Journal of Current Glaucoma Practice

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2018 | April | Volume 12 | Issue 1

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Bernhard A Sabel, Lizbeth Cárdenas-Morales, Ying Gao

Vision Restoration in Glaucoma by Activating Residual Vision with a Holistic, Clinical Approach: A Review

[Year:2018] [Month:] [Volume:12] [Number:1] [Pages:9] [Pages No:1 - 9]

   DOI: 10.5005/jp-journals-10028-1237  |  Open Access |  How to cite  | 



Moon J Lee, Alison G Abraham, Bonnielin K Swenor, A Richey Sharrett, Pradeep Y Ramulu

Application of Optical Coherence Tomography in the Detection and Classification of Cognitive Decline

[Year:2018] [Month:] [Volume:12] [Number:1] [Pages:9] [Pages No:10 - 18]

Keywords: Alzheimer's disease, Cognitive impairment, Dementia, Literature review, Optical coherence tomography (OCT), Retinal nerve fiber layer.

   DOI: 10.5005/jp-journals-10028-1238  |  Open Access |  How to cite  | 


Aim: This review aims to critically analyze the current literature on the relationship of optical coherence tomography (OCT) measures to cognition and dementia. Background: Optical coherence tomography, a noninvasive method of imaging neuroretinal layers, and OCT angiography, a highly precise method of examining retinal vasculature, have widely been used to aid in the diagnosis and monitoring of a variety of ocular diseases. There is now an increasing body of evidence relating the structural and microvascular changes of the retina to cognitive impairment. Review results: In general, several studies have found decreased retinal nerve fiber layer (RNFL) thickness in Alzheimer's disease (AD) and mild cognitive impairment (MCI) and an association between RNFL thickness and continuous measures of cognitive ability, though findings were inconsistent across studies. In many studies, associations were found for specific regions of the RNFL but not with overall thickness. Studies linking OCT measures to non-Alzheimer's dementia were lacking, and limited work has been done on persons with past cognitive decline but who remain cognitively normal (the ideal stage at which to target treatment). Common limitations of prior studies include a failure to account for intraocular pressure (IOP) and axial length. Conclusion: Current research suggests a potential association between retinal findings observed on OCT and cognitive impairment. Methodologically robust research accounting for important covariates and looking at changes in OCT and/ or cognition is needed to better characterize the association between OCT and cognitive ability. Clinical significance: Further research is warranted to determine whether OCT findings can help identify the etiology of cognitive decline and/or serve as objective markers of AD. If this is the case, OCT may also help identify the presence of disease processes in cognitively normal individuals.



Louise J Lu, Laura Hall, Ji Liu

Improving Glaucoma Surgical Outcomes with Adjunct Tools

[Year:2018] [Month:] [Volume:12] [Number:1] [Pages:10] [Pages No:19 - 28]

Keywords: Adjunct tools, Amniotic membrane, Collagen matrix implant, Fibrin adhesive, Fibrin glue, Glaucoma, Innovations, Ologen, Surgery, Trabeculectomy

   DOI: 10.5005/jp-journals-10028-1239  |  Open Access |  How to cite  | 


Conventional glaucoma surgeries, such as trabeculectomy and glaucoma drainage device (GDD) surgery, have been enhanced by surgeons to improve outcome and decrease complications. Over the last two decades, adjuncts, such as collagen matrix implants, fibrin adhesives, and amniotic membrane transplantation (AMT) have been found to be effective in modulating fibrosis and scarring during the wound-healing process, reducing postoperative inflammation, and repairing bleb leakage or conjunctival erosion. The use of these tools provides several advantages when used in trabeculectomy, GDD surgery, and surface reconstruction associated with glaucoma surgery complications. Their use will be discussed in this review.



Richard Trevino, Carolyn E Majcher, Joey Allen, Jeffery Rabin

Association of Diopsys® Short-duration Transient Visual Evoked Potential Latency with Visual Field Progression in Chronic Glaucoma

[Year:2018] [Month:] [Volume:12] [Number:1] [Pages:7] [Pages No:29 - 35]

Keywords: Cohort study, Electrophysiology, Glaucoma, Perimetry, Visual evoked potential.

   DOI: 10.5005/jp-journals-10028-1240  |  Open Access |  How to cite  | 


Aim: To determine the association of Diopsys® NOVA-LX amplitude and latency abnormality scores with perimetric staging of chronic glaucoma, and to explore potential single-visit short-duration transient visual evoked potential (SD-tVEP) trend detection ability utilizing Humphrey 30-2 field progression data. Materials and methods: Setting: Glaucoma subspecialty clinic. Participants: Treated adult chronic glaucoma patients undergoing SD-tVEP evaluation. Main outcome measures: (1) Proportion of eyes designated as suspect or abnormal by the NOVA-LX multifactorial algorithm were determined as a function of glaucoma severity using the most recent Humphrey visual field analyzer (HVFA) 30-2 field. (2) Association between long-term HVFA-guided progression analysis (GPA) annual slopes and SD-tVEP abnormality was assessed to determine whether a single VEP test might help to identify eyes more prone to progressive visual field (VF) loss. Results: One hundred and thirty-three eyes of 84 patients (mean age 68 years) were analyzed. The SD-tVEP abnormality increased proportionately with severity of VF loss under highcontrast (Hc) test conditions for both latency (p = 0.001) and amplitude (p < 0.01). The HVFA progression analysis printouts existed for 91 eyes (mean 12.3 fields per eye/range 5.18). Nearly three-quarters (72.5%) of eyes with mean annual HVFA progression ≥0.7 dB/year (n = 29) had single-visit VEP latency abnormalities. Fewer than half (46.7%) of the remainder (n = 62) showed latency abnormality. Mean progression for eyes with abnormal vs normal VEP latency was -0.87 ± 0.3 dB/year vs -0.32 ± 0.4 dB/year. Conclusion: Diopsys NOVA-LX Hc latency abnormality shows strong association with VF loss among a diverse population of clinical patients undergoing active treatment for chronic glaucoma, and appears likely to afford clinically useful trenddetecting test. Clinical significance: The SD-tVEP has the potential to serve as a single-visit clinical indicator to identify glaucoma patients at high risk for VF progression.



Keith Barton, Laura Beltran-Agullo, Jason Cheng, Kin Sheng Lim, Anurag Garg, Kirithika Muthusamy

Comparison of Short-term Postoperative Hypotony Rates of 23-gauge vs 25-gauge Needles in Formation of the Scleral Tract for Baerveldt Tube Insertion into the Anterior Chamber

[Year:2018] [Month:] [Volume:12] [Number:1] [Pages:4] [Pages No:36 - 39]

Keywords: Baerveldt, Drainage device, Glaucoma, Leak, Needle entry.

   DOI: 10.5005/jp-journals-10028-1241  |  Open Access |  How to cite  | 


Introduction:To compare the early postoperative hypotony rates and intraocular pressure (IOP) in two groups of eyes using either 23-gauge (23G) or 25-gauge (25G) needle in the creation of the anterior chamber entry tract for Baerveldt tube. The primary outcome measure was incidence of hypotony, and secondary outcome measures included comparison of mean IOP and other early complications. Materials and methods: Ours was a retrospective case review of consecutive patients who underwent 350 mm2 Baerveldt implantation in two units over a 2-year period. Data including IOP and complications were collected at 1 day, 1 week, and 1 month following surgery from patients’ notes. Statistical analysis between groups was determined using the unpaired 2-tailed t-test for continuous variables and chi-squared test for categorical variables. Statistical significance was defined at the 0.05 level. Results: A total of 58 eyes of 58 patients were included in this study. Preoperative mean IOP in the 25G group was significantly higher (26.4 ± 6.8 mm Hg) when compared with the 23G group (21.6 ± 4.0 mm Hg) (p = 0.002). The mean postoperative IOP remained significantly higher in the 25G group at day 1 (p=0.004), week 1 (p = 0.008), but not at month 1 (p = 0.744). Four patients in the 23G group had hypotony within 1 month postsurgery compared with no cases in the 25G group (chisquared test p = 0.038). Conclusion: T here w as a s ignificantly h igher r isk o f e arly hypotony and lower IOP in the larger 23G group at days 1 and 7, although the IOP was similar in both groups by 1 month. Clinical significance: After all glaucoma drainage device (GDD) tube implantation, regardless of which needle is used to create the tract, the entry site should always be checked with 2% fluorescein drop and 10.0 nylon suture is used with or without autologous Tenon's tissue to close any leakage.



Oscar Albis-Donado, Giovanna Casale-Vargas, Marina Gil-Reyes, Nancy Arreguin-Rebollar, Malik Y Kahook

Citius, Altius, Fortius: Agreement between Perkins and Dynamic Contour Tonometry (Pascal) and the Impact of Altitude

[Year:2018] [Month:] [Volume:12] [Number:1] [Pages:5] [Pages No:40 - 44]

Keywords: Atmospheric pressure, Bias, Glaucoma, Tonometry.

   DOI: 10.5005/jp-journals-10028-1242  |  Open Access |  How to cite  | 


Introduction: To ascertain differences in intraocular pressure (IOP) measurement and their repeatability between dynamic contour tonometry (DCT) and Goldmann/Perkins applanation tonometry (GAT) at two different atmospheric pressures. Materials and methods: Forty-one eyes of 41 healthy consenting subjects were enrolled for this observational, crosssectional study. Pachymetry and IOP measurements with DCT and GAT for both eyes of each subject at Acapulco (0 m from sea level) and at Mexico City (2,234 m from sea level) were done by the same observer. The IOP was compared between tonometers at each of the altitudes, and also for repeatability of each tonometer at different altitudes. Pearson's correlation coefficient and Bland–Altman plots were used to assess reliability of measurements and their differences at the two altitudes. Results: The mean age of patients was 41.7 (28–66 years); 22 were females. Mean IOP with DCT was 16.1 ± 2.2 mm Hg at sea level and 15.9 ± 2.1 mm Hg at 2,234 m above sea level, not a significant difference. Mean GAT IOP at the two altitudes was 13.1 ± 1.8 and 11.5 ± 1.7 mm Hg respectively, a statistically significant difference. In contrast, central corneal thickness (CCT) was not significantly changed (548.3 to 549.4 ìm, p = 0.496). Conclusion: Repeatability of single-observer measurements with GAT remains clinically acceptable, but not at different altitudes. The DCT seems to more consistently measure a similar IOP at different altitudes in the same subjects. The two tonometers may not be used interchangeably in the serial follow-up of patients at any of the altitudes.



Ian AS Rodrigues, Pouya Alaghband, Saurabh Goyal

Phacoemulsification with Intraocular Implantation of Lens, Endocyclophotocoagulation, and Endoscopic-Goniosynechialysis (PIECES): A Combined Technique for the Management of Extensive Synechial Primary Angle Closure Glaucoma

[Year:2018] [Month:] [Volume:12] [Number:1] [Pages:5] [Pages No:45 - 49]

Keywords: Angle closure, Cyclophotocoagulation, Glaucoma, Goniosynechialysis, Intraocular pressure.

   DOI: 10.5005/jp-journals-10028-1243  |  Open Access |  How to cite  | 


Primary angle closure glaucoma (PACG) is more blinding (1 in 4 cases) than primary open angle glaucoma (1 in 10 cases). Cataract surgery is an effective initial treatment for majority of cases of PACG. However, cataract surgery alone may not be enough to control intraocular pressure (IOP) in cases with extensive synechial angle closure glaucoma. It is reported that glaucoma drainage surgery is needed in 12% of PACG cases after cataract surgery. Some experts combine cataract surgery with either goniosynechialysis (GSL) or endocyclophotocoagulation (ECP) to enhance IOP control. However, neither combination ensures complete success. We report three subjects with extensive synechial angle closure in whom we facilitated a technique that combines lens extraction with ECP and endoscopic—GSL (PIECES). We demonstrated that this combined technique was a more effective and efficient method of achieving lower IOP in the presence of extensive synechial PACG. We believe that it addresses both the inflow and outflow of the aqueous humor simultaneously. Two out of three patients had good IOP control without medication and one patient needed one drop after a minimum 12 months of follow up. Furthermore, it may reduce the need for medical therapy and future more invasive glaucoma drainage surgery.


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