To evaluate the accuracy and appropriateness of responses provided by ChatGPT in identifying congenital glaucoma from a series of written and image-based prompts. A series of questions regarding common signs and symptoms of congenital glaucoma were developed and queried to ChatGPT-3.5 and ChatGPT-4.0, and a set of publicly available images of patients with congenital glaucoma were queried to the image search function of ChatGPT-4.0. Outputs were graded by three pediatric ophthalmologists with expertise in congenital glaucoma. Completeness of response, accuracy, potential for harm, and concern for glaucoma were assessed by each reviewer. A higher proportion of prompt responses from ChatGPT-4.0 were graded to be acceptable/appropriate than from ChatGPT-3.5 (22/33 vs 9/33 [P = 0.001]) among text-based queries. A higher proportion of ChatGPT-4.0 responses were felt to raise appropriate concern for congenital glaucoma (8/11 vs 2/11 [P = 0.03]) and a lower proportion of responses had incorrect or inappropriate information of major clinical significance (0/33 vs 6/33 [P = 0.02]) than ChatGPT-3.5 responses. There was no significant difference in the proportion of responses from ChatGPT-3.5 and ChatGPT-4.0 that were deemed to have potential likelihood of harm (P = 0.17). Among clinical images queried to ChatGPT-4.0, responses to two of three images were universally felt to be unacceptable with a major amount of incorrect or inappropriate clinical information and high/definitive likelihood of harm. Among readability indices, the SMOG Index score showed more difficult readability scores for ChatGPT-4.0 than for ChatGPT-3.5 (14.8 ± 1.2 vs 14.0 ± 1.4 [P = 0.009]). Despite superior performance from ChatGPT-4.0 compared with ChatGPT-3.5 in raising concern for congenital glaucoma and appropriateness of responses from text-based prompts, it performed poorly in recognizing clinical images of congenital glaucoma.
To summarize the main topics discussed during the 29th Annual Optic Nerve Rescue and Restoration Think Tank Meeting "THE FUTURE OF GLAUCOMA: HARNESSING DATA, AI, AND PRECISION MEDICINE FOR PATIENT-CENTERED CARE" held in New York on June 20th and 21st 2025. The main findings from presentations focusing on data integration and the application of artificial intelligence (AI) to advance the understanding of primary open-angle glaucoma pathogenesis, as well as to improve disease diagnosis and management, are summarized. The researchers discussed the importance of data integration for AI development, highlighting the specific challenges in the field of glaucoma, including data standardization and sharing, and the initiatives of the National Institutes of Health (NIH) and National Eye Institute (NEI) in this context. Specific examples of the use of AI tools for advancing the knowledge in glaucoma pathophysiology, diagnosis and management are showcased. AI is improving the understanding of glaucoma and enhancing its diagnosis and management. The NEI and NIH are spearheading several initiatives in AI, Ophthalmology, and Glaucoma; yet glaucoma as a disease entity remains without a unified definition. There is also a need to measure critical glaucoma endophenotypes with devices that possess uniform standards. For imaging devices, interoperability across platforms and data unfettered access could improve patient care and advance our understanding of glaucoma. With its rich data resources, the glaucoma community is uniquely positioned to lead a cultural shift, enabling larger datasets, stronger collaboration, and future studies that would help translate AI advances into clinical care.
The role of optometrists in glaucoma care is evolving rapidly in many parts of the world. This review aims to describe the current global scope of clinical practice for optometrists with respect to glaucoma, highlighting progress and identifying barriers to care across diverse regions. We reviewed the current landscape of optometric glaucoma practice across Africa, Australia and New Zealand, Canada, Europe, the United Kingdom (UK), and the United States of America (USA). The review of practice in each region was led by authors active in the region using, where possible, publicly available legislation, published guidelines, and peer-reviewed publications. For Africa and Europe, where the general scope of practice and training level of optometrists varies by country, we used the World Council of Optometry Competency Framework and the European 'Blue Book' to benchmark levels of proficiency and standardize comparisons between jurisdictions. A survey was also distributed to optometrists across Europe to collect further information on glaucoma practice patterns, given the lack of published information for many European countries. No countries with optometry in Asia, Mexico, the Greater Caribbean Region, Central, or South America were included in this review. The global landscape is characterized by a significant shift from traditional 'case-finding' to comprehensive diagnostic and therapeutic management. In the USA, all 50 states permit independent topical therapy, with an increasing number authorizing laser procedures. In the UK and New Zealand, independent prescribing and expanding roles in laser procedures are also available to optometrists with higher qualifications. Conversely, Europe and Africa exhibit stark variations between countries; while countries, such as Ghana and Nigeria, train to the Doctor of Optometry level with high nominal scope, 'effective' scope is often constrained by equipment shortages and high medication costs. A 'regulatory lag' persists in some regions, where legislative expansion has not yet translated into broad clinical uptake. Optometrists are increasingly essential to patient access and sustainable glaucoma care delivery. Although educational and training standards continue to improve, significant barriers-including regulatory restrictions, inconsistent public funding, and resource limitations-must be addressed to optimize optometry's role in addressing the global burden of glaucoma.
GATT was effective in decreasing the IOP and the number of glaucoma medications significantly in patients with UG. Active uveitis at the time of surgery was associated with a higher likelihood of requiring glaucoma medications. To study the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in uveitic glaucoma (UG). This was a prospective interventional case series that included 42 eyes of 35 patients with open angle UG who required glaucoma surgery. Cases requiring combined GATT and cataract surgery were excluded. Surgical success was defined as achieving an IOP ≤21 mm Hg and a ≥30% IOP reduction on the same or fewer medications, without additional glaucoma interventions. The primary outcomes were changes in IOP and the number of glaucoma medications. Secondary outcomes included the success rate and complications. After a 12-month follow-up period, the IOP was reduced from 31±10.6 to 12.5±2.5 mm Hg ( P <0.001), representing a 62.11%±25.09% reduction. The number of glaucoma medications decreased from 3.67±1.18 to 0.97±1.12 ( P <0.001). Mean BCVA (log MAR) improved from 0.62±0.79 preoperatively to 0.51±0.72 at 12 months ( P =0.054). At the final follow-up, complete success was achieved in 21 eyes (50%), qualified success in 16 eyes (38.1%), and failure in 5 eyes (11.9%). No serious complications were encountered. The only significant adverse prognostic factor was uveitis activity at the time of surgery, which was associated with a higher likelihood of requiring glaucoma medications ( P =0.04, OR=4.85). GATT is a safe and effective procedure for UG. The outcome is influenced by the uveitis activity at the time of surgery, which can result in the need for more antiglaucoma medications postoperatively.
The Susanna Glaucoma Drainage Device achieved sustained 5-year IOP and medication reduction, with a 80.9% success rate and favorable safety profile, supporting its effectiveness for long-term management of refractory glaucoma. To evaluate the 5-year outcomes of the Susanna Glaucoma Drainage Device for the treatment of glaucoma. Medical records from consecutive patients aged 18 years or older with glaucoma who underwent implant surgery with the Susanna Glaucoma Drainage Device from January 2017 to january 2020 were included. The primary outcome was success, defined as IOP ≥6 and <18 mmHg for and absence of loss of light perception or additional glaucoma surgery. Secondary outcomes included IOP, hypotensive therapy, adverse events, and surgical interventions. A total of 104 patients were included, mean patient age was 60.8±17.6 years. Mean preoperative IOP was 29.9±11.6 mmHg under 2.8±0.9 glaucoma medications. At 5 years, the cumulative success rate was 80.9%. IOP and medication use were significantly reduced at all postoperative visits. At 5 years, mean IOP was 13.4±3.6 mmHg (55.2% reduction, P<0.001), and mean medication use was 1.9±1.4 (32.1% reduction, P<0.001). The primary reason for failure was elevated IOP (38.9%). Five patients underwent glaucoma reoperation to lower IOP; two cases were treated with cyclophotocoagulation, while three underwent a second SGDD inferiorly. Hypotony-related failure was observed in one case. Among the failures, five patients developed significant vision loss (27.8%). The Susanna implant effectively reduced IOP and medication dependence over 5 years. It demonstrated a high success rate (80.9%) and sustained pressure control. These findings support the long-term efficacy of the Susanna implant in managing refractory glaucoma.
In complex cases of secondary glaucoma following vitreoretinal surgery (VR) where patients require both intraocular pressure (IOP) control and treatment of coexisting vitreoretinal (VR) pathology, a combined surgical approach with VR surgery and glaucoma drainage devices (GDD) may be necessary. However, there is limited literature on the outcomes of PAUL® Glaucoma Implant (PGI) implantation in conjunction with pars plana vitrectomy (PPV). The goal of this study was to evaluate the clinical outcomes and safety of simultaneous combined PGI implantation and pars plana vitrectomy (ppV) in patients with complex or refractory glaucoma requiring concurrent VR surgery. This monocentric retrospective case series included six eyes of six patients who underwent combined PGI implantation and PPV at the University Eye Hospital Bonn, Germany, between October 2022 and March 2024. Pre- and postoperative data on IOP, best-corrected visual acuity (BCVA), number of glaucoma medications, complications, and reinterventions were collected over a minimum follow-up period of 12 months. Mean preoperative IOP was 34.0 mmHg (31-38 mmHg), which decreased to 12.01 mmHg (8 - 14 mmHg) after 12 months. The mean number of IOP-lowering medications was reduced from 2.83 (1-5) to 1.8 (0-2) without requiring systemic acetazolamide. BCVA improved from a mean of 1.80 logMAR to 1.15 logMAR. Complications included tube migration with exposure requiring explantation, silicone oil-related tube occlusion, and transient hyphema. Combined PGI implantation and PPV provided effective IOP control with an acceptable safety profile. These findings suggest that this combined approach represents a viable surgical option for challenging glaucoma cases requiring simultaneous vitreoretinal intervention.
AGV implantation through the ciliary sulcus offers similar IOP control to anterior chamber insertion with reduced corneal endothelial cell loss, despite technical difficulties during the insertion process. To report the surgical outcomes of Ahmed glaucoma valve (AGV) implantation through the ciliary sulcus (CS). We performed a retrospective analysis of 204 eyes of 204 patients with AGV implantation through the CS and 85 eyes of 85 patients with AGV implantation through the anterior chamber (AC). The cumulative probability of success was defined as an IOP between 5 and 18 mmHg and reduction of IOP≧20% from the preoperative IOP. Kaplan-Meier analysis evaluated success up to five years. AGV-CS/AC eyes included POAG (74/12 eyes), PACG (8/0), XFG (62/50), NVG (4/1) and secondary glaucoma (56/22), respectively. There was no significant difference in qualified success rates of AGV-CS (89.7%) and AGV-AC (87.1%). Intraoperative tube insertion difficulties occurred in 47 eyes (23.0%) in the CS group and none in the AC group. Layered hyphema was more frequently observed in CS group (25 eyes, 12.3%) than in AC group (5 eyes, 5.9%). The monthly loss of corneal endothelial cell density (per mm 2 ) was significantly lower in CS group (14.5±20.4) than in AC group (24.5±34.3). Although the higher rates of intraoperative troubles for insertion and postoperative hyphema were observed, the IOP control of AGV-CS insertion is comparable to that of AC insertion with less detrimental effects on the corneal endothelium. With appropriate techniques, CS is a reasonable insertion site for refractory glaucoma.
To investigate the association between endogenous estrogen exposure and intraocular pressure (IOP) in postmenopausal women stratified by glaucoma status. This population-based, cross-sectional study analyzed 1,823 postmenopausal women aged ≥50 years from the Korea National Health and Nutrition Examination Survey (2010-2011). Age at menarche, and menopause, reproductive span, and time since menopause were used as surrogate markers of lifetime estrogen exposure. Multivariate linear regression analyses were performed for the non-glaucoma and glaucoma groups, adjusting for confounders. Among women without glaucoma, indicators of longer estrogen exposure were significantly associated with higher IOP. Menopause at the age of ≥49 years and reproductive span of ≥33 years were associated with IOP increases of 0.79 mmHg and 0.88 mmHg, respectively. Conversely, in women with glaucoma, longer estimated estrogen exposure was associated with lower IOP. Menopause at ≥48 years of age and reproductive span at ≥31 years were not associated with IOP reduction. These findings demonstrate distinct associations between endogenous estrogen exposure proxies and IOP in women with and without glaucoma. Our results suggest a context-dependent role of estrogen in ocular physiology, with potential implications for glaucoma risk assessment and the development of preventive strategies in aging women.
Geriatric assessment scores, including Mini-Cog, G8, and age-adjusted Charlson Comorbidity Index, improve the prediction of severe hemorrhagic complications after glaucoma surgery, enabling more individualized risk stratification in glaucoma patients. To investigate the associations between various postoperative complications and background factors-including geriatric assessment (GA) scores-and to evaluate the predictive value of GA-based risk stratification for severe hemorrhagic complications following glaucoma surgery. Retrospective observational case series. A total of 729 eyes from 464 Japanese patients (mean age±SD, 70.2±12.4 y) who underwent glaucoma surgery with perioperative GA assessment at Shimane University Hospital. Geriatric assessments, including Mini-Cog, G8, and age-adjusted Charlson Comorbidity Index (ACCI), were conducted preoperatively. Surgical complications and interventions were comprehensively collected and analyzed in relation to multiple background factors using both univariate and multivariate statistical models. Predictive performance for severe hemorrhagic complications (vitreous hemorrhage and hemorrhagic choroidal detachment) was assessed via machine learning algorithms. Postoperative complications occurred in 37% of eyes, with 8% experiencing severe hemorrhagic complications. Multivariate analysis identified low Mini-Cog scores ( P <0.0001) and high ACCI scores ( P =0.003) as independent risk factors for severe hemorrhagic events. The inclusion of GA scores with age enhanced predictive performance, achieving an area under the curve (AUC) of up to 0.96. Optimal thresholds for high-risk identification were age ≥80 years, Mini-Cog score ≤4, G8 score ≤14, and ACCI score ≥5. GA scores are significantly associated with the risk of severe hemorrhagic complications after glaucoma surgery. Integrating GA-based risk stratification with traditional background factors enhances the prediction of high-risk cases, facilitating more individualized and safer surgical planning for elderly patients with glaucoma.
To investigate the long-term medical and surgical treatment of patients with primary open-angle glaucoma (POAG). This retrospective cohort study analyzed data from the Health Insurance Review and Assessment Service (HIRA) database in Korea, focusing on patients newly diagnosed with POAG in 2010. The study examined glaucoma eye drop prescriptions and the occurrence of glaucoma surgery over a 10-year period, from 2010 to 2020. The main outcome measures included changes in glaucoma eye drop prescriptions and the cumulative incidence of glaucoma surgery following the initial diagnosis of POAG. A total of 1,599 patients with POAG were enrolled. Prostaglandin analogue eye drops monotherapy was the most frequently prescribed glaucoma eye drop prescriptions in the first year (39.9%). The average number of prescribed glaucoma eye drops per patient was 1.19 in the first year and significantly increased to 1.40 by the tenth year. Similarly, the average number of prescribed ingredients per patient increased from 1.54 to 1.99 over the same period. The cumulative incidence of glaucoma surgery over 10 years was 3.1% (2.9% in males and 3.4% in females). This study quantitatively confirmed an increase in glaucoma medication use in patients newly diagnosed with POAG over a 10-year treatment period. Additionally, it reveals the incidence of glaucoma surgery based on sex and age. These findings provide valuable evidence for consulting patients with glaucoma.
Peripapillary retinal nerve fiber layer thickness (pRNFLT) artifacts were more prevalent than Bruch's membrane opening-minimum rim width (BMO-MRW) artifacts in pathologic myopia. Considering artifacts, the diagnostic performance of pRNFLT and BMO-MRW was comparable. To investigate the prevalence of peripapillary retinal nerve fiber layer thickness (pRNFLT) and Bruch's membrane opening-minimum rim width (BMO-MRW) artifacts in pathologic myopia (PM) and the impact of artifacts on the diagnostic ability for open-angle glaucoma (OAG). This cross-sectional study was conducted at Zhongshan Ophthalmic Center. PM eyes were divided into two groups based on OAG diagnosis. Artifacts of pRNFLT and BMO-MRW were classified and their prevalences were compared. The diagnostic ability of pRNFLT and BMO-MRW for OAG was compared before and after the inclusion of eyes with artifacts. A total of 136 participants with PM were included from July 2023 to January 2025, with a median (interquartile range) age of 49 (16) years and mean (standard deviation) axial length of 28.03 (2.01) mm. Seventy-four (54.4%) eyes were diagnosed as OAG. Seven and three types of pRNFLT and BMO-MRW artifacts were observed, respectively. Presence of pRNFLT artifacts was identified in 74.2% of eyes in the PM group and 63.5% of eyes in the PM with OAG (PMG) group, which was more prevalent than BMO-MRW artifacts (27.4% in the PM group and 4.1% in the PMG group, both P<0.001). Before and after including eyes with artifacts, the AUC of global RNFLT decreased from 0.927 to 0.869, and the AUC of global BMO-MRW slightly decreased from 0.884 to 0.882. Artifacts of pRNFLT were more complex and prevalent than those of BMO-MRW. In PM, the diagnostic ability of pRNFLT and BMO-MRW were comparable when artifacts were considered.
Angle width and iris area measured by anterior OCT are increasingly predictive of intraocular pressure and ocular hypertension below parameter-specific angle width cutoffs. Cumulative gonioscopy score is weakly predictive below all score cutoffs. To assess ocular biometric determinants of intraocular pressure (IOP) and risk factors for ocular hypertension (OHTN). CHES participants underwent Goldmann applanation tonometry, gonioscopy, ultrasound A-scan, and anterior segment OCT (AS-OCT) imaging. Biometric data from one eye per participant were used to develop linear and logistic regression models of IOP and OHTN (IOP >21 mm Hg), respectively, below different angle width cutoffs adjusted for central cornea thickness (CCT). A total of 2360 eyes of 2360 eligible participants (1518 female, 842 male) were analyzed. Mean age was 60.2±7.8 years. Multivariable stepwise linear regression models and change-point analysis showed that below a trabecular iris space area (TISA 750 ) measurement of 0.08 mm 2 , models became increasingly predictive of IOP up to an adjusted R 2 of 0.84. Smaller TISA 750 and iris area (IA) were the only parameters consistently associated ( P ≤0.04) with higher IOP for TISA 750 below 0.20, 0.10, and 0.05 mm 2 . In multivariable models of OHTN (AUC≤0.95), smaller TISA 750 was associated with OHTN for TISA 750 <0.20, 0.10, and 0.05 mm 2 ( P ≤0.03), while IA was associated with OHTN for TISA 750 <0.05 mm 2 ( P ≤0.03). Cumulative gonioscopy score (sum of gonioscopy grades) was weakly predictive of IOP at all cutoffs (adjusted R 2 ≤0.08). TISA 750 and IA become strongly predictive of IOP when angle width decreases below a TISA 750 cutoff of 0.08 mm 2 . The relationship between cumulative gonioscopy score and IOP is weak below all gonioscopy score cutoffs. AS-OCT measurements could supplement gonioscopy by helping identify individuals at higher risk for elevated IOP from angle closure.
Aqueous humor outflow (AHO) is significantly lower in primary angle closure glaucoma (PACG) compared with primary open angle glaucoma (POAG). To quantitatively compare circumferential, perilimbal aqueous humor outflow (AHO) pathways in patients of primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) using aqueous angiography (AA). Thirty-two eyes of 32 patients were included, with 16 patients with POAG and 16 age-matched patients with PACG presenting with age-related cataract and planned phacoemulsification surgery. IOP and the number of antiglaucoma medications (AGMs) were noted. All patients underwent AA with 0.1% indocyanine green dye injected into the anterior chamber before the capsulorrhexis step, followed by capture of images up to 60 seconds. Images at 60 seconds were exported for image analysis, in which the mean gray value was assessed to calculate angiographic signal intensity (ASI) along the limbus into 8 sectors (45 degrees each), 4 quadrants (90 degrees each), and overall flow (360 degrees) for POAG and PACG. Statistical tests for the relationship of age and severity of disease with overall flow were performed. The mean age (years) was 58.8±5.8 (POAG) and 59.8±8.6 (PACG) [ P =0.704]. The mean preoperative IOP [POAG (16.5±2.48 mm Hg) and PACG (18.44±4.03 mm Hg)] and median number of AGMs {POAG [3 (1.75-3.25)] and PACG [3 (2.75-4)]} between the 2 groups were comparable ( P >0.05). There was no significant difference in the severity of baseline disease between POAG (MD=-16.79±8.73) and PACG (MD=-16.39±9.57), P =0.904. The overall flow was lower in PACG [123.72 (105.18-205.68)] compared with POAG [188.32 (163.58-234.40)], P =0.029. In multivariate linear regression analysis, higher overall flow in POAG compared with PACG (β=56.705, P =0.010) was noted. The correlation with age [POAG ( r =-0.267, P =0.316); PACG ( r =-0.301, P =0.256)] and MD [POAG ( r =0.106, P =0.697); PACG ( r =0.515, P =0.044)] was documented. Both POAG and PACG had segmental AHO. PACG eyes had lower functional AHO compared with POAG in phakic, dilated patients. With increasing disease severity, a decrease in overall flow was noted in PACG.
This study investigated RNFL asymmetry in 834 African ancestry patients with primary open-angle glaucoma. Associated with optic disc and visual field differences, RNFL asymmetry may signal early glaucomatous damage. Primary open-angle glaucoma (POAG) disproportionately affects individuals of African ancestry, with retinal nerve fiber layer (RNFL) asymmetry being a potential early marker of glaucomatous damage. This study aimed to determine the prevalence of RNFL asymmetry and to identify associated demographic, clinical, and ocular factors in individuals of African ancestry with POAG. This cross-sectional study included 834 POAG cases from the Primary Open-Angle African American Glaucoma Genetics study who had bilateral RNFL thickness measurements. RNFL asymmetry was defined as an interocular RNFL thickness difference of >9 µm. Demographic, clinical, and ocular characteristics were compared between individuals with and without RNFL asymmetry using univariable and multivariable logistic regression. Among 834 POAG cases, 32.09% (95% CI: 28.93-35.38%) had RNFL asymmetry. In univariate analysis, compared to patients without RNFL asymmetry, patients with asymmetry exhibited significantly larger differences in the following: average and vertical cup-to-disc ratio (CDR), visual field (VF) mean deviation (MD), and pattern standard deviation (PSD), rim area, and cup volume (P<0.001). In their worse eye, patients with RNFL asymmetry had a smaller rim area (P<0.001) and a larger average and vertical CDR (P=0.002, P<0.001, respectively). In multivariate analysis, greater rim area difference (OR: 1.92, P<0.001) and a more negative PSD difference (OR: 0.69, P<0.001) were significantly associated with risk of RNFL asymmetry. In POAG patients of African ancestry, RNFL asymmetry is linked to optic disc structural asymmetries and-in a subset with available visual field data-functional asymmetries. These findings suggest RNFL asymmetry may indicate asymmetric glaucomatous damage, though prospective validation with comprehensive functional testing is needed to establish clinical utility.
Background/Objectives: Glaucoma is one of the leading causes of irreversible blindness worldwide. Open-angle glaucoma (OAG) predominates in East Asian populations, with normal-tension glaucoma accounting for the majority of cases. Although intraocular pressure remains the most established risk factor, non-pressure-dependent mechanisms, including ocular vascular dysregulation, warrant further investigation. Cold extremities, a hallmark of Flammer syndrome reflecting primary vascular dysregulation, and underweight (body mass index [BMI] < 18.5 kg/m2) are each independently associated with OAG; however, their combined effect has not been examined at the population level. Materials and Methods: Using nationally representative data from the Korea National Health and Nutrition Examination Survey 2008-2012 (n = 8135; controls 7418, OAG 717), participants aged ≥ 50 years with measured intraocular pressure within the normal range (5-21 mmHg) at the time of examination were classified into four groups: non-underweight without cold extremities (N-N, reference), cold extremities only (CEO), underweight only (UWO), and underweight with cold extremities (UW+CE). Complex sample logistic regression was adjusted for sex, age, diabetes mellitus, mean arterial pressure, intraocular pressure, and spherical equivalent. Results: UW+CE was associated with significantly higher odds of OAG than N-N (adjusted odds ratio [OR] = 2.10, 95% confidence interval: 1.14-3.88, p = 0.018), whereas neither CEO (OR = 1.10, p = 0.431) nor UWO (OR = 1.54, p = 0.170) was significantly associated individually. This association with UW+CE remained robust across alternative BMI thresholds and after further adjustment for socioeconomic, lifestyle, and cardiometabolic variables. Conclusions: Co-occurring cold extremities and underweight status were associated with a combined hemodynamic risk profile for OAG, suggesting their potential utility as clinically accessible noninvasive markers for the early identification of highly vulnerable individuals and informing proactive glaucoma screening strategies.
Glaucoma patients of similar age and educational level, compared with healthy individuals, exhibit a greater number of saccades and fixations during eye-tracking-aloud reading, resulting in reduced reading speed. To evaluate reading performance in patients with glaucoma compared with controls using an eye tracker and to explore the potential confounding effects of patients' contrast sensitivity and cognition. A cross-sectional study was conducted with 111 participants (57 with glaucoma and 54 controls) with a best-corrected visual acuity of ≥0.5 logMAR. Cognition was assessed using the Montreal Cognitive Assessment, and contrast sensitivity was measured with the Freiburg Visual Acuity and Contrast Test. A reading performance evaluation was conducted using the Minnesota Low Vision Reading Test displayed on slides on a computer screen. Reading speed was calculated in words per minute, and an eye tracker was used to analyze saccade and fixation patterns during the reading task. Mean age was 61.8 (±11.6) and 66.5 (±13.7) in the glaucoma and control groups, respectively ( P =0.05). Best-corrected visual acuity was 0.18 (±0.16) and 0.04 (±0.10) logMAR in the glaucoma and control groups, respectively ( P <0.001). Montreal Cognitive Assessment score was 21.8 (±3.5) in the glaucoma and 21.4 (±4.0) in the control group ( P =0.566). A total of 26% of the glaucoma group and 33% of the control group had at least a primary education. Controls read faster and showed fewer saccades and fixations than patients with glaucoma ( P <0.05) across all 5 slides. Patients with glaucoma exhibit poorer reading performance, as evidenced by eye-tracking data, compared with controls of similar age, cognitive function, and educational level.
To highlight the overlooked role of ocular surface disease (OSD) in glaucoma, explore its pathophysiological links to treatment, and propose integrated strategies to improve patient care. A narrative review of current literature on the relationship between glaucoma therapies and ocular surface health was conducted. Evidence on prevalence, mechanisms, diagnostic approaches, and management strategies for OSD in glaucoma patients was reviewed. Glaucoma remains the leading cause of irreversible blindness worldwide, with treatment adherence being a critical determinant of long-term outcomes. Chronic use of topical intraocular pressure (IOP)-lowering eye drops, particularly those containing benzalkonium chloride (BAK), induces epithelial and goblet cell toxicity, tear film instability, and ocular inflammation. The prevalence of OSD in glaucoma patients is markedly higher than in the general population, affecting up to 60%. Symptoms such as dryness, burning, and blurred vision significantly reduce quality of life and compromise adherence to treatment. Emerging alternatives, including preservative-free formulations, selective laser trabeculoplasty, and minimally invasive glaucoma surgery, provide opportunities to reduce ocular surface burden. Structured evaluation using questionnaires, slit-lamp examination, and diagnostic tests can facilitate early detection and tailored management. The ocular surface, long considered secondary in glaucoma care, is central to optimizing both adherence and visual outcomes. Protecting ocular surface health through preservative-sparing regimens, procedural interventions, and patient-centered strategies is essential. Reframing OSD as an integral component of glaucoma management may improve long-term quality of life and enhance treatment success.
To understand the challenges faced by family members or friends providing informal care and support to patients with low-vision glaucoma seeking treatment at the Presbyterian Hospital, Agogo in the Ashanti region of Ghana. The study employed a qualitative design using semi-structured in-depth interviews to explore the lived experiences of informal caregivers of patients with low vision due to glaucoma. Participants were purposively selected at the hospital during patients' review visits, as they accompanied them for care. Data were collected through audio-recorded interviews in Akan (Twi) guided by open-ended questions until thematic saturation was achieved. Transcripts were analysed using abductive thematic analysis, combining inductive coding with interpretation informed by the Stress Process Model. The study involved 11 informal caregivers, out of which 8 were females. The study identified 4 main themes and 10 subthemes. These included caregiving roles (basic activities of daily living, instrumental activities of daily living and emotional support), caregiving challenges (practical challenges, emotional challenges and financial challenges), coping strategies (adaptive and maladaptive coping strategies) and recommendations to clinicians (quantity of medication, review appointments and health education). Caregivers of patients with low-vision glaucoma face practical, financial and emotional challenges that may require caregiver support, patient education and improved access to eye care services. Addressing these needs may be vital to enhance caregiver resilience, reduce caregiver burden and improve patient outcomes.
Higher age-adjusted Charlson Comorbidity Index scores were significantly associated with increased odds of glaucoma progression, with differential effects by disease stage and baseline comorbidity burden, supporting integration of systemic health assessment into glaucoma risk stratification. To evaluate whether higher comorbidity burden, measured by the age-adjusted Charlson Comorbidity Index (age-CCI), is associated with increased odds of glaucoma progression over a 5-year-period. This retrospective cohort study included 11,863 patients aged 18 years of age or older diagnosed with primary open angle glaucoma, preglaucoma, or ocular hypertension at the Cole Eye Institute between 2018 and 2024 with at least 5 years of follow-up. Age-CCI scores were calculated using the 19-item index based on ICD-10 diagnoses. Glaucoma severity was categorized as early-stage, moderate-stage, or severe-stage. Patients were stratified into tertiles by age-CCI: T1 (n=3966, mean age-CCI=1.7), T2 (n=3967, mean=3.8), and T3 (n=3930, mean=7.1). Multivariate logistic regression examined associations between age-CCI and disease progression, adjusting for demographic and clinical covariates. Mean age was 72.6 years, and mean age-CCI was 4.2. Each one-point increase in age-CCI was associated with a 6% increased odds of progression from early-stage to moderate-stage (OR=1.06, 95% CI: 1.04-1.09, P=1.05×10⁻⁷) and 9% increased odds of progression to severe-stage (OR=1.09, 95% CI: 1.06-1.13, P=2.88×10-7). Stratified analyses revealed age-CCI was associated with progression to moderate-stage only in T1 (OR=1.34, P=8.94×10⁻⁸) and progression to severe-stage only in T3 (OR=1.07, P=0.03). Male sex, Black race, public insurance, ophthalmic procedure history, and additional prescribed medications were independently associated with higher odds of progression. Higher comorbidity burden, as measured by age-CCI, is significantly associated with glaucoma progression, with associations varying by disease stage and baseline comorbidity level. The age-CCI may serve as a practical risk stratification tool for targeted glaucoma management.
The Excavation Index is a novel OCT-based parameter quantifying optic nerve head excavation, showing independent associations with RNFL thickness and lamina cribrosa curvature index, and demonstrating sensitivity to early structural changes in glaucoma. Glaucomatous optic neuropathy is characterized by progressive deformation of the lamina cribrosa (LC) and scleral canal, leading to optic disc (OD) excavation and visual field (VF)loss. This study proposes the Excavation Index (EI), a novel optical coherence tomography-based parameter designed to quantify the OD excavation. A total of 107 eyes (23 controls, 84 with primary open-angle glaucoma of varying severity) underwent OCT and VF testing. The EI was defined as the ratio of excavation width (Ew) to peripheral LC depth (PLCD), multiplied by 100 (EI=Ew/PLCD×100). Correlations with LC curvature index (LCCI), retinal nerve fiber layer (RNFL)thickness, and visual field indices were analyzed using univariate and multivariate models. EI values increased progressively from control to advanced glaucoma (14.72±2.79 to 31.00±10.21; P<0.001) and showed strong correlations with RNFL thickness (r=-0.749), MD (r=-0.696), PSD (r=0.570), VFI (r=-0.701) and LCCI (r=0.710), (all P<0.001). In multivariate analysis, intraocular pressure, RNFL thickness and LCCI were independently associated with EI (P<0.05). ROC analysis showed that AUC of EI was 0.860, comparable to LCCI (AUC=0.864,P=0.923). EI significantly differentiated control from all disease stages (all P<0.01). The EI provides a reliable measurement of glaucomatous OD excavation. Its structural-functional correlations suggest potential utility as a complementary biomarker for disease staging and monitoring of OD excavation in glaucoma. EI may represent a promising parameter for the detection of early-stage glaucoma, suggesting sensitivity to glaucomatous changes; however, further studies are needed to confirm its diagnostic role.