studies on the ECS and its implications in glaucoma are warranted to develop newer, effective, and better-targeted treatment strategies. Warjri GB, Gowtham L, Venkatraman V, et al. Role of Endocannabinoids in Glaucoma: A Review. J Curr Glaucoma Pract 2025;19(1):28-37.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), initially developed for type 2 diabetes (T2D) and later adopted for weight loss, have demonstrated potential protection against the development of glaucoma in various peer-reviewed publications. This review provides a synthesis of the emerging evidence evaluating the link between GLP-1 RA treatment and glaucoma risk. We performed a comprehensive literature search across PubMed, Embase (via OVID), and Scopus on May 28, 2025. Studies were included if they examined the association between GLP-1 RA use and glaucoma risk and presented novel quantitative data published in the last 6 years. Exclusion criteria included studies unrelated to glaucoma, those not evaluating GLP-1 RAs, and reviews without original data. Of the 44 studies identified, 9 met inclusion criteria: 5 retrospective observational studies, 1 nested case-control study, 1 preclinical study, 1 systematic review and meta-analysis, and 1 Mendelian randomization study. Most studies found a statistically significant association between GLP-1 RA use and reduced glaucoma risk, with stronger effects observed with prolonged exposure in three studies. One preclinical study demonstrated that the GLP-1 RA NLY01 mitigated retinal neuroinflammation and protected ganglion cells in a mouse model. Proposed mechanisms include intraocular pressure (IOP) reduction, attenuation of oxidative stress, and direct neuroprotection via GLP-1 receptor activation. However, one Mendelian randomization study did not support a causal link. Current evidence suggests that GLP-1 RAs may confer a secondary benefit in reducing glaucoma risk, supported by both clinical and preclinical data. However, the predominance of retrospective studies, coupled with the lack of randomized controlled trials, limit causal inference. Further randomized controlled trials and mechanistic investigations are warranted to validate these findings and assess their translational potential in glaucoma prevention. Lang MV, Vasu P, Dorairaj EA, et al. Glaucoma Risk Reduction as a Secondary Benefit of Glucagon-like Peptide-1 Receptor Agonists: A Review of Emerging Evidence. J Curr Glaucoma Pract 2025;19(4):223-228.
To describe cases of primary angle closure glaucoma (PACG) with neovascularization of iris/angle (NVI/NVA) with no obvious retinal pathology. We provide a description of three patients with a diagnosis of PACG with NVI/NVA. Detailed history taking along with ophthalmic and systemic examination including slit lamp examination, gonioscopy, and fundus fluorescein angiography (FFA) was done in all patients. FFA revealed peripheral hyperfluorescence and capillary nonperfusion (CNP) areas in periphery in all three eyes. Carotid Doppler and tests for blood coagulation profile were done and no apparent cause of NVI/NVA could be found. Secondary causes of NVI such as proliferative diabetic retinopathy, central retinal vein occlusion, ocular ischemic syndrome (OIS), vasculitis, branch retinal vein occlusion, central retinal artery occlusion, branch retinal artery occlusion, and ocular tumors were ruled out. All these patients had features of angle closure and were hence diagnosed with PACG with NVI/NVA. We hypothesize that chronically raised intraocular pressure (IOP) can result in peripheral retinal ischemia, leading to elevated vascular endothelial growth factor (VEGF) production resulting in NVI/NVA. PACG with NVI/NVA in absence of an obvious retinal pathology is a separate clinical entity. NVI without any obvious retinal pathology may occur in cases of PACG on account of development of peripheral retinal nonperfusion. PACG with NVI/NVA as per our series seem to have better prognosis than other causes of neovascular glaucoma (NVG). This distinction would help in management and follow-up. Caution should be taken to rule out all other causes. Angmo D, Wajiri GB, Verma S, et al. Neovascularization of the Iris/Angle in Primary Angle Closure Glaucoma: A Distinct Entity!. J Curr Glaucoma Pract 2025;19(4):229-233.
This study compares the quality of life (QoL) assessment using the glaucoma QoL (GQL-15), where patients rate their actual status for each of the four domains of visual disability, with that when the relative importance of each domain is reported by the patient. This observational, cross-sectional pilot study, conducted at a tertiary care hospital in North India, enrolled 37 patients with moderate to severe glaucoma. Each patient was administered the GQL-15 questionnaire. After each question was answered, the patient was asked to indicate the relative weighting of each domain, and the answer was graded from 1 to 5. The overall QoL score was obtained by multiplying each level of functioning with each domain weight and then adding these products. The individualized measures so obtained, divided by 5, were considered as a real-world measure of personalized QoL of the patient. Personalized QoL was compared to the standard GQL-15 score. The mean age of the patients was 63.86 ± 11.08 years, with male predominance (67.57%). Patients reported the highest visual impairment with walking on uneven ground (score = 2.70 ± 1.31), seeing at night (score = 2.54 ± 1.44), and reading newspapers (score = 2.51 ± 1.36). Patients gave the highest weightage to recognizing faces (score = 3.97 ± 0.64), and finding dropped objects (score = 3.73 ± 0.77). Highest score was bagged by seeing at night (8.35 ± 5.590 and adjusting to dim lights (8.35 ± 6.05, respectively), on analysis of the weighted GQL scores. Patients with moderate to severe glaucoma prioritize recognizing faces and finding dropped objects. The patients who reported greater difficulty in lighting-related tasks, as well as peripheral and distance vision, also gave it more importance. Individualizing QoL measures is necessary for a better understanding of the patients' perception of their visual disability. Bhartiya S, Ichhpujani P, Kapoor S, et al. Weighted Quality of Life in Glaucoma Patients with Advanced Disease. J Curr Glaucoma Pract 2025;19(2):85-89.
This study aims to evaluate the institutional interdisciplinary management protocol for neovascular glaucoma patients, focusing on a combined surgical approach involving posterior vitrectomy and Ahmed valve implantation, with previous antiangiogenic application. A retrospective review was conducted for 14 neovascular glaucoma patients who underwent the combined procedure over 4 years. Patients aged 18 years or older with prior antiangiogenic application and without other types of glaucoma or prior posterior vitrectomy were included. Surgical success was assessed as intraocular pressure reduction below 21 mm Hg, either without hypotensive medication (absolute success) or with medication (qualified success) at various time points. Secondary outcomes included intraocular pressure (IOP), number of hypotensive medications, visual acuity, underlying etiology, and postoperative complications. At baseline, patients had an average IOP of 50 mm Hg and were taking 4.4 glaucoma medications. After the 12-month follow-up, the mean IOP decreased significantly to 16.4 mm Hg, reducing the need for hypotensive medications. The qualified success rate was 100%, while absolute success was not achieved. Visual acuity and anatomical outcomes were maintained, with no cases of anatomical loss. Postoperative complications, including hyphema, choroidal detachment, and vitreous hemorrhage, were transient and self-resolved. The interdisciplinary management protocol proposed showed favorable results for neovascular glaucoma management. The combined surgical approach led to a considerable reduction in intraocular pressure and glaucoma medication use, indicating a high success rate in controlling the disease. Visual acuity and anatomical outcomes remained stable during the follow-up period, with no cases of anatomical loss. This study demonstrates that combining posterior vitrectomy and Ahmed valve implantation, preceded by antiangiogenic therapy, effectively reduces intraocular pressure and glaucoma medication use in neovascular glaucoma patients. This interdisciplinary approach offers improved management and potential for better patient outcomes. Belalcazar S, Villa J, Saldarriaga C, et al. Combined Posterior Vitrectomy and Ahmed Valve Implantation with Prior Antiangiogenic Application for the Management of Neovascular Glaucoma: A Case Series Study. J Curr Glaucoma Pract 2025;19(1):3-7.
Glaucoma, a multifactorial disease, currently leads the causes of irreversible blindness globally, with complex underlying pathophysiology. For a long time, decreasing intraocular pressure (IOP) has remained the desired primary outcome for each modality of glaucoma management-medical, laser, or surgical. However, the understanding of non-IOP-dependent mechanisms and the identification of additional risk factors affecting optic nerve health have extended the range of preventive and therapeutic options for tackling glaucoma in a more holistic manner. Adopting a healthy lifestyle has been the key to managing all chronic diseases, especially cardiovascular disorders and diabetes, with proven benefits in significantly reducing their incidence and severity. Glaucoma is recognized as a chronic degenerative ailment of the second cranial nerve, and lately, there has been a tremendous upsurge in the subject to evaluate the potential role of lifestyle factors like diet, nutrition, exercises, sleep postures, and smoking in relation to the health of the optic nerve. Existing evidence suggests that some modifications in lifestyle have positive impact in preventing development and retarding its progression, although some findings are conflicting. This write-up aims to furnish a comprehensive overview of the same by analyzing existing evidence and summarizing the repercussions of different lifestyle factors-namely diet and nutritional supplements or exercises-on IOP or the perfusion pressure of the eye, which ultimately leads to retinal ganglion cell loss and optic neuropathy. Knowledge of their putative role as preventive or supportive medicine in glaucoma management can empower both patients and glaucoma specialists in mitigating the agony of the disease affecting the quality of life. Saha BC, Kumari R, Onkar A, et al. Lifestyle Modification as Complementary Medicine in Glaucoma Management. J Curr Glaucoma Pract 2025;19(1):38-49.
A previously developed machine-learning approach with Kalman filtering technology accurately predicted the disease trajectory for patients with various glaucoma types and severities using clinical trial data. This study assesses performance of the KF approach with real-world data. Retrospective cohort study. We tested the performance of a previously validated KF model (PKF) initially trained using data from the African Descent and Glaucoma Evaluation Study and the Diagnostic Innovations in Glaucoma Study in patients with different types and severities of glaucoma receiving care in the United Kingdom (UK), comparing the predictive accuracy to 2 conventional linear regression (LR) models and a newly developed KF trained on UK patients (UK-KF). A total of 3116 patients with open-angle glaucoma or suspects were divided into training (n=1584) and testing (n=1532) sets. The predictive accuracy for MD within 2.5 dB of the observed value at 60 months' follow-up for PKF (75.7%) was substantially better than those for the LR models (P < .01 for both) and similar to that for UK-KF (75.2%, P = .70). The proportion of MD predictions in the 95% repeatability intervals at 60 months' follow-up for PKF (67.9%) was higher than those for the LR models (40.2%, 40.9%) and similar to that for UK-KF (71.4%). This study validates the performance of our previously developed KF model on a real-world, multicenter patient population. Our model substantially outperforms the current clinical standard (LR) and forecasts well for patients with different glaucoma types and severities. This study supports the generalizability of PKF performance and supports prospective study of implementation into clinical practice.
Erectile dysfunction (ED) and primary open-angle glaucoma (POAG) are common in the elderly population. The current study aimed at assessing the incidence of ED and its correlation with POAG severity in Malaysia. A cross-sectional study at three Malaysian suburban ophthalmology clinics was conducted from September 2019 to 2020. A total of 220 participants aged 40-80 years completed a validated Malay version of the International Index of Erectile Function-5 (IIEF-5). Glaucoma severity was classified using a revised Advanced Glaucoma Intervention Study (AGIS) score. Medical history, ocular parameters, and treatments were reviewed. The participants' mean age was found to be 69.3 (±7.5) years, with prevalence of ED being 91%. IIEF-5 scores significantly declined with increasing glaucoma severity (p < 0.001), even after adjusting for comorbidities and topical beta-blockers. AGIS and IIEF-5 scores were significantly correlated (r = -0.262, p = 0.010). The incidence of ED increased by 1.23 times (OR = 1.23, 95% CI: 1.10-1.38) with the increase of every year in age. ED was not influenced by diabetes, hypertension, hyperlipidemia, or topical beta-blockers. ED is common among POAG patients and increases with glaucoma severity. The association between ED and POAG is influenced by aging, complicating the determination of a direct relationship. This study highlights the potential association between vision impairment, specifically glaucoma, and sexual health in men. Focusing on sexual health in glaucoma patients is vital in order to improve overall quality of life (QoL) as well as ensure a holistic approach to patient care. Given the commonness of both conditions in older adults, this research provides insights into the significance of taking sexual health into consideration in the comprehensive treatment of glaucoma. Chee CC, Sabah H, Yaakub A, et al. Erectile Dysfunction in Patients with Primary Open-angle Glaucoma in Malaysia. J Curr Glaucoma Pract 2025;19(2):79-84.
The objective of this study is to determine the prevalence of female sexual dysfunction (FSD) in older adults with primary open-angle glaucoma (POAG) and its correlation with the severity of visual field (VF) defects. Additionally, potential associated factors with FSD were identified. This cross-sectional study included a total of 210 female patients with POAG, aged between 40 and 80 years, from three tertiary centers in two states of Malaysia, conducted between September 2019 and 2020. FSD was assessed using the self-administered Bahasa Malaysia version of the Female Sexual Function Index-6 (MvFSFI-6), with scores of ≤19 indicating FSD. The severity of POAG was evaluated using the modified Advanced Glaucoma Intervention Study (AGIS) scoring system, predicated on two reliable consecutive VFs evaluated by two masked investigators, categorizing the condition as mild, moderate, or severe. Medical records were reviewed for POAG management and other systemic comorbidities. Sociodemographic data, including education and living status, were obtained from the participants. The participants' average age was 66.7 (7.9) years. The prevalence of FSD is 78.5%. MvFSFI-6 scores decreased with age (r = -0.88; p < 0.001) and revealed an exponential decline with increasing AGIS scores (r = -0.238, p = 0.010). Higher education was correlated with a 67% decreased possibility of experiencing FSD (OR = 0.33, 95% CI 0.12-0.88). FSD is common among female patients with POAG. Sexual well-being is a crucial factor for women with POAG, particularly those with severe VF defects and lower education levels. Ophthalmologists, gerontologists, and women's health experts need to address this issue to ensure a better quality of life (QoL) for older adults. Sexual dysfunction (SD) among women with POAG increases with the severity of the disease, especially among those with lower education levels. To ensure a good QoL for these women, sexual function should be included in the comprehensive management of POAG. Chee CC, Sabah H, Yaakub A, et al. Severity of Primary Open-angle Glaucoma and Female Sexual Dysfunction among Older Adults in Malaysia. J Curr Glaucoma Pract 2024;18(4):155-161.
To evaluate the effect of sub-Tenon's triamcinolone acetonide (TA) on the hypertensive phase (HP) and postoperative outcomes in patients with neovascular glaucoma (NVG) after Ahmed glaucoma valve (AGV) surgery. We conducted a retrospective review of 112 NVG patients (58 TA, 54 non-TA) who underwent AGV implantation with a 6-month follow-up. HP was defined as intraocular pressure (IOP) > 21 mm Hg within the first 3 months. Primary outcomes included IOP and HP occurrence. Secondary outcomes included complications, number of glaucoma drops, surgical failure, and visual acuity (VA). Non-TA patients were significantly more likely to develop HP (70 vs 50%, p = 0.03). Mean IOP (18.34 ± 7.96 vs 17.75 ± 6.16 mm Hg, p = 0.75), VA (1.46 ± 0.96 vs 1.32 ± 0.94 logMAR, p = 0.56), surgical failure (63 vs 48%, p = 0.13), rates of complication (9.3 vs 5.2%, p = 0.48), and number of glaucoma eye drops (2.59 ± 1.38 vs 2.18 ± 1.63, p = 0.29) were similar at 6 months. Compared to baseline, significant IOP reductions were observed in the TA group at month 1 (-24.62 ± 16.60 vs -18.43 ± 14.39 mm Hg, p = 0.05) and month 3 (-25.65 ± 14.05 vs -19.05 ± 13.14 mm Hg, p = 0.03). Sub-Tenon's TA reduces the risk of HP and short-term IOP spikes in NVG patients undergoing AGV implantation but does not improve long-term IOP regulation, visual outcomes, or surgical success. Reducing HP may help prevent early postoperative complications, improving short-term management of NVG patients receiving AGV implants. Hong AT, Kishi SH, Humayun L, et al. Effect of Sub-Tenon's Triamcinolone on Hypertensive Phase and Clinical Outcomes Following Ahmed Glaucoma Valve Implantation in Neovascular Glaucoma Patients. J Curr Glaucoma Pract 2025;19(3):129-135.