Science.gov

Sample records for glaucoma open-angle

  1. Primary open-angle glaucoma.

    PubMed

    Weinreb, Robert N; Khaw, Peng Tee

    2004-05-22

    Primary open-angle glaucoma is a progressive optic neuropathy and, perhaps, the most common form of glaucoma. Because the disease is treatable, and because the visual impairment caused by glaucoma is irreversible, early detection is essential. Early diagnosis depends on examination of the optic disc, retinal nerve fibre layer, and visual field. New imaging and psychophysical tests can improve both detection and monitoring of the progression of the disease. Recently completed long-term clinical trials provide convincing evidence that lowering intraocular pressure prevents progression at both the early and late stages of the disease. The degree of protection is related to the degree to which intraocular pressure is lowered. Improvements in therapy consist of more effective and better-tolerated drugs to lower intraocular pressure, and more effective surgical procedures. New treatments to directly treat and protect the retinal ganglion cells that are damaged in glaucoma are also in development.

  2. Linkage studies in primary open angle glaucoma

    SciTech Connect

    Avramopoulos, D.; Grigoriadu, M.; Kitsos, G.

    1994-09-01

    Glaucoma is a leading cause of blindness worldwide. The majority of glaucoma is associated with an open, normal appearing anterior chamber angle and is termed primary open angle glaucoma (POAG, MIM 137760). It is characterized by elevated intraocular pressure and onset in middle age or later. A subset of POAG with juvenile onset has recently been linked to chromosome 1q in two families with autosomal dominant inheritance. Eleven pedigrees with autosomal dominant POG (non-juvenile-onset) have been identified in Epirus, Greece. In the present study DNA samples have been collected from 50 individuals from one large pedigree, including 12 affected individuals. Preliminary results of linkage analysis with chromosome 1 microsatellites using the computer program package LINKAGE Version 5.1 showed no linkage with the markers previously linked to juvenile-onset POAG. Further linkage analysis is being pursued, and the results will be presented.

  3. Novel therapies for open-angle glaucoma

    PubMed Central

    Wentz, Scott M.; Kim, Nathaniel J.; Wang, Jenny; Amireskandari, Annahita; Siesky, Brent

    2014-01-01

    Open-angle glaucoma is a multifactorial optic neuropathy characterized by progressive loss of retinal ganglion cells and their axons. It is an irreversible disease with no established cure. The only currently approved treatment is aimed at lowering intraocular pressure, the most significant risk factor known to date. However, it is now clear that there are other risk factors involved in glaucoma's pathophysiology. To achieve future improvements in glaucoma management, new approaches to therapies and novel targets must be developed. Such therapies may include new tissue targets for lowering intraocular pressure, molecules influencing ocular hemodynamics, and treatments providing neuroprotection of retinal ganglion cells. Furthermore, novel drug delivery systems are in development that may improve patient compliance, increase bioavailability, and decrease adverse side effects. PMID:25580256

  4. [The visual evoked potentials in open angle glaucoma].

    PubMed

    Damian, Carmen; Iancău, Maria; Costache, Doina

    2004-01-01

    The study purpose to analyse the variations of Visual Evoked Potentials on a group of patients with Open Angle Glaucoma. It was performed the Visual Evoked Potential recordings on a number of patients with Open Angle Glaucoma in different stages of evolutions. Some of the patients were monitored by the Visual Evoked Potentials recordings in a dynamic way, before and after the law pressure treatment. The type of Visual Evoked Potentials recording was pattern reversal with vertical bars. In incipient stage of Open Angle Glaucoma the alteration of the tract was minimal with inconstant presence of the N75 and N135 waves and just a few variation of the delay of P100. In advanced stages of Open Angle Glaucoma the alterations of the tract were important: the delay of P100 wave. In absolute stage the tract was null. The alterations of Visual Evoked Potentials tract was influenced by the different stages of evolution of Open Angle Glaucoma. The gradual alteration of the Visual Evoked Potential tract represents a prognosis of the disease.

  5. Beta adrenergic blocking agents for open-angle glaucoma.

    PubMed

    Lee, M E

    1988-07-01

    Beta adrenergic blocking agents have gained wide acceptance among practitioners and patients alike as extremely useful drugs for the treatment of open-angle glaucoma. This new class of antiglaucoma agents usually is effective in reducing elevated intraocular pressure and is generally well tolerated. This paper is intended to provide an understanding of the ophthalmic beta adrenergic blocking agents to optometrists who are actively involved in the treatment of glaucoma and/or in the monitoring of glaucoma patients. The clinical pharmacology of the three FDA-approved beta blockers -- timolol, levobunolol, and betaxolol, is evaluated and the drugs are compared.

  6. Canaloplasty versus Viscocanalostomy in Primary Open Angle Glaucoma

    PubMed Central

    Wagdy, Faried Mohammed

    2017-01-01

    Introduction The purpose of this study was to compare the efficacy and safety of canaloplasty versus viscocanalostomy in management of uncontrolled primary open angle glaucoma (POAG) with medication. Methods Canaloplasty surgery was applied for thirty eyes of thirty patients (45–55 years) with a mean age of 48 years (Group A) and viscocanalostomy surgery was applied also for thirty eyes of thirty patients (43–54 years) with a mean age of 46 years (group B). All patients were with uncontrolled primary open angle glaucoma by maximally tolerated medical therapy. Results Intraocular pressure (IOP) in both surgeries was significantly reduced through follow up period (p < 0.0.001). Complete success was 86.6% in group A and 80% in group B. Visual field deterioration was in 2 cases (6%) in group A and in 4 cases (13%) in group B. Low incidence of postoperative complications was reported as Descemet’s membrane detachment (3% in group A and 8% in group B), ocular hypotony (2% in group A and 4% in group B) and hyphema (3% in group A and 5% in group B). Conclusion Canaloplasty was more effective and safer than viscocanalostomy in management of uncontrolled primary open angle glaucoma (POAG) with medication. PMID:28243422

  7. Blindness following bleb-related infection in open angle glaucoma.

    PubMed

    Yamada, Hiroki; Sawada, Akira; Kuwayama, Yasuaki; Yamamoto, Tetsuya

    2014-11-01

    To estimate the risk of blindness following bleb-related infection after trabeculectomy with mitomycin C in open angle glaucoma, utilizing data obtained from two prospective multicenter studies. The incidence of bleb-related infection in open angle glaucoma after the first or second glaucoma surgery was calculated using a Kaplan-Meier analysis and data from the Collaborative Bleb-related Infection Incidence and Treatment Study (CBIITS). The rate of blindness following bleb-related infection was calculated using data from the Japan Glaucoma Society Survey of Bleb-related Infection (JGSSBI). Finally, the rate of blindness following bleb-related infection after filtering surgery was estimated based on the above two data sets. Blindness was defined as an eye with a visual acuity of 0.04 or less. The incidences of development of bleb-related infection at 5 years were 2.6 ± 0.7 % (calculated cumulative incidence ± standard error) for all infections and 0.9 ± 0.4 % for endophthalmitis in all cases in the CBIITS data. The rates of blindness in the JGSSBI data were 14 % for the total cases with bleb-related infection and 30 % for the endophthalmitis subgroup. The rate of blindness developing within 5 years following trabeculectomy was estimated to be approximately 0.24-0.36 %. The rate of blindness following bleb-related infection within 5 years after trabeculectomy is considerable and thus careful consideration must be given to the indication for trabeculectomy and the selection of surgical techniques.

  8. Lifetime risk of blindness in open-angle glaucoma.

    PubMed

    Peters, Dorothea; Bengtsson, Boel; Heijl, Anders

    2013-10-01

    To determine the lifetime risk and duration of blindness in patients with manifest open-angle glaucoma (OAG). Retrospective chart review. We studied glaucoma patients who died between January 2006 and June 2010. Most glaucoma patients living in the catchment area (city of Malmö; n = 305 000) are managed at the Department of Ophthalmology at Skåne University Hospital in Malmö. From the patient records we extracted visual field status, visual acuity, and low vision or blindness as defined by the World Health Organization (WHO) criteria and caused by glaucoma at the time of diagnosis and during follow-up. We also noted age at diagnosis and death and when low vision or blindness occurred. Five hundred and ninety-two patients were included. At the time of the last visit 250 patients (42.2%) had at least 1 blind eye because of glaucoma, while 97 patients (16.4%) were bilaterally blind, and 12 patients (0.5%) had low vision. Median time with a glaucoma diagnosis was 12 years (<1-29), median age when developing bilateral blindness was 86 years, and median duration of bilateral blindness was 2 years (<1-13). The cumulative incidences of blindness in at least 1 eye and bilateral blindness from glaucoma were 26.5% and 5.5%, respectively, after 10 years, and 38.1% and 13.5% at 20 years. Approximately 1 out of 6 glaucoma patients was bilaterally blind from glaucoma at the last visit. Median duration of bilateral blindness was 2 years. Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

  9. Outcome of Trabeculectomy Surgery in Primary Open Angle Glaucoma

    PubMed Central

    Bhatia, Jagdish

    2008-01-01

    Objectives Retrospective study to evaluate the short term outcome and contributing prognostic factors of trabeculectomy in terms of intraocular pressure in Omani patients of South Batinah region with primary open-angle glaucoma. Methods This study involved retrospective evaluation of 18 patients (22 eyes) with primary open angle glaucoma who underwent primary trabeculectomy between February 2005 and February 2008. All patients were aged over 40 years and were Omani. Follow-up for all subjects lasted at least 6 months or more [Average follow up 388 days with standard deviation of 182]. Successful control of Intraocular pressure (IOP) was defined as achieving IOP of 21 mmHg or less without medication (complete success). Results The results are presented with particular emphasis being placed only on intraocular pressure (IOP) control. The tonometric success rate of trabeculectomy in controlling the IOP at 21mmHg or less without any medication was 46% [complete successes], 18% had qualified success [Post operative IOP 21 mm Hg or less with one topical medication], while 36% trabeculectomies failed to show desired results. Conclusion The results of this retrospective study underline that the procedure of trabeculectomy has moderate success in controlling the intra ocular pressure in the study population. The procedure failed to show the desired result in almost one third of the patients (36%) and topical medical treatment was reinstated in these patients with either two or three drugs. However these results lead to the following question: Should trabeculectomy be the therapy of first choice in the early stage of glaucoma? PMID:22379543

  10. Oxidative stress in primary open-angle glaucoma.

    PubMed

    Zanon-Moreno, Vicente; Marco-Ventura, Pilar; Lleo-Perez, Antonio; Pons-Vazquez, Sheila; Garcia-Medina, Jose J; Vinuesa-Silva, Ignacio; Moreno-Nadal, Maria A; Pinazo-Duran, Maria Dolores

    2008-01-01

    To analyze oxidative stress in primary open-angle glaucoma (POAG). A case-control study including 90 eyes of 90 patients who needed antiglaucomatous surgery in the course of POAG (glaucoma group, n=50) and from patients who were operated of nonpathologic cataracts (cataract group, n=40). Free radical formation via lipid peroxidation by malondialdehyde-thiobarbituric acid reactive substances (MDA-TBARS) test and total antioxidant status in the aqueous humor samples of both groups were determined. Statistical analyses were carried out in relation to MDA-TBARS and total antioxidant status and their correlations with glaucoma risk factors. Significantly higher MDA-TBARS were detected in the POAG with respect to the comparative group of cataract subjects (P<0.001). Antioxidant activity was significantly lower in the POAG than in the cataract group (P<0.001). Aqueous humor samples may be used for determining oxidative and antioxidant status in pathologic processes. Glaucomatous eyes had a significant increase in oxidative status and decreased antioxidant activity in the aqueous humor than the cataract eyes. Oxidative stress may play a pathogenical role in the POAG.

  11. Vascular and Autonomic Dysregulation in Primary Open-Angle Glaucoma

    PubMed Central

    Pasquale, Louis R.

    2015-01-01

    Purpose of the review To discuss whether vascular dysfunction and autonomic dysfunction are related to primary open-angle glaucoma stratified by the intraocular pressure (IOP) level (the high tension glaucoma and normal tension glaucoma subtypes). Recent findings Patients with POAG across the spectrum of IOP exhibit a variety of ocular and non-ocular vascular abnormalities. Interestingly common genetic variation in NOS3 and the CAV1/CAV2 genomic regions, which code for proteins involved in setting vascular tone, are associated with POAG. These markers seem to stratify with POAG subtypes by sex or pattern of initial visual field loss. Overall it is clear that there is also cardiovascular autonomic dysfunction in HTG and NTG but it is unclear if this dysfunction is more common in NTG compared to HTG. Summary Overall POAG is likely a heterogeneous disease but stratifying cases by IOP level associated with initial optic nerve damage may be less useful than using other endophenotype approaches. Embracing the evidence suggesting systemic endothelial and autonomic dysfunction are operative in POAG will help move beyond an IOP-centric view of the disease and facilitate “tearing down the wall” that divides treating physicians and a better understanding of POAG pathogenesis. PMID:26720776

  12. The inheritance of juvenile onset primary open angle glaucoma.

    PubMed

    Gupta, V; Somarajan, B I; Gupta, S; Chaurasia, A K; Kumar, S; Dutta, P; Gupta, V; Sharma, A; Tayo, B O; Nischal, K

    2016-10-25

    Juvenile onset open angle glaucoma (JOAG) affects patients before 40 years of age, who present with high intraocular pressure and deep steep cupping of the optic nerve head. While it was considered to be inherited in an autosomal dominant fashion, recent studies have shown an autosomal recessive pattern as well as sporadic occurrence of the disease in several families. In this review, we analyze the genetic basis of the disease along with common mutations and their association with JOAG. We also analyzed the inheritance patterns in a large group of unrelated JOAG patients (n = 336) from Northern India wherein the prevalence of familial occurrence was assessed and segregation analysis performed, to determine the mode of inheritance.

  13. Clinical results of Trabectome surgery for open-angle glaucoma

    PubMed Central

    Mizoguchi, Takanori; Nishigaki, Shiro; Sato, Tomoki; Wakiyama, Harumi; Ogino, Nobuchika

    2015-01-01

    Background The purpose of this study was to determine outcomes when using Trabectome surgery and to evaluate factors associated with its effects in primary open-angle glaucoma (POAG) and exfoliation glaucoma (EXG). Methods This was a prospective, non-randomized, observational, comparative cohort study in which Trabectome surgery was used alone in patients with POAG or EXG. Trabectome surgery was considered to have failed when at least one of the following three criteria was fulfilled: intraocular pressure (IOP) ≥21 mmHg and a <20% reduction below the baseline IOP on two consecutive follow-up visits 3 months or more after surgery; need for additional glaucoma surgery; and an increase in number of medications compared with baseline. Results The subjects were 32 males (34 eyes) and 46 females (48 eyes). POAG was observed in 43 eyes and EXG in 39 eyes. IOP after Trabectome surgery decreased significantly from 22.3±6.8 mmHg at baseline to 14.0±3.9 mmHg (23.0% reduction) at month 24 in all cases (P<0.0000). The success rate at 2 years was 51.2% for all cases (POAG, 50.9%; EXG, 49.2%). There was no significant difference in success rate between POAG and EXG (P=0.91). Preoperative IOP (P=0.033) and number of medications (P=0.041) were significant factors for surgical success/failure in multivariate logistic regression. No serious complications were observed. Conclusion Trabectome surgery achieved favorable IOP control and was equally effective in patients with POAG and those with EXG. Its effects were influenced by preoperative IOP and number of preoperative medications. PMID:26487799

  14. Antithrombotic medication and incident open-angle glaucoma.

    PubMed

    Marcus, Michael W; Müskens, Rogier P H M; Ramdas, Wishal D; Wolfs, Roger C W; de Jong, Paulus T V M; Vingerling, Johannes R; Hofman, Albert; Stricker, Bruno H C; Jansonius, Nomdo M

    2012-06-20

    To determine the associations between the use of antithrombotic drugs and incident open-angle glaucoma (OAG). Ophthalmic examinations including measurements of the IOP and perimetry were performed at baseline and follow-up in 3939 participants of the prospective population-based Rotterdam Study who did not have OAG at baseline. The use of antithrombotic drugs was monitored continuously during follow-up. Antithrombotic drugs were stratified into anticoagulants and platelet aggregation inhibitors. Associations between incident OAG and the use of antithrombotic drugs were assessed using Cox regression; the model was adjusted for age, sex, baseline IOP and IOP-lowering treatment, family history of glaucoma, and myopia. Associations between antithrombotic drugs and IOP at follow-up were analyzed with multiple linear regression. During a mean follow-up of 9.8 years, 108 participants (2.7%) developed OAG. The hazard ratio for anticoagulant use was 0.90 (95% confidence interval [CI], 0.55-1.48; P = 0.69) and for platelet aggregation inhibitors 0.80 (0.53-1.21; P = 0.28). There was no trend towards a reduced or increased risk of incident OAG with prolonged anticoagulant use (P value for trend 0.84) or platelet aggregation inhibitor use (0.59). There was a significant IOP-lowering effect of anticoagulants (-0.31 mm Hg; 95% CI, -0.58 to -0.04 mm Hg; P = 0.025) but not of platelet aggregation inhibitors (P = 0.06). The IOP-lowering effect of anticoagulants disappeared after additional adjustment for the use of systemic beta-blockers. Use of anticoagulants or platelet aggregation inhibitors appears not to be associated with incident OAG.

  15. Mediterranean diet adherence by patients with primary open angle glaucoma.

    PubMed

    Abreu-Reyes, J A; Álvarez-Luis, D; Arteaga-Hernández, V; Sánchez-Mendez, M; Abreu-González, R

    2017-08-01

    To study the adherence to the Mediterranean diet in patients affected by primary open angle glaucoma (POAG). An observational study was conducted to assess the adherence to the Mediterranean diet in patients affected by POAG, and who attended the Ophthalmology Department of the Canary Islands University Hospital. The study included completing a 14-item questionnaire validated by the PREDIMED Study, in person or by telephone. A total of 100 questionnaires were completed successfully by 50 males and 50 females. The mean age was 69.58 years for the males and 67.42 years for women. The men had more comorbidities than women (tobacco 14 vs. 3%), arterial hypertension, and diabetes (30 vs. 28%, and 16 vs. 6%, respectively). Adherence to the Mediterranean diet in males, was low in 9 patients (18%), moderate in 37 (74%), and high in 4 (8%) cases. In women adherence was low in 14 patients (28%), moderate in 34 (68%), and high in 2 (6%) cases. The overall adhesion to the Mediterranean diet is low in 23%, moderate in 71% and high in 6% of the cases. Patients who are affected by POAG have moderate adherence to the Mediterranean diet. Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Current primary open-angle glaucoma treatments and future directions

    PubMed Central

    Beidoe, Gabriel; Mousa, Shaker A

    2012-01-01

    Primary open-angle glaucoma (POAG) is a leading cause of blindness with no known cure. Management of the disease focuses on lowering intraocular pressure (IOP) with current classes of drugs like prostaglandin analogs, beta-blockers, alpha-agonists, and carbonic anhydrase inhibitors. These treatments have not helped all patients. Some patients continue to experience deterioration in the optic nerve even though their IOPs are within the normal range. New views have surfaced about other pathophysiological processes (such as oxidative stress, vascular dysfunction, and retinal cell apoptosis) being involved in POAG progression, and adjunctive treatments with drugs like memantine, bis(7)-tacrine, nimodipine, and mirtogenol are advocated. This review examines the current and proposed treatments for POAG. Some of the proposed drugs (bis(7)-tacrine, nimodipine, vitamin E, and others) have shown good promise, mostly as monotherapy in various clinical trials. It is recommended that both the current and proposed drugs be put through further robust trials in concurrent administration and evaluated. PMID:23118520

  17. Race, ethnicity and prevalence of primary open-angle glaucoma.

    PubMed Central

    Kosoko-Lasaki, Omofolasade; Gong, Gordon; Haynatzki, Gleb; Wilson, M. Roy

    2006-01-01

    BACKGROUND: Recently, some authors pooled data from studies on the Dutch, Australians and Americans of European origin in an attempt to predict the prevalence of primary open-angle glaucoma (POAG) in the United States. PURPOSE: To examine potential ethnic diversity in the prevalence of POAG among populations of the "same race." Methods: Medical literature was searched, and 11 population-based studies on populations of African origin and five on populations of European origin were identified. RESULTS: The prevalence of POAG was significantly higher in white Australians than in the Dutch (p<0.001) and was significantly lower (p<0.001) among black populations in South Africa, Nigeria, Tanzania and the United States than in Ghana, St. Lucia or Barbados. Notably, the prevalence was significantly lower in Afro Caribbeans living in London than in St. Lucia or Barbados (p<0.001). There was, however, inconsistency in the definition of POAG among the different studies. CONCLUSIONS: There is a wide range in the prevalence of POAG among populations of the same "race," which might be attributed to the different methodology and definition of POAG; potential difference in social, behavioral and environmental factors; and/or genetic predisposition. Scrutiny is warranted when pooling data from different ethnic groups of the "same race" in meta-analyses. PMID:17052053

  18. Metabolome-Wide Association Study of Primary Open Angle Glaucoma

    PubMed Central

    Burgess, L. Goodwin; Uppal, Karan; Walker, Douglas I.; Roberson, Rachel M.; Tran, ViLinh; Parks, Megan B.; Wade, Emily A.; May, Alexandra T.; Umfress, Allison C.; Jarrell, Kelli L.; Stanley, Brooklyn O. C.; Kuchtey, John; Kuchtey, Rachel W.; Jones, Dean P.; Brantley, Milam A.

    2015-01-01

    Purpose To determine if primary open-angle glaucoma (POAG) patients can be differentiated from controls based on metabolic characteristics. Methods We used ultra-high resolution mass spectrometry with C18 liquid chromatography for metabolomic analysis on frozen plasma samples from 72 POAG patients and 72 controls. Metabolome-wide Spearman correlation was performed to select differentially expressed metabolites (DEM) correlated with POAG. We corrected P values for multiple testing using Benjamini and Hochberg false discovery rate (FDR). Hierarchical cluster analysis (HCA) was used to depict the relationship between participants and DEM. Differentially expressed metabolites were matched to the METLIN metabolomics database; both DEM and metabolites significantly correlating with DEM were analyzed using MetaboAnalyst to identify metabolic pathways altered in POAG. Results Of the 2440 m/z (mass/charge) features recovered after filtering, 41 differed between POAG cases and controls at FDR = 0.05. Hierarchical cluster analysis revealed these DEM to associate into eight clusters; three of these clusters contained the majority of the DEM and included palmitoylcarnitine, hydroxyergocalciferol, and high-resolution METLIN matches to sphingolipids, other vitamin D-related metabolites, and terpenes. MetaboAnalyst also indicated likely alteration in steroid biosynthesis pathways. Conclusions Global ultrahigh resolution metabolomics emphasized the importance of altered lipid metabolism in POAG. The results suggest specific metabolic processes, such as those involving palmitoylcarnitine, sphingolipids, vitamin D-related compounds, and steroid precursors, may contribute to POAG status and merit more detailed study with targeted methods. PMID:26230767

  19. Evaluation of primary open-angle glaucoma clinical practice guidelines.

    PubMed

    Wu, Annie M; Wu, Connie M; Young, Benjamin K; Wu, Dominic J; Chen, Allison; Margo, Curtis E; Greenberg, Paul B

    2015-06-01

    To evaluate the methodologic quality of 3 primary open-angle glaucoma (POAG) clinical practice guidelines (CPGs). The CPGs were assessed with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Four authors (A.M.W., C.M.W., B.K.Y., D.J.W.) performed independent assessments of POAG CPGs. POAG CPGs published by the American Academy of Ophthalmology (AAO), Canadian Ophthalmological Society (COS), and National Institute for Health and Care Excellence (NICE) were appraised using the AGREE II instrument's 6 domains (Scope and Purpose, Stakeholder Involvement, Rigor of Development, Clarity of Presentation, Applicability, and Editorial Independence) and Overall Assessment score summarizing guideline quality across all domains. Scores ranged from 28% to 85% for the AAO CPG, 51% to 96% for the COS CPG, and 55% to 97% for the NICE CPG. Intraclass correlation coefficients for the reliability of mean scores for the AAO, COS, and NICE CPGs were 0.89, 0.86, and 0.74; 95% CIs were 0.80 to 0.95, 0.74 to 0.93, and 0.51 to 0.87, respectively. The strongest domains were Scope and Purpose (AAO, COS, NICE) and Clarity of Presentation (COS, NICE). The weakest domains were Stakeholder Involvement (AAO, COS) and Editorial Independence (AAO, COS, NICE). Future POAG CPGs can be improved by addressing potential conflicts of interest within the development group, ensuring transparency of guideline development methodology, and involving all relevant stakeholders in guideline development and review. Published by Elsevier Inc.

  20. Screening of candidate genes for primary open angle glaucoma

    PubMed Central

    Liu, Ting; Xie, Lin; Ye, Jian; Liu, Yuewuyang

    2012-01-01

    Purpose Primary open-angle glaucoma (POAG) is one of the leading causes of irreversible blindness in the world. To make progress in understanding POAG, it is necessary to identify more POAG-causing genes. Methods Using haplotype analysis, we found that mutational region is located on chromosome 2 in two families. Furthermore, we screened 11 candidate genes on chromosome 2 by protein–protein interaction (PPI) analysis, including mutS homolog 6 (MSH6), mutS homolog 2 (MSH2), v-rel reticuloendotheliosis viral oncogene homolog (REL), endothelial PAS domain protein 1 (EPAS1), vaccinia related kinase 2 (VRK2), F-box protein 11 (FBXO11), EGF containing fibulin-like extracellular matrix protein 1 (EFEMP1), reticulon 4 (RTN4), RAB1A, member RAS oncogene family (RAB1A), ARP2 actin-related protein 2 homolog (ACTR2), and calmodulin 2 (phosphorylase kinase, delta; CALM2). These 11 genes are all predicted to be related to trabecular meshwork changes and progressive loss of retinal ganglion cells in POAG patients. Results According to our study, FBXO11 and VRK2 may interact with tumor protein p53 to regulate mitochondrial membrane permeability, mitochondrial membrane organization, and apoptosis. MSH2 is responsible for repairing DNA mismatches and RTN4 is for neuronal regeneration. Therefore, they are supposed to play a negative role in cellular process in POAG. CALM2 may be involved in retinal ganglion cell death and oxidative damage to cell communication. Conclusions The results demonstrate that the genes above may be associated with pathogenesis of POAG. PMID:22876139

  1. Retinal oximetry in primary open-angle glaucoma.

    PubMed

    Olafsdottir, Olof Birna; Hardarson, Sveinn Hakon; Gottfredsdottir, Maria Soffia; Harris, Alon; Stefánsson, Einar

    2011-08-16

    PURPOSE. To determine whether retinal vessel oxygen saturation is affected in primary open-angle glaucoma (POAG) patients. METHODS. Retinal oxygen saturation in patients with POAG was measured in retinal vessels with a spectrophotometric retinal oximeter in darkness, and visual fields were obtained. Oxygen tension (Po(2)) was calculated from oxygen saturation values. Statistical analysis was performed using Pearson's correlation and Student's t-test. RESULTS. Mean oxygen saturation in venules was higher in persons with poor visual fields (68% ± 4%, mean ± SD) than in those with good visual fields (62% ± 3%; P = 0.0018). The mean arteriovenous difference in oxygen saturation was lower in persons with poor visual fields (30% ± 4%, n = 9) than in those with good visual fields (37% ± 4%; P = 0.0003; n = 12). No correlation was found between saturation in retinal arterioles and visual field mean defect (n = 31; r = -0.16; P = 0.38). Oxygen saturation in retinal venules correlated positively with worsening visual field mean defect (r = 0.43; P = 0.015). Arteriovenous difference in oxygen saturation decreased significantly as the visual field mean defect worsened (r = -0.55; P = 0.0013). Mean Po(2) in venules was 38 ± 3 mm Hg. It was significantly higher in persons with poor visual field fields (40 ± 3 mm Hg) than in those with good visual fields (36 ± 2 mm Hg; P = 0.0016). CONCLUSIONS. Deeper glaucomatous visual field defects are associated with increased oxygen saturation in venules and decreased arteriovenous difference in retinal oxygen saturation. The data suggest that oxygen metabolism is affected in the glaucomatous retina, possibly related to tissue atrophy.

  2. Medical interventions for primary open angle glaucoma and ocular hypertension.

    PubMed

    Vass, C; Hirn, C; Sycha, T; Findl, O; Bauer, P; Schmetterer, L

    2007-10-17

    Primary open angle glaucoma (POAG) is a progressive optic neuropathy with an elevated intraocular pressure (IOP), where the optic nerve head becomes pathologically excavated and the visual field (VF) is characteristically altered. Ocular hypertension (OHT) is a condition with elevated IOP but without discernible pathology of the optic nerve head or the VF. It is a major risk factor for development of POAG. To assess and compare the effectiveness of topical pharmacological treatment for POAG or OHT to prevent progression or onset of glaucomatous optic neuropathy. We searched CENTRAL, MEDLINE and EMBASE in May 2007. We searched the bibliographies of identified articles and contacted experts, investigators and pharmaceutical companies for additional published and unpublished studies. Randomised controlled trials comparing topical pharmacological treatment to placebo, no treatment or other treatment for specified endpoints which included people with POAG or OHT, and with duration of treatment of at least one year. Two authors independently extracted data and assessed trial quality. Where appropriate, we summarised data using Peto odds ratio and mean difference after testing for heterogeneity between studies. We included 26 trials, which randomised 4979 participants, in this review. Meta-analysis of 10 trials clearly demonstrated reduction of onset of VF defects in treated OHT (OR 0.62, 95% CI 0.47 to 0.81). No single drug showed a significant VF protection compared to placebo or untreated controls. We did identify some border line evidence for a positive influence of treatment on VF prognosis (OR 0.67, 95% CI 0.45 to 1.00) for the beta-blockers . The results of this review support the current practice of IOP lowering treatment of OHT. A visual field protective effect has been clearly demonstrated for medical IOP lowering treatment. Positive but weak evidence for a beneficial effect of the class of beta-blockers has been shown. Direct comparisons of prostaglandins or

  3. Effect of betaxolol on primary open-angle glaucoma and normal-tension glaucoma patients.

    PubMed

    Saccà, S C; Macrì, A; Rolando, M; Ciurlo, G

    1998-06-01

    This study is aimed at establishing the efficacy of the therapeutic agent, betaxolol, in diurnal control of IOP (intraocular pressure). Therapy was performed on 32 eyes affected by POAG (primary open-angle glaucoma) and 16 eyes affected by NTG (normal-tension glaucoma). Two preparations of betaxolol were utilized: betaxolol hydrochloride 0.50% (Betoptic) was administered to 15 POAG and 7 NTG eyes; betaxolol hydrochloride 0.25% ophthalmic suspension (Betoptic S) was administered to 17 POAG and 9 NTG eyes. IOP measurements were taken every two hours from 8 a.m. to 8 p.m. IOP was measured before therapy and at 12 hours, 30 days, and 3 months of therapy. Betaxolol hydrochloride 0.50% was more effective at lowering IOP during the day. Diurnal pressure peaks, which are a risk factor concerning the maintenance of visual field in glaucoma patients, were also reduced using 0.50% betaxolol hydrochloride.

  4. Combination medical treatment for primary open angle glaucoma and ocular hypertension: a network meta-analysis

    PubMed Central

    Michelessi, Manuele; Lindsley, Kristina; Yu, Tsung; Li, Tianjing

    2014-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: The objectives of this review are to examine the comparative effectiveness and safety of different glaucoma fixed combination therapies and monotherapies in eyes with primary open angle glaucoma or ocular hypertension and to provide relative rankings of these treatments. PMID:25774087

  5. Little evidence for association of the glaucoma gene MYOC with open-angle glaucoma

    PubMed Central

    Sohn, Seongsoo; Hur, Wonhee; Choi, Young Ran; Chung, Yun Shin; Ki, Chang-Seok

    2010-01-01

    Background/aim To determine if overexpression of the glaucoma gene MYOC is involved in the development of open-angle glaucoma (OAG) and if its promoter variants are associated with glaucoma in the Korean population. Methods Human trabecular meshwork cells were cultured in the presence of ophthalmic steroids such as fluorometholone, fluorometholone acetate, dexamethasone, prednisolone acetate and rimexolone. The cells were cultured at a hydrostatic pressure of 32 mm Hg above atmospheric pressure and induction of MYOC was evaluated by northern blot analysis. Genomic DNA was extracted from blood samples obtained from 74 normal controls and 168 unrelated Korean patients with OAG, including primary OAG, normal tension glaucoma and steroid-induced glaucoma. A 461 base pair (bp) DNA fragment of the MYOC promoter region was amplified using PCR and its genotype was analysed by directly sequencing the product. Results The potencies of steroid eye drops in MYOC induction in vitro was the same regardless of their potential for elevating intraocular pressure in vivo. Hydrostatic pressure had no effect on MYOC induction. A dinucleotide repeat polymorphism and three single nucleotide polymorphisms were identified, but no obvious differences in the genotype distribution and allele frequency of the variants between the control group and any type of OAG were observed. Conclusion Our data suggest that MYOC overexpression is not a cause or an effect of intraocular pressure elevation and that MYOC itself is not associated with OAG. PMID:20447966

  6. The distinction between juvenile and adult-onset primary open-angle glaucoma

    SciTech Connect

    Wiggs, J.L.; Haines, J.L.; Damji, K.F.

    1996-01-01

    Because of the significant differences between the juvenile and adult forms of open-angle glaucoma, especially with regard to inheritance, prevalence, severity, and age of onset, we read with interest the recent publication by Morissette et al., describing a pedigree with a phenotype that overlaps the distinctive features of juvenile-onset open-angle glaucoma (JOAG) and adult-onset primary open-angle glaucoma (usually abbreviated as POAG or COAG). These authors conclude that a gene mapped to human chromosome 1q21-q31 (GLC1A) can be responsible for both juvenile and adult forms of open-angle glaucoma. The implications of such a result could be extremely important, in light of the high prevalence of the adult form of the disease. However, while the data presented in this report suggest that variable expressivity of the GLC1A gene may lead to a broader range of onset for this form of juvenile glaucoma, these data do not identify the GLC1A gene as an important cause of POAG. To prevent misleading interpretations of this and similar studies, we wish to clarify the distinction between the juvenile and adult forms of open-angle glaucoma. 8 refs.

  7. Effect of phacoemulsification on intraocular pressure in patients with primary open angle glaucoma and pseudoexfoliation glaucoma

    PubMed Central

    Jimenez-Roman, Jesus; Lazcano-Gomez, Gabriel; Martínez-Baez, Karina; Turati, Mauricio; Gulías-Cañizo, Rosario; Hernández-Zimbrón, Luis F.; Ochoa-De la Paz, Lenin; Zamora, Rubén; Gonzalez-Salinas, Roberto

    2017-01-01

    AIM To compare the effect of phacoemulsification on intraocular pressure (IOP) in patients with primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). METHODS A retrospective comparative case series conducted at the Glaucoma Department at the Association to Prevent Blindness in Mexico. The study enrolled consecutive patients having phacoemulsification with intraocular lens (IOL) implantation and a diagnosis of POAG or PXG. Data about IOP values and number of glaucoma medications used was collected at baseline, 1, 3, 6 and 12mo postoperatively. RESULTS The study enrolled 88 patients (88 eyes). After phacoemulsification, there was a statistically significant reduction in IOP values and glaucoma medications use compared to baseline in both POAG and PXG patients (P<0.001). In the POAG group, a 20% decrease in IOP values was evidenced, and a 56.5% reduction in the number of medications used at the one-year follow-up. The PXG group showed a 20.39%, and a 34.46% decrease in IOP and number of medications used, respectively. A significant difference in the mean ΔIOP (postoperative changes in IOP) was evidenced between groups (P=0.005). The reduction of the postsurgical IOP mean values in both groups, the POAG group showed a greater reduction in IOP values compared to the PXG group. CONCLUSION In both types of glaucoma, phacoemulsification cataract surgery can result in a significant IOP reduction (20%) over a 12mo follow-up period. The number of medications used is also significantly reduced up to 12mo after surgery, especially in the PXG group. PMID:28944195

  8. MYOCILIN LEVELS IN PRIMARY OPEN-ANGLE GLAUCOMA AND PSEUDOEXFOLIATION GLAUCOMA HUMAN AQUEOUS HUMOR

    PubMed Central

    Howell, Kyle G.; Vrabel, Anne M.; Chowdhury, Uttio Roy; Stamer, W. Daniel; Fautsch, Michael P.

    2010-01-01

    Purpose To determine the concentration of myocilin in primary open-angle and pseudoexfoliation glaucoma aqueous humor. Methods Aqueous humor was collected during surgery from patients with primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEXG), and elective cataract removal (control). Volume-equivalent aqueous samples were separated on SDS-PAGE gradient gels. Quantification of myocilin levels was performed using Western blots probed with two independent N-terminal polyclonal anti-myocilin antibodies (AB1 and AB2) followed by densitometry. Myocilin levels in aqueous humor were quantified by plotting the densitometry readings of the aqueous samples against a recombinant myocilin standard curve. Total protein concentration was determined by Bradford protein assay. Transforming growth factor beta 2 (TGFβ2) levels were assessed by ELISA. Results Myocilin levels are significantly elevated in human POAG aqueous humor when compared to control aqueous humor (AB1: 0.66 ± 0.53 ng/μl vs. 0.23 ± 0.20 ng/μl, p<0.001; AB2: 0.98 ± 0.59 ng/μl vs. 0.65 ± 0.5 ng/μl, p<0.03; mean ± SD). Myocilin makes up a larger percent of the total protein in POAG aqueous humor compared to control aqueous (AB1: 0.26 ± 0.20% vs. 0.10 ± 0.20%, p<0.001; AB2: 0.43 ± 0.32% vs. 0.28 ± 0.18%, p<0.05). In contrast to POAG, myocilin levels were not elevated in PEXG aqueous humor when compared to control aqueous humor. No correlation between myocilin and TGFβ2 levels was observed. Conclusions Myocilin is elevated in POAG, but not PEXG aqueous humor. PMID:20179615

  9. [Morphological alterations of the trabecular meshwork in primary open angle glaucoma].

    PubMed

    Potau, J M; Canals, M; Costa, J; Merindano, M D; Ruano, D

    2000-03-01

    In the present essay we have compared the morphology and structure of normal trabecular meshworks and glaucomatous trabecular meshworks with the purpose of obtaining information about the etiopathogeny of primary open angle glaucoma. We have observed by conventional light microscopy and scanning electron microscopy a total amount of 20 trabecular meshworks from non-glaucomatous patients and 35 trabecular meshworks from surgical pieces of trabeculectomy performed in patients diagnosed of primary open angle glaucoma. We have observed that glaucomatous trabecular meshworks show morphological and structural alterations of their trabecular beams, as their enlarging, collapse, the partial loss of endothelial cells and the existence of plenty of material accumulated on them, like pigment granules and calcium precipitates. Glaucomatous trabecular meshworks present morphological and structural alterations which can be related to etiopathogeny of primary open angle glaucoma since they modify the normal conditions of drainage of aqueous humour to Schlemm's channel.

  10. Tank-Binding Kinase 1 (TBK1) Gene and Open-Angle Glaucomas (An American Ophthalmological Society Thesis).

    PubMed

    Fingert, John H; Robin, Alan L; Scheetz, Todd E; Kwon, Young H; Liebmann, Jeffrey M; Ritch, Robert; Alward, Wallace L M

    2016-08-01

    To investigate the role of TANK-binding kinase 1 (TBK1) gene copy-number variations (ie, gene duplications and triplications) in the pathophysiology of various open-angle glaucomas. In previous studies, we discovered that copy-number variations in the TBK1 gene are associated with normal-tension glaucoma. Here, we investigated the prevalence of copy-number variations in cohorts of patients with other open-angle glaucomas-juvenile-onset open-angle glaucoma (n=30), pigmentary glaucoma (n=209), exfoliation glaucoma (n=225), and steroid-induced glaucoma (n=79)-using a quantitative polymerase chain reaction assay. No TBK1 gene copy-number variations were detected in patients with juvenile-onset open-angle glaucoma, pigmentary glaucoma, or steroid-induced glaucoma. A TBK1 gene duplication was detected in one (0.44%) of the 225 exfoliation glaucoma patients. TBK1 gene copy-number variations (gene duplications and triplications) have been previously associated with normal-tension glaucoma. An exploration of other open-angle glaucomas detected a TBK1 copy-number variation in a patient with exfoliation glaucoma, which is the first example of a TBK1 mutation in a glaucoma patient with a diagnosis other than normal-tension glaucoma. A broader phenotypic range may be associated with TBK1 copy-number variations, although mutations in this gene are most often detected in patients with normal-tension glaucoma.

  11. Tank-Binding Kinase 1 (TBK1) Gene and Open-Angle Glaucomas (An American Ophthalmological Society Thesis)

    PubMed Central

    Fingert, John H.; Robin, Alan L.; Scheetz, Todd E.; Kwon, Young H.; Liebmann, Jeffrey M.; Ritch, Robert; Alward, Wallace L.M.

    2016-01-01

    Purpose To investigate the role of TANK-binding kinase 1 (TBK1) gene copy-number variations (ie, gene duplications and triplications) in the pathophysiology of various open-angle glaucomas. Methods In previous studies, we discovered that copy-number variations in the TBK1 gene are associated with normal-tension glaucoma. Here, we investigated the prevalence of copy-number variations in cohorts of patients with other open-angle glaucomas—juvenile-onset open-angle glaucoma (n=30), pigmentary glaucoma (n=209), exfoliation glaucoma (n=225), and steroid-induced glaucoma (n=79)—using a quantitative polymerase chain reaction assay. Results No TBK1 gene copy-number variations were detected in patients with juvenile-onset open-angle glaucoma, pigmentary glaucoma, or steroid-induced glaucoma. A TBK1 gene duplication was detected in one (0.44%) of the 225 exfoliation glaucoma patients. Conclusions TBK1 gene copy-number variations (gene duplications and triplications) have been previously associated with normal-tension glaucoma. An exploration of other open-angle glaucomas detected a TBK1 copy-number variation in a patient with exfoliation glaucoma, which is the first example of a TBK1 mutation in a glaucoma patient with a diagnosis other than normal-tension glaucoma. A broader phenotypic range may be associated with TBK1 copy-number variations, although mutations in this gene are most often detected in patients with normal-tension glaucoma. PMID:27881886

  12. Impaired ocular blood flow regulation in patients with open-angle glaucoma and diabetes.

    PubMed

    Shoshani, Yochai; Harris, Alon; Shoja, Mohammadali M; Arieli, Yoel; Ehrlich, Rita; Primus, Sally; Ciulla, Thomas; Cantor, Adam; Wirostko, Barbara; Siesky, Brent A

    2012-01-01

      To elucidate the potential impact of diabetes mellitus on primary open-angle glaucoma pathology through vascular deficiency.   Cross-section analysis from a longitudinal, prospective study.   Eighty-four open-angle glaucoma patients (20 diabetic open-angle glaucoma patients and 64 non-diabetic open-angle glaucoma patients)   Patients were analyzed for ocular structure, ocular perfusion pressure (OPP), retrobulbar blood flow and retinal capillary perfusion. Statistical analysis was performed by SPSS version 18.0. Comparisons between groups were made as well as multivariate linear regression analysis.   Retrobulbar blood flow and the retinal microcirculation.   Central retinal artery peak systolic velocity was 13.5% lower in diabetic patients (P = 0.007). In diabetic open-angle glaucoma patients, ocular perfusion pressure positively correlated with central retinal artery and temporal posterior ciliary artery peak systolic velocity (R = 0.476, P = 0.039 and R = 0.529, P = 0.02, respectively), and with central retinal artery and nasal posterior ciliary artery resistance index (R = 0.537, P = 0.018 and R = 0.566, P = 0.012 respectively). Average retinal nerve fibre layer positively correlated with central retinal artery peak systolic velocity and temporal posterior ciliary artery end diastolic velocity (R = 0.501, P = 0.029 and R = 0.553, P = 0.019, respectively), and negatively correlated with superior and inferior retinal avascular space in the diabetic group (R = -0.498, P = 0.030 and R = -0.700, P = 0.001, respectively); no correlations were found in the non-diabetic group. Negative correlations between retrobulbar and retinal circulations were only found in the diabetic open-angle glaucoma patients, whereas positive correlations between retinal flow and non-flow were only found in non-diabetic open-angle glaucoma patients.   Diabetes may interfere with normal vascular regulation and

  13. Refractory open-angle glaucoma after neodymium-yttrium-aluminum-garnet laser lysis of vitreous floaters.

    PubMed

    Cowan, Lisa A; Khine, Kay T; Chopra, Vikas; Fazio, Doreen T; Francis, Brian A

    2015-01-01

    To illustrate 3 cases of chronic open-angle glaucoma secondary to the neodymium-yttrium-aluminum-garnet (Nd:YAG) laser vitreolysis procedure for symptomatic vitreous floaters. Observational case series. Location of the study was the Doheny Eye Institute. Three eyes of 2 patients who developed chronic open-angle glaucoma after Nd:YAG vitreolysis for symptomatic floaters presenting with very high intraocular pressure (IOP >40 mm Hg) were selected. The time from the laser treatment to the onset of elevated pressure ranges from 1 week to 8 months. There was no associated inflammation, steroid use, or other identifiable cause of chronic IOP elevation. All eyes were treated initially with glaucoma medication, followed by selective laser trabeculoplasty (SLT) and eventually glaucoma surgery (Trabectome) in 2 eyes for disease management. In all eyes, intraocular pressures were eventually stabilized within a normal pressure range from 18 to 38 months following Nd:YAG vitreolysis. At the latest follow-up post surgery, all eyes had intraocular pressures of 22 mm Hg or less with or without medications. Secondary open-angle glaucoma is a complication of Nd:YAG vitreolysis for symptomatic floaters that may present with an increase in intraocular pressure immediately, or many months after the surgery. Furthermore this complication may be permanent and require chronic medical therapy or glaucoma surgery. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. [Basic and clinical studies of pressure-independent damaging factors of open angle glaucoma].

    PubMed

    Araie, Makoto

    2011-03-01

    Pathogenesis of open-angle glaucoma involves both pressure-dependent damaging factors and pressure-independent damaging factors. The high prevalence of open-angle glaucoma with normal pressure (normal-tension glaucoma) in Japan implies that treatment of pressure-independent damaging factors in Japanese open-angle glaucoma patients is of importance. In an attempt to investigate the roles of pressure-independent damaging factors in open-angle glaucoma, we carried out basic and clinical studies and obtained the following results. 1. The rate of deterioration of visual field after trabeculectomy in normal tension glaucoma patients with post-operative intraocular pressure (IOP) of 10 mmHg was found to be -0.25 dB/year of mean deviation (MD), suggesting that contribution of pressure-independent damaging factors to the deterioration of MD in open-angle glaucoma is around -0.25 dB/year of mean deviation (MD). 2. Experiments using isolated purified cultured retinal ganglion cells (RGCs) indicated that calcium-channel blockers and some of antiglaucoma drugs showed neuroprotective effects on RGCs at concentrations of 0.01 microM or higher. 3. In mice, damage to RGCs resulted in secondary degeneration of neurons and activation of glial cells in the lateral geniculate nucleous (LGN) and superior colliculus, and these secondary changes in the central nervous system (CNS) due to RGC damage was partly ameliorated by systemic administration of memantine. 4. Mice experimental high IOP glaucoma models could be established using laser irradiation of the limbal area, and the usefulness of Tonolab in IOP measurements of mice eye was confirmed. 5. Monkey experimental high IOP glaucoma models revealed that in the glaucomatous optic nerve head vaso-constrictive reactions to an alpha-1 agonist was abolished, while vasodilative reaction to a prostaglandin FP receptor agonist was retained. 6. In monkeys with experimental high IOP glaucoma, secondary damage to neurons in the LGN and the glial

  15. Is nail fold capillaroscopy useful in normotensive and primary open angle glaucoma? A pilot study.

    PubMed

    Božić, Marija; Senćanić, Paraskeva-Hentova; Spahić, Goran; Kontić, Dorđe; Marković, Vujica; Marjanović, Ivan; Stojkovic, Milenko; Dorđević-Jocić, Jasmina

    2010-12-01

    Vascular dysregulation is deemed a significant risk factor in glaucoma occurrence and progression. Capillaroscopy of the blood vessels on the finger nail-fold is a method that can provide information regarding the state of the vascular system at the capillary level. The aim of this pilot study was to determine whether there are significant differences in the morphological characteristics of the peripheral blood vessels in normotensive glaucoma and primary open angle glaucoma. An ophthalmological and capillaroscopic examination was conducted on 30 normotensive glaucoma patients and 30 primary open angle glaucoma patients. The capillaroscopic characteristics described were as follows: capillary row density, capillary diameter, number of spirally formed capillaries, permeability of the loop, and loop resistance. Statistically, significantly more intensively spiraled capillaries were found in normotensive glaucoma patients (χ(2) test, p < 0.05). Results confirm the thesis that vascular factors play a significant role in the pathogenesis of the glaucoma, especially in cases where the level of intraocular pressure cannot be deemed responsible for the present damage of the optical nerve. Despite the newer, technologically more developed methods for diagnostics and monitoring glaucoma, it is often not easy to establish the right diagnosis and determine further the course of the illness, since the role the intraocular pressure (IOP) plays compared to the role of vascular factors is unknown; hence, capillaroscopy as a complementary diagnostic procedure can be of help.

  16. Laser trabeculoplasty for open-angle glaucoma: a report by the american academy of ophthalmology.

    PubMed

    Samples, John R; Singh, Kuldev; Lin, Shan C; Francis, Brian A; Hodapp, Elizabeth; Jampel, Henry D; Smith, Scott D

    2011-11-01

    To provide an evidence-based summary of the outcomes, repeatability, and safety of laser trabeculoplasty for open-angle glaucoma. A search of the peer-reviewed literature in the PubMed and the Cochrane Library databases was conducted in June 2008 and was last repeated in March 2010 with no date or language restrictions. The search yielded 637 unique citations, of which 145 were considered to be of possible clinical relevance for further review and were included in the evidence analysis. Level I evidence indicates an acceptable long-term efficacy of initial argon laser trabeculoplasty for open-angle glaucoma compared with initial medical treatment. Among the remaining studies, level II evidence supports the efficacy of selective laser trabeculoplasty for lowering intraocular pressure for patients with open-angle glaucoma. Level III evidence supports the efficacy of repeat use of laser trabeculoplasty. Laser trabeculoplasty is successful in lowering intraocular pressure for patients with open-angle glaucoma. At this time, there is no literature establishing the superiority of any particular form of laser trabeculoplasty. The theories of action of laser trabeculoplasty are not elucidated fully. Further research into the differences among the lasers used in trabeculoplasty, the repeatability of the procedure, and techniques of treatment is necessary. Proprietary or commercial disclosure may be found after the references. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  17. Changing Concepts of Primary Open-Angle Glaucoma and Early Detection

    PubMed Central

    Battista, Renaldo N.; Huston, Patricia; Davis, M. William L.

    1986-01-01

    The understanding of primary open-angle glaucoma has changed over the past 20 years and recommendations on early detection are being revised. In this paper the use of Shiotz tonometry is critically examined, and the problems encountered in instituting alternative screening techniques are reviewed. ImagesFigure 3c PMID:21267099

  18. Clinical profiles of primary open angle glaucoma versus normal tension glaucoma patients: a pilot study.

    PubMed

    Asrani, Sanjay; Samuels, Brian; Thakur, Mugdha; Santiago, Cecilia; Kuchibhatla, Maragatha

    2011-05-01

    To study the health profiles and behavioral differences between primary open angle glaucoma (POAG) and normal tension glaucoma (NTG) patients. Confidential mail survey of ICD-9 defined POAG (n = 277) and NTG (n = 116) patients was carried out to collect information regarding age, gender, height, weight, waist circumference, blood pressure (BP), medications [prescription (Rx) and over the counter (OTC)], education, and the Short Health Anxiety Inventory (SHAI). NTG patients (59/116) were significantly more likely to respond to the survey than POAG patients (43/277), p = 0.0001, and to have obtained college level education (70% vs. 42%), p = 0.003. Body weight, waist circumference, body mass index, systolic BP, pulse pressure, and ratio of prescription medications to OTC medications were significantly lower in the NTG group (p < 0.0001). The SHAI score, mean age, and diastolic BP were not different between the two groups. A subgroup analysis of college-educated patients in both groups revealed persisting significant differences in waist circumference, systolic BP, and ratio of Rx to OTC medications. NTG patients do not have significantly greater health anxiety than POAG patients. NTG patients are more likely to have lower BMI, systolic BP, and ratio of Rx to OTC medications than POAG patients. The pilot nature of this study limits generalizability of these findings. Larger studies confirming these findings and elucidating the role of refractive error and medical history on such differences are needed.

  19. Targeting relatives of patients with primary open angle glaucoma: the help the family glaucoma project.

    PubMed

    Okeke, Constance Nduaguba; Friedman, David S; Jampel, Henry D; Congdon, Nathan G; Levin, Lisa; Lai, Hong; Quigley, Harry A

    2007-09-01

    To assess the knowledge of patients with open angle glaucoma (OAG) and their family members about OAG risk factors and to study the referral of family members for eye examinations. Cross-sectional survey and prospective cohort study. We interviewed OAG patients (probands) at the Wilmer Eye Institute and their biologically related parents, siblings, and children about their knowledge of OAG risk factors. Qualified family members were offered an eye examination through the EyeCare America program. Three months after initial contact, a follow-up telephone questionnaire determined the outcome of the referral. Among 102 probands and 100 (of 230 eligible) family members who were interviewed, there was high awareness that OAG is related to older age (85% both groups). More probands knew of the association with higher intraocular pressure (95%) compared with family (78%). Yet, 21% of both groups were not aware that OAG is hereditary, and only 53% of probands and 30% of family members knew that OAG is more common in certain ethnic groups. Only two-thirds of probands had suggested that family members have an eye examination. Eighty percent of family members had had an eye examination within the last year; of 21 with no recent examination, 66% (13/21) accepted referral. The Help the Family Glaucoma project developed a novel approach to identify those at high-risk for OAG. Screening of relatives of OAG patients deserves further study in a more representative selection of the general population.

  20. Association of open-angle glaucoma loci with incident glaucoma in the Blue Mountains Eye Study.

    PubMed

    Burdon, Kathryn P; Mitchell, Paul; Lee, Anne; Healey, Paul R; White, Andrew J R; Rochtchina, Elena; Thomas, Peter B M; Wang, Jie Jin; Craig, Jamie E

    2015-01-01

    To determine if open-angle glaucoma (OAG)-associated single nucleotide polymorphisms (SNPs) are associated with incident glaucoma and if such genetic information is useful in OAG risk prediction. Case-control from within a population-based longitudinal study. study population: Individuals aged over 49 years of age living in the Blue Mountains region west of Sydney and enrolled in the Blue Mountains Eye Study. observation: Cases for this sub-study (n = 67) developed incident OAG between baseline and 10-year visits, in either eye, while controls (n = 1919) had no evidence for OAG at any visit. All participants had an ocular examination and DNA genotyped for reported OAG risk SNPs. main outcome measure: Incident OAG. Two loci also known to be associated with cup-to-disc ratio as well as OAG (9p21 near CDKN2B-AS1 and SIX1/SIX6) were both significantly associated with incident OAG in the Blue Mountains Eye Study cohort (P = .006 and P = .004, respectively). The TMCO1 locus was nominally associated (P = .012), while the CAV1/CAV2 and 8q22 loci were not associated. Multivariate logistic regression and neural network analysis both indicated that the genetic risk factors contributed positively to the predictive models incorporating traditional risk factors. This study shows that previously reported genetic variations related to OAG and cup-to-disc ratio are associated with the onset of OAG and thus may become useful in risk prediction algorithms designed to target early treatment to those most at risk of developing glaucoma. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  1. Macular Thickness Variability in Primary Open Angle Glaucoma Patients using Optical Coherence Tomography.

    PubMed

    Sharma, Anjali; Agarwal, Prakashchand; Sathyan, P; Saini, V K

    2014-01-01

    To compare the difference of retinal macular thickness and macular volume using optical coherence tomography (OCT) in primary open angle glaucoma (POAG) patients with the normal subjects. This observational case control study included primary open angle glaucoma (POAG) patients (n = 124 eyes) and healthy subjects in the control group (n = 124 eyes). All subjects underwent detailed history, general and systemic exami -nation. Complete ocular examination included best corrected visual acuity (BCVA), slit lamp examination, intraocular pressure (IOP), central corneal thickness, gonioscopy, dilated fundus biomicroscopy. Field analysis was done by white on white Humphrey Field Analyzer (Carl Zeiss). Optical coherence tomography imaging of macular area was performed using Stratus OCT (OCT 3, Version 4, Carl Zeiss Inc, Dublin, California, USA). In both these groups, parameters analyzed were macular thickness, inner macular thicknesses (IMT), outer macular thicknesses (OMT), central macular thick ness (CMT) and total macular volume (TMV). The POAG group had significantly decreased values of TMV, OMT and IMT, compared to control group, while there was no difference in CMT, presumably due to absence of ganglion cells in the central part. Thus, macular thickness and volume parameters may be used for making the diagnosis of glaucoma especially in patients with abnormalities of disc. Macular thickness parameters correlated well with the diagnosis of glaucoma. How to cite this article: Sharma A, Agarwal P, Sathyan P, Saini VK. Macular Thickness Variability in Primary Open Angle Glaucoma Patients using Optical Coherence Tomography. J Current Glau Prac 2014;8(1):10-14.

  2. Comparison of Prelaminar Thickness between Primary Open Angle Glaucoma and Normal Tension Glaucoma Patients

    PubMed Central

    Jung, Youn Hea; Park, Hae-Young L.; Jung, Kyoung In; Park, Chan Kee

    2015-01-01

    Main Objective The thinning of prelaminar tissue and prelamina cupping is known to occur by ischemia, as we see in anterior ischemic optic neuropathy. Since normal tension glaucoma (NTG) is thought to be more related to vascular factor than in primary open-angle glaucoma (POAG), we hypothesized that prelamina thinning may occur prominently in NTG patients. This study investigated the difference in prelaminar tissue thickness between patients with POAG and NTG and verified the factors related to prelaminar thinning. Methods Complete ophthalmic examination including standard automatic perimetry was performed in all patients. The prelaminar tissue thickness was measured in all patients by performing enhanced depth imaging with a Heidelberg Spectralis Optical Coherence Tomography. The retinal nerve fiber layer and optic nerve head parameters were obtained using the Heidelberg Retina Tomography II and Cirrus Optical Coherence Tomography. Various ocular factors and their relationships with prelaminar thickness were analyzed. Results The mean prelaminar tissue thickness was significantly thinner in patients with POAG than in those with NTG. The difference in the prelaminar thickness between patients with POAG and those with NTG was greater in the early field defect group than in the moderate and severe field groups. In multivariate analysis, the mean prelaminar thickness was related to the intraocular pressure, mean deviation, cup-disc ratio, and cup volume. Conclusions The prelaminar tissue was thinner in patients with POAG than in patients with NTG, and intraocular pressure had a strong influence on the prelaminar thickness in both POAG and NTG. This may indicate that mechanical compression is the main pathogenic factor in both POAG and NTG. PMID:25793734

  3. DNA copy number variants of known glaucoma genes in relation to primary open-angle glaucoma.

    PubMed

    Liu, Yutao; Garrett, Melanie E; Yaspan, Brian L; Bailey, Jessica Cooke; Loomis, Stephanie J; Brilliant, Murray; Budenz, Donald L; Christen, William G; Fingert, John H; Gaasterland, Douglas; Gaasterland, Terry; Kang, Jae H; Lee, Richard K; Lichter, Paul; Moroi, Sayoko E; Realini, Anthony; Richards, Julia E; Schuman, Joel S; Scott, William K; Singh, Kuldev; Sit, Arthur J; Vollrath, Douglas; Weinreb, Robert; Wollstein, Gadi; Zack, Donald J; Zhang, Kang; Pericak-Vance, Margaret A; Haines, Jonathan L; Pasquale, Louis R; Wiggs, Janey L; Allingham, R Rand; Ashley-Koch, Allison E; Hauser, Michael A

    2014-11-20

    We examined the role of DNA copy number variants (CNVs) of known glaucoma genes in relation to primary open angle glaucoma (POAG). Our study included DNA samples from two studies (NEIGHBOR and GLAUGEN). All the samples were genotyped with the Illumina Human660W_Quad_v1 BeadChip. After removing non-blood-derived and amplified DNA samples, we applied quality control steps based on the mean Log R Ratio and the mean B allele frequency. Subsequently, data from 3057 DNA samples (1599 cases and 1458 controls) were analyzed with PennCNV software. We defined CNVs as those ≥5 kilobases (kb) in size and interrogated by ≥5 consecutive probes. We further limited our investigation to CNVs in known POAG-related genes, including CDKN2B-AS1, TMCO1, SIX1/SIX6, CAV1/CAV2, the LRP12-ZFPM2 region, GAS7, ATOH7, FNDC3B, CYP1B1, MYOC, OPTN, WDR36, SRBD1, TBK1, and GALC. Genomic duplications of CDKN2B-AS1 and TMCO1 were each found in a single case. Two cases carried duplications in the GAS7 region. Genomic deletions of SIX6 and ATOH7 were each identified in one case. One case carried a TBK1 deletion and another case carried a TBK1 duplication. No controls had duplications or deletions in these six genes. A single control had a duplication in the MYOC region. Deletions of GALC were observed in five cases and two controls. The CNV analysis of a large set of cases and controls revealed the presence of rare CNVs in known POAG susceptibility genes. Our data suggest that these rare CNVs may contribute to POAG pathogenesis and merit functional evaluation. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

  4. DNA Copy Number Variants of Known Glaucoma Genes in Relation to Primary Open-Angle Glaucoma

    PubMed Central

    Liu, Yutao; Garrett, Melanie E.; Yaspan, Brian L.; Bailey, Jessica Cooke; Loomis, Stephanie J.; Brilliant, Murray; Budenz, Donald L.; Christen, William G.; Fingert, John H.; Gaasterland, Douglas; Gaasterland, Terry; Kang, Jae H.; Lee, Richard K.; Lichter, Paul; Moroi, Sayoko E.; Realini, Anthony; Richards, Julia E.; Schuman, Joel S.; Scott, William K.; Singh, Kuldev; Sit, Arthur J.; Vollrath, Douglas; Weinreb, Robert; Wollstein, Gadi; Zack, Donald J.; Zhang, Kang; Pericak-Vance, Margaret A.; Haines, Jonathan L.; Pasquale, Louis R.; Wiggs, Janey L.; Allingham, R. Rand; Ashley-Koch, Allison E.; Hauser, Michael A.

    2014-01-01

    Purpose. We examined the role of DNA copy number variants (CNVs) of known glaucoma genes in relation to primary open angle glaucoma (POAG). Methods. Our study included DNA samples from two studies (NEIGHBOR and GLAUGEN). All the samples were genotyped with the Illumina Human660W_Quad_v1 BeadChip. After removing non–blood-derived and amplified DNA samples, we applied quality control steps based on the mean Log R Ratio and the mean B allele frequency. Subsequently, data from 3057 DNA samples (1599 cases and 1458 controls) were analyzed with PennCNV software. We defined CNVs as those ≥5 kilobases (kb) in size and interrogated by ≥5 consecutive probes. We further limited our investigation to CNVs in known POAG-related genes, including CDKN2B-AS1, TMCO1, SIX1/SIX6, CAV1/CAV2, the LRP12-ZFPM2 region, GAS7, ATOH7, FNDC3B, CYP1B1, MYOC, OPTN, WDR36, SRBD1, TBK1, and GALC. Results. Genomic duplications of CDKN2B-AS1 and TMCO1 were each found in a single case. Two cases carried duplications in the GAS7 region. Genomic deletions of SIX6 and ATOH7 were each identified in one case. One case carried a TBK1 deletion and another case carried a TBK1 duplication. No controls had duplications or deletions in these six genes. A single control had a duplication in the MYOC region. Deletions of GALC were observed in five cases and two controls. Conclusions. The CNV analysis of a large set of cases and controls revealed the presence of rare CNVs in known POAG susceptibility genes. Our data suggest that these rare CNVs may contribute to POAG pathogenesis and merit functional evaluation. PMID:25414181

  5. Molecular biomarkers in primary open-angle glaucoma: from noninvasive to invasive.

    PubMed

    Agnifili, Luca; Pieragostino, Damiana; Mastropasqua, Alessandra; Fasanella, Vincenzo; Brescia, Lorenza; Tosi, Gian Marco; Sacchetta, Paolo; Mastropasqua, Leonardo

    2015-01-01

    Glaucoma, the first cause of irreversible blindness worldwide, is a neurodegenerative disease characterized by the progressive loss of retinal ganglion cells. There are different subtypes of glaucoma, all expression of a common optic neuropathy; primary open-angle glaucoma (POAG) is the most diffuse subtype in western countries. To date, unfortunately, several questions still remain unsolved in the glaucoma management, such as the availability of powerful methods for screening high-risk populations, early diagnosis, timely detection of damage progression, and prediction of response to therapy. Over the last years, biomarkers have gained immense scientific and clinical interest to solve these issues, with countless molecules that have been candidate as potential biomarkers. In the present review, we summarize the current knowledge about the most robust molecular biomarkers proposed in POAG, distinguishing noninvasive from minimally invasive, and invasive biomarkers, according to the procedure adopted to collect fluid samples.

  6. Pit-like changes of the optic nerve head in open-angle glaucoma.

    PubMed Central

    Radius, R. L.; Maumenee, A. E.; Green, W. R.

    1978-01-01

    Six patients with open-angle glaucoma and acquired pit-like changes in the optic nerve head are presented. In 1 patient evolution of the pit-like defect is documented. In all 6 patients progression of associated visual field deficits is described. It is suggested that such pit-like changes in selected patients with glaucoma may not represent congenital lesions but rather local, progressive nerve head disease, occurring particularly in response to raised intraocular pressure. The management of patients with optic nerve head pitting and the pathogenesis of glaucomatous optic neuropathy are discussed with respect to this observation. Images PMID:666988

  7. New drugs and preparations for open-angle glaucoma in adults.

    PubMed

    2015-12-01

    Primary (or chronic) open-angle glaucoma (POAG or COAG) may be asymptomatic but causes progressive optic nerve damage with significant loss of visual field. Treatments aim to lower intraocular pressure (IOP) by reducing the production of aqueous humour and/or increasing its drainage. Here we update our previous articles to reflect new drugs, preservative-free preparations and fixed-dose drug combinations for POAG.

  8. Efficacy and Safety of Trabectome Surgery in Chinese Open-Angle Glaucoma

    PubMed Central

    Lee, Jacky W.Y.; Yick, Doris W.F.; Tsang, Susanna; Yuen, Can Y.F.; Lai, Jimmy S.M.

    2016-01-01

    Abstract To investigate the clinical outcome of the Trabectome in Chinese open-angle glaucoma (OAG). This prospective case series recruited pseudophakic glaucoma subjects with open-angle configuration. Trabeculectomy ab interno was performed using the Trabectome to 120° of the trabecular meshwork. Intraocular pressure (IOP) and medications were recorded preoperatively and every 3 months postoperatively. Visual acuity was measured preoperatively and at 1 and 6 months postoperatively. One-way ANOVA with Tukey Multiple Comparison Test were used to measure the pre and postoperative parameters. In 19 eyes of 19 Chinese subjects, 26.3% were uveitic, 68.4% were primary open-angle glaucoma, and 5.3% had a history of chronic angle-closure glaucoma with open-angles after cataract extraction. The subjects’ mean age was 67.5 ± 14.4 years, with 4 females and 15 males. Two patients required secondary filtration procedure. At 6 months, the IOP reduced by 34.8% (24.4 ± 4.4 mm Hg to 15.9 ± 5.1 mm Hg, P < 0.0001). The number of types of antiglaucoma medications was reduced by 28.2% (3.9 ± 0.8–2.8 ± 1.6, P < 0.0001). The visual acuity was static at 1 and 6 months postoperatively (P = 0.4). There were no intraoperative complications. 26.3% of subjects had a transient IOP spike > 21 mm Hg, 1 had hyphema requiring washout, and 1 had reactivation of herpetic keratitis. The success rate at 6 months was 89.5%. Trabectome achieved a modest reduction in IOP and medications in the majority of pseudophakic Chinese OAG eyes. PMID:27082559

  9. Open-Angle Glaucoma: Drug Development Pipeline during the Last 20 Years (1995-2015).

    PubMed

    Vicente, André; Prud'homme, Sylvie; Ferreira, Joana; Abegão Pinto, Luís; Stalmans, Ingeborg

    2017-01-01

    To analyse drug development for open-angle glaucoma during the last 20 years. Research was performed by referring to clinical trials registered at the International Clinical Trials Registry Platform (ICTRP). A search for the condition "open-angle glaucoma" with the intervention "drug" was performed. We included trials registered from 01/01/1995 to 01/01/2015, only involving studies in phases 1, 2, and 3. Only studies resorting to novel treatment strategies (either novel drugs or yet-untested fixed associations of approved medication) were considered. We recorded 158 studies for the condition of open-angle glaucoma with a drug-based intervention; 65 of the studies reported phase 2 trials and 74 reported phase 3 trials. Pharmaceutical companies were the primary sponsors of 95.3% of the trials. Most of the studies (66.5%, n = 105) involved a new drug, and the remainder (33.5%, n = 53) tested fixed drug associations. The bulk of the trials (n = 99, 62.7%) involved the use of prostaglandin analogues, either as a comparator or a study drug. In descending order of frequency, the studies conducted involved Rho-kinase inhibitors (n = 15), carbonic anhydrase inhibitors (n = 14), β-blockers (n = 7), angiostatic steroids (n = 6), α2-adrenergic agonists (n = 4), 5-HT2A receptor agonists (n = 4), and NMDA receptor antagonists (n = 2). A cyclin-dependent kinase inhibitor, an LIM-domain kinase 2 inhibitor, an A1 adenosine receptor agonist, catechin, macrolide, saffron, and seawater were each tested in 1 clinical trial. Research into the medical treatment of glaucoma indicates the use of prostaglandin analogues. However, there are a significant number of trials testing other drug classes, particularly Rho-kinase inhibitors. This new focus could lead to a potential increase in the number of therapeutical options for the management of glaucoma in the future. © 2017 S. Karger AG, Basel.

  10. RAND-like appropriateness methodology consensus for primary open-angle glaucoma in Latin America.

    PubMed

    Lerner, S Fabian; Singh, Kuldev; Susanna, Remo; Wilson, M Roy; Lee, Brian L; Maul, Eugenio

    2012-09-01

    To report the results of a Latin American consensus panel regarding the diagnosis and management of primary open-angle glaucoma and to compare these results with those from a similar panel in the United States. A RAND-like (Research and Development) appropriateness methodology was used to assess glaucoma practice in Latin America. The 148 polling statements created for the RAND- like analysis in the United States and 10 additional statements specific to glaucoma care in Latin America were presented to a panel of Latin American glaucoma experts. Panelists were polled in private using the RAND- like methodology before and after the panel meeting. Consensus agreement or disagreement among Latin American experts was reached for 51.3% of statements before the meeting and increased to 66.5% in the private, anonymous meeting after polling (79.0% agreement, 21.0% disagreement). Although there was a high degree of concordance (111 of 148 statements; 75%) between the results of this Latin American panel and the United States panel, there were some notable exceptions relating to diagnostic and therapeutic decision making. This RAND-like consensus methodology provides a perspective of how Latin American glaucoma practitioners view many aspects of glaucoma and compares these results with those obtained using a similar methodology from practitioners in the United States. These findings may be helpful to ophthalmologists providing glaucoma care in Latin America and in other regions of the world. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Adherence to treatment in patients with open-angle glaucoma and its related factors

    PubMed Central

    Movahedinejad, Tayebeh; Adib-Hajbaghery, Mohsen

    2016-01-01

    Introduction Lack of adherence to medical treatments typically lead to burdensome consequences such as progressive visual impairment, blindness, and disabilities. This study aimed to determine the adherence to medication in patients with open-angle glaucoma and related factors in patients referred to the Matini Ophthalmology Hospital in Kashan, Iran. Methods A cross-sectional study was conducted from 23 July 2015 to 20 January 2016 on all patients with open-angle glaucoma referred to the Matini Ophthalmology Hospital in Kashan, Iran. A questionnaire was used to gather data about patients’ demographics and factors affecting adherence to medical treatments. The Morisky Medication Adherence Scale was used to evaluate the adherence to glaucoma medication. Results were analyzed using SPSS version 13. Descriptive statistics, chi-square, and logistic regression analysis were used. Results In total, 130 patients with a mean age of 55.36 ± 15.54 were studied. Only 34.6% of patients completely adhered to glaucoma medications. The chi-square test showed that age (p=0.007), education (p=0.01), life entourage (p=0.04), place of residence (p=0.06), average monthly income (p=0.005), the interval between medical visits (p=0.007), problem in scheduling the medical visits (p<0.001), number of medications (p<0.001), lifelong using and side-effects of medications (p<0.001), answers of the physician to the patient’s questions (p<0.001), financial and traveling problems (p<0.001), lack of skill in using eye drops (p<0.001), lack of awareness of glaucoma complications and symptoms (p<0.001), forgetting, fatigue, impatience, believing in uselessness of medications, and lack of support from family (p<0.001) were associated with patients’ adherence. Logistic regression showed that 89% of variance of patients’ adherence to glaucoma medications can be predicted by seven factors: problems in traveling and scheduling medical visits, the large number and side effects of medications

  12. [The effect of crystalline lens extraction on intraocular pressure in patients with primary open-angle glaucoma].

    PubMed

    Macarie, S; Macarie, Daniela

    2013-01-01

    This issue presents the results of a study on patients with cataract and primary open angle glaucoma who suffered lens extraction for cataract. We analise the effects of the lens extraction on the level of intraocular pressure at this patients.

  13. Mapping a gene for adult-onset primary open-angle glaucoma to chromosome 3q

    SciTech Connect

    Wirtz, M.K.; Samples, J.R.; Kramer, P.L.

    1997-02-01

    Glaucoma is the third-leading cause of blindness in the world, affecting >13.5 million people. Adult-on-set primary open-angle glaucoma (POAG) is the most common form of glaucoma in the United States. We present a family in which adult-onset POAG is inherited as an autosomal dominant trait. Twelve affected family members were identified from 44 at-risk individuals. The disease-causing gene was mapped to chromosome 3q21-24, with analysis of recombinant haplotypes suggesting a total inclusion region of 11.1 cM between markers D3S3637 and D3S1744. This is the first report of mapping of an adult-onset POAG gene to chromosome 3q, gene symbol GLC1C. 57 refs., 3 figs., 3 tabs.

  14. Bilateral juvenile onset primary open-angle glaucoma among keratoconus patients.

    PubMed

    Goel, Sahil; Ganger, Anita; Gupta, Viney

    2015-01-01

    To report the occurrence of juvenile open-angle glaucoma (JOAG) in patients with keratoconus. In this observational case series we report 6 eyes of 3 patients with keratoconus who had concomitant JOAG. Corneal topography, intraocular pressure, gonioscopic, and fundus findings were recorded for all the eyes. All 3 patients presented with corneal ectasia, high intraocular pressure, and advanced glaucomatous damage and had no family history of glaucoma or keratoconus. Two of the 3 patients needed collagen cross-linking with riboflavin for progression of keratoconus and trabeculectomy for control of intraocular pressure. One of the patients also underwent a lamellar keratoplasty for keratoconus. This is the first case series pointing toward a possible association of JOAG with keratoconus and highlights the importance of a thorough workup of glaucoma in patients with keratoconus.

  15. Mapping a gene for adult-onset primary open-angle glaucoma to chromosome 3q.

    PubMed Central

    Wirtz, M K; Samples, J R; Kramer, P L; Rust, K; Topinka, J R; Yount, J; Koler, R D; Acott, T S

    1997-01-01

    Glaucoma is the third-leading cause of blindness in the world, affecting >13.5 million people. Adult-onset primary open-angle glaucoma (POAG) is the most common form of glaucoma in the United States. We present a family in which adult-onset POAG is inherited as an autosomal dominant trait. Twelve affected family members were identified from 44 at-risk individuals. The disease-causing gene was mapped to chromosome 3q21-24, with analysis of recombinant haplotypes suggesting a total inclusion region of 11.1 cM between markers D3S3637 and D3S1744. This is the first report of mapping of an adult-onset POAG gene to chromosome 3q, gene symbol GLC1C. PMID:9012402

  16. Analysis of the qualitative dermatoglyphics of the digito-palmar complex in patients with primary open angle glaucoma.

    PubMed

    Novak-Laus, Katia; Milicić, Jasna; Tedeschi-Reiner, Eugenia; Iveković, Renata; Korsić, Jadranka; Zrinsćak, Ognjen; Mandić, Zdravko

    2006-03-01

    The primary open-angle glaucomas are a group of diseases that have in common characteristic morphological changes at the optic nerve head and retinal nerve fiber layer, progressive retinal ganglion cells death and characteristic visual field loss. The risk for primary open angle glaucoma rises continuously with the level of the intraocular pressure. The disease advances slowly and there are no symptoms. Primary open angle glaucoma is caused by abnormal aqueous humour outflow in the trabecular meshwork in the open angle. Etiopathogenesis of primary open angle glaucoma is unclear. The increased risk of glaucoma in relatives has long been recognized. Frequency for manifestation of the disease is 10-30% in family members. The discovery of the specific gene loci responsible for the manifestation of glaucoma has helped us to understand its mechanism of origin and definitely confirmed the hereditary nature of this disease. Digito-palmar dermatoglyphs were already used to determine hereditary base of many diseases and it was the reason for investigation of their qualitative patterns in patients with glaucoma (22 males and 23 females), their immediate relatives (19 males and 23 females) in comparison to a group of phenotypically healthy population (52 males and 56 females). The results pointed a connection with the dermatoglyphic traits of the digito-palmar complex between patients with glaucoma and their immediate relatives. There is a possible discrimination of patients and their immediate relatives from phenotypically healthy population, too.

  17. Question on clinical efficiency and principles of diode laser radiation activity at a primary open-angle glaucoma

    NASA Astrophysics Data System (ADS)

    Bolshunov, A. V.; Litvinova, G. G.; Ilyina, O. S.; Easakiva, A. L.; Fyodorov, A. A.; Poleva, R. P.

    1999-07-01

    The efficiency of a diode laser with a wavelength 0,81 microns in treatment of an open-angle glaucoma is investigated. The diode LTP is a pathogenesis oriented method of treatment of an open angle glaucoma: it gives in improvement of outflow of an intraocular fluid, stabilization and improvement of visual functions for patients with initial and developed stages of disease at term of observation up to 12 months.

  18. Selective laser trabeculoplasty (SLT): 1-year results in early and advanced open angle glaucoma.

    PubMed

    Schlote, Torsten; Kynigopoulos, Myron

    2016-02-01

    The purpose of this study was to examine the efficacy of selective laser trabeculoplasty (SLT) in eyes with early and more advanced stages of open angle glaucoma within 1 year of follow-up. Retrospective chart review in a consecutive series of patients treated by SLT to reduce intraocular pressure (IOP) or decrease number of topical medications in cases of discomfort and allergy. The cup-to-disc ratio of the optic nerve and the GSS 2 (glaucoma staging system 2) was used to differentiate between early (group 1) and more advanced (group 2) stages of glaucoma. At the time of SLT treatment, no new signs of glaucoma progression were seen. Only the first treated eye of every patient was included in the analysis. In group 1 (early glaucoma), 27 eyes were included. IOP reduction <21 mmHg/>20 % of the preoperative IOP-value and reduction of medication were achieved in 17 eyes (62.96 %). Successful re-treatment was necessary in 2 eyes (7.4 %). In group 2 (advanced glaucoma), 44 eyes underwent SLT. In eight eyes (18.18 %), filtrating surgery was necessary after initial SLT. In the remaining 36 eyes, IOP reduction <21 mmHg/>20 % of the baseline IOP was achieved in 26 eyes (59.09 % of 44 eyes) and IOP reduction <18 mmHg/> 30 % of the baseline IOP in 22 eyes (50 % of 44 eyes). SLT was safe and effective in nearly 2/3 of early glaucoma patients and also in 50 % of advanced glaucoma patients using stronger criteria of success. Failure of SLT in advanced glaucoma should lead to immediate filtrating surgery, which seems not to be associated with higher risk of fibrosis.

  19. Evaluation of Contrast Sensitivity, Chromatic Vision, and Reading Ability in Patients with Primary Open Angle Glaucoma

    PubMed Central

    Güerri, Noemi; Cameo, Beatriz; Polo, Vicente; Larrosa, Jose M.

    2016-01-01

    Purpose. To compare contrast sensitivity, acquired color vision deficiency, and reading ability in patients with glaucoma at different stages of the disease and to establish correlations between visual field parameters and visual function scores. Methods. This prospective cross-sectional study included 121 glaucoma patients. Subjects with a diagnosis of chronic open angle glaucoma were recruited and classified according to Hodapp-Parrish-Anderson criteria. Patients with severe visual field defects were excluded because they were older, which could bias the interpretation of visual function tests. Contrast sensitivity was measured using the Pelli-Robson Chart and the CSV1000E test. Chromatic vision was evaluated using the Farnsworth-panel D15 and the L'Anthony D15 tests of Vision Color Recorder software. Reading ability was measured using Radner-Vissum test. Results. Contrast sensitivity (with photopic and mesopic luminance with glare) differed significantly between patients with early and moderate visual field defects (p < 0.05). Reading ability scores and results of the chromatic vision tests did not differ significantly between the two groups. Significant and moderate Spearman correlations between visual field indexes and contrast sensitivity tests were detected. Conclusions. Contrast sensitivity was significantly worse in patients with moderate glaucoma compared to those with early-stage glaucoma. Evaluation of visual function in clinical practice provides important information to address a glaucoma patient's vision complaints. PMID:27872754

  20. Anti-Neurotrophic Effects from Autoantibodies in Adult Diabetes Having Primary Open Angle Glaucoma or Dementia

    PubMed Central

    Zimering, Mark B.; Moritz, Thomas E.; Donnelly, Robert J.

    2013-01-01

    Aim: To test for anti-endothelial and anti-neurotrophic effects from autoantibodies in subsets of diabetes having open-angle glaucoma, dementia, or control subjects. Methods: Protein-A eluates from plasma of 20 diabetic subjects having glaucoma or suspects and 34 age-matched controls were tested for effects on neurite outgrowth in rat pheochromocytoma PC12 cells or endothelial cell survival. The mechanism of the diabetic glaucoma autoantibodies’ neurite-inhibitory effect was investigated in co-incubations with the selective Rho kinase inhibitor Y27632 or the sulfated proteoglycan synthesis inhibitor sodium chlorate. Stored protein-A eluates from certain diabetic glaucoma or dementia subjects which contained long-lasting, highly stable cell inhibitory substances were characterized using mass spectrometry and amino acid sequencing. Results: Diabetic primary open angle glaucoma (POAG) or suspects (n = 20) or diabetic dementia (n = 3) autoantibodies caused significantly greater mean inhibition of neurite outgrowth in PC12 cells (p < 0.0001) compared to autoantibodies in control diabetic (n = 24) or non-diabetic (n = 10) subjects without glaucoma (p < 0.01). Neurite inhibition by the diabetic glaucoma autoantibodies was completely abolished by 10 μM concentrations of Y27632 (n = 4). It was substantially reduced by 30 mM concentrations of sodium chlorate (n = 4). Peak, long-lasting activity survived storage ×5 years at 0–4°C and was associated with a restricted subtype of Ig kappa light chain. Diabetic glaucoma or dementia autoantibodies (n = 5) caused contraction and process retraction in quiescent cerebral cortical astrocytes effects which were blocked by 5 μM concentrations of Y27632. Conclusion: These data suggest that autoantibodies in subsets of adult diabetes having POAG (glaucoma suspects) and/or dementia inhibit neurite outgrowth and promote a reactive astrocyte morphology by a mechanism which may involve

  1. iStent trabecular micro-bypass stent for open-angle glaucoma

    PubMed Central

    Le, Kim; Saheb, Hady

    2014-01-01

    Trabecular micro-bypass stents, commonly known as iStents, are micro-invasive glaucoma surgery (MIGS) devices used to treat open-angle glaucoma. Like other MIGS procedures that enhance trabecular outflow, the iStent lowers intraocular pressure (IOP) by creating a direct channel between the anterior chamber and Schlemm’s canal. iStents are typically implanted at the time of phacoemulsification for patients with open-angle glaucoma and visually significant cataracts. This review summarizes the published data regarding the efficacy, safety, and cost considerations of trabecular micro-bypass stents. Most studies found statistically significant reductions in mean IOP and ocular medication use after combined phacoemulsification with single or double iStent implantation. The devices were found to be very safe, with a safety profile similar to that of cataract surgery. Complications were infrequent, with the most common complications being temporary stent obstruction or malposition, which resolved with observation or secondary procedures. Future studies are needed to evaluate long-term outcomes, patient satisfaction, cost effectiveness, and expanded indications. PMID:25284980

  2. Abnormal interhemispheric resting-state functional connectivity in primary open-angle glaucoma.

    PubMed

    Peng Zhou; Jieqiong Wang; Ting Li; Ningli Wang; Junfang Xian; Huiguang He

    2016-08-01

    Glaucoma is the second leading cause of blindness and it has been the topic of massive studies to explore the underlying mechanisms of the disease. Resting-state neuroimaging studies have been widely applied to investigate the functional damage of the brain, but little is known about the alterations of the interhemispheric resting-state functional connectivity (RSFC) in patients with primary open-angle glaucoma (POAG). In the present study, we used a newly developed voxel-mirrored homotopic connectivity (VMHC) method to explore the interhemispheric RSFC of the brain in POAG patients. The result showed decreased VMHC in the precuneus and the occipital lobe including calcarine and cuneus, as well as increased VMHC in the lingual gyrus, insula, supramarginal gyrus, and frontal gyrus. Meanwhile, we found the mean VMHC in precuneus was negatively correlated (r=-0.551, P=0.041) with Cup-to-disk Ratio. Significant differences between POAG patients and normal controls reveal the altered brain regions and the functional damage, strengthening the understanding of the primary open-angle glaucoma.

  3. Novel Pharmacologic Candidates for Treatment of Primary Open-Angle Glaucoma

    PubMed Central

    Lu, Louise J.; Tsai, James C.; Liu, Ji

    2017-01-01

    Primary open-angle glaucoma (OAG) affects approximately 45 million people worldwide and more than 2.5 million people aged 40 years or older in the United States. Pharmacologic treatment for glaucoma is directed towards lowering intraocular pressure (IOP) to slow disease progression and delay visual field loss. Current medical treatment options for the lowering of IOP include the following classes of topical medications: beta-adrenergic antagonists, alpha-adrenergic agonists, cholinergic agonists, carbonic anhydrase inhibitors, and prostaglandin analogs. Issues with existing drugs include failure to achieve target IOP with monotherapy, drug-related side effects, and low patient compliance with multiple daily administration of eye drops. In recent years, the scientific and medical community has seen encouraging development of novel classes of drugs for primary OAG, the majority of which lower IOP by targeting the trabecular meshwork outflow pathway to increase aqueous humor outflow. Among the most promising new pharmacologic candidates are rho kinase inhibitors including ripasudil (K-115), netarsudil (AR-13324), and AMA0076; adenosine receptor agonists including trabodenoson (INO-8875); and modified prostaglandin analogs including latanoprostene bunod (LBN, BOL-303259-X) and ONO-9054. This study aims to systematically review and summarize the most recent developments in clinical trials for new pharmacologic options for the treatment of primary open-angle glaucoma. PMID:28356898

  4. The Association Between Primary Open Angle Glaucoma and Clustered Components of Metabolic Syndrome

    PubMed Central

    Rasoulinejad, Seyed Ahmad; Kasiri, Ali; Montazeri, Mahdi; Rashidi, Negin; Montazeri, Maryam; Montazeri, Mohammad; Hedayati, Hesam

    2015-01-01

    Purpose : There is conflicting evidence whether components of metabolic syndrome (MetS) increase or decrease the risk of primary open-angle glaucoma (POAG). The aim of the present study was to determine the association between metabolic syndrome and primary open-angle glaucoma. Methods : A total of 200 participants comprising 100 controls and 100 patients with POAG documented by clinical tests and examined by an experienced ophthalmologist using standard ophthalmologic equipment were included in the study. MetS was defined and based on ATP III criteria and POAG was defined by the criteria of the International Society of Geographic and Epidemiological Ophthalmology (ISGEO). The data were entered into the SPSS software and analyzed. Results : The prevalence of MetS in the glaucoma group was 53% in comparison to 38% in the control group (p=0.037). MetS was associated with an increased odds ratio for an IOP higher than 21 mmHg (OR: 1.72; 95% CI 1.03-2.79; p=0.034). The mean IOP was 24.91±4.29 mmHg in the patients without MetS, and 27.23±4.81 mmHg in those with MetS (p=0.027). The mean values of CCT were 603.64±63.16 µm in MetS patients and 579.27±72.87 µm in controls (p=0.018). Conclusion : Data showed an increased prevalence of components of metabolic syndrome in patients with glaucoma. The mechanisms underlying these associations need to be established in future studies. Our results support the recommendation that patients with metabolic syndrome undergo regular ophthalmological exams to monitor for the onset or progression of glaucoma. PMID:26535072

  5. Literature review and meta-analysis of translaminar pressure difference in open-angle glaucoma.

    PubMed

    Siaudvytyte, L; Januleviciene, I; Daveckaite, A; Ragauskas, A; Bartusis, L; Kucinoviene, J; Siesky, B; Harris, A

    2015-10-01

    There is increasing evidence in the literature regarding translaminar pressure difference's (TPD) role in the pathophysiology of glaucoma. The optic nerve is exposed not only to intraocular pressure in the eye, but also to intracranial pressure (ICP), as it is surrounded by cerebrospinal fluid in the subarachnoid space. Although pilot studies have identified the potential importance of TPD in glaucoma, limited available data currently prevent a comprehensive description of the role that TPD may have in glaucomatous pathophysiology. In this review, we present all available qualified data from a systematic review of the literature of the role of TPD in open-angle glaucoma (OAG). PubMed (Medline), OVID Medline, ScienceDirect, SpringerLink, and all available library databases were reviewed and subsequent meta-analysis of pooled mean differences are presented where appropriate. Five papers including 396 patients met criteria for inclusion to the analysis. Importantly, we included all observational studies despite differences in ICP measurement methods, as there is no consensus regarding best-practice ICP measurements in glaucoma. Our results show that not only TPD is higher in glaucoma patients compared with healthy subjects, it is related to structural glaucomatous changes of the optic disc. Our analysis suggests further longitudinal prospective studies are needed to investigate the influence of TPD in OAG, with a goal of overcoming methodological weaknesses of previous studies.

  6. Literature review and meta-analysis of translaminar pressure difference in open-angle glaucoma

    PubMed Central

    Siaudvytyte, L; Januleviciene, I; Daveckaite, A; Ragauskas, A; Bartusis, L; Kucinoviene, J; Siesky, B; Harris, A

    2015-01-01

    There is increasing evidence in the literature regarding translaminar pressure difference's (TPD) role in the pathophysiology of glaucoma. The optic nerve is exposed not only to intraocular pressure in the eye, but also to intracranial pressure (ICP), as it is surrounded by cerebrospinal fluid in the subarachnoid space. Although pilot studies have identified the potential importance of TPD in glaucoma, limited available data currently prevent a comprehensive description of the role that TPD may have in glaucomatous pathophysiology. In this review, we present all available qualified data from a systematic review of the literature of the role of TPD in open-angle glaucoma (OAG). PubMed (Medline), OVID Medline, ScienceDirect, SpringerLink, and all available library databases were reviewed and subsequent meta-analysis of pooled mean differences are presented where appropriate. Five papers including 396 patients met criteria for inclusion to the analysis. Importantly, we included all observational studies despite differences in ICP measurement methods, as there is no consensus regarding best-practice ICP measurements in glaucoma. Our results show that not only TPD is higher in glaucoma patients compared with healthy subjects, it is related to structural glaucomatous changes of the optic disc. Our analysis suggests further longitudinal prospective studies are needed to investigate the influence of TPD in OAG, with a goal of overcoming methodological weaknesses of previous studies. PMID:26183286

  7. Common Genetic Determinants of Intraocular Pressure and Primary Open-Angle Glaucoma

    PubMed Central

    Ikram, M. Kamran; Jansonius, Nomdo M.; Pasutto, Francesca; Hysi, Pirro G.; Macgregor, Stuart; Janssen, Sarah F.; Hewitt, Alex W.; Viswanathan, Ananth C.; ten Brink, Jacoline B.; Hosseini, S. Mohsen; Amin, Najaf; Despriet, Dominiek D. G.; Willemse-Assink, Jacqueline J. M.; Kramer, Rogier; Rivadeneira, Fernando; Struchalin, Maksim; Aulchenko, Yurii S.; Weisschuh, Nicole; Zenkel, Matthias; Mardin, Christian Y.; Gramer, Eugen; Welge-Lüssen, Ulrich; Montgomery, Grant W.; Carbonaro, Francis; Young, Terri L.; Bellenguez, Céline; McGuffin, Peter; Foster, Paul J.; Topouzis, Fotis; Mitchell, Paul; Wang, Jie Jin; Wong, Tien Y.; Czudowska, Monika A.; Hofman, Albert; Uitterlinden, Andre G.; Wolfs, Roger C. W.; de Jong, Paulus T. V. M.; Oostra, Ben A.; Paterson, Andrew D.; Mackey, David A.; Bergen, Arthur A. B.; Reis, André; Hammond, Christopher J.; Vingerling, Johannes R.; Lemij, Hans G.; Klaver, Caroline C. W.; van Duijn, Cornelia M.

    2012-01-01

    Intraocular pressure (IOP) is a highly heritable risk factor for primary open-angle glaucoma and is the only target for current glaucoma therapy. The genetic factors which determine IOP are largely unknown. We performed a genome-wide association study for IOP in 11,972 participants from 4 independent population-based studies in The Netherlands. We replicated our findings in 7,482 participants from 4 additional cohorts from the UK, Australia, Canada, and the Wellcome Trust Case-Control Consortium 2/Blue Mountains Eye Study. IOP was significantly associated with rs11656696, located in GAS7 at 17p13.1 (p = 1.4×10−8), and with rs7555523, located in TMCO1 at 1q24.1 (p = 1.6×10−8). In a meta-analysis of 4 case-control studies (total N = 1,432 glaucoma cases), both variants also showed evidence for association with glaucoma (p = 2.4×10−2 for rs11656696 and p = 9.1×10−4 for rs7555523). GAS7 and TMCO1 are highly expressed in the ciliary body and trabecular meshwork as well as in the lamina cribrosa, optic nerve, and retina. Both genes functionally interact with known glaucoma disease genes. These data suggest that we have identified two clinically relevant genes involved in IOP regulation. PMID:22570627

  8. Modern Concepts of the Diagnosis and Treatment of Chronic Open-Angle Glaucoma

    PubMed Central

    Mikelberg, Frederick S.

    1986-01-01

    Chronic open-angle glaucoma is an important cause of blindness in North America. It consists of the triad of elevated intraocular pressure, pathological cupping of the optic nerve head, and visual field loss. Sophisticated techniques have been developed to determine more accurately the health of the optic nerve head and the status of the visual field. Therapy is aimed at lowering intraocular pressure. This includes topical and systemic therapy followed by laser therapy if necessary. Surgery is indicated if laser and medical treatment fail. The family practitioner has an important role to play in screening individuals to detect this disease. The family practitioner should be aware of the systemic and topical side effects of anti-glaucoma medications. ImagesFigure 1Figure 3 PMID:21267101

  9. Genes, pathways, and animal models in primary open-angle glaucoma

    PubMed Central

    Iglesias, A I; Springelkamp, H; Ramdas, W D; Klaver, C C W; Willemsen, R; van Duijn, C M

    2015-01-01

    Glaucoma is an optic neuropathy characterized by loss of retinal ganglion cells (RGCs) and consequently visual field loss. It is a complex and heterogeneous disease in which both environmental and genetic factors play a role. With the advent of genome-wide association studies (GWASs), the number of loci associated with primary open-angle glaucoma (POAG) have increased greatly. There has also been major progress in understanding the genes determining the vertical cup–disc ratio (VCDR), disc area (DA), cup area (CA), intraocular pressure (IOP), and central corneal thickness (CCT). In this review, we will update and summarize the genetic loci associated so far with POAG, VCDR, DA, CA, IOP, and CCT. We will describe the pathways revealed and supported by genetic association studies, integrating current knowledge from human and experimental data. Finally, we will discuss approaches for functional genomics and clinical translation. PMID:26315706

  10. Structural brain alterations in primary open angle glaucoma: a 3T MRI study

    PubMed Central

    Wang, Jieqiong; Li, Ting; Sabel, Bernhard A.; Chen, Zhiqiang; Wen, Hongwei; Li, Jianhong; Xie, Xiaobin; Yang, Diya; Chen, Weiwei; Wang, Ningli; Xian, Junfang; He, Huiguang

    2016-01-01

    Glaucoma is not only an eye disease but is also associated with degeneration of brain structures. We now investigated the pattern of visual and non-visual brain structural changes in 25 primary open angle glaucoma (POAG) patients and 25 age-gender-matched normal controls using T1-weighted imaging. MRI images were subjected to volume-based analysis (VBA) and surface-based analysis (SBA) in the whole brain as well as ROI-based analysis of the lateral geniculate nucleus (LGN), visual cortex (V1/2), amygdala and hippocampus. While VBA showed no significant differences in the gray matter volumes of patients, SBA revealed significantly reduced cortical thickness in the right frontal pole and ROI-based analysis volume shrinkage in LGN bilaterally, right V1 and left amygdala. Structural abnormalities were correlated with clinical parameters in a subset of the patients revealing that the left LGN volume was negatively correlated with bilateral cup-to-disk ratio (CDR), the right LGN volume was positively correlated with the mean deviation of the right visual hemifield, and the right V1 cortical thickness was negatively correlated with the right CDR in glaucoma. These results demonstrate that POAG affects both vision-related structures and non-visual cortical regions. Moreover, alterations of the brain visual structures reflect the clinical severity of glaucoma. PMID:26743811

  11. Structural brain alterations in primary open angle glaucoma: a 3T MRI study.

    PubMed

    Wang, Jieqiong; Li, Ting; Sabel, Bernhard A; Chen, Zhiqiang; Wen, Hongwei; Li, Jianhong; Xie, Xiaobin; Yang, Diya; Chen, Weiwei; Wang, Ningli; Xian, Junfang; He, Huiguang

    2016-01-08

    Glaucoma is not only an eye disease but is also associated with degeneration of brain structures. We now investigated the pattern of visual and non-visual brain structural changes in 25 primary open angle glaucoma (POAG) patients and 25 age-gender-matched normal controls using T1-weighted imaging. MRI images were subjected to volume-based analysis (VBA) and surface-based analysis (SBA) in the whole brain as well as ROI-based analysis of the lateral geniculate nucleus (LGN), visual cortex (V1/2), amygdala and hippocampus. While VBA showed no significant differences in the gray matter volumes of patients, SBA revealed significantly reduced cortical thickness in the right frontal pole and ROI-based analysis volume shrinkage in LGN bilaterally, right V1 and left amygdala. Structural abnormalities were correlated with clinical parameters in a subset of the patients revealing that the left LGN volume was negatively correlated with bilateral cup-to-disk ratio (CDR), the right LGN volume was positively correlated with the mean deviation of the right visual hemifield, and the right V1 cortical thickness was negatively correlated with the right CDR in glaucoma. These results demonstrate that POAG affects both vision-related structures and non-visual cortical regions. Moreover, alterations of the brain visual structures reflect the clinical severity of glaucoma.

  12. Cytokine biomarkers in tear film for primary open-angle glaucoma

    PubMed Central

    Gupta, Divakar; Wen, Joanne C; Huebner, Janet L; Stinnett, Sandra; Kraus, Virginia B; Tseng, Henry C; Walsh, Molly

    2017-01-01

    Purpose To determine the utility of tear film cytokines as biomarkers for early primary open-angle glaucoma (POAG). Methods Patients without POAG and eye drop-naïve patients with newly diagnosed POAG were recruited from an academic hospital-based glaucoma practice. Tear films of recruited patients were obtained and analyzed using a multiplex, high-sensitivity electrochemiluminescent enzyme-linked immunosorbent assay for proinflammatory cytokines (IFNγ, IL-10, IL-12p70, IL-13, IL-1β, IL-2, IL-4, IL-6, IL-8, and TNFα). Results Mean concentrations of tear film cytokines were lower in the glaucoma group for 8 of 10 cytokines tested. IL-12p70 (3.94±2.19 pg/mL in control vs 2.31±1.156 pg/mL in POAG; P=0.035) was significantly lower in the tear film of patients with newly diagnosed POAG. Conclusion Proinflammatory cytokines were lower in eye drop-naïve newly diagnosed glaucoma patients. Tear film cytokine profiles may be used as biomarkers of early POAG. PMID:28260854

  13. Comparison of canaloplasty and trabeculectomy for open angle glaucoma: a Meta-analysis

    PubMed Central

    Lin, Zhong-Jing; Xu, Shuo; Huang, Shou-Yue; Zhang, Xiao-Bin; Zhong, Yi-Sheng

    2016-01-01

    AIM To evaluate the advantage of canaloplasty compared to trabeculectomy for patients with open angle glaucoma. METHODS Potentially relevant studies were systematically searched using various databases from inception until December 2015. The outcome analyses performed automatically using Revman 5.3 included intraocular pressure reduction (IOPR), postoperative success rate, anti-glaucoma medications reduction and the incidence of adverse events. RESULTS We included four qualified studies incorporating a total of 215 eyes for quantitative synthesis. The weighted mean difference (WMD) of IOPR between canaloplasty and trabeculectomy from baseline to 12mo was -2.33 (95%CI: -4.00, -0.66). There was not significant improvement in the complete or qualified success rate (OR: 0.58, 95%CI: 0.26, 1.31; OR: 0.50, 95%CI: 0.10, 2.44, respectively). Similarly, no statistically significance was observed in anti-glaucoma mediations reduction (WMD: -0.54, 95%CI: -1.18, 0.09). Sensitivity analysis of the primary outcome estimate confirmed the stability of the Meta-analysis result. CONCLUSION Trabeculectomy seems to be more effective in lowering IOP up to 12mo when comparing with canaloplasty. Canaloplasty does not seem to be inferior to trabeculectomy considering the postoperative success rate or the number of postoperative anti-glaucoma medications. Meanwhile, it has an advantage of less bleb related complications. PMID:28003985

  14. Factors associated with lifetime risk of open-angle glaucoma blindness.

    PubMed

    Peters, Dorothea; Bengtsson, Boel; Heijl, Anders

    2014-08-01

    To investigate factors associated with bilateral glaucoma blindness, particularly factors available at the time of diagnosis. Retrospective chart review of all patients with primary open-angle glaucoma (POAG) or pseudoexfoliative glaucoma (PEXG) followed at the Department of Ophthalmology or Low Vision Center of Skåne University Hospital, Malmö, Sweden, who died between January 2006 and June 2010. Disease stage at diagnosis was defined by a simplified version of Mills' glaucoma staging system using perimetric mean deviation (MD) to define six stages of severity. Blindness was defined according to WHO criteria. We used logistic regression analysis to examine the association between risk factors and glaucoma blindness. Four hundred and 23 patients were included; 60% POAG and 40% PEXG. Sixty-four patients (15%) became blind from glaucoma. Blind patients had significantly longer mean duration with diagnosed disease than patients who did not go blind (14.8 years ± 5.8 versus 10.6 years ± 6.5, p < 0.001). The risk of blindness increased with higher intraocular pressure (IOP) (OR 1.08, 95% CI 1.03-1.13) and with each stage of more advanced field loss at time of diagnosis (OR 1.80 95% CI 1.34-2.41). Older age at death was also associated with an increased risk of blindness (OR 1.09 95% CI 1.03-1.14), while age at diagnosis was unimportant. PEXG was not an independent risk factor for blindness. Higher IOP and worse visual field status at baseline were important risk factors, as was older age at death. © 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  15. Central Corneal Thickness in Primary Angle Closure and Open Angle Glaucoma

    PubMed Central

    Moghimi, Sasan; Torabi, Hamidreza; Hashemian, Hesam; Amini, Heydar; Lin, Shan

    2014-01-01

    Purpose: To quantitatively analyze central corneal thickness (CCT) in patients with primary angle closure glaucoma (PACG) and primary open-angle glaucoma (POAG), and to evaluate its correlation with severity of glaucoma. Methods: In this retrospective study, records of patients with previously diagnosed POAG or PACG at a tertiary glaucoma service were reviewed. CCT was measured by ultrasound pachymetry. Mean deviation (MD) on visual field (VF) testing was recorded for glaucoma severity determination. CCT and age- and sex-adjusted CCT were compared among the study groups using Student's t-test and analysis of covariance (ANCOVA), respectively. Univariate and multivariate regression models were used for correlation of age, MD and CCT. Results: A total of 115 patients with PACG, 215 with POAG, and 100 normal controls were included with mean age of 64.1 ± 10.4, 59.9 ± 10.5, and 62.04 ± 10.80 years, respectively. CCT was thicker in PACG eyes (545.5 ± 46.1 μm) as compared to POAG eyes (531.7 ± 37.3 μm) and controls (531.0 ± 38.3 μm) even after age and gender adjustment (ANCOVA, P = 0.05). CCT was found to decrease with increasing age only in the POAG group (β = -0.57, P = 0.01). Disease severity (MD of VF) was significantly and inversely correlated with CCT in both POAG and PACG eyes (β = 1.89, P = 0.02; and β = 1.38, P = 0.04, respectively) after age and sex correction. Conclusion: PACG eyes had thicker CCT as compared to POAG and normal healthy eyes in Iranian subjects. Severity of the disease was inversely correlated with CCT in eyes with both POAG and PACG. PMID:25709768

  16. Primary Open Angle Glaucoma is Associated with MR Biomarkers of Cerebral Small Vessel Disease.

    PubMed

    Mercieca, Karl; Cain, John; Hansen, Thomas; Steeples, Laura; Watkins, Amy; Spencer, Fiona; Jackson, Alan

    2016-02-29

    This prospective study tests the hypotheses that: 1) glaucoma is associated with evidence of cerebral small vessel disease; 2) that imaging biomarkers of cerebral small vessel disease in POAG and NTG will show different characteristics. 12 normal controls, 7 patients with primary open angle glaucoma (POAG) and 9 patients with normal tension glaucoma (NTG) were recruited. Ophthalmological clinical assessment and MR imaging of the brain were performed. MR imaging was used to quantify white matter lesion load, frequency of dilated perivascular spaces (PVS) and abnormalities in cerebral hydrodynamics. Patients with POAG had significantly greater white matter lesion load (p < 0.05), more PVS in the centrum semiovale (p < 0.05) and had higher overall PVS scores than controls (p < 0.05). In the POAG group, optic cup-to-disc ratio (CDR) was positively correlated with deep white matter hyperintensities (R(2) = 0.928, p < 0.01). Mean deviation on the Humphrey visual field assessment was negatively correlated with deep white matter lesion load (R(2) = -0.840, p < 0.01), total white matter lesion load (R(2) = -0.928, p < 0.01) and total PVS (R(2) = -0.820, p < 0.01). MR evidence of cerebral small vessel disease is strongly associated with a diagnosis of POAG and with the severity of abnormalities in CDR and visual field.

  17. Lack of association between polymorphism rs540782 and primary open angle glaucoma in Saudi patients.

    PubMed

    Kondkar, Altaf A; Edward, Nikhil B; Kalantan, Hatem; Al-Kharashi, Abdullah S; Altuwaijri, Saleh; Mohamed, Gamal; Sultan, Tahira; Azad, Taif A; Abu-Amero, Khaled K

    2017-02-02

    To investigate whether polymorphism rs540782 on chromsome 1, in close proximity to the Zona Pellucida Glycoprotein 4 (ZP4) gene, is a risk factor for primary open angle glaucoma (POAG). The study genotyped 92 unrelated POAG cases and 95 control subjects from Saudi Arabia using Taq-Man® assay. The genotype frequency distribution did not deviate significantly from the Hardy-Weinberg equilibrium (p > 0.05). Overall, both the genotype and allele frequencies were not significantly different between cases and controls. The minor 'C' allele frequency was 49.4%, which was comparable to the Japanese population and higher than the Indian and Afro-Caribbean populations. Similarly, no significant association was found between genotypes and systemic diseases and health awareness/behavior domain variables. Importantly, glaucoma specific indices, such as intraocular pressure, cup/disc ratio and number of anti-glaucoma medication, also showed no statistically significant effect of genotypes within POAG cases. Polymorphism rs540782 is not a risk factor for POAG in the Saudi cohort.

  18. Red blood cell plasmalogens and docosahexaenoic acid are independently reduced in primary open-angle glaucoma.

    PubMed

    Acar, Niyazi; Berdeaux, Olivier; Juaneda, Pierre; Grégoire, Stéphane; Cabaret, Stéphanie; Joffre, Corinne; Creuzot-Garcher, Catherine P; Bretillon, Lionel; Bron, Alain M

    2009-12-01

    Among several theories involved in the pathogenesis of primary open-angle glaucoma (POAG), the vascular theory considers the disease to be a consequence of reduced ocular blood flow associated with red blood cell abnormalities. Red blood cell membrane structure and function are influenced by their phospholipid composition. We investigated whether specific lipid entities that may affect the membrane physiology, namely, polyunsaturated fatty acids (PUFAs) and plasmalogens, are modified in POAG and whether these potential variations are related to the stage of glaucoma. Blood samples were collected from 31 POAG patients and 10 healthy individuals. The stage of glaucoma was determined according to the Hodapp and Parrish classification. Lipids were extracted from red blood cell membranes and individual phospholipid species were quantified by liquid chromatography combined with mass spectrometry using triple quadrupole technology. POAG patients had reduced erythrocyte levels of phosphatidyl-choline (PC) carrying docosahexaenoic acid (DHA). POAG patients also displayed lower levels of choline plasmalogens (PlsC) carrying PUFAs other than DHA. These differences were greater as the severity of the disease increased. Linear regressions predicted that red blood cell PlsC levels would decrease years before clinical symptoms, whereas the levels of PC carrying DHA were linearly correlated to visual field loss. Our data demonstrate the selective loss of some individual phospholipid species in red blood cell membranes, which may partly explain their loss of flexibility in POAG.

  19. [Study of novel mutation of OPTN gene in two primary open angle glaucoma families in northeast China].

    PubMed

    Yuan, Hui-Ping; Xiao, Zheng; Xu, Na; Yang, Bin-Bin; Meng, Qing-Feng; Li, Yuan-Yuan

    2008-02-01

    To identify the mutation gene of two Chinese families with primary open angle glaucoma. It was a case control study. Clinical observation and pedigree analysis were undertaken in two families with primary open angle glaucoma. Venous blood were drawn from 6 affected and 6 unaffected subjects in family L, and from 4 affected and 4 unaffected subjects in family C. Genomic DNA was extracted. Linkage to OPTN gene locus was determined. Mutation of this gene was screened by PCR of OPTN gene exons and direct sequencing. A missense mutation A1274G in exon 10 of OPTN gene was identified in affected members of family L. The corresponding amino acid change was Lys322Glu. This mutation was not found in unaffected family members of family L, all members of family C and 87 unrelated normal controls. A novel mutation of OPTN gene with Lys322Glu change is responsible for the occurrence of primary open angle glaucoma in a Chinese family.

  20. Latanoprost for open-angle glaucoma (UKGTS): a randomised, multicentre, placebo-controlled trial.

    PubMed

    Garway-Heath, David F; Crabb, David P; Bunce, Catey; Lascaratos, Gerassimos; Amalfitano, Francesca; Anand, Nitin; Azuara-Blanco, Augusto; Bourne, Rupert R; Broadway, David C; Cunliffe, Ian A; Diamond, Jeremy P; Fraser, Scott G; Ho, Tuan A; Martin, Keith R; McNaught, Andrew I; Negi, Anil; Patel, Krishna; Russell, Richard A; Shah, Ameet; Spry, Paul G; Suzuki, Katsuyoshi; White, Edward T; Wormald, Richard P; Xing, Wen; Zeyen, Thierry G

    2015-04-04

    Treatments for open-angle glaucoma aim to prevent vision loss through lowering of intraocular pressure, but to our knowledge no placebo-controlled trials have assessed visual function preservation, and the observation periods of previous (unmasked) trials have typically been at least 5 years. We assessed vision preservation in patients given latanoprost compared with those given placebo. In this randomised, triple-masked, placebo-controlled trial, we enrolled patients with newly diagnosed open-angle glaucoma at ten UK centres (tertiary referral centres, teaching hospitals, and district general hospitals). Eligible patients were randomly allocated (1:1) with a website-generated randomisation schedule, stratified by centre and with a permuted block design, to receive either latanoprost 0·005% (intervention group) or placebo (control group) eye drops. Drops were administered from identical bottles, once a day, to both eyes. The primary outcome was time to visual field deterioration within 24 months. Analyses were done in all individuals with follow-up data. The Data and Safety Monitoring Committee (DSMC) recommended stopping the trial on Jan 6, 2011 (last patient visit July, 2011), after an interim analysis, and suggested a change in primary outcome from the difference in proportions of patients with incident progression between groups to time to visual field deterioration within 24 months. This trial is registered, number ISRCTN96423140. We enrolled 516 individuals between Dec 1, 2006, and March 16, 2010. Baseline mean intraocular pressure was 19·6 mm Hg (SD 4·6) in 258 patients in the latanoprost group and 20·1 mm Hg (4·8) in 258 controls. At 24 months, mean reduction in intraocular pressure was 3·8 mm Hg (4·0) in 231 patients assessed in the latanoprost group and 0·9 mm Hg (3·8) in 230 patients assessed in the placebo group. Visual field preservation was significantly longer in the latanoprost group than in the placebo group: adjusted hazard ratio (HR) 0

  1. Minimally-invasive glaucoma surgeries (MIGS) for open angle glaucoma: A systematic review and meta-analysis

    PubMed Central

    Maule, Milena; Ceccarelli, Manuela; Fea, Antonio Maria

    2017-01-01

    Background MIGS have been developed as a surgical alternative for glaucomatous patients. Purpose To analyze the change in intraocular pressure (IOP) and glaucoma medications using different MIGS devices (Trabectome, iStent, Excimer Laser Trabeculotomy (ELT), iStent Supra, CyPass, XEN, Hydrus, Fugo Blade, Ab interno canaloplasty, Goniscopy-assisted transluminal trabeculotomy) as a solo procedure or in association with phacoemulsification. Methods Randomized control trials (RCT) and non-RCT (non randomized comparative studies, NRS, and before-after studies) were included. Studies with at least one year of follow-up in patients affected by primary open angle glaucoma, pseudoexfoliative glaucoma or pigmentary glaucoma were considered. Risk of Bias assessment was performed using the Cochrane Risk of Bias and the ROBINS-I tools. The main outcome was the effect of MIGS devices compared to medical therapy, cataract surgery, other glaucoma surgeries and other MIGS on both IOP and use of glaucoma medications 12 months after surgery. Outcomes measures were the mean difference in the change of IOP and glaucoma medication compared to baseline at one and two years and all ocular adverse events. The current meta-analysis is registered on PROSPERO (reference n° CRD42016037280). Results Over a total of 3,069 studies, nine RCT and 21 case series with a total of 2.928 eyes were included. Main concerns about risk of bias in RCTs were lack of blinding, allocation concealment and attrition bias while in non-RCTs they were represented by patients’ selection, masking of participants and co-intervention management. Limited evidence was found based on both RCTs and non RCTs that compared MIGS surgery with medical therapy or other MIGS. In before-after series, MIGS surgery seemed effective in lowering both IOP and glaucoma drug use. MIGS showed a good safety profile: IOP spikes were the most frequent complications and no cases of infection or BCVA loss due to glaucoma were reported

  2. Minimally-invasive glaucoma surgeries (MIGS) for open angle glaucoma: A systematic review and meta-analysis.

    PubMed

    Lavia, Carlo; Dallorto, Laura; Maule, Milena; Ceccarelli, Manuela; Fea, Antonio Maria

    2017-01-01

    MIGS have been developed as a surgical alternative for glaucomatous patients. To analyze the change in intraocular pressure (IOP) and glaucoma medications using different MIGS devices (Trabectome, iStent, Excimer Laser Trabeculotomy (ELT), iStent Supra, CyPass, XEN, Hydrus, Fugo Blade, Ab interno canaloplasty, Goniscopy-assisted transluminal trabeculotomy) as a solo procedure or in association with phacoemulsification. Randomized control trials (RCT) and non-RCT (non randomized comparative studies, NRS, and before-after studies) were included. Studies with at least one year of follow-up in patients affected by primary open angle glaucoma, pseudoexfoliative glaucoma or pigmentary glaucoma were considered. Risk of Bias assessment was performed using the Cochrane Risk of Bias and the ROBINS-I tools. The main outcome was the effect of MIGS devices compared to medical therapy, cataract surgery, other glaucoma surgeries and other MIGS on both IOP and use of glaucoma medications 12 months after surgery. Outcomes measures were the mean difference in the change of IOP and glaucoma medication compared to baseline at one and two years and all ocular adverse events. The current meta-analysis is registered on PROSPERO (reference n° CRD42016037280). Over a total of 3,069 studies, nine RCT and 21 case series with a total of 2.928 eyes were included. Main concerns about risk of bias in RCTs were lack of blinding, allocation concealment and attrition bias while in non-RCTs they were represented by patients' selection, masking of participants and co-intervention management. Limited evidence was found based on both RCTs and non RCTs that compared MIGS surgery with medical therapy or other MIGS. In before-after series, MIGS surgery seemed effective in lowering both IOP and glaucoma drug use. MIGS showed a good safety profile: IOP spikes were the most frequent complications and no cases of infection or BCVA loss due to glaucoma were reported. Although MIGS seem efficient in the

  3. [Magnetotherapy designed to affect cervical sympathetic ganglia for the treatment of patients with primary open-angle glaucoma].

    PubMed

    Veselova, E V; Kamenskikh, T G; Raĭgorodkiĭ, Iu M; Kolbenev, I O; Myshkina, E S

    2010-01-01

    The traveling magnetic field was used to treat primary open-angle glaucoma. The field was applied to the projection of cervical sympathetic ganglia of the patients. Hemodynamic parameters of posterior short ciliary arteries and central retinal artery were analysed along with visual evoked potentials, visual field limits, and visual acuity. It was shown that magnetotherapy with the use of an AMO-ATOS apparatus produces better clinical results in patients with stage I and II primary open-angle glaucoma compared with medicamentous therapy (intake of trental tablets).

  4. A comparison of betaxolol and timolol in open angle glaucoma and ocular hypertension.

    PubMed

    Feghali, J G; Kaufman, P L; Radius, R L; Mandell, A I

    1988-04-01

    In a randomized, double-masked study, 41 patients with primary open-angle glaucoma or ocular hypertension were treated with betaxolol 0.5% or timolol 0.5% drops for 26 weeks. The average decrease in intraocular pressure (IOP) over the total study period was significant with both betaxolol (-6.3 mmHg) and timolol (-7.2 mmHg) in patients receiving no adjunctive therapy. There was no difference between betaxolol and timolol with respect to changes from baseline IOP. Significantly decreased mean brachial arterial pressure (MAP) was seen only with timolol, although the difference between the two groups was not significant. Pulse, pupil size, and basal tear secretion were unchanged in both groups. Burning upon instillation of the drops was more frequent with betaxolol.

  5. Visual impairment in an optineurin mouse model of primary open-angle glaucoma.

    PubMed

    Tseng, Henry C; Riday, Thorfinn T; McKee, Celia; Braine, Catherine E; Bomze, Howard; Barak, Ian; Marean-Reardon, Carrie; John, Simon W M; Philpot, Benjamin D; Ehlers, Michael D

    2015-06-01

    Primary open-angle glaucoma (POAG) is characterized by progressive neurodegeneration of retinal ganglion cells (RGCs). Why RGCs degenerate in low-pressure POAG remains poorly understood. To gain mechanistic insights, we developed a novel mouse model based on a mutation in human optineurin associated with hereditary, low-pressure POAG. This mouse improves the design and phenotype of currently available optineurin mice, which showed high global overexpression. Although both 18-month-old optineurin and nontransgenic control mice showed an age-related decrease in healthy axons and RGCs, the expression of mutant optineurin enhanced axonal degeneration and decreased RGC survival. Mouse visual function was determined using visual evoked potentials, which revealed specific visual impairment in contrast sensitivity. The E50K optineurin transgenic mouse described here exhibited clinical features of POAG and may be useful for mechanistic dissection of POAG and therapeutic development. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Effect of caffeine on the intraocular pressure in patients with primary open angle glaucoma.

    PubMed

    Chandra, Peeyush; Gaur, Ajit; Varma, Shambhu

    2011-01-01

    Coffee and tea are very common nonalcoholic beverages. However, their intake, particularly that of coffee, has been suggested to increase intraocular pressure (IOP) in patients with open angle glaucoma/ocular hypertension. The causative agent has been suggested to be their caffeine content. The objective of this study was to determine if this represents a direct caffeine effect. This study was therefore done using pure caffeine applied directly to the eyes. The study was conducted with five human volunteers with open angle glaucoma/ ocular hypertension. IOP was measured using a Perkins applanation tonometer. Eye drops of 1% caffeine were prepared in-home. Following the initial (basal) measurement of the IOP, 50 μL of the eye drop preparation was instilled in the eye at 0-, 4-, and 6-hour intervals. IOPs were measured 30 minutes after each instillation. A second study was also undertaken following the first. In this study, the same patients instilled the eye drops three times per day for 1 week at home and then returned to the clinic on day 7. They were then again treated with caffeine eye drops as above and IOPs measured. In the 1-day study, the mean basal IOP was 23.6 ± 2.80 mmHg. Thirty minutes after instillation of the drops as described, the pressures were 23.2 ± 1.93, 22.2 ± 1.99, and 22.6 ± 2.31. The basal reading was taken at 10 am and another reading was then taken at 10.30 am. Additional eye drops were instilled at 2 and 8 pm and readings taken 30 minutes after each instillation. In the 1 week study, the basal value was 22.6 ± 2.32. After instillation of the drops as above the values were 23 ± 2.16, 22.4 ± 2.27, and 23 ± 1.94. Administration of caffeine into the eyes of patients did not have any effect on IOP and it remained relatively unchanged. This was true in the 1-day study as well as in the 1-week study. A cumulative effect was not visible. The results therefore demonstrate that caffeine has no significant effect on IOP in patients with

  7. Hierarchical cluster analysis of progression patterns in open-angle glaucoma patients with medical treatment.

    PubMed

    Bae, Hyoung Won; Rho, Seungsoo; Lee, Hye Sun; Lee, Naeun; Hong, Samin; Seong, Gong Je; Sung, Kyung Rim; Kim, Chan Yun

    2014-04-29

    To classify medically treated open-angle glaucoma (OAG) by the pattern of progression using hierarchical cluster analysis, and to determine OAG progression characteristics by comparing clusters. Ninety-five eyes of 95 OAG patients who received medical treatment, and who had undergone visual field (VF) testing at least once per year for 5 or more years. OAG was classified into subgroups using hierarchical cluster analysis based on the following five variables: baseline mean deviation (MD), baseline visual field index (VFI), MD slope, VFI slope, and Glaucoma Progression Analysis (GPA) printout. After that, other parameters were compared between clusters. Two clusters were made after a hierarchical cluster analysis. Cluster 1 showed -4.06 ± 2.43 dB baseline MD, 92.58% ± 6.27% baseline VFI, -0.28 ± 0.38 dB per year MD slope, -0.52% ± 0.81% per year VFI slope, and all "no progression" cases in GPA printout, whereas cluster 2 showed -8.68 ± 3.81 baseline MD, 77.54 ± 12.98 baseline VFI, -0.72 ± 0.55 MD slope, -2.22 ± 1.89 VFI slope, and seven "possible" and four "likely" progression cases in GPA printout. There were no significant differences in age, sex, mean IOP, central corneal thickness, and axial length between clusters. However, cluster 2 included more high-tension glaucoma patients and used a greater number of antiglaucoma eye drops significantly compared with cluster 1. Hierarchical cluster analysis of progression patterns divided OAG into slow and fast progression groups, evidenced by assessing the parameters of glaucomatous progression in VF testing. In the fast progression group, the prevalence of high-tension glaucoma was greater and the number of antiglaucoma medications administered was increased versus the slow progression group. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

  8. Differential protein expression in tears of patients with primary open angle and pseudoexfoliative glaucoma.

    PubMed

    Pieragostino, Damiana; Bucci, Sonia; Agnifili, Luca; Fasanella, Vincenzo; D'Aguanno, Simona; Mastropasqua, Alessandra; Ciancaglini, Marco; Mastropasqua, Leonardo; Di Ilio, Carmine; Sacchetta, Paolo; Urbani, Andrea; Del Boccio, Piero

    2012-04-01

    Primary open angle (POAG) and pseudoexfoliative glaucoma (PXG) are the most common primary and secondary forms of glaucoma, respectively. Even though the patho-physiology, aqueous humor composition, risk factors, clinical features, therapy and drug induced ocular surface changes in POAG and PXG have been widely studied, to date information concerning tear protein characterization is lacking. Tears are a source of nourishment for ocular surface tissues and a vehicle to remove local waste products, metabolized drugs and inflammatory mediators produced in several ophthalmic diseases. In glaucoma, the proteomic definition of tears may provide insights concerning patho-physiology of the disease and ocular surface modifications induced by topical therapy. Our study aimed at characterizing protein patterns in tears of patients with medically controlled POAG and PXG. A comparative tears proteomic analysis by label-free LC-MS(E) highlighted differences in the expression of several proteins in the two glaucoma sub-types and control subjects, highlighting inflammation pathways expressed in both diseases. Results were independently reconfirmed by SDS-PAGE and linear MALDI-TOF MS, validating altered levels of Lysozyme C, Lipocalin-1, Protein S100, Immunoglobulins and Prolactin Inducible Protein. Moreover, we found a differential pattern of phosphorylated Cystatin-S that distinguishes the two pathologies. The most relevant results suggest that in both pathologies there may be active inflammation pathways related to the disease and/or induced by therapy. We show, for the first time, tear protein patterns expressed under controlled intraocular pressure conditions in POAG and PXG subjects. These findings could help in the understanding of molecular machinery underlying these ophthalmologic diseases, resulting in early diagnosis and more specific therapy.

  9. Single nucleotide polymorphisms of metabolic syndrome-related genes in primary open angle glaucoma

    PubMed Central

    Zhou, Gang; Liu, Bin

    2010-01-01

    AIM To analyze single nucleotide polymorphisms (SNP) of primary open angle glaucoma- and metabolic syndrome-related genes in primary open angle glaucoma (POAG), in order to elucidate the roles of metabolic syndrome as a risk factor in POAG progress. METHODS SNP genotypes and alleles of interleukin-6 (IL-6), IL-6 receptor (IL-6R), dopamine D2 receptor (DRD2), beta-fibrinogen (FGB), peroxisome proliferator-activated receptor-γ2 (PPARG), transforming growth factor-β1 (TGF-β1), E-selectin (E-Sel), apolipoprotein A-5 (APOA5), C-reactive protein (CRP), ectonueleotide pyrophosphatase/phosphodiesterase 1 (ENPP1), hepatic lipase (LIPC), adiponectin (ADIPOQ), paraoxonase 1 (PON1) and serine protease inhibitor E (SERPINE1) genes in POAG (n=37) and normal control (n=100) groups were measured with ABI Prism 7900HT Fluorescence Quantitative PCR and TaqMan SNP Genotyping fluorescence probe kit. RESULTS Genotypes and allele frequencies of IL-6R, IL-6, FGB, CRP, ENPP1, LIPC, ADIPOQ, PON1, and SERPINE1 in total POAG group were significantly different compared to the control group. CONCLUSION Metabolic syndrome as a risk factor for POAG may be associated with genotypes and allele frequencies of the related genes. The corresponding gene expression and function can affect POAG progress, including roles of SERPINE1 in extracellular matrix, ENPP1 in insulin inhibition, IL-6 in endogenous neuroprotection, IL-6, IL-6R and E-Sel in autoimmune response, LIPC and FGB in blood hyperviscosity syndrome, ADIPOQ in NOS/NO production, PON1 in vascular endothelial protection. PMID:22553514

  10. Effect of topical Beta blocker (Timolol maleate 0.5%) in primary open angle glaucoma.

    PubMed

    Khan, N; Khaleque, M A; Islam, M S; Begum, R A; Uddin, M S; Hossain, M M; Ali, M

    2012-10-01

    The study was undertaken to measure the effects of Beta blocker (Timolol maleate 0.5%) in moderate and advanced stage of primary open angle glaucoma by controlling intra-ocular pressure (IOP) and assessing the visual acuity (VA) and mean sensitivity (MS) of visual field. Study was done in the department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka from January 2002 to December 2005. It was a Prospective and interventional study. Thirty patients of bilateral primary open angle glaucoma were treated medically by B-blocker (Timolol maleate 0.5%) two times daily. Follow up were done after 7 days, 1 month, 3 months and 6 months. Before treatment Intra ocular pressure (IOP) range was 22-30 mm of Hg (mean 23.40 ± 2.04). After beta-blockers IOP reduced to the range of 10-20mm of Hg (mean 13.12 ± 2.01) which was statistically significant (p>0.02) in moderate stage & 8-18 mm Hg (mean 13.50 ± 2.0) in advance stage which was also statistically significant (p<0.02). VA and MS also improved in 15 eyes (50%), remained unchanged in 9 eyes (30%) and deteriorated in 6 eyes (20%) in moderate stage and also improved in 15 eyes (50%), remained unchanged in 6 eyes (20%) and deteriorated in 9 eyes (30%) in advanced stage. Success rate was 80% in moderate (p>0.02) & 70% in advanced stage (p<0.02) and which was statistically significant.

  11. A cohort study of duplex Doppler examinations of the carotid artery in primary open angle glaucoma

    PubMed Central

    Marmion, Vincent J; Aldoori, Munther I; Woodcock, John P

    2014-01-01

    Objectives To explore the possibility of pathological change in the common carotid artery at the bifurcation and in the internal carotid artery beyond the bifurcation which could contribute to a reduced diastolic pressure as observed in primary open angle glaucoma. Design Duplex ultrasonic examinations of carotid bifurcations were conducted on 80 patients. Carotid artery defects were allocated into three types: no demonstrable flow defects, internal carotid artery abnormalities and disease in the carotid bulb. Setting Bristol Royal Infirmary Vascular Laboratory. Participants Eighty patients (mean age 69.6 years) providing a total of 160 sides to the analysis. Main outcome measures An estimated central retinal artery pressure, intraocular pressure and field loss were recorded for each side measured. Results Doppler investigations revealed significant levels of pathological change in the internal carotid distinct from changes at the carotid bulb. The disease revealed in the internal carotid artery was significantly associated with intraocular pressure (p = 0.032), with an effect small to medium in magnitude. The Q2 measure, derived from mean arterial pressure and intraocular pressure, was also substantively associated with disease in the internal carotid artery. Both intraocular pressure and the Q2 measure effectively discriminated between groups, with field loss providing rather less discriminating capability. There was a strong trend towards a higher intraocular pressures and a greater visual field loss with internal carotid artery disease. Conclusions Pathological changes in the extra cranial carotid artery in primary open angle glaucoma exceed those in the arteries classified as normal. The presence of disease specifically in the internal carotid artery emphasised the need for a mechanism for the evaluation of the internal carotid apart from the carotid bulb. A basis for clarifying the presence of an ischaemic zone is proposed. PMID:25289141

  12. Using the Utah Population Database to assess familial risk of primary open angle glaucoma.

    PubMed

    Wang, Xiaolei; Harmon, Jennifer; Zabrieskie, Norman; Chen, Yuhong; Grob, Seanna; Williams, Brice; Lee, Clara; Kasuga, Daniel; Shaw, Peter X; Buehler, Jeanette; Wang, Ningli; Zhang, Kang

    2010-11-23

    Primary open angle glaucoma (POAG) is a leading cause of irreversible blindness in the elderly. Previous epidemiological studies have identified family history, ethnic origin, age, high intraocular pressure and diabetes mellitus as risk factors. However, it is difficult to assess the extent family history plays in this disease process. The Utah Population Database (UPDB), created by the University of Utah, has recently become a resource for which greater than 9 million records are available for use. The UPDB is divided into two major data sets from which family members can be identified, namely 1.6 million genealogy records and 2 million Utah birth certificates. This study utilizes these resources to assess the familial risk of POAG within the Utah Population. The University of Utah's hospital and clinic records were searched for patients with primary and chronic open angle glaucoma (ICD9 codes 365.04 and 365.11) between the years 1995 and 2005. A case-control analysis was then performed with specialized UPDB software that was modified to constrain the control and pedigree populations to over 1 million University of Utah-UPDB linked records. Controls were matched to cases by gender and birth year (±2.5years) with only one control being used per case. Population-attributable risk (PAR) to familial factors and relative risk (RR) were computed using conditional logistic regression (CLR). From the original 1.5 million medical records, 6198 patients with glaucoma were identified. Of these, 3391 met the inclusion criteria, which required patients to have at least one parent or one child in the UPDB. The PAR in this population was found to be 0.20, indicating 20% of the risk for glaucoma is attributable to genetic factors. CLR computations also showed a significantly increased relative risk (p<0.05) in first cousins (RR=1.45 (95% confidence interval (CI) 1.16-1.8)), second cousins (RR=1.19 (95% CI 1.08-1.32)), siblings (RR=3.76 (95% CI 2.66-5.31)), parents (RR=6.25 (95

  13. Type 2 Diabetes Mellitus and the Risk of Open-angle Glaucoma

    PubMed Central

    Chopra, Vikas; Varma, Rohit; Francis, Brian A.; Wu, Joanne; Torres, Mina; Azen, Stanley P.

    2016-01-01

    Purpose To examine the relationship between type 2 diabetes mellitus (T2DM) and the risk of having open-angle glaucoma (OAG) in an adult Latino population. Design Population-based cross-sectional study. Participants Latinos 40 years and older (n = 5894) from 6 census tracts in Los Angeles, California. Methods Participants from the Los Angeles Latino Eye Study (LALES), a large population-based study of self-identified adult Latinos, answered an interviewer-administered questionnaire and underwent a clinical and complete ocular examination, including visual field (VF) testing and stereo fundus photography. A participant was defined as having diabetes mellitus (DM) if she or he had a history of being treated for DM, the participant’s glycosylated hemoglobin was measured at 7.0% or higher, or the participant had random blood glucose of 200 mg% or higher. Type 2 DM was defined if the participant was 30 years or older when diagnosed with DM. Open-angle glaucoma was defined as the presence of an open angle and a glaucomatous VF abnormality and/or evidence of glaucomatous optic disc damage in at least one eye. Logistic regression analysis was used to identify the risk of having OAG in persons with T2DM. Main Outcome Measure Prevalence of OAG. Results Of the 5894 participants with complete data, 1157 (19.6%) had T2DM and 288 (4.9%) had OAG. The prevalence of OAG was 40% higher in participants with T2DM than in those without T2DM (age/gender/intraocular pressure–adjusted odds ratio, 1.4; 95% confidence interval, 1.03–1.8; P = 0.03). Trend analysis revealed that a longer duration of T2DM (stratified into 5-year increments) was associated with a higher prevalence of OAG (P<0.0001). Conclusion The presence of T2DM and a longer duration of T2DM were independently associated with a higher risk of having OAG in the LALES cohort. The high prevalences of T2DM and OAG and their association in this fastest growing segment of the United States population have significant

  14. Linkage analysis of primary open-angle glaucoma excludes the juvenile glaucoma region on chromosome 1q

    SciTech Connect

    Wirtz, M.K.; Acott, T.S.; Samples, J.R. |

    1994-09-01

    The gene for one form of juvenile glaucoma has been mapped to chromosome 1q21-q31. This raises the possibility of primary open-angle glaucoma (POAG) also mapping to this region if the same defective gene causes both diseases. To ask this question linkage analysis was performed on a large POAG kindred. Blood samples or skin biopsies were obtained from 40 members of this family. Individuals were diagnosed as having POAG if they met two or more of the following criteria: (1) Visual field defects compatible with glaucoma on automated perimetry; (2) Optic nerve head and/or nerve fiber layer analysis compatible with glaucomatous damage; (3) high intraocular pressures (> 20 mm Hg). Patients were considered glaucoma suspects if they only met one criterion. These individuals were excluded from the analysis. Of the 40 members, seven were diagnosed with POAG; four were termed suspects. The earliest age of onset was 38 years old, while the average age of onset was 65 years old. We performed two-point and multipoint linkage analysis, using five markers which encompass the region 1q21-q31; specifically, D1S194, D1S210, D1S212, D1S191 and LAMB2. Two-point lod scores excluded tight linkage with all markers except D1S212 (maximum lod score of 1.07 at theta = 0.0). In the multipoint analysis, including D1S210-D1S212-LAMB2 and POAG, the entire 11 cM region spanned by these markers was excluded for linkage with POAG; that is, lod scores were < -2.0. In conclusion, POAG in this family does not map to chromosome 1q21-q31 and, thus, they carry a gene that is distinct from the juvenile glaucoma gene.

  15. Enhanced depth imaging detects lamina cribrosa thickness differences in normal tension glaucoma and primary open-angle glaucoma.

    PubMed

    Park, Hae-Young Lopilly; Jeon, So Hee; Park, Chan Kee

    2012-01-01

    To confirm the advantages of the enhanced depth imaging (EDI) mode over the standard mode of the Heidelberg Spectralis spectral domain optical coherence tomography (SD-OCT) for imaging of the lamina cribrosa, and to compare laminar thicknesses of various glaucoma types with or without disc hemorrhage in a similar state of visual field loss. Cross-sectional, case-control design. We included 137 glaucoma patients and 49 healthy controls. Optic nerve head B-scans were obtained by both the standard and EDI modes of the Spectralis OCT. Laminar thickness was measured at the center of mid-superior, central, and mid-inferior horizontal B-scans. Laminar thickness in patients with normal tension glaucoma (NTG) was compared with that in patients with primary open-angle glaucoma (POAG). To verify the reproducibility of EDI imaging, intraclass correlation coefficients and test-retest variability were calculated from selected B-scans. Laminar thickness and mean deviation values on standard automatic perimetry. The EDI OCT imaging showed significantly better intraobserver, interobserver, intravisit, and intervisit reproducibility than those by standard imaging. Laminar thickness in mid-superior, central, and mid-inferior regions was thinner in the POAG and NTG groups than in the normal control group (P<0.001). The mid-superior, central, and mid-inferior regions of the lamina were also significantly thinner in patients with NTG and disc hemorrhage than in those with NTG but no disc hemorrhage. The EDI mode of the Heidelberg Spectralis SD-OCT detected differences in the lamina cribrosa by glaucoma type. The lamina cribrosa was thinner in NTG eyes and in NTG eyes with disc hemorrhage. The authors have no proprietary or commercial interest in any of the materials discussed in this article. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  16. Conjunctival inflammatory cells and their predictive role for deep sclerectomy in primary open-angle glaucoma and exfoliation glaucoma.

    PubMed

    Helin, Minna; Rönkkö, Seppo; Puustjärvi, Tuomo; Teräsvirta, Markku; Ollikainen, Minna; Uusitalo, Hannu

    2011-03-01

    To investigate the conjunctival inflammatory alterations of patients with primary open-angle glaucoma (POAG) and exfoliation glaucoma (ExG) and correlate the findings with the success of deep sclerectomy (DS) surgery and with the patients' medical history. Altogether 25 POAG and ExG patients of the prospective DS study were divided, based on the diagnosis and success of the operation, into 4 groups, POAG S (success), POAG F (failure), ExG S, and ExG F. Controls were obtained from other ophthalmologic surgery patients who did not have glaucoma, and their conjunctiva was examined to be normal. Inflammatory cell subtypes in the conjunctiva were identified and quantified by using immunohistochemistry and monoclonal antibodies: CD3 (T-lymphocyte marker), CD4 (T-helper lymphocyte marker), CD8 (T-cytotoxic lymphocyte marker), CD20 (pan-B cell marker), CD38 (plasma cell marker), CD45RA (naïve T-cell marker), and CD68 (macrophage marker). Higher numbers of inflammatory cells were found in the conjunctiva of the glaucoma patients on medical treatment compared with the normal conjunctiva of the controls. Moreover, T-lymphocytes, T-helper lymphocytes, T-cytotoxic lymphocytes, B cells, plasma cells, and macrophages were found in significantly higher numbers in patients in whom DS failed during the follow-up period of 2.5 years than those with surgical success. High numbers of cytotoxic and helper T-lymphocytes, plasma cells, and macrophages indicate a chronic inflammatory reaction in the conjunctiva of glaucoma patients. The chronic inflammation is most probably owing to the chronic topical treatment of the patients and seems to be a significant risk factor for DS surgery failure.

  17. Steroid-induced glaucoma treated with trabecular ablation in a matched comparison with primary open-angle glaucoma.

    PubMed

    Dang, Yalong; Kaplowitz, Kevin; Parikh, Hardik A; Roy, Pritha; Loewen, Ralitsa T; Francis, Brian A; Loewen, Nils A

    2016-12-01

    To evaluate the outcomes of trabectome-mediated ab interno trabeculectomy in patients with steroid-induced glaucoma (SIG). A retrospective, observational cohort study performed in the Department of Ophthalmology, University of Pittsburgh Medical Center. The data of 60 patients with SIG and 484 controls with primary open-angle glaucoma (POAG) matched by age, gender and glaucoma index were collected from the Trabectome Study Group database. Reduction of intraocular pressure (IOP) and medications were compared between POAG and SIG by multivariate regression. Kaplan-Meier was used for survival analysis. Success was defined as IOP ≤21 mmHg and at least 20% IOP reduction from baseline for any two consecutive visits after 3 months without secondary glaucoma surgery. Postoperative IOP and number of medications were compared with baseline in the SIG subgroups by the Wilcoxon test. Intraocular pressure reduction and 1-year success rate. Patients with SIG had a higher baseline IOP (31.4 ± 10.4 vs. 24.1 ± 7.6 mmHg, P < 0.01) and obtained a greater IOP reduction than controls with POAG (48.4% vs. 31.5%, P < 0.01). Multivariate regression showed that patients with SIG had an IOP reduction of 6.7 ± 1.1 mmHg more than those with POAG. Survival rates at 12 months were comparable at 86% in the SIG group and 85% in the POAG group (P = 0.47). Patients with SIG with a high baseline IOP, younger age and advanced glaucoma experienced a larger IOP drop. Trabectome appears to be an effective surgical treatment in reducing IOP for patients with SIG. © 2016 Royal Australian and New Zealand College of Ophthalmologists.

  18. Extracting Primary Open-Angle Glaucoma from Electronic Medical Records for Genetic Association Studies

    PubMed Central

    Restrepo, Nicole A.; Farber-Eger, Eric; Goodloe, Robert; Haines, Jonathan L.; Crawford, Dana C.

    2015-01-01

    Electronic medical records (EMRs) are being widely implemented for use in genetic and genomic studies. As a phenotypic rich resource, EMRs provide researchers with the opportunity to identify disease cohorts and perform genotype-phenotype association studies. The Epidemiologic Architecture for Genes Linked to Environment (EAGLE) study, as part of the Population Architecture using Genomics and Epidemiology (PAGE) I study, has genotyped more than 15,000 individuals of diverse genetic ancestry in BioVU, the Vanderbilt University Medical Center’s biorepository linked to a de-identified version of the EMR (EAGLE BioVU). Here we develop and deploy an algorithm utilizing data mining techniques to identify primary open-angle glaucoma (POAG) in African Americans from EAGLE BioVU for genetic association studies. The algorithm described here was designed using a combination of diagnostic codes, current procedural terminology billing codes, and free text searches to identify POAG status in situations where gold-standard digital photography cannot be accessed. The case algorithm identified 267 potential POAG subjects but underperformed after manual review with a positive predictive value of 51.6% and an accuracy of 76.3%. The control algorithm identified controls with a negative predictive value of 98.3%. Although the case algorithm requires more downstream manual review for use in large-scale studies, it provides a basis by which to extract a specific clinical subtype of glaucoma from EMRs in the absence of digital photographs. PMID:26061293

  19. Aging changes of the optic nerve head in relation to open angle glaucoma

    PubMed Central

    Garway-Heath, D; Wollstein, G; Hitchings, R

    1997-01-01

    AIMS—To determine the age related changes in optic nerve head structure in a group of normal subjects and assess the significance of any changes in relation to those found in open angle glaucoma.
METHODS—A group of 88 white volunteers and friends and spouses of patients with a normal visual field and normal intraocular pressure was studied. Two different imaging and measurement devices were used (computer assisted planimetry and scanning laser ophthalmoscopy), and the results from each were compared. Measurements were made of the optic disc, optic cup, and neuroretinal rim areas, and the vertical optic disc diameter and cup/disc diameter ratio.
RESULTS—Neuroretinal rim area declined at the rate of between 0.28% and 0.39% per year. Vertical optic cup diameter and optic cup area increased with age. The mean cup/disc diameter ratio increased by about 0.1 between the ages of 30 and 70 years.
CONCLUSIONS—Age related changes are significant and measurable, and should be taken into account when assessing the glaucoma suspect, and when estimating the rate of progression of glaucomatous optic neuropathy in patients with established disease.

 PMID:9486023

  20. Open angle glaucoma in a case of Type IV Ehler Danlos syndrome: a rarely reported association.

    PubMed

    Mitra, Arijit; Ramakrishnan, R; Kader, Mohideen Abdul

    2014-08-01

    A 26-year-old male presented to us with defective vision in the left eye. He had best corrected visual acuity (BCVA) of hand movement (HM) in right eye and 6/9 in left eye. He had ptosis with ectropion in both eyes and relative afferent pupillary defect (RAPD) in right eye. Intraocular pressure (IOP) was 46 and 44 mmHg in right and left eye, respectively. Fundus showed glaucomatous optic atrophy (GOA) in right eye and cup disc ratio (CDR) of 0.75 with bipolar rim thinning in left eye. Systemic examination showed hyperextensible skin and joints, acrogeria, hypodontia, high arched palate, and varicose veins. He gave history of easy bruising and tendency to fall and history of intestinal rupture 5 years ago for which he had undergone surgery. He was diagnosed as a case of Type IV Ehler-Danlos syndrome (EDS) with open angle glaucoma. He underwent trabeculectomy in both eyes. This is a rare case that shows glaucoma in a patient of EDS Type IV. Very few such cases have been reported in literature.

  1. Open angle glaucoma in a case of Type IV Ehler Danlos syndrome: A rarely reported association

    PubMed Central

    Mitra, Arijit; Ramakrishnan, R.; Kader, Mohideen Abdul

    2014-01-01

    A 26-year-old male presented to us with defective vision in the left eye. He had best corrected visual acuity (BCVA) of hand movement (HM) in right eye and 6/9 in left eye. He had ptosis with ectropion in both eyes and relative afferent pupillary defect (RAPD) in right eye. Intraocular pressure (IOP) was 46 and 44 mmHg in right and left eye, respectively. Fundus showed glaucomatous optic atrophy (GOA) in right eye and cup disc ratio (CDR) of 0.75 with bipolar rim thinning in left eye. Systemic examination showed hyperextensible skin and joints, acrogeria, hypodontia, high arched palate, and varicose veins. He gave history of easy bruising and tendency to fall and history of intestinal rupture 5 years ago for which he had undergone surgery. He was diagnosed as a case of Type IV Ehler-Danlos syndrome (EDS) with open angle glaucoma. He underwent trabeculectomy in both eyes. This is a rare case that shows glaucoma in a patient of EDS Type IV. Very few such cases have been reported in literature. PMID:25230966

  2. A common variant near TGFBR3 is associated with primary open angle glaucoma

    PubMed Central

    Li, Zheng; Allingham, R. Rand; Nakano, Masakazu; Jia, Liyun; Chen, Yuhong; Ikeda, Yoko; Mani, Baskaran; Chen, Li-Jia; Kee, Changwon; Garway-Heath, David F.; Sripriya, Sarangapani; Fuse, Nobuo; Abu-Amero, Khaled K.; Huang, Chukai; Namburi, Prasanthi; Burdon, Kathryn; Perera, Shamira A.; Gharahkhani, Puya; Lin, Ying; Ueno, Morio; Ozaki, Mineo; Mizoguchi, Takanori; Krishnadas, Subbiah Ramasamy; Osman, Essam A.; Lee, Mei Chin; Chan, Anita S.Y.; Tajudin, Liza-Sharmini A.; Do, Tan; Goncalves, Aurelien; Reynier, Pascal; Zhang, Hong; Bourne, Rupert; Goh, David; Broadway, David; Husain, Rahat; Negi, Anil K.; Su, Daniel H; Ho, Ching-Lin; Blanco, Augusto Azuara; Leung, Christopher K.S.; Wong, Tina T.; Yakub, Azhany; Liu, Yutao; Nongpiur, Monisha E.; Han, Jong Chul; Hon, Do Nhu; Shantha, Balekudaru; Zhao, Bowen; Sang, Jinghong; Zhang, NiHong; Sato, Ryuichi; Yoshii, Kengo; Panda-Jonas, Songhomita; Ashley Koch, Allison E.; Herndon, Leon W.; Moroi, Sayoko E.; Challa, Pratap; Foo, Jia Nee; Bei, Jin-Xin; Zeng, Yi-Xin; Simmons, Cameron P.; Bich Chau, Tran Nguyen; Sharmila, Philomenadin Ferdinamarie; Chew, Merwyn; Lim, Blanche; Tam, Pansy O.S.; Chua, Elaine; Ng, Xiao Yu; Yong, Victor H.K.; Chong, Yaan Fun; Meah, Wee Yang; Vijayan, Saravanan; Seongsoo, Sohn; Xu, Wang; Teo, Yik Ying; Cooke Bailey, Jessica N.; Kang, Jae H.; Haines, Jonathan L.; Cheng, Ching Yu; Saw, Seang-Mei; Tai, E-Shyong; Richards, Julia E.; Ritch, Robert; Gaasterland, Douglas E.; Pasquale, Louis R.; Liu, Jianjun; Jonas, Jost B.; Milea, Dan; George, Ronnie; Al-Obeidan, Saleh A.; Mori, Kazuhiko; Macgregor, Stuart; Hewitt, Alex W.; Girkin, Christopher A.; Zhang, Mingzhi; Sundaresan, Periasamy; Vijaya, Lingam; Mackey, David A.; Wong, Tien Yin; Craig, Jamie E.; Sun, Xinghuai; Kinoshita, Shigeru; Wiggs, Janey L.; Khor, Chiea-Chuen; Yang, Zhenglin; Pang, Chi Pui; Wang, Ningli; Hauser, Michael A.; Tashiro, Kei; Aung, Tin; Vithana, Eranga N.

    2015-01-01

    Primary open angle glaucoma (POAG), a major cause of blindness worldwide, is a complex disease with a significant genetic contribution. We performed Exome Array (Illumina) analysis on 3504 POAG cases and 9746 controls with replication of the most significant findings in 9173 POAG cases and 26 780 controls across 18 collections of Asian, African and European descent. Apart from confirming strong evidence of association at CDKN2B-AS1 (rs2157719 [G], odds ratio [OR] = 0.71, P = 2.81 × 10−33), we observed one SNP showing significant association to POAG (CDC7–TGFBR3 rs1192415, ORG-allele = 1.13, Pmeta = 1.60 × 10−8). This particular SNP has previously been shown to be strongly associated with optic disc area and vertical cup-to-disc ratio, which are regarded as glaucoma-related quantitative traits. Our study now extends this by directly implicating it in POAG disease pathogenesis. PMID:25861811

  3. Tag SNPs detect association of the CYP1B1 gene with primary open angle glaucoma.

    PubMed

    Burdon, Kathryn P; Hewitt, Alex W; Mackey, David A; Mitchell, Paul; Craig, Jamie E

    2010-11-04

    The cytochrome p450 family 1 subfamily B (CYP1B1) gene is a well known cause of autosomal recessive primary congenital glaucoma. It has also been postulated as a modifier of disease severity in primary open angle glaucoma (POAG), particularly in juvenile onset families. However, the role of common variation in the gene in relation to POAG has not been thoroughly explored. Seven tag single nucleotide polymorphisms (SNPs), including two coding variants (L432V and N543S), were genotyped in 860 POAG cases and 898 examined normal controls. Each SNP and haplotype was assessed for association with disease. In addition, a subset of 396 severe cases and 452 elderly controls were analyzed separately. There was no association of any individual SNP in the full data set. Two SNPs (rs162562 and rs10916) were nominally associated under a dominant model in the severe cases (p<0.05). A common haplotype (AGCAGCC) was also found to be nominally associated in both the full data set (p=0.048, OR [95%CI]=0.83 [0.69-0.90]) and more significantly in the severe cases (p=0.004, OR [95%CI]=0.68 [0.52-0.89]) which survives correction for multiple testing. Although no major effect of common variation at the CYP1B1 locus on POAG was found, there could be an effect of SNPs tagged by rs162562 and represented on the AGCAGCC haplotype.

  4. Vessel Caliber in Normal Tension and Primary Open Angle Glaucoma Eyes With Hemifield Damage.

    PubMed

    Rao, Aparna; Agarwal, Komal; Mudunuri, Harika; Padhy, Debananda; Roy, Avik K; Mukherjee, Sujoy

    2017-01-01

    The purpose of the study was to evaluate retinal vessel diameter in age-matched normal tension glaucoma (NTG) and primary open angle glaucoma (POAG) eyes with hemifield involvement. Fundus photographs of patients with hemifield defect, good visibility of retinal nerve fiber layer defect, and vessels were compared with 30 controls. One eye of each patient (28 NTG and 30 POAG) was randomly chosen for analysis using Image J software by different clinicians at 2 levels. The structural parameters analyzed included retinal nerve fiber layer defect width, diameter of vessels (superotemporal or inferotemporal artery and superotemporal or inferotemporal vein). The average superotemporal artery diameter was similar in NTG (71±16.8 µm), POAG (79±26.6 µm), and controls (82±14.1 µm), P=0.2 with similar pattern seen for other vessels. The affected quadrant in all eyes and those with disc hemorrhage (n=8) did not have significantly different arteries and veins diameter as compared with the unaffected quadrant in that eye. No relation of artery or vein diameter with retinal nerve fiber layer defect width or clinical variables in NTG or POAG eyes was seen on multivariate regression analysis. The vessel diameter was not significantly different in the affected and unaffected quadrants of age and severity-matched NTG and POAG eyes with hemifield structural and functional defect as reported in earlier studies. These results point toward the possibility that vascular diameter changes may not be the cause for glaucomatous changes.

  5. [Effect of physical and psychological stress on the course of primary open angle glaucoma].

    PubMed

    Marc, Alexandra; Stan, Cristina

    2013-01-01

    Analyzing how mutch mental or physical stress influences the elevation of intraocular pressure (lOP) and therefore the influence of stress over the progress of primary open angle glaucoma (POAG), monitoring the changes of the glaucoma parameters that occur either under stress or under normal life conditions. Observational analytical prospective nonexposed-exposed study that took place over a period of 18 months and reviewed 151 patients. Of the 64 patients that had mental stress before presenting to the doctor, in 47 (73%) of them, were foud increased lOP and visual field changes at regular consultation and 17 (27%) have experienced mental stress without increasing lOP values or any visual field change. Of the 69 patients that reported insomnia, 47 (68%) had elevated lOP, while 22 (32%) had unchanged IOP values. Of the 42 patients that had an increased stress score due to physical fatigue, 22 (52%) had increased lOP and visual field changes (CV) and 20 (48%) had no change in lOP or visual field. The presence of mental stress in a glaucomatous patient increases lOP values and leads to the worsening of the disease, while insomnia represents only a potential risk factor for POAG and physical exercise might even have a beneficial effect.

  6. A common variant near TGFBR3 is associated with primary open angle glaucoma.

    PubMed

    Li, Zheng; Allingham, R Rand; Nakano, Masakazu; Jia, Liyun; Chen, Yuhong; Ikeda, Yoko; Mani, Baskaran; Chen, Li-Jia; Kee, Changwon; Garway-Heath, David F; Sripriya, Sarangapani; Fuse, Nobuo; Abu-Amero, Khaled K; Huang, Chukai; Namburi, Prasanthi; Burdon, Kathryn; Perera, Shamira A; Gharahkhani, Puya; Lin, Ying; Ueno, Morio; Ozaki, Mineo; Mizoguchi, Takanori; Krishnadas, Subbiah Ramasamy; Osman, Essam A; Lee, Mei Chin; Chan, Anita S Y; Tajudin, Liza-Sharmini A; Do, Tan; Goncalves, Aurelien; Reynier, Pascal; Zhang, Hong; Bourne, Rupert; Goh, David; Broadway, David; Husain, Rahat; Negi, Anil K; Su, Daniel H; Ho, Ching-Lin; Blanco, Augusto Azuara; Leung, Christopher K S; Wong, Tina T; Yakub, Azhany; Liu, Yutao; Nongpiur, Monisha E; Han, Jong Chul; Hon, Do Nhu; Shantha, Balekudaru; Zhao, Bowen; Sang, Jinghong; Zhang, NiHong; Sato, Ryuichi; Yoshii, Kengo; Panda-Jonas, Songhomita; Ashley Koch, Allison E; Herndon, Leon W; Moroi, Sayoko E; Challa, Pratap; Foo, Jia Nee; Bei, Jin-Xin; Zeng, Yi-Xin; Simmons, Cameron P; Bich Chau, Tran Nguyen; Sharmila, Philomenadin Ferdinamarie; Chew, Merwyn; Lim, Blanche; Tam, Pansy O S; Chua, Elaine; Ng, Xiao Yu; Yong, Victor H K; Chong, Yaan Fun; Meah, Wee Yang; Vijayan, Saravanan; Seongsoo, Sohn; Xu, Wang; Teo, Yik Ying; Cooke Bailey, Jessica N; Kang, Jae H; Haines, Jonathan L; Cheng, Ching Yu; Saw, Seang-Mei; Tai, E-Shyong; Richards, Julia E; Ritch, Robert; Gaasterland, Douglas E; Pasquale, Louis R; Liu, Jianjun; Jonas, Jost B; Milea, Dan; George, Ronnie; Al-Obeidan, Saleh A; Mori, Kazuhiko; Macgregor, Stuart; Hewitt, Alex W; Girkin, Christopher A; Zhang, Mingzhi; Sundaresan, Periasamy; Vijaya, Lingam; Mackey, David A; Wong, Tien Yin; Craig, Jamie E; Sun, Xinghuai; Kinoshita, Shigeru; Wiggs, Janey L; Khor, Chiea-Chuen; Yang, Zhenglin; Pang, Chi Pui; Wang, Ningli; Hauser, Michael A; Tashiro, Kei; Aung, Tin; Vithana, Eranga N

    2015-07-01

    Primary open angle glaucoma (POAG), a major cause of blindness worldwide, is a complex disease with a significant genetic contribution. We performed Exome Array (Illumina) analysis on 3504 POAG cases and 9746 controls with replication of the most significant findings in 9173 POAG cases and 26 780 controls across 18 collections of Asian, African and European descent. Apart from confirming strong evidence of association at CDKN2B-AS1 (rs2157719 [G], odds ratio [OR] = 0.71, P = 2.81 × 10(-33)), we observed one SNP showing significant association to POAG (CDC7-TGFBR3 rs1192415, ORG-allele = 1.13, Pmeta = 1.60 × 10(-8)). This particular SNP has previously been shown to be strongly associated with optic disc area and vertical cup-to-disc ratio, which are regarded as glaucoma-related quantitative traits. Our study now extends this by directly implicating it in POAG disease pathogenesis. © The Author 2015. Published by Oxford University Press.

  7. Optineurin coding variants in Ghanaian patients with primary open-angle glaucoma

    PubMed Central

    Liu, Yutao; Akafo, Stephen; Santiago-Turla, Cecile; Cohen, Claudia S.; LaRocque-Abramson, Karen R.; Qin, Xuejun; Herndon, Leon W.; Challa, Pratap; Schmidt, Silke; Hauser, Michael A.

    2008-01-01

    Purpose Coding variants in the optineurin gene (OPTN, GLC1E) have been reported to play a role in primary open-angle glaucoma (POAG) in various populations. This study investigated the role of OPTN sequence variants in patients with POAG in Ghana (West Africa). Methods This is a case-control study of unrelated Ghanaian POAG cases and non-glaucomatous controls. Ascertainment criteria for POAG included the presence of glaucomatous optic nerve neuropathy, associated visual field loss, and elevated intraocular pressure (IOP) in both eyes, all in the absence of secondary causes of glaucoma. Controls had normal optic nerves, visual fields, and IOP. All the coding exons of OPTN were polymerase chain reaction (PCR) amplified and sequenced in all 140 cases and 130 controls using an ABI 3730 DNA analyzer. Results All the coding exons of OPTN were sequenced in 140 POAG patients and 130 controls. Several coding variants were identified including M98K, A134A, V147L, P292P, A301G, S321S, and E322K. Three coding variants (V147L, P292P, and A301G) have not been reported previously. There were no significant differences on the frequencies of all the identified variants between POAG cases and controls in this population. Conclusions This is the first comprehensive study of OPTN in a single West African population. Our results suggest that coding variants in OPTN may not contribute to the risk for POAG in persons of West African descent. PMID:19096531

  8. Applying the recent clinical trials on primary open angle glaucoma: the developing world perspective.

    PubMed

    Thomas, Ravi; Kumar, Rajesh S; Chandrasekhar, G; Parikh, Rajul

    2005-08-01

    Recent clinical trials have provided scientific guidelines for the treatment of ocular hypertension and primary open angle glaucoma. The developing world need to apply these trials in a sensible and cost effective manner. The number needed to treat (NNT) attempts to tailor treatment to the individual patient. The NNT for the average ocular hypertensive is 20. Those with intraocular pressure > or =26 mm Hg have an NNT of 6. Restricting treatment to those with lower central corneal thickness and or high cup disc ratios can further lower NNT and make treatment more cost effective. The NNT for the average patient with early POAG is 5. Targeting those at higher risk for progression, (bilateral POAG, higher IOP and or pseudo-exfoliation) can further reduce NNT. As far as the modality of treatment is concerned, provided quality can be ensured, collaborative initial glaucoma treatment study (CIGTS) could be interpreted to justify primary surgery in the developing world context. Population attributable risk percentage (PAR), a measure that reflects the public health importance of a disease was used to extrapolate results to the overall population. Ocular hypertension has an "effective" PAR of 8.5%, a value not considered high enough to warrant public health intervention. POAG had an "effective" PAR of 16%, perhaps high enough to be considered a public health problem and justify inclusion as a target disease in the Vision 2020 program. However the logistics and opportunity costs of diagnosis and treatment would probably prevent inclusion of POAG in public health budgets of most developing countries.

  9. The Primary Open-Angle African-American Glaucoma Genetics (POAAGG) Study: Baseline Demographics

    PubMed Central

    Charlson, Emily S.; Sankar, Prithvi S.; Miller-Ellis, Eydie; Regina, Meredith; Fertig, Raymond; Salinas, Julia; Pistilli, Maxwell; Salowe, Rebecca J.; Rhodes, Allison L.; Merritt, William T.; Chua, Michael; Trachtman, Benjamin T.; Gudiseva, Harini V.; Collins, David W.; Chavali, Venkata Ramana Murthy; Nichols, Charles; Henderer, Jeffrey; Ying, Gui-shuang; Varma, Rohit; Jorgenson, Eric

    2014-01-01

    Objective To describe the baseline characteristics of the Primary Open-Angle African-American Glaucoma Genetics (POAAGG) study cohort, the largest African-American primary open-angle glaucoma (POAG) population recruited at a single institution (University of Pennsylvania, Department of Ophthalmology, Scheie Eye Institute) to date. Design Population-based, cross-sectional, case-control study. Participants 2,520 African-American subjects 35 years and older, recruited from the greater Philadelphia, Pennsylvania area. Methods Each subject underwent a detailed interview and eye examination. The interview assessed demographic, behavioral, medical, and ocular risk factors. Current zip codes surrounding the University of Pennsylvania were recorded and United States census data were queried to infer socioeconomic status. The eye exam included measurement of visual acuity and intraocular pressure, a detailed anterior and posterior segment examination including gonioscopy, dilated fundus and optic disc examination, visual fields, stereo disc photography, optical coherence tomography imaging, and measurement of central corneal thickness. Main Outcome Measures The baseline characteristics of gender, age, and glaucoma diagnosis were collected. Body mass index (BMI), hypertension, diabetes, and alcohol and tobacco use, as well as ocular conditions including blindness, cataract, non-proliferative diabetic retinopathy, age-related macular degeneration, and use of ocular medication and surgery, were examined. Median population density, income, education level, and other socioeconomic measures were determined for the study cohort. Results Of the 2,520 African-Americans recruited to the POAAGG study to date, 2,067 (82.0%) including 807 controls and 1,260 POAG cases met all inclusion criteria and completed the detailed clinical ocular exam. Cases were more likely to have a lower BMI (p<0.01) and report a history of blindness (visual acuity of 20/200 or worse, p<0.001), while controls

  10. Nailfold Capillary Abnormalities in Primary Open-Angle Glaucoma: A Multisite Study

    PubMed Central

    Pasquale, Louis R.; Hanyuda, Akiko; Ren, Ai; Giovingo, Michael; Greenstein, Scott H.; Cousins, Clara; Patrianakos, Thomas; Tanna, Angelo P.; Wanderling, Christopher; Norkett, William; Wiggs, Janey L.; Green, Kelsey; Kang, Jae H.; Knepper, Paul A.

    2015-01-01

    Purpose There is considerable evidence for systemic vascular dysfunction in primary open-angle glaucoma (POAG). We performed nailfold capillary video microscopy to observe directly the nature of nonocular microvasculature abnormalities in POAG. Methods We enrolled 199 POAG patients and 124 control subjects from four sites. We used JH-1004 capillaroscopes to perform nailfold capillary video microscopy on the fourth and fifth digits of each subject's nondominant hand. Videos were evaluated for hemorrhages, dilated capillary loops > 50 μm, and avascular zones > 100 μm by graders masked to case status. Multivariable odds ratios (ORs) and 95% confidence intervals (CIs) for POAG were obtained by means of logistic regression analyses that were applied to data from all cases and controls. Corresponding estimates of moderate or severe POAG versus mild POAG (based on the Hodapp-Anderson-Parrish scale) were obtained among cases only. Results After controlling for demographic factors, family history of glaucoma, systemic diseases, and use of anticoagulation and antiplatelet therapy, for each 100 nailfold capillaries assessed, all types of microvascular abnormalities were significantly associated with POAG. Specifically, the presence of any dilated capillaries (OR = 2.9; 95% CI, 1.6–5.6), avascular zones (OR = 4.4; 95% CI, 1.7–11.3) and hemorrhages (OR = 12.2; 95% CI, 5.9–25.1) were associated with POAG. Among cases, the frequency of microvascular abnormalities was not associated with glaucoma severity (P ≥ 0.43). Conclusions These data provided support for nonocular capillary bed abnormalities in POAG. Comparable vascular abnormalities in the optic nerve may render it susceptible to glaucomatous damage. PMID:26523386

  11. Learning effect of Humphrey Matrix frequency doubling technology perimetry in patients with open-angle glaucoma.

    PubMed

    De Tarso Pierre-Filho, Paulo; Gomes, Paulo R P; Pierre, Erika T L; Pierre, Leandro M

    2010-01-01

    To evaluate the learning effect of frequency doubling technology (FDT) perimetry using the Humphrey Matrix perimeter in patients with open-angle glaucoma with no perimetric experience. One eye each of 30 glaucoma patients who had no history of visual field testing underwent 3 Matrix tests using 24-2 program with full-threshold strategy. The parameters investigated to detect learning effect were test duration, reliability indexes, mean deviation (MD), pattern standard deviation (PSD), and the number of points with a p of <5% and <1% in the total and pattern deviation maps. MD showed a larger defect at the first test (-13.64 +/- 1.63 dB) than at the second (-12.68 +/- 1.45 dB) and third (-11.69 +/- 1.48 dB) tests (p<0.05). A statistically significant reduction (p<0.05) in the number of points with a p <5% and <1% in the total deviation map was observed when repeating the examination. The values of test duration, PSD, fixation losses, false-positive rate, false-negative rate, and number of points with a p <5% and <1% in the pattern deviation map were not changed significantly (p>0.05). Humphrey Matrix FDT perimetry showed a statistically significant learning effect on MD and the number of significantly depressed points of the total deviation map in glaucoma patients with no perimetric experience. It is probably necessary to obtain at least 3 repetitions to rule out the presence of a learning effect in such patients before providing useful results.

  12. Discovery and Functional Annotation of SIX6 Variants in Primary Open-Angle Glaucoma

    PubMed Central

    Allingham, R. Rand; Whigham, Benjamin T.; Havens, Shane; Garrett, Melanie E.; Qiao, Chunyan; Katsanis, Nicholas; Wiggs, Janey L.; Pasquale, Louis R.; Ashley-Koch, Allison; Oh, Edwin C.; Hauser, Michael A.

    2014-01-01

    Glaucoma is a leading cause of blindness worldwide. Primary open-angle glaucoma (POAG) is the most common subtype and is a complex trait with multigenic inheritance. Genome-wide association studies have previously identified a significant association between POAG and the SIX6 locus (rs10483727, odds ratio (OR) = 1.32, p = 3.87×10−11). SIX6 plays a role in ocular development and has been associated with the morphology of the optic nerve. We sequenced the SIX6 coding and regulatory regions in 262 POAG cases and 256 controls and identified six nonsynonymous coding variants, including five rare and one common variant, Asn141His (rs33912345), which was associated significantly with POAG (OR = 1.27, p = 4.2×10−10) in the NEIGHBOR/GLAUGEN datasets. These variants were tested in an in vivo Danio rerio (zebrafish) complementation assay to evaluate ocular metrics such as eye size and optic nerve structure. Five variants, found primarily in POAG cases, were hypomorphic or null, while the sixth variant, found only in controls, was benign. One variant in the SIX6 enhancer increased expression of SIX6 and disrupted its regulation. Finally, to our knowledge for the first time, we have identified a clinical feature in POAG patients that appears to be dependent upon SIX6 genotype: patients who are homozygous for the SIX6 risk allele (His141) have a statistically thinner retinal nerve fiber layer than patients homozygous for the SIX6 non-risk allele (Asn141). Our results, in combination with previous SIX6 work, lead us to hypothesize that SIX6 risk variants disrupt the development of the neural retina, leading to a reduced number of retinal ganglion cells, thereby increasing the risk of glaucoma-associated vision loss. PMID:24875647

  13. Primary Open Angle Glaucoma is Associated with MR Biomarkers of Cerebral Small Vessel Disease

    PubMed Central

    Mercieca, Karl; Cain, John; Hansen, Thomas; Steeples, Laura; Watkins, Amy; Spencer, Fiona; Jackson, Alan

    2016-01-01

    This prospective study tests the hypotheses that: 1) glaucoma is associated with evidence of cerebral small vessel disease; 2) that imaging biomarkers of cerebral small vessel disease in POAG and NTG will show different characteristics. 12 normal controls, 7 patients with primary open angle glaucoma (POAG) and 9 patients with normal tension glaucoma (NTG) were recruited. Ophthalmological clinical assessment and MR imaging of the brain were performed. MR imaging was used to quantify white matter lesion load, frequency of dilated perivascular spaces (PVS) and abnormalities in cerebral hydrodynamics. Patients with POAG had significantly greater white matter lesion load (p < 0.05), more PVS in the centrum semiovale (p < 0.05) and had higher overall PVS scores than controls (p < 0.05). In the POAG group, optic cup-to-disc ratio (CDR) was positively correlated with deep white matter hyperintensities (R2 = 0.928, p < 0.01). Mean deviation on the Humphrey visual field assessment was negatively correlated with deep white matter lesion load (R2 = −0.840, p < 0.01), total white matter lesion load (R2 = −0.928, p < 0.01) and total PVS (R2 = −0.820, p < 0.01). MR evidence of cerebral small vessel disease is strongly associated with a diagnosis of POAG and with the severity of abnormalities in CDR and visual field. PMID:26923106

  14. Vascular tone pathway polymorphisms in relation to primary open-angle glaucoma

    PubMed Central

    Kang, J H; Loomis, S J; Yaspan, B L; Bailey, J C; Weinreb, R N; Lee, R K; Lichter, P R; Budenz, D L; Liu, Y; Realini, T; Gaasterland, D; Gaasterland, T; Friedman, D S; McCarty, C A; Moroi, S E; Olson, L; Schuman, J S; Singh, K; Vollrath, D; Wollstein, G; Zack, D J; Brilliant, M; Sit, A J; Christen, W G; Fingert, J; Forman, J P; Buys, E S; Kraft, P; Zhang, K; Allingham, R R; Pericak-Vance, M A; Richards, J E; Hauser, M A; Haines, J L; Wiggs, J L; Pasquale, L R

    2014-01-01

    Aims Vascular perfusion may be impaired in primary open-angle glaucoma (POAG); thus, we evaluated a panel of markers in vascular tone-regulating genes in relation to POAG. Methods We used Illumina 660W-Quad array genotype data and pooled P-values from 3108 POAG cases and 3430 controls from the combined National Eye Institute Glaucoma Human Genetics Collaboration consortium and Glaucoma Genes and Environment studies. Using information from previous literature and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways, we compiled single-nucleotide polymorphisms (SNPs) in 186 vascular tone-regulating genes. We used the ‘Pathway Analysis by Randomization Incorporating Structure' analysis software, which performed 1000 permutations to compare the overall pathway and selected genes with comparable randomly generated pathways and genes in their association with POAG. Results The vascular tone pathway was not associated with POAG overall or POAG subtypes, defined by the type of visual field loss (early paracentral loss (n=224 cases) or only peripheral loss (n=993 cases)) (permuted P≥0.20). In gene-based analyses, eight were associated with POAG overall at permuted P<0.001: PRKAA1, CAV1, ITPR3, EDNRB, GNB2, DNM2, HFE, and MYL9. Notably, six of these eight (the first six listed) code for factors involved in the endothelial nitric oxide synthase activity, and three of these six (CAV1, ITPR3, and EDNRB) were also associated with early paracentral loss at P<0.001, whereas none of the six genes reached P<0.001 for peripheral loss only. Discussion Although the assembled vascular tone SNP set was not associated with POAG, genes that code for local factors involved in setting vascular tone were associated with POAG. PMID:24603425

  15. [A comparison study of pulsitile ocular blood flow in normal eyes and primary open angle glaucoma].

    PubMed

    Zhang, Ming-Zhi; Fu, Zhi-Fu; Liu, Xiao-Rui; Zheng, C

    2004-04-01

    To compare pulsatile ocular blood flow (POBF) and intraocular pressure (IOP) in primary open angle glaucoma (POAG) and normal control group matched for age, sex and refraction error, to investigate the rule of hem-dynamics in POAG and to determine the sensitivity and specificity of POBF measurement as a diagnostic test for glaucoma. Prior to the test a questionnaire was completed to determine age, sex, refractive error, family history of glaucoma, history of eye diseases, ocular medication, medical history and using of systemic beta-blockers. Patients of POAG were determined by following diagnostics standards: (1) Three IOP >25 mm Hg in different times of one day. (2) The fluctuate of IOP > 8 mm Hg during 24 hours. (3) Typical glaucoma changes in the visual field. (4) Typical glaucoma changes in optic disc. There were 100 POAG subjects with single eye observed (50 male and 50 female). We picked up 100 eyes randomly (50 male and 50 female) in 534 normal persons who matched for following conditions: (1) Sex. (2) Discrepancy of age less than 5 years. (3) Discrepancy of the refraction error less than +/- 2.00 DS. as the normal comparison group. The tonometer used was the POBF Tonometry. Pulse amplitude of IOP (PA), pulsatile ocular blood flow (POBF), pulse/heart rate (PR), maximum-IOP (max-IOP), minimum-IOP (min-IOP) and average IOP (aver-IOP) were obtained before the medical therapy and 1 or 2 weeks after the operation. The correlation between the POBF & mean value of the perimeter was analyzed. POBF was analyzed to determine the sensitivity and specificity of POBF measurement as a diagnostic test. The value of POBF in POAG and normal control was (9.72 +/- 3.47) microl/s and (12.04 +/- 4.68) microl/s, respectively. POAG patients' POBF, PV, PA, and AVE-IOP were less than those in the normal control, and the difference was statistically significant. There was no statistically significant correlation between the changes of visual field and POBF (r = 0.224, P = 0

  16. [Effects of nootropic agents on visual functions and lacrimal antioxidative activity in patients with primary open-angle glaucoma].

    PubMed

    Davydova, N G; Kuznetsova, T P; Borisova, S A; Abdulkadyrova, M Zh

    2006-01-01

    The paper presents the results of an investigation of the effect of the nootropic agents pantogam and nooclerine on visual functions in patients with primary open-angle glaucoma. These agents have been found to have a beneficial effect on the functional activity of the retina and optic nerve, light sensitivity, hemo- and hydrodynamics of the eye.

  17. [Psychosomatic symptoms in somatic diseases - open-angle glaucoma for example].

    PubMed

    Emmerich, G M

    2010-08-01

    Psychological aspects exist in somatic diseases like tumours and even fractures, not only in the beginning but also in the management of disease. Somatic diseases give rise to signs of a special constellation of life and management of these diseases is important for the psychological constellation of the individual. Studies on open-angle glaucoma have shown that many patients suffering from this disease are anxious, hypochondric, perfectionist and emotional instable. Chronic diseases are demanding processes of flexibility and defense, and define how the individual can deal with the diseases and what place in life the disease will occupy in the future. In the holistic view of medicine even psychological conflicts should be treated. In many situations, these conflicts are not consciously experienced by the individual. Therapeutically, 2 different tools can be used: symbolic stories can bring forces to manage the conflict and to solve the conflict (2 examples in the text). The method of positive psychotherapy describes the reasons for psychosomatic diseases in three parts: psychosomatic in the traditional understanding, in further and comprehensive understanding. Especially the psychosomatic effects in comprehensive understanding are embedded in the individual's sociocultural environment and provide tips on reasons for the diseases in those parts of life. The "positive balance model" gives an example of life-management and conflict-therapy. In ophthalmology, fear is often more important for the patient than pain. To avoid this, the patients develop techniques to deny, to cover or to suppress the fear. In the article questions are presented like those the ophthalmologist should be able to ask patients in the office concerning open-angle glaucoma. Tips for the therapy and management for neurotic stress are offered and some special anamnestic questions for the ophthalmologist are presented. Unsolved conflicts and denied desires as neurotic symptoms can be focused in

  18. Association of primary open-angle glaucoma with mitochondrial variants and haplogroups common in African Americans

    PubMed Central

    Gudiseva, Harini V.; Trachtman, Benjamin; Bowman, Anita S.; Sagaser, Anna; Sankar, Prithvi; Miller-Ellis, Eydie; Lehman, Amanda; Addis, Victoria; O'Brien, Joan M.

    2016-01-01

    Purpose To estimate the population frequencies of all common mitochondrial variants and ancestral haplogroups among 1,999 subjects recruited for the Primary Open-Angle African American Glaucoma Genetics (POAAGG) Study, including 1,217 primary open-angle glaucoma (POAG) cases and 782 controls, and to identify ancestral subpopulations and mitochondrial mutations as potential risk factors for POAG susceptibility. Methods Subject classification by characteristic glaucomatous optic nerve findings and corresponding visual field defects, as defined by enrolling glaucoma specialists, stereo disc photography, phlebotomy, extraction of total DNA from peripheral blood or saliva, DNA quantification and normalization, PCR amplification of whole mitochondrial genomes, Ion Torrent deep semiconductor DNA sequencing on DNA pools (“Pool-seq”), Sanger sequencing of 3,479 individual mitochondrial DNAs, and bioinformatic analysis. Results The distribution of common African haplogroups within the POAAGG study population was broadly similar to prior surveys of African Americans. However, the POAG case population was found to be enriched in L1c2 haplogroups, which are defined in part by missense mutations m.6150G>A (Val83Ile, odds ratio [OR] 1.8, p=0.01), m.6253C>T (Met117Thr, rs200165736, OR 1.6, p=0.04), and m.6480G>A (Val193Ile, rs199476128, OR 4.6, p=0.04) in the cytochrome c oxidase subunit 1 (MT-CO1) gene and by a variant, m.2220A>G (OR 2.0, p=0.01), in MT-RNR2, which encodes the mitochondrial ribosomal 16s RNA gene. L2 haplogroups were predicted to be overrepresented in the POAG case population by Pool-seq, and the difference was confirmed to be significant with Sanger sequencing, that targeted the L2-associated variants m.2416T>C (rs28358580, OR 1.2, p=0.02) and m.2332C>T (OR 1.2, p=.02) in MT-RNR2. Another variant within MT-RNR2, m.3010G>A (rs3928306), previously implicated in sensitivity to the optic neuropathy-associated antibiotic linezolid, and arising on D4 and J1

  19. Topical bimatoprost: a review of its use in open-angle glaucoma and ocular hypertension.

    PubMed

    Easthope, Stephanie E; Perry, Caroline M

    2002-01-01

    Bimatoprost, a synthetic prostamide analogue, is a new ocular hypotensive agent indicated for the second-line treatment of open-angle glaucoma and ocular hypertension. The drug is formulated as a 0.03% ophthalmic solution. Bimatoprost lowers intraocular pressure (IOP) by increasing aqueous humour outflow. When applied topically once daily in patients with ocular hypertension or glaucoma, bimatoprost 0.03% significantly reduced IOP. Mean IOP was reduced by approximately 7.5 to 9.2mm Hg 12 hours after drug administration in randomised clinical trials. The reduction in IOP was maintained throughout the 24-hour dosage interval. Once-daily treatment with bimatoprost 0.03% was found to be significantly more effective than timolol 0.5% (administered twice daily as an ophthalmic solution or once daily as a gel-forming solution) in randomised comparative trials in patients with ocular hypertension and glaucoma. Furthermore, after 1 to 6 months' treatment, the percentage of patients reaching a target IOP of < or =17mm Hg was significantly greater in the bimatoprost-treated groups than in those receiving timolol. Bimatoprost 0.03% ophthalmic solution was found to be at least as effective as topical latanoprost 0.005% administered once daily in two clinical trials. Reductions in IOP 16 and 20 hours postdose were greater in patients treated with bimatoprost, indicating superior control of IOP at timepoints throughout the dosage interval. In patients refractory to beta-blocker therapy, treatment with bimatoprost 0.03% produced greater reductions in diurnal IOP measurements than combination therapy with topical dorzolamide 2%/timolol 0.5%; approximately twice as many bimatoprost 0.03% recipients achieved an IOP of < or =16mm Hg. The most commonly reported adverse effect during clinical trials of once-daily bimatoprost 0.03% was conjunctival hyperaemia which occurred in 42 to 46% of patients treated. However, most cases were mild and only 1 to 4% of patients withdrew from

  20. Glaucoma

    MedlinePlus

    ... closure glaucoma; Acute glaucoma; Secondary glaucoma; Congenital glaucoma; Vision loss - glaucoma ... the optic nerve causes blind spots in your vision. Open-angle glaucoma tends to run in families. ...

  1. Clinical results with the Trabectome, a novel surgical device for treatment of open-angle glaucoma.

    PubMed

    Minckler, Don; Baerveldt, George; Ramirez, Marina Alfaro; Mosaed, Sameh; Wilson, Richard; Shaarawy, Tarek; Zack, Barend; Dustin, Laurie; Francis, Brian

    2006-01-01

    To describe treatment outcomes after Trabectome surgery in an initial series of 101 patients with open-angle glaucoma. A 19-gauge microelectrosurgical device enabled ab interno removal of a strip of trabecular meshwork and inner wall of Schlemm's canal under gonioscopic control with continual infusion and foot-pedal control of aspiration and electrosurgery. A smooth, pointed ceramic-coated insulating footplate was inserted into Schlemm's canal to act as a guide within the canal and to protect adjacent structures from mechanical or heat injury during ablation of a 30- to 90-degree arc of angle tissue. Mean preoperative intraocular pressure (IOP) in the initial 101 patients was 27.6 +/- 7.2 mm Hg. Thirty months postoperatively, mean IOP was 16.3 +/- 3.3 mm Hg (n = 11). The mean percentage drop over the whole course of follow-up was 40%. At all times postoperatively, the absolute and percent decrease in IOP from preoperative levels were statistically significant (paired t test, P < .0001). Overall success (IOP glaucoma surgery, which spares the conjunctiva and does not preclude subsequent standard filtering procedures.

  2. CLINICAL RESULTS WITH THE TRABECTOME, A NOVEL SURGICAL DEVICE FOR TREATMENT OF OPEN-ANGLE GLAUCOMA

    PubMed Central

    Minckler, Don; Baerveldt, George; Ramirez, Marina Alfaro; Mosaed, Sameh; Wilson, Richard; Shaarawy, Tarek; Zack, Barend; Dustin, Laurie; Francis, Brian

    2006-01-01

    Purpose To describe treatment outcomes after Trabectome surgery in an initial series of 101 patients with open-angle glaucoma. Methods A 19-gauge microelectrosurgical device enabled ab interno removal of a strip of trabecular meshwork and inner wall of Schlemm’s canal under gonioscopic control with continual infusion and foot-pedal control of aspiration and electrosurgery. A smooth, pointed ceramic-coated insulating footplate was inserted into Schlemm’s canal to act as a guide within the canal and to protect adjacent structures from mechanical or heat injury during ablation of a 30- to 90-degree arc of angle tissue. Results Mean preoperative intraocular pressure (IOP) in the initial 101 patients was 27.6 ± 7.2 mm Hg. Thirty months postoperatively, mean IOP was 16.3 ± 3.3 mm Hg (n = 11). The mean percentage drop over the whole course of follow-up was 40%. At all times postoperatively, the absolute and percent decrease in IOP from preoperative levels were statistically significant (paired t test, P < .0001). Overall success (IOP ≤ 21 mm Hg with or without medications and no subsequent surgery) was 84%. Nine eyes subsequently underwent trabeculectomy, two others had IOP greater than 21 mm Hg in spite of resuming topical medications, and the rest of the patients either refused to resume medications or were still in the 1-month postoperative period without medications (total failure rate including trabeculectomies, 16/101 = 16%). Intraoperative reflux bleeding occurred in 100% of cases. Complications have been minimal and not vision-threatening. Conclusions The Trabectome facilitates minimally invasive and effective glaucoma surgery, which spares the conjunctiva and does not preclude subsequent standard filtering procedures. PMID:17471324

  3. Tag SNPs detect association of the CYP1B1 gene with primary open angle glaucoma

    PubMed Central

    Hewitt, Alex W.; Mackey, David A.; Mitchell, Paul; Craig, Jamie E.

    2010-01-01

    Purpose The cytochrome p450 family 1 subfamily B (CYP1B1) gene is a well known cause of autosomal recessive primary congenital glaucoma. It has also been postulated as a modifier of disease severity in primary open angle glaucoma (POAG), particularly in juvenile onset families. However, the role of common variation in the gene in relation to POAG has not been thoroughly explored. Methods Seven tag single nucleotide polymorphisms (SNPs), including two coding variants (L432V and N543S), were genotyped in 860 POAG cases and 898 examined normal controls. Each SNP and haplotype was assessed for association with disease. In addition, a subset of 396 severe cases and 452 elderly controls were analyzed separately. Results There was no association of any individual SNP in the full data set. Two SNPs (rs162562 and rs10916) were nominally associated under a dominant model in the severe cases (p<0.05). A common haplotype (AGCAGCC) was also found to be nominally associated in both the full data set (p=0.048, OR [95%CI]=0.83 [0.69–0.90]) and more significantly in the severe cases (p=0.004, OR [95%CI]=0.68 [0.52–0.89]) which survives correction for multiple testing. Conclusions Although no major effect of common variation at the CYP1B1 locus on POAG was found, there could be an effect of SNPs tagged by rs162562 and represented on the AGCAGCC haplotype. PMID:21139974

  4. Role of MYOC and OPTN sequence variations in Spanish patients with Primary Open-Angle Glaucoma

    PubMed Central

    López-Martínez, Francisco; López-Garrido, María-Pilar; Sánchez-Sánchez, Francisco; Campos-Mollo, Ezequiel; Coca-Prados, Miguel

    2007-01-01

    Purpose To retrospectively investigate the contribution of myocilin (MYOC) and optineurin (OPTN) sequence variations to adult-onset ocular hypertension (OHT) and primary open-angle glaucoma (POAG) in Spanish patients. Methods The promoter region and the three exons of MYOC were analyzed by direct PCR DNA sequencing in 40 OHT and 110 POAG unrelated patients. We used 98 subjects in whom OHT or glaucoma had been ruled out as controls. We also screened the complete coding region of the OPTN gene (exons 4-16) in all subjects by single-stranded conformational polymorphisms (SSCPs). Results We identified six common single nucleotide polymorphisms (SNPs) in the promoter region of MYOC (-1000C>G, -387C>T, -306G>A, -224T>C, -126T>C and -83G>A) and a polymorphic GT microsatellite (-339(GT)11-19). In addition, we detected four novel, rare DNA polymorphisms. None of these DNA sequence variations were associated with either OHT or POAG. We also found three (2.7%) POAG patients with MYOC pathogenic mutations. Two of these pathogenic mutations (Gln368Stop and Ala445Val) were previously described whereas the third (Tyr479His) was novel. Transient expression of the novel mutation in 293T cells supported its pathogenicity. Only two OPTN polymorphisms, which are not associated with the disease, were detected. Conclusions Overall, our data show that in Spain a minority of adult-onset high-pressure POAG patients carry heterozygous disease-causing mutations in the MYOC gene and that OPTN is not involved in either OHT or POAG. PMID:17615537

  5. Elevated Plasma Endothelin-1 Levels in Normal Tension Glaucoma and Primary Open-Angle Glaucoma: A Meta-Analysis

    PubMed Central

    Li, Shengjie; Zhang, Aiping

    2016-01-01

    Purpose. The aim of this meta-analysis was to clarify the association between the plasma endothelin-1 level and the risks of normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG). Methods. Relevant publications were collected from three databases including PubMed, EMBASE, and the Web of Science through December 31, 2015. In this study, the terms “(endothelin OR ET) AND glaucoma” were searched. Review Manager 5.2 was used to process the data. Results. Seven studies (212 cases, 164 controls) were included for the NTG analysis. The mean plasma endothelin-1 level in the NTG subjects was 0.60 pg/mL (p = 0.02, 95% CI: 0.17–1.04) higher than that of the healthy controls. Six studies (160 cases, 174 controls) were included for the POAG analysis, and the endothelin-1 level was 0.63 pg/mL (p = 0.007, 95% CI: 0.12–1.15) higher in the POAG subjects than in the healthy controls. Additionally, two studies influenced the meta-analysis results regarding the association of plasma endothelin-1 with POAG by sensitivity analysis, and the probability of publication bias was low. Conclusions. The observation that NTG and POAG subjects showed significantly elevated endothelin-1 plasma concentrations suggests that a higher plasma level of endothelin-1 might increase the risk of NTG and POAG development. PMID:27965889

  6. Longitudinal Analysis of Serum Autoantibody-Reactivities in Patients with Primary Open Angle Glaucoma and Optic Disc Hemorrhage

    PubMed Central

    Keilani, Munir M.; Wasielica-Poslednik, Joanna; Pfeiffer, Norbert; Grus, Franz H.

    2016-01-01

    Background The aim of our current investigation was to analyze the autoantibody-reactivities of primary open angle glaucoma patients with optic disc hemorrhage as possibly correlated to disease progression by means of a protein microarray approach. Methods Sera of patients with primary open angle glaucoma and optic disc hemorrhage (n = 16) were collected directly after study inclusion (0 weeks) and after 2 weeks, 4 weeks and 12 weeks. As a control group patients with primary open angle glaucoma (n = 18) were used (0 weeks and 12 weeks). Microarrays were incubated and occurring antibody-antigen-reactions were visualized with fluorescence labeled anti-human-IgG secondary antibodies. To detect changes in autoantibodies spot intensities were digitized and compared. Results With respect to the immunoreactivity at 0 weeks level increment of anti-adaptor protein 1 complex subunit mu-1 antibodies and anti-SPRY domain-containing SOCS box protein 3 antibodies in sera of primary open angle patients with optic disc hemorrhage was detected. Linear trend analysis revealed a positive correlation with r ≥ 0.8 between antibody-level and time course. Control group show no relevant changes in the same period. Significant changes were found in time point 4 comparison between patient groups in anti-adaptor protein 1 complex subunit mu-1-level (p = 0.01). No significant changes in visual acuity were found. Conclusion With this approach we were able to detect autoimmune reactivities in sera of patients with primary open angle glaucoma and optic disc hemorrhage compared to patients without optic disc hemorrhage. These antibodies could give further insights into the pathogenesis and the autoimmune component of glaucomatous optic neuropathy. PMID:28030545

  7. An Updated Review on the Genetics of Primary Open Angle Glaucoma

    PubMed Central

    Abu-Amero, Khaled; Kondkar, Altaf A.; Chalam, Kakarla V.

    2015-01-01

    Epidemiological studies suggest that by 2020 the prevalence of primary open angle glaucoma (POAG) is estimated to increase to 76.0 million, and to 111.8 million by 2040 globally due to the population aging. The prevalence of POAG is the highest among those of African descent, followed by Asians, and the lowest in Europeans. POAG is a genetically complex trait with a substantial fraction exhibiting a significant heritability. Less than 10% of POAG cases in the general population are caused by specific gene mutations and the remaining cases are polygenic. Quantitative traits related to POAG pathogenesis such as intra-ocular pressure (IOP), vertical cup/disc ratio (VCDR), optic disc area, and central corneal thickness (CCT) are highly heritable, and likely to be influenced at least in part by genes and show substantial variation in human populations. Recent genome-wide association studies (GWAS) have identified several single nucleotide polymorphisms (SNPs) at different loci including CAV1/CAV2, TMCO1, CDKN2B-AS1, CDC7-TGFBR3, SIX1/SIX6, GAS7 and ATOH7 to be associated with POAG and its related quantitative traits (endophenotypes). The chapter provides a brief overview on the different GWAS and SNP association studies and their correlation with various clinical parameters important for POAG in the population worldwide, including the Middle East. PMID:26690118

  8. Influence of topical betaxolol and timolol on visual field in Japanese open-angle glaucoma patients.

    PubMed

    Araie, Makoto; Azuma, Ikuo; Kitazawa, Yoshiaki

    2003-01-01

    To assess the effects of topical betaxolol and timolol on the visual field in Japanese open-angle glaucoma (OAG) patients. This study was a multicenter, 2-year, prospective, randomized and double-masked study. Tests using the Humphrey 30-2 perimeter program were conducted every 6 months and the data of 95 patients were analyzed using regression analysis. Estimated regression coefficients for mean deviation (MD), corrected pattern standard deviation (CPSD), and total deviation (TD) values clustered into 15 sectors were obtained for each treatment group. Estimated slopes (dB/year) for MD and CPSD showed no significant difference from zero in either group. However, in the betaxolol group, estimated slopes (dB/year) for two adjacent sectors in the inferior arcuate area were significantly positive (P =.0135,.0116) while in the timolol group, no significant difference from zero was seen in any of the sectors. IOP changes from baseline in the timolol group were greater than in the betaxolol group, although no statistical significance was seen at any of the examination times. MD and CPSD showed no significant change in either group. In the betaxolol group, however, a significant trend in improvement of visual field performance was seen in the inferior arcuate subfield. Timolol reduced IOP more effectively than betaxolol in OAG patients.

  9. Genetic screening in a large family with juvenile onset primary open angle glaucoma

    PubMed Central

    Booth, A.; Anwar, R.; Chen, H.; Churchill, A.; Jay, J.; Polansky, J.; Nguyen, T.; Markham, A.

    2000-01-01

    AIMS—A number of genetic loci have been implicated in the pathogenesis of primary open angle glaucoma (POAG). The aim of this study was to identify the genetic cause of POAG in a large Scottish family and, if possible, offer genetic screening and advice to family members.
METHODS—Family members were examined to determine their disease status. Base excision sequence scanning was carried out in order to test for the presence of a POAG causing mutation at known genetic loci. Direct DNA sequencing was performed in order to determine the mutation sequence.
RESULTS—All family members of known affected disease status and two family members of unknown disease status were found to have a mutation in the TIGR gene. The mutation resulted in the substitution of a glycine residue with an arginine residue at codon 252 (Gly252Arg). No other sequence variations were present in any members of the family.
CONCLUSION—The Gly252Arg mutation in the TIGR gene results in the development of POAG in this family. It was possible to identify younger, currently unaffected, members of the family who carry the mutation and who are therefore at a very high risk of developing POAG themselves. This is the first demonstration that Gly252Arg can be a disease causing mutation rather than a benign polymorphism. The possible pathogenic mechanisms and wider implications of the mutation are considered.

 PMID:10873982

  10. Fascicular Visual Field Defects in Open-Angle Glaucoma: Evaluation with Microperimetry

    PubMed Central

    Fratipietro, Manuela; Malagola, Romualdo

    2016-01-01

    Purpose. Use of microperimetry (Mp-1), correlating with Humphrey perimetry (30-2 program), in patients affected by primary open-angle glaucoma (POAG) with perimetric defects, in order to obtain an evaluation of the accuracy of the results obtained by Mp-1. Materials and Methods. In this study 40 eyes of 25 patients affected by POAG with perimetric defects were included. All patients underwent microperimetry test by Nidek Mp-1 (NAVIS software version 1.7.2, Nidek Technologies). Mean sensitivity values expressed in decibel (dB) of all tested dots and mean values for each quadrant obtained by microperimetric test were correlated with corresponding quadrants obtained by static perimetry analysis. Data were analyzed by Pearson's correlation and Bland-Altman analysis. Results. Interpolated data showed that mean sensitivity values in all spots tested by Mp-1 (11.98 dB, SD 4.31) may be significantly correlated with mean total values obtained by Humphrey 30-2 perimetry (17.95, SD 4.32), with correlation coefficient of 0.556. Conclusions. Topographic visualization of the perimetric alteration by microperimetry allows retesting areas with reduced sensitivity which are topographically visualized and displayable on the ocular fundus examination, avoiding worsening of the functional defect by better modulation of the antiglaucoma therapy and therefore it allows better monitoring of the pathologic functional damage. PMID:27366329

  11. Intraocular Pressure, Axial Length, and Refractive Changes after Phacoemulsification and Trabeculectomy for Open-Angle Glaucoma.

    PubMed

    Popa-Cherecheanu, Alina; Iancu, Raluca Claudia; Schmetterer, Leopold; Pirvulescu, Ruxandra; Coviltir, Valeria

    2017-01-01

    To compare changes in intraocular pressure (IOP), axial eye length (AEL), and refractive outcome in primary open-angle glaucoma patients undergoing cataract surgery and trabeculectomy in dependence of the sequence of surgeries. We retrospectively analysed 48 eyes. The changes in refraction, intraocular pressure, and axial eye length were analysed after surgery. In group A (21 subjects), phacoemulsification was performed before trabeculectomy, and in group B (27 subjects), trabeculectomy was performed before phacoemulsification with a minimum time span between interventions of 6 months. The reduction in IOP and the decrease in AEL after trabeculectomy were significant after 6 and 12 months postsurgery (p < 0.001 each). The decrease in AEL was 0.42 ± 0.11% at 6 months after surgery and 0.40 ± 0.13% after 12 months from surgery; this decrease in AEL was comparable between the groups. The refractive outcome was significantly different between the groups (group A: 0.35 ± 0.75 dpt, group B: -0.05 ± 0.36 dpt, p = 0.018); in group A, trabeculectomy caused a hyperopic shift of 0.34 ± 0.44 dpt (p = 0.002) at 12 months postsurgery. IOP reduction after trabeculectomy causes AEL shortening. The effect on refractive outcome depends on the sequence of surgeries. Better refractive outcome is achieved if phacoemulsification is performed after trabeculectomy.

  12. Shorter Scleral Spur in Eyes With Primary Open-Angle Glaucoma

    PubMed Central

    Swain, David L.; Ho, Joseph; Lai, Julia; Gong, Haiyan

    2015-01-01

    Purpose. We determined whether the scleral spur is shorter in primary open-angle glaucoma (POAG) eyes compared to age-matched normal eyes and whether the collapse of Schlemm's canal (SC) is more prevalent in eyes with a shorter scleral spur. Methods. The anterior segments of normal (n = 20) and POAG eyes (n = 20) were fixed and processed for light microscopy. The scleral spur length, ratio of posterior trabecular meshwork (TM) insertion into the scleral spur to the posterior TM height, and the percentage of SC collapse were measured. Analysis using an existing mathematical model was conducted to estimate the distances that the scleral spur theoretically would move in vivo and to determine if these distances would be sufficient to keep SC open in POAG compared to normal eyes. Results. The mean scleral spur length was significantly shorter in POAG eyes compared to normal eyes (P < 0.0001). A higher mean percentage of SC collapse was found in POAG eyes than in normal eyes (P < 0.0001). Estimated posterior movement of scleral spur in POAG eyes was less than sufficient to prevent the collapse of SC. A significant negative correlation was found between the posterior scleral spur movement and percent collapse of SC (P < 0.0001). Conclusions. A shorter scleral spur found in POAG eyes was associated with a higher percent of SC collapse. Our data suggest that a shorter scleral spur may be a risk factor in the development of POAG by being insufficient to hold SC open. PMID:25670488

  13. Electrophysiological and psychophysical flicker sensitivity in patients with primary open-angle glaucoma and ocular hypertension.

    PubMed

    Holopigian, K; Seiple, W; Mayron, C; Koty, R; Lorenzo, M

    1990-09-01

    Temporal sensitivity was assessed in patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT). Three measures of flicker sensitivity were obtained: psychophysical modulation thresholds, visual-evoked potentials (VEPs), and focal electroretinograms (FERGs). We found elevated psychophysical thresholds at higher temporal frequencies (30-50 Hz) in patients with POAG, relative to thresholds for age-matched controls. The OHT patients had elevated psychophysical thresholds only at 50 Hz. On the other hand, VEP amplitudes in POAG patients were reduced at all temporal frequencies, with the magnitude of the loss increasing with temporal frequency. The OHT patients, however, showed no reductions in VEP amplitude at any temporal frequency. Finally, POAG patients' FERG amplitudes were reduced at 30-50 Hz; whereas FERG amplitudes in the OHT patients were normal at all temporal frequencies. These results indicate that OHT patients can exhibit psychophysical threshold losses at high temporal frequencies which are not observed in the suprathreshold electrophysiological amplitude measures. On the other hand, patients with POAG show both psychophysical and VEP losses across a range of temporal frequencies. In addition, the decreases in FERG amplitudes in POAG patients suggest changes in the functioning of the outer retina in this disease.

  14. Short-term effects of relaxation music on patients suffering from primary open-angle glaucoma

    PubMed Central

    Bertelmann, Thomas; Strempel, Ilse

    2015-01-01

    Purpose To evaluate whether additive relaxation music (RM) has an adjuvant short-term effect on physiological and psychological parameters in patients with primary open-angle glaucoma. Methods Prospective, randomized clinical trial. Patients in the therapy group (TG) received a 30-minute RM via headphones, whereas members of the control group (CG) did not. Best corrected visual acuity, intraocular pressure, visual field testing, short- and long-term mental states, and blood levels of different stress hormones were analyzed and compared. Results A total of 25 (61%)/16 (39%) patients were assigned to the TG/CG. Best corrected visual acuity, daily intraocular pressure, and short-term mental state (KAB) development were significantly better in the TG in comparison to controls. Visual field testing, long-term mental well-being (profile of mood states), and adrenalin, cortisol, and endothelin-I blood levels did not differ significantly between both groups. Conclusion Additive RM applied on a daily basis can positively impact various physiological and psychological parameters in the short term. PMID:26543350

  15. Evaluation of brimonidine-timolol fixed combination in patients of primary open-angle glaucoma.

    PubMed

    Joshi, Sachin R; Akat, Pramod B; Ramanand, Jaiprakash B; Ramanand, Sunita J; Karande, Vitthal B; Jain, Suyog S

    2013-12-01

    The aim of present study was to compare the efficacy and safety of fixed combination of brimonidine and timolol with individual components used as monotherapy in patients of primary open angle glaucoma. Patients were randomly assigned to receive brimonidine or timolol or brimonidine-timolol fixed combination, with 30 patients in each group. The mean reduction in intraocular pressure in brimonidine, timolol, and brimonidine-timolol group were 4.29 ± 1.97 mm Hg, 4.34 ± 1.21 mm Hg, and 5.54 ± 1.87 mm Hg respectively at 2 weeks and 4.86 ± 1.16 mm Hg, 5.42 ± 1.50 mm Hg, and 7.36 ± 2.58 mm Hg respectively at 6 weeks. When values of mean reduction in intraocular pressure were compared between brimonidine-timolol fixed combination with brimonidine and timolol, it was found to be statistically significant ( P < 0.05) at 2 weeks and highly significant (0.001) at 6 weeks. The overall frequency of adverse effects was similar in all three groups.

  16. Corneal biomechanical properties affect Goldmann applanation tonometry in primary open-angle glaucoma.

    PubMed

    Costin, Bryan R; Fleming, Gloria P; Weber, Paul A; Mahmoud, Ashraf M; Roberts, Cynthia J

    2014-02-01

    To study differences in corneal biomechanical properties between primary open-angle glaucoma (POAG) and central corneal thickness (CCT)-matched control subjects and their effect on intraocular pressure (IOP) measurement. Thirteen eyes of 13 POAG subjects and 15 eyes of 15 normal subjects underwent corneal topography; IOP using Goldmann applanation tonometry (GAT), dynamic contour tonometry (DCT), and corneal compensated IOP (IOPcc) using the Reichert ocular response analyzer (ORA); corneal hysteresis; and CCT. Results from POAG and control eyes were then compared using t tests. Ages in the POAG group were slightly greater than that in the control group. CCT was closely matched between groups. Significant differences were found between GAT versus DCT and GAT versus IOPcc within both groups: Mean GAT IOP was not significantly different between POAG and controls, whereas mean DCT IOP did show a significant difference between groups as did mean IOPcc. The delta differences, GATΔDCT and GATΔIOPcc, were of greater magnitude in POAG subjects when compared with controls. Corneal hysteresis was significantly lower in POAG subjects. The delta differences between GAT and newer measures of IOP are greater in magnitude in patients with POAG than in the normal controls, independent of CCT. This is likely due to differences in the corneal biomechanical properties with POAG corneas being softer than healthy corneas, which causes greater underestimation of IOP by GAT in POAG than controls. Underestimation of IOP could affect treatment decisions and outcomes in POAG.

  17. Role of cholesterol 24S-hydroxylase gene polymorphism (rs754203) in primary open angle glaucoma

    PubMed Central

    Weger, Martin; Faschinger, Christoph; Schmut, Otto; Renner, Wilfried; Wedrich, Andreas; Zimmermann, Christina; El-Shabrawi, Yosuf

    2011-01-01

    Purpose The enzyme cholesterol 24S-hydroxylase (Cyp46A1) is responsible for the conversion of cholesterol to its more polar metabolite 24S-hydroxycholesterol, thereby enabling the intracerebral elimination of cholesterol. An intronic single nucleotide polymorphism in the gene CYP46A1 (IVS2 −150 T>C; rs754203) has recently been associated with primary open angle glaucoma (POAG). This association, however, lacks confirmation in other studies. The purpose of the present study was to investigate a hypothesized association between rs754203 and the presence of POAG in a Central European population of Caucasian descent. Methods The present institutional study comprised a total of 581 unrelated subjects: 330 patients with POAG, and 251 control subjects. Main outcome measures are genotype distributions and allelic frequencies determined by polymerase chain reaction. Results No significant differences in either genotype distribution or allelic frequencies were found between patients with POAG and control subjects (p>0.05). The presence of the rs754203 T-allele was associated with a nonsignificant odds ratio of 0.81 (95% CI: 0.63–1.04; p=0.11) for POAG. Conclusions Our data suggest that the rs754203 polymorphism itself is unlikely a genetic risk factor for POAG in Caucasian individuals. PMID:21386929

  18. Assessment of polygenic effects links primary open-angle glaucoma and age-related macular degeneration.

    PubMed

    Cuellar-Partida, Gabriel; Craig, Jamie E; Burdon, Kathryn P; Wang, Jie Jin; Vote, Brendan J; Souzeau, Emmanuelle; McAllister, Ian L; Isaacs, Timothy; Lake, Stewart; Mackey, David A; Constable, Ian J; Mitchell, Paul; Hewitt, Alex W; MacGregor, Stuart

    2016-05-31

    Primary open-angle glaucoma (POAG) and age-related macular degeneration (AMD) are leading causes of irreversible blindness. Several loci have been mapped using genome-wide association studies. Until very recently, there was no recognized overlap in the genetic contribution to AMD and POAG. At genome-wide significance level, only ABCA1 harbors associations to both diseases. Here, we investigated the genetic architecture of POAG and AMD using genome-wide array data. We estimated the heritability for POAG (h(2)g = 0.42 ± 0.09) and AMD (h(2)g = 0.71 ± 0.08). Removing known loci for POAG and AMD decreased the h(2)g estimates to 0.36 and 0.24, respectively. There was evidence for a positive genetic correlation between POAG and AMD (rg = 0.47 ± 0.25) which remained after removing known loci (rg = 0.64 ± 0.31). We also found that the genetic correlation between sexes for POAG was likely to be less than 1 (rg = 0.33 ± 0.24), suggesting that differences of prevalence among genders may be partly due to heritable factors.

  19. Assessment of polygenic effects links primary open-angle glaucoma and age-related macular degeneration

    PubMed Central

    Cuellar-Partida, Gabriel; Craig, Jamie E.; Burdon, Kathryn P.; Wang, Jie Jin; Vote, Brendan J.; Souzeau, Emmanuelle; McAllister, Ian L.; Isaacs, Timothy; Lake, Stewart; Mackey, David A.; Constable, Ian J.; Mitchell, Paul; Hewitt, Alex W.; MacGregor, Stuart

    2016-01-01

    Primary open-angle glaucoma (POAG) and age-related macular degeneration (AMD) are leading causes of irreversible blindness. Several loci have been mapped using genome-wide association studies. Until very recently, there was no recognized overlap in the genetic contribution to AMD and POAG. At genome-wide significance level, only ABCA1 harbors associations to both diseases. Here, we investigated the genetic architecture of POAG and AMD using genome-wide array data. We estimated the heritability for POAG (h2g = 0.42 ± 0.09) and AMD (h2g = 0.71 ± 0.08). Removing known loci for POAG and AMD decreased the h2g estimates to 0.36 and 0.24, respectively. There was evidence for a positive genetic correlation between POAG and AMD (rg = 0.47 ± 0.25) which remained after removing known loci (rg = 0.64 ± 0.31). We also found that the genetic correlation between sexes for POAG was likely to be less than 1 (rg = 0.33 ± 0.24), suggesting that differences of prevalence among genders may be partly due to heritable factors. PMID:27241461

  20. Optic disc topography in Malay patients with normal-tension glaucoma and primary open-angle glaucoma.

    PubMed

    Adlina, Abdul Rahim; Alisa-Victoria, Koh; Shatriah, Ismail; Liza-Sharmini, Ahmad Tajudin; Ahmad, Mt Saad

    2014-01-01

    There are limited data concerning the optic disc topography in normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG) patients living in Southeast Asian countries. This study aims to compare optic disc parameters in patients with NTG and POAG in Malaysia and to discuss the results in comparison with studies of NTG and POAG in other Asian countries. This prospective cross-sectional study was performed in two hospitals with glaucoma service in Malaysia from 2010 to 2012. Seventy-seven patients of Malay ethnicity were enrolled in this study, including 32 NTG patients and 45 POAG patients. Using the Heidelberg Retinal Tomograph III, we measured optic disc area, cup area, rim area, cup volume, rim volume, cup-to-disc area ratio, mean cup depth, maximum cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness, and retinal nerve fiber layer cross-sectional area. The eyes for NTG patients had significantly larger optic disc areas (2.65 [standard deviation, 0.41] vs 2.40 [standard deviation, 0.36] mm(2), respectively; P=0.006) and cup areas (1.54 [standard deviation, 0.43] vs 1.32 [standard deviation, 0.40] mm(2), respectively; P=0.027) compared with the eyes of POAG patients. Comparison of the other parameters between the two groups revealed no significant difference (P>0.050). The moderate and severe NTG patients showed significantly deeper cups and larger disc and cup areas when compared with the moderate and severe POAG patients (P<0.050). The NTG patients in this study have notably larger optic disc and cup areas than the POAG patients. Our observations are consistent with those reported in studies of NTG and POAG patients in Korea. The deeper cups and larger disc and cup areas may serve as indicators of severity when comparing NTG with POAG. However, these findings require verification with IOP and visual field results.

  1. Intraocular pressure fluctuation after water drinking test in primary angle-closure glaucoma and primary open-angle glaucoma.

    PubMed

    Poon, Yi-Chieh; Teng, Mei-Ching; Lin, Pei-Wen; Tsai, Jen-Chia; Lai, Ing-Chou

    2016-12-01

    Only a few studies have assessed intraocular pressure (IOP) changes during the water drinking test (WDT) in patients with primary angle-closure glaucoma (PACG). The aim of this study is to investigate IOP changes during WDT in patients with PACG versus primary open-angle glaucoma (POAG). This was a prospective and single tertiary center study. PACG and POAG patients (n = 15 each) without prior glaucoma surgery were enrolled and subjected to WDT, wherein they consumed an amount of water proportional to their body weight within 10 min. IOP was measured at baseline and every 15 min for 1 h after water intake. Intergroup comparisons were performed using Mann-Whitney U-test for continuous variables and Chi-square test for categorical variables. Wilcoxon signed-ranks test was used for comparisons of IOP before and after water intake in the two groups. Regression analysis was used to determine factors associated with IOP fluctuations during WDT. IOP changes over 1 h after water intake showed no significant differences between groups. The mean maximum fluctuation from baseline was 3.61 ± 2.49 and 3.79 ± 1.91 mmHg, respectively, in the PACG and POAG groups. The mean peak IOP was 19.17 ± 4.32 and 19.87 ± 3.44 mmHg in the PACG and PAOG groups, respectively. The axial length and anterior chamber depth showed no correlations with IOP fluctuations. We found similar IOP fluctuation curves and peak IOP values in both PACG and POAG patients subjected to WDT. These findings suggest that WDT is a useful test to induce IOP peaks in both POAG and PACG patients.

  2. Intraocular pressure fluctuation after water drinking test in primary angle-closure glaucoma and primary open-angle glaucoma

    PubMed Central

    Poon, Yi-Chieh; Teng, Mei-Ching; Lin, Pei-Wen; Tsai, Jen-Chia; Lai, Ing-Chou

    2016-01-01

    Context: Only a few studies have assessed intraocular pressure (IOP) changes during the water drinking test (WDT) in patients with primary angle-closure glaucoma (PACG). Aims: The aim of this study is to investigate IOP changes during WDT in patients with PACG versus primary open-angle glaucoma (POAG). Settings and Design: This was a prospective and single tertiary center study. Materials and Methods: PACG and POAG patients (n = 15 each) without prior glaucoma surgery were enrolled and subjected to WDT, wherein they consumed an amount of water proportional to their body weight within 10 min. IOP was measured at baseline and every 15 min for 1 h after water intake. Statistical Analysis Used: Intergroup comparisons were performed using Mann–Whitney U-test for continuous variables and Chi-square test for categorical variables. Wilcoxon signed-ranks test was used for comparisons of IOP before and after water intake in the two groups. Regression analysis was used to determine factors associated with IOP fluctuations during WDT. Results: IOP changes over 1 h after water intake showed no significant differences between groups. The mean maximum fluctuation from baseline was 3.61 ± 2.49 and 3.79 ± 1.91 mmHg, respectively, in the PACG and POAG groups. The mean peak IOP was 19.17 ± 4.32 and 19.87 ± 3.44 mmHg in the PACG and PAOG groups, respectively. The axial length and anterior chamber depth showed no correlations with IOP fluctuations. Conclusions: We found similar IOP fluctuation curves and peak IOP values in both PACG and POAG patients subjected to WDT. These findings suggest that WDT is a useful test to induce IOP peaks in both POAG and PACG patients. PMID:28112134

  3. Analysis of the quantitative dermatoglyphic traits of the digito-palmar complex in patients with primary open angle glaucoma.

    PubMed

    Novak-Laus, Katia; Milicić, Jasna; Tedeschi-Reiner, Eugenia; Iveković, Renata; Mijić, Vesna; Masnec-Paskvalin, Sanja; Zrinsćak, Ognjen; Mandić, Zdravko

    2005-12-01

    Patient with primary open angle glaucoma (PAOG), which is known to have a genetic predisposition, and their immediate relatives unaffected with PAOG, may have some changes in dermatoglyphic traits of the digito-palmar complex, since the trabecular meshwork develops at the same time and with the same hereditary base like dermatoglyphs, which have high genetic transmission. The objective of this study is to determine whether differences in quantitative dermatoglyphic traits of the digito-palmar complex exist between patients with glaucoma and the phenotipically healthy population and whether their family members have the same dermatoglyphic changes. The quantitative dermatoglyphic traits in patients suffering from glaucoma, first-degree members of their family and the phenotypically healthy population have been screened in this study. Descriptive statistics, univariate analysis of variance (ANOVA) and post hoc (Tukey HSD) method have been used. The results have shown that there is a link between the quantitative dermatoglyphic traits of the digito-palmar complex in patients affected by glaucoma and a first-degree healthy member of their family, as well as the difference between patients with glaucoma and their first-degree relatives, which may discriminate them from the phenotypically healthy population. The results of the study mostly affirm the existence of genetic predisposition for the development of primary open-angle glaucoma, thus emphasizing the relevance of hereditary factors in the etiopathogenesis of this disease.

  4. Using Filtered Forecasting Techniques to Determine Personalized Monitoring Schedules for Patients with Open-Angle Glaucoma

    PubMed Central

    Schell, Greggory J.; Lavieri, Mariel S.; Helm, Jonathan E.; Liu, Xiang; Musch, David C.; Van Oyen, Mark P.; Stein, Joshua D.

    2015-01-01

    Purpose To determine whether dynamic and personalized schedules of visual field (VF) testing and intraocular pressure (IOP) measurements result in an improvement in disease progression detection compared with fixed interval schedules for performing these tests when evaluating patients with open-angle glaucoma (OAG). Design Secondary analyses using longitudinal data from two randomized controlled trials. Participants 571 participants from Advanced Glaucoma Intervention Study (AGIS) and Collaborative Initial Glaucoma Treatment Study (CIGTS). Methods Perimetric and tonometric data were obtained for AGIS and CIGTS trial participants and used to parameterize and validate a Kalman filter model. The Kalman filter updates knowledge about each participant’s disease dynamics as additional VF tests and IOP measurements are obtained. After incorporating the most recent VF and IOP measurements, the model forecasts each participant’s disease dynamics into the future and characterizes the forecasting error. To determine personalized schedules for future VF tests and IOP measurements, we developed an algorithm by combining the Kalman filter for state estimation with the predictive power of logistic regression to identify OAG progression. The algorithm was compared against 1, 1.5, and 2 year fixed interval schedules of obtaining VF and IOP measurements. Main Outcome Measures Length of diagnostic delay in detecting OAG progression, efficiency of detecting progression, number of VF and IOP measurements needed to assess for progression. Results Participants were followed in the AGIS and CIGTS trials for a mean (standard deviation) of 6.5 (2.8) years. Our forecasting model achieved a 29% increased efficiency in identifying OAG progression (p<0.0001) and detected OAG progression 57% sooner (reduced diagnostic delay) (p= 0.02) than following a fixed yearly monitoring schedule, without increasing the number of VF tests and IOP measurements required. The model performed well on

  5. Trends in Utilization of Ancillary Glaucoma Tests for Patients with Open-Angle Glaucoma from 2001 to 2009

    PubMed Central

    Stein, Joshua D.; Talwar, Nidhi; Laverne, Alejandra; Nan, Bin; Lichter, Paul R.

    2011-01-01

    Purpose To assess trends in the use of ancillary diagnostic tests in the evaluation of patients with open-angle glaucoma (OAG) and glaucoma suspects over the past decade. Design Retrospective longitudinal cohort analysis. Participants 169,917 individuals with OAG and 395,721 with suspected glaucoma age ≥40 enrolled in a national United States managed care network between 2001–2009. Methods Claims data were analyzed to assess trends in visual field (VF) testing, fundus photography (FP), and other ocular imaging (OOI) testing for patients with OAG or suspected glaucoma in 2001–2009. Repeated measures logistic regression was performed to identify differences in the odds of undergoing these procedures in 2001, 2005, and 2009 and whether differences exist for patients under the exclusive care of optometrists versus ophthalmologists. Main Outcome Measures Odds and annual probabilities of undergoing VF testing, FP, and OOI for OAG from 2001–2009. Results For patients with OAG, the odds of undergoing VF testing decreased by 36% from 2001 to 2005, 12% from 2005 to 2009, and 44% from 2001 to 2009. By comparison, the odds of having OOI increased by 100% from 2001 to 2005, 24% from 2005 to 2009, and 147% from 2001 to 2009. Probabilities of undergoing FP were relatively low (13–25%) for both provider types and remained fairly steady over the decade. For patients cared for exclusively by optometrists, the probability of VF testing decreased from 66% in 2001 to 44% in 2009. Among those seen exclusively by ophthalmologists, the probability of VF testing decreased from 65% in 2001 to 51% in 2009. The probability of undergoing OOI increased from 26% in 2001 to 47% in 2009 for patients of optometrists and from 30% in 2001 to 46% in 2009 for patients of ophthalmologists. By 2008, patients with OAG receiving care exclusively by optometrists had a higher probability of undergoing OOI than VF testing. Conclusion During 2001–2009 OOI rose dramatically whereas VF testing

  6. Topical Ocular Sodium 4-Phenylbutyrate Rescues Glaucoma in a Myocilin Mouse Model of Primary Open-Angle Glaucoma

    PubMed Central

    Zode, Gulab S.; Bugge, Kevin E.; Mohan, Kabhilan; Grozdanic, Sinisa D.; Peters, Joseph C.; Koehn, Demelza R.; Anderson, Michael G.; Kardon, Randy H.; Stone, Edwin M.

    2012-01-01

    Purpose. Mutations in the myocilin gene (MYOC) are the most common known genetic cause of primary open-angle glaucoma (POAG). The purpose of this study was to determine whether topical ocular sodium 4-phenylbutyrate (PBA) treatment rescues glaucoma phenotypes in a mouse model of myocilin-associated glaucoma (Tg-MYOCY437H mice). Methods. Tg-MYOCY437H mice were treated with PBA eye drops (n = 10) or sterile PBS (n = 8) twice daily for 5 months. Long-term safety and effectiveness of topical PBA (0.2%) on glaucoma phenotypes were examined by measuring intraocular pressure (IOP) and pattern ERG (PERG), performing slit lamp evaluation of the anterior chamber, analyzing histologic sections of the anterior segment, and comparing myocilin levels in the aqueous humor and trabecular meshwork of Tg-MYOCY437H mice. Results. Tg-MYOCY437H mice developed elevated IOP at 3 months of age when compared with wild-type (WT) littermates (n = 24; P < 0.0001). Topical PBA did not alter IOP in WT mice. However, it significantly reduced elevated IOP in Tg-MYOCY437H mice to the level of WT mice. Topical PBA-treated Tg-MYOCY437H mice also preserved PERG amplitudes compared with vehicle-treated Tg-MYOCY437H mice. No structural abnormalities were observed in the anterior chamber of PBA-treated WT and Tg-MYOCY437H mice. Analysis of the myocilin in the aqueous humor and TM revealed that PBA significantly improved the secretion of myocilin and reduced myocilin accumulation as well as endoplasmic reticulum (ER) stress in the TM of Tg-MYOCY437H mice. Furthermore, topical PBA reduced IOP elevated by induction of ER stress via tunicamycin injections in WT mice. Conclusions. Topical ocular PBA reduces glaucomatous phenotypes in Tg-MYOCY437H mice, most likely by reducing myocilin accumulation and ER stress in the TM. Topical ocular PBA could become a novel treatment for POAG patients with myocilin mutations. PMID:22328638

  7. Identification of a novel MYOC mutation, p.(Trp373), in a family with open angle glaucoma.

    PubMed

    Crawford, April; Souzeau, Emmanuelle; Agar, Ashish; Ridge, Bronwyn; Dubowsky, Andrew; Burdon, Kathryn P; Craig, Jamie E

    2014-07-25

    MYOC gene variants are associated with autosomal dominant primary open angle glaucoma (POAG). In this study, we describe a previously unreported MYOC variant segregating with a POAG phenotype in an Australian family. Two individuals affected with POAG and three unaffected individuals from the same family were recruited through the Australian and New Zealand Registry of Advanced Glaucoma (ANZRAG). Direct sequencing of all MYOC coding exons identified the novel heterozygous single nucleotide transition MYOC:c.1119G>A, p.(Trp373), predicted to encode an aberrant truncated MYOC protein in two affected siblings. Two unaffected siblings and an unaffected niece were negative for the MYOC sequence variant.

  8. [Computer-assisted multimedia interactive learning program "Primary Open-Angle Glaucoma"].

    PubMed

    Dick, V B; Zenz, H; Eisenmann, D; Tekaat, C J; Wagner, R; Jacobi, K W

    1996-05-01

    Advances in the area of information technology have opened up new possibilities for the use of interactive media in the training of medical students. Classical instructional technologies, such as video, slides, audio cassettes and computer programs with a textbook orientation, have been merged into one multimedia computer system. The medical profession has been increasingly integrating computer-based applications which can be used, for example, for record keeping within a medical practice. The goal of this development is to provide access to all modes of information storage and retrieval as well as documentation and training systems within a specific context. Since the beginning of the winter semester 1995, the Department of Ophthalmology in Giessen has used the learning program "Primary Open Angle Glaucoma" in student instruction. One factor that contributed to the implementation of this project was that actual training using patients within the clinic is difficult to conduct. Media-supported training that can provide a simulation of actual practice offers a suitable substitute. The learning program has been installed on Power PCs (Apple MacIntosh), which make up the technical foundation of our system. The program was developed using Hypercard software, which provides userfriendly graphical work environment. This controls the input and retrieval of data, direct editing of documents, immediate simulation, the creation of on-screen documents and the integration of slides that have been scanned in as well as QuickTime films. All of this can be accomplished without any special knowledge of programming language or operating systems on the part of the user. The glaucoma learning program is structured along the lines of anatomy, including an explanation of the circulation of the aqueous humor, pathology, clinical symptoms and findings, diagnosis and treatment. This structure along with the possibility for creating a list of personal files for the user with a collection

  9. Effect of selective laser trabeculoplasty on ocular haemodynamics in primary open-angle glaucoma.

    PubMed

    Pillunat, Karin R; Spoerl, Eberhard; Terai, Naim; Pillunat, Lutz E

    2017-06-01

    Selective laser trabeculoplasty (SLT) is known to reduce intraocular pressure (IOP) effectively. The aim of this study, however, was to evaluate the effect of SLT on ocular haemodynamics. A total of 69 eyes of 69 patients (age 67.8 ± 9.9 years) with already treated primary open-angle glaucoma who were assigned for SLT for further IOP reduction were consecutively enrolled in this prospective interventional case series. Intraocular pressure, the ocular pulse amplitude (OPA), ocular pulse volume (OPV) and pulsatile ocular blood flow (pOBF) were assessed with the Ocular Blood Flow Analyzer prior to and 3 months after SLT. Intraocular pressure was statistically significantly reduced from 16.0 ± 5.4 mmHg to 12.8 ± 4.0 mmHg (p = 0.001). The OPA did not change (p = 0.783) after IOP reduction following SLT. OPV and pOBF increased statistically significantly. OPV increased from 7.33 ± 3.05 to 8.59 ± 3.35 μl (17.2%; p = 0.001) and pOBF from 17.11 ± 5.42 to 19.74 ± 6.59 μl/s (15.4%; p = 0.002). Selective laser trabeculoplasty probably does not induce any pharmacological changes effecting systemic blood pressure or ocular blood flow as topical IOP-lowering medication might do, nor does it change biomechanical properties of the eye as surgery could. Therefore, an increase in ocular blood flow following SLT can only be explained by the reduction in IOP and might be a sign of dysfunctional autoregulation in glaucoma patients. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  10. Relationship between visual field progression and baseline refraction in primary open-angle glaucoma.

    PubMed

    Naito, Tomoko; Yoshikawa, Keiji; Mizoue, Shiro; Nanno, Mami; Kimura, Tairo; Suzumura, Hirotaka; Umeda, Yuzo; Shiraga, Fumio

    2016-01-01

    To analyze the relationship between visual field (VF) progression and baseline refraction in Japanese patients with primary open-angle glaucoma (POAG) including normal-tension glaucoma. In this retrospective study, the subjects were patients with POAG who had undergone VF tests at least ten times with a Humphrey Field Analyzer (Swedish interactive thresholding algorithm standard, Central 30-2 program). VF progression was defined as a significantly negative value of mean deviation (MD) slope at the final VF test. Multivariate logistic regression models were applied to detect an association between MD slope deterioration and baseline refraction. A total of 156 eyes of 156 patients were included in this analysis. Significant deterioration of MD slope was observed in 70 eyes of 70 patients (44.9%), whereas no significant deterioration was evident in 86 eyes of 86 patients (55.1%). The eyes with VF progression had significantly higher baseline refraction compared to those without apparent VF progression (-1.9±3.8 diopter [D] vs -3.5±3.4 D, P=0.0048) (mean ± standard deviation). When subject eyes were classified into four groups by the level of baseline refraction applying spherical equivalent (SE): no myopia (SE > -1D), mild myopia (-1D ≥ SE > -3D), moderate myopia (-3D ≥ SE > -6D), and severe myopia (-6D ≥ SE), the Cochran-Armitage trend analysis showed a decreasing trend in the proportion of MD slope deterioration with increasing severity of myopia (P=0.0002). The multivariate analysis revealed that baseline refraction (P=0.0108, odds ratio [OR]: 1.13, 95% confidence interval [CI]: 1.03-1.25) and intraocular pressure reduction rate (P=0.0150, OR: 0.97, 95% CI: 0.94-0.99) had a significant association with MD slope deterioration. In the current analysis of Japanese patients with POAG, baseline refraction was a factor significantly associated with MD slope deterioration as well as intraocular pressure reduction rate. When baseline refraction was classified into

  11. Predictive factors for open-angle glaucoma among patients with ocular hypertension in the European Glaucoma Prevention Study.

    PubMed

    Miglior, Stefano; Pfeiffer, Norbert; Torri, Valter; Zeyen, Thierry; Cunha-Vaz, Jose; Adamsons, Ingrid

    2007-01-01

    To evaluate the predictive factors of open-angle glaucoma (OAG) in patients affected by ocular hypertension enrolled in the European Glaucoma Prevention Study (EGPS). Randomized, double-masked, controlled clinical trial. One thousand seventy-seven patients, > or =30 years old, were enrolled at 18 European centers. The patients met inclusion criteria: intraocular pressure, 22 to 29 mmHg; 2 normal and reliable visual fields (VFs) (on the basis of mean deviation and corrected pattern standard deviation [PSD]); and a normal optic disc, as determined by an optic disc reading center. Treatment with dorzolamide or a placebo (the vehicle of dorzolamide) in one or both eyes. Efficacy end points were VF and/or optic disc changes. Baseline demographic and clinical data were collected before randomization, except for corneal thickness measurements, which were determined during follow-up. Proportional hazards models were used to identify factors that predicted which participants in the EGPS had developed OAG. In multivariate analyses, factors that predicted the development of OAG included older age (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.04-1.69), larger vertical cup-to-disc (C/D) ratio (HR, 1.34; 95% CI, 1.14-1.58), larger vertical C/D ratio asymmetry (HR, 1.46; 95% CI, 1.11-1.93), higher PSD (HR, 1.66; 95% CI, 1.15-2.38), and lesser central corneal thickness (HR, 1.32; 95% CI, 1.05-1.67). Baseline age, vertical C/D ratio, vertical C/D ratio asymmetry, and PSD were good predictors of the onset of OAG in the EGPS. Central corneal thickness was found to be a powerful predictor of the development of OAG. The EGPS results agree with the findings of the Ocular Hypertension Treatment Study and support the need for a thorough evaluation of patients with ocular hypertension.

  12. Structure-function correlations using scanning laser polarimetry in primary angle-closure glaucoma and primary open-angle glaucoma.

    PubMed

    Lee, Pei-Jung; Liu, Catherine Jui-Ling; Wojciechowski, Robert; Bailey-Wilson, Joan E; Cheng, Ching-Yu

    2010-05-01

    To assess the correlations between retinal nerve fiber layer (RNFL) thickness measured with scanning laser polarimetry and visual field (VF) sensitivity in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Prospective, comparative, observational cases series. Fifty patients with POAG and 56 patients with PACG were examined using scanning laser polarimetry with variable corneal compensation (GDx VCC; Laser Diagnostic Technologies, Inc.) and Humphrey VF analyzer (Carl Zeiss Meditec, Inc.) between August 2005 and July 2006 at Taipei Veterans General Hospital. Correlations between RNFL thickness and VF sensitivity, expressed as mean sensitivity in both decibel and 1/Lambert scales, were estimated by the Spearman rank correlation coefficient (r(s)) and multivariate median regression models (pseudo R(2)). The correlations were determined globally and for 6 RNFL sectors and their corresponding VF regions. The correlation between RNFL thickness and mean sensitivity (in decibels) was weaker in the PACG group (r(s) = 0.38; P = .004; pseudo R(2) = 0.17) than in the POAG group (r(s) = 0.51; P < .001; pseudo R(2) = .31), but the difference in the magnitude of correlation was not significant (P = .42). With Bonferroni correction, the structure-function correlation was significant in the superotemporal (r(s) = 0.62), superonasal (r(s) = 0.56), inferonasal (r(s) = 0.53), and inferotemporal (r(s) = 0.50) sectors in the POAG group (all P < .001), whereas it was significant only in the superotemporal (r(s) = 0.53) and inferotemporal (r(s) = 0.48) sectors in the PACG group (both P < .001). The results were similar when mean sensitivity was expressed as 1/Lambert scale. Both POAG and PACG eyes had moderate structure-function correlations using scanning laser polarimetry. Compared with eyes with POAG, fewer RNFL sectors have significant structure-function correlations in eyes with PACG. Copyright 2010 Elsevier Inc. All rights reserved.

  13. Structure-Function Correlations using Scanning Laser Polarimetry in Primary Angle-Closure Glaucoma and Primary Open Angle Glaucoma

    PubMed Central

    Lee, Pei-Jung; Liu, Catherine Jui-Ling.; Wojciechowski, Robert; Bailey-Wilson, Joan E.; Cheng, Ching-Yu

    2010-01-01

    Purpose To assess the correlations between retinal nerve fiber layer (RNFL) thickness measured with scanning laser polarimetry (SLP) and visual field (VF) sensitivity in primary open angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Design Prospective, comparative, observational cases series Methods Fifty patients with POAG and 56 with PACG were examined using SLP with variable corneal compensation (GDx VCC) and Humphrey VF analyzer between August 2005 and July 2006 at Taipei Veterans General Hospital. Correlations between RNFL thickness and VF sensitivity, expressed as mean sensitivity (MS) in both decibel (dB) and 1/Lambert (L) scales, were estimated by Spearman's rank correlation coefficient (rs) and multivariate median regression models (pseudo R2). The correlations were determined globally and for six RNFL sectors and their corresponding VF regions. Results The correlation between RNFL thickness and MS (in dB) was weaker in the PACG group (rs = 0.38, P = 0.004, pseudo R2 = 0.17) than in the POAG group (rs = 0.51, P <0.001, pseudo R2 = 0.31), but the difference in the magnitude of correlation was not significant (P = 0.42).With Bonferroni correction, the structure-function correlation was significant in the superotemporal (rs = 0.62), superonasal (rs = 0.56), inferonasal (rs = 0.53), and inferotemporal (rs = 0.50) sectors in the POAG group (all P <0.001), while it was significant only in the superotemporal (rs = 0.53) and inferotemporal (rs = 0.48) sectors in the PACG group (both P <0.001). The results were similar when MS was expressed as 1/L scale. Conclusions Both POAG and PACG eyes had moderate structure-function correlations using SLP. Compared to eyes with POAG, fewer RNFL sectors have significant structure-function correlations in eyes with PACG. PMID:20202618

  14. Early Postoperative Effects of Cataract Surgery on Anterior Segment Parameters in Primary Open-Angle Glaucoma and Pseudoexfoliation Glaucoma

    PubMed Central

    Elgin, Ufuk; Şen, Emine; Şimşek, Tülay; Tekin, Kemal; Yılmazbaş, Pelin

    2016-01-01

    Objectives: To compare the effect of cataract surgery on anterior segment parameters measured by optical biometry in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). Materials and Methods: Twenty-five eyes of 25 patients with POAG and 29 eyes of 29 patients with PXG who had uncomplicated phacoemulsification and posterior chamber intraocular lens implantation surgery were included to our prospective study. Central corneal thickness (CCT), anterior chamber depth (ACD) and axial length (AL) were measured with an optical biometer preoperatively and at 1 month postoperatively. The pre- and postoperative values of intraocular pressure (IOP) and the anterior segment parameters and the differences between POAG and PXG were compared statistically by paired t, independent t and chi-square tests. Results: The mean values of preoperative CCT (p=0.042) and ACD (p=0.012) were significantly lower in the PXG than in the POAG group. In the PXG group, IOP decreased (p=0.001) but CCT (p=0.03) and ACD (p=0.001) increased significantly postoperatively; AL did not change significantly. In the POAG group, IOP decreased (p=0.01) and ACD (p=0.004) increased significantly postoperatively, while AL and CCT did not change significantly. There were no significant differences in the pre- to postoperative changes in IOP (p=0.76), AL (p=0.44) and CCT (p=0.52) values between the two groups. However, the postoperative increase in ACD was larger in the PXG group (p=0.03). Conclusion: Cataract surgery may cause some changes in IOP and anterior segment parameters like ACD and CCT postoperatively in eyes with POAG and PXG, and these changes may differ between eyes with PXG and POAG. PMID:27800269

  15. Corneal changes after a single session of selective laser trabeculoplasty for open-angle glaucoma

    PubMed Central

    Lee, J W Y; Chan, J C H; Chang, R T; Singh, K; Liu, C C L; Gangwani, R; Wong, M O M; Lai, J S M

    2014-01-01

    Purpose To investigate the changes in endothelial cell count, central corneal thickness (CCT), and refractive error after a session of selective laser trabeculoplasty (SLT) for open angle glaucoma (OAG). Methods This prospective cohort study recruited 111 eyes of 66 consecutive subjects with OAG. Subjects received SLT to 360° of the trabecular meshwork. Endothelial cell count, CCT, and spherical equivalent were measured at baseline before SLT as well as at 1 week and 1 month post SLT. A repeated measure nested ANOVA with Tukey's multiple comparison test was performed to compare the outcome measures before and after SLT. Results In 111 eyes of 66 subjects, the mean number of laser applications per treatment was 166.9±41.4 with a mean energy level of 1.0±0.07 mJ. The mean endothelial cell count decreased significantly from 2465.0±334.0 cells/mm2 at baseline to 2355.0±387.0 cells/mm2 at 1 week (P=0.0004) but increased to baseline levels at 1 month post SLT (2424.0±379.4 cells/mm2, P=0.3). The CCT, which decreased from a baseline of 549.4±37.6 to 543.9±40.2 μm at 1 week post SLT (P=0.02), also returned to the baseline level by 1 month (P=0.2). The spherical equivalent was static from baseline. A positive correlation was found between total laser energy and CCT at 1 month post treatment (r=0.3, P=0.005). Conclusion The transient reductions in endothelial cell count and CCT following SLT returned to baseline levels 1 month after the procedure. Patients undergoing SLT should be aware of the risk of potential corneal changes. PMID:24136571

  16. Dementia is associated with open-angle glaucoma: a population-based study

    PubMed Central

    Chung, S-D; Ho, J-D; Chen, C-H; Lin, H-C; Tsai, M-C; Sheu, J-J

    2015-01-01

    Purpose Previous epidemiologic studies that focused on the association between open-angle glaucoma (OAG) and dementia showed inconsistent results. In the present study, we explored the association between OAG and dementia in an ethnic Chinese (ie, Taiwanese) population using a population-based data set. Methods We retrieved data on study subjects for this case-control study from the Longitudinal Health Insurance Database 2000. We identified 7770 patients who had a diagnosis of dementia as cases, and 7770 subjects matched in terms of sex and age, which were randomly extracted as controls. A conditional logistic regression conditioned on age group, sex, and index year was used to assess the association of dementia with previously diagnosed OAG among the sampled patients. Results Of 15 540 patients, 1.70% had prior OAG, including 2.02% of the dementia group and 1.38% of the controls. After adjusting for patient socioeconomic characteristics and comorbid medical disorders, dementia patients were more likely to have had prior OAG than controls (odds ratio (OR): 1.44; 95% confidence interval (CI): 1.12–1.85; P<0.01). In addition, female dementia patients were more likely to have had prior OAG than controls (OR: 1.93; 95% CI: 1.35–2.77; P<0.001), whereas no statistical difference in prior OAG between male dementia patients and controls was found. Conclusions Female dementia patients were associated with a higher proportion of prior OAG than were the controls. PMID:26160529

  17. Axial Myopia Is Associated with Visual Field Prognosis of Primary Open-Angle Glaucoma

    PubMed Central

    Qiu, Chen; Qian, Shaohong; Sun, Xinghuai; Zhou, Chuandi; Meng, Fanrong

    2015-01-01

    Purpose To identify whether myopia was associated with the visual field (VF) progression of primary open-angle glaucoma (POAG). Methods A total of 270 eyes of 270 POAG followed up for more than 3 years with ≥9 reliable VFs by Octopus perimetry were retrospectively reviewed. Myopia was divided into: mild myopia (-2.99 diopter [D], 0), moderate myopia (-5.99, 3.00 D), marked myopia (-9.00, -6.00 D) and non-myopia (0 D or more). An annual change in the mean defect (MD) slope >0.22 dB/y and 0.30 dB/y was defined as fast progression, respectively. Logistic regression was performed to determine prognostic factors for VF progression. Results For the cutoff threshold at 0.22 dB/y, logistic regression showed that vertical cup-to-disk ratio (VCDR; p = 0.004) and the extent of myopia (p = 0.002) were statistically significant. When logistic regression was repeated after excluding the extent of myopia, axial length (AL; p = 0.008, odds ratio [OR] = 0.796) reached significance, as did VCDR (p = 0.001). Compared to eyes with AL≤23 mm, the OR values were 0.334 (p = 0.059), 0.309 (p = 0.044), 0.266 (p = 0.019), 0.260 (p = 0.018), respectively, for 23 26 mm. The significance of vertical cup-to-disk ratio of (p = 0.004) and the extent of myopia (p = 0.008) did not change for the cutoff threshold at 0.30dB/y. Conclusions VCDR and myopia were associated with VF prognosis of POAG. Axial myopia may be a protective factor against VF progression. PMID:26214313

  18. Axial Myopia Is Associated with Visual Field Prognosis of Primary Open-Angle Glaucoma.

    PubMed

    Qiu, Chen; Qian, Shaohong; Sun, Xinghuai; Zhou, Chuandi; Meng, Fanrong

    2015-01-01

    To identify whether myopia was associated with the visual field (VF) progression of primary open-angle glaucoma (POAG). A total of 270 eyes of 270 POAG followed up for more than 3 years with ≥9 reliable VFs by Octopus perimetry were retrospectively reviewed. Myopia was divided into: mild myopia (-2.99 diopter [D], 0), moderate myopia (-5.99, 3.00 D), marked myopia (-9.00, -6.00 D) and non-myopia (0 D or more). An annual change in the mean defect (MD) slope >0.22 dB/y and 0.30 dB/y was defined as fast progression, respectively. Logistic regression was performed to determine prognostic factors for VF progression. For the cutoff threshold at 0.22 dB/y, logistic regression showed that vertical cup-to-disk ratio (VCDR; p = 0.004) and the extent of myopia (p = 0.002) were statistically significant. When logistic regression was repeated after excluding the extent of myopia, axial length (AL; p = 0.008, odds ratio [OR] = 0.796) reached significance, as did VCDR (p = 0.001). Compared to eyes with AL≤23 mm, the OR values were 0.334 (p = 0.059), 0.309 (p = 0.044), 0.266 (p = 0.019), 0.260 (p = 0.018), respectively, for 23 26 mm. The significance of vertical cup-to-disk ratio of (p = 0.004) and the extent of myopia (p = 0.008) did not change for the cutoff threshold at 0.30dB/y. VCDR and myopia were associated with VF prognosis of POAG. Axial myopia may be a protective factor against VF progression.

  19. The association between primary open-angle glaucoma and fall: an observational study.

    PubMed

    Tanabe, Sachiko; Yuki, Kenya; Ozeki, Naoki; Shiba, Daisuke; Tsubota, Kazuo

    2012-01-01

    Falls are among the most serious public health concerns for the elderly. Information conveyed via the visual sense is relevant to postural balance and movement, and proper visual function is essential to avoid falls. Here we investigated the prevalence of injurious falls among patients with primary open-angle glaucoma (POAG) who were more than 45 years old, compared with comparably aged healthy subjects. This is a cross-sectional study. Consecutive patients who visited the Tanabe Eye Clinic, Yamanashi, Japan between January 1 and March 30, 2009 were screened for eligibility by ophthalmic examination. A total of 117 control subjects (77 men, 40 women; aged 60.2 ± 7.5 years) who were free of ocular disease and 101 POAG patients (58 men, 43 women; aged 62.3 ± 8.7 years) were consecutively enrolled. Participants answered a questionnaire on injurious fall experience during the previous 10 years. The prevalence of injurious fall in subjects with POAG versus healthy controls was examined with Fisher's exact test. Adjusted odds ratios and 95% confidence intervals were estimated with logistic regression models for the subjects with POAG (factors: age, gender, mean deviation in the better eye or worse eye). The self-reported prevalence of injurious fall was 0.9% (1/117) in the control group and 6.9% (7/101) in the POAG group. The association between injurious fall and POAG was statistically significant (P = 0.026, Fisher's exact test). Within the POAG patients, the group reporting falls was significantly older and had a lower BMI, worse BCVA, and worse mean deviation in both the better and worse eye than the group reporting no falls. Worse mean deviation in the eye with the better visual field (odds ratios 0.75; 95% confidence intervals: 0.57 to 0.99; P = 0.036) was a significant risk factor for injurious falls in subjects with POAG. POAG was significantly associated with injurious falls.

  20. A common gene for juvenile and adult-onset primary open-angle glaucomas confined on chromosome 1q

    SciTech Connect

    Morissette, J.; Plante, M.; Raymond, V.

    1995-06-01

    Primary open-angle glaucoma (POAG), which causes progressive loss of the visual fields, was subdivided into two groups according to age at onset: (1) chronic open-angle glaucoma (COAG) diagnosed after 40 years and (2) juvenile open-angle glaucoma (JOAG) diagnosed between 3 years of age and early adulthood. A JOAG gene (GLC1A) was recently mapped to chromosome 1q. We studied 142 members of a huge multigenerational French Canadian family affected with autosomal dominant POAG. Either JOAG or COAG was diagnosed with ocular hypertension (OHT), which may lead to POAG. To localize a common disease gene that might be responsible for both glaucoma subsets, we performed linkage analysis considering JOAG and COAG under the same phenotypic category. JOAG/COAG was tightly linked to seven microsatellite markers on chromosome 1q23-q25; a maximum lod score of 6.62 was obtained with AF-M278ye5. To refine the disease locus, we exploited a recombination mapping strategy based on a unique founder effect. The same characteristic haplotype, composed of 14 markers spanning 12 cM between loci D1S196 and D1S212, was recognized in all persons affected by JOAG, COAG, or OHT, but it did not occur in unaffected spouses and in normal family members >35 years of age, except for three obligatory carriers. Key combination events confined the disease region within a 9-cM interval between loci D1S445 and D1S416/D1S480. These observations demonstrate that the GLC1A gene is responsible for both adult-onset and juvenile glaucomas and suggest that the JOAG and COAG categories within this family may be part of a clinical continuum artificially divided at age 40 years. 49 refs., 4 figs., 2 tabs.

  1. Five-year extension of a clinical trial comparing the EX-PRESS glaucoma filtration device and trabeculectomy in primary open-angle glaucoma.

    PubMed

    de Jong, Leo; Lafuma, Antoine; Aguadé, Anne-Sophie; Berdeaux, Gilles

    2011-01-01

    This study compared the efficacy of the EX-PRESS(®) glaucoma filtration device and trabeculectomy in primary open-angle glaucoma up to five years after surgery. Patients from a previously reported randomized, open-label, parallel-arm clinical trial in which 78 patients received either the EX-PRESS glaucoma filtration device or underwent a trabeculectomy were followed for up to an additional four years (five total) beyond the original study (39 eyes per treatment group). Risk-benefit data were obtained for up to five years after glaucoma surgery. Outcome variables were intraocular pressures and intraocular pressure medications. Complete success was denoted by intraocular pressure values ≤ 18 mmHg without medication. The EX-PRESS glaucoma filtration device controlled intraocular pressure more effectively without medication for more patients from year 1 (86.8% versus 61.5%, P = 0.01) to year 3 (66.7% versus 41.0%, P = 0.02) than trabeculectomy. At year 1, only 12.8% of patients required intraocular pressure medication after EX-PRESS implantation, compared with 35.9% after trabeculectomy. The proportions became closer at year 5 (41% versus 53.9%). The responder rate was higher with EX-PRESS and time to failure was longer. In addition, surgical interventions for complications were fewer after EX-PRESS implantation. This five-year analysis confirmed and extended the results reported after one year. Compared with trabeculectomy, EX-PRESS provided better intraocular pressure control in the first three years, and patients required fewer intraocular pressure medications and fewer surgical interventions during the five-year study period. For patients with primary open-angle glaucoma, the EX-PRESS glaucoma filtration device, implanted under a superficial scleral flap, produced significantly higher success rates than trabeculectomy. EX-PRESS is an effective device for long-term treatment of primary open-angle glaucoma.

  2. Novel and known MYOC exon 3 mutations in an admixed Peruvian primary open-angle glaucoma population

    PubMed Central

    Mendoza-Reinoso, Veronica; Guevara-Fujita, Maria L.; Fernández, Silvia; Vargas, Enrique; Castillo-Herrera, Wilder; Perez-Grossmann, Rodolfo; Lizaraso-Caparó, Frank; Richards, Julia E.; Fujita, Ricardo

    2012-01-01

    Purpose The aim of this study was to characterize a representative sample of the Peruvian population suffering open-angle glaucoma (OAG) with respect to the myocilin gene (MYOC) mutations, glaucoma phenotype, and ancestry for future glaucoma risk assessment. Methods DNA samples from 414 unrelated Peruvian subjects, including 205 open-angle glaucoma cases (10 juvenile glaucoma [JOAG], 19 normal-tension glaucoma [NTG], and 176 POAG) and 209 randomly sampled controls, were screened for nucleotide changes in MYOC exon 3 by conformational sensitive gel electrophoresis (CSGE) and mutation screening. Results We identified a probable causative novel MYOC missense mutation, Gly326Ser, in one POAG case and found a consistent genotype-phenotype correlation in eight of his relatives. We also found the known causative MYOC mutation Trp286Arg in one JOAG case and one POAG case. A known causative single base MYOC deletion, T1357, was found in one POAG case. Two previously reported silent polymorphisms, Thr325Thr and Tyr347Tyr, were found in both the case and the control populations. A novel missense variant, Met476Arg, was identified in two unrelated controls. Conclusions The screening of exon 3 of MYOC in a representative sample of 205 independent POAG patients from Peru and 209 matched controls identified novel and previously reported mutations (both pathogenic and nonpathogenic) from other global regions. These results reflect the complex admixture of Amerindian and Old World ancestry in urban populations of Latin America, in general, and in Peru, in particular. It will be important to gather information about the ancestral origin of MYOC and other POAG gene mutations to develop screening panels and risk assessment for POAG in Peru. PMID:22879734

  3. Technique of goniocurettage: a potential treatment for advanced chronic open angle glaucoma

    PubMed Central

    Jacobi, P.; Dietlein, T.; Krieglstein, G.

    1997-01-01

    AIM—To introduce a new concept of anterior chamber angle microsurgery, designed to scrape pathologically altered trabecular meshwork from the scleral sulcus as a potential treatment in primary open angle glaucoma.
METHODS—Gonioscopically controlled ab interno abrasion of the trabecular meshwork was performed on six human eye banking eyes for morphological analysis. Thereafter, four eyes suffering from terminal glaucomatous optic nerve atrophy as a result of medically uncontrolled intraocular pressure were also treated by `goniocurettage'. The newly designed instrument resembles a modified cyclodialysis spatula with a bowl-shaped tip, 300 µm in diameter, and with its edges sharpened. The treatment zone comprised 4-5 clock hours of the chamber angle circumference.
RESULTS—Microscopic examination of the treatment zone revealed that in addition to a complete disruption of the trabecular meshwork and internal wall of Schlemm's canal goniocurettage also caused damage to intracanalicular septa. A splitting along the posterior wall of Schlemm's canal was also noted in one specimen. The clinical data of goniocurettage also showed some promising results. Mean pretreatment IOP averaged 40.7 (SD 8.8) mm Hg (range 32-51 mm Hg) and was significantly (p<0.04) reduced to 18.0 (4.2) mm Hg (12-22 mm Hg) after 6 months, representing an absolute decrease in IOP of 22.7 mm Hg and a mean decrease in IOP of 56%. Clinically significant hyphaema occurred in one eye, caused by iatrogenic trauma to a prominent chamber angle vessel. In three eyes a minor reflux of blood occurred at the treatment site. However, no hypotony, choroidal effusion, flattened anterior chamber, or cyclodialysis were observed in these patients.
CONCLUSION—Morphological analysis of treated postmortem eyes confirmed that goniocurettage completely removed the trabecular meshwork and opened Schlemm's canal, ensuring direct access into the anterior chamber. In a small number of patients over a limited

  4. Anthropometric measures and their relation to incident primary open-angle glaucoma.

    PubMed

    Pasquale, Louis R; Willett, Walter C; Rosner, Bernard A; Kang, Jae Hee

    2010-08-01

    To assess the relation between anthropometric measures and incident primary open-angle glaucoma (POAG). Prospective cohort study. Included were 78,777 women in the Nurses' Health Study and 41,352 men in the Health Professionals Follow-up Study. Females and male health professionals were followed prospectively from 1980 through 2004 and 1986 through 2004, respectively. Eligible participants were 40 years of age or older, did not have POAG at baseline, and reported undergoing eye examinations during follow-up. Information regarding anthropometric measures, potential confounders, and ophthalmic status was updated using biennial questionnaires. During follow-up, 980 POAG cases were identified. Multivariate rate ratios (MVRR) of POAG and their 95% confidence intervals (CIs). There was no significant relation between cumulatively averaged body mass index (BMI) in kilograms per meter squared and POAG overall (P = 0.06, for trend). However, in relation to POAG with intraocular pressure (IOP) of 22 mmHg or less at diagnosis, each unit increase in BMI was associated with a 6% reduced risk in women (MVRR, 0.94; 95% CI, 0.91-0.98; P = 0.01), but not for men (MVRR, 1.02; 95% CI, 0.96-1.09; P = 0.57); this gender difference was significant (P = 0.03, for heterogeneity). In multivariate analyses to explore the independent effects of height and weight, weight (as height-adjusted weight residuals; P = 0.002, for trend), but not height (P = 0.10, for trend) seemed to account for most of the inverse association between BMI and POAG with IOP of 21 mmHg or less at diagnosis in women. There was no association between BMI and POAG with IOP of more than 21 mmHg at diagnosis for either gender (P> or =0.26, for trend). Among women, analyses found that the relations between anthropometric parameters and both POAG subtypes (POAG with IOP< or =21 mmHg vs. POAG with IOP >21 mmHg when diagnosed) were significantly different (P< or =0.0001). Among women, higher BMI was associated with a lower

  5. [Morphological changes of cerebral cortex in primary open-angle glaucoma patients under magnetic resonance imaging].

    PubMed

    Zhang, Yuyan; Zhao, Jin; Ning, Li; Zhang, Jinling; Tang, Weijun

    2015-09-08

    To observe the morphology changes of cerebral cortex in primary open-angle glaucoma (POAG) patients, and to explore the damage mechanism in the central nerve system. 30 patients, 19 males and 11 females (age ranged from 26 to 82 years old), who were diagnosed with POAG in the department of ophthalmology at Huashan Hospital of Fudan University from February 2011 to December 2012 were enrolled. Meanwhile, additional 30 age- and sex- matched patients were collected as controls. All subjects underwent a complete ophthalmic evaluation. As for magnetic resonance imaging (MRI), we adopted the scans of T1WI, T2WI and fluid attenuated inversion recovery (FLAIR) on a Siemens Magneton Verio 3T MRI machine with a 12-channel head coil. Subjects with space occupying or vascular lesion in brain imaging were excluded from the study. The three-dimensional magnetization prepared rapid acquisition gradient echo sequence (3D-MPRAGE) was used to acquire the volume data of whole brain of all subjects. SPM8 and VBM8 toolbox were used to analyze the image data. Voxel-based analysis was done for whole brain grey matter images. Compared with the control group, the volume of grey matter from several brain regions of the POAG patients decreased. These structures included left lingual gyrus (t=3.207, P=0.002), left medial frontal gyrus (t=2.912, P=0.004), right superior frontal gyrus (t=2.745, P=0.005), left middle temporal gyrus (t=2.958, P=0.003), right precuneus (t=3.291, P=0.001), right postcentral gyrus (t=3.306, P=0.001), left inferior parietal lobule(t=2.716, P=0.006), left parahippocampa gyrus (t=2.815, P=0.005). The results were assessed with comparative t-test to perform statistical analysis. When t>2.479, P<0.01, the difference between the two groups was considered statistically significant. The volume of grey matter in POAG patients' brain decreased in several regions. It is illustrated that POAG is a syndrome, which causes damages in the brain of POAG patients at multi-aspects and

  6. Concordance of diurnal intraocular pressure between fellow eyes in primary open-angle glaucoma.

    PubMed

    Dinn, Robert B; Zimmerman, M Bridget; Shuba, Lesya M; Doan, Andrew P; Maley, Michael K; Greenlee, Emily C; Alward, Wallace L M; Kwon, Young H

    2007-05-01

    To study the concordance of diurnal intraocular pressure (IOP) between fellow eyes in primary open-angle glaucoma (POAG). Retrospective chart review. Ninety-three POAG patients. Patients who met the definition of POAG and underwent diurnal curve measurement were included. Subjects were excluded if there was a history of surgery, trauma, ocular vascular disease, incomplete diurnal curve, or asymmetric ocular medication use. Patients on symmetric ocular medication were included and analyzed separately. Goldmann applanation tonometry was performed at 10 am, 1 pm, 4 pm, 7 pm, 10 pm, and 7 am (the next day). The following statistical analyses were performed: (1) average Pearson correlation coefficient (r) from individual correlations of right and left eye IOP over the 6 time points for each subject; (2) linear mixed model analysis for repeated measures, with eye (right and left) and time as the within-subject fixed effects, and (3) absolute difference in change in IOP between fellow eyes over each time interval and probability that the difference was within 2 or 3 mmHg. The concordance of the IOP between fellow eyes as measured by absolute difference in change in IOP between fellow eyes and probability of the difference being within 2 or 3 mmHg. Thirty-seven patients were untreated and 56 were treated on symmetric IOP-lowering medications. The diurnal curves of fellow eyes exhibited parallel profiles according to the linear mixed model. The average difference in the change of IOP between fellow eyes over given time intervals ranged from 1.6 to 2.0 mmHg. The estimated probability that the absolute change in IOP between fellow eyes was within 2 mmHg was 68% to 90%, and within 3 mmHg was 78% to 95% for all time intervals. The diurnal variation of IOP in POAG is largely concordant between fellow eyes. For any given time interval, the fellow eye IOPs may fluctuate asymmetrically a minority of the time. Clinicians who utilize the uniocular trial should be aware of the limit

  7. Mutations in MYOC gene of Indian primary open angle glaucoma patients.

    PubMed

    Mukhopadhyay, Arijit; Acharya, Moulinath; Mukherjee, Saibal; Ray, Jharna; Choudhury, Sumit; Khan, Mita; Ray, Kunal

    2002-11-15

    Glaucoma is the second leading cause of blindness worldwide after cataract. Defects in the myocilin gene (MYOC) have been shown to be associated with Primary Open Angle Glaucoma (POAG), the most common form of the disease, especially in its juvenile form. Most of the reported mutations in MYOC are in POAG patients of Caucasian origin. A few studies have been reported on Asian patients (such as Chinese, Japanese, and Koreans) but none from the Indian subcontinent. The purpose of this study was to investigate the molecular basis of POAG among Indians, using MYOC as the candidate gene, and broaden our understanding on the pathogenesis caused by MYOC. Fifty-six unrelated POAG patients, comprising 39 sporadic cases and 17 patients having familial history for POAG were enrolled in this study. The coding sequence of the gene was amplified by polymerase chain reaction (PCR) using genomic DNA from 30 POAG patients, followed by sequencing of the PCR products. Nucleotide changes were detected by identifying double peaks in the chromatogram due to heterozygosity and pairwise BLAST analysis of the sequence output data against the normal copy of the MYOC cDNA. Alteration of restriction sites due to nucleotide changes was identified. Twenty-six patients (not sequenced) and controls were screened for nucleotide changes by allele specific restriction digestion of the PCR products followed by separation of the digested DNA fragments by polyacrylamide gel electrophoresis. From a pool of 56 unrelated POAG patients two mutations were identified. A putative novel mutation (144 G->T; Gln48His) of a conserved amino acid was detected in the exon 1 of MYOC from three unrelated patients but none in the 51 control samples examined. The other mutation (1109 C->T; Pro370Leu), located in exon 3 and detected in a family affected with POAG, cosegregated with the disease and was not present in control samples. Two single nucleotide polymorphisms (SNPs) were identified; one in the promoter region

  8. Prospective evaluation of microinvasive glaucoma surgery with trabecular microbypass stents and prostaglandin in open-angle glaucoma.

    PubMed

    Ahmed, Iqbal Ike K; Katz, L Jay; Chang, David F; Donnenfeld, Eric D; Solomon, Kerry D; Voskanyan, Lilit; Samuelson, Thomas W

    2014-08-01

    To evaluate the intraocular pressure (IOP) lowering effect of 2 trabecular microbypass stents and postoperative travoprost in patients with open-angle glaucoma (OAG) not controlled on 2 medications preoperatively. S.V. Malayan Ophthalmology Centre, Yerevan, Armenia. Prospective open-label nonrandomized study. This prospective pilot study involved 39 qualified phakic patients with OAG, medicated IOP between 18 mm Hg and 30 mm Hg, and unmedicated baseline (after washout) IOP between 22 mm Hg and 38 mm Hg. Patients received 2 stents (iStent) through a clear corneal incision and were prescribed travoprost starting the night of postoperative day 1. Intraocular pressure, complications, and various safety measures were assessed at examinations through 18 months and planned for every 6 months thereafter until month 60. A washout of medications was performed 13 months postoperatively. All patients achieved an IOP reduction of 20% or more from baseline to 12 months with reduction of 1 medication and with IOP 18 mm Hg or less. Follow-up through 18 months showed that medicated IOP decreased from 22.2 mm Hg ± 2.0 (SD) on 2 medications preoperatively to 14 mm Hg or less on 1 medication at the postoperative visits. The mean unmedicated IOP decreased from 25.3 ± 1.8 mm Hg preoperatively to 17.1 ± 2.2 mm Hg 13 months postoperatively. No intraoperative or serious device-related adverse events occurred. Patients with OAG treated with 2 trabecular microbypass stents and 1 presumptive postoperative medication achieved a significant and sustained reduction in IOP and medication through 18 months. Dr. Katz served as the medical monitor for this study. All authors are consultants to Glaukos Corp. Copyright © 2014. Published by Elsevier Inc.

  9. Evaluation of the intraocular pressure-reducing effect of latanoprost as monotherapy in open-angle glaucoma.

    PubMed

    Mandić, Z; Bojić, L; Novak-Laus, K; Sarić, D

    2002-12-01

    Objective of this study was to evaluate the intraocular pressure-reducing effect of latanoprost as monotherapy after replacing current dual therapy in glaucoma patients. The 6-months study comprised 189 patients with primary open angle glaucoma who were treated at least 6 months with two different kind of topical medications (beta-blockers, pilocarpine, dorzolamide and brimonidine). Due to local side effects, multiple dosing regime and inadequately controlled intraocular pressure (IOP), they where switched to latanoprost 0.005% monotherapy. After switched to latanoprost, mean (IOP) was measured at baseline, after 15 days, 2 and 6 months of treatment. After six-months 178 patients had completed the study. These analyses enrolled all patients (n = 189), thus, the Intention-To-Treat (ITT) results were shown instead of the results of the reduced population. IOP was clinically importantly reduced from baseline level. Five patients had uncontrolled IOP. The difference between IOP before (21.9 +/- 2.4) and after 15 days (17.4 +/- 1.7), 2 months (16.7 +/- 1.8) and 6 months (16.6 +/- 1.4) was statistically significant (p < 0.001). 90% patients has reached target IOP < or = 18 mm. A conjunctional hyperaemia in 18 (9%), stinging and itching in 7 (4%) patients was reported. Increased iris pigmentation was seen in 3 (2%) patients. The results of this study indicate that dual therapy in open-angle glaucoma can effectively be replaced by latanoprost monotherapy in many patients.

  10. Mapping of a gene for autosomal dominant juvenile-onset open-angle glaucoma to chromosome 1 q

    SciTech Connect

    Richards, J.E.; Lichter, P.R.; Torrez, D.; Wong, D.; Johnson, A.T.; Boehnke, M.; Uro, J.L.A. )

    1994-01-01

    A large Caucasian family is presented, in which a juvenile-onset form of open-angle glaucoma is transmitted in an autosomal dominant fashion. Sixteen affected family members were identified from 31 at-risk individuals descended from the affected founder. Affected patients developed high intraocular pressures (sometimes >40 mm Hg) within the first 2 decades of life. Linkage analysis between the disease phenotype and 12 microsatellite repeat markers located on chromosome 1 q gave a maximum lod score of 8.38 at a recombination fraction of zero for marker D1S210. Analysis of recombinant haplotypes suggests a total inclusion region of about 14 cM between markers D1S194 and D1S218 at 1q21-q31. This represents the second juvenile-glaucoma family, in which the disease has been mapped to the long arm of chromosome 1. 57 refs., 2 figs., 3 tabs.

  11. Risk Factors Associated with Progression to Blindness from Primary Open-Angle Glaucoma in an African-American Population.

    PubMed

    Pleet, Alexander; Sulewski, Melanie; Salowe, Rebecca J; Fertig, Raymond; Salinas, Julia; Rhodes, Allison; Merritt Iii, William; Natesh, Vikas; Huang, Jiayan; Gudiseva, Harini V; Collins, David W; Chavali, Venkata Ramana Murthy; Tapino, Paul; Lehman, Amanda; Regina-Gigiliotti, Meredith; Miller-Ellis, Eydie; Sankar, Prithvi; Ying, Gui-Shuang; O'Brien, Joan M

    2016-08-01

    To determine the risk factors associated with progression to blindness from primary open-angle glaucoma (POAG) in an African-American population. This study examined 2119 patients enrolled in the Primary Open-Angle African-American Glaucoma Genetics (POAAGG) study. A total of 59 eyes were identified as legally blind as a result of POAG (cases) and were age-and sex-matched to 59 non-blind eyes with glaucoma (controls). Chart reviews were performed to record known and suspected risk factors. Cases were diagnosed with POAG at an earlier age than controls (p = 0.005). Of the 59 eyes of cases, 16 eyes (27.1%) presented with blindness at diagnosis. Cases had worse visual acuity (VA) at diagnosis (p < 0.0001), with VA worse than 20/40 conferring a 27 times higher risk of progression to blindness (p = 0.0005). Blind eyes also demonstrated more visual field defects (p = 0.01), higher pre-treatment intraocular pressure (IOP; p < 0.0001), and higher cup-to-disc ratio (p = 0.006) at diagnosis. IOP was less controlled in cases, and those with IOP ≥21 mmHg at more than 20% of follow-up visits were 73 times more likely to become blind (p < 0.0001). Cases missed a greater number of appointments per year (p = 0.003) and had non-adherence issues noted in their charts more often than controls (p = 0.03). However, other compliance data did not significantly differ between groups. Access to care, initial VA worse than 20/40, and poor control of IOP were the major risk factors associated with blindness from POAG. Future studies should examine earlier, more effective approaches to glaucoma screening as well as the role of genetics in these significantly younger patients who progress to blindness.

  12. Assessing the Association of Mitochondrial Genetic Variation With Primary Open-Angle Glaucoma Using Gene-Set Analyses

    PubMed Central

    Khawaja, Anthony P.; Cooke Bailey, Jessica N.; Kang, Jae Hee; Allingham, R. Rand; Hauser, Michael A.; Brilliant, Murray; Budenz, Donald L.; Christen, William G.; Fingert, John; Gaasterland, Douglas; Gaasterland, Terry; Kraft, Peter; Lee, Richard K.; Lichter, Paul R.; Liu, Yutao; Medeiros, Felipe; Moroi, Syoko E.; Richards, Julia E.; Realini, Tony; Ritch, Robert; Schuman, Joel S.; Scott, William K.; Singh, Kuldev; Sit, Arthur J.; Vollrath, Douglas; Wollstein, Gadi; Zack, Donald J.; Zhang, Kang; Pericak-Vance, Margaret; Weinreb, Robert N.; Haines, Jonathan L.; Pasquale, Louis R.; Wiggs, Janey L.

    2016-01-01

    Purpose Recent studies indicate that mitochondrial proteins may contribute to the pathogenesis of primary open-angle glaucoma (POAG). In this study, we examined the association between POAG and common variations in gene-encoding mitochondrial proteins. Methods We examined genetic data from 3430 POAG cases and 3108 controls derived from the combination of the GLAUGEN and NEIGHBOR studies. We constructed biological-system coherent mitochondrial nuclear-encoded protein gene-sets by intersecting the MitoCarta database with the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. We examined the mitochondrial gene-sets for association with POAG and with normal-tension glaucoma (NTG) and high-tension glaucoma (HTG) subsets using Pathway Analysis by Randomization Incorporating Structure. Results We identified 22 KEGG pathways with significant mitochondrial protein-encoding gene enrichment, belonging to six general biological classes. Among the pathway classes, mitochondrial lipid metabolism was associated with POAG overall (P = 0.013) and with NTG (P = 0.0006), and mitochondrial carbohydrate metabolism was associated with NTG (P = 0.030). Examining the individual KEGG pathway mitochondrial gene-sets, fatty acid elongation and synthesis and degradation of ketone bodies, both lipid metabolism pathways, were significantly associated with POAG (P = 0.005 and P = 0.002, respectively) and NTG (P = 0.0004 and P < 0.0001, respectively). Butanoate metabolism, a carbohydrate metabolism pathway, was significantly associated with POAG (P = 0.004), NTG (P = 0.001), and HTG (P = 0.010). Conclusions We present an effective approach for assessing the contributions of mitochondrial genetic variation to open-angle glaucoma. Our findings support a role for mitochondria in POAG pathogenesis and specifically point to lipid and carbohydrate metabolism pathways as being important. PMID:27661856

  13. Assessing the Association of Mitochondrial Genetic Variation With Primary Open-Angle Glaucoma Using Gene-Set Analyses.

    PubMed

    Khawaja, Anthony P; Cooke Bailey, Jessica N; Kang, Jae Hee; Allingham, R Rand; Hauser, Michael A; Brilliant, Murray; Budenz, Donald L; Christen, William G; Fingert, John; Gaasterland, Douglas; Gaasterland, Terry; Kraft, Peter; Lee, Richard K; Lichter, Paul R; Liu, Yutao; Medeiros, Felipe; Moroi, Syoko E; Richards, Julia E; Realini, Tony; Ritch, Robert; Schuman, Joel S; Scott, William K; Singh, Kuldev; Sit, Arthur J; Vollrath, Douglas; Wollstein, Gadi; Zack, Donald J; Zhang, Kang; Pericak-Vance, Margaret; Weinreb, Robert N; Haines, Jonathan L; Pasquale, Louis R; Wiggs, Janey L

    2016-09-01

    Recent studies indicate that mitochondrial proteins may contribute to the pathogenesis of primary open-angle glaucoma (POAG). In this study, we examined the association between POAG and common variations in gene-encoding mitochondrial proteins. We examined genetic data from 3430 POAG cases and 3108 controls derived from the combination of the GLAUGEN and NEIGHBOR studies. We constructed biological-system coherent mitochondrial nuclear-encoded protein gene-sets by intersecting the MitoCarta database with the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. We examined the mitochondrial gene-sets for association with POAG and with normal-tension glaucoma (NTG) and high-tension glaucoma (HTG) subsets using Pathway Analysis by Randomization Incorporating Structure. We identified 22 KEGG pathways with significant mitochondrial protein-encoding gene enrichment, belonging to six general biological classes. Among the pathway classes, mitochondrial lipid metabolism was associated with POAG overall (P = 0.013) and with NTG (P = 0.0006), and mitochondrial carbohydrate metabolism was associated with NTG (P = 0.030). Examining the individual KEGG pathway mitochondrial gene-sets, fatty acid elongation and synthesis and degradation of ketone bodies, both lipid metabolism pathways, were significantly associated with POAG (P = 0.005 and P = 0.002, respectively) and NTG (P = 0.0004 and P < 0.0001, respectively). Butanoate metabolism, a carbohydrate metabolism pathway, was significantly associated with POAG (P = 0.004), NTG (P = 0.001), and HTG (P = 0.010). We present an effective approach for assessing the contributions of mitochondrial genetic variation to open-angle glaucoma. Our findings support a role for mitochondria in POAG pathogenesis and specifically point to lipid and carbohydrate metabolism pathways as being important.

  14. Comparison of relation between visual function index and retinal nerve fiber layer structure by optical coherence tomography among primary open angle glaucoma and primary angle closure glaucoma eyes.

    PubMed

    Rao, Aparna

    2014-01-01

    To compare the visual field index (VFI) in primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) eyes, and to study the correlation with disc variables on optical coherence tomography (OCT) in all stages of severity. Thirty POAG and PACG underwent Humphrey visual field 24-2 along with detailed examination. They also underwent stratus OCT imaging of the optic nerve and retinal nerve fiber layer (RNFL). The correlation of VFI with RNFL thickness was compared in POAG and PACG. The VFI significantly differed between POAG and PACG, with POAG eyes apparently having a better VFI at all severities of glaucoma. There were statistically significant differences in the superior max (Smax) and inferior max (Imax) in early and moderate POAG and PACG eyes. In early and moderate glaucoma, multivariate regression showed that maximum correlation of the VFI was seen with the mean deviation (b = 1.7, P < 0.001), average and superior RNFL thickness (b = 2.1, P < 0.001 and b = 1.8, P = 0.03, respectively), and age (b = 0.7, P = 0.04); while no correlation was seen with intraocular pressure (IOP), axial length, sex, or other clinical variables. VFI did not correlate well with RNFL thickness or other disc variables on OCT in severe glaucoma. VFI may not serve as a useful indicator of visual function in severe glaucoma. More useful indicators are required to monitor glaucoma patients with severe damage.

  15. An evaluation of ocular elasticity using real-time ultrasound elastography in primary open-angle glaucoma.

    PubMed

    Agladioglu, Kadir; Pekel, Gökhan; Altintas Kasikci, Seher; Yagci, Ramazan; Kiroglu, Yilmaz

    2016-01-01

    The aim of this study was to compare sonoelastographic findings in the retina-choroid-sclera (RCS) complex and vitreous in glaucomatous and healthy eyes. For this cross-sectional comparative study, 20 patients with primary open-angle glaucoma and 20 healthy volunteers were recruited. Ultrasound elastography measurements were taken with a sonographic scanner of the RCS complex, anterior vitreous (AV), posterior vitreous (PV), retrobulbar fat tissue (RFT), optic disc (OD) and optic nerve (ON) in each eye. The elasticity index of the RCS complex, RFT, OD, ON, AV and PV was similar in both groups (p  >  0.05), although the AV/PV strain ratio in the group of patients with glaucoma was significantly higher (p  =  0.04). Glaucoma increases the AV/PV strain ratio. In providing reproducible and consistent values, the real-time elastography (RTE) technique may be helpful in elucidating the mechanisms of glaucoma in some aspects. This study can help to evaluate the elasticity of the RCS complex and vitreous in glaucomatous eyes with RTE.

  16. [Analysis of the effectiveness of beta-blockers for intraocular pressure and visual field in primary open-angle glaucoma].

    PubMed

    Dobre, Xenia

    2008-01-01

    The aim of this study was the evaluation of beta-blockers efficiency (as a monotherapy) in the lowering of IOP and the evolution of the visual field. An observational clinical study was carried out over a determined period of time (January 2005-January 2007) on a number of 73 eyes with primary open-angle glaucoma in which one parameter was observed: IOP; on a number of 77 eyes with primary open-angle glaucoma the evolution of the visual field, while receiving specific treatment, was observed. Pressure release situated at 21.65%, with initial medium IOP at 23.95, and a final value of 17.51; p <0.0001. The aspect of the visual field suffered no negative transformations and no improvements either. The MD and PD parameters were recorded. CONCLUSIONS Beta-blockers can be efficient in monotherapy by offering the reduction and stabilisation of IOP. No problems with regard to tolerability in the eyes observed; no negative side effects emerged because it was not administered to patients which suffered from heart diseases or bronchial asthma. However, patient satisfaction is reduced by an administration of twice a day.

  17. Effects of self-relaxation methods and visual imagery on IOP in patients with open-angle glaucoma.

    PubMed

    Kaluza, G; Strempel, I

    1995-01-01

    In this study, the effects of a training in relaxation and visual imagery on the intra-ocular pressure (IOP) of patients with primary open-angle glaucoma were investigated. Twenty-three patients, aged 24-69 years, were assigned either to a training group or to a waiting-list control group. The intervention included a basic programme (BP) of standard autogenic relaxation exercises and an advanced programme (AP) in which special exercises in ocular relaxation and imagination of aqueous humour drainage were conducted. IOP was measured before and after each training session. Twenty-four-hour IOP profiles were ascertained, and the water drinking test to provoke maximum IOP levels was performed during clinical assessments prior to the training, between the BP and the AP and after termination of the training. Results indicate only slight short-term changes of IOP levels immediately after each training session. However, during the course of the BP as well as of the AP a relevant decrease in IOP could be measured. Twenty-four-hour IOP profiles as well as the water drinking test also showed significant reductions of IOP during time. Medication could be reduced for 56% of the initially treated patients. The findings suggest that relaxation and visual imagery techniques can be beneficial in reducing elevated IOP levels in patients with open-angle glaucoma though the conclusiveness of the data is limited due to methodological shortcomings.

  18. Brinzolamide/brimonidine: a review of its use in patients with open-angle glaucoma or ocular hypertension.

    PubMed

    Greig, Sarah L; Deeks, Emma D

    2015-03-01

    Brinzolamide 1 %/brimonidine 0.2 % ophthalmic suspension (Simbrinza(®)) is a fixed-combination of a carbonic anhydrase inhibitor and an α2-adrenergic receptor agonist that is indicated for the reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension in both the USA and EU (with the EU indication restricted to patients for whom monotherapy provides insufficient IOP reduction). In phase III randomized trials, both three-times-daily and twice-daily administration of brinzolamide/brimonidine provided significantly greater IOP-lowering efficacy over 3-6 months than either of its individual components alone, and twice-daily brinzolamide/brimonidine was noninferior to concomitant administration of brinzolamide plus brimonidine over 6 months in this regard. Brinzolamide/brimonidine was generally well tolerated, with a tolerability profile that was consistent with its individual components and with no unexpected safety findings. Therefore, brinzolamide/brimonidine is an effective treatment option for patients with open-angle glaucoma or ocular hypertension, providing a convenient alternative for those patients who require multiple IOP-lowering medications. Brinzolamide/brimonidine is the first available fixed-combination that does not contain timolol, and maybe particularly suited to patients with comorbidities that restrict treatment with β-adrenergic receptor antagonists.

  19. Estrogen pathway polymorphisms in relation to primary open angle glaucoma: An analysis accounting for gender from the United States

    PubMed Central

    Loomis, Stephanie J.; Weinreb, Robert N.; Kang, Jae H.; Yaspan, Brian L.; Bailey, Jessica Cooke; Gaasterland, Douglas; Gaasterland, Terry; Lee, Richard K.; Scott, William K.; Lichter, Paul R.; Budenz, Donald L.; Liu, Yutao; Realini, Tony; Friedman, David S.; McCarty, Catherine A.; Moroi, Sayoko E.; Olson, Lana; Schuman, Joel S.; Singh, Kuldev; Vollrath, Douglas; Wollstein, Gadi; Zack, Donald J.; Brilliant, Murray; Sit, Arthur J.; Christen, William G.; Fingert, John; Kraft, Peter; Zhang, Kang; Allingham, R. Rand; Pericak-Vance, Margaret A.; Richards, Julia E.; Hauser, Michael A.; Haines, Jonathan L.; Wiggs, Janey L.

    2013-01-01

    Purpose Circulating estrogen levels are relevant in glaucoma phenotypic traits. We assessed the association between an estrogen metabolism single nucleotide polymorphism (SNP) panel in relation to primary open angle glaucoma (POAG), accounting for gender. Methods We included 3,108 POAG cases and 3,430 controls of both genders from the Glaucoma Genes and Environment (GLAUGEN) study and the National Eye Institute Glaucoma Human Genetics Collaboration (NEIGHBOR) consortium genotyped on the Illumina 660W-Quad platform. We assessed the relation between the SNP panels representative of estrogen metabolism and POAG using pathway- and gene-based approaches with the Pathway Analysis by Randomization Incorporating Structure (PARIS) software. PARIS executes a permutation algorithm to assess statistical significance relative to the pathways and genes of comparable genetic architecture. These analyses were performed using the meta-analyzed results from the GLAUGEN and NEIGHBOR data sets. We evaluated POAG overall as well as two subtypes of POAG defined as intraocular pressure (IOP) ≥22 mmHg (high-pressure glaucoma [HPG]) or IOP <22 mmHg (normal pressure glaucoma [NPG]) at diagnosis. We conducted these analyses for each gender separately and then jointly in men and women. Results Among women, the estrogen SNP pathway was associated with POAG overall (permuted p=0.006) and HPG (permuted p<0.001) but not NPG (permuted p=0.09). Interestingly, there was no relation between the estrogen SNP pathway and POAG when men were considered alone (permuted p>0.99). Among women, gene-based analyses revealed that the catechol-O-methyltransferase gene showed strong associations with HTG (permuted gene p≤0.001) and NPG (permuted gene p=0.01). Conclusions The estrogen SNP pathway was associated with POAG among women. PMID:23869166

  20. Associations of sleep duration with open angle glaucoma in the Korea national health and nutrition examination survey

    PubMed Central

    Lee, Jin-Ah; Han, Kyungdo; Min, Jung Ah; Choi, Jin A

    2016-01-01

    Abstract The aim of this study is to investigate the relationship between sleep duration and glaucoma, stratified by obesity status. This study was conducted using data from the Korean National Health and Nutrition Examination Survey V 2010 to 2012. Open-angle glaucoma was diagnosed according to the International Society of Geographical and Epidemiological Ophthalmology criteria. Subjects were divided into subgroups based on those who were overweight (body mass index ≥25 kg/m2 or <25 kg/m2) or with abdominal obesity (based on waist circumference). Multiple logistic regression analysis was done to estimate the magnitude of the association between sleep duration (<7 h, 7–<9, or ≥9 hours) and prevalence of glaucoma in the total population and in the subgroups. Individuals who slept <5 hours per night had the highest prevalence of glaucoma (5.55 ± 1.09%), followed by those who slept ≥9 hours per night (4.56 ± 0.10%), and then by those who slept 5 to <6 hours per night (4.15 ± 0.68%), which revealed a U-shaped pattern (P for trend = 0.072). Among overweight individuals, subjects who slept <7 hours and those who slept ≥9 hours were significantly more likely to have glaucoma compared with subjects who slept 7 to <9 hours after adjusting for survey year, age, sex, smoking, drinking, exercise, education level, household income, hypertension, intraocular pressure, stress, and depression (odds ratio, 2.41; 95% confidence interval, 1.14–5.03). Unlike for overweight individuals, sleep duration in nonoverweight individuals was not statistically significantly associated with glaucoma. Our results reveal a U-shaped association between sleep duration and the prevalence of glaucoma. An effect of sleep duration on glaucoma was present in the subgroup of overweight patients. PMID:28033268

  1. Associations of sleep duration with open angle glaucoma in the Korea national health and nutrition examination survey.

    PubMed

    Lee, Jin-Ah; Han, Kyungdo; Min, Jung Ah; Choi, Jin A

    2016-12-01

    The aim of this study is to investigate the relationship between sleep duration and glaucoma, stratified by obesity status.This study was conducted using data from the Korean National Health and Nutrition Examination Survey V 2010 to 2012. Open-angle glaucoma was diagnosed according to the International Society of Geographical and Epidemiological Ophthalmology criteria. Subjects were divided into subgroups based on those who were overweight (body mass index ≥25 kg/m or <25 kg/m) or with abdominal obesity (based on waist circumference). Multiple logistic regression analysis was done to estimate the magnitude of the association between sleep duration (<7 h, 7-<9, or ≥9 hours) and prevalence of glaucoma in the total population and in the subgroups.Individuals who slept <5 hours per night had the highest prevalence of glaucoma (5.55 ± 1.09%), followed by those who slept ≥9 hours per night (4.56 ± 0.10%), and then by those who slept 5 to <6 hours per night (4.15 ± 0.68%), which revealed a U-shaped pattern (P for trend = 0.072). Among overweight individuals, subjects who slept <7 hours and those who slept ≥9 hours were significantly more likely to have glaucoma compared with subjects who slept 7 to <9 hours after adjusting for survey year, age, sex, smoking, drinking, exercise, education level, household income, hypertension, intraocular pressure, stress, and depression (odds ratio, 2.41; 95% confidence interval, 1.14-5.03). Unlike for overweight individuals, sleep duration in nonoverweight individuals was not statistically significantly associated with glaucoma.Our results reveal a U-shaped association between sleep duration and the prevalence of glaucoma. An effect of sleep duration on glaucoma was present in the subgroup of overweight patients.

  2. Phacoemulsification combined with deep sclerectomy augmented with mitomycin and amniotic membrane implantation in chronic primary open angle glaucoma with cataract

    PubMed Central

    Helmy, Hazem

    2016-01-01

    Objective The aim of this study was to determine the safety and efficacy of combined phacoemulsification plus Intraocular lens (IOL) implantation with deep sclerectomy augmented with mitomycin C (MMC) and sub-flap implantation of amniotic membrane for the management of uncontrolled, chronic, primary open-angle glaucoma patients. Methods This prospective study included 41 patients with chronic, primary, open-angle glaucoma and cataract uncontrolled with medical treatment who underwent combined phacoemulsification augmented with mitomycin C (MMC) application and amniotic membrane implantation under the scleral flap. Intraocular pressure (IOP), visual acuity, glaucoma medications, stabilization of visual field, complications, and viability of the success rate were assessed a 36-month follow-up period. Results The mean age of cases was 54.8 ± 5.3 years. Sixty-one percent of cases were males, and 39% were females. The mean IOP decreased from 23.8 ± 1.8 mmHg preoperatively to 16.8 ± 2.3 mmHg postoperatively. The overall success rate was 97.5, 95, and 92.7% in the first, second, and third year, respectively. The overall success rate was 90% in the first year, but that decreased to 85.3 and 78% in the second and third year, respectively. Qualified success was 7.5, 10, and 14.7% in the first, second, and third year, respectively. Failure was recorded as 2.5, 5, and 7.3% in the first, second, and third year, respectively. IOP reduction was sustained through the follow-up period. Visual acuity improved from 0.13 ± 0.06 to 0.9 ± 0.07 (p < 0.001). The visual field improved significantly in the first assessment, from 14.0 ± 2.7 preoperatively to 12.6 ± 2.6 at three months postoperatively (p < 0.001), after which it became stable for the remainder of the follow-up period. One hundred percent of cases were on three anti-glaucoma drugs preoperatively, while postoperatively, 12.2% were on three drugs, 4.2% were on two drugs, and 82.9% were controlled without anti-glaucoma

  3. Unilateral Open-Angle Glaucoma Associated with the Ipsilateral Nevus of Ota

    PubMed Central

    2013-01-01

    The nevus of Ota also known as “congenital melanosis bulbi” and “oculodermal melanocytosis” is a blue-gray hyperpigmentation that occurs on the face and eyes. The sclera is involved in two-thirds of cases (causing an increased risk of glaucoma). Women are nearly five times more likely to be affected than men. It is rare among Caucasian people. The nevus of Ota is congenital or acquired. Most cases of the nevus of Ota are unilateral (90%), although pigmentation is present bilaterally in 5%–10%. Ocular abnormalities included pigmentation of the sclera, cornea, retina, and optic disc and cavernous hemangiomas of the optic disc, elevated intraocular pressure, glaucoma, and ocular melanoma. We reported an appearance of unilateral glaucoma in a Caucasian female patient with the acquired, ipsilateral nevus of Ota. PMID:23781367

  4. Medical management of primary open-angle glaucoma: Best practices associated with enhanced patient compliance and persistency

    PubMed Central

    Kulkarni, Sadhana V; Damji, Karim F; Buys, Yvonne M

    2008-01-01

    Primary open angle glaucoma is a chronic optic neuropathy often requiring lifelong treatment. Patient compliance, adherence and persistence with therapy play a vital role in improved outcomes by reducing morbidity and the economic consequences that are associated with disease progression. A literature review including searches of The Cochrane Library, MEDLINE, PubMed, conference proceedings, and bibliographies of identified articles reveals the enormous public health burden in various populations due to the impact of glaucoma associated visual impairment on the overall quality of life eg, fear of blindness, inability to work in certain occupations, driving restrictions, motor vehicle accidents, falls, and general health status. Providing specific definitions for the frequently misunderstood terms “compliance, persistence and adherence” with reference to medication use is central not only for monitoring patients’ drug dosing histories and clinical outcomes but also for subsequent research. In this review article, a summary of the advantages/disadvantages including cost-effectiveness of various medical approaches to glaucoma treatment, techniques employed for measuring patient compliance and actual patient preferences for therapy are outlined. We conclude by identifying the key barriers to ongoing treatment and suggest some best practices to enhance compliance and persistence. PMID:19920977

  5. Intraocular Pressure, Central Corneal Thickness, and Prevalence of Open-Angle Glaucoma: The Los Angeles Latino Eye Study

    PubMed Central

    Francis, Brian A.; Varma, Rohit; Chopra, Vikas; Lai, Mei-Ying; Shtir, Corina; Azen, Stanley P.

    2008-01-01

    Purpose To examine the relationship between the prevalence of open-angle glaucoma (OAG) and intraocular pressure (IOP) and the impact of central corneal thickness (CCT) on this relationship. Design Population based cross-sectional study. Methods The study cohort consisted of 5970 participants from the Los Angeles Latino Eye Study (LALES) with no history of glaucoma treatment and with complete ophthalmic examination data. The relationship between the prevalence of OAG and IOP was contrasted across persons with CCT designated as thin, normal or thick. Results Prevalence of OAG was exponentially related to IOP. When stratified by CCT, persons with thin CCT had a significantly higher prevalence of OAG than did those with normal or thick CCT’s at all levels of IOP. Adjusting each IOP individually for CCT did not impact significantly the relationship between the prevalence of OAG and IOP. Conclusions These findings suggest that adjusting for the impact of CCT on IOP by correction algorithms is not necessary in a population analysis of glaucoma prevalence; CCT and other associated corneal properties, however, are important independent risk factors for the prevalence of OAG. PMID:18672218

  6. Genome-Wide Linkage Scan for Primary Open Angle Glaucoma: Influences of Ancestry and Age at Diagnosis

    PubMed Central

    Qin, Xuejun; Liu, Yutao; Gibson, Jason R.; Santiago-Turla, Cecilia; Larocque-Abramson, Karen R.; Del Bono, Elizabeth; Challa, Pratap; Herndon, Leon W.; Akafo, Stephen; Wiggs, Janey L.; Schmidt, Silke; Hauser, Michael A.

    2011-01-01

    Primary open-angle glaucoma (POAG) is the most common form of glaucoma and one of the leading causes of vision loss worldwide. The genetic etiology of POAG is complex and poorly understood. The purpose of this work is to identify genomic regions of interest linked to POAG. This study is the largest genetic linkage study of POAG performed to date: genomic DNA samples from 786 subjects (538 Caucasian ancestry, 248 African ancestry) were genotyped using either the Illumina GoldenGate Linkage 4 Panel or the Illumina Infinium Human Linkage-12 Panel. A total of 5233 SNPs was analyzed in 134 multiplex POAG families (89 Caucasian ancestry, 45 African ancestry). Parametric and non-parametric linkage analyses were performed on the overall dataset and within race-specific datasets (Caucasian ancestry and African ancestry). Ordered subset analysis was used to stratify the data on the basis of age of glaucoma diagnosis. Novel linkage regions were identified on chromosomes 1 and 20, and two previously described loci—GLC1D on chromosome 8 and GLC1I on chromosome 15—were replicated. These data will prove valuable in the context of interpreting results from genome-wide association studies for POAG. PMID:21765929

  7. Hypothesis-independent pathway analysis implicates GABA and acetyl-CoA metabolism in primary open-angle glaucoma and normal-pressure glaucoma.

    PubMed

    Bailey, Jessica N Cooke; Yaspan, Brian L; Pasquale, Louis R; Hauser, Michael A; Kang, Jae H; Loomis, Stephanie J; Brilliant, Murray; Budenz, Donald L; Christen, William G; Fingert, John; Gaasterland, Douglas; Gaasterland, Terry; Kraft, Peter; Lee, Richard K; Lichter, Paul R; Liu, Yutao; McCarty, Catherine A; Moroi, Sayoko E; Richards, Julia E; Realini, Tony; Schuman, Joel S; Scott, William K; Singh, Kuldev; Sit, Arthur J; Vollrath, Douglas; Wollstein, Gadi; Zack, Donald J; Zhang, Kang; Pericak-Vance, Margaret A; Allingham, R Rand; Weinreb, Robert N; Haines, Jonathan L; Wiggs, Janey L

    2014-10-01

    Primary open-angle glaucoma (POAG) is a leading cause of blindness worldwide. Using genome-wide association single-nucleotide polymorphism data from the Glaucoma Genes and Environment study and National Eye Institute Glaucoma Human Genetics Collaboration comprising 3,108 cases and 3,430 controls, we assessed biologic pathways as annotated in the KEGG database for association with risk of POAG. After correction for genic overlap among pathways, we found 4 pathways, butanoate metabolism (hsa00650), hematopoietic cell lineage (hsa04640), lysine degradation (hsa00310) and basal transcription factors (hsa03022) related to POAG with permuted p < 0.001. In addition, the human leukocyte antigen (HLA) gene family was significantly associated with POAG (p < 0.001). In the POAG subset with normal-pressure glaucoma (NPG), the butanoate metabolism pathway was also significantly associated (p < 0.001) as well as the MAPK and Hedgehog signaling pathways (hsa04010 and hsa04340), glycosaminoglycan biosynthesis-heparan sulfate pathway (hsa00534) and the phenylalanine, tyrosine and tryptophan biosynthesis pathway (hsa0400). The butanoate metabolism pathway overall, and specifically the aspects of the pathway that contribute to GABA and acetyl-CoA metabolism, was the only pathway significantly associated with both POAG and NPG. Collectively these results implicate GABA and acetyl-CoA metabolism in glaucoma pathogenesis, and suggest new potential therapeutic targets.

  8. Role of the beta-adrenergic receptor-binding agent 'timolol' in the treatment of open-angle glaucoma.

    PubMed

    Strempel, I

    1982-01-01

    A follow-up study was performed on 54 eyes with chronic open-angle glaucoma treated with timolol maleate. It was carried out as an open clinical trial with a selected group of eyes. During 2 years of application the effect of timolol under normal conditions as well as under stress tests (darkness test, water-, coffee- or tea-drinking test, early morning measurements) was observed. Until now 40% of patients were regulated with 0.25% timolol twice daily. Another 50% obtained good pressure values under 0.5% timolol therapy and the rest with 0.5% timolol and 2% pilocarpine twice daily. Early morning measurement was shown to be the most important indicator of intraocular pressure regulation by beta-blocking agents. While timolol is usually very effective in reducing the intraocular pressure during daytime, several patients showed unattended high morning pressure values. Up to now, no severe side-effects of timolol therapy have been observed.

  9. [The effect of parenteral citicoline on visual functions and life quality of patients with primary open-angle glaucoma].

    PubMed

    Frolov, M A; Gonchar, P A; Barashkov, V I; Kumar, V; Morozova, N S; Frolov, A M; Kazakova, K A

    2011-01-01

    The effect of nootropic drug citicoline on visual functions, perimetric indexes of static automated perimetry, morphometric characteristics of retinal tomography and life quality of patients with primary open-angle glaucoma (POAG) stage I-III and normalized intraocular pressure (IOP) was studied. 40 patients aged 46-78 years old with POAG stage I-III and normalized IOP were treated with citicoline. Among them there were 24 female and 16 male. The patients were divided into 2 equal groups--experimental and control. Patients of both groups were treated with intravenous citicoline for 10 days. The dose of citicoline in experimental group was 1000 mg/day, in control--500 mg/day. After treatment in both groups visual functions, perimetric indexes of static automated perimetry, morphometric characteristics of retinal tomography and life quality showed improvement. Citicoline has significant neuroprotective effect preventing apoptosis.

  10. Selective laser trabeculoplasty compared with medical treatment for the initial management of open angle glaucoma or ocular hypertension.

    PubMed

    Pérez, Efraín; Rada, Gabriel; Maul, Eugenio

    2015-12-16

    Selective laser trabeculoplasty is a relatively new therapeutic alternative for the management of open angle glaucoma and ocular hypertension. On the other hand, medical treatment has robust data supporting its efficacy and has progressed in last decades with the introduction of prostaglandin analogues. To compare these two therapies, we searched Epistemonikos database, which is maintained by screening 30 databases, and identified four systematic reviews including four randomized and one non-randomized clinical trial. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded that selective laser trabeculoplasty leads to a smaller absolute intraocular pressure reduction than medical treatment. However, it is not clear if there are differences in treatment success rate or need of additional antiglaucomatous interventions, because the quality of the evidence is low.

  11. Safety and efficacy of bimatoprost/timolol fixed combination in Chinese patients with open-angle glaucoma or ocular hypertension.

    PubMed

    Ling, Zhihong; Zhang, Mingchang; Hu, Yizhen; Yin, Zhengqin; Xing, Yiqiao; Fang, Aiwu; Ye, Jian; Chen, Xiaoming; Liu, Dachuan; Wang, Yusheng; Sun, Wei; Dong, Yangceng; Sun, Xinghuai

    2014-01-01

    Lowering intraocular pressure (IOP) is currently the only therapeutic approach in primary open-angle glaucoma. and the fixed-combination medications are needed to achieve sufficiently low target IOP. A multicenter prospective study in the Chinese population was needed to confirm the safety and efficacy of Bimatoprost/Timolol Fixed Combination Eye Drop in China. In this study, we evaluated the safety and efficacy of Bimatoprost/Timolol Fixed Combination with concurrent administration of its components in Chinese patients with open-angle glaucoma or ocular hypertension. In this multicenter, randomized, double-masked, parallel controlled study, patients with open-angle glaucoma or ocular hypertension who were insufficiently responsive to monotherapy with either topical β-blockers or prostaglandin analogues were randomized to one of two active treatment groups in a 1:1 ratio at 11 Chinese ophthalmic departments. Bimatoprost/timolol fixed combination treatment was a fixed combination of 0.03% bimatoprost and 0.5% timolol (followed by vehicle for masking) once daily at 19:00 P.M. and concurrent treatment was 0.03% bimatoprost followed by 0.5% timolol once daily at 19:00 P.M. The primary efficacy variable was change from baseline in mean diurnal intraocular pressure (IOP) at week 4 visit in the intent-to-treat (ITT) population. Primary analysis evaluated the non-inferiority of bimatoprost/ timolol fixed combination to concurrent with respect to the primary variable using a confidence interval (CI) approach. Bimatoprost/timolol fixed combination was to be considered non-inferior to concurrent if the upper limit of the 95% CI for the between-treatment (bimatoprost/timolol fixed combination minus concurrent) difference was ≤ 1.5 mmHg. Adverse events were collected and slit-lamp examinations were performed to assess safety. Between-group comparisons of the incidence of adverse events were performed using the Pearson chi-square test or Fisher's exact test. Of the enrolled

  12. [The effect of chronic beta-blocker treatment on the evolution of primary open-angle glaucoma].

    PubMed

    Chiselita, D; Vancea, P P; Poiata, I

    1998-01-01

    Comparative analysis of the results of the trabeculectomy in primary open-angle glaucoma (POAG) when it was chosen as a primary treatment and when was preceded by chronic use of topic beta-blockers. Retrospective study of 59 patients (group A) with primary trabeculectomy and 42 patients (group B) with topic beta-blockers treatment for at least 3 years subsequent to trabeculectomy was performed. The average postoperative follow-up period was 3 years and 5 months. Postoperative IOP lowering was similar in both groups; There are no statistical differences between group A and B concerning stationary cases (76.27% in group A and 75.4% in group B), regressive cases (6.8% and 7.14% respectively) and progressive cases (18.6% and 17.9% respectively); Preoperative and postoperative complication rates were similar in the 2 groups. The chronic beta-blockers use does not influence the evolution of operated POAG.

  13. Recent Developments in Understanding the Role of Aqueous Humor Outflow in Normal and Primary Open Angle Glaucoma

    PubMed Central

    Hann, Cheryl R.; Fautsch, Michael P.

    2015-01-01

    Primary open angle glaucoma (POAG) is the second leading cause of blindness in the world's rapidly aging population. POAG is characterized by progressive degeneration of neural structures in the posterior segment, often associated with a concomitant elevation of intraocular pressure. Changes in IOP are believed to be caused by a disruption in the normal outflow of aqueous humor. This article reviews recent research associated with normal and POAG aqueous humor outflow. Novel findings elucidating biochemical and pathological changes in the ocular tissues affected in POAG are presented. Stem cell research, identification of lymphatic markers, and increased use of mouse models give researchers exciting new tools to understand aqueous humor outflow, changes associated with POAG and identify underlying causes of the disease. PMID:26236568

  14. Association between primary open angle glaucoma and genetic polymorphisms GSTM1/GSTT1 in patients from Goiânia Central-West Region of Brazil.

    PubMed

    Silva, C T X; Costa, N B; Silva, K S F; Silva, R E; Moura, K K V O

    2014-10-31

    In this study, we evaluated the genotype profile of GSTM1 and GSTT1 polymorphisms in patient carriers of primary open-angle glaucoma in the population of Goiânia, GO, Brazil. This case-control study included 100 Brazilian patients with glaucoma and 53 patients without glaucoma. Blood samples were genotyped for polymorphisms in GST genes using polymerase chain reaction-based methods. Polymorphism frequencies were compared using the X(2) test and odds ratio (α = 0.05). The GSTM1-present genotype was 40% in the glaucoma group and 71.6% in the control group, while the GSTM1 null genotype was 60 and 28.3% in the same groups, respectively. The GSTT1-present genotype was 52% in the primary open-angle glaucoma group and 66% in the control group; the null genotype was 48% in the case group and 34% in the control group. The GSTM1 null genotype was more frequent in the glaucoma group than in the control group (P = 0.0004; odds ratio = 6.7; 95% confidence interval = 2.7- 20.3). The combined GSTM1 null and GSTT1-present genotypes were more frequent in the primary open-angle glaucoma group compared to the control group (P = 0.02; odds ratio = 3.1; 95% confidence interval = 1.2-7.9).

  15. Correlation of endothelin-1 concentration in aqueous humor with intraocular pressure in primary open angle and pseudoexfoliation glaucoma.

    PubMed

    Choritz, Lars; Machert, Maren; Thieme, Hagen

    2012-10-23

    Endothelin-1 (ET-1) has been found in elevated concentrations in the aqueous humor of glaucoma patients. Indirect evidence from animal studies suggests that ET-1 might directly influence intraocular pressure (IOP). The aim of this study was to determine whether ET-1 concentrations in aqueous humor of cataract and glaucoma patients correlate with IOP. Aqueous humor and blood samples from patients with either cataract (control, n = 38), primary open angle glaucoma (POAG, n = 35), or pseudoexfoliation glaucoma (PEXG, n = 21), without other ocular or systemic disease, were collected during routine cataract surgery or trabeculectomy. ET-1 concentration was determined by an ET-1 ELISA kit. IOP was measured preoperatively by standard Goldmann applanation tonometry. All statistical analysis was performed using commercial predictive analytics software. Both IOP and ET-1 concentration in aqueous humor were significantly increased in POAG (23.4 ± 6.8 mm Hg, 5.9 ± 2.9 pg/mL) and PEXG (24.3 ± 8.8 mm Hg, 7.7 ± 2.1 pg/mL) compared with control (15.0 ± 2.9 mm Hg, 4.3 ± 2.4 pg/mL). No difference was detected for plasma ET-1 concentrations. IOP and ET-1 in the aqueous humor were significantly correlated (R = 0.394, R² = 0.155, P < 0.001), although no correlation was found between IOP and ET-1 in blood plasma or between ET-1 in aqueous humor and ET-1 in plasma. In this study, a small but highly significant correlation between IOP and the ET-1 concentration in the aqueous humor was found. Although no causative relationship can be deduced from this, ocular ET-1 effects on IOP control may merit further investigation.

  16. Delta-9-tetrahydrocannabinol (THC) in the treatment of end-stage open-angle glaucoma.

    PubMed Central

    Flach, Allan J

    2002-01-01

    PURPOSE: Evidence exists that the administration of cannabinoid derivatives can lower intraocular pressure. Some patients with glaucoma believe they are being deprived of a potentially beneficial treatment. Therefore, the Research Advisory Panel of California instituted the Cannabis Therapeutic Research Program to permit compassionate access to cannabinoid derivatives. Data about the potential therapeutic usefulness and toxicity of these agents were collected. This study reviews the results of this program with the specific aim of providing further direction for these investigational efforts. METHODS: A survey of local ophthalmologists indicated an impressive interest in participating in and contributing patients with glaucoma unresponsive to treatment to this study. Appropriate patients were treated with either orally administered delta-9-tetrahydrocannabinol capsules or inhaled marijuana in addition to their existing therapeutic regimen. RESULTS: Although 20 ophthalmologists were approved as investigators, only nine patients were enrolled in the study. An initial decrease in intraocular pressure was observed in all patients, and the investigator's therapeutic goal was met in four of the nine patients. However, the decreases in intraocular pressure were not sustained, and all patients elected to discontinue treatment within 1 to 9 months for various reasons. CONCLUSIONS: This uncontrolled, unmasked, nonrandomized study does not permit definitive conclusions about the efficacy or toxicity of cannabinoids in the treatment of glaucoma. There is an impression that this treatment can lower intraocular pressure, but the development of tolerance and significant systemic toxicity appears to limit the usefulness of this potential treatment. Both patients and ophthalmologists greatly appreciated the opportunity to participate in this study. PMID:12545695

  17. Long-term efficacy and safety of ExPress implantation for treatment of open angle glaucoma

    PubMed Central

    Lee, Geun Young; Lee, Chong Eun; Lee, Kyoo Won; Seo, Sam

    2017-01-01

    AIM To compare the long-term efficacy and safety of ExPress implantation and standard trabeculectomy in patients with primary open angle glaucoma (POAG). METHODS In this retrospective study, we compared 17 eyes treated by ExPress implantation with 23 eyes treated by trabeculectomy. Efficacy was assessed according to the relevant intraocular pressure (IOP) values and success rates during the first year of follow-up. Postoperative corneal endothelial cell loss was also compared. RESULTS The number of antiglaucoma medications and the IOP reduction were similar between the 2 groups during the follow-up period. Although the mean IOP was similar, the IOP-fluctuation rate during the early postoperative period was significantly lower in the ExPress group than in the trabeculectomy group (P=0.038). A Kaplan-Meier survival curve analysis showed no significant success-rate difference between the groups (P=0.810). The corneal endothelial cell loss rate, moreover, was significantly lower in the ExPress group (P=0.05). CONCLUSION ExPress implantation compared with trabeculectomy showed similar IOP-reduction and success rates along with lower IOP fluctuation and endothelial cell loss rates. For this reason, it can be considered to be the treatment of choice for patients with advanced glaucoma or low corneal endothelial cell density. PMID:28944196

  18. CYP1B1 Mutations are a Major Contributor to Juvenile-Onset Open Angle Glaucoma in Saudi Arabia.

    PubMed

    Abu-Amero, Khaled K; Morales, Jose; Aljasim, Leyla A; Edward, Deepak P

    2015-06-01

    To describe the genotype and phenotype in 14 unrelated Saudis with juvenile open angle glaucoma (JOAG). Detailed clinical examination was carried out and we sequenced cytochrome P450, family 1, subfamily B (CYP1B1), Myocilin (MYOC) and latent-transforming growth factor beta-binding protein 2 (LTBP2) genes. Twelve (85.7%) patients had apparent sporadic inheritance and 2 (14.3%) presented with a family history of glaucoma. Overall, 12 patients (85.7%) had CYP1B1 mutation. Nine patients had CYP1B1 mutations in a homozygous status. Eight of these had homozygous p.G61E mutation and one had a silent (no amino acid change) sequence change. Two patients had p.G61E mutation in a compound heterozygous status with another CYP1B1 mutation (p.L432V). Two patients had p.G61E in a heterozygous status with no other mutation, while one patient had no mutation(s). None of the patients had any mutation(s) in the MYOC or LTBP2 genes. JOAG associated with CYP1B1 mutations occurs at a high rate in the Saudi population. A specific genotype-phenotype relationship was not demonstrated.

  19. Optic nerve head slope-based quantitative parameters for identifying open-angle glaucoma on SPECTRALIS OCT images.

    PubMed

    Al-Hinnawi, Abdel-Razzak M; Al-Naami, Bassam O; Al-Latayfeh, Motasem M

    2017-08-01

    To investigate monitoring slope-based features of the optic nerve head (ONH) cup as open-angle glaucoma (OAG) occurs. A dataset of 46 retrospective OCT cases was acquired from the SPECTRALIS Heidelberg Engineering OCT device. A set of five parameters, which are based on the ONH cup-incline, are measured on the OAG and normal subjects in the dataset. Then, three new ONH cup-shape indices were deduced. The ONH cup-incline parameters and ONH cup-shape indices are analyzed to estimate their clinical value. The statistical difference between measurements on normal and glaucoma eyes was remarkably significant for all of the analyzed parameters and indices (p value < 0.001). The geometric shape of the ONH cup can be transferred to numerical parameters and indices. The proposed ONH cup-incline parameters and ONH cup-shape indices have shown suggestive clinical value to identify the development of OAG. As OAG appears, the top ONH cup-incline parameters decrease while the bottom ONH cup-incline parameters increase. The ONH cup-shape indices suggest capability to discriminate OAG from normal eyes.

  20. Induced Pluripotent Stem Cells Restore Function in a Human Cell Loss Model of Open-Angle Glaucoma

    PubMed Central

    Abu-Hassan, Diala W; Li, Xinbo; Ryan, Eileen I; Acott, Ted S; Kelley, Mary J

    2015-01-01

    Normally, trabecular meshwork (TM) and Schlemm's canal inner wall endothelial cells within the aqueous humor outflow pathway maintain intraocular pressure within a narrow safe range. Elevation in intraocular pressure, because of the loss of homeostatic regulation by these outflow pathway cells, is the primary risk factor for vision loss due to glaucomatous optic neuropathy. A notable feature associated with glaucoma is outflow pathway cell loss. Using controlled cell loss in ex vivo perfused human outflow pathway organ culture, we developed compelling experimental evidence that this level of cell loss compromises intraocular pressure homeostatic function. This function was restored by repopulation of the model with fresh TM cells. We then differentiated induced pluripotent stem cells (iPSCs) and used them to repopulate this cell depletion model. These differentiated cells (TM-like iPSCs) became similar to TM cells in both morphology and expression patterns. When transplanted, they were able to fully restore intraocular pressure homeostatic function. This successful transplantation of TM-like iPSCs establishes the conceptual feasibility of using autologous stem cells to restore intraocular pressure regulatory function in open-angle glaucoma patients, providing a novel alternative treatment option. Stem Cells 2015;33:751–761 PMID:25377070

  1. [TNF-alfa (-857C/T) polymorphism in open angle glaucoma in Romania -- results of a pilot study].

    PubMed

    Simionescu, Ruxandra; Voinea, Liliana; Cornăţeanu, Roxana Sfrenţ

    2013-01-01

    Primary open angle glaucoma is a progressive optic neuropathy with multiple causative factors including genetic immune disregulation. TNF-alfa has pro-apoptotic effects on the retinal ganglion cells, thus being directly involved in the neurodegeneration of the optic nerve head. Our purpose was to investigate the influence on susceptibility and/or clinical and characteristics of TNF-alfa promoter polymorphism -857 C/T in Romanian patients diagnosed with POAG. We assessed 159 Romanian subjects, 61 diagnosed with glaucoma (F/M 39/22) and 98 healthy unrelated matched controls-HC for the polymorphism -857 C/T, genotyped by Real Time PCR (Taqman SNP Genotyping Assay C_2215707_10, Applied Biosystems, USA). The diagnosis and the staging of the disease in the POAG group were assessed using the current guidelines. Association tests for the SNP were performed using SPSS 11.2 (Fisher test) and p values < or = 0.05 were considered significant. The Hardy-Weinberg equilibrium assessed using Chi-square test was respected in both studied groups- POAG and HC (p = 0.000009 and respectively p = 0.04771). There was no association found between the frequencies of alleles between studied groups (CC/CT/TT= 0.81/0.09/0.08 respectively 0.70/0.23/0.06). TNF-alfa promoter polymorphism -857 C/T doesn't seem to influence the susceptibility to POAG and the results should be confirmed on larger cohorts.

  2. Differential Association of Metabolic Risk Factors with Open Angle Glaucoma according to Obesity in a Korean Population

    PubMed Central

    Kim, Hyun-Ah; Han, Kyungdo; Lee, Yun-Ah; Choi, Jin A; Park, Yong-Moon

    2016-01-01

    The associations of the metabolic syndrome (MetS) with intraocular pressure and primary open angle glaucoma (OAG) have been reported. This study aimed to determine whether a difference in association exists between OAG and metabolic risk factors according to obesity status among Korean adults. A total of 8,816 participants (≥40 years) in the Korea National Health and Nutrition Examination Survey were classified into obese, body mass index (BMI) ≥ 25 kg/m2 and non-obese, BMI < 25 kg/m2. The prevalence of MetS was 40.1% in non-obese OAG and 66.0% in obese OAG. The prevalence of OAG increased with increasing number components for MetS in total population and in non-obese subjects (P < 0.001, respectively), while the prevalence of OAG was not associated with number of components for MetS in obese subjects (P = 0.14). In non-obese individuals, subjects with high triglycerides, high blood pressure (BP), and MetS were more likely to have OAG compared with those without high triglycerides, high BP, and MetS after adjusting for potential confounders. However, MetS or its components exhibited no significant association with glaucoma status in obese individuals. Our study provides understanding on the differences in association of OAG with MetS and its components according to obesity status. PMID:28004731

  3. Induced pluripotent stem cells restore function in a human cell loss model of open-angle glaucoma.

    PubMed

    Abu-Hassan, Diala W; Li, Xinbo; Ryan, Eileen I; Acott, Ted S; Kelley, Mary J

    2015-03-01

    Normally, trabecular meshwork (TM) and Schlemm's canal inner wall endothelial cells within the aqueous humor outflow pathway maintain intraocular pressure within a narrow safe range. Elevation in intraocular pressure, because of the loss of homeostatic regulation by these outflow pathway cells, is the primary risk factor for vision loss due to glaucomatous optic neuropathy. A notable feature associated with glaucoma is outflow pathway cell loss. Using controlled cell loss in ex vivo perfused human outflow pathway organ culture, we developed compelling experimental evidence that this level of cell loss compromises intraocular pressure homeostatic function. This function was restored by repopulation of the model with fresh TM cells. We then differentiated induced pluripotent stem cells (iPSCs) and used them to repopulate this cell depletion model. These differentiated cells (TM-like iPSCs) became similar to TM cells in both morphology and expression patterns. When transplanted, they were able to fully restore intraocular pressure homeostatic function. This successful transplantation of TM-like iPSCs establishes the conceptual feasibility of using autologous stem cells to restore intraocular pressure regulatory function in open-angle glaucoma patients, providing a novel alternative treatment option. © 2014 The Authors. STEM CELLS Published by Wiley Periodicals, Inc. on behalf of AlphaMed Press.

  4. Effect of Different Head Positions in Lateral Decubitus Posture on Intraocular Pressure in Treated Patients With Open-Angle Glaucoma.

    PubMed

    Lee, Tae-Eun; Yoo, Chungkwon; Lin, Shan C; Kim, Yong Yeon

    2015-11-01

    To investigate the effects of different head positions in the lateral decubitus posture on intraocular pressure (IOP) in medically treated patients with open-angle glaucoma (OAG). Prospective observational study. setting: Institutional. Twenty patients with bilateral OAG who received only latanoprost as treatment. IOP was measured using an ICare Pro tonometer in the sitting, supine, right, and left lateral decubitus posture. In lateral decubitus posture, IOP measurements were taken with 3 different head positions (30 degrees higher than, 30 degrees lower than, and parallel to the center of the thoracic vertebra) in a randomized sequence. Comparison of the IOPs between the dependent (lower-sided) and nondependent eyes in the lateral decubitus postures with different head positions. We also analyzed the differences in IOPs between the better and worse eyes. IOP was higher in the dependent eyes than in the nondependent eyes in lateral decubitus posture, regardless of the head position (all P < .05). Lower head position increased the IOP of dependent eyes, compared with the neutral or higher head position. However, the amounts of IOP elevation seen during the changes of body posture or head position were not significantly different between the better and worse eyes. Low head position elevates IOP of the dependent eyes of medically treated OAG patients compared with neutral head position in the lateral decubitus posture. Adjustment of the height of a pillow may help mitigate IOP elevations resulting from lying on the side with a low or no pillow in glaucoma patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Investigation of blood flow regulation and oxygen saturation of the retinal vessels in primary open-angle glaucoma.

    PubMed

    Ramm, L; Jentsch, S; Peters, S; Augsten, R; Hammer, M

    2014-11-01

    To examine the supply of oxygen to the retina in primary open-angle glaucoma (POAG). Forty-one patients with primary open-angle glaucoma (mean age 64.1 ± 12.9 years) and 40 healthy subjects (63.6 ± 14.1 years) were included. Fundus images, centered at the optic disc, were taken using the Retinal Vessel Analyzer (RVA). The vessel diameters were calculated as central retinal artery (CRAE) and vein equivalent (CRVE) from diameter measurements in the peripapillary vessels. The oxygen saturation of the arteries and veins was investigated employing a two-wavelengths technique. After the measurement at baseline, the vascular response to flicker light exposure was measured. In glaucoma patients the mean oxygen saturation of the retinal veins at baseline was higher than in the healthy controls (64.36 ± 7.11 vs. 59.78 ± 8.47, p = 0.01), whereas the mean arteriovenous oxygen saturation difference was lower (33.07 ± 5.24 vs. 37.53 ± 6.95, p = 0.002). The arterial oxygen saturation as well as the arterial and venous diameters showed no difference between the groups. The increase of the CRVE during flicker light stimulation (3.72 ± 3.29 % vs. 5.43 ± 4.04, p = 0.039), as well as the change of the venous oxygen saturation (2.08 ± 3.74 % vs. 4.18 ± 3.88 %, p = 0.016) and the arteriovenous saturation difference (-2.1 ± 3.31 % vs. -4.43 ± 3.6 %, p = 0.003) were smaller in POAG patients than in the healthy group. The reduction in the arteriovenous difference in oxygen saturation in POAG patients might show a decreased oxygen demand of the retina caused by the glaucomatous loss of neuroretinal tissue. The lower extent of the flicker light-induced change of the diameter of retinal veins and the venous oxygen saturation could indicate an impairment of blood flow regulation.

  6. Age-based analysis of choroidal thickness and choroidal vessel diameter in primary open-angle glaucoma.

    PubMed

    Toprak, Ibrahim; Yaylalı, Volkan; Yildirim, Cem

    2016-04-01

    We aimed to assess choroidal thickness and vessel diameter in patients with primary open-angle glaucoma (POAG) using enhanced depth imaging (EDI) optical coherence tomography (OCT) with age-based analysis. Fifty-four patients with a confirmed diagnosis of POAG and 44 age-sex matched healthy subjects were included into the study. A masked physician performed measurements of largest choroidal vessel diameter and choroidal thicknesses (subfoveal, nasal, and temporal) using EDI OCT. Subgroup analyses were performed to compare choroidal measurements based on age (with a cut point of 70 years). The study cohort comprised 54 patients with POAG (mean age of 63.2 ± 8.8 years) and 44 healthy control subjects (mean age of 62.9 ± 8.5 years) (P = 0.870). We found no significant differences in terms of choroidal measurements (P > 0.05) between the glaucoma and control groups. However, in the glaucoma group, patients with an age ≥70 years had significantly thinner subfoveal and nasal choroid compared to those of the patients with <70 years of age (P = 0.017, 0.002 respectively). In the control group, choroidal thickness and vessel measurements showed no significant difference when the subjects were subgrouped according to the age cut point (P > 0.05). Choroidal thickness and vessel caliber seem not to differ between patients with POAG and healthy controls. However, an age ≥70 years might be associated with thinning in subfoveal and nasal choroid in patients with POAG. Further studies are needed to elucidate whether choroidal thinning is a cause or result in POAG.

  7. Investigation of known genetic risk factors for primary open angle glaucoma in two populations of African ancestry.

    PubMed

    Liu, Yutao; Hauser, Michael A; Akafo, Stephen K; Qin, Xuejun; Miura, Shiroh; Gibson, Jason R; Wheeler, Joshua; Gaasterland, Douglas E; Challa, Pratap; Herndon, Leon W; Ritch, Robert; Moroi, Sayoko E; Pasquale, Louis R; Girkin, Christopher A; Budenz, Donald L; Wiggs, Janey L; Richards, Julia E; Ashley-Koch, Allison E; Allingham, R Rand

    2013-09-17

    Multiple genes have been associated with primary open angle glaucoma (POAG) in Caucasian populations. We now examine the association of these loci in populations of African ancestry, populations at particularly high risk for POAG. We genotyped DNA samples from two populations: African American (1150 cases and 999 controls) and those from Ghana, West Africa (483 cases and 593 controls). Our analysis included 57 single nucleotide polymorphisms (SNPs) in five loci previously associated with POAG at the genome-wide level, including CDKN2B-AS1, TMCO1, CAV1/CAV2, chromosome 8q22 intergenic region, and SIX1/SIX6. We evaluated association in the full datasets, as well as subgroups with normal pressure glaucoma (NPG, maximum IOP ≤21 mm Hg) and high pressure glaucoma (HPG, IOP >21 mm Hg). In African Americans, we identified an association of rs10120688 in the CDNK2B-AS1 region with POAG (P = 0.0020). Several other SNPs were nominally associated, but did not survive correction for multiple testing. In the subgroup analyses, significant associations were identified for rs10965245 (P = 0.0005) in the CDKN2B-AS1 region with HPG and rs11849906 in the SIX1/SIX6 region with NPG (P = 0.006). No significant association was identified with any loci in the Ghanaian samples. POAG genetic susceptibility alleles associated in Caucasians appear to play a greatly reduced role in populations of African ancestry. Thus, the major genetic components of POAG of African origin remain to be identified. This finding underscores the critical need to pursue large-scale genome-wide association studies in this understudied, yet disproportionately affected population.

  8. Genetic correlations between intraocular pressure, blood pressure and primary open-angle glaucoma: a multi-cohort analysis.

    PubMed

    Aschard, Hugues; Kang, Jae H; Iglesias, Adriana I; Hysi, Pirro; Cooke Bailey, Jessica N; Khawaja, Anthony P; Allingham, R Rand; Ashley-Koch, Allison; Lee, Richard K; Moroi, Sayoko E; Brilliant, Murray H; Wollstein, Gadi; Schuman, Joel S; Fingert, John H; Budenz, Donald L; Realini, Tony; Gaasterland, Terry; Scott, William K; Singh, Kuldev; Sit, Arthur J; Igo, Robert P; Song, Yeunjoo E; Hark, Lisa; Ritch, Robert; Rhee, Douglas J; Gulati, Vikas; Haven, Shane; Vollrath, Douglas; Zack, Donald J; Medeiros, Felipe; Weinreb, Robert N; Cheng, Ching-Yu; Chasman, Daniel I; Christen, William G; Pericak-Vance, Margaret A; Liu, Yutao; Kraft, Peter; Richards, Julia E; Rosner, Bernard A; Hauser, Michael A; Klaver, Caroline C W; vanDuijn, Cornelia M; Haines, Jonathan; Wiggs, Janey L; Pasquale, Louis R

    2017-08-30

    Primary open-angle glaucoma (POAG) is the most common chronic optic neuropathy worldwide. Epidemiological studies show a robust positive relation between intraocular pressure (IOP) and POAG and modest positive association between IOP and blood pressure (BP), while the relation between BP and POAG is controversial. The International Glaucoma Genetics Consortium (n=27 558), the International Consortium on Blood Pressure (n=69 395), and the National Eye Institute Glaucoma Human Genetics Collaboration Heritable Overall Operational Database (n=37 333), represent genome-wide data sets for IOP, BP traits and POAG, respectively. We formed genome-wide significant variant panels for IOP and diastolic BP and found a strong relation with POAG (odds ratio and 95% confidence interval: 1.18 (1.14-1.21), P=1.8 × 10(-27)) for the former trait but no association for the latter (P=0.93). Next, we used linkage disequilibrium (LD) score regression, to provide genome-wide estimates of correlation between traits without the need for additional phenotyping. We also compared our genome-wide estimate of heritability between IOP and BP to an estimate based solely on direct measures of these traits in the Erasmus Rucphen Family (ERF; n=2519) study using Sequential Oligogenic Linkage Analysis Routines (SOLAR). LD score regression revealed high genetic correlation between IOP and POAG (48.5%, P=2.1 × 10(-5)); however, genetic correlation between IOP and diastolic BP (P=0.86) and between diastolic BP and POAG (P=0.42) were negligible. Using SOLAR in the ERF study, we confirmed the minimal heritability between IOP and diastolic BP (P=0.63). Overall, IOP shares genetic basis with POAG, whereas BP has limited shared genetic correlation with IOP or POAG.European Journal of Human Genetics advance online publication, 30 August 2017; doi:10.1038/ejhg.2017.136.

  9. Clinical evaluation of a trabecular microbypass stent with phacoemulsification in patients with open-angle glaucoma and cataract

    PubMed Central

    Ferguson, Tanner J; Berdahl, John P; Schweitzer, Justin A; Sudhagoni, Ramu G

    2016-01-01

    Purpose To evaluate the safety and efficacy of the iStent trabecular microbypass stent in combination with cataract surgery in patients with open-angle glaucoma (OAG). Methods Retrospective, consecutive case series from October 2012 to December 2015 with no exclusion criteria. The series comprised of 350 eyes with OAG and cataract. Data were collected both preoperatively and postoperatively at day 1 week 1, months 1, 3, 6, 12, 18, and 24. Data included intraocular pressure (IOP), number of glaucoma medications, visual acuity, the incidence of postoperative IOP pressure spikes of greater than ≥15 mmHg at any time point, and need for additional surgery. Results The mean preoperative IOP was 19.13±6.34 mmHg. At 2 years postoperation, mean IOP was 15.17±3.53 mmHg (P<0.0001). The mean number of glaucoma medications was 1.19±1.00 preoperatively and 0.61±0.96 (P<0.0001) at 2 years postoperation. At 1 day postoperatively, 31 eyes (12.4%) experienced an IOP increase of 15 mmHg above their baseline IOP that responded to topical therapy. Two patients required additional tube shunt surgery. Conclusion The insertion of the iStent trabecular microbypass stent in combination with cataract surgery effectively lowers IOP in OAG patients. The magnitude of IOP reduction was more significant in patients with higher preoperative pressure. Medication use was also significantly reduced postoperatively. The safety profile appears favorable with a low rate of IOP spikes and only two eyes (<1%) requiring additional surgery. PMID:27695280

  10. Optic Disc Perfusion in Primary Open Angle and Normal Tension Glaucoma Eyes Using Optical Coherence Tomography-Based Microangiography

    PubMed Central

    Wen, Joanne C.; Zhang, Qinqin; Xin, Chen; Gupta, Divakar; Mudumbai, Raghu C.; Johnstone, Murray A.; Wang, Ruikang K.; Chen, Philip P.

    2016-01-01

    Purpose To investigate optic disc perfusion differences in normal, primary open-angle glaucoma (POAG), and normal tension glaucoma (NTG) eyes using optical microangiography (OMAG) based optical coherence tomography (OCT) angiography technique. Design Cross-sectional, observational study. Subjects Twenty-eight normal, 30 POAG, and 31 NTG subjects. Methods One eye from each subject was scanned with a 68 kHz Cirrus HD-OCT 5,000-based OMAG prototype system centered at the optic nerve head (ONH) (Carl Zeiss Meditec Inc, Dublin, CA). Microvascular images were generated from the OMAG dataset by detecting the differences in OCT signal between consecutive B-scans. The pre-laminar layer (preLC) was isolated by a semi-automatic segmentation program. Main Outcome Measures Optic disc perfusion, quantified as flux, vessel area density, and normalized flux (flux normalized by the vessel area) within the ONH. Results Glaucomatous eyes had significantly lower optic disc perfusion in preLC in all three perfusion metrics (p<0.0001) compared to normal eyes. The visual field (VF) mean deviation (MD) and pattern standard deviation (PSD) were similar between the POAG and NTG groups, and no differences in optic disc perfusion were observed between POAG and NTG. Univariate analysis revealed significant correlation between optic disc perfusion and VF MD, VF PSD, and rim area in both POAG and NTG groups (p≤0.0288). However, normalized optic disc perfusion was correlated with some structural measures (retinal nerve fiber layer thickness and ONH cup/disc ratio) only in POAG eyes. Conclusions Optic disc perfusion detected with OMAG was significantly reduced in POAG and NTG groups compared to normal controls, but no difference was seen between POAG and NTG groups with similar levels of VF damage. Disc perfusion was significantly correlated with VF MD, VF PSD, and rim area in glaucomatous eyes. Vascular changes at the optic disc as measured using OMAG may provide useful information for

  11. A novel MYOC heterozygous mutation identified in a Chinese Uygur pedigree with primary open-angle glaucoma.

    PubMed

    Cai, Su-ping; Muhemaiti, Paerheti; Yin, Yan; Cheng, Hongbo; Di Ya, A; Keyimu, Maliyamu; Cao, Xu; Fan, Ning; Jiang, Liqiong; Yan, Naihong; Zhou, Xiaomin; Wang, Yun; Liu, Xuyang

    2012-01-01

    To characterize the clinical features of a Chinese Uygur pedigree with primary open-angle glaucoma (POAG) and to identify mutations in two candidate genes, trabecular meshwork inducible glucocorticoid response (MYOC/TIGR) and human dioxin-inducible cytochrome P450 (CYP1B1). Twenty one members from a Chinese Uygur family of four generations were included in the study. All participants underwent complete ophthalmologic examinations. Five were diagnosed as POAG, four as glaucoma suspects, and the rest were asymptomatic. Molecular genetic analysis was performed on all subjects included in the study. All exons of CYP1B1 and MYOC were amplified by polymerase chain reaction (PCR), sequenced and compared with a reference database. The variations detected were evaluated in available family members as well as 102 normal controls. Possible changes in structure and function of the protein induced by amino acid variance were predicted by bioinformatics analysis. Elevated intraocular pressure and late-stage glaucomatous cupping of the optic disc were found in five patients of this family. A novel heterozygous missense mutation c.1151 A>G in exon 3 of MYOC was found in all five patients diagnosed as POAG and four glaucoma suspects, but not in the rest of the family members and 102 normal controls. This mutation caused an amino acid substitution of aspartic acid to glycine at position 384 (p. D384G) of the MYOC protein. This substitution may cause structural and functional changes of the protein based on bioinformatics analysis. No mutations were found in CYP1B1. Our study suggests that the novel mutation D384G of MYOC is likely responsible for the pathogenesis of POAG in this pedigree.

  12. Association of Myopic Deformation of Optic Disc with Visual Field Progression in Paired Eyes with Open-Angle Glaucoma

    PubMed Central

    Hangai, Masanori; Ishikawa, Makoto; Yoshitomi, Takeshi

    2017-01-01

    Purpose The influence of myopia on glaucoma progression remains unknown, possibly because of the multifactorial nature of glaucoma and difficulty in assessing a solo contribution of myopia. The purpose of this study is to investigate the association of myopia with visual field (VF) progression in glaucoma using a paired-eye design to minimize the influence of confounding systemic factors that are diverse among individuals. Methods This retrospective study evaluated 144 eyes of 72 subjects with open-angle glaucoma, with similar intra-ocular pressure between paired eyes, spherical equivalent (SE) ≤ -2 diopter (D), and axial length ≥ 24 mm. Paired eyes with faster and slower VF progression were grouped separately, according to the global VF progression rate assessed by automated pointwise linear regression analysis. The SE, axial length, tilt ratio and torsion angle of optic discs, Bruch’s membrane (BM) opening area, and gamma zone parapapillary atrophy (PPA) width were compared between the two groups. Factors associated with faster VF progression were determined by logistic regression analysis. Results The mean follow-up duration was 8.9 ± 4.4 years. The mean value of SE and axial length were -6.31 ± 1.88 D and 26.05 ± 1.12 mm, respectively. The mean global visual field progression rate was -0.32 ± 0.38 dB/y. Tilt ratio, BM opening area, and gamma zone PPA width were significantly greater in the eyes with faster VF progression than those with slower progression. In multivariate analysis, these factors were significantly associated with faster VF progression (all P < 0.05), while SE and axial length were not associated with it. Conclusion In myopic glaucoma subjects, tilt of the optic disc and temporal shifting and enlargement of the BM opening were associated with faster rate of VF progression between paired eyes. This suggests that myopia influences VF progression in glaucomatous eyes via optic disc deformations rather than via refractive error itself

  13. Nitric oxide-donating carbonic anhydrase inhibitors for the treatment of open-angle glaucoma.

    PubMed

    Steele, Rebecca M; Benedini, Francesca; Biondi, Stefano; Borghi, Valentina; Carzaniga, Laura; Impagnatiello, Francesco; Miglietta, Daniela; Chong, Wesley K M; Rajapakse, Ranjan; Cecchi, Alessandro; Temperini, Claudia; Supuran, Claudiu T

    2009-12-01

    Novel bi-functional compounds with a nitric oxide (NO)-releasing moiety bound to a dorzolamide scaffold were investigated. Several compounds were synthesized and their activity as selective carbonic anhydrase inhibitors (CAI) evaluated in vitro on recombinant hCA type I, II and IV enzyme isoforms where they showed different degrees of potency and selectivity to hCA II. A high resolution X-ray crystal structure for the CA II adduct with 8 confirmed the high affinity of this class of compounds for the enzyme. Compounds 4, 6, and 8 showed highly potent and efficacious NO-mediated properties as assessed by their vascular relaxant effect on methoxamine-precontracted rabbit aortic rings. Finally, compounds 4 and 6 exerted potent intraocular pressure (IOP) lowering effects in vivo in normotensive rabbits thereby anticipating their potential for the treatment of hypertensive glaucoma.

  14. Travoprost in the management of open-angle glaucoma and ocular hypertension

    PubMed Central

    Denis, Philippe; Covert, David; Realini, Anthony

    2007-01-01

    Travoprost is a member of the prostaglandin analogue class of intraocular pressure (IOP)-lowering drugs used to treat ocular hypertension and glaucoma. Like other prostaglandin analogues, travoprost lowers IOP by enhancing the egress of aqueous humor through both the uveoscleral and trabecular outflow channels. This review summarizes the published data regarding the safety and efficacy of travoprost. Travoprost provides statistically significant and clinically relevant reductions in mean IOP, of the order of 6.5–9.0 mmHg in most studies. In addition, travoprost provides consistent diurnal IOP control, with statistically significant IOP reductions persisting up to 84 hours post-dose. Travoprost has a highly favorable safety profile; most adverse events are cosmetic in nature (such as iris hyperpigmentation and eyelash growth), although more serious adverse events (such as iritis and macular edema) have been associated with travoprost and the other prostaglandin drugs. In some markets, travoprost is available in a fixed combination with timolol; clinical studies have demonstrated that the fixed combination – dosed once daily – lowers IOP by 7–11.5 mmHg. In conclusion, travoprost provides safe and effective reduction of IOP, with convenient once-daily dosing, supporting its role as primary monotherapy. PMID:19668462

  15. A Common Variant in MIR182 Is Associated With Primary Open-Angle Glaucoma in the NEIGHBORHOOD Consortium

    PubMed Central

    Liu, Yutao; Bailey, Jessica Cooke; Helwa, Inas; Dismuke, W. Michael; Cai, Jingwen; Drewry, Michelle; Brilliant, Murray H.; Budenz, Donald L.; Christen, William G.; Chasman, Daniel I.; Fingert, John H.; Gaasterland, Douglas; Gaasterland, Terry; Gordon, Mae O.; Igo, Robert P.; Kang, Jae H.; Kass, Michael A.; Kraft, Peter; Lee, Richard K.; Lichter, Paul; Moroi, Sayoko E.; Realini, Anthony; Richards, Julia E.; Ritch, Robert; Schuman, Joel S.; Scott, William K.; Singh, Kuldev; Sit, Arthur J.; Song, Yeunjoo E.; Vollrath, Douglas; Weinreb, Robert; Medeiros, Felipe; Wollstein, Gadi; Zack, Donald J.; Zhang, Kang; Pericak-Vance, Margaret A.; Gonzalez, Pedro; Stamer, W. Daniel; Kuchtey, John; Kuchtey, Rachel W.; Allingham, R. Rand; Hauser, Michael A.; Pasquale, Louis R.; Haines, Jonathan L.; Wiggs, Janey L.

    2016-01-01

    Purpose Noncoding microRNAs (miRNAs) have been implicated in the pathogenesis of glaucoma. We aimed to identify common variants in miRNA coding genes (MIR) associated with primary open-angle glaucoma (POAG). Methods Using the NEIGHBORHOOD data set (3853 cases/33,480 controls with European ancestry), we first assessed the relation between 85 variants in 76 MIR genes and overall POAG. Subtype-specific analyses were performed in high-tension glaucoma (HTG) and normal-tension glaucoma subsets. Second, we examined the expression of miR-182, which was associated with POAG, in postmortem human ocular tissues (ciliary body, cornea, retina, and trabecular meshwork [TM]), using miRNA sequencing (miRNA-Seq) and droplet digital PCR (ddPCR). Third, miR-182 expression was also examined in human aqueous humor (AH) by using miRNA-Seq. Fourth, exosomes secreted from primary human TM cells were examined for miR-182 expression by using miRNA-Seq. Fifth, using ddPCR we compared miR-182 expression in AH between five HTG cases and five controls. Results Only rs76481776 in MIR182 gene was associated with POAG after adjustment for multiple comparisons (odds ratio [OR] = 1.23, 95% confidence interval [CI]: 1.11–1.42, P = 0.0002). Subtype analysis indicated that the association was primarily in the HTG subset (OR = 1.26, 95% CI: 1.08–1.47, P = 0.004). The risk allele T has been associated with elevated miR-182 expression in vitro. Data from ddPCR and miRNA-Seq confirmed miR-182 expression in all examined ocular tissues and TM-derived exosomes. Interestingly, miR-182 expression in AH was 2-fold higher in HTG patients than nonglaucoma controls (P = 0.03) without controlling for medication treatment. Conclusions Our integrative study is the first to associate rs76481776 with POAG via elevated miR-182 expression. PMID:27537254

  16. A Common Variant in MIR182 Is Associated With Primary Open-Angle Glaucoma in the NEIGHBORHOOD Consortium.

    PubMed

    Liu, Yutao; Bailey, Jessica Cooke; Helwa, Inas; Dismuke, W Michael; Cai, Jingwen; Drewry, Michelle; Brilliant, Murray H; Budenz, Donald L; Christen, William G; Chasman, Daniel I; Fingert, John H; Gaasterland, Douglas; Gaasterland, Terry; Gordon, Mae O; Igo, Robert P; Kang, Jae H; Kass, Michael A; Kraft, Peter; Lee, Richard K; Lichter, Paul; Moroi, Sayoko E; Realini, Anthony; Richards, Julia E; Ritch, Robert; Schuman, Joel S; Scott, William K; Singh, Kuldev; Sit, Arthur J; Song, Yeunjoo E; Vollrath, Douglas; Weinreb, Robert; Medeiros, Felipe; Wollstein, Gadi; Zack, Donald J; Zhang, Kang; Pericak-Vance, Margaret A; Gonzalez, Pedro; Stamer, W Daniel; Kuchtey, John; Kuchtey, Rachel W; Allingham, R Rand; Hauser, Michael A; Pasquale, Louis R; Haines, Jonathan L; Wiggs, Janey L

    2016-08-01

    Noncoding microRNAs (miRNAs) have been implicated in the pathogenesis of glaucoma. We aimed to identify common variants in miRNA coding genes (MIR) associated with primary open-angle glaucoma (POAG). Using the NEIGHBORHOOD data set (3853 cases/33,480 controls with European ancestry), we first assessed the relation between 85 variants in 76 MIR genes and overall POAG. Subtype-specific analyses were performed in high-tension glaucoma (HTG) and normal-tension glaucoma subsets. Second, we examined the expression of miR-182, which was associated with POAG, in postmortem human ocular tissues (ciliary body, cornea, retina, and trabecular meshwork [TM]), using miRNA sequencing (miRNA-Seq) and droplet digital PCR (ddPCR). Third, miR-182 expression was also examined in human aqueous humor (AH) by using miRNA-Seq. Fourth, exosomes secreted from primary human TM cells were examined for miR-182 expression by using miRNA-Seq. Fifth, using ddPCR we compared miR-182 expression in AH between five HTG cases and five controls. Only rs76481776 in MIR182 gene was associated with POAG after adjustment for multiple comparisons (odds ratio [OR] = 1.23, 95% confidence interval [CI]: 1.11-1.42, P = 0.0002). Subtype analysis indicated that the association was primarily in the HTG subset (OR = 1.26, 95% CI: 1.08-1.47, P = 0.004). The risk allele T has been associated with elevated miR-182 expression in vitro. Data from ddPCR and miRNA-Seq confirmed miR-182 expression in all examined ocular tissues and TM-derived exosomes. Interestingly, miR-182 expression in AH was 2-fold higher in HTG patients than nonglaucoma controls (P = 0.03) without controlling for medication treatment. Our integrative study is the first to associate rs76481776 with POAG via elevated miR-182 expression.

  17. Retinal and choroidal oxygen saturation of the optic nerve head in open-angle glaucoma subjects by multispectral imaging

    PubMed Central

    Li, Gai-yun; Al-wesabi, Samer abdo; Zhang, Hong

    2016-01-01

    Abstract The aim of this study was to determine whether differences exist in oxygen supply to the optic nerve head (ONH) from the retinal and choroidal vascular layers in patients with primary open angle glaucoma (POAG) using multispectral imaging (MSI).This ia an observational, cross-sectional study. Multispectral images were acquired from 38 eyes of 19 patients with POAG, and 42 healthy eyes from 21 matched volunteers with Annidis’ RHA multispectral digital ophthalmoscopy. Superficial and deeper oxygen saturation of the optic disc was represented by the mean gray scale values on the retinal and choroidal oxy-deoxy maps, respectively. Statistical analysis was performed to detect differences in ONH oxygen saturation between the 2 groups. Oxygen saturation levels in the eyes of POAG patients with severe glaucoma were compared to those of fellow eyes from the same subjects. Linear correlation analysis was performed to assess the association between ONH oxygen saturation and systemic and ocular parameters. No statistical difference was found in retinal and choroidal oxygen saturation between the POAG and control groups. In the glaucoma patients, retinal oxygen saturation was lower for eyes with worse visual fields than in those with good visual fields (t = 4.009, P = 0.001). In POAG patients, retinal oxygen saturation was dependent on mean defect of visual field and retinal nerve fiber layer thickness (RNFLT) (r = 0.511, 0.504, P = 0.001, 0.001, respectively), whereas the choroid vasculature oxygen saturation was inversely related to RNFLT (r = −0.391, P = 0.015). An age-dependent increase in retinal oxygen saturation was found for both the POAG and control groups (r = 0.473, 0.410, P = 0.007, 0.003, respectively). MSI revealed a significant correlation between functional and structural impairments in glaucoma and retinal oxygen saturation. MSI could provide objective assessments of perfusion impairments of the glaucomatous ONH

  18. Retinal and choroidal oxygen saturation of the optic nerve head in open-angle glaucoma subjects by multispectral imaging.

    PubMed

    Li, Gai-Yun; Al-Wesabi, Samer Abdo; Zhang, Hong

    2016-12-01

    The aim of this study was to determine whether differences exist in oxygen supply to the optic nerve head (ONH) from the retinal and choroidal vascular layers in patients with primary open angle glaucoma (POAG) using multispectral imaging (MSI).This ia an observational, cross-sectional study.Multispectral images were acquired from 38 eyes of 19 patients with POAG, and 42 healthy eyes from 21 matched volunteers with Annidis' RHA multispectral digital ophthalmoscopy. Superficial and deeper oxygen saturation of the optic disc was represented by the mean gray scale values on the retinal and choroidal oxy-deoxy maps, respectively. Statistical analysis was performed to detect differences in ONH oxygen saturation between the 2 groups. Oxygen saturation levels in the eyes of POAG patients with severe glaucoma were compared to those of fellow eyes from the same subjects. Linear correlation analysis was performed to assess the association between ONH oxygen saturation and systemic and ocular parameters.No statistical difference was found in retinal and choroidal oxygen saturation between the POAG and control groups. In the glaucoma patients, retinal oxygen saturation was lower for eyes with worse visual fields than in those with good visual fields (t = 4.009, P = 0.001). In POAG patients, retinal oxygen saturation was dependent on mean defect of visual field and retinal nerve fiber layer thickness (RNFLT) (r = 0.511, 0.504, P = 0.001, 0.001, respectively), whereas the choroid vasculature oxygen saturation was inversely related to RNFLT (r = -0.391, P = 0.015). An age-dependent increase in retinal oxygen saturation was found for both the POAG and control groups (r = 0.473, 0.410, P = 0.007, 0.003, respectively).MSI revealed a significant correlation between functional and structural impairments in glaucoma and retinal oxygen saturation. MSI could provide objective assessments of perfusion impairments of the glaucomatous ONH. This is a

  19. Resident compliance with the american academy of ophthalmology preferred practice pattern guidelines for primary open-angle glaucoma.

    PubMed

    Ong, Sally S; Sanka, Krishna; Mettu, Priyatham S; Brosnan, Thomas M; Stinnett, Sandra S; Lee, Paul P; Challa, Pratap

    2013-12-01

    To examine resident adherence to preferred practice pattern (PPP) guidelines set up by the American Academy of Ophthalmology for follow-up care of primary open-angle glaucoma (POAG) patients. Retrospective chart review. One hundred three charts were selected for analysis from all patients with an International Classification of Diseases, Ninth Revision, code of open-angle glaucoma or its related entities who underwent a follow-up evaluation between July 2, 2003, and December 15, 2004, at the resident ophthalmology clinic in the Durham Veteran Affairs Medical Center. Follow-up visits of POAG patients were evaluated for documentation of 19 elements in accordance to PPP guidelines. Compliance rates for the 19 elements of PPP guidelines first were averaged in all charts, and then were averaged per resident and were compared among 8 residents between their first and second years of residency. The overall mean compliance rate for all 19 elements was 82.6% for all charts (n = 103), 78.8% for first-year residents, and 81.7% for second-year residents. The increase from first to second year of residency was not significant (P>0.05). Documentation rates were high (>90%) for 14 elements, including all components of the physical examination and follow-up as well as most components of the examination history and management plan. Residents documented adjusting target intraocular pressure downward, local or systemic problems with medications, and impact of visual function on daily living approximately 50% to 80% of the time. Documentation rates for components of patient education were the lowest, between 5% and 16% in all charts. Residents' compliance with PPP guidelines for a POAG follow-up visit was very high for most elements, but documentation rates for components of patient education were poor. Adherence rates to PPP guidelines can be used as a tool to evaluate and improve resident performance during training. However, further studies are needed to establish the advantages of

  20. [A study on the association of apolipoprotein E genotypes with primary open-angle glaucoma and primary angle-closure glaucoma in northeast of China].

    PubMed

    Yuan, Hui-ping; Xiao, Zheng; Yang, Bin-bin

    2007-05-01

    To analysis the association of apolipoprotein E (APOE) genotype with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) in northeast of China. The polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) technique were used to detect the distribution of genotype and gene frequency of APOE alleles in 36 patients with POAG, 69 with PACG and 57 healthy subjects as control. The frequency of APOE epsilon 3/epsilon 4 genotype in POAG group (41.7%)and epsilon 2/epsilon 4 in PACG group (43.5%) was significantly (P < 0.05) higher than that in control group (14.0% and 21.1%, respectively). The frequency of APOE epsilon 4 allele in both of POAG (37.5%) and PACG group (39.2%) was significantly (P < 0.05) higher than that in control group (17.5%), whereas the frequency of APOE epsilon 2 allele in POAG group (8.3%) was significantly (P < 0.05) lower than that in control group (15.8%). APOE epsilon 4 allele may be a latent risk factor in the development of primary glaucoma, but APOE epsilon 2 allele may play a protective role in POAG and warrant further investigation.

  1. Development of Dorzolamide Loaded 6-O-Carboxymethyl Chitosan Nanoparticles for Open Angle Glaucoma

    PubMed Central

    Ahmed, Mohammed Hadi

    2013-01-01

    Chitosan (CS) is a biodegradable, biocompatible, and mucoadhesive natural polymer soluble in acidic pH only and can be irritating to the eye. Objective of the study was to synthesize water soluble 6-O-carboxymethyl (OCM-CS) derivative of CS, and to develop CS and OCM-CS nanoparticles (NPs) loaded with dorzolamide hydrochloride (DRZ). CS was reacted with monochloroacetic acid (MCA) for OCM-CS synthesis and was characterized by FT-IR, DSC, and 13C NMR. CS and OCM-CS NPs were prepared by ionic gelation method. Ocular irritation potential were evaluated and therapeutic efficacy was measured by reduction in intraocular pressure (IOP) in normotensive rabbits. Maximum yield was obtained when the ratio of water/isopropyl alcohol was 1/4 at 55°C. The FT-IR, DSC and 13C NMR confirmed the formation of an ether linkage between hydroxyl groups of CS and MCA. The particle size and zeta potential of optimised CSNPs was 250.3 ± 2.62 nm and +33.47 ± 0.723 mV, whereas those for OCM-CSNPs were 187.1 ± 2.72 nm and 30.87 ± 0.86 mV. The entrapment efficiency was significantly improved for OCM-CSNPs, compared to CSNPs. OCM-CSNPs had tailored drug release and improved bioavailability with reduction in pulse entry as compared to CSNPs. Hence, it can be concluded that DRZ loaded OCM-CSNPs would be better alternative option to available eye drops for glaucoma treatment. PMID:24222858

  2. Preservative-free latanoprost eye drops in patients with primary open-angle glaucoma/ocular hypertension.

    PubMed

    Sanford, Mark

    2014-07-01

    Latanoprost is an ester prodrug prostaglandin F2α analogue that is a selective agonist of endogenous prostanoid FP receptors and that reduces intraocular pressure (IOP) by increasing the uveoscleral outflow of aqueous humour. Preservative-free (PF) latanoprost [Monoprost(®)] is a new formulation of latanoprost that is approved for use in the EU in patients with primary open-angle glaucoma (POAG)/ocular hypertension. This article reviews the clinical pharmacology of this new formulation, focussing on its efficacy and tolerability in this indication. PF latanoprost was efficacious in reducing IOP in a randomized, investigator-masked, multinational trial in patients with POAG/ocular hypertension (n = 404). At days 15, 42 and 84 of follow-up, PF latanoprost was noninferior to benzalkonium chloride-preserved (BAK) latanoprost in terms of reductions in IOP. In this trial, at days 42 and 84 the proportions of patients with conjunctival hyperaemia were significantly lower with PF latanoprost than with BAK latanoprost. Patient subjective ratings of ocular symptoms were also significantly lower with PF latanoprost than with BAK latanoprost. In the absence of head-to-head comparisons with other anti-glaucoma drugs, an adjusted, indirect comparison meta-analysis was performed using data from 21 randomized clinical trials in patients with POAG/ocular hypertension. Based on this analysis, PF latanoprost had similar efficacy to different formulations of three comparator prostaglandin analogues in reducing the patient's IOP and was associated with a significantly lower risk of developing hyperaemia/ocular redness than these comparators. PF latanoprost offers a useful alternative to the available preserved prostaglandin analogues for the treatment of POAG/ocular hypertension.

  3. Estimated Cerebrospina Fluid Pressure and the 5-Year Incidence of Primary Open-Angle Glaucoma in a Chinese Population

    PubMed Central

    Zhong, Hua; Tao, Yijin; Yuan, Yuansheng; Pan, Chen-Wei

    2016-01-01

    Purpose We aim to assess the longitudinal association between baseline estimated cerebrospinal fluid pressure (CSFP) and 5-year incident primary open angle glaucoma (POAG) in a population-based sample of Bai Chinese living in rural China. Methods Among the 2133 Bai Chinese aged 50 years or older who had participated in the baseline examination of the Yunnan Minority Eye Study, 1520 (71.3%) attended the follow-up examination after five years and 1485 were at risk of developing POAG. Participants underwent comprehensive ophthalmic examinations at both baseline and follow-up surveys. CSFP in mmHg was estimated as 0.55 × body mass index (kg/m2) + 0.16 × diastolic blood pressure (mmHg)-0.18 × age (years)-1.91. Glaucoma was defined using the International Society of Geographical and Epidemiological Ophthalmology Classification criteria. Multivariate logistic regression models were established to determine the association between baseline CSFP and incident POAG. Results After a mean follow-up time of 5 years, 19 new cases of POAG were detected, with an incidence rate of 1.3% (95% confidence interval, 0.7–1.9%). In multivariate logistic regression analysis, after adjusting for age, gender, education, intraocular pressure, central corneal thickness, hypertension and diabetes, no significant associations, nor any trends, were evident between baseline estimated CSFP and incident POAG. The association between estimated CSFP per mmHg increase in baseline and 5-year incidence of POAG was also non-significant, with adjusted relative risk of 0.96 (P = 0.11) in multivariate analysis. Conclusions This longitudinal cohort study does not support previously observed cross-sectional association between estimated CSFP and POAG in population-based studies. PMID:27611879

  4. Comparison of Pattern Electroretinography and Optical Coherence Tomography Parameters in Patients with Primary Open-Angle Glaucoma and Ocular Hypertension

    PubMed Central

    Tiryaki Demir, Semra; Oba, Mehmet Ersin; Erdoğan, Ezgi Tuna; Odabaşı, Mahmut; Dirim, Ayşe Burcu; Demir, Mehmet; Can, Efe; Kara, Orhan; Yekta Şendül, Selam

    2015-01-01

    Objectives: To investigate the correlation of visual field (VF), pattern electroretinography (PERG) and Fourier domain optical coherence tomography (FD-OCT) results in patients with ocular hypertension (OHT) and early primary open-angle glaucoma (POAG). Materials and Methods: The study included 72 eyes of 37 patients with early POAG, 76 eyes of 38 patients with OHT, and 60 eyes of 30 controls. All subjects underwent full ophthalmologic examination, VF assessment with 24-2 Humphrey standard automated perimetry (Swedish Interactive Thresholding Algorithm (SITA)-Standard), retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness measurement with FD-OCT, and PERG P50 and N95 wave latency and amplitude measurements with electroretinography (Nihon Kohden). Results: With the exception of the nasal quadrant, all GCC parameters and RNFL results were significantly lower in the POAG group compared to the OHT and control groups. There was no statistically significant difference between the OHT and control group. PERG amplitudes were lower in the POAG and OHT groups than in the control group. Reduction in N95 amplitude was greater than that of P50 amplitude. No difference was detected in PERG latencies among groups. GCC was significantly correlated with VF and RNFL in the POAG group. Conclusion: Significant thinning of the GCC and RNFL occurs in addition to VF pathologies in patients with early POAG, and these examinations should be concomitantly evaluated. During diagnostic assessment of patients with early POAG, GCC and RNFL analysis by FD-OCT are highly effective. GCC is as reliable as RNLF in the early diagnosis of glaucoma and there is a highly significant correlation between them. Dysfunction of ganglion cells in patients with OHT may be detected earlier using PERG amplitude analysis. PMID:27800239

  5. Brinzolamide ophthalmic suspension: a review of its pharmacology and use in the treatment of open angle glaucoma and ocular hypertension.

    PubMed

    Iester, Michele

    2008-09-01

    Brinzolamide is a white powder commercially formulated as a 1% ophthalmic suspension to reduce intraocular pressure (IOP). Pharmacologically, brinzolamide is a highly specific, non-competitive, reversible, and effective inhibitor of carbonic anhydrase II (CA-II), able to suppress formation of aqueous humor in the eye and thus to decrease IOP. Several clinical trials have evaluated its safety and the most commonly ocular adverse events are blurred vision (3%-8%), ocular discomfort (1.8%-5.9%), and eye pain (0.7%-4.0%). Brinzolamide has been introduced to treat ocular hypertension and primary open-angle glaucoma. In some clinical studies it has been estimated that brinzolamide reduced IOP by was about 18%. Brinzolamide can be added to beta-blockers and prostaglandins. In the latter combination, because prostaglandin derivatives improve the uveoscleral outflow but also increase the activity of CA in ciliary epithelium with a secondary increase in aqueous humor secretion, and slightly reduce the efficacy of prostaglandin analogues, theoretically topical CA inhibitors (CAI) decrease IOP by inhibiting CA-II, thus improving prostaglandin efficacy as well as lowering IOP. Brinzolamide could have a secondary possible effect on ocular flow too. Some clinical studies showed a mild improvement of ocular blood flow. Theoretically, CAI could give rise to metabolic acidosis, with secondary vasodilatation and improvement of blood flow. Systemic acidosis can occur in the setting of oral CAI therapy, and local acidosis within ocular tissues is theoretically possible with topical CAI therapy, with the potential for a local increase in ocular blood flow. In conclusion, topical CAI treatment has efficacy in IOP-lowering ranging from 15% to 20%. From published data, brinzolamide can be used as first-line medication, even if other medications have a higher efficacy, with few side effects and it is a good adjunctive treatment. In some type of glaucoma patients with a vascular

  6. Measurement of Systemic Mitochondrial Function in Advanced Primary Open-Angle Glaucoma and Leber Hereditary Optic Neuropathy.

    PubMed

    Van Bergen, Nicole J; Crowston, Jonathan G; Craig, Jamie E; Burdon, Kathryn P; Kearns, Lisa S; Sharma, Shiwani; Hewitt, Alex W; Mackey, David A; Trounce, Ian A

    2015-01-01

    Primary Open Angle Glaucoma (POAG) is a common neurodegenerative disease characterized by the selective and gradual loss of retinal ganglion cells (RGCs). Aging and increased intraocular pressure (IOP) are glaucoma risk factors; nevertheless patients deteriorate at all levels of IOP, implying other causative factors. Recent evidence presents mitochondrial oxidative phosphorylation (OXPHOS) complex-I impairments in POAG. Leber Hereditary Optic Neuropathy (LHON) patients suffer specific and rapid loss of RGCs, predominantly in young adult males, due to complex-I mutations in the mitochondrial genome. This study directly compares the degree of OXPHOS impairment in POAG and LHON patients, testing the hypothesis that the milder clinical disease in POAG is due to a milder complex-I impairment. To assess overall mitochondrial capacity, cells can be forced to produce ATP primarily from mitochondrial OXPHOS by switching the media carbon source to galactose. Under these conditions POAG lymphoblasts grew 1.47 times slower than controls, whilst LHON lymphoblasts demonstrated a greater degree of growth impairment (2.35 times slower). Complex-I enzyme specific activity was reduced by 18% in POAG lymphoblasts and by 29% in LHON lymphoblasts. We also assessed complex-I ATP synthesis, which was 19% decreased in POAG patients and 17% decreased in LHON patients. This study demonstrates both POAG and LHON lymphoblasts have impaired complex-I, and in the majority of aspects the functional defects in POAG were milder than LHON, which could reflect the milder disease development of POAG. This new evidence places POAG in the spectrum of mitochondrial optic neuropathies and raises the possibility for new therapeutic targets aimed at improving mitochondrial function.

  7. Micro-Bypass Implantation for Primary Open-Angle Glaucoma Combined with Phacoemulsification: 4-Year Follow-Up

    PubMed Central

    Fea, Antonio Maria; Consolandi, Giulia; Zola, Marta; Pignata, Giulia; Cannizzo, Paola; Lavia, Carlo; Rolle, Teresa; Grignolo, Federico Maria

    2015-01-01

    Purpose. To report the long-term follow-up results in patients with cataract and primary open-angle glaucoma (POAG) randomly assigned to cataract surgery combined with micro-bypass stent implantation or phacoemulsification alone. Methods. 36 subjects with cataract and POAG were randomized in a 1 : 2 ratio to either iStent implantation and cataract surgery (combined group) or cataract surgery alone (control group). 24 subjects agreed to be evaluated again 48 months after surgery. Patients returned one month later for unmedicated washout assessment. Results. At the long-term follow-up visit we reported a mean IOP of 15,9 ± 2,3 mmHg in the iStent group and 17 ± 2,5 mmHg in the control group (p = NS). After washout, a 14,2% between group difference in favour of the combined group was statistically significant (p = 0,02) for mean IOP reduction. A significant reduction in the mean number of medications was observed in both groups compared to baseline values (p = 0,005 in the combined group and p = 0,01 in the control group). Conclusion. Patients in the combined group maintained low IOP levels after long-term follow-up. Cataract surgery alone showed a loss of efficacy in controlling IOP over time. Both treatments reduced the number of ocular hypotensive medications prescribed. This trial is registered with: NCT00847158. PMID:26587282

  8. Common variants near ABCA1, AFAP1 and GMDS confer risk of primary open-angle glaucoma

    PubMed Central

    Fogarty, Rhys; Sharma, Shiwani; Hewitt, Alex W.; Martin, Sarah; Law, Matthew H.; Cremin, Katie; Bailey, Jessica N. Cooke; Loomis, Stephanie J.; Pasquale, Louis R.; Haines, Jonathan L.; Hauser, Michael A.; Viswanathan, Ananth C.; McGuffin, Peter; Topouzis, Fotis; Foster, Paul J.; Graham, Stuart L; Casson, Robert J; Chehade, Mark; White, Andrew J; Zhou, Tiger; Souzeau, Emmanuelle; Landers, John; Fitzgerald, Jude T; Klebe, Sonja; Ruddle, Jonathan B; Goldberg, Ivan; Healey, Paul R; Mills, Richard A.; Wang, Jie Jin; Montgomery, Grant W.; Martin, Nicholas G.; Radford-Smith, Graham; Whiteman, David C.; Brown, Matthew A.; Wiggs, Janey L.; Mackey, David A; Mitchell, Paul; MacGregor, Stuart; Craig, Jamie E.

    2014-01-01

    Primary open-angle glaucoma (POAG) is a major cause of irreversible blindness worldwide. We performed a genome-wide association study in an Australian discovery cohort comprising 1,155 advanced POAG cases and 1,992 controls. Association of the top SNPs from the discovery stage was investigated in two Australian replication cohorts (total 932 cases, 6,862 controls) and two US replication cohorts (total 2,616 cases, 2,634 controls). Meta-analysis of all cohorts revealed three novel loci associated with development of POAG. These loci are located upstream of ABCA1 (rs2472493 [G] OR=1.31, P= 2.1 × 10−19), within AFAP1 (rs4619890 [G] OR=1.20, P= 7.0 × 10−10) and within GMDS (rs11969985 [G] OR=1.31, and P= 7.7 × 10−10). Using RT-PCR and immunolabelling, we also showed that these genes are expressed within human retina, optic nerve and trabecular meshwork and that ABCA1 and AFAP1 are also expressed in retinal ganglion cells. PMID:25173105

  9. Association of Common Variants in eNOS Gene with Primary Open Angle Glaucoma: A Meta-Analysis

    PubMed Central

    Xiang, Yang; Dong, Yi; Li, Xuan; Tang, Xin

    2016-01-01

    Purpose. To clarify the association of endothelial nitric oxide synthase (eNOS) polymorphisms and primary open angle glaucoma (POAG). Methods. After a systematic literature search in the MEDLINE, EMBASE, and ISI Web of Science databases, all relevant studies evaluating the association between the polymorphisms (rs2070744 and rs1799983) of eNOS gene and POAG were screened and included. The pooled odds ratios (ORs) and the 95% confidence interval (CI) of each single-nucleotide polymorphism (SNP) in five genetic models were estimated using fixed-effect model if I2 < 50% in the test for heterogeneity; otherwise the random-effects model was used. Results. Thirty-one records were obtained, with five being suitable for meta-analysis. The overall results showed that both TT genotype in rs2070744 and GG genotype in rs1799983 are associated with decreased risk of POAG susceptibility. Stratified analysis based on ethnicity showed that the association of rs2070744 with POAG remained only in Caucasians. Results of subgroup analysis by sex indicated association between both polymorphisms and POAG in female group, but not in male group. Conclusions. TT genotype and/or T-allele in rs2070744, as well as GG genotype and/or G-allele in rs1799983, was associated with decreased risk for POAG overall and in female group. PMID:27242919

  10. Primary open-angle glaucoma patients characterized by ocular vasospasm demonstrate a different ocular vascular response to timolol versus betaxolol.

    PubMed

    Evans, D W; Harris, A; Cantor, L B

    1999-12-01

    We evaluated the retrobulbar response to a selective versus nonselective beta blocker in a subgroup of primary open-angle glaucoma patients (POAG) characterized by ocular vasospasm. Eleven patients who exhibited ocular vasospasm (i.e. a significant increase in ophthalmic artery blood flow velocity or a significant decrease in ophthalmic artery resistance index during hypercapnia) underwent medication washout for 4 weeks and were enrolled in a double-masked cross-over study (betaxolol versus timolol). Patients were evaluated for blood flow velocity of the retrobulbar vessels using color Doppler imaging, intraocular pressure, visual field sensitivity and contrast sensitivity at the beginning and end of each 4 week treatment period. Timolol treatment caused a significant reduction in IOP (p = .007), but no change in retrobulbar hemodynamics or visual function. After betaxolol treatment, resistance index fell significantly (p = .040) in the ophthalmic artery and increased significantly in both the central retinal (p = .003) and temporal posterior ciliary arteries (p = .030). Also following betaxolol treatment, contrast sensitivity improved significantly (p = .006), and a significant positive correlation was shown between change in contrast sensitivity and change in resistance index (r = .70; p = .015) of the ciliary arteries. POAG patients characterized by ocular vasospasm display a significant hemodynamic response to betaxolol, but not to timolol.

  11. Predicting Clinical Binary Outcome Using Multivariate Longitudinal Data: Application to Patients with Newly Diagnosed Primary Open-Angle Glaucoma.

    PubMed

    Gao, Feng; Miller, J Philip; Beiser, Julia A; Xiong, Chengjie; Gordon, Mae O

    2015-10-01

    Primary open angle glaucoma (POAG) is a chronic, progressive, irreversible, and potentially blinding optic neuropathy. The risk of blindness due to progressive visual field (VF) loss varies substantially from patient to patient. Early identification of those patients destined to rapid progressive visual loss is crucial to prevent further damage. In this article, a latent class growth model (LCGM) was developed to predict the binary outcome of VF progression using longitudinal mean deviation (MD) and pattern standard deviation (PSD). Specifically, the trajectories of MD and PSD were summarized by a functional principal component (FPC) analysis, and the estimated FPC scores were used to identify subgroups (latent classes) of individuals with distinct patterns of MD and PSD trajectories. Probability of VF progression for an individual was then estimated as weighted average across latent classes, weighted by posterior probability of class membership given baseline covariates and longitudinal MD/PSD series. The model was applied to the participants with newly diagnosed POAG from the Ocular Hypertension Treatment Study (OHTS), and the OHTS data was best fit by a model with 4 latent classes. Using the resultant optimal LCGM, the OHTS participants with and without VF progression could be accurately differentiated by incorporating longitudinal MD and PSD.

  12. Fluctuation in systolic blood pressure is a major systemic risk factor for development of primary open-angle glaucoma

    PubMed Central

    Lee, Na Young; Jung, Younhea; Han, Kyungdo; Park, Chan Kee

    2017-01-01

    We evaluated the risk of development of primary open-angle glaucoma (POAG) in terms of variability in BP using a nationwide, population-based, 11-year longitudinal study using the Korean National Health Insurance Research Database. We included patients who underwent health care examinations more than twice between January 2002 and December 2006. We divided all subjects by the quartiles of variability in systolic blood pressure (SBP), diastolic blood pressure (DBP), and the difference between SBP and DBP. Of the total of 80,021 included subjects, 910 were diagnosed with POAG between January 2007 and December 2013. Both the Kaplan-Meier survival curves and log-rank test data indicated that patients with higher-level BP variability developed POAG significantly more frequently than did patients with lower-level variability (P < 0.001). On multivariate Cox’s regression modeling including gender, age, sex, household income, smoking status, level of alcohol intake, extent of exercise, diabetes mellitus status, dyslipidemia status, SBP, and DBP; the hazard ratios among the highest and lowest quartiles of SD SBP and CV SBP were 1.256 and 1.238, respectively. Our findings suggest that subjects in the highest quartile of SBP variability were significantly more likely to develop POAG in our population-based sample of Korean adults. PMID:28262703

  13. Soluble Guanylate Cyclase α1–Deficient Mice: A Novel Murine Model for Primary Open Angle Glaucoma

    PubMed Central

    Buys, Emmanuel S.; Ko, Yu-Chieh; Alt, Clemens; Hayton, Sarah R.; Jones, Alexander; Tainsh, Laurel T.; Ren, Ruiyi; Giani, Andrea; Clerté, Maeva; Abernathy, Emma; Tainsh, Robert E. T.; Oh, Dong-Jin; Malhotra, Rajeev; Arora, Pankaj; de Waard, Nadine; Yu, Binglan; Turcotte, Raphael; Nathan, Daniel; Scherrer-Crosbie, Marielle; Loomis, Stephanie J.; Kang, Jae H.; Lin, Charles P.; Gong, Haiyan; Rhee, Douglas J.; Brouckaert, Peter; Wiggs, Janey L.; Gregory, Meredith S.; Pasquale, Louis R.; Bloch, Kenneth D.; Ksander, Bruce R.

    2013-01-01

    Primary open angle glaucoma (POAG) is a leading cause of blindness worldwide. The molecular signaling involved in the pathogenesis of POAG remains unknown. Here, we report that mice lacking the α1 subunit of the nitric oxide receptor soluble guanylate cyclase represent a novel and translatable animal model of POAG, characterized by thinning of the retinal nerve fiber layer and loss of optic nerve axons in the context of an open iridocorneal angle. The optic neuropathy associated with soluble guanylate cyclase α1–deficiency was accompanied by modestly increased intraocular pressure and retinal vascular dysfunction. Moreover, data from a candidate gene association study suggests that a variant in the locus containing the genes encoding for the α1 and β1 subunits of soluble guanylate cyclase is associated with POAG in patients presenting with initial paracentral vision loss, a disease subtype thought to be associated with vascular dysregulation. These findings provide new insights into the pathogenesis and genetics of POAG and suggest new therapeutic strategies for POAG. PMID:23527308

  14. Cost Effectiveness of Medications Compared with Laser Trabeculoplasty in Patients with Newly-Diagnosed Open-Angle Glaucoma

    PubMed Central

    Stein, Joshua D.; Kim, David D.; Peck, Will W.; Giannetti, Steven M.; Hutton, David W.

    2012-01-01

    Objective To determine the most cost-effective treatment option for patients with newly-diagnosed mild open-angle glaucoma (OAG): observation only, treatment with generic topical prostaglandin analogs (PGAs) or treatment with laser trabeculoplasty (LTP) Methods Using a Markov model with a 25 year time horizon, we compared the incremental cost effectiveness of treating newly-diagnosed mild OAG with PGAs, LTP, or observation only. Results The incremental cost effectiveness of LTP over no treatment is $16824/ quality-adjusted life year (QALY). By comparison, the incremental cost effectiveness of PGAs over no treatment is $14179/QALY and it provides greater health-related quality of life relative to LTP. If PGAs are 25% less effective due to poor patient adherence, LTP can confer greater value. Conclusion PGAs and LTP are both cost-effective options for the management of newly-diagnosed mild OAG. Assuming optimal medication adherence, PGAs confer greater value compared with LTP. However, when assuming more realistic levels of medication adherence (making them 25% less effective than the documented effectiveness reported in clinical trials), at today's prices for PGAs, LTP may be a more cost effective alternative. PMID:22332202

  15. Comparison of Newly Diagnosed Ocular Hypertension and Open-Angle Glaucoma: Ocular Variables, Risk Factors, and Disease Severity

    PubMed Central

    Buys, Yvonne M.; Harasymowycz, Paul; Gaspo, Rania; Kwok, Kenneth; Hutnik, Cindy M. L.; Blondeau, Pierre; Birt, Catherine M.; Piemontesi, Robert L. G.; Gould, Lisa F.; Lesk, Mark R.; Ahmed, Iqbal K.

    2012-01-01

    Purpose. To describe the distribution of ocular variables, risk factors, and disease severity in newly diagnosed ocular hypertension (OH) or open-angle glaucoma (OAG). Methods. Eligible subjects underwent a complete history and examination. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) obtained from multiple logistic regression models were used to compare OAG to OH and advanced to early/moderate OAG. Results. 405 subjects were enrolled: 292 (72.1%) with OAG and 113 (27.9%) with OH. 51.7% had early, 27.1% moderate, and 20.9% advanced OAG. The OR for OAG versus OH was 8.19 (P < 0.0001) for disc notch, 5.36 (P < 0.0001) for abnormal visual field, 1.45 (P = 0.001) for worsening mean deviation, 1.91 (P < 0.0001) for increased cupping, 1.03 for increased age (P = 0.030), and 0.36 (P = 0.010) for smoking. Conclusions. Increased age was a risk for OAG, and smoking decreased the risk of OAG compared to OH. Almost half of the OAG subjects had moderate/advanced disease at diagnosis. PMID:21869921

  16. Comparison of self-measured diurnal intraocular pressure profiles using rebound tonometry between primary angle closure glaucoma and primary open angle glaucoma patients

    PubMed Central

    Tan, Shaoying; Baig, Nafees; Hansapinyo, Linda; Jhanji, Vishal; Wei, Shihui; Tham, Clement C.

    2017-01-01

    Purpose To document the diurnal intraocular pressure (IOP) profile with rebound tonometry performed by primary glaucoma patients in non-clinic environment. Patients and methods Fifty-three medically-treated eyes of 31 primary angle closure glaucoma (PACG) and 22 primary open angle glaucoma (POAG) patients with no previous eye surgery were recruited. Diurnal IOP was measured 5 times per day at four-hourly intervals from 08:00 to 24:00 for 1 week in patients’ study eye using rebound tonometry in a non-clinic environment. The diurnal IOP profiles were compared between PACG and POAG eyes. Results For both PACG and POAG eyes, mean patient-measured IOP was highest in the morning, gradually decreased over the course of a day, and was lowest by midnight (p < 0.001). The diurnal IOP fluctuation ± 1 standard deviation (SD), as documented by SD in daily IOP values, was lower in PACG group (1.6 ± 1.1 mmHg) than in POAG group (2.0 ± 1.2 mmHg; p = 0.049). The mean trough IOP ± 1 SD was higher in PACG group (12.9 ± 2.8 mmHg), compared to POAG group (11.5 ± 3.8 mmHg; p = 0.041). The mean IOP level at midnight ± 1 SD in PACG group (14.0 ± 3.2 mmHg) was higher than that in POAG group (12.1 ± 3.7 mmHg; p = 0.013). Conclusions IOP in primary glaucoma patients was highest in the morning, and decreased over the course of a day in non-clinic environment. Treated diurnal IOP fluctuation seemed to be greater in POAG than PACG eyes. PMID:28333942

  17. Prospective, unmasked evaluation of the iStent® inject system for open-angle glaucoma: synergy trial.

    PubMed

    Voskanyan, Lilit; García-Feijoó, Julián; Belda, Jose I; Fea, Antonio; Jünemann, Anselm; Baudouin, Christophe

    2014-02-01

    Micro-invasive glaucoma surgical implantation of trabecular micro-bypass stents, previously shown to be safe and effective for open-angle glaucoma (OAG) subjects during cataract surgery, was considered for evaluation as a sole procedure. The aim of this study was to evaluate the safety and intraocular pressure (IOP)-lowering efficacy after ab interno implantation of two Glaukos Trabecular Micro-Bypass iStent inject second generation devices in subjects with OAG. This study was performed at sites in France, Germany, Italy, Republic of Armenia, and Spain. In this pan-European, multi-center prospective, post-market, unmasked study, 99 patients with OAG on at least two topical ocular hypotensive medications who required additional IOP lowering to control glaucoma disease underwent implantation of two GTS400 stents in a stand-alone procedure. Patients were qualified if they presented with preoperative mean IOP between 22 and 38 mmHg after medication washout. Postoperatively, subjects were assessed at Day 1, Months 1, 3, 6, 7, 9, and 12. IOP, medication use and safety were assessed at each visit. Sixty-six percent of subjects achieved IOP ≤18 mmHg at 12 months without medication, and 81% of subjects achieved Month 12 IOP ≤ 18 mmHg with either a single medication or no medication. Mean baseline washout IOP values decreased by 10.2 mmHg or 39.7% from 26.3 (SD 3.5) mmHg to 15.7 (SD 3.7) mmHg at Month 12. Mean IOP at 12 months was 14.7 (SD 3.1) mmHg in subjects not using ocular hypotensive medications. Reduction from preoperative medication burden was achieved in 86.9% of patients, including 15.2% with reduction of one medication and 71.7% with reduction of two or more medications. Postoperative complications occurred at a low rate and resolved without persistent effects. In this series, implantation of two trabecular micro-bypass second generation stents in subjects with OAG resulted in IOP and medication reduction and favorable safety outcomes.

  18. Bupropion Use and Risk of Open-Angle Glaucoma among Enrollees in a Large U.S. Managed Care Network

    PubMed Central

    Stein, Joshua D.; Talwar, Nidhi; Kang, Jae H.; Okereke, Olivia I.; Wiggs, Janey L.; Pasquale, Louis R.

    2015-01-01

    Objective Tumor Necrosis Factor (TNF) mediates retinal ganglion cell death in glaucoma. Anti-TNF drugs are neuroprotective in an animal model of glaucoma. It is unclear whether medications with anti-TNF properties such as bupropion have an impact on the risk of developing open-angle glaucoma (OAG) in humans. The purpose of this study is to determine whether bupropion use alters the risk of developing OAG. Methods Claims data for beneficiaries age ≥35 years with no pre-existing OAG enrolled in a large nationwide U.S. managed care network continuously for ≥4 years between 2001-2011 was analyzed to identify patients who had been newly-diagnosed with OAG. The amount of bupropion use as captured from outpatient pharmacy claims over a four-year period was also quantified for each beneficiary. Multivariable Cox regression modeling assessed the impact of bupropion and other antidepressant medications on the risk of developing OAG with adjustment for sociodemographic characteristics of the enrollees along with medical and ocular comorbidities. Results Of 638,481 eligible enrollees, 15,292 (2.4%) developed OAG. After adjustment for confounding factors including use of other antidepressant medication classes, each additional month of bupropion use was associated with a 0.6% reduced risk of OAG (HR = 0.994, (95% CI: 0.989-0.998), p = 0.007). Compared to nonusers, those with 24-48 months of bupropion use had a 21% reduced hazard (HR=0.79, (CI: 0.65-0.94), p = 0.0099) of OAG. This association did not differ among persons taking bupropion for depression or for other reasons (p-interaction = 0.82). There was no significant association between use of tricyclic antidepressants (HR = 1.000, (CI: 0.997-1.004), p = 0.95) or selective serotonin reuptake inhibitors (HR = 0.999, (CI: 0.997-1.001), p = 0.39) and development of OAG. Conclusion These findings suggest bupropion use may be beneficial in reducing the risk of OAG. If prospective studies confirm the findings of this analysis

  19. Distribution of ocular perfusion pressure and its relationship with open-angle glaucoma: the singapore malay eye study.

    PubMed

    Zheng, Yingfeng; Wong, Tien Y; Mitchell, Paul; Friedman, David S; He, Mingguang; Aung, Tin

    2010-07-01

    PURPOSE. To describe the distribution of ocular perfusion pressure and its relationship with open-angle glaucoma (OAG) in a Malay population. METHODS. This was a population-based, cross-sectional study comprising 3280 (78.7% response) ethnic Malays. Intraocular pressure (IOP) was measured with Goldmann applanation tonometry. Systolic and diastolic blood pressure (SBP and DBP) was measured with a digital automatic blood pressure monitor. Mean ocular perfusion pressure (MOPP) = (2/3)(mean arterial pressure - IOP), where mean arterial pressure (MAP) = DBP + (1/3)(SBP - DBP), systolic perfusion pressure (SPP) = SBP - IOP, and diastolic perfusion pressure (DPP) = DBP - IOP, was calculated. The diagnosis of OAG was based on International Society for Geographical and Epidemiologic Ophthalmology criteria. RESULTS. A total of 3261 persons (mean age, 58.7 +/- 11 years, including 131 [4.0%] cases of OAG) were available for analyses. Among persons without glaucoma, the mean +/- SD IOP, MOPP, SPP, and DPP were 15.3 +/- 3.5, 52.8 +/- 9.3, 131.5 +/- 23.3, and 64.5 +/- 11.3 mm Hg, respectively. Among persons with OAG, the corresponding values were 16.8 +/- 5.9, 51.6 +/- 10.2, 134.5 +/- 24.6, and 61.4 +/- 11.5 mm Hg, respectively. In multiple logistic regression models adjusting for IOP, age, sex, and IOP- and BP-lowering treatments, OAG risk was significantly higher in participants with DBP, MOPP, or DPP in the lowest quartile (Q1) than in participants in the highest quartile (Q4) (Q1 vs. Q4: odds ratio [OR], 1.71 [95% confidence interval (CI), 1.04-2.96] for DBP; OR, 1.73 [95% CI, 1.05-3.15] for MOPP; OR, 1.75 [95% CI, 1.02-3.01] for DPP). CONCLUSIONS. Low DBP, low MOPP, and low DPP are independent risk factors for OAG in ethnic Malays, providing further evidence of a vascular mechanism in glaucoma pathogenesis across different populations.

  20. Bupropion use and risk of open-angle glaucoma among enrollees in a large U.S. managed care network.

    PubMed

    Stein, Joshua D; Talwar, Nidhi; Kang, Jae H; Okereke, Olivia I; Wiggs, Janey L; Pasquale, Louis R

    2015-01-01

    Tumor Necrosis Factor (TNF) mediates retinal ganglion cell death in glaucoma. Anti-TNF drugs are neuroprotective in an animal model of glaucoma. It is unclear whether medications with anti-TNF properties such as bupropion have an impact on the risk of developing open-angle glaucoma (OAG) in humans. The purpose of this study is to determine whether bupropion use alters the risk of developing OAG. Claims data for beneficiaries age ≥35 years with no pre-existing OAG enrolled in a large nationwide U.S. managed care network continuously for ≥4 years between 2001-2011 was analyzed to identify patients who had been newly-diagnosed with OAG. The amount of bupropion use as captured from outpatient pharmacy claims over a four-year period was also quantified for each beneficiary. Multivariable Cox regression modeling assessed the impact of bupropion and other antidepressant medications on the risk of developing OAG with adjustment for sociodemographic characteristics of the enrollees along with medical and ocular comorbidities. Of 638,481 eligible enrollees, 15,292 (2.4%) developed OAG. After adjustment for confounding factors including use of other antidepressant medication classes, each additional month of bupropion use was associated with a 0.6% reduced risk of OAG (HR = 0.994, (95% CI: 0.989-0.998), p = 0.007). Compared to nonusers, those with 24-48 months of bupropion use had a 21% reduced hazard (HR=0.79, (CI: 0.65-0.94), p = 0.0099) of OAG. This association did not differ among persons taking bupropion for depression or for other reasons (p-interaction = 0.82). There was no significant association between use of tricyclic antidepressants (HR = 1.000, (CI: 0.997-1.004), p = 0.95) or selective serotonin reuptake inhibitors (HR = 0.999, (CI: 0.997-1.001), p = 0.39) and development of OAG. These findings suggest bupropion use may be beneficial in reducing the risk of OAG. If prospective studies confirm the findings of this analysis, this may identify a novel

  1. Risk factors for open-angle glaucoma in Nigeria: results from the Nigeria National Blindness and Visual Impairment Survey.

    PubMed

    Kyari, Fatima; Abdull, Mohammed M; Wormald, Richard; Evans, Jennifer R; Nolan, Winifred; Murthy, Gudlavelleti V S; Gilbert, Clare E

    2016-06-07

    The glaucoma-specific blindness prevalence in Nigeria (0.7 %, 95 % CI 0.6-0.9 %) among those aged ≥40 years is one of the highest ever reported. This study determined the risk factors for open-angle glaucoma (OAG) in adults examined in the Nigeria National Blindness and Visual Impairment Survey. A nationally representative sample of 13,591 people aged ≥40 years in 305 clusters in Nigeria were examined (response rate 90.4 %) between January 2005 to June 2007. Everyone had logMAR visual acuity measurement, Frequency Doubling Technology (FDT) visual field testing, autorefraction, A-scan biometry and optic disc assessment. Full ocular examination (n = 6397), included Goldmann applanation tonometry. Values for defining glaucoma using International Society of Geographical and Epidemiological Ophthalmology criteria were derived from the study population. Disc images were graded by Moorfields Eye Hospital Reading Centre. Socio-demographic factors (age, gender, ethnicity, literacy and place of residence), ocular parameters (intraocular pressure [IOP], axial length and mean ocular perfusion pressure [MOPP]) and systemic parameters (blood pressure, blood glucose and body mass index [BMI]) were assessed for association with OAG. Thirteen thousand eighty-one (96 %) of 13,591 participants had vertical cup:disc ratio measured in at least one eye. 682 eyes of 462 participants were classified as OAG, with 12,738 controls. In univariate analyses the following were associated with OAG: increasing age, male gender, Igbo and Yoruba ethnic groups, illiteracy, longer axial length, higher IOP, lower MOPP, greater severity of hypertension and low BMI (underweight). In multivariate analysis, increasing age (odds ratio [OR] 1.04, 95 % CI 1.03-1.05), higher IOP (OR 1.22, 95 % CI 1.18-1.25) and Igbo ethnicity (OR 1.73, 95 % CI 1.18-2.56) were independent risk factors for OAG. Case detection strategies for OAG should be improved for those aged ≥40 years and for ethnic groups

  2. Ocular rigidity, outflow facility, ocular pulse amplitude, and pulsatile ocular blood flow in open-angle glaucoma: a manometric study.

    PubMed

    Dastiridou, Anna I; Tsironi, Evangelia E; Tsilimbaris, Miltiadis K; Ginis, Harilaos; Karyotakis, Nikos; Cholevas, Pierros; Androudi, Sofia; Pallikaris, Ioannis G

    2013-07-10

    To compare ocular rigidity (OR) and outflow facility (C) coefficients in medically treated open-angle glaucoma (OAG) patients and controls, and to investigate differences in ocular pulse amplitude (OPA) and pulsatile ocular blood flow (POBF) between the two groups. Twenty-one OAG patients and 21 controls undergoing cataract surgery were enrolled. Patients with early or moderate primary or pseudoexfoliative OAG participated in the glaucoma group. A computer-controlled system, consisting of a pressure transducer and a microstepping device was employed intraoperatively. After cannulation of the anterior chamber, IOP was increased by infusing the eye with microvolumes of saline solution. IOP was recorded after each infusion step. At an IOP of 40 mm Hg, an IOP decay curve was recorded for 4 minutes. OR coefficients, C, OPA, and POBF were estimated from IOP and volume recordings. There were no differences in age or axial length in the two groups. The OR coefficient was 0.0220 ± 0.0053 μl(-1) in the OAG and 0.0222 ± 0.0039 μl(-1) in the control group (P = 0.868). C was 0.092 ± 0.082 μL/min/mm Hg in the glaucoma group compared with 0.149 ± 0.085 μL/min/mm Hg in the control group at an IOP of 35 mm Hg (P < 0.001) and 0.178 ± 0.133 μL/min/mm Hg vs. 0.292 ± 0.166 μL/min/mm Hg, respectively, at an IOP of 25 mm Hg (P < 0.001). There were no differences in OPA or POBF between the two groups in baseline and increased levels of IOP (P > 0.05). Manometric data reveal lower C in OAG patients and increased C with increasing IOP. There were no differences in the OR coefficient, OPA, and POBF between medically treated OAG patients and controls, failing to provide evidence of altered scleral distensibility and choroidal blood flow in OAG.

  3. Determination of Serum Ceruloplasmin Concentration in Patients with Primary Open Angle Glaucoma with Cataract and Patients with Cataract Only: A Pilot Study

    PubMed Central

    Sarnat-Kucharczyk, Monika; Rokicki, Wojciech; Zalejska-Fiolka, Jolanta; Pojda-Wilczek, Dorota; Mrukwa-Kominek, Ewa

    2016-01-01

    Background The aim of this article was to describe the role of ceruloplasmin and to report preliminary results of ceruloplasmin concentrations in patients with primary open-angle glaucoma (POAG) with cataract and in patients with only cataract. Glaucoma, a neurodegenerative disease, is a heterogeneous group of conditions characterized by loss of retinal ganglion cells (RGC), their axons, progressive optic nerve damage, and visual field deterioration. Material/Methods The POAG group included 30 patients and the cataract group included 25 patients. Results Ceruloplasmin plays an essential role in iron metabolism and inactivating free radicals. In the presented pilot study, serum ceruloplasmin level was lower in the POAG group in comparison to the group with only cataract. Conclusions In treating persistent inflammation in the course of glaucoma, antiglaucoma drugs may increase the permeability of the blood-ocular barrier, which may be connected with the lower concentration of serum ceruloplasmin in the glaucoma patients group. PMID:27109647

  4. Trabeculectomy Versus Ex-Press Glaucoma Filtration Device in Silicomacrophagocytic Open Angle Glaucoma Secondary to Silicone Oil Emulsification

    PubMed Central

    Errico, Donato; Scrimieri, Francesca Luigia; Riccardi, Roberta; Iarossi, Giancarlo

    2016-01-01

    Purpose: To compare the outcomes of Ex-PRESS device implantation versus trabeculectomy in patients with ocular hypertension after pars plana vitrectomy and silicone oil injection (SOI). Materials and Methods: Twenty-six consecutive eyes with ocular hypertension after pars plana vitrectomy and SOI were included in this study and randomized to one of two groups: A group treated with Ex-PRESS (model P50) placed under a scleral flap (Ex-PRESS group), and a group treated with trabeculectomy (trabeculectomy group). Complete success (intraocular pressure [IOP] <21 mmHg without medication) and qualified success rates (IOP <21 mmHg with one or two glaucoma medications) at 2 years postoperatively were analyzed. Between-groups comparison was performed with the Mann-Whitney U-test for continuous variables, and Fischer exact test for categorical data. Success rates between groups were compared using Kaplan-Meier life analysis and the log-rank test. P < 0.05 was considered statistically significant. Results: In the Ex-PRESS group, complete success was achieved in 73% eyes and qualified success in 81.8% of eyes. In the trabeculectomy group, complete success was achieved in 40% and qualified success was achieved in 60% of eyes. The difference in mean IOP between groups was statistically significant from the 3rd postoperative month onward (P = 0.007 at 3 months, P = 0.003 at 6 months, and P = 0.03 at 24 months). Conclusion: Ex-PRESS implantation was more effective than trabeculectomy in controlling IOP in ocular hypertensives after pars plana vitrectomy and SOI, but the surgical technique may require improvement. PMID:27162449

  5. Examining Delay Intervals in the Diagnosis and Treatment of Primary Open Angle Glaucoma in an Egyptian Population and Its Impact on Lifestyle

    PubMed Central

    Abu Hussein, Nahla B.; Habib, Ahmed E.; El Sayed, Yasmine M.

    2016-01-01

    Purpose. To examine causes as well as extent of delay in diagnosis and treatment of primary open angle glaucoma patients in a sample of Egyptians. Patients and Methods. 440 patients with primary open angle glaucoma were interviewed to evaluate delay in their diagnosis and treatment. The extent and cause of delay were investigated. The total delay interval, if any, was correlated with socioeconomic and other factors. Results. The median total delay was one year, with 50% of patients having a total delay of 1 year or less, of which 25% exhibited zero total delay. 25% of patients had a delay ranging from 1 to 3 years, and 25% had a total delay ranging from 3 to 27 years. Diagnostic delay accounted for 43.03% of cases. Longer delays were met in patients with certain socioeconomic factors. Patients with a positive family history of glaucoma displayed shorter delay periods. Conclusion. Significant delay in the diagnosis and treatment of glaucoma was found. Poor socioeconomic status seems to hinder timely diagnosis and treatment of POAG. Certain socioeconomic factors seem to correlate with the extent of delay. More effort is thus needed to subsidize the cost of investigations and treatment for glaucoma patients. PMID:28116140

  6. Patient-Reported Vision-Related Quality-of-Life Differences between Primary Angle-Closure Glaucoma and Primary Open-Angle Glaucoma

    PubMed Central

    Guo, Chao-Yu; Chen, Yu-Jing; Chen, Mei-Ju; Ko, Yu-Chieh; Huang, Nicole; Liu, Catherine Jui-ling

    2016-01-01

    Purpose To investigate the different impacts on patient-reported vision-related quality of life (pVRQOL) outcomes in patients with primary angle-closure glaucoma(PACG) and primary open-angle glaucoma(POAG). Methods Prospective cross-sectional study. PACG and POAG patients who had a best-corrected visual acuity(BCVA) in the better eye equal to or better than 20/60, intraocular pressure controlled at or below 25 mmHg and reliable visual field test were invited to participate. The control group included patients with BCVA in the better eye equal to or better than 20/60 and who did not have major eye disease. A validated Taiwanese version of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25(T)) was performed to assess pVRQOL. The association between each domain of NEI VFQ-25(T) among 3 groups was determined using multivariable linear regression analysis. Results A total of 106 PACG, 186 POAG, and 95 controls were enrolled. In multivariable regression analysis of all three groups(PACG/POAG/controls), compared to POAG, PACG showed a weakly positive association with social functioning (R2 = 0.13, β = 0.22, P = 0.04). PACG showed no significantly negative impact on pVRQOL compared to controls. Taking only glaucoma patients into consideration, PACG patients had a higher score on social functioning compared to POAG (R2 = 0.16, β = 0.27, P = 0.01). The results of other domains of NEI VFQ-25(T) between the two groups did not differ significantly(p>0.05). Conclusions In patients with controlled disease, the impact of PACG and POAG on most domains of NEI VFQ-25(T) were similar, except for better social functioning in PACG compared to POAG. PMID:27690232

  7. Apolipoprotein E gene ε4ε4 is associated with elevated risk of primary open angle glaucoma in Asians: a meta-analysis.

    PubMed

    Wang, Yong; Zhou, Yan-Feng; Zhao, Bing-Ying; Gu, Zheng-Yu; Li, Shou-Ling

    2014-05-19

    Epidemiological studies have evaluated the association between Apolipoprotein E (APOE) gene ε2/ε3/ε4 polymorphism and glaucoma susceptibility. However, the published data are still inconclusive. The aim of the present study is to evaluate the impact of APOE gene ε2/ε3/ε4 polymorphism on glaucoma risk by using meta-analysis. A comprehensive literature search of PubMed, EMBASE, Cochrane, Elsevier Science Direct and CNKI databases was conducted to identify relevant articles, with the last report up to January 5, 2014. Pooled odds ratio (OR) and 95% confidence interval (CI) were used to assess the strength of association by using the fixed or random effect model. Fifteen separate studies including 2,700 cases and 2,365 controls were included in the meta-analysis. We did not detect a significant association between APOE gene ε2/ε3/ε4 polymorphism and glaucoma in overall population (P > 0.0083). In Asians, we detected an association of the ε4ε4 genotype with elevated risk for glaucoma (OR = 5.22, 95% CI = 1.85-14.68, P = 0.002), mainly for primary open angle glaucoma (OR = 4.98, 95% CI = 1.75-14.20, P = 0.003). The meta-analysis suggests that APOE gene ε4ε4 may be associated with elevated risk for primary open angle glaucoma in Asians. However, more epidemiologic studies based on larger sample size, case-control design and stratified by ethnicity as well as types of glaucoma are suggested to further clarify the relationship between APOE gene ε2/ε3/ε4 polymorphism and genetic predisposition to glaucoma.

  8. Apolipoprotein E gene ε4ε4 is associated with elevated risk of primary open angle glaucoma in Asians: a meta-analysis

    PubMed Central

    2014-01-01

    Background Epidemiological studies have evaluated the association between Apolipoprotein E (APOE) gene ε2/ε3/ε4 polymorphism and glaucoma susceptibility. However, the published data are still inconclusive. The aim of the present study is to evaluate the impact of APOE gene ε2/ε3/ε4 polymorphism on glaucoma risk by using meta-analysis. Methods A comprehensive literature search of PubMed, EMBASE, Cochrane, Elsevier Science Direct and CNKI databases was conducted to identify relevant articles, with the last report up to January 5, 2014. Pooled odds ratio (OR) and 95% confidence interval (CI) were used to assess the strength of association by using the fixed or random effect model. Results Fifteen separate studies including 2,700 cases and 2,365 controls were included in the meta-analysis. We did not detect a significant association between APOE gene ε2/ε3/ε4 polymorphism and glaucoma in overall population (P > 0.0083). In Asians, we detected an association of the ε4ε4 genotype with elevated risk for glaucoma (OR = 5.22, 95% CI = 1.85-14.68, P = 0.002), mainly for primary open angle glaucoma (OR = 4.98, 95% CI = 1.75-14.20, P = 0.003). Conclusions The meta-analysis suggests that APOE gene ε4ε4 may be associated with elevated risk for primary open angle glaucoma in Asians. However, more epidemiologic studies based on larger sample size, case–control design and stratified by ethnicity as well as types of glaucoma are suggested to further clarify the relationship between APOE gene ε2/ε3/ε4 polymorphism and genetic predisposition to glaucoma. PMID:24885013

  9. Two-Year COMPASS Trial Results: Supraciliary Microstenting with Phacoemulsification in Patients with Open-Angle Glaucoma and Cataracts.

    PubMed

    Vold, Steven; Ahmed, Iqbal Ike K; Craven, E Randy; Mattox, Cynthia; Stamper, Robert; Packer, Mark; Brown, Reay H; Ianchulev, Tsontcho

    2016-10-01

    We evaluated 2-year safety and efficacy of supraciliary microstenting (CyPass Micro-Stent; Transcend Medical, Inc., Menlo Park, CA) for treating mild-to-moderate primary open-angle glaucoma (POAG) in patients undergoing cataract surgery. Multicenter (24 US sites), interventional randomized clinical trial (RCT) (ClinicalTrials.gov identifier, NCT01085357). Subjects were enrolled beginning July 2011, with study completion in March 2015. Subjects had POAG with mean diurnal unmedicated intraocular pressure (IOP) 21-33 mmHg and were undergoing phacoemulsification cataract surgery. After completing cataract surgery, subjects were intraoperatively randomized to phacoemulsification only (control) or supraciliary microstenting with phacoemulsification (microstent) groups (1:3 ratio). Microstent implantation via an ab interno approach to the supraciliary space allowed concomitant cataract and glaucoma surgery. Outcome measures included percentage of subjects achieving ≥20% unmedicated diurnal IOP lowering versus baseline, mean IOP change and glaucoma medication use, and ocular adverse event (AE) incidence through 24 months. Of 505 subjects, 131 were randomized to the control group and 374 were randomized to the microstent group. Baseline mean IOPs in the control and microstent groups were similar: 24.5±3.0 and 24.4±2.8 mmHg, respectively (P > 0.05); mean medications were 1.3±1.0 and 1.4±0.9, respectively (P > 0.05). There was early and sustained IOP reduction, with 60% of controls versus 77% of microstent subjects achieving ≥20% unmedicated IOP lowering versus baseline at 24 months (P = 0.001; per-protocol analysis). Mean IOP reduction was ↓7.4 mmHg for the microstent group versus ↓5.4 mmHg in controls (P < 0.001), with 85% of microstent subjects not requiring IOP medications at 24 months. Mean 24-month medication use was 67% lower in microstent subjects (P < 0.001); 59% of control versus 85% of microstent subjects were medication free. Mean medication use in

  10. Magnetic Resonance Imaging of Optic Nerve Traction During Adduction in Primary Open-Angle Glaucoma With Normal Intraocular Pressure

    PubMed Central

    Demer, Joseph L.; Clark, Robert A.; Suh, Soh Youn; Giaconi, JoAnn A.; Nouri-Mahdavi, Kouros; Law, Simon K.; Bonelli, Laura; Coleman, Anne L.; Caprioli, Joseph

    2017-01-01

    Purpose We used magnetic resonance imaging (MRI) to ascertain effects of optic nerve (ON) traction in adduction, a phenomenon proposed as neuropathic in primary open-angle glaucoma (POAG). Methods Seventeen patients with POAG and maximal IOP ≤ 20 mm Hg, and 31 controls underwent MRI in central gaze and 20° to 30° abduction and adduction. Optic nerve and sheath area centroids permitted computation of midorbital lengths versus minimum paths. Results Average mean deviation (±SEM) was −8.2 ± 1.2 dB in the 15 patients with POAG having interpretable perimetry. In central gaze, ON path length in POAG was significantly more redundant (104.5 ± 0.4% of geometric minimum) than in controls (102.9 ± 0.4%, P = 2.96 × 10−4). In both groups the ON became significantly straighter in adduction (28.6 ± 0.8° in POAG, 26.8 ± 1.1° in controls) than central gaze and abduction. In adduction, the ON in POAG straightened to 102.0% ± 0.2% of minimum path length versus 104.5% ± 0.4% in central gaze (P = 5.7 × 10−7), compared with controls who straightened to 101.6% ± 0.1% from 102.9% ± 0.3% in central gaze (P = 8.7 × 10−6); and globes retracted 0.73 ± 0.09 mm in POAG, but only 0.07 ± 0.08 mm in controls (P = 8.8 × 10−7). Both effects were confirmed in age-matched controls, and remained significant after correction for significant effects of age and axial globe length (P = 0.005). Conclusions Although tethering and elongation of ON and sheath are normal in adduction, adduction is associated with abnormally great globe retraction in POAG without elevated IOP. Traction in adduction may cause mechanical overloading of the ON head and peripapillary sclera, thus contributing to or resulting from the optic neuropathy of glaucoma independent of IOP. PMID:28829843

  11. The Accuracy and Clinical Application of Predictive Models for Primary Open-Angle Glaucoma in Ocular Hypertensive Individuals

    PubMed Central

    2011-01-01

    Objective This report compares the accuracy of three prediction models for the development of primary open-angle glaucoma (POAG). The models differ primarily in their handling of these eye-specific variables: intraocular pressure (IOP), central corneal thickness (CCT), vertical cup-to-disc ratio (VCD) and visual field pattern standard deviation (PSD). 1). The “means” model includes age and the means of right and left eyes, 2). The “means plus asymmetry” model includes age, the means of right and left eyes as well as the absolute difference between eyes for eye-specific variables, 3). The “worse” eye model includes age and values from the eye at higher risk for developing POAG. Design This report uses data from the observation group of the Ocular Hypertension Treatment Study (OHTS) and the placebo group of the European Glaucoma Prevention Study (EGPS) who have complete data on both eyes at baseline. Performance of the prediction models is assessed using the c-statistic, calibration chi-square and Pearson correlation coefficient. Participants The OHTS observation group (n=717, 6.7 years median follow-up) and the EGPS placebo group (n=324, 4.9 years median follow-up). Testing Baseline data included demographic characteristics, medical history, ocular examination, visual fields and optic disc photographs. Main Outcome Measures Development of reproducible visual field abnormality or optic disc deterioration as determined by masked readers and attributed to POAG by a masked endpoint committee. Results Baseline factors that were statistically significant in all predictive models were-age, IOP, CCT, VCD and PSD. Also, statistically significant were baseline asymmetry in IOP and asymmetry in VCD. The c-statistics for the “means” model, “means plus asymmetry” model and “worse” eye model were 0.74, 0.77 and 0.75 respectively. The calibration chi-squares were 7.32, 11.19 and 1.81 respectively. Correlation coefficients between risk estimates calculated

  12. A Validated Prediction Model for the Development of Primary Open Angle Glaucoma in Individuals with Ocular Hypertension

    PubMed Central

    2007-01-01

    Objective To test the validity and generalizability of the Ocular Hypertension Treatment Study (OHTS) prediction model for the development of primary open angle glaucoma (POAG) in a large independent sample of untreated ocular hypertensive individuals. To develop a quantitative calculator to estimate the 5-year risk that an individual with ocular hypertension will develop POAG. Design A prediction model was developed from the observation group of the OHTS and then tested on the placebo group of the European Glaucoma Prevention Study (EGPS) using a z-statistic to compare hazard ratios, a c-statistic for discrimination and a calibration chi-square for systematic over/under estimation of predicted risk. The two study samples were pooled to increase precision and generalizability of a 5-year predictive model for developing POAG. Participants The OHTS observation group (n=819, 6.6 years median follow-up) and the EGPS placebo group (n=500, 4.8 years median follow-up). Testing Data were collected on demographic characteristics, medical history, ocular examination visual fields and optic disc photographs. Main Outcome Measures Development of reproducible visual field abnormality or optic disc progression as determined by masked readers and attributed to POAG by a masked endpoint committee. Results The same predictors for the development of POAG were independently identified in both the OHTS observation group and the EGPS placebo group - baseline age, intraocular pressure (IOP), central corneal thickness, vertical cup/disc ratio, and Humphrey visual field pattern standard deviation. The pooled multivariate model for the development of POAG had good discrimination (c-statistic 0.74) and accurate estimation of POAG risk (calibration chi-square 7.05). Conclusions The OHTS prediction model was validated in the EGPS placebo group. A calculator to estimate the 5-year risk of developing POAG, based on the pooled OHTS-EGPS predictive model, has high precision and will be useful to

  13. Risk Factors for Motor Vehicle Collisions in Patients with Primary Open-Angle Glaucoma: A Multicenter Prospective Cohort Study

    PubMed Central

    Yuki, Kenya; Awano-Tanabe, Sachiko; Ono, Takeshi; Shiba, Daisuke; Murata, Hiroshi; Asaoka, Ryo; Tsubota, Kazuo

    2016-01-01

    Purpose To identify the incidence rate of motor vehicle collisions (MVCs) in patients with no ocular pathology other than primary open-angle glaucoma (POAG) and determine the putative risk factors for MVCs in this group of patients. Methods We designed a prospective cohort study across three centers utilizing a consecutive sampling method to identify all patients with POAG between the ages of 40 and 80 years old. Patients with glaucoma were consecutively screened for eligibility. All study participants answered a questionnaire about motor vehicle collisions at baseline, and answered the questionnaire again every 12 months (± 1 month) after baseline for three years. A binocular integrated visual field was calculated for each patient by merging a patient’s monocular Humphrey Field Analyzer (HFA) visual fields (VFs), using the ‘best sensitivity’ method. Patients with incident MVCs were defined as the “MVC+” group and patients without incident MVCs were defined as the “MVC-" group. Adjusted odds ratios for the incidence of MVCs were estimated with a logistic regression model. Results One hundred and ninety-one Japanese POAG patients were analyzed in this study. The age of the participants was 63.7 ± 10.2 [mean ± standard deviation]. A total of 28 participants experienced a MVC during the follow up period of three years (4.9% per year). Ten patients (5.2%) experienced a MVC in the first year, 13 patients (6.8%) in the second year, and 11 patients (5.8%) in the third year (some patients experienced multiple MVCs over different years). Best corrected visual acuity in the worst eye was significantly worse in the MVC+ group (0.03 ± 0.01, mean ± standard deviation, LogMar) compared with the MVC- group (0.01 ± 0.003, p = 0.01), and was the only variable identified as a significant predictor of future MVCs in the multiple logistic regression model [odds ratio: 1.2, 95% confidence interval (CI): 1.1 to 1.4]. Conclusion Deterioration in visual acuity in the

  14. A survey of preoperative blood tests in primary open-angle glaucoma patients versus cataract surgery patients

    PubMed Central

    Cohen, Laura P.; Wong, Jessica; Jiwani, Aliya Z.; Greenstein, Scott H.; Brauner, Stacey C.; Chen, Sherleen C.; Turalba, Angela V.; Chen, Teresa C.; Shen, Lucy; Rhee, Douglas J.; Wiggs, Janey L.; Kang, Jae Hee; Loomis, Stephanie; Pasquale, Louis R.

    2014-01-01

    Purpose To investigate biomarker differences in routine preoperative blood tests performed on primary open-angle glaucoma (POAG) case and control patients presenting for anterior segment eye surgery. Methods POAG cases and age-related cataract surgery patients (controls) who underwent anterior segment surgery at Massachusetts Eye and Ear from January 2009 through March 2012 were identified by retrospective record review. Patients with diabetes mellitus, secondary glaucoma, and cataract due to trauma or steroid exposure were excluded. Data on demographic features, preoperative ophthalmological and medical diagnosis, blood pressure, anthropometric measures, basic metabolic panel, and complete blood count were extracted from the medical records. Univariate differences in lab values between POAG cases and controls were assessed using unpaired t tests. Multivariate logistic regression analysis was completed to determine the independent associations of biomarkers with POAG. Results A total of 150 cases and 150 age-related controls were included. In multivariate analysis, higher AG was inversely associated with POAG (odds ratio [OR] = 0.90; 95% confidence interval [CI], 0.80–1.00), and higher Cl− level was positively associated with POAG (OR = 1.15; 95% CI, 1.02–1.29). The lower AG in POAG patients could be explained by higher IgG levels as the available data in post hoc analysis showed a nonsignificant trend toward higher IgG in cases compared to controls (17 vs 23; 1142 ± 284 mg/dl vs 1028 ± 291 mg/dl; P = 0.22). Furthermore, in multivariable analysis, a higher red blood cell count was also associated with POAG (OR = 1.91; 95% CI, 1.11–3.28). Conclusions Patients with POAG presenting for anterior segment surgery had a lower AG compared to age-related cataract surgery patients. The etiology of this reduced gap is unclear but the possible contribution of IgG warrants further exploration. The etiology of higher red blood cell counts in POAG cases is unknown and

  15. Risk Factors for Motor Vehicle Collisions in Patients with Primary Open-Angle Glaucoma: A Multicenter Prospective Cohort Study.

    PubMed

    Yuki, Kenya; Awano-Tanabe, Sachiko; Ono, Takeshi; Shiba, Daisuke; Murata, Hiroshi; Asaoka, Ryo; Tsubota, Kazuo

    2016-01-01

    To identify the incidence rate of motor vehicle collisions (MVCs) in patients with no ocular pathology other than primary open-angle glaucoma (POAG) and determine the putative risk factors for MVCs in this group of patients. We designed a prospective cohort study across three centers utilizing a consecutive sampling method to identify all patients with POAG between the ages of 40 and 80 years old. Patients with glaucoma were consecutively screened for eligibility. All study participants answered a questionnaire about motor vehicle collisions at baseline, and answered the questionnaire again every 12 months (± 1 month) after baseline for three years. A binocular integrated visual field was calculated for each patient by merging a patient's monocular Humphrey Field Analyzer (HFA) visual fields (VFs), using the 'best sensitivity' method. Patients with incident MVCs were defined as the "MVC+" group and patients without incident MVCs were defined as the "MVC-" group. Adjusted odds ratios for the incidence of MVCs were estimated with a logistic regression model. One hundred and ninety-one Japanese POAG patients were analyzed in this study. The age of the participants was 63.7 ± 10.2 [mean ± standard deviation]. A total of 28 participants experienced a MVC during the follow up period of three years (4.9% per year). Ten patients (5.2%) experienced a MVC in the first year, 13 patients (6.8%) in the second year, and 11 patients (5.8%) in the third year (some patients experienced multiple MVCs over different years). Best corrected visual acuity in the worst eye was significantly worse in the MVC+ group (0.03 ± 0.01, mean ± standard deviation, LogMar) compared with the MVC- group (0.01 ± 0.003, p = 0.01), and was the only variable identified as a significant predictor of future MVCs in the multiple logistic regression model [odds ratio: 1.2, 95% confidence interval (CI): 1.1 to 1.4]. Deterioration in visual acuity in the worst eye is a risk factor for future MVCs in

  16. Ocular characteristics associated with the location of focal lamina cribrosa defects in open-angle glaucoma patients.

    PubMed

    Park, H-Yl; Hwang, Y S; Park, C K

    2017-04-01

    PurposeTo investigate the clinical characteristics according to the location of focal lamina cribrosa (LC) defects and its associated ocular features.Patients and methodsA total of 139 open-angle glaucoma patients underwent Spectralis optical coherence tomography (OCT) with enhanced depth imaging. Alterations in the contour of the LC were investigated to find focal LC defects. The location of the visible LC defect from the neural canal wall (far-peripheral and mid-peripheral) and clock-hour position (superotemporal, temporal and inferotemporal) were classified. Disc ovality ratio and disc-foveal angle were measured from disc and retinal nerve fiber layer (RNFL) photographs. The disc tilt degree was measured using a Heidelberg Retina Tomograph (HRT) III system. The en face OCT image of the disc scans was registered to the disc and RNFL photographs, to determine whether the focal LC defects corresponded spatially to the glaucomatous damage location.ResultsEyes with far-peripheral LC defects were significantly myopic and had a higher disc ovality ratio. The disc tilt degree obtained by HRT revealed significant temporal disc tilt in eyes with temporal LC defects (P<0.001). Eyes with inferotemporal LC defects had a significantly larger disc-foveal angle (P=0.027). The inferotemporal LC defects corresponded to the location of glaucomatous damage in 81.6%; however, only 46.2% of eyes with a superotemporal LC defect and 3.2% of eyes with a temporal LC defect corresponded spatially with the glaucomatous damage location.ConclusionsThe clinical characteristics and association with glaucomatous damage location were different according to the location of focal LC defect.

  17. The Relationship between Central Visual Field Damage and Motor Vehicle Collisions in Primary Open-Angle Glaucoma Patients

    PubMed Central

    Yuki, Kenya; Asaoka, Ryo; Tsubota, Kazuo

    2014-01-01

    Purpose To investigate the relationship between visual field (VF) damage and history of motor vehicle collisions (MVCs) in subjects with primary open-angle glaucoma (POAG). Methods MVC history and driving habits were recorded using patient questionnaires in 247 POAG patients. Patients' driving attitudes (carefulness) were estimated using Rasch analysis. The relationship between MVC outcomes and 52 total deviation (TD) values of integrated binocular VF (IVF), better and worse visual acuities (VAs), age and gender was analyzed using principal component analysis and logistic regression. Results 51 patients had the history of MVCs. Significant difference was observed between patients with and without history of MVCs only for: better VA, a single TD value in the superior-right VF, and the typical distance driven in a week (unpaired t-test, p = 0.002, 0.015 and 0.006, respectively). There was not a significant relationship between MVCs and mean deviation (MD) of IVF (p = 0.41, logistic regression). None of the principal components were significantly correlated with MVC outcome (p>0.05, polynomial logistic regression analysis). There was a significant relationship between IVF MD and Rasch derived Person parameter (R2 = 0.023, p = 0.0095). There was also a significant positive relationship between MVCs and the distance driven in a week (p = 0.005, logistic regression). Conclusions In this study of POAG patients, MVCs were not related to central binocular VF damage. These results suggest the relationship between visual function and driving is not straightforward, and careful consideration should be given when predicting patients' driving ability using their VF. PMID:25545660

  18. Oxygen saturation measurements of the retinal vasculature in treated asymmetrical primary open-angle glaucoma using hyperspectral imaging

    PubMed Central

    Mordant, D J; Al-Abboud, I; Muyo, G; Gorman, A; Harvey, A R; McNaught, A I

    2014-01-01

    Purpose To determine whether there are differences in retinal vascular oxygen saturation measurements, estimated using a hyperspectral fundus camera, between normal eyes and treated eyes of subjects with asymmetrical primary open-angle glaucoma (POAG). Methods A noninvasive hyperspectral fundus camera was used to acquire spectral images of the retina at wavelengths between 556 and 650 nm in 2-nm increments. In total, 14 normal eyes and both eyes of 11 treated POAG subjects were imaged and analyzed using algorithms that use the spectral variation of the optical densities of blood vessels to estimate the oxygen saturation of blood within the retinal vasculature. In the treated POAG group, each of the eyes were categorized, based on the mean deviation of the Humphrey visual-field analyzer result, as either more-advanced or less-advanced, glaucomatous eyes. Unpaired t-tests (two-tailed) with Welch's correction were used to compare the mean oxygen saturation between the normal subjects and the treated POAG subgroups. Results In less-advanced and more-advanced-treated POAG eyes, mean retinal venular oxygen saturations (48.2±21.6% and 42.6±18.8%, respectively) were significantly higher than in normal eyes (27.9±9.9% P=0.03 and 0.01, respectively). Arteriolar oxygen saturation was not significantly different between normal eyes and treated POAG eyes. Conclusions The increased oxygen saturation of the retinal venules in advanced-treated POAG eyes may indicate reduced metabolic consumption of oxygen in the inner retinal tissues. PMID:25060843

  19. [Effectiveness of 3-hydroxypyridine and succinic acid derivatives in complex treatment of primary open-angle glaucoma].

    PubMed

    Volchegorskiĭ, I A; Tur, E V; Soliannikova, O V; Rykun, V S; Sumina, M S; Dmitrienko, V N; Berdnikova, E V

    2012-01-01

    Prospective, placebo-controlled, single-blind, randomized clinical investigation of the influence of domestic 3-hydroxypyridine and succinic acid derivatives (emoxipin, reamberin, mexidol) on the effectiveness of a complex treatment of primary open-angle glaucoma (POAG) has been performed in a group of patients. It is established that intravenous infusion of 3-hydroxypyridine derivatives (emoxipin and mexidol) for two weeks, beginning 14 days after the start of POAG treatment, produced a retinoprotective action, with three months postponed changes in the central retinal artery (CRA) blood velocity. The retinoprotective effect of emoxipin (single dose, 150 mg) was manifested by reduction in the horizontal size of blind spot in two weeks, with the subsequent reduction of the CRA end-diastolic blood velocity observed three months after finish of the infusion therapy. The administration of mexidol (single dose, 300 mg) after 14 days of treatment led to widening of the summarized field of vision (test-object square, 16 mm), accompanied by a decrease in the electrosensitivity threshold of the optic nerve and the intensity of POAG-associated hypothymia. All indices of CRA blood velocity increased three months after termination of mexidol infusions. Reamberin (single dose, 400 ml 1,5% solution of reamberine, containing polyelectrolyte and meglumine succinate mixture) did not show retinoprotective action, but caused proatherogenic changes of blood lipids and 3 months postponed CRA end-diastolic blood velocity increase. The effect of mexidol (which is a derivative of both 3- hydroxypyridine and succinic acid) exceeds that of separate 3-hydroxypyridine (emoxipin) and succinic acid (reamberin) derivatives in the degree of retinoprotection and positive effect on the optic nerve condition and mood of POAG patients.

  20. Bimatoprost/timolol fixed combination (BTFC) in patients with primary open angle glaucoma or ocular hypertension in Greece

    PubMed Central

    Rotsos, Tryfon G.; Kliafa, Vasso G.; Asher, Kevin J.; Papaconstantinou, Dimitrios

    2016-01-01

    AIM To evaluate the efficacy and tolerability of the fixed combination of bimatoprost 0.03% and timolol 0.5% (BTFC) in patients in Greece with primary open angle glaucoma (POAG) or ocular hypertension (OHT) whose previous therapy provided insufficient lowering of intraocular pressure (IOP). METHODS A multicenter, prospective, open-label, non-interventional, observational study of the use of BTFC in clinical practice was conducted at 41 sites in Greece. The primary endpoint was the reduction in IOP from baseline at study end, approximately 12wk after initiation of BTFC therapy. RESULTS A total of 785 eligible patients were enrolled in the study and 97.6% completed the study. The mean±SD IOP reduction from baseline at 12wk after initiation of BTFC was 6.3±2.8 mm Hg (n=764; P<0.001). In patients (n=680) who replaced their previous IOP-lowering monotherapy (a single drug, or a fixed combination of 2 drugs in a single ophthalmic drop) with once-daily BTFC, the mean±SD IOP reduction from baseline at 12wk was 6.2±2.8 mm Hg (P<0.001). IOP was reduced from baseline in 99.2% of patients, and 58.0% of patients reached or exceeded their target IOP. Substantial mean IOP reductions were observed regardless of the previous therapy. BTFC was well tolerated, with 96.0% of patients who completed the study rating the tolerability of BTFC as “good” or “very good.” Adverse events were reported in 8.3% of patients; only 0.6% of patients discontinued the study due to adverse events. CONCLUSION In clinical practice in Greece, BTFC is well tolerated and effectively lower the IOP in patients with POAG or OHT who requires additional IOP lowering on their previous therapy. PMID:26949613

  1. A 7 year prospective comparative study of three topical beta blockers in the management of primary open angle glaucoma.

    PubMed

    Watson, P G; Barnett, M F; Parker, V; Haybittle, J

    2001-08-01

    To determine the long term efficacy of monotherapy with topically applied beta blocking agents and to determine whether selective beta blockers were able to preserve the visual field more effectively than non-selective agents. A prospective randomised, open, comparative study of three topically applied beta blockers-timolol, betaxolol, and carteolol-was carried out on 153 patients (280 eyes) with newly diagnosed open angle glaucoma. Those patients who were not withdrawn were followed by the same observers for a minimum of 2 years and a maximum of 7 years, with clinical observations, Goldmann tonometry and 24.2 Humphrey visual field analysis. All three drugs lowered the IOP significantly from untreated levels but betaxolol took up to 12 months in some instances to reach the maximum pressure reduction. After 7 years only 43% of the eyes begun on timolol, 34% of those started on carteolol, and 29% of those on betaxolol were still being treated with these medications alone. Visual fields were analysed throughout the trial by CPSD and MD and at the end by linear regression analysis (PROGRESSOR). The visual fields remained the same without apparent improvement or deterioration throughout the period of follow up. Eight patients (11 eyes) were withdrawn because of continuing field loss in spite of reduction in IOP (six using carteolol and five using betaxolol). Analysis shows that less than half the eyes initially treated with topical beta blockers might be expected to still be being treated with their original medication after 5 years. The rest required either additional medication or trabeculectomy. There was no statistically significant improvement or deterioration in the visual fields over a 7 year period. On the evidence of this trial there are no particular advantages in using selective beta blockers.

  2. Associations between obstructive sleep apnoea, primary open angle glaucoma and age-related macular degeneration: record linkage study.

    PubMed

    Keenan, Tiarnan D L; Goldacre, Raph; Goldacre, Michael J

    2017-02-01

    Primary open angle glaucoma (POAG) is thought to be associated with obstructive sleep apnoea (OSA) but previous studies are conflicting and have methodological limitations. This potential relationship has implications for investigation and treatment strategies, and may provide insights into disease pathogenesis. The relationship between OSA and age-related macular degeneration (AMD) is unknown. A sleep apnoea cohort of 67 786 people was constructed from linked English hospital episode statistics (1999-2011). We compared this cohort with a reference cohort (2 684 131 people) for rates of subsequent POAG and AMD. A POAG cohort (comprising 87 435 people) and an AMD cohort (248 408 people) were also constructed and compared with the reference cohort for rates of subsequent sleep apnoea. All analyses were restricted to people aged 55 and over and, within this age range, were age standardised using 5-year age groups. Risk of POAG following sleep apnoea was not elevated: the rate ratio for POAG was 1.01 (95% CI 0.85 to 1.19). Similarly, the risk of sleep apnoea following POAG was not elevated: the rate ratio was 1.00 (0.86 to 1.17). These findings held true across subgroup analysis according to sex and age group. By contrast, the risk of AMD following sleep apnoea was significantly elevated, with rate ratio 1.44 (1.32 to 1.57). Although plausible mechanisms exist to consider a link between OSA and POAG, the two conditions are not positively associated. This holds true in either temporal direction. By contrast, OSA is positively associated with AMD. While potential confounding factors may contribute, obesity does not appear sufficient to explain this association. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  3. Correlations between Preoperative Angle Parameters and Postoperative Unpredicted Refractive Errors after Cataract Surgery in Open Angle Glaucoma (AOD 500)

    PubMed Central

    Lee, Wonseok; Bae, Hyoung Won; Lee, Si Hyung; Kim, Chan Yun

    2017-01-01

    Purpose To assess the accuracy of intraocular lens (IOL) power prediction for cataract surgery with open angle glaucoma (OAG) and to identify preoperative angle parameters correlated with postoperative unpredicted refractive errors. Materials and Methods This study comprised 45 eyes from 45 OAG subjects and 63 eyes from 63 non-glaucomatous cataract subjects (controls). We investigated differences in preoperative predicted refractive errors and postoperative refractive errors for each group. Preoperative predicted refractive errors were obtained by biometry (IOL-master) and compared to postoperative refractive errors measured by auto-refractometer 2 months postoperatively. Anterior angle parameters were determined using swept source optical coherence tomography. We investigated correlations between preoperative angle parameters [angle open distance (AOD); trabecular iris surface area (TISA); angle recess area (ARA); trabecular iris angle (TIA)] and postoperative unpredicted refractive errors. Results In patients with OAG, significant differences were noted between preoperative predicted and postoperative real refractive errors, with more myopia than predicted. No significant differences were recorded in controls. Angle parameters (AOD, ARA, TISA, and TIA) at the superior and inferior quadrant were significantly correlated with differences between predicted and postoperative refractive errors in OAG patients (-0.321 to -0.408, p<0.05). Superior quadrant AOD 500 was significantly correlated with postoperative refractive differences in multivariate linear regression analysis (β=-2.925, R2=0.404). Conclusion Clinically unpredicted refractive errors after cataract surgery were more common in OAG than in controls. Certain preoperative angle parameters, especially AOD 500 at the superior quadrant, were significantly correlated with these unpredicted errors. PMID:28120576

  4. Genetic African Ancestry Is Associated With Central Corneal Thickness and Intraocular Pressure in Primary Open-Angle Glaucoma.

    PubMed

    Bonnemaijer, Pieter W M; Cook, Colin; Nag, Abhishek; Hammond, Christopher J; van Duijn, Cornelia M; Lemij, Hans G; Klaver, Caroline C W; Thiadens, Alberta A H J

    2017-06-01

    To unravel the relationship between African ancestry, central corneal thickness (CCT), and intraocular pressure (IOP) by estimating the genetic African ancestry (GAA) proportion in primary open-angle glaucoma (POAG) patients and controls from an admixed South African Colored (SAC) and a South African Black (SAB) population. In this case-control study, 268 POAG patients and 137 controls were recruited from a university clinic in Cape Town, South Africa. All participants were genotyped on the Illumina HumanOmniExpress beadchip or HumanOmni2.5Exome beadchip. ADMIXTURE was used to infer participant's GAA among 86,632 SNPs. Linear and logistic regression models were used to assess the relation between GAA, POAG, CCT, and IOP. The median proportion of GAA was 60% in the study population. GAA was significantly associated with thinner CCT (P < 0.001) and IOP (P = 0.034) in POAG patients. The effect of GAA on CCT was marginally different among POAG patients versus controls (P = 0.066). In POAG patients, the CCT was significantly thinner compared to controls after adjusting for age and sex (P = 0.016). In a stratified analysis in participants with >60% GAA, CCT was not associated with POAG (P = 0.550). This study demonstrated that a higher proportion of GAA was associated with a thinner CCT and a higher IOP in POAG patients. Remarkably, at higher proportions of GAA, the difference in CCT between POAG and controls was reduced. This suggests that thinner CCT is not associated with POAG in Africans.

  5. Correlations between corneal and optic nerve head variables in healthy subjects and patients with primary open angle glaucoma

    PubMed Central

    Saenz-Frances, Federico; Jañez, Luis; Borrego-Sanz, Lara; Berrozpe-Villabona, Clara; Martinez-de-la-Casa, Jose Maria; Morales-Fernandez, Laura; Garcia-Sanchez, Julian; Santos-Bueso, Enrique; Garcia-Feijoo, Julian

    2015-01-01

    AIM To correlate corneal variables (determined using the Pentacam) with optic nerve head (ONH) variables determined using the Heidelberg retina tomograph (HRT) in healthy subjects and patients diagnosed with primary open angle glaucoma (POAG). METHODS Measurements were made in 75 healthy eyes and 73 eyes with POAG and correlations examined through Pearson correlation coefficients between the two sets of variables in the two subject groups. The corneal variables determined were corneal volume (CVol), central corneal thickness (CCT), overall corneal thickness (OvCT), the mean thickness of a circular zone centered at the corneal apex of 1 mm radius (zone I) and the mean thickness of several concentric rings, also centered at the apex until the limbus, each of 1 mm width (zones II to VI respectively). The ONH variables were determined using the HRT. RESULTS The following pairs of variables were correlated in the control group: CCT-disc area (DAr) (-0.48; P<0.0001), Zone I-DAr (-0.503; P<0.0001) and Zone II-DAr (-0.443; P<0.0001); and in the POAG group: CCT-cup-to-disc area ratio (CDRa) (-0.402; P<0.0001), Zone I-CDRa (-0.418; P<0.0001), Zone II-CDRa (-0.405; P=0.006), Zone I-cup shape measure (CSM) (-0.415; P=0.002), Zone II-CSM (-0.405; P=0.001), Zone IV-height variation contour (HVC) (0.378; P=0.002); Zone V-HVC (0.388, P<0.0001). CONCLUSIONS In the healthy subjects, significant negative correlation was detected between central and paracentral corneal thickness and optic disc area. In contrast, the POAG patients showed significant negative correlation between central and paracentral corneal thickness and the cup-disc ratio and CSM, and positive correlation between peripheral corneal thickness and HVC. PMID:26682165

  6. Albuminuria Is Associated with Open-Angle Glaucoma in Nondiabetic Korean Subjects: A Cross-Sectional Study

    PubMed Central

    Kim, Gyu Ah; Park, Se Hee; Ko, Jaesang; Lee, Si Hyung; Bae, Hyoung Won; Seong, Gong Je; Kim, Chan Yun

    2016-01-01

    Objective Systemic vascular dysfunction has been suggested to contribute to glaucomatous damage. Albuminuria is a surrogate marker of endothelial injury, including vessels. However, their relationship is not well understood. This study aimed to investigate the association between albuminuria and the prevalence of open-angle glaucoma (OAG) in nondiabetic subjects. Methods We conducted a cross-sectional study of 4186 nondiabetic participants aged 19 years or older from the 2011–2012 Korea National Health and Nutrition Examination Survey. OAG was defined based on the criteria of the International Society for Geographic and Epidemiologic Ophthalmology. Urinary albumin excretion was assessed by the urinary albumin-to-creatinine ratio (UACR). A multivariate logistic regression analysis was performed to evaluate the relationship between albuminuria and OAG. Results Among the subjects, 124 had OAG. The weighted prevalences of microalbuminuria (UACR of 30–299 mg/g creatinine [Cr]) and macroalbuminuria (UACR ≥ 300 mg/g Cr) were 3.2 ± 0.3% and 0.4 ± 0.1%, respectively. The percentages of OAG increased in accordance with increasing UACR tertiles. Compared with subjects in the lower UACR tertile, those in the upper tertile showed an increased prevalence of OAG (odds ratio, 1.963; 95% confidence interval 1.072–3.595, P = 0.029) after adjusting for demographic factors, laboratory parameters, kidney function, and intraocular pressure. Furthermore, even after excluding 155 subjects with microalbuminuria and 19 subjects with macroalbuminuria, a positive association persisted between the upper UACR tertile (low-grade albuminuria) and an increased prevalence of OAG (odds ratio, 2.170; 95% confidence interval, 1.174–4.010, P = 0.014). Conclusion Albuminuria, even low-grade, was significantly associated with OAG in nondiabetic subjects. This result implies the role of vascular endothelial dysfunction in the pathogenic mechanism of OAG and suggests that careful monitoring of

  7. Expression profile of the matricellular protein osteopontin in primary open-angle glaucoma and the normal human eye.

    PubMed

    Chowdhury, Uttio Roy; Jea, Seung-Youn; Oh, Dong-Jin; Rhee, Douglas J; Fautsch, Michael P

    2011-08-16

    PURPOSE. To characterize the role of osteopontin (OPN) in primary open-angle glaucoma (POAG) and normal eyes. METHODS. OPN quantification was performed by enzyme-linked immunosorbent assay in aqueous humor (AH) obtained from human donor eyes (POAG and normal) and surgical samples (POAG and elective cataract removal). OPN expression and localization in whole eye tissue sections and primary normal human trabecular meshwork (NTM) cells were studied by Western blot and immunohistochemistry. Latanoprost-free acid (LFA)-treated NTM cells were analyzed for OPN gene and protein expression. Intraocular pressure was measured by tonometry, and central corneal thickness was measured by optical coherence tomography in young OPN(-/-) and wild-type mice. RESULTS. OPN levels were significantly reduced in donor POAG AH compared with normal AH (0.54 ± 0.18 ng/μg [n = 8] vs. 0.77 ± 0.23 ng/μg [n = 9]; P = 0.039). A similar trend was observed in surgical AH (1.05 ± 0.31 ng/μg [n = 20] vs. 1.43 ± 0.88 ng/μg [n = 20]; P = 0.083). OPN was present in the trabecular meshwork, corneal epithelium and endothelium, iris, ciliary body, retina, vitreous humor, and optic nerve. LFA increased OPN gene expression, but minimal change in OPN protein expression was observed. No difference in intraocular pressure (17.5 ± 2.0 mm Hg [n = 56] vs. 17.3 ± 1.9 mm Hg [n = 68]) but thinner central corneal thickness (91.7 ± 3.6 μm [n = 50] vs. 99.2 ± 5.5 μm [n = 70]) was noted between OPN(-/-) and wild-type mice. CONCLUSIONS. OPN is widely distributed in the human eye and was found in lower concentrations in POAG AH. Reduction of OPN in young mice does not affect IOP.

  8. Glaucoma, Open-Angle

    MedlinePlus

    ... visual function, preservation of sight, and the special health problems and requirements of the blind.” News & Events Events Calendar NEI Press Releases News from NEI Grantees Spokesperson bios Statistics and ... Frequently asked questions Clinical Studies Publications Catalog ...

  9. Comparative study of the retinal nerve fibre layer thickness performed with optical coherence tomography and GDx scanning laser polarimetry in patients with primary open-angle glaucoma.

    PubMed

    Wasyluk, Jaromir T; Jankowska-Lech, Irmina; Terelak-Borys, Barbara; Grabska-Liberek, Iwona

    2012-03-01

    We compared the parameters of retinal nerve fibre layer in patients with advanced glaucoma with the use of different OCT (Optical Coherence Tomograph) devices in relation to analogical measurements performed with GDx VCC (Nerve Fiber Analyzer with Variable Corneal Compensation) scanning laser polarimetry. Study subjects had advanced primary open-angle glaucoma, previously treated conservatively, diagnosed and confirmed by additional examinations (visual field, ophthalmoscopy of optic nerve, gonioscopy), A total of 10 patients were enrolled (9 women and 1 man), aged 18-70 years of age. Nineteen eyes with advanced glaucomatous neuropathy were examined. 1) Performing a threshold perimetry Octopus, G2 strategy and ophthalmoscopy of optic nerve to confirm the presence of advanced primary open-angle glaucoma; 2) performing a GDx VCC scanning laser polarimetry of retinal nerve fibre layer; 3) measuring the retinal nerve fibre layer thickness with 3 different optical coherence tomographs. The parameters of the retinal nerve fibre layer thickness are highly correlated between the GDx and OCT Stratus and 3D OCT-1000 devices in mean retinal nerve fibre layer thickness, retinal nerve fibre layer thickness in the upper sector, and correlation of NFI (GDx) with mean retinal nerve fibre layer thickness in OCT examinations. Absolute values of the retinal nerve fibre layer thickness (measured in µm) differ significantly between GDx and all OCT devices. Examination with OCT devices is a sensitive diagnostic method of glaucoma, with good correlation with the results of GDx scanning laser polarimetry of the patients.

  10. Funduscopic versus HRT III Confocal Scanner Vertical Cup-Disc Ratio Assessment in Normal Tension and Primary Open Angle Glaucoma (The Leuven Eye Study).

    PubMed

    Willekens, Koen; Bataillie, Sophie; Sarens, Inge; Odent, Sofie; Abegão Pinto, Luìs; Vandewalle, Evelien; Van Keer, Karel; Stalmans, Ingeborg

    2017-01-01

    To compare funduscopic and confocal scanning vertical cup-disc ratio (VCDR) assessments and their respective predictive value for estimating functional glaucomatous damage. Data from a single eye of open angle glaucoma patients from the Leuven Eye Study were included: age, gender, intra-ocular pressure, visual acuity, refractive error, visual field mean deviation and pattern standard deviation, funduscopic and HRT III VCDRs as well as mean retinal nerve fibre layer thickness. Non-parametric tests to compare differences within and between diagnostic groups were used, and receiver-operating characteristic curves as well as Bland-Altman plots constructed. Three hundred and one eyes of 301 subjects with primary open angle glaucoma (POAG) and normal tension glaucoma (NTG) were included. The average VCDR assessed with HRT III was significantly smaller than the funduscopic measurement (0.69 ± 0.16 vs. 0.81 ± 0.14, respectively; p < 0.001). The predictive value of both measurement techniques did not differ in NTG patients, but the funduscopic estimate yielded a significantly larger predictive power in patients with severe POAG. Funduscopic and confocal scanner estimates of VCDR differ significantly and should not be used interchangeably. In POAG patients with severe glaucoma, a subjective VCDR predicts functional glaucomatous damage significantly better. © 2016 S. Karger AG, Basel.

  11. Mitomycin C-augmented deep sclerectomy in primary open-angle glaucoma and exfoliation glaucoma: a three-year prospective study.

    PubMed

    Ollikainen, Minna L; Puustjärvi, Tuomo J; Rekonen, Petri K; Uusitalo, Hannu M; Teräsvirta, Markku E

    2011-09-01

    To investigate the efficacy and safety of mitomycin C (MMC)-augmented deep sclerectomy with implant (DSCI) in primary open-angle glaucoma (POAG) and exfoliation glaucoma (ExG) patients. A total of 68 eyes of 68 patients with POAG and ExG were enrolled consecutively to undergo DSCI with MMC (0.4 mg/ml for 2 min). The intraocular pressure (IOP), number of antiglaucoma medications, neodymium:yttrium-aluminum-garnet (Nd:YAG) laser goniopuncture treatments and complications were compared postoperatively after 36- month follow-up. Surgery was considered as a complete success when IOP was <18 mmHg without antiglaucoma medication. Preoperatively the mean IOPs were 23 ± 6 mmHg and 25 ± 8 mmHg, and 13 ± 4 mmHg and 11 ± 4 mmHg in the POAG and ExG groups, respectively, at 36 months. At 36 months, 74% and 73% of surgeries were a complete success in the POAG and ExG group, respectively [not significant (NS)]. Two patients (8%) of the POAG group and one of the ExG group (3%) were receiving antiglaucoma medication at 36 months (NS). Nd:YAG laser goniopuncture was performed more often in the ExG group (87%) than in the POAG group (61%, p = 0.024). Postoperatively choroidal detachment occurred in 16% of eyes in the POAG group and in 11% of eyes in the ExG group (NS). DSCI with MMC augmentation appears to be as effective in patients with ExG and POAG in lowering IOP to target levels at medium term with few immediate postoperative complications. © 2009 The Authors. Journal compilation © 2009 Acta Ophthalmol.

  12. Mitomycin-C-augmented deep sclerectomy in patients with primary open-angle glaucoma and exfoliation glaucoma: a 1-year prospective study.

    PubMed

    Ollikainen, Minna; Puustjärvi, Tuomo; Rekonen, Petri; Uusitalo, Hannu; Teräsvirta, Markku

    2010-02-01

    To investigate the efficacy and safety of mitomycin C (MMC)-augmented deep sclerectomy with implant (DSCI) in patients with primary open-angle glaucoma (POAG) and exfoliation glaucoma (ExG). A total of 68 eyes of 68 patients with POAG and ExG were enrolled consecutively to undergo DSCI with MMC (0.4 mg/ml for 2 min). The intraocular pressure (IOP), number of antiglaucoma medications, neodymium:yttrium-aluminum-garnet (Nd:YAG) laser goniopunctures and complications were compared postoperatively. Surgery was considered as a complete success when IOP was < 18 mmHg without antiglaucoma medication. Preoperatively, the mean IOPs were 23.1 +/- 5.8 and 25.4 +/- 8.3 mmHg, and 13.8 +/- 6.1 and 11.2 +/- 5.6 mmHg in the POAG and ExG groups, respectively, at 12 months. 77.4% and 75.7% of surgeries were a complete success in the POAG and ExG groups, respectively [not significant (NS)]. Five patients (16.1%) in the POAG group but none in the ExG group (0%) were receiving antiglaucoma medication at 12 months (NS). Nd:YAG laser goniopuncture was performed in 29.0% of eyes in the POAG group and in 55.6% of eyes in the ExG group (p = 0.047). Postoperatively, choroidal detachment occurred in 16.1% of eyes in the POAG group and in 10.8% of eyes in the ExG group (NS). We encountered no serious complications related to MMC use. DS with MMC augmentation appears to be equally effective in ExG and POAG patients in lowering IOP to target levels, at least in the short term, with few immediate postoperative complications.

  13. A Randomized Trial of a Schlemm's Canal Microstent with Phacoemulsification for Reducing Intraocular Pressure in Open-Angle Glaucoma.

    PubMed

    Pfeiffer, Norbert; Garcia-Feijoo, Julian; Martinez-de-la-Casa, Jose M; Larrosa, Jose M; Fea, Antonio; Lemij, Hans; Gandolfi, Stefano; Schwenn, Oliver; Lorenz, Katrin; Samuelson, Thomas W

    2015-07-01

    To assess the safety and effectiveness of the Hydrus Microstent (Ivantis, Inc, Irvine, CA) with concurrent cataract surgery (CS) for reducing intraocular pressure (IOP) in open-angle glaucoma (OAG). Prospective, multicenter, randomized, single-masked, controlled clinical trial. One hundred eyes from 100 patients 21 to 80 years of age with OAG and cataract with IOP of 24 mmHg or less with 4 or fewer hypotensive medications and a washed-out diurnal IOP (DIOP) of 21 to 36 mmHg. On the day of surgery, patients were randomized 1:1 to undergo CS with the microstent or CS alone. Postoperative follow-up was at 1 day, 1 week, and 1, 3, 6, 12, 18, and 24 months. Washout of hypotensive medications was repeated at 12 and 24 months. Response to treatment was defined as a 20% or more decrease in washed out DIOP at 12 and 24 months of follow-up compared with baseline. Mean DIOP at 12 and 24 months, the proportion of subjects requiring medications at follow-up, and the mean number of medications were analyzed. Safety measures included change in visual acuity, slit-lamp observations, and adverse events. The proportion of patients with a 20% reduction in washed out DIOP was significantly higher in the Hydrus plus CS group at 24 months compared with the CS group (80% vs. 46%; P = 0.0008). Washed out mean DIOP in the Hydrus plus CS group was significantly lower at 24 months compared with the CS group (16.9±3.3 mmHg vs. 19.2±4.7 mmHg; P = 0.0093), and the proportion of patients using no hypotensive medications was significantly higher at 24 months in the Hydrus plus CS group (73% vs. 38%; P = 0.0008). There were no differences in follow-up visual acuity between groups. The only notable device-related adverse event was focal peripheral anterior synechiae (1-2 mm in length). Otherwise, adverse event frequency was similar in the 2 groups. Intraocular pressure was clinically and statistically significantly lower at 2 years in the Hydrus plus CS group compared with the CS alone group

  14. Association of Geroprotective Effects of Metformin and Risk of Open-Angle Glaucoma in Persons With Diabetes Mellitus.

    PubMed

    Lin, Hsien-Chang; Stein, Joshua D; Nan, Bin; Childers, David; Newman-Casey, Paula Anne; Thompson, Debra A; Richards, Julia E

    2015-08-01

    Caloric restriction mimetic drugs have geroprotective effects that delay or reduce risks for a variety of age-associated systemic diseases, suggesting that such drugs might also have the potential to reduce risks of blinding ophthalmologic conditions for which age is a major risk factor. To determine whether the caloric restriction mimetic drug metformin hydrochloride is associated with reduced risk of open-angle glaucoma (OAG) in persons with diabetes mellitus. Retrospective cohort study of patients aged 40 years or older with diabetes mellitus and no preexisting record of OAG in a large US managed care network from January 1, 2001, through December 31, 2010. Quantity of metformin and other prescribed diabetes medications as captured from outpatient pharmacy records. Risk of developing OAG. Of 150 016 patients with diabetes mellitus, 5893 (3.9%) developed OAG. After adjusting for confounding factors, those prescribed the highest quartile of metformin hydrochloride (>1110 g in 2 years) had a 25% reduced OAG risk relative to those who took no metformin (hazard ratio = 0.75; 95% CI, 0.59-0.95; P = .02). Every 1-g increase in metformin hydrochloride use was associated with a 0.16% reduction in OAG risk (adjusted hazard ratio = 0.99984; 95% CI, 0.99969-0.99999; P = .04), which predicts that taking a standard dose of 2 g of metformin hydrochloride per day for 2 years would result in a 20.8% reduction in risk of OAG. After accounting for potential confounders, including metformin and diabetic medications, the risk of developing OAG was increased by 8% (hazard ratio = 1.08; 95% CI, 1.03-1.13; P = .003) for each unit of increase in glycated hemoglobin level. Metformin use is associated with reduction in risk of developing OAG, and risk is reduced even when accounting for glycemic control in the form of glycated hemoglobin level. Other diabetes medications did not confer a similar OAG risk reduction. This study suggests that metformin may be

  15. Effects of betaxolol and latanoprost on ocular blood flow and visual fields in patients with primary open-angle glaucoma.

    PubMed

    Erkin, E F; Tarhan, S; Kayikçioğlu, O R; Deveci, H; Güler, C; Göktan, C

    2004-01-01

    To evaluate the effects of betaxolol and latanoprost on ocular blood flow and visual fields in patients with primary open-angle glaucoma (POAG) by means of an observer-masked, prospective clinical study. Thirty-two patients with newly diagnosed POAG were included in the study. The patients were randomized into two groups. The first group was treated with betaxolol 0.50% twice daily and the second group with latanoprost 0.005% once daily. Baseline and posttreatment examinations on the first and third months of treatment included intraocular pressure (IOP) measurement, automated visual field testing, and ocular blood flow assessment. For evaluation of visual fields, mean defect and pattern standard deviation indices were used. Ocular blood flow was assessed by means of color Doppler imaging of the central retinal artery (CRA) and the temporal short posterior ciliary artery (PCA). For each vessel, peak systolic (PSV) and end-diastolic (EDV) blood flow velocities were measured and resistivity index (RI) calculated. After exclusion of one noncompliant patient, the study was completed with 31 eyes of 31 patients. Both drugs significantly reduced IOP (p<0.05). The mean IOP lowering effect of latanoprost was significantly higher than that of betaxolol (p=0.03). Visual field indices exhibited no significant changes in either group (p>0.05). There were no significant changes in PSV or EDV measurements of CRA or PCA in either group (p>0.05). RI decreased in both CRA and PCA with both drugs. The mean changes between baseline and 3 month blood flow measurements were not significantly different between betaxolol and latanoprost (p>0.05). Over a treatment period of 3 months, both betaxolol and latanoprost tended to improve ocular blood flow without one of them being superior to the other. The results suggest that the direct (non IOP-dependent) influence on ocular circulation is better for betaxolol than for latanoprost. In addition, neither drug caused significant generalized

  16. Assessment of SNPs associated with the human glucocorticoid receptor in primary open-angle glaucoma and steroid responders.

    PubMed

    Fingert, John H; Alward, Wallace L; Wang, Kai; Yorio, Thomas; Clark, Abbot F

    2010-04-03

    While chronic glucocorticoid (GC) therapy leads to ocular hypertension in about one third of individuals, almost all primary open-angle glaucoma (POAG) patients show this response and are called "steroid responders." Two differentially spliced isoforms of the glucocorticoid receptor (GR), GRalpha and GRbeta, regulate GC responsiveness in trabecular meshwork (TM) cells. GRbeta acts as a dominant negative regulator of GC activity and is expressed at lower levels in glaucomatous TM cells, making them more sensitive to GCs. Several arginine/serine-rich splicing factor (SR) proteins have been implicated in alternative splicing of the GR. We have previously demonstrated that immunophilins FKBP5 and FKBP4 are required for GRalpha and GRbeta translocation into the nucleus, which is essential for their biologic activity. The purpose of the present study was to use single nucleotide polymorphism (SNP) genotyping to determine whether there are any allele frequency differences in GR, FKBP4/5, or SR genes between normal control, POAG, and steroid responder populations. Clinically characterized individuals (400 normal controls, 197 POAG, and 107 steroid responders) were recruited from the U. Iowa Ophthalmology Clinics after IRB approved consent. Genotyping of DNA samples for 48 SNPs in SFRS3, SFRS5, SFRS9, FKBP4, FKBP5, and NR3C1 was done at GeneSeek using a mass spectroscopy based system. All 48 SNPs displayed high call rates (99%). There were no significant differences in allele frequencies or genotypes in SNPs for SFRS5, SFRS9, FKBP4, FKBP5, and NR3C1 between the 3 groups. Up to three SNPs in SFRS3 had p-values <0.05 when comparing controls to POAG or steroid responders, but this statistical significance was lost when the p values were adjusted for multiple measures. Although these 6 genes may be involved in the pathogenesis of GC-induced ocular hypertension, it does not appear that major heritable risk alleles in these genes are responsible for the development of GC

  17. Ab-interno goniotrabeculotomy versus mitomycin C trabeculectomy for adult open-angle glaucoma: a 2-year randomized clinical trial.

    PubMed

    Quaranta, L; Hitchings, R A; Quaranta, C A

    1999-07-01

    To evaluate the effect of ab-interno goniotrabeculotomy (AIGT) on the intraocular pressure (IOP) in adult patients with primary open-angle glaucoma (POAG), compared with the effects of mitomycin C trabeculectomy (MT). Prospective, randomized, clinical trial. Thirty-two eyes of 32 patients with medically uncontrolled POAG. Standard limbus-based trabeculectomy with adjunct mitomycin C (0.3 mg/mL for 3 minutes) in 16 eyes of 16 patients; AIGT was performed in 16 eyes of 16 patients. The groups were matched for age, preoperative IOP, duration of preoperative antiglaucoma treatment, use of preoperative beta-blockers and parasympathomimetics, and use of beta-blockers in the fellow eye. The IOP (average of the two highest values measured in the diurnal curve, from 8 AM to 6 PM, every 2 hours) and complications were recorded 1, 3, 6, 12, 18, and 24 months after surgery. Identification of complications and IOP. All patients were followed up for 24 months. More postoperative complications occurred in the MT group during the 2-year follow-up. One month after surgery, IOP was 10 +/- 1.46 mmHg (range, 8-13) in the MT group and 12.12 +/- 1.63 mmHg (range, 8-14) in the AIGT group (Student's t test, P = 0.001). Three months after surgery, IOP was 11.5 +/- 1.59 mmHg (range, 8-14) and 12.75 +/- 1.57 mmHg (range, 10-16) in the MT and AIGT groups, respectively (Student's t test, P = 0.033). From the 6th to the 24th postoperative month, no statistically significant difference in IOP was found between the two groups. At the end of follow-up, 14 of 16 eyes (87.5%) of the AIGT group and 13 of the 16 eyes (81.25%) of the MT group showed an IOP < or = 14 mmHg. Ab-interno goniotrabeculotomy appears to be a viable and safe surgical treatment for adult POAG. More extended follow-up, however, and a larger series of patients are needed to ascertain the actual effectiveness of this procedure in adult POAG.

  18. A prospective 3-year follow-up trial of implantation of two trabecular microbypass stents in open-angle glaucoma

    PubMed Central

    Donnenfeld, Eric D; Solomon, Kerry D; Voskanyan, Lilit; Chang, David F; Samuelson, Thomas W; Ahmed, Iqbal Ike K; Katz, L Jay

    2015-01-01

    Purpose To evaluate 3-year safety and intraocular pressure (IOP) following two trabecular microbypass stents in phakic and pseudophakic subjects with open-angle glaucoma (OAG) not controlled on preoperative medication. Patients and methods In this prospective pilot study, phakic or pseudophakic subjects with OAG and IOP between 18 mmHg and 30 mmHg on one preoperative topical ocular hypotensive medication underwent medication washout. Thirty-nine qualified subjects with preoperative unmedicated IOP ≥22 mmHg and ≤38 mmHg received two stents. Postoperative examinations were scheduled at Day 1, Week 1, Months 1, 3, 6, and 12, and semiannually through Month 60. Ocular hypotensive medication was considered if postoperative IOP exceeded 21 mmHg. IOP, medication use, and safety were assessed at each visit. Subject follow-up through Month 36 was completed. Results Thirty-six eyes (92.3%; 95% confidence interval [CI] 79.1%, 98.4%) achieved the primary efficacy end point of Month 12 reduction in IOP ≥20% from baseline (unmedicated IOP) without ocular hypotensive medication. Four subjects required medication during the Month 36 follow-up period. Mean IOP at 36 months for subjects not taking medication was 15.2 mmHg. At 36 months, subjects sustained mean IOP decrease of 9.1±2.7 mmHg (95% CI 8.0 mmHg, 10.14 mmHg), or 37% IOP reduction, from unmedicated baseline IOP. Compared to preoperative medicated IOP, subjects had mean reduction at Month 36 of 5.5±2.7 mmHg (95% CI 4.5 mmHg, 6.6 mmHg), or 26% reduction. Both measures of IOP reduction were highly significant (P<0.001). Other than one case of early postoperative hyphema that resolved at 1 week, no postoperative adverse events were attributed to stent implantation. Conclusion In a pilot study, two trabecular microbypass stents to treat OAG subjects on one preoperative medication provided statistically significant, sustained, and safe reduction of IOP to ≤15 mmHg without medication through 36 months. PMID:26604675

  19. Usefulness of frequency-doubling technology for perimetrically normal eyes of open-angle glaucoma patients with unilateral field loss.

    PubMed

    Fan, Xiang; Wu, Ling-Ling; Ma, Zhi-Zhong; Xiao, Ge-Ge; Liu, Feng

    2010-08-01

    To determine whether frequency-doubling technology (FDT) perimetry detects visual field loss in perimetrically normal eyes of patients with open-angle glaucoma (OAG) and whether these visual field defects subsequently are detected by standard automated perimetry (SAP), and to explore the relating factors of the progression from abnormalities based on FDT to visual field loss based on SAP. Prospective cohort study. Sixty-eight OAG patients with unilateral field loss detected by SAP (Octopus, G2 program; Interzeig, Schlieren, Switzerland). Perimetrically normal eyes of participants were examined with the FDT N-30 threshold program (Humphrey Instruments, Welch-Allyn, Skaneateles, NY). The visual field examination was followed by a series of SAP examinations administered over 3 years. The relationship between FDT and subsequent SAP results in perimetrically normal eyes was analyzed. Glaucomatous optic neuropathy (GON), visual field indices, intraocular pressure (IOP), and central corneal thickness (CCT) were compared between converters (eyes with subsequent SAP abnormality) and nonconverters within perimetrically normal eyes with abnormal FDT results. Finally, the SAP test points were matched to the abnormal FDT sectors. The relative risk (RR) of subsequent SAP abnormality corresponding to FDT abnormal sectors was calculated. Sixty perimetrically normal eyes of 60 participants had complete data and a qualifying follow-up. Baseline FDT results were abnormal in 65%. Of the eyes with abnormal FDT results, 51% developed abnormal SAP results after 4 to 27 months, whereas none of the eyes with normal FDT results developed abnormal SAP results (P<0.05). In perimetrically normal eyes with abnormal FDT results, converters had a greater cup-to-disc ratio, more eyes with GON, larger and deeper cups, and worse FDT mean deviation than nonconverters (P<0.05). The IOP and CCT did not differ between the 2 groups. The RR of subsequent SAP abnormality corresponding to abnormal FDT

  20. Identification of Mutations in Myocilin and Beta-1,4-galactosyltransferase 3 Genes in a Chinese Family with Primary Open-angle Glaucoma.

    PubMed

    Liao, Rong-Feng; Zhong, Zi-Lin; Ye, Min-Jie; Han, Li-Yun; Ye, Dong-Qing; Chen, Jian-Jun

    2016-12-05

    Glaucoma is a major cause of irreversible blindness worldwide. There is evidence showing that a subset of the disease is genetically determined. In this study, we screened for mutations in chromosome 1q-linked open-angle glaucoma (GLC1A) in a Chinese family with primary open-angle glaucoma (POAG). A total of 23 members from five generations of a family were enrolled and underwent thorough ophthalmologic examinations. In addition, 200 unrelated healthy Chinese controls were also recruited as normal control. GLC1A gene was amplified by polymerase chain reaction, and DNA sequencing was performed to screen for mutations. Six members were diagnosed as POAG, with severe clinical manifestations, and history of high intraocular pressures. The mean age of disease onset was 26.3 years. However, the others were asymptomatic. In six affected and three asymptomatic members, gene sequencing revealed a mutation c.C1456T in exon 3 of myocilin gene (MYOC). Furthermore, we also identified a novel mutation c.G322A in beta-1,4-galactosyltransferase 3 (B4GALT3) gene in all six affected and three asymptomatic members, which was not reported previously in POAG patients. The two newly identified variants were absent in other family members as well as controls. The mutations c.1456C < T (p.L486F) in MYOC and c.322G < A (p.V108I) in B4GALT3 are likely responsible for the pathogenesis of POAG in this family.

  1. When Is Evidence Enough Evidence? A Systematic Review and Meta-Analysis of the Trabectome as a Solo Procedure in Patients with Primary Open-Angle Glaucoma.

    PubMed

    Chow, Jeffrey T Y; Hutnik, Cindy M L; Solo, Karla; Malvankar-Mehta, Monali S

    2017-01-01

    The purpose of this systematic review and meta-analysis was to examine the availability of evidence for one of the earliest available minimally invasive glaucoma surgery (MIGS) procedures, the Trabectome. Various databases were searched up to December 20, 2016, for any published studies assessing the use of the Trabectome as a solo procedure in patients with primary open-angle glaucoma (POAG). The standardized mean differences (SMD) were calculated for the change in intraocular pressure (IOP) and number of glaucoma mediations used at 1-month, 6-month, and 12-month follow-up. After screening, three studies and one abstract with analyzable data were included. The meta-analysis showed statistically significant reductions in IOP and number of glaucoma medications used at all time points. Though the Trabectome as a solo procedure appears to lower IOP and reduces the number of glaucoma medications, more high-quality studies are required to make definitive conclusions. The difficulty of obtaining evidence may be one of the many obstacles that limit a full understanding of the potential safety and/or efficacy benefits compared to standard treatments. The time has come for a thoughtful and integrated approach with stakeholders to determine optimal access to care strategies for our patients.

  2. When Is Evidence Enough Evidence? A Systematic Review and Meta-Analysis of the Trabectome as a Solo Procedure in Patients with Primary Open-Angle Glaucoma

    PubMed Central

    Chow, Jeffrey T. Y.; Hutnik, Cindy M. L.; Solo, Karla

    2017-01-01

    The purpose of this systematic review and meta-analysis was to examine the availability of evidence for one of the earliest available minimally invasive glaucoma surgery (MIGS) procedures, the Trabectome. Various databases were searched up to December 20, 2016, for any published studies assessing the use of the Trabectome as a solo procedure in patients with primary open-angle glaucoma (POAG). The standardized mean differences (SMD) were calculated for the change in intraocular pressure (IOP) and number of glaucoma mediations used at 1-month, 6-month, and 12-month follow-up. After screening, three studies and one abstract with analyzable data were included. The meta-analysis showed statistically significant reductions in IOP and number of glaucoma medications used at all time points. Though the Trabectome as a solo procedure appears to lower IOP and reduces the number of glaucoma medications, more high-quality studies are required to make definitive conclusions. The difficulty of obtaining evidence may be one of the many obstacles that limit a full understanding of the potential safety and/or efficacy benefits compared to standard treatments. The time has come for a thoughtful and integrated approach with stakeholders to determine optimal access to care strategies for our patients. PMID:28740733

  3. A single gene for juvenile and middle-age onset open-angle glaucomas confined within a small interval on chromosome 1q

    SciTech Connect

    Raymond, V.; Dumont, M.; Plante, M.

    1994-09-01

    Primary open-angle glaucoma (POAG) encompasses a complex of ocular disease entities characterized by an optic neuropathy causing progressive loss of the visual fields and usually associated with elevated intraocular pressure. POAG can be subdivided into two groups according to age of onset: (1) the more prevalent middle to late-age onset chronic open-angle glaucoma (COAG) diagnosed after age 40 and (2) the less common form, juvenile open-angle glaucoma (JOAG), which occurs between 3 years of age and early adulthood. Susceptibility to either COAG or JOAG has been found to be inherited. We studied 141 members of a huge multigeneration French Canadian family affected with an autosomal dominant form of POAG. Both JOAG and COAG were diagnosed in 43 patients. To first position the disease gene, AFM microsatellites markers specific to chromosome 1q21-q31 were selected since linkage of JOAG to this region was recently demonstrated in two Caucasian families. Tight linkage was observed between the JOAG/COAG phenotype and 7 microsatellite markers on chromosome 1q23-q25; a maximum lod score of 6.62 at {theta}=0 was obtained with AFM278ye5. Using a recombination mapping strategy based on a unique founder effect, a characteristic JOAG/COAG haplotype spanning 12 cM was next recognized between loci D1S196 and D1S212. Two key recombination events in affected patients further confined the disease locus within a 5 cM interval between loci D1S445 and D1S452/D1S210. These results are the first to demonstrate that JOAG and one adult form of POAG map at a single locus on chromosome 1q23-q25. They also provide members of this family with a new diagnostic tool to identify the at-risk individuals.

  4. Ocular hypotensive efficacy and safety of travoprost 0.004% in inadequately controlled primary open-angle glaucoma or ocular hypertension: short-term, multicenter, prospective study.

    PubMed

    Blini, Mirella; Rossi, Gemma Caterina Maria; Trabucchi, Giuseppe; Curatola, Maria R; David, Alessandro; Radaelli, Rosella; Merlo, Giancarlo; Ratiglia, Roberto

    2009-01-01

    To evaluate the intraocular pressure (IOP) lowering efficacy and safety of travoprost 0.004% in patients with open-angle glaucoma or ocular hypertension, poorly controlled with or intolerance to beta-blockers. To record the short-term effect on diastolic ocular perfusion pressure (DOPP). One hundred and three patients with open-angle glaucoma or ocular hypertension were treated with travoprost 0.004% once daily for 90 days in an open-label, non-controlled study. Efficacy and safety were assessed at baseline, after 45 and 90 days. Clinical registry number IT0301. The primary outcome measure, IOP, was recorded at 10 am, 12 pm, and 4 pm at each visit. DOPP was evaluated at 10 am, at baseline and visit 3. Safety measures included adverse events, biomicroscopy, visual acuity, heart rate, and blood pressure. Mean IOP was reduced from 22.2 +/- 1.7 mmHg to 16.5 +/- 2.1 after 45 days (p < 0.0001), and to 16.1 +/- 2.2 after 90 days (p < 0.0001). The DOPP increased by 5.3 +/- 6.3 mmHg after 90 days of treatment (p < 0.0001). No drug related serious adverse events were reported during the study. The open-label and non-comparative nature of the study represented its principal limitations. The study confirmed the efficacy and tolerability of travoprost in the treatment of open-angle glaucoma or ocular hypertension, in a subset of patients unsuccessfully treated with beta-blockers. In this study, travoprost significantly increased DOPP at short-term follow-up. Further studies to assess the effect of travoprost on DOPP are warranted.

  5. Common variants near CAV1 and CAV2 are associated with primary open-angle glaucoma in Caucasians from the USA.

    PubMed

    Wiggs, Janey L; Kang, Jae Hee; Yaspan, Brian L; Mirel, Daniel B; Laurie, Cathy; Crenshaw, Andrew; Brodeur, Wendy; Gogarten, Stephanie; Olson, Lana M; Abdrabou, Wael; DelBono, Elizabeth; Loomis, Stephanie; Haines, Jonathan L; Pasquale, Louis R

    2011-12-01

    Primary open-angle glaucoma (POAG) is a genetically complex common disease characterized by progressive optic nerve degeneration that results in irreversible blindness. Recently, a genome-wide association study (GWAS) for POAG in an Icelandic population identified significant associations with single nucleotide polymorphisms (SNPs) between the CAV1 and CAV2 genes on chromosome 7q31. In this study, we confirm that the identified SNPs are associated with POAG in our Caucasian US population and that specific haplotypes located in the CAV1/CAV2 intergenic region are associated with the disease. We also present data suggesting that associations with several CAV1/CAV2 SNPs are significant mostly in women.

  6. [Genetic variants of CYP1B1 and WDR36 in the patients with primary congenital glaucoma and primary open angle glaucoma from Saint-Petersburg].

    PubMed

    Motushchuk, A E; Komarova, T Iu; Grudinina, N A; Rakhmanov, V V; Mandel'shtam, M Iu; Astakhov, Iu S; Vasil'ev, V B

    2009-12-01

    In 32 patients with primary congenital glaucoma (PCG), a search for mutations in the myocilin (MYOC), cytochrome P450B1 (CYP1B1), and WDR36 genes was performed. The Q368X mutation in myocilin gene, typical of the patients with adult-onset primary open-angle glaucoma (POAG), was not detected in the PCG patients. Screening of the CYP1B1 introns 2 and 3 for the presence of mutations in PCG patients revealed only six DNA polymorphisms, including IVS1-12ntT>C (g.3793 T>C), A119S (g.4160 G>T; GCC>TCC), G188G (g.4369 C>A; GGC>GGA), L432V (G.8131 C>G; CTG>GTG), D449D (g.8184 C>T; GAC>GAT), and N453S (g.8195 A>G; AAC>AGC) (nucleotide numbering is given in accordance with the GenBank sequence U56438). In the groups of PCG patients and donors without eye diseases, the frequencies of these variants were not statistically significantly different, pointing to the neutrality of these polymorphisms. Furthermore, the CYP1B1 polymorphism L432V, considered to be associated with POAG in some world populations, was not associated with this disease in the patients from St. Petersburg. DNA collections obtained from the POAG and PCG patients and from the control group were tested for the carriage of the worldwide distributed mutations of the WRD36 gene, D658G, R529Q, A449T, and N355S. D658G variant was found with equally low frequencies in the groups of POAG and PCG patients, as well as in the control group. Mutations A449T and R529Q were found only once each, while mutation N355S was not detected in any of the groups examined. Our results indicate that the WDR36 variants make no substantial contribution to the development of POAG and PCG in the patients from St. Petersburg and represent normal DNA polymorphism. It is likely that in most of the PCG patients from the population examined the disease is not associated with the CYP1B1 gene defects.

  7. Genome-wide linkage and association analysis of primary open-angle glaucoma endophenotypes in the Norfolk Island isolate.

    PubMed

    Matovinovic, Elizabeth; Kho, Pik Fang; Lea, Rodney A; Benton, Miles C; Eccles, David A; Haupt, Larisa M; Hewitt, Alex W; Sherwin, Justin C; Mackey, David A; Griffiths, Lyn R

    2017-01-01

    Primary open-angle glaucoma (POAG) refers to a group of heterogeneous diseases involving optic nerve damage. Two well-established risk factors for POAG are elevated intraocular pressure (IOP) and a thinner central corneal thickness (CCT). These endophenotypes exhibit a high degree of heritability across populations. Large-scale genome-wide association studies (GWASs) of outbred populations have robustly implicated several susceptibility gene variants for both IOP and CCT. Despite this progress, a substantial amount of genetic variance remains unexplained. Population-specific variants that might be rare in outbred populations may also influence POAG endophenotypes. The Norfolk Island population is a founder-effect genetic isolate that has been well characterized for POAG endophenotypes. This population is therefore a suitable candidate for mapping new variants that influence these complex traits. Three hundred and thirty participants from the Norfolk Island Eye Study (NIES) core pedigree provided DNA. Ocular measurements of CCT and IOP were also taken for analysis. Heritability analyses and genome-wide linkage analyses of short tandem repeats (STRs) were conducted using SOLAR. Pedigree-based GWASs of single-nucleotide polymorphisms (SNPs) were performed using the GenABEL software. CCT was the most heritable endophenotype in this cohort (h(2) = 0.77, p = 6×10(-6)), while IOP showed a heritability of 0.39 (p = 0.008). A genome-wide linkage analysis of these POAG phenotypes identified a maximum logarithm of the odds (LOD) score of 1.9 for CCT on chromosome 20 (p = 0.0016) and 1.3 for IOP on chromosome 15 (p = 0.0072). The GWAS results revealed a study-wise significant association for IOP at rs790357, which is located within DLG2 on chr11q14.1 (p = 1.02×10(-7)). DLG2 is involved in neuronal signaling and development, and while it has not previously been associated with IOP, it has been associated with myopia. An analysis of 12 known SNPs for IOP showed that rs12419342

  8. Comparison of vision-related quality of life in primary open-angle glaucoma and dry-type age-related macular degeneration.

    PubMed

    Karadeniz Ugurlu, S; Kocakaya Altundal, A E; Altin Ekin, M

    2017-03-01

    PurposeTo compare quality of life (QoL) in patients with primary open-angle glaucoma (POAG) and dry-type age-related macular degeneration (AMD) with similar best-corrected visual acuity.MethodsAge-, sex-, and visual acuity-matched POAG and dry AMD patients were included in the study. Each patient performed 24-2 and 10-2 SITA standard visual field tests. Contrast sensitivity was evaluated with CSV-1000 HGT instrument. The 25 item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) was used to analyze QoL. Overall and subscale scores were converted to scores between 0 and 100, the higher scores indicating better vision-related QoL.ResultsOverall NEI-VFQ-25 scores were 86.44 and 84.66 in glaucoma and AMD groups, respectively (P=0.244). The highest scores were obtained in 'vision-related dependency' subgroup in glaucoma and 'color and peripheral vision' in AMD group, whereas the lowest scores were noted 'in peripheral vision' in both glaucoma and AMD patients. Glaucoma patients had significantly lower scores in ocular pain, color vision, and peripheral vision subgroups compared with the AMD group, whereas AMD patients had lower scores in near and distance vision activities, vision-related social activity, and dependency subgroups. Contrast sensitivity results and mean defect values showed correlation with NEI-VFQ-25 scores in both groups.ConclusionsGlaucoma and AMD patients with similar visual acuity experienced similar overall impairment in QoL. However, glaucoma patients described more difficulty with peripheral vision and ocular pain, whereas AMD patients complained more about near and distance vision and dependency items.

  9. Comparative study of the retinal nerve fibre layer thickness performed with optical coherence tomography and GDx scanning laser polarimetry in patients with primary open-angle glaucoma

    PubMed Central

    Wasyluk, Jaromir T.; Jankowska-Lech, Irmina; Terelak-Borys, Barbara; Grabska-Liberek, Iwona

    2012-01-01

    Summary Background We compared the parameters of retinal nerve fibre layer in patients with advanced glaucoma with the use of different OCT (Optical Coherence Tomograph) devices in relation to analogical measurements performed with GDx VCC (Nerve Fiber Analyzer with Variable Corneal Compensation) scanning laser polarimetry. Material/Methods Study subjects had advanced primary open-angle glaucoma, previously treated conservatively, diagnosed and confirmed by additional examinations (visual field, ophthalmoscopy of optic nerve, gonioscopy), A total of 10 patients were enrolled (9 women and 1 man), aged 18–70 years of age. Nineteen eyes with advanced glaucomatous neuropathy were examined. 1) Performing a threshold perimetry Octopus, G2 strategy and ophthalmoscopy of optic nerve to confirm the presence of advanced primary open-angle glaucoma; 2) performing a GDx VCC scanning laser polarimetry of retinal nerve fibre layer; 3) measuring the retinal nerve fibre layer thickness with 3 different optical coherence tomographs. Results The parameters of the retinal nerve fibre layer thickness are highly correlated between the GDx and OCT Stratus and 3D OCT-1000 devices in mean retinal nerve fibre layer thickness, retinal nerve fibre layer thickness in the upper sector, and correlation of NFI (GDx) with mean retinal nerve fibre layer thickness in OCT examinations. Absolute values of the retinal nerve fibre layer thickness (measured in μm) differ significantly between GDx and all OCT devices. Conclusions Examination with OCT devices is a sensitive diagnostic method of glaucoma, with good correlation with the results of GDx scanning laser polarimetry of the patients. PMID:22367131

  10. Aqueous humor erythropoietin levels in open-angle glaucoma patients with and without TTR V30M familial amyloid polyneuropathy.

    PubMed

    Beirão, João M; Moreira, Luciana M; Oliveira, João C; Menéres, Maria J; Pessoa, Bernardete B; Matos, Maria E; Costa, Paulo P; Torres, Paulo A; Beirão, Idalina B

    2014-01-01

    Glaucoma is the leading cause of irreversible blindness in familial amyloidotic polyneuropathy (FAP) patients. Erythropoietin (EPO) is a cytokine that has been shown to play a role in neuroprotection and is endogenously produced in the eye. EPO levels in the aqueous humor are increased in eyes with glaucoma. In this study, we evaluated the EPO concentration in the aqueous humor of FAP and non-FAP patients, with and without glaucoma. Undiluted aqueous humor samples were obtained from 42 eyes that underwent glaucoma surgery, phacoemulsification, or vitrectomy. EPO concentration in the aqueous humor and blood were measured using the Immulite 2000 Xpi using an automatic analyzer (Siemens Healthcare Diagnostics). The mean EPO concentration in the aqueous humor of non-FAP glaucoma eyes group 2 (75.73±13.25 mU/ml) was significantly higher than non-FAP cataract eyes (17.22±5.33 mU/ml; p<0.001), FAP glaucoma eyes (18.82±10.16 mU/ml; p<0.001), and FAP nonglaucoma eyes (20.62±6.22 mU/ml; p<0.001). There was no statistically significant difference between FAP nonglaucoma eyes versus non-FAP cataract eyes (p = 0.23) and FAP glaucoma eyes versus FAP nonglaucoma eyes (p = 0.29). In the glaucoma groups, there was no correlation between the aqueous humor EPO concentration and the ocular pressure (p = 0.95) and mean deviation (p = 0.41). There was no correlation between the EPO serum concentration and EPO aqueous humor concentration in our patients (p = 0.77). Unlike other glaucomatous patients, FAP patients with glaucoma do not show increased and potentially neuroprotective endocular EPO production in the aqueous humor and may need more aggressive glaucoma management.

  11. First-line treatment for elevated intraocular pressure (IOP) associated with open-angle glaucoma or ocular hypertension: focus on bimatoprost

    PubMed Central

    Law, Simon K

    2007-01-01

    The goal of treatment for open-angle glaucoma or ocular hypertension is to improve quality of life through reduction of intraocular pressure (IOP) to preserve visual function. Prostaglandins, as a newer class of ocular hypotensive agents, have been shown to be effective in IOP reduction by the primary mechanism of action of increase the uveoscleral outflow. Bimatoprost is a member this class, but different from the other members by having an ethyl amide group rather than an isopropyl ester at the C-1 carbon of the alpha chain. Bimatoprost used once daily has been shown to be more effect in IOP reduction than other classes of topical ocular hypotensive agents including beta-blockers, carbonic anhydrase inhibitors, and alpha agonists. Comparing with other topical prostaglandins, bimatoprost may be slightly more effective in IOP reduction, but the clinical significance is uncertain. The commonly reported adverse events associated with bimatoprost are localized to the eye and include conjunctival hyperemia, changes in the pigmentation of the periocular skin and iris, and eyelash darkening and growth. It is currently approved by the Food and Drug Administration (FDA) and the European Commission (EC) for first-line therapy for the reduction of elevated IOP in patients with open-angle glaucoma or ocular hypertension. PMID:19668476

  12. First-line treatment for elevated intraocular pressure (IOP) associated with open-angle glaucoma or ocular hypertension: focus on bimatoprost.

    PubMed

    Law, Simon K

    2007-09-01

    The goal of treatment for open-angle glaucoma or ocular hypertension is to improve quality of life through reduction of intraocular pressure (IOP) to preserve visual function. Prostaglandins, as a newer class of ocular hypotensive agents, have been shown to be effective in IOP reduction by the primary mechanism of action of increase the uveoscleral outflow. Bimatoprost is a member this class, but different from the other members by having an ethyl amide group rather than an isopropyl ester at the C-1 carbon of the alpha chain. Bimatoprost used once daily has been shown to be more effect in IOP reduction than other classes of topical ocular hypotensive agents including beta-blockers, carbonic anhydrase inhibitors, and alpha agonists. Comparing with other topical prostaglandins, bimatoprost may be slightly more effective in IOP reduction, but the clinical significance is uncertain. The commonly reported adverse events associated with bimatoprost are localized to the eye and include conjunctival hyperemia, changes in the pigmentation of the periocular skin and iris, and eyelash darkening and growth. It is currently approved by the Food and Drug Administration (FDA) and the European Commission (EC) for first-line therapy for the reduction of elevated IOP in patients with open-angle glaucoma or ocular hypertension.

  13. [Clinical phenotype of a Japanese family with primary open-angle glaucoma caused by a Ala 363 Thr mutation in the MYOC gene].

    PubMed

    Ohyama, Akihiro; Fujimaki, Takuro; Kimura, Tairoh; Kawabata, Kiho; Fujiki, Keiko; Ishikawa, Karin; Mashima, Yukihiko; Murakami, Akira

    2006-01-01

    Myocilin is a gene that causes primary open-angle glaucoma (POAG). We report a family whose members had an Ala 363 Thr mutation in the myocilin gene. We present the clinical phenotype of this family. The proband was a 57-year-old man diagnosed with POAG. His younger sister (50 years old) was also diagnosed with POAG. Visual field impairment did not worsen and ocular pressure decreased with eyedrop treatment. Although two of their children in their 30s had ocular hypertension, they did not have any sign of glaucomatous optic neuropathy. Genetic analysis revealed that all four family members had an Ala 363 Thr mutation in myocilin gene. Ala 363 Thr mutation was considered to be the cause of open-angle glaucoma. In this family, age at onset was comparatively high The two patients in their 30s had high intraocular pressure but no loss in visual acuity. The family members who had POAG and those who did not have POAG were not different from each other in the results of standard ocular examinations, only in age. Patients with this mutation will develop high intraocular pressure after 30 years of age and glaucomatous neuropathy after 50 years of age. When this gene mutation is detected in juvenile patients, careful follow-up and early therapy are necessary.

  14. Fixed combination of bimatoprost and timolol in patients with primary open-angle glaucoma or ocular hypertension with inadequate IOP adjustment

    PubMed Central

    Brief, Gerrett; Lammich, Tobias; Nagel, Edgar; Pfennigsdorf, Sabine; Spraul, Christoph W; Ho, Selwyn

    2010-01-01

    Objective To assess the efficacy and tolerability of a fixed combination of bimatoprost and timolol (BTFC) in a large patient sample in a clinical setting. Methods In this multicenter, observational, noncontrolled, open-label study, patients (n = 1862) with primary open-angle glaucoma or ocular hypertension were treated with BTFC. Assessments were made at baseline, six weeks, and three months. Results Prior to starting BTFC, 92.3% of patients were taking other ocular hypotensive medications. In the overall group at three months, mean intraocular pressure was reduced from baseline (21.7 ± 4.5 mmHg and 21.8 ± 4.9 mmHg for the right and left eye, respectively) to 16.1 ± 3.0 mmHg for each eye (P < 0.0001). The majority of patients (92%) reported no adverse events. The most commonly reported adverse events (in >1% of patients) were eye irritation, and ocular and conjunctival hyperemia. Adherence to treatment was generally better than (35.4%) or the same as (57.5%) with prior therapy. BTFC tolerability was rated as excellent or good by 92.3% of physicians and 85.8% of patients. Conclusions In a large group of patients with primary open-angle glaucoma or ocular hypertension, treatment with BTFC was associated with consistent reductions in IOP, improved adherence to treatment, and good tolerability. PMID:20957059

  15. Presenting Visual Acuity and Ocular Comorbidity in Patients with Primary Open Angle Glaucoma in a Private Tertiary Eye Center in Nigeria.

    PubMed

    Duke, Roseline; Akinye, Ayodele; Ameh, Soter

    2013-01-01

    To determine the presenting visual acuity (VA) of patients with primary open angle glaucoma (POAG) and the relationship to ocular comorbidity. A retrospective case note audit was undertaken in Eye Foundation Hospital, Calabar, between 1st January 2010 and 31st June 2011. The case notes of all newly presenting patients diagnosed with POAG were retrieved and data were extracted for analysis. Inclusion criteria for glaucoma was defined. Out of a total of 320 new patients, 88 patients were diagnosed with POAG, with a prevalence of 27.5% (95% CI: 22.7-32.7). The mean age for males is 57.1 ± 8.8 while that of females is 52.6 ± 11.2 and the total mean of 55.8 ± 9.7. Of the 88 patients, there were 84 self referrals [95.5% (95% CI: 88.8-98.7)], of these, 45, 53.6% (95% CI: 42.4-64.5) were for second opinion. There was no statistical significance between the gender, education and occupation and the level of VA seen on presentation. The best corrected visual acuity (BCVA ) in the right and left eye respectively, was significantly (p < 0.0001) related to the cup disk ratio. Ocular comorbid conditions were seen in 19 (22%) patients in the study. The presenting BCVA was significantly related to the presence of ocular comorbidity in the best eye. Comorbidity was not strongly related to the age of the patients. The course of glaucomatous progression is highly variable, identifying factors that not only predict progression but influence the VA and ocular health of the eye can help to guide clinical practice and patient treatment and monitoring. How to cite this article: Duke R, Akinye A, Ameh S. Presenting Visual Acuity and Ocular Comorbidity in Patients with Primary Open Angle Glaucoma in a Private Tertiary Eye Center in Nigeria. J Current Glau Prac 2013;7(1):6-10.

  16. The novel Y371D myocilin mutation causes an aggressive form of juvenile open-angle glaucoma in a Caucasian family from the Middle-East.

    PubMed

    Avisar, Inbal; Lusky, Moshe; Robinson, Anat; Shohat, Mordechai; Dubois, Stéphane; Raymond, Vincent; Gaton, Dan D

    2009-09-24

    To search for the genetic cause of juvenile open-angle glaucoma (JOAG) in a Caucasian family and to perform genotype/phenotype correlation studies in the kindred. Six members of a three-generation family originating from Uzbekistan and now living in the Middle East were recruited from one large clinic in Israel. Ophthalmologic investigations comprised of visual field assessments, intraocular pressure measurements, optic disc evaluation, and gonioscopy. Medical charts were obtained to date the onset of glaucoma and to evaluate aggressivity of the trait. We screened the myocilin gene (MYOC, OMIM 601652) by direct genomic sequencing of its three exons in all family members. JOAG segregated as an autosomal dominant trait in four members of the family. The proband, a 14-year-old girl, had been diagnosed with juvenile open-angle glaucoma at 12 years old. Her mother, maternal aunt, and maternal grandfather all had JOAG that started at an early age. The disorder progressed rapidly even under optimal medical treatment, and all four patients had to undergo trabeculectomy. One missense mutation, Y371D (1111t-->g, Tyr [Y] 371 Asp [D]), was identified. This mutation cosegregated with the disorder in all affected members and was absent in 200 Caucasian controls. The Y371D MYOC mutation has not been reported before. One cousin of the proband was a silent heterozygotic carrier of the mutation and was still asymptomatic at nine years of age. We identified a novel mutation (Y371D) in MYOC from a Caucasian family who presented with an aggressive form of JOAG that required early trabeculectomy. Genetic screening of the MYOC mutation was beneficial in predicting one asymptomatic heterozygotic carrier.

  17. Identification of Mutations in Myocilin and Beta-1,4-galactosyltransferase 3 Genes in a Chinese Family with Primary Open-angle Glaucoma

    PubMed Central

    Liao, Rong-Feng; Zhong, Zi-Lin; Ye, Min-Jie; Han, Li-Yun; Ye, Dong-Qing; Chen, Jian-Jun

    2016-01-01

    Background: Glaucoma is a major cause of irreversible blindness worldwide. There is evidence showing that a subset of the disease is genetically determined. In this study, we screened for mutations in chromosome 1q-linked open-angle glaucoma (GLC1A) in a Chinese family with primary open-angle glaucoma (POAG). Methods: A total of 23 members from five generations of a family were enrolled and underwent thorough ophthalmologic examinations. In addition, 200 unrelated healthy Chinese controls were also recruited as normal control. GLC1A gene was amplified by polymerase chain reaction, and DNA sequencing was performed to screen for mutations. Results: Six members were diagnosed as POAG, with severe clinical manifestations, and history of high intraocular pressures. The mean age of disease onset was 26.3 years. However, the others were asymptomatic. In six affected and three asymptomatic members, gene sequencing revealed a mutation c.C1456T in exon 3 of myocilin gene (MYOC). Furthermore, we also identified a novel mutation c.G322A in beta-1,4-galactosyltransferase 3 (B4GALT3) gene in all six affected and three asymptomatic members, which was not reported previously in POAG patients. The two newly identified variants were absent in other family members as well as controls. Conclusion: The mutations c.1456C

  18. Controlled five-year follow-up study of laser trabeculoplasty as primary therapy for open-angle glaucoma

    SciTech Connect

    Tuulonen, A.; Niva, A.K.; Alanko, H.I.

    1987-10-15

    We followed up 32 eyes of 32 patients with early glaucoma (22 with capsular glaucoma and ten with simple glaucoma) who received laser trabeculoplasty as a primary therapy. These eyes were compared with a matched control group of 32 eyes treated with medication initially. The success rate (intraocular pressure below 22 mm Hg with laser alone or medication alone) at five years was 50% (16 of 32 eyes) in the laser-treated group and 22% (seven of 32 eyes) in the control group (P less than .02). The control group required more modifications of their therapy to control intraocular pressure. The neuroretinal rim area in the control eyes decreased 2.5 times as much as in the laser group (P = .017). Changes in the Friedmann visual fields did not differ significantly between the two groups.

  19. Polymorphism rs547984 on human chromosome 1q43 is not associated with primary open angle glaucoma in a Saudi cohort.

    PubMed

    Azad, Taif A; Edward, Nikhil B; Kondkar, Altaf A; Kalantan, Hatem; Altuwaijri, Saleh; Sultan, Tahira; Al-Mobarak, Faisal A; Al-Obeidan, Saleh A; Abu-Amero, Khaled K

    2017-06-26

    To investigate the association between polymorphism rs547984, located in close proximity to the Zona Pellucida Glycoprotein 4 (ZP4) gene on human chromosome 1q43 and primary open angle glaucoma (POAG). Polymorphism rs547984 was genotyped using Taq-Man® assay in 185 subjects comprising of 90 unrelated POAG cases and 95 controls of Saudi origin. Association analysis between cases and controls revealed no significant genotype distribution under additive (p = 0.356), dominant (p = 0.517) and recessive (p = 0.309) models. Besides, the allele frequency distribution was also found to be non-significant (p = 0.70). The minor "A" allele frequency was found to be 0.49 and 0.50 among POAG cases and controls, respectively. In addition, specific clinical indices used to assess severity of glaucoma such as intraocular pressure (IOP), cup/disc ratio and number of anti-glaucoma medication also did not show any significant genotype distribution in POAG cases. Polymorphism rs547984 is neither associated with any clinical indices important for POAG such as IOP and cup/disc ratio nor is a risk factor for POAG in the Saudi cohort.

  20. Ophthalmic and Glaucoma Treatment Characteristics Associated with Changes in Health-Related Quality of Life Before and After Newly Diagnosed Primary Open-Angle Glaucoma in Nurses Health Study Participants

    PubMed Central

    Bailey, Lucy A.; Okereke, Olivia I.; Kawachi, Ichiro; Cioffi, George A.; Pasquale, Louis R.; Kang, Jae H.

    2015-01-01

    Purpose To identify attributes related to glaucoma diagnosis or early glaucoma treatment patterns that are associated with changes in health-related quality of life among those with newly diagnosed primary open-angle glaucoma. Methods Among Nurses’ Health Study participants with incident medical record-confirmed primary open-angle glaucoma diagnosed in 1992–2000, we included 317 women who completed the Short-Form 36 Health Survey pre- and post-diagnosis. The two primary outcomes were 4-year changes (1992–1996 or 1996–2000) in the physical and mental component summary scores. Multiple regression models were used to estimate differences in score changes by early treatment pattern history and characteristics as of diagnosis (i.e., number of eyes affected, history of cataract, macular degeneration, cup-to-disc ratio, intraocular pressure, visual field loss type). Results In multivariable models, no ophthalmologic characteristics were associated with physical component score change. However, compared to treatment with eye drops or pills only, laser trabeculoplasty treatment (concomitant with history of treatment with eye drops or pills in 84%) was associated with a worse mental component score change over four years (-2.5 units; 95% confidence interval: −4.6, −0.3); this association was stronger with a family history of glaucoma (p-interaction=0.04) or with bilateral disease (p-interaction=0.001). Conclusions Among patients with incident glaucoma, no major factors were associated with change in physical well-being. However, compared to medical treatment only, a history of laser trabeculoplasty, which was commonly accompanied with a history of medical treatment and likely represented the need for a second line of treatment, was associated with a worse decline in mental well-being. PMID:26125994

  1. Ophthalmic and Glaucoma Treatment Characteristics Associated With Changes in Health-related Quality of Life Before and After Newly Diagnosed Primary Open-angle Glaucoma in Nurses' Health Study Participants.

    PubMed

    Bailey, Lucy A; Okereke, Olivia I; Kawachi, Ichiro; Cioffi, George A; Pasquale, Louis R; Kang, Jae H

    2016-03-01

    To identify attributes related to glaucoma diagnosis or early glaucoma treatment patterns that are associated with changes in health-related quality of life among those with newly diagnosed primary open-angle glaucoma. Among Nurses' Health Study participants with incident medical record-confirmed primary open-angle glaucoma diagnosed in 1992 to 2000, we included 317 women who completed the Short Form-36 Health Survey prediagnosis and postdiagnosis. The 2 primary outcomes were 4-year changes (1992 to 1996 or 1996 to 2000) in the physical and mental component summary scores. Multiple regression models were used to estimate differences in score changes by early treatment pattern history and characteristics as of diagnosis (ie, number of eyes affected, history of cataract, macular degeneration, cup-to-disc ratio, intraocular pressure, visual field loss type). In multivariable models, no ophthalmologic characteristics were associated with physical component score change. However, compared with treatment with eye drops or pills only, laser trabeculoplasty treatment (concomitant with history of treatment with eye drops or pills in 84%) was associated with a worse mental component score change over 4 years (-2.5 units; 95% confidence interval: -4.6, -0.3); this association was stronger with a family history of glaucoma (P-interaction=0.04) or with bilateral disease (P-interaction=0.001). Among patients with incident glaucoma, no major factors were associated with change in physical well being. However, compared with medical treatment only, a history of laser trabeculoplasty, which was commonly accompanied with a history of medical treatment and likely represented the need for a second line of treatment, was associated with a worse decline in mental well being.

  2. Common variants near CAV1 and CAV2 are associated with primary open-angle glaucoma in Caucasians from the USA

    PubMed Central

    Wiggs, Janey L.; Hee Kang, Jae; Yaspan, Brian L.; Mirel, Daniel B.; Laurie, Cathy; Crenshaw, Andrew; Brodeur, Wendy; Gogarten, Stephanie; Olson, Lana M.; Abdrabou, Wael; DelBono, Elizabeth; Loomis, Stephanie; Haines, Jonathan L.; Pasquale, Louis R.

    2011-01-01

    Primary open-angle glaucoma (POAG) is a genetically complex common disease characterized by progressive optic nerve degeneration that results in irreversible blindness. Recently, a genome-wide association study (GWAS) for POAG in an Icelandic population identified significant associations with single nucleotide polymorphisms (SNPs) between the CAV1 and CAV2 genes on chromosome 7q31. In this study, we confirm that the identified SNPs are associated with POAG in our Caucasian US population and that specific haplotypes located in the CAV1/CAV2 intergenic region are associated with the disease. We also present data suggesting that associations with several CAV1/CAV2 SNPs are significant mostly in women. PMID:21873608

  3. Levobetaxolol hydrochloride: a review of its pharmacology and use in the treatment of chronic open-angle glaucoma and ocular hypertension

    PubMed Central

    Quaranta, Luciano; Turano, Raffaele; Pizzolante, Teodoro

    2007-01-01

    Levobetaxolol is a cardioselective β-blocker that has been demonstrated to reduce intraocular pressure in patients affected with primary open-angle glaucoma and ocular hypertension. Levobetaxolol may be an effective neuroprotectant because of its great capacity to block sodium and calcium influx, which might confer a neuroprotective activity. Experimental and clinical studies have demonstrated the effects of levobetaxolol on ocular hemodynamics and visual field, and the pharmacologic differences between β-blockers currently used for the treatment of elevated IOP have become of more than academic interest since a number of studies have shown improvements to various extents. Unlike the initially manufactured 0.5% ophthalmic solution, levobetaxolol is suspended in a different delivery vehicle in levobetaxolol ophthalmic suspension, to increase the ocular tolerance and allow a similarity of effect with a 2-fold reduced concentration (0.25%). PMID:19668496

  4. Genetic heterogeneity of primary open angle glaucoma and ocular hypertension: linkage to GLC1A associated with an increased risk of severe glaucomatous optic neuropathy.

    PubMed Central

    Brézin, A P; Béchetoille, A; Hamard, P; Valtot, F; Berkani, M; Belmouden, A; Adam, M F; Dupont de Dinechin, S; Bach, J F; Garchon, H J

    1997-01-01

    The GLC1A locus for autosomal dominant juvenile and middle age onset primary open angle glaucoma (OAG) has been mapped to chromosome 1q21-q31. OAG, however, is a heterogeneous disease. We tested linkage of OAG and ocular hypertension (OHT), a major risk factor for OAG, to GLC1A in eight French families with multiple cases of juvenile and middle age onset OAG. There was strong evidence of genetic heterogeneity, four families being linked to GLC1A and two or three others being unlinked, depending on whether the complete OAG phenotype was analysed alone or jointly with OHT. Peak intraocular pressure (IOP) did not differ significantly between the two groups of families, while linkage to GLC1A conferred a highly increased risk of developing OAG and of having severe glaucomatous optic neuropathy. Testing linkage of familial OAG to GLC1A may therefore have prognostic value too. PMID:9222961

  5. Levobetaxolol hydrochloride: a review of its pharmacology and use in the treatment of chronic open-angle glaucoma and ocular hypertension.

    PubMed

    Quaranta, Luciano; Turano, Raffaele; Pizzolante, Teodoro

    2007-06-01

    Levobetaxolol is a cardioselective beta-blocker that has been demonstrated to reduce intraocular pressure in patients affected with primary open-angle glaucoma and ocular hypertension. Levobetaxolol may be an effective neuroprotectant because of its great capacity to block sodium and calcium influx, which might confer a neuroprotective activity. Experimental and clinical studies have demonstrated the effects of levobetaxolol on ocular hemodynamics and visual field, and the pharmacologic differences between beta-blockers currently used for the treatment of elevated IOP have become of more than academic interest since a number of studies have shown improvements to various extents. Unlike the initially manufactured 0.5% ophthalmic solution, levobetaxolol is suspended in a different delivery vehicle in levobetaxolol ophthalmic suspension, to increase the ocular tolerance and allow a similarity of effect with a 2-fold reduced concentration (0.25%).

  6. Effect of 2% dorzolamide on retinal blood flow: a study on juvenile primary open-angle glaucoma patients already receiving 0.5% timolol

    PubMed Central

    Costagliola, Ciro; Campa, Claudio; Parmeggiani, Francesco; Incorvaia, Carlo; Perri, Paolo; D’Angelo, Sergio; Lamberti, Giuseppe; Sebastiani, Adolfo

    2007-01-01

    Aim To investigate whether dorzolamide modifies peripapillary retinal haemodynamics in juvenile primary open-angle glaucoma (JPOAG) patients treated with timolol. Methods In 40 JPOAG subjects, before and after dorzolamide coadministration with timolol, the following examinations were achieved: intraocular pressure (IOP), blood pressure (BP), ocular perfusion pressure (OPP), heart rate (HR), visual field and retinal flowmetry. Results Adjunctive therapy with dorzolamide induced the following modifications: IOP reduction [1.75 mmHg, 95% confidence interval (CI) 1.23, 2.26; P < 0.05], OPP increase (5.09 mmHg, 95% CI 2.97, 7.20; P < 0.02) and retinal blood flow improvement (35.0 arbitrary units, 95% CI 12.20, 57.80; P < 0.03). BP, HR and visual field indices did not change. Conclusions Dorzolamide, in association or in fixed combination with timolol, significantly improves retinal blood flow in JPOAG patients. PMID:16981897

  7. Localization of a locus (GLC1B) for adult-onset primary open angle glaucoma to the 2cen-q13 region

    SciTech Connect

    Stoilova, D.; Trifan, O.C.; Sarfarazi, M.

    1996-08-15

    Primary open angle glaucoma (GLC1) is a common ocular disorder with a characteristic degeneration of the optic nerve and visual field defects that is often associated with an elevated intraocular pressure. The severe but rare juvenile-onset type has previously been mapped to 1q21-q31, and its genetic heterogeneity has been established. Herein, we present a new locus (GLC1B) for one form of GLC1 on chromosome 2cen-q13 with a clinical presentation of low to moderate intraocular pressure, onset in late 40s, and a good response to medical treatment. Two-point and haplotype analyses of affected and unaffected meioses in six families provided maximum linkage information with D2S417, GATA112EO3, D2S113, D2S373, and D2S274 (lod scores ranging from 3.11 to 6.48) within a region of 8.5 cM that is flanked by D2S2161 and D2S2264. Analysis of affected meioses alone revealed no recombination with an additional two markers (D2S2264 and D2S135) in a region of 11.2 cM that is flanked by D2S2161 and D2S176. Analysis of unaffected meioses identified only one healthy 86-year-old male who has inherited the entire affected haplotype and, hence, is a gene carrier for this condition. Eight additional families with similar and/or different clinical presentation did not show any linkage to this region and, therefore, provided evidence for genetic heterogeneity of adult-onset primary open angle glaucoma. 63 refs., 2 figs., 2 tabs.

  8. EP3/FP dual receptor agonist ONO-9054 administered morning or evening to patients with open-angle glaucoma or ocular hypertension: results of a randomised crossover study

    PubMed Central

    Berlin, Michael S; Rowe-Rendleman, Cheryl; Ahmed, Ike; Ross, Douglas T; Fujii, Akifumi; Ouchi, Takafumi; Quach, Christine; Wood, Andrew; Ward, Caroline L

    2016-01-01

    Background/aims The novel prostaglandin E (EP) 3 and prostaglandin F (FP) receptor agonist ONO-9054 is effective in lowering intraocular pressure (IOP) in patients with ocular hypertension and open-angle glaucoma when administered once daily. This study compares the effects of morning (AM) versus evening (PM) dosing of ONO-9054 on tolerability and IOP lowering. Methods This was a single-centre, randomised, double-masked, two-sequence, placebo-controlled crossover study in 12 subjects with bilateral primary open-angle glaucoma or ocular hypertension. Two 14-day crossover regimens were separated by a 2-week washout: ONO-9054 (1 drop to each eye) in the morning (07:00) and vehicle in the evening (19:00) and vice versa. IOP was measured multiple times during select days. Ocular examinations also evaluated safety and tolerability. Results Mild ocular hyperaemia, reported by six subjects with PM dosing, was the most frequent adverse event. Mild to moderate dryness was also slightly more frequent after PM dosing. Maximum IOP reduction from baseline occurred on day 2 with decreases from baseline of −7.4 mm Hg (−30.8%) for AM dosing and −9.1 mm Hg, (−38.0%) for PM dosing; after 14 days, mean reduction in IOP was −6.8 mm Hg (−28.6%) for AM dosing and −7.5 mm Hg (−31.0%) for PM dosing. Conclusions PM dosing of ONO-0954 was associated with a slightly increased frequency of mild hyperaemia and mild to moderate dryness. Both dosing schedules provided sustained reduction in IOP. Trial registration number NCT01670266. PMID:26453641

  9. Association of NT-proANP Level in Plasma and Humor Aqueous with Primary Open-Angle Glaucoma.

    PubMed

    Baumane, Kristine; Ranka, Renate; Laganovska, Guna

    2017-02-01

    The aim of this study is to determine differences in the levels of NT-proANP in the plasma and aqueous humor of glaucoma and cataract patients and to evaluate whether any relationships are present. The study group consisted of 58 patients with primary-open glaucoma (POAG) undergoing trabeculectomy surgery. The control group was comprised of 32 age-matched cataract patients. The concentration of the N-terminal fragment of the proatrial natriuretic peptide (NT-proANP, 1-98) in the aqueous humor and blood plasma samples was measured using an immunochemical method (ELISA). The plasma NT-proANP concentration was significantly increased in patients with POAG compared to that in the control group (7.00 vs. 4.65 nmol/L, P = 0.0054). Similarly, the NT-proANP concentration in the aqueous humor was significantly higher in the POAG patients (0.47 vs. 0.09 nmol/L, P = 0.0112). However, there was no correlation between the NT-proANP values in the aqueous humor and the plasma of the POAG patients, as well as between the NT-proANP values in the aqueous humor and the intraocular pressure. We identified an association between the levels of NT-proANP in the plasma and the aqueous humor with POAG. Our data support the idea of the involvement of NP system in the development of POAG and highlight ANP as a possible biomarker of glaucoma.

  10. Developing the specifications of an Open Angle Glaucoma screening intervention in the United Kingdom: a Delphi approach

    PubMed Central

    2012-01-01

    Background Glaucoma is a leading cause of blindness. Early detection is advocated but there is insufficient evidence from randomized controlled trials (RCTs) to inform health policy on population screening. Primarily, there is no agreed screening intervention. For a screening programme, agreement is required on the screening tests to be used, either individually or in combination, the person to deliver the test and the location where testing should take place. This study aimed to use ophthalmologists (who were experienced glaucoma subspecialists), optometrists, ophthalmic nurses and patients to develop a reduced set of potential screening tests and testing arrangements that could then be explored in depth in a further study of their feasibility for evaluation in a glaucoma screening RCT. Methods A two-round Delphi survey involving 38 participants was conducted. Materials were developed from a prior evidence synthesis. For round one, after some initial priming questions in four domains, specialists were asked to nominate three screening interventions, the intervention being a combination of the four domains; target population, (age and higher risk groups), site, screening test and test operator (provider). More than 250 screening interventions were identified. For round two, responses were condensed into 72 interventions and each was rated by participants on a 0-10 scale in terms of feasibility. Results Using a cut-off of a median rating of feasibility of ≥5.5 as evidence of agreement of intervention feasibility, six interventions were identified from round 2. These were initiating screening at age 50, with a combination of two or three screening tests (varying combinations of tonometry/measures of visual function/optic nerve damage) organized in a community setting with an ophthalmic trained technical assistant delivering the tests. An alternative intervention was a ‘glaucoma risk score’ ascertained by questionnaire. The advisory panel recommended that

  11. Whole-brain voxel-based analysis of diffusion tensor MRI parameters in patients with primary open angle glaucoma and correlation with clinical glaucoma stage

    PubMed Central

    Dai, Hui; Yin, Dazhi; Hu, Chunhong; Morelli, John N.; Hu, Su; Yan, Xu

    2013-01-01

    Introduction Glaucoma is the second leading cause of blindness worldwide. The purpose of this study is to identify areas of neurodegeneration in glaucoma utilizing 3 T magnetic resonance (MR) diffusion tensor imaging (DTI) parameters with whole-brain voxel-based analysis (VBA) and determine whether these parameters correlate with disease severity. Methods Twenty-five glaucoma patients and 25 age-matched healthy volunteers were prospectively examined. Clinical glaucoma severity was assessed utilizing static threshold visual field parameters. All subjects underwent 3 T MRI utilizing a DTI sequence (repetition time/echo time 13,000/68.9 ms, maximal b value 800 s/mm2 along 30 directions) and an anatomic sequence to provide structural information. All data sets were processed by VBA. Brain fractional anisotropy, mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) were compared in the two groups. Correlation between DTI parameters and glaucoma stage were determined. Results The bilateral optic radiations and chiasma of glaucoma patients demonstrated statistically significantly lower fractional anisotropy (p<0.05). Optic radiation RD was similarly decreased in glaucoma patients (p<0.05). There were no statistically significant differences noted in MD or AD between the two groups (p>0.05). Optic chiasm fractional anisotropy values were negatively correlated with glaucoma stage (r=−0.53, p<0.05) and optic radiation RD values positively correlated (left r=0.45, p<0.05; right = 0.38, p=0.06). Conclusion DTI parameters fractional anisotropy and RD are altered in the optic chiasm and radiations of glaucoma patients. As fractional anisotropy and RD also correlate with glaucoma stage, these values could serve as potential non-invasive markers of disease severity. PMID:23223846

  12. Whole exome sequencing implicates eye development, the unfolded protein response and plasma membrane homeostasis in primary open-angle glaucoma

    PubMed Central

    Souzeau, Emmanuelle; Sharma, Shiwani; Landers, John; Mills, Richard; Goldberg, Ivan; Healey, Paul R.; Graham, Stuart; Hewitt, Alex W.; Mackey, David A.; Galanopoulos, Anna; Casson, Robert J.; Ruddle, Jonathan B.; Ellis, Jonathan; Leo, Paul; Brown, Matthew A.; MacGregor, Stuart; Lynn, David J.; Burdon, Kathryn P.; Craig, Jamie E.

    2017-01-01

    Purpose To identify biological processes associated with POAG and its subtypes, high-tension (HTG) and normal-tension glaucoma (NTG), by analyzing rare potentially damaging genetic variants. Methods A total of 122 and 65 unrelated HTG and NTG participants, respectively, with early onset advanced POAG, 103 non-glaucoma controls and 993 unscreened ethnicity-matched controls were included in this study. Study participants without myocilin disease-causing variants and non-glaucoma controls were subjected to whole exome sequencing on an Illumina HiSeq2000. Exomes of participants were sequenced on an Illumina HiSeq2000. Qualifying variants were rare in the general population (MAF < 0.001) and potentially functionally damaging (nonsense, frameshift, splice or predicted pathogenic using SIFT or Polyphen2 software). Genes showing enrichment of qualifying variants in cases were selected for pathway and network analysis using InnateDB. Results POAG cases showed enrichment of rare variants in camera-type eye development genes (p = 1.40×10–7, corrected p = 3.28×10–4). Implicated eye development genes were related to neuronal or retinal development. HTG cases were significantly enriched for key regulators in the unfolded protein response (UPR) (p = 7.72×10–5, corrected p = 0.013). The UPR is known to be involved in myocilin-related glaucoma; our results suggest the UPR has a role in non-myocilin causes of HTG. NTG cases showed enrichment in ion channel transport processes (p = 1.05×10–4, corrected p = 0.027) including calcium, chloride and phospholipid transporters involved in plasma membrane homeostasis. Network analysis also revealed enrichment of the MHC Class I antigen presentation pathway in HTG, and the EGFR1 and cell-cycle pathways in both HTG and NTG. Conclusion This study suggests that mutations in eye development genes are enriched in POAG. HTG can result from aberrant responses to protein misfolding which may be amenable to molecular chaperone therapy. NTG

  13. Ultra-high resolution profiles of macular intra-retinal layer thicknesses and associations with visual field defects in primary open angle glaucoma

    NASA Astrophysics Data System (ADS)

    Chen, Qi; Huang, Shenghai; Ma, Qingkai; Lin, Huiling; Pan, Mengmeng; Liu, Xinting; Lu, Fan; Shen, Meixiao

    2017-02-01

    The structural characteristics of the outer retinal layers in primary open angle glaucoma (POAG) are still controversial, and these changes, along with those in the inner retinal layers, could have clinical and/or pathophysiological significance. A custom-built ultra-high resolution optical coherence tomography (UHR-OCT) combined with an automated segmentation algorithm can image and measure the eight intra-retinal layers. The purpose of this study is to determine the thickness characteristics of the macular intra-retinal layers, especially the outer layers, in POAG patients. Thirty-four POAG patients (56 eyes) and 33 normal subjects (63 eyes) were enrolled. Thickness profiles of the eight intra-retinal layers along a 6-mm length centred on the fovea at the horizontal and vertical meridians were obtained and the regional thicknesses were compared between two groups. The associations between the thicknesses of each intra-retinal layer and the macular visual field (VF) sensitivity were then analysed. POAG affected not only the inner retinal layers but also the photoreceptor layers and retinal pigment epithelium of the outer retina. However, the VF loss was correlated mainly with the damage of the inner retinal layers. UHR-OCT with automated algorithm is a useful tool in detecting microstructural changes of macula with respect to the progression of glaucoma.

  14. Sensory stimulation for lowering intraocular pressure, improving blood flow to the optic nerve and neuroprotection in primary open-angle glaucoma.

    PubMed

    Rom, Edith

    2013-12-01

    Primary open-angle glaucoma is a group of optic neuropathies that can lead to irreversible blindness. Sensory stimulation in the form of acupuncture or ear acupressure may contribute to protecting patients from blindness when used as a complementary method to orthodox treatment in the form of drops, laser or surgery. The objective of this article is to provide a narrative overview of the available literature up to July 2012. It summarises reported evidence on the potential beneficial effects of sensory stimulation for glaucoma. Sensory stimulation appears to significantly enhance the pressure-lowering effect of orthodox treatments. Studies suggest that it may also improve blood flow to the eye and optic nerve head. Furthermore, it may play a role in neuroprotection through regulating nerve growth factor and brain-derived neurotrophic factor and their receptors, thereby encouraging the survival pathway in contrast to the pathway to apoptosis. Blood flow and neuroprotection are areas that are not directly influenced by orthodox treatment modalities. Numerous different treatment protocols were used to investigate the effect of sensory stimulation on intraocular pressure, blood flow or neuroprotection of the retina and optic nerve in the animal model and human pilot studies. Objective outcomes were reported to have been evaluated with Goldmann tonometry, Doppler ultrasound techniques and electrophysiology (pattern electroretinography, visually evoked potentials), and supported with histological studies in the animal model. Taken together, reported evidence from these studies strongly suggests that sensory stimulation is worthy of further research.

  15. Common variants on chromosome 2 and risk of primary open-angle glaucoma in the Afro-Caribbean population of Barbados

    PubMed Central

    Jiao, Xiaodong; Yang, Zhenglin; Yang, Xian; Chen, Yuhong; Tong, Zongzhong; Zhao, Chao; Zeng, Jiexi; Chen, Haoyu; Gibbs, Daniel; Sun, Xufang; Li, Bei; Wakins, W. Scott; Meyer, Cynthia; Wang, Xiaolei; Kasuga, Daniel; Bedell, Matthew; Pearson, Erik; Weinreb, Robert N.; Leske, M. Cristina; Hennis, Anselm; DeWan, Andrew; Nemesure, Barbara; Jorde, Lynn B.; Hoh, Josephine; Hejtmancik, J. Fielding; Zhang, Kang

    2009-01-01

    Primary open-angle glaucoma (POAG) is the second leading cause of blindness worldwide. Although a number of genetic loci have shown association or genetic linkage to monogenic forms of POAG, the identified genes and loci do not appear to have a major role in the common POAG phenotype. We seek to identify genetic loci that appear to be major risk factors for POAG in the Afro-Caribbean population of Barbados, West Indies. We performed linkage analyses in 146 multiplex families ascertained through the Barbados Family Study of Glaucoma (BFSG) and identified a strong linkage signal on chromosome 2p (logarithm of odds score = 6.64 at θ = 0 with marker D2S2156). We subsequently performed case-control analyses using unrelated affected individuals and unaffected controls. A set of SNPs on chromosome 2p was evaluated in two independent groups of BFSG participants, a discovery group (130 POAG cases, 65 controls) and a replication group (122 POAG cases, 65 controls), and a strong association was identified with POAG and rs12994401 in both groups (P < 3.34 E−09 and P < 1.21E−12, respectively). The associated SNPs form a common disease haplotype. In summary, we have identified a locus with a major impact on susceptibility to the common POAG phenotype in an Afro-Caribbean population in Barbados. Our approach illustrates the merit of using an isolated population enriched with common disease variants as an efficient method to identify genetic underpinning of POAG. PMID:19805132

  16. Apolipoprotein E–Promoter Single-Nucleotide Polymorphisms Affect the Phenotype of Primary Open-Angle Glaucoma and Demonstrate Interaction with the Myocilin Gene

    PubMed Central

    Copin, Bruno; Brézin, Antoine P.; Valtot, Françoise; Dascotte, Jean-Claude; Béchetoille, Alain; Garchon, Henri-Jean

    2002-01-01

    Primary open-angle glaucoma (POAG) is an optic neuropathy that has a high worldwide prevalence and that shows strong evidence of complex inheritance. The myocilin (MYOC) gene is the only one that has thus far been shown to have mutations in patients with POAG. Apolipoprotein E (APOE) plays an essential role in lipid metabolism, and the APOE gene has been involved in neuronal degeneration that occurs in Alzheimer disease (AD). Here, we report that two APOE-promoter single-nucleotide polymorphisms (SNPs) previously associated with AD also modify the POAG phenotype. APOE(−219G) is associated with increased optic nerve damage, as reflected by increased cup:disk ratio and visual field alteration. In addition, APOE(−491T), interacting at a highly significant level with an SNP in the MYOC promoter, MYOC(−1000G), is associated with increased intraocular pressure (IOP) and with limited effectiveness of IOP-lowering treatments in patients with POAG. Together, these findings establish APOE as a potent modifier for POAG, which could explain the linkage to chromosome 19q previously observed by use of a genome scan for this condition and an increased frequency of glaucoma in patients with AD. The findings also shed new light on potential mechanisms of optic nerve damage and of IOP regulation in POAG. PMID:11992263

  17. Ultra-high resolution profiles of macular intra-retinal layer thicknesses and associations with visual field defects in primary open angle glaucoma

    PubMed Central

    Chen, Qi; Huang, Shenghai; Ma, Qingkai; Lin, Huiling; Pan, Mengmeng; Liu, Xinting; Lu, Fan; Shen, Meixiao

    2017-01-01

    The structural characteristics of the outer retinal layers in primary open angle glaucoma (POAG) are still controversial, and these changes, along with those in the inner retinal layers, could have clinical and/or pathophysiological significance. A custom-built ultra-high resolution optical coherence tomography (UHR-OCT) combined with an automated segmentation algorithm can image and measure the eight intra-retinal layers. The purpose of this study is to determine the thickness characteristics of the macular intra-retinal layers, especially the outer layers, in POAG patients. Thirty-four POAG patients (56 eyes) and 33 normal subjects (63 eyes) were enrolled. Thickness profiles of the eight intra-retinal layers along a 6-mm length centred on the fovea at the horizontal and vertical meridians were obtained and the regional thicknesses were compared between two groups. The associations between the thicknesses of each intra-retinal layer and the macular visual field (VF) sensitivity were then analysed. POAG affected not only the inner retinal layers but also the photoreceptor layers and retinal pigment epithelium of the outer retina. However, the VF loss was correlated mainly with the damage of the inner retinal layers. UHR-OCT with automated algorithm is a useful tool in detecting microstructural changes of macula with respect to the progression of glaucoma. PMID:28169283

  18. A comparison of the effects of betaxolol, timolol, and pilocarpine on visual function in patients with open-angle glaucoma.

    PubMed

    Drance, S M

    1998-08-01

    The author compares the effect of betaxolol, timolol, and pilocarpine on visual functions in patients with glaucoma. Sixty-eight patients with early glaucoma were randomly allocated to betaxolol, timolol, or pilocarpine treatment and their visual fields, motion detection, and contrast sensitivity were studied over a 24-month period. A subset of the betaxolol and timolol group were also followed with short-wave automated perimetry. One eye of each patient was used in the analysis. All three drugs reduced pressure effectively. Pilocarpine and timolol were not significantly different from each other and both produced a more marked pressure reduction than betaxolol. There were no significant differences between the drugs on the visual fields, contrast sensitivity, or motion detection. Betaxolol appeared to have a better impact on the blue-yellow sensitivity of the upper nasal and upper temporal visual field quadrants than timolol. In spite of a greater pressure reduction, timolol did not have a more favorable effect on visual function. In the short-wave automated perimetry, the betaxolol did marginally better than timolol. The apparent dissociation between pressure reduction and protection of visual function deserves further study.

  19. Patient-reported vision-related quality of life differences between superior and inferior hemifield visual field defects in primary open-angle glaucoma.

    PubMed

    Cheng, Hui-Chen; Guo, Chao-Yu; Chen, Mei-Ju; Ko, Yu-Chieh; Huang, Nicole; Liu, Catherine Jui-ling

    2015-03-01

    Previous studies have found that glaucoma is associated with impaired patient-reported vision-related quality of life (pVRQOL) but few, to our knowledge, have assessed how the visual field (VF) defect location impacts the pVRQOL. To investigate the associations of VF defects in the superior vs inferior hemifields with pVRQOL outcomes in patients with primary open-angle glaucoma. Prospective cross-sectional study at a tertiary referral center from March 1, 2012, to January 1, 2013, including patients with primary open-angle glaucoma who had a best-corrected visual acuity in the better eye equal to or better than 20/60 and reliable VF tests. The pVRQOL was assessed by a validated Taiwanese version of the 25-item National Eye Institute Visual Function Questionnaire. Reliable VF tests obtained within 3 months of enrollment were transformed to binocular integrated VF (IVF). The IVF was further stratified by VF location (superior vs inferior hemifield). The association between each domain of the 25-item National Eye Institute Visual Function Questionnaire and superior or inferior hemifield IVF was determined using multivariable linear regression analysis. The analysis included 186 patients with primary open-angle glaucoma with a mean age of 59.1 years (range, 19-86 years) and IVF mean deviation (MD) of -4.84 dB (range, -27.56 to 2.17 dB). In the multivariable linear regression analysis, the MD of the full-field IVF showed positive associations with near activities (β = 0.05; R2 = 0.20; P < .001), vision-specific role difficulties (β = 0.04; R2 = 0.19; P = .01), vision-specific dependency (β = 0.04; R2 = 0.20; P < .001), driving (β = 0.05; R2 = 0.24; P < .001), peripheral vision (β = 0.03; R2 = 0.18; P = .02), and composite scores (β = 0.04; R2 = 0.27; P = .005). Subsequent analysis showed that the MD of the superior hemifield IVF was associated only with near activities (β = 0.04; R2

  20. Clinical effectiveness of brinzolamide 1%–brimonidine 0.2% fixed combination for primary open-angle glaucoma and ocular hypertension

    PubMed Central

    Sharma, Sourabh; Trikha, Sameer; Perera, Shamira A; Aung, Tin

    2015-01-01

    The main first-line treatment strategy for glaucoma is to reduce intraocular pressure (IOP) by topical ocular hypotensive medications, but many patients require multiple medications for adequate IOP control. Fixed-combination therapies provide several benefits, including simplified treatment regimens, theoretical improved treatment adherence, elimination of the potential for washout of the first drug by the second, and the reduction in ocular exposure to preservatives. β-Adrenoceptor antagonists (particularly 0.5% timolol) are the most commonly used agents in combination with other classes of drugs as fixed-combination eyedrops, but they are contraindicated in many patients, owing to local allergy or systemic side effects. A fixed-combination preparation without a β-blocker is therefore warranted. This paper reviews the clinical effectiveness of brinzolamide 1% and brimonidine 0.2% fixed combination (BBFC) for use in patients with primary open-angle glaucoma and ocular hypertension. We searched PubMed and the ClinicalTrials.gov registry, and identified three randomized controlled trials comparing BBFC vs its constituents (brimonidine vs brinzolamide), and one comparing BBFC with unfixed brimonidine and brinzolamide. All of the studies demonstrated mean diurnal IOP to be statistically significantly lower in the BBFC group compared with constituent groups and noninferior to that with the concomitant group using two separate bottles. The safety profile of BBFC was consistent with that of its individual components, the most common ocular adverse events being ocular hyperemia, visual disturbances, and ocular allergic reactions. Common systemic adverse effects included altered taste sensation, oral dryness, fatigue, somnolence, and decreased alertness. BBFC seems to be a promising new fixed combination for use in glaucoma patients. However, long-term effects of BBFC on IOP, treatment adherence, and safety need to be determined. PMID:26648686

  1. Comparison of Risk Factor Profiles for Primary Open-Angle Glaucoma Subtypes Defined by Pattern of Visual Field Loss: A Prospective Study

    PubMed Central

    Kang, Jae H.; Loomis, Stephanie J.; Rosner, Bernard A.; Wiggs, Janey L.; Pasquale, Louis R.

    2015-01-01

    Purpose. We explored whether risk factor associations differed by primary open-angle glaucoma (POAG) subtypes defined by visual field (VF) loss pattern (i.e., paracentral or peripheral). Methods. We included 77,157 women in the Nurses' Health Study (NHS) and 42,773 men in the Health Professionals Follow-up Study (HPFS 1986–2010), and incident medical record confirmed cases of paracentral (n = 440) and peripheral (n = 865) POAG subtypes. We evaluated African heritage, glaucoma family history, body mass index (BMI), mean arterial blood pressure, diabetes mellitus, physical activity, smoking, caffeine intake, and alcohol intake. We used competing risk Cox regression analyses modeling age as the metameter and stratified by age, cohort, and event type. We sequentially identified factors with the least significant differences in associations with POAG subtypes (“stepwise down” approach with P for heterogeneity [P-het] < 0.10 as threshold). Results. Body mass index was more inversely associated with the POAG paracentral VF loss subtype than the peripheral VF loss subtype (per 10 kg/m2; hazard ratio [HR] = 0.67 [95% confidence interval (CI): 0.52, 0.86] versus HR = 0.93 [95% CI: 0.78, 1.10]; P-het = 0.03) as was smoking (per 10 pack-years; HR = 0.92 [95% CI: 0.87, 0.98] versus HR = 0.98 [95% CI: 0.94, 1.01]; P-het = 0.09). These findings were robust in sensitivity analyses using a “stepwise up” approach (identify factors that showed the most significant differences). Nonheterogeneous (P-het > 0.10) adverse associations with both POAG subtypes were observed with glaucoma family history, diabetes, African heritage, greater caffeine intake, and higher mean arterial pressure. Conclusions. These data indicate that POAG with early paracentral VF loss has distinct as well as common determinants compared with POAG with peripheral VF loss. PMID:25758813

  2. Selective Laser Trabeculoplasty versus Argon Laser Trabeculoplasty in Patients with Open-Angle Glaucoma: A Systematic Review and Meta-Analysis

    PubMed Central

    Wang, Wei; He, Miao; Zhou, Minwen; Zhang, Xiulan

    2013-01-01

    Objective To examine possible differences in clinical outcomes between selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT) in open-angle glaucoma at different times post-treatment. Methods Randomized controlled trials (RCTs) comparing SLT versus ALT were searched through August 2013. The main outcome measure was IOP, and secondary outcomes included the number of glaucoma medications, the success rate, and adverse events. Results Six RCTs, involving 482 eyes treated with laser trabeculoplasty, were included in the meta-analysis. For all patients (including first and previous laser trabeculoplasy), no significant difference in IOP lowering was observed between SLT and ALT at one hour (P = 0.40), one week (P = 0.72), one month (P = 0.37), six months (P = 0.08), one year (P = 0.34), two years (P = 0.58), three years (P = 0.34), four years (P = 0.47), and five years (P = 0.50). A statistically significant difference in favor of SLT was found when comparing the IOP reduction at three months after intervention (weighted mean difference (WMD): 1.19 mmHg [0.41; 1.97]; I2=0%; P = 0.003). For patients who were naive to laser, there was no significant difference of reduction in IOP comparing SLT with ALT at any time point. In patients’ previous LT, no statistically significant difference in IOP reduction was found at six months (WMD: 1.92 mmHg [-0.91; 4.74]; I2 = 77.3%; P = 0.18). There was no significant difference in the reduction in the number of glaucoma medications, the success rate, or adverse event rates between the two treatments. Conclusions SLT has equivalent efficacy to ALT with a similar constellation of side effects. In the case of retreatment, SLT appears to be similar to ALT in IOP lowering at six months. PMID:24367649

  3. Three Toxic Heavy Metals in Open-Angle Glaucoma with Low-Teen and High-Teen Intraocular Pressure: A Cross-Sectional Study from South Korea.

    PubMed

    Lee, Si Hyung; Kang, Eun Min; Kim, Gyu Ah; Kwak, Seung Woo; Kim, Joon Mo; Bae, Hyoung Won; Seong, Gong Je; Kim, Chan Yun

    2016-01-01

    To investigate the association between heavy metal levels and open-angle glaucoma (OAG) with low- and high-teen baseline intraocular pressure (IOP) using a population-based study design. This cross-sectional study included 5,198 participants older than 19 years of age who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2012 and had blood heavy metal levels available. The OAG with normal baseline IOP (IOP ≤ 21 mmHg) subjects were stratified into low-teen OAG (baseline IOP ≤ 15 mmHg) and high-teen OAG (15 mmHg < baseline IOP ≤ 21 mmHg), and the association between blood lead, mercury, and cadmium levels and glaucoma prevalence was assessed for low- and high-teen OAG. The adjusted geometric mean of blood cadmium levels was significantly higher in subjects with low-teen OAG than that of the non-glaucomatous group (P = 0.028), whereas there were no significant differences in blood lead and mercury levels. After adjusting for potential confounders, the low-teen OAG was positively associated with log-transformed blood cadmium levels (OR, 1.41; 95% confidence interval (CI), 1.03-1.93; P = 0.026). For high-teen OAG, log-transformed blood levels of the three heavy metals were not associated with disease prevalence. The association between log-transformed blood cadmium levels and low-teen OAG was significant only in men (OR, 1.65; 95% CI, 1.10-2.48; P = 0.016), and not in women (OR, 1.10; 95% CI, 0.66-1.85; P = 0.709). The results of this study suggest that cadmium toxicity could play a role in glaucoma pathogenesis, particularly in men and in OAG with low-teen baseline IOP.

  4. Shotgun proteomics reveals specific modulated protein patterns in tears of patients with primary open angle glaucoma naïve to therapy.

    PubMed

    Pieragostino, Damiana; Agnifili, Luca; Fasanella, Vincenzo; D'Aguanno, Simona; Mastropasqua, Rodolfo; Di Ilio, Carmine; Sacchetta, Paolo; Urbani, Andrea; Del Boccio, Piero

    2013-06-01

    Primary open angle glaucoma (POAG) is one of the main causes of irreversible blindness worldwide. The pathogenesis of POAG is still unclear. Alteration and sclerosis of trabecular meshwork with changes in aqueous humor molecular composition seem to play the key role. Increased intraocular pressure is widely known to be the main risk factor for the onset and progression of the disease. Unfortunately, the early diagnosis of POAG still remains the main challenge. In order to provide insight into the patho-physiology of glaucoma, here we report a shotgun proteomics approach to tears of patients with POAG naïve to therapy. Our proteomics results showed 27 differential tear proteins in POAG vs. CTRL comparison (25 up regulated proteins in the POAG group and two unique proteins in the CTRL group), 16 of which were associated with inflammatory response, free radical scavenging, cell-to-cell signaling and interaction. Overall the protein modulation shown in POAG tears proves the involvement of biochemical networks linked to inflammation. Among all regulated proteins, a sub-group of 12 up-regulated proteins in naïve POAG patients were found to be down-regulated in medically controlled POAG patients treated with prostanoid analogues (PGA), as reported in our previous work (i.e., lipocalin-1, lysozyme C, lactotransferrin, proline-rich-protein 4, prolactin-inducible protein, zinc-alpha-2-glycoprotein, polymeric immunoglobulin receptor, cystatin S, Ig kappa chain C region, Ig alpha-2 chain C region, immunoglobulin J chain, Ig alpha-1 chain C region). In summary, our findings indicate that the POAG tears protein expression is a mixture of increased inflammatory proteins that could be potential biomarkers of the disease, and their regulation may be involved in the mechanism by which PGA are able to decrease the intraocular pressure in glaucoma patients.

  5. Dependence of diameters and oxygen saturation of retinal vessels on visual field damage and age in primary open-angle glaucoma.

    PubMed

    Ramm, Lisa; Jentsch, Susanne; Peters, Sven; Sauer, Lydia; Augsten, Regine; Hammer, Martin

    2016-05-01

    To investigate the interrelationship between the oxygen supply of the retina and its regulation with the severity of primary open-angle glaucoma (POAG). Central retinal artery (CRAE) and vein (CRVE) diameters and oxygen saturation of peripapillary retinal vessels in 41 patients suffering from POAG (64.1 ± 12.9 years) and 40 healthy volunteers (63.6 ± 14.1 years) were measured using the retinal vessel analyzer. All measures were taken before and during flicker light stimulation. The mean retinal nerve fiber layer thickness (RNFLT) was determined by OCT and the visual field mean defect (MD) was identified using perimetry. In glaucoma patients, CRAE (r = -0.48 p = 0.002) and CRVE (r = -0.394 p = 0.014) at baseline were inversely related to MD, while arterial and venous oxygen saturation showed no significant dependence on the severity of the damage. However, the flicker light-induced change in arterio-venous difference in oxygen saturation was correlated with the MD (r = 0.358 p = 0.027). The diameters of arteries and veins at baseline decreased with reduction of the mean RNFLT (arteries: r = 0.718 p < 0.001; veins: r = 0.685 p < 0.001). Vessel diameters showed a strong correlation with RNFLT and MD. This, as well as the reduction of stimulation-induced change in arterio-venous oxygen saturation difference with visual field loss, may be explained by a reduction of the retinal metabolic demand with progressive loss of neuronal tissue in glaucoma. © 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  6. Three Toxic Heavy Metals in Open-Angle Glaucoma with Low-Teen and High-Teen Intraocular Pressure: A Cross-Sectional Study from South Korea

    PubMed Central

    Lee, Si Hyung; Kang, Eun Min; Kim, Gyu Ah; Kwak, Seung Woo; Kim, Joon Mo; Bae, Hyoung Won; Seong, Gong Je; Kim, Chan Yun

    2016-01-01

    Background To investigate the association between heavy metal levels and open-angle glaucoma (OAG) with low- and high-teen baseline intraocular pressure (IOP) using a population-based study design. Methods This cross-sectional study included 5,198 participants older than 19 years of age who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2012 and had blood heavy metal levels available. The OAG with normal baseline IOP (IOP ≤ 21 mmHg) subjects were stratified into low-teen OAG (baseline IOP ≤ 15 mmHg) and high-teen OAG (15 mmHg < baseline IOP ≤ 21 mmHg), and the association between blood lead, mercury, and cadmium levels and glaucoma prevalence was assessed for low- and high-teen OAG. Results The adjusted geometric mean of blood cadmium levels was significantly higher in subjects with low-teen OAG than that of the non-glaucomatous group (P = 0.028), whereas there were no significant differences in blood lead and mercury levels. After adjusting for potential confounders, the low-teen OAG was positively associated with log-transformed blood cadmium levels (OR, 1.41; 95% confidence interval (CI), 1.03–1.93; P = 0.026). For high-teen OAG, log-transformed blood levels of the three heavy metals were not associated with disease prevalence. The association between log-transformed blood cadmium levels and low-teen OAG was significant only in men (OR, 1.65; 95% CI, 1.10–2.48; P = 0.016), and not in women (OR, 1.10; 95% CI, 0.66–1.85; P = 0.709). Conclusions The results of this study suggest that cadmium toxicity could play a role in glaucoma pathogenesis, particularly in men and in OAG with low-teen baseline IOP. PMID:27768724

  7. Clinical results of ab interno trabeculotomy using the trabectome for open-angle glaucoma: the Mayo Clinic series in Rochester, Minnesota.

    PubMed

    Ahuja, Yachna; Ma Khin Pyi, Son; Malihi, Mehrdad; Hodge, David O; Sit, Arthur J

    2013-11-01

    To determine outcomes of ab interno trabeculotomy for treatment of open-angle glaucoma (OAG). Retrospective interventional single-surgeon, single-center case series. Data were collected from 246 patients undergoing ab interno trabeculotomy between September 1, 2006, and December 1, 2010, with 3 months' follow-up or longer. Kaplan-Meier analysis was performed using Criteria A (postoperative intraocular pressure [IOP] ≤21 mm Hg or ≥20% reduction from preoperative IOP) and Criteria B (IOP ≤18 mm Hg and ≥20% reduction in IOP). Failure included increased glaucoma medications or subsequent surgery. Failure risk factors were identified using Cox proportional hazards ratio (HR). Of 88 cases of ab interno trabeculotomy-only and 158 cases of ab interno trabeculotomy with cataract extraction, the retention rate was 70% for 1 year and 62% for 2 years. Preoperative mean IOP was 21.6 ± 8.6 mm Hg; the number of glaucoma medications was 3.1 ± 1.1. At 24 months postoperatively, mean IOP was reduced 29% to 15.3 ± 4.6 mm Hg (P < 0.001) and the number of glaucoma medications was reduced 38% to 1.9 ± 1.3 (P < 0.001) with a success rate of 62% (95% CI, 56%-68%) using Criteria A and 22% (95% CI, 16%-29%) using Criteria B. Failure risk factors using Criteria A included primary OAG (HR 3.14, P < 0.01, 95% CI, 1.91-5.17) and past argon laser trabeculoplasty (HR 1.81, P < 0.01, 95% CI, 1.18-2.77). Using Criteria B, the HR for pseudoexfoliative glaucoma was 0.43 (P < 0.01, 95% CI 0.27-0.67). Of the cases, 66 (26.8%) required subsequent surgery on an average of 10 months (2 days to 3.2 years) after ab interno trabeculotomy. For criteria involving IOP ≤18 mm Hg, the 24-month survival of ab interno trabeculotomy is low. This surgery is appropriate for patients requiring a target IOP of 21 mm Hg or above. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Reductions in retrobulbar and retinal capillary blood flow strongly correlate with changes in optic nerve head and retinal morphology over four years in open-angle glaucoma patients of African descent compared to patients of European descent

    PubMed Central

    Siesky, Brent; Harris, Alon; Carr, Joseph; Vercellin, Alice Verticchio; Hussain, Rehan; Hembree, Priyanka Parekh; Wentz, Scott; Isaacs, Michael; Eckert, George; Moore, Nicholas A.

    2016-01-01

    Purpose To investigate the relationship of changes in ocular blood flow with optic nerve head and retinal morphology in open-angle glaucoma patients of African versus European descent over four years. Materials and Methods In this study, 112 patients with open-angle glaucoma were examined at baseline, 79 (59 European descent, 20 African descent) of which were followed for four years. Retinal capillary blood flow was assessed with Heidelberg retinal flowmetry. Retrobulbar blood flow was measured by color Doppler imaging. Retinal structural changes were examined with optical coherence tomography and Heidelberg retinal tomography-III. Mixed-model analysis of covariance was used to test for the significance of change from baseline to four-year follow-up, and Pearson correlation coefficients were calculated to evaluate linear associations. Results In open-angle glaucoma patients of African descent, structural changes of the optic nerve head demonstrated a strong association with the end diastolic velocities and resistive indices of the short posterior ciliary arteries over four years. In addition, there was a significantly larger increase in the avascular area of the inferior retina in patients of African descent, and this reduction in retinal capillaries strongly correlated with a reduction in macular thickness. Conclusion Reductions in retinal capillary and retrobulbar blood flow strongly correlated with changes in the optic nerve head and macular thickness over four years in open-angle glaucoma patients of African descent compared to European descent. This data suggests that ocular vascular health may be a more influential contributing factor in the pathophysiology of open-angle glaucoma in patients of African descent compared to European descent. PMID:27561102

  9. Comparison between the EX-PRESS P-50 implant and trabeculectomy in patients with open-angle glaucoma

    PubMed Central

    Mendoza-Mendieta, María Elena; López-Venegas, Ana Paola; Valdés-Casas, Gerardo

    2016-01-01

    Purpose To evaluate the EX-PRESS P-50 implant compared to standard trabeculectomy (TBC). Methods Single-center prospective randomized study; 20 eyes of 20 patients were treated with the EX-PRESS P-50 implant, and 20 eyes of 20 patients with TBC, over a 19-month period. Records of all patients were reviewed and compared. Success was defined as intraocular pressure (IOP) <21 and >5 mmHg or a decrease of 30% of IOP. Failure was defined as >21 mmHg or decline in visual acuity. Statistical analysis was made with Student’s t-test and χ2 test analyzed with SPSS version 13.0. Results The average follow-up was 8.6 months (±4.9 months) for the EX-PRESS P-50 group and 9.6 months (±5.3 months) for the TBC group. The postoperative visual acuity and IOP were not significantly different. We report more complications in the EX-PRESS P-50 group. At 3, 6, and 12 months follow-up, the control group was found to be free of complications, whereas multiple complications were observed in the EX-PRESS P-50 group at 3 and 6 months follow-up. We found no differences in either group with respect to success. Conclusion Both procedures are equally effective for the treatment of glaucoma, with 80% success in the EX-PRESS P-50 group and 72.7% in the control group. PMID:26893540

  10. Efficacy and safety of benzalkonium chloride-free fixed-dose combination of latanoprost and timolol in patients with open-angle glaucoma or ocular hypertension

    PubMed Central

    Bhagat, Purvi; Sodimalla, Kalyani; Paul, Chandrima; Pandav, Surinder S; Raman, Ganesh V; Ramakrishnan, Rengappa; Joshi, Abhijeet; Raut, Atul

    2014-01-01

    Background Benzalkonium chloride (BAK) is a common preservative in topical ocular preparations; however, prolonged use may lead to deleterious effects on the ocular surface, affecting quality of life and reducing adherence to treatment and overall outcomes. This study compared the intraocular pressure (IOP)-lowering efficacy and safety of a novel once-daily, BAK-free, fixed-dose combination of latanoprost plus timolol with latanoprost or timolol administered as monotherapy or concomitantly. Methods This was a 6-week, randomized, open-label, parallel-group, active-controlled study in patients aged ≥18 years with open-angle glaucoma or ocular hypertension. A total of 227 patients were randomized to either a once-daily, BAK-free, fixed-dose combination of latanoprost 0.005%/timolol 0.5% ophthalmic solution or concomitant administration of once-daily latanoprost 0.005% plus twice-daily timolol 0.5% or once-daily latanoprost 0.005% monotherapy, or twice-daily timolol 0.5% monotherapy. Efficacy end points were assessed at three time points on visits at weeks 1, 2, 4, and 6 versus baseline. Results The IOP-lowering efficacy of the fixed-dose combination of latanoprost/timolol was similar to that of latanoprost plus timolol administered concomitantly at all time points (mean IOP difference and 95% confidence interval within ±1.5 mmHg; P=0.4223 to P=0.9981). The fixed-dose combination of latanoprost/timolol demonstrated significantly better IOP-lowering efficacy than timolol monotherapy at all time points (P=0.001 to P<0.0001) and significantly better IOP-lowering efficacy than latanoprost monotherapy at all time points. Responder rates on at least one time point and on at least two time points with fixed-dose combination latanoprost/timolol were similar to those with concomitant latanoprost plus timolol (85.5% versus 82.1%, P=0.6360; 78.2% versus 75%, P=0.6923), but significantly better than either latanoprost or timolol monotherapy (68.5%, P=0.0355; 55.4%, P=0.0005; 57

  11. Preservative-free bimatoprost 0.03% in patients with primary open-angle glaucoma or ocular hypertension in clinical practice

    PubMed Central

    Pillunat, Lutz E; Eschstruth, Peter; Häsemeyer, Stefan; Thelen, Ulrich; Foja, Christian; Leaback, Richard; Pfennigsdorf, Stefan

    2016-01-01

    Background Intraocular pressure (IOP)-lowering medications for primary open-angle glaucoma and ocular hypertension commonly contain preservatives that can cause ocular surface damage in many patients. The purpose of this study was to evaluate the efficacy and tolerability of, and compliance to, preservative-free (PF) bimatoprost 0.03% in patients with primary open-angle glaucoma or ocular hypertension (IOP ≥18 mmHg) in a clinical practice setting. Methods This open-label study observed patients who were switched to PF bimatoprost 0.03% for medical reasons. IOP was measured at baseline and ~12 weeks later at the final visit, and the change in IOP was calculated. Tolerability and continuation of therapy were assessed at two follow-up visits. Results A total of 1,830 patients were included in the study, and complete IOP data were available for 1,543 patients. Mean IOP was reduced by 23% from 21.64 mmHg to 16.59 mmHg (P<0.0001). In subgroup analyses, the mean IOP was significantly reduced compared with baseline, regardless of prior therapy, including those previously treated with PF monotherapy. A total of 85.7% of physicians reported the IOP-lowering efficacy of PF bimatoprost 0.03% to be as expected or better than expected. Adverse events (AEs) were experienced by 5.7% of patients, and there were no serious AEs reported. The most common AEs were eye irritation (1.7%) and hyperemia (1.4%). Physician-reported treatment compliance was reported as better than (48.7%) or equal to (43.6%) prior treatment in most patients. Most patients (82%) were expected to continue PF bimatoprost 0.03% after the end of the study. Conclusion This observational study showed that, in clinical practice, switching to PF bimatoprost 0.03% was associated with a significant IOP reduction from baseline. There was a low AE rate. PF bimatoprost 0.03% may, therefore, be an effective treatment option for patients who are intolerant of preservatives or have an inadequate response to prior IOP

  12. Efficacy and safety of benzalkonium chloride-free fixed-dose combination of latanoprost and timolol in patients with open-angle glaucoma or ocular hypertension.

    PubMed

    Bhagat, Purvi; Sodimalla, Kalyani; Paul, Chandrima; Pandav, Surinder S; Raman, Ganesh V; Ramakrishnan, Rengappa; Joshi, Abhijeet; Raut, Atul

    2014-01-01

    Benzalkonium chloride (BAK) is a common preservative in topical ocular preparations; however, prolonged use may lead to deleterious effects on the ocular surface, affecting quality of life and reducing adherence to treatment and overall outcomes. This study compared the intraocular pressure (IOP)-lowering efficacy and safety of a novel once-daily, BAK-free, fixed-dose combination of latanoprost plus timolol with latanoprost or timolol administered as monotherapy or concomitantly. This was a 6-week, randomized, open-label, parallel-group, active-controlled study in patients aged ≥18 years with open-angle glaucoma or ocular hypertension. A total of 227 patients were randomized to either a once-daily, BAK-free, fixed-dose combination of latanoprost 0.005%/timolol 0.5% ophthalmic solution or concomitant administration of once-daily latanoprost 0.005% plus twice-daily timolol 0.5% or once-daily latanoprost 0.005% monotherapy, or twice-daily timolol 0.5% monotherapy. Efficacy end points were assessed at three time points on visits at weeks 1, 2, 4, and 6 versus baseline. The IOP-lowering efficacy of the fixed-dose combination of latanoprost/timolol was similar to that of latanoprost plus timolol administered concomitantly at all time points (mean IOP difference and 95% confidence interval within ±1.5 mmHg; P=0.4223 to P=0.9981). The fixed-dose combination of latanoprost/timolol demonstrated significantly better IOP-lowering efficacy than timolol monotherapy at all time points (P=0.001 to P<0.0001) and significantly better IOP-lowering efficacy than latanoprost monotherapy at all time points. Responder rates on at least one time point and on at least two time points with fixed-dose combination latanoprost/timolol were similar to those with concomitant latanoprost plus timolol (85.5% versus 82.1%, P=0.6360; 78.2% versus 75%, P=0.6923), but significantly better than either latanoprost or timolol monotherapy (68.5%, P=0.0355; 55.4%, P=0.0005; 57.4%, P=0.0202; and 46.4%, P

  13. Localization of the fourth locus (GLC1E) for adult-onset primary open-angle glaucoma to the 10p15-p14 region.

    PubMed Central

    Sarfarazi, M; Child, A; Stoilova, D; Brice, G; Desai, T; Trifan, O C; Poinoosawmy, D; Crick, R P

    1998-01-01

    One of the major causes of blindness is primary open-angle glaucoma, which affects millions of elderly people worldwide. Genetic studies have so far mapped three loci for the adult-onset form of this condition to the 2cen-q13, 3q21-q24, and 8q23 regions. Herein, we report the localization of a fourth locus, to the 10p15-p14 region, in one large British family with a classical form of normal-tension open-angle glaucoma. Of the 42 meioses genotyped in this pedigree, 39 subjects (16 affected) inherited a haplotype compatible with their prior clinical designation, whereas the remaining 3 were classified as unknown. Although a maximum LOD score of 10.00 at a recombination fraction of straight theta=.00 was obtained with D10S1216, 21 other markers provided significant values, varying between 3.77 and 9.70. When only the affected meioses of this kindred were analyzed, LOD scores remained statistically significant, ranging from 3.16 (D10S527) to 3.57 (D10S506). Two critical recombinational events in the affected subjects positioned this new locus to a region of approximately 21 cM, flanked by D10S1729 and D10S1664. However, an additional recombination in a 59-year-old unaffected female suggests that this locus resides between D10S585 (or D10S1172) and D10S1664, within a genetic distance of 5-11 cM. However, the latter minimum region must be taken cautiously, because the incomplete penetrance has previously been documented for this group of eye conditions. A partial list of genes that positionally are considered as candidates includes NET1, PRKCT, ITIH2, IL2RA, IL15RA, IT1H2, hGATA3, the mRNA for open reading frame KIAA0019, and the gene for D123 protein. PMID:9497264

  14. CDKN2B polymorphism is associated with primary open-angle glaucoma (POAG) in the Afro-Caribbean population of Barbados, West Indies.

    PubMed

    Cao, Dan; Jiao, Xiaodong; Liu, Xing; Hennis, Anselm; Leske, M Cristina; Nemesure, Barbara; Hejtmancik, J Fielding

    2012-01-01

    The purpose of this study was to confirm previously reported associations of common variants in or near CDC7/TGFBR3, ZP4, SRBD1, ELOVL5, CAV1/CAV2, TLR4, CDKN2B, CDKN2B-AS1, ATOH7, PLXDC2, TMTC2, SIX1, and CARD10, with primary open angle glaucoma (POAG) in the Afro-Caribbean population of Barbados, West Indies. A total of 437 unrelated subjects from the Barbados Family Study of Open Angle Glaucoma (BFSG), including 272 with POAG and 165 unaffected individuals were included in this study. Eighteen SNPs were genotyped by using the multiplex SNaPshot method. Allelic, genotypic and model-based (dominant, recessive, and additive) associations of the SNPs with POAG were analyzed using Chi-squared tests and logistic regression. SNP rs1063192 (near CDKN2B) was found to be significantly associated with POAG (allelic P = 0.0008, genotypic P = 0.0029), and the minor allele C of rs1063192 was protective against POAG (OR = 0.39; 95%CI = 0.22-0.69). Suggestive association was also noted for rs7916697 (near ATHO7, allelic P = 0.0096, genotypic P = 0.01) with the minor allele being protective (OR = 0.67; 95% CI = 0.50-0.91), although this finding did not withstand correction for multiple testing. However, a significant interactive effect on POAG risk was identified between rs1063192 and rs7916697 (P-interaction = 2.80 × 10(-5)). Individuals with the rs1063192 protective genotype CC or CT and also rs7916697 genotypes GG or GA show a significantly decreased risk of POAG (OR = 0.17, 95%CI: 0.07-0.41). Our study confirms the significant association between SNP rs1063192 (CDKN2B, previously shown to influence vertical cup-to-disc ratio and POAG at 9p21) and POAG in the Afro-Caribbean population of Barbados. The minor allele of rs1063192 interacts with that of rs7916697 (ATOH7)) to reduce POAG risk. Our results also suggest that rs1063912 is a common protective variant for POAG in populations of African as well as European descent.

  15. CDKN2B Polymorphism Is Associated with Primary Open-Angle Glaucoma (POAG) in the Afro-Caribbean Population of Barbados, West Indies

    PubMed Central

    Cao, Dan; Jiao, Xiaodong; Liu, Xing; Hennis, Anselm; Leske, M. Cristina; Nemesure, Barbara; Hejtmancik, J. Fielding

    2012-01-01

    The purpose of this study was to confirm previously reported associations of common variants in or near CDC7/TGFBR3, ZP4, SRBD1, ELOVL5, CAV1/CAV2, TLR4, CDKN2B, CDKN2B-AS1, ATOH7, PLXDC2, TMTC2, SIX1, and CARD10, with primary open angle glaucoma (POAG) in the Afro-Caribbean population of Barbados, West Indies. A total of 437 unrelated subjects from the Barbados Family Study of Open Angle Glaucoma (BFSG), including 272 with POAG and 165 unaffected individuals were included in this study. Eighteen SNPs were genotyped by using the multiplex SNaPshot method. Allelic, genotypic and model-based (dominant, recessive, and additive) associations of the SNPs with POAG were analyzed using Chi-squared tests and logistic regression. SNP rs1063192 (near CDKN2B) was found to be significantly associated with POAG (allelic P = 0.0008, genotypic P = 0.0029), and the minor allele C of rs1063192 was protective against POAG (OR  = 0.39; 95%CI  = 0.22−0.69). Suggestive association was also noted for rs7916697 (near ATHO7, allelic P  = 0.0096, genotypic P = 0.01) with the minor allele being protective (OR  = 0.67; 95% CI  = 0.50−0.91), although this finding did not withstand correction for multiple testing. However, a significant interactive effect on POAG risk was identified between rs1063192 and rs7916697 (P-interaction  = 2.80×10−5). Individuals with the rs1063192 protective genotype CC or CT and also rs7916697 genotypes GG or GA show a significantly decreased risk of POAG (OR = 0.17, 95%CI: 0.07−0.41). Our study confirms the significant association between SNP rs1063192 (CDKN2B, previously shown to influence vertical cup-to-disc ratio and POAG at 9p21) and POAG in the Afro-Caribbean population of Barbados. The minor allele of rs1063192 interacts with that of rs7916697 (ATOH7)) to reduce POAG risk. Our results also suggest that rs1063912 is a common protective variant for POAG in populations of African as well as European descent. PMID

  16. Polymorphism of CYP46A1 and PPARγ2 Genes in Risk Prediction of Primary Open Angle Glaucoma Among North Indian Population

    PubMed Central

    Chandra, Anu; Abbas, Shania; Raza, Syed Tasleem; Singh, Luxmi; Rizvi, Saliha; Mahdi, Farzana

    2016-01-01

    Purpose: Glaucoma is the leading cause of irreversible blindness and the second most common cause of all blindness after cataracts. This study investigates the association of polymorphism in the CYP46A1 and PPARγ2 genes and primary open angle glaucoma (POAG). Materials and Methods: This study evaluated 122 POAG cases (POAG group) and 112 cases of nonglaucomatous patients (control group). Polymorphisms of the CYP46A1 gene and PPARγ2 gene were evaluated with the polymerase chain reaction-restriction fragment length polymorphism method in both groups. Results: The mean ages were 49.88 ± 12.34 years and 53.74 ± 11.87 years for the POAG group and control group, respectively. The CYP46A1 gene CC, CT, TT genotype frequencies were 13.93%, 58.2%, 27.87% in the POAG group and 19.6%, 40.19%, 40.19% in the control group, respectively. The PPARγ2 gene CC, CG, GG genotype frequencies were 16.83%, 54.45%, 28.71% in cases and 3.92%, 28.43%, 67.64% in the control group, respectively. Statistically, significant differences in the frequencies of CYP46A1 CC, CT, TT and PPARγ2 CC, CG, GG (P < 0.05) genotype were found between groups (P < 0.05, all comparisons). Conclusion: Findings of this study suggest that CYP46A1 gene and PPARγ2 gene polymorphisms can be a predictive marker for early identification of population at risk of POAG, although a larger sample size is required to determine the role of these polymorphisms in the pathogenesis and course of POAG. PMID:27162448

  17. Investigating the usefulness of a cluster-based trend analysis to detect visual field progression in patients with open-angle glaucoma.

    PubMed

    Aoki, Shuichiro; Murata, Hiroshi; Fujino, Yuri; Matsuura, Masato; Miki, Atsuya; Tanito, Masaki; Mizoue, Shiro; Mori, Kazuhiko; Suzuki, Katsuyoshi; Yamashita, Takehiro; Kashiwagi, Kenji; Hirasawa, Kazunori; Shoji, Nobuyuki; Asaoka, Ryo

    2017-04-27

    To investigate the usefulness of the Octopus (Haag-Streit) EyeSuite's cluster trend analysis in glaucoma. Ten visual fields (VFs) with the Humphrey Field Analyzer (Carl Zeiss Meditec), spanning 7.7 years on average were obtained from 728 eyes of 475 primary open angle glaucoma patients. Mean total deviation (mTD) trend analysis and EyeSuite's cluster trend analysis were performed on various series of VFs (from 1st to 10th: VF1-10 to 6th to 10th: VF6-10). The results of the cluster-based trend analysis, based on different lengths of VF series, were compared against mTD trend analysis. Cluster-based trend analysis and mTD trend analysis results were significantly associated in all clusters and with all lengths of VF series. Between 21.2% and 45.9% (depending on VF series length and location) of clusters were deemed to progress when the mTD trend analysis suggested no progression. On the other hand, 4.8% of eyes were observed to progress using the mTD trend analysis when cluster trend analysis suggested no progression in any two (or more) clusters. Whole field trend analysis can miss local VF progression. Cluster trend analysis appears as robust as mTD trend analysis and useful to assess both sectorial and whole field progression. Cluster-based trend analyses, in particular the definition of two or more progressing cluster, may help clinicians to detect glaucomatous progression in a timelier manner than using a whole field trend analysis, without significantly compromising specificity. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. Excimer laser trabeculotomy vs 180 degrees selective laser trabeculoplasty in primary open-angle glaucoma. A 2-year randomized, controlled trial.

    PubMed

    Babighian, S; Caretti, L; Tavolato, M; Cian, R; Galan, A

    2010-04-01

    To compare the effectiveness and safety of excimer laser trabeculotomy (ELT) ab interno vs selective laser trabeculoplasty (SLT) over 24 months of follow-up in patients with primary open-angle glaucoma (POAG) refractory to medical therapy. This prospective, randomized study included 30 consecutive eyes assigned randomly to either ELT or SLT group. ELT was carried out using a XeCl Excimer Laser with an emission wavelength of 308 nm. Eight spots were equally distributed at a distance of 500 microm from one another over the anterior trabeculum. The SLT patients were treated with a frequency-doubled q-switched neodymium:yytrium-aluminum-garnet laser (wavelength 532 nm). Approximately 50 adjacent, but not overlapping, laser spots were distributed over 180 degrees of the trabecular meshwork, using an energy level ranging from 0.7 to 1.0 mJ per pulse. The main outcome measure was intraocular pressure (IOP) lowering after ELT and SLT. Success was defined as >or=20% reduction in IOP without further glaucoma intervention. At 24 months, complete success rates were 53.3% for the ELT group and 40% for the SLT group (P=0.35, Fisher's exact test); qualified success rates were 33.3% for the ELT and 26.6% for the SLT group (P=0.5, Fisher's exact test).Mean IOP decreased from 25.0+/-1.9 to 17.6+/-2.2 mmHg (-29.6%; P<0.0001) in the ELT group and from 23.9+/-0.9 to 19.1+/-1.8 mmHg (-21%; P<0.0001) in the SLT group. Both ELT and SLT proved to be effective techniques in the treatment of POAG refractory to medical therapy.

  19. Age at natural menopause genetic risk score in relation to age at natural menopause and primary open-angle glaucoma in a US-based sample.

    PubMed

    Pasquale, Louis R; Aschard, Hugues; Kang, Jae H; Bailey, Jessica N Cooke; Lindström, Sara; Chasman, Daniel I; Christen, William G; Allingham, R Rand; Ashley-Koch, Allison; Lee, Richard K; Moroi, Sayoko E; Brilliant, Murray H; Wollstein, Gadi; Schuman, Joel S; Fingert, John; Budenz, Donald L; Realini, Tony; Gaasterland, Terry; Gaasterland, Douglas; Scott, William K; Singh, Kuldev; Sit, Arthur J; Igo, Robert P; Song, Yeunjoo E; Hark, Lisa; Ritch, Robert; Rhee, Douglas J; Gulati, Vikas; Havens, Shane; Vollrath, Douglas; Zack, Donald J; Medeiros, Felipe; Weinreb, Robert N; Pericak-Vance, Margaret A; Liu, Yutao; Kraft, Peter; Richards, Julia E; Rosner, Bernard A; Hauser, Michael A; Haines, Jonathan L; Wiggs, Janey L

    2017-02-01

    Several attributes of female reproductive history, including age at natural menopause (ANM), have been related to primary open-angle glaucoma (POAG). We assembled 18 previously reported common genetic variants that predict ANM to determine their association with ANM or POAG. Using data from the Nurses' Health Study (7,143 women), we validated the ANM weighted genetic risk score in relation to self-reported ANM. Subsequently, to assess the relation with POAG, we used data from 2,160 female POAG cases and 29,110 controls in the National Eye Institute Glaucoma Human Genetics Collaboration Heritable Overall Operational Database (NEIGHBORHOOD), which consists of 8 datasets with imputed genotypes to 5.6+ million markers. Associations with POAG were assessed in each dataset, and site-specific results were meta-analyzed using the inverse weighted variance method. The genetic risk score was associated with self-reported ANM (P = 2.2 × 10) and predicted 4.8% of the variance in ANM. The ANM genetic risk score was not associated with POAG (Odds Ratio (OR) = 1.002; 95% Confidence Interval (CI): 0.998, 1.007; P = 0.28). No single genetic variant in the panel achieved nominal association with POAG (P ≥0.20). Compared to the middle 80 percent, there was also no association with the lowest 10 percentile or highest 90 percentile of genetic risk score with POAG (OR = 0.75; 95% CI: 0.47, 1.21; P = 0.23 and OR = 1.10; 95% CI: 0.72, 1.69; P = 0.65, respectively). A genetic risk score predicting 4.8% of ANM variation was not related to POAG; thus, genetic determinants of ANM are unlikely to explain the previously reported association between the two phenotypes.

  20. Vascular and metabolic comorbidities in open-angle glaucoma with low- and high-teen intraocular pressure: a cross-sectional study from South Korea.

    PubMed

    Lee, Si Hyung; Kim, Gyu Ah; Lee, Wonseok; Bae, Hyoung Won; Seong, Gong Je; Kim, Chan Yun

    2017-07-05

    To assess the associations between vascular and metabolic comorbidities and the prevalence of open-angle glaucoma (OAG) with low-teen and high-teen intraocular pressure (IOP) in Korea. Cross-sectional data from the Korean National Health and Nutrition Examination Survey from 2008 to 2012 were analysed. Participants diagnosed with OAG with normal IOP were further classified into low-teen IOP (IOP ≤ 15 mmHg) and high-teen IOP (15 mmHg < IOP ≤ 21 mmHg) groups. Using multiple logistic regression analyses, the associations between vascular and metabolic comorbidities and the prevalence of glaucoma were investigated for the low- and high-teen IOP groups. The prevalences of hypertension, hyperlipidemia, ischaemic heart disease, stroke and metabolic syndrome were significantly higher among subjects with low-teen OAG compared with normal subjects, while only the prevalences of hypertension and stroke were higher among subjects with high-teen OAG compared with normal subjects. In multivariate logistic regression models adjusted for confounding factors, low-teen OAG was significantly associated with hypertension (OR, 1.68; 95% CI, 1.30-2.18), hyperlipidemia (OR, 1.49; 95% CI, 1.07-2.08), ischaemic heart disease (OR, 1.83; 95% CI, 1.07-3.11), stroke (OR, 1.91; 95% CI, 1.12-3.25) and metabolic syndrome (OR, 1.46; 95% CI, 1.12-1.90). High-teen OAG was only associated with stroke (OR, 2.58; 95% CI, 1.20-5.53). Various vascular and metabolic comorbidities were significantly associated with low-teen OAG, but not with high-teen OAG. These data support the hypothesis that vascular factors play a more significant role in the pathogenesis of OAG with low-teen baseline IOP. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  1. Association Between Statin Use and Open-angle Glaucoma in Hyperlipidemia Patients: A Taiwanese Population-based Case-control Study.

    PubMed

    Chen, Hsin-Yi; Hsu, Sheng-Yao; Chang, Yue-Cune; Lin, Che-Chen; Sung, Fung-Chang; Chen, Wen-Chi; Kao, Chia-Huang

    2015-11-01

    The aim of the study was to investigate the association between statin use and open-angle glaucoma (OAG) risk in hyperlipidemia patients.We used the research database of the Taiwan National Health Insurance program to conduct a population-based case-control study. A total of 1276 patients with newly diagnosed OAG were identified from 2004 to 2011. Controls comprised of 12,760 patients without glaucoma and were frequency-matched for age, sex, history of diabetes mellitus, and year of hyperlipidemia diagnosis at a 1:10 ratio. Accumulated defined daily doses (DDDs) of statins prescribed during follow-up were calculated. Average statin use was calculated as the sum of DDDs divided by the duration from the initial statin prescription date to the index date (per year), and was subdivided into 3 levels: <30, 30 to 119, and ≥120 DDDs. Comorbidity, including hypertension, depression, and the Charlson comorbidity index, the frequency of eye care visits, and the use of nonstatin cholesterol-lowering drugs, were all considered as confounding factors.For the group with statin use, the adjusted odds ratio of OAG was 1.02 (95% confidence interval 0.90-1.15) when compared with the group without statin use. Subanalysis showed that a high dosage of statin use (≥120 DDD/y) resulted in a1.24-fold increased risk of OAG (odds ratio 1.24, 95% confidence interval 1.03-1.49). The incidence of OAG was increased with the increase of the dosage of statin use (P for trend = 0.0458).Clinicians should be cautious of hyperlipidemia patients with a high dosage of statin use because it might be associated with an increased risk of OAG. Ophthalmologist consultation is necessary for this high-risk group.

  2. A comparison of the diagnostic ability of vessel density and structural measurements of optical coherence tomography in primary open angle glaucoma

    PubMed Central

    Pradhan, Zia S.; Weinreb, Robert N.; Riyazuddin, Mohammed; Dasari, Srilakshmi; Venugopal, Jayasree P.; Puttaiah, Narendra K.; Rao, Dhanaraj A. S.; Devi, Sathi; Mansouri, Kaweh; Webers, Carroll A. B.

    2017-01-01

    Purpose To compare the diagnostic abilities of vessel density measurements of the optic nerve head (ONH), peripapillary and macular regions on optical coherence tomography (OCT) angiography in eyes with primary open angle glaucoma (POAG) with that of the ONH rim area, peripapillary retinal nerve fiber layer (RNFL) thickness and the macular ganglion cell complex (GCC) thickness measurements. Methods In a cross sectional study, 78 eyes of 50 control subjects and 117 eyes of 67 POAG patients underwent vessel density and structural measurements with spectral domain OCT. POAG was diagnosed based on the masked evaluation of optic disc stereo photographs. Area under receiver operating characteristic curves (AUC) and sensitivities at fixed specificities of vessel densities in ONH, peripapillary and macular regions were compared with rim area, RNFL and GCC thickness. Results The AUC (sensitivity at 95% specificity) of average vessel densities within the ONH, peripapillary and macular region were 0.77 (31%), 0.85 (56%) and 0.70 (18%) respectively. The same of ONH rim area, average RNFL and GCC thickness were 0.94 (83%), 0.95 (72%) and 0.93 (62%) respectively. AUCs of vessel densities were significantly lower (p<0.05) than that of the corresponding structural measurements. Pre-treatment IOP (coefficient: 0.08) affected (p<0.05) the AUC of ONH vessel density but not of any other vessel density or structural measurements. Conclusions Diagnostic abilities of ONH, peripapillary and the macular vessel densities in POAG were significantly lower than ONH rim area, peripapillary RNFL and macular GCC measurements respectively. At fixed levels of glaucoma severity, the diagnostic ability of the ONH vessel density was significantly greater in eyes with higher pre-treatment IOP. PMID:28288185

  3. A characteristic optic disc appearance associated with myopia in subjects with Graves’ ophthalmopathy and in subjects with primary open-angle glaucoma

    PubMed Central

    Yamazaki, Sei; Inoue, Rishu; Tsuboi, Toshikazu; Kozaki, Ai; Inoue, Toshu; Inoue, Toyoko; Inoue, Yoichi

    2013-01-01

    Purpose To determine if qualitatively defining the appearance of optic disc change was a valid characteristic of myopia in subjects with Graves’ ophthalmopathy (GO) or primary open-angle glaucoma (POAG). Methods We defined typical tilt appearance as the simultaneous presence of the following: an elliptical optic disc, a crescent, unequal sharpness of the cupping margin (horizontally), and nasally displaced vessels in the optic cup. Ninety-two eyes from 92 subjects each with GO or with POAG and no severe complications were included in the study after matching for spherical refractive errors. Using our definition of tilt appearance, two independent observers subjectively judged optic disc photographs. One observer repeated judgments in 70 randomly selected eyes and judgment reproducibility was assessed using kappa statistics. Tilt ratio was used as a quantitative parameter. Results The numbers of eyes judged as having a typical tilt appearance in the GO group and in the POAG group were 25 (27.2%) and 39 (42.4%), respectively, by one observer (P = 0.0297), and 12 (13%) and 44 (47.8%), respectively, by another observer (P < 0.0001). Intra- and interobserver reproducibility of tilt judgment were very good (kappa = 0.93) and good (kappa = 0.65), respectively. Tilt ratio did not significantly differ between the two groups. Analytical results including background factors were essentially the same for the two observers: multivariate logistic regression for one observer’s judgment showed that the presence of the typical tilt appearance was associated with belonging to the glaucoma group (odds ratio [OR], 6.25; P = 0.0054), tilt ratio (OR per 0.01, 0.77; P < 0.0001), and spherical refractive error (OR per diopter, 0.80; P < 0.003). Conclusion The optic disc feature we designated as typical tilt was associated with myopia, and its frequency was higher in subjects with POAG compared to those with GO. PMID:23326183

  4. Fixed combination of latanoprost and timolol vs individual components for primary open-angle glaucoma or ocular hypertension: a randomized, double-masked study.

    PubMed

    Higginbotham, Eve J; Olander, Kenneth W; Kim, Elizabeth E; Grunden, John W; Kwok, Kenneth K; Tressler, Charles S

    2010-02-01

    To assess the efficacy and safety of fixed-combination latanoprost-timolol (FCLT) vs latanoprost or timolol monotherapy. This 12-week, randomized, double-masked, parallel-group study included patients with open-angle glaucoma or ocular hypertension treated with a beta-blocker and with baseline intraocular pressure (IOP) of 26 through 36 mm Hg. Following washout, eligible patients were randomized to once-daily FCLT in the evening, latanoprost in the evening, or timolol in the morning. Postbaseline IOP assessments at 8 am, 10 am, and 4 pm at weeks 2, 6, and 12; statistical superiority of FCLT for the 18 pairwise comparisons between FCLT and the 2 monotherapies, using analysis of variance. All therapies resulted in significant IOP reductions from baseline. Pairwise comparisons favored FCLT at all time points. When the 18 comparisons were tested simultaneously, FCLT was statistically superior to latanoprost at 7 of 9 time points and at all 9 time points when compared with timolol. In addition, FCLT was associated with greater percentage reductions in diurnal IOP levels and a greater likelihood of achieving lower mean diurnal IOP levels. Diurnal IOP reductions of 30% or more from baseline to week 12 were achieved by 73.5%, 57.5%, and 32.8% of those treated with FCLT, latanoprost, and timolol, respectively (P = .007 for FCLT vs timolol; P < .001 for FCLT vs latanoprost). All therapies were well tolerated. Fixed-combination latanoprost-timolol therapy is as safe and effective in lowering IOP in patients with either ocular hypertension or glaucoma as monotherapy with latanoprost or timolol. Combination therapy can be used to treat patients for whom monotherapy does not provide sufficient IOP reduction. The simplicity, efficacy, and tolerability of FCLT contribute to its utility in clinical practice. clinicaltrials.gov Identifier NCT00277498.

  5. Genome-wide association analysis identifies TXNRD2, ATXN2 and FOXC1 as susceptibility loci for primary open-angle glaucoma.

    PubMed

    Bailey, Jessica N Cooke; Loomis, Stephanie J; Kang, Jae H; Allingham, R Rand; Gharahkhani, Puya; Khor, Chiea Chuen; Burdon, Kathryn P; Aschard, Hugues; Chasman, Daniel I; Igo, Robert P; Hysi, Pirro G; Glastonbury, Craig A; Ashley-Koch, Allison; Brilliant, Murray; Brown, Andrew A; Budenz, Donald L; Buil, Alfonso; Cheng, Ching-Yu; Choi, Hyon; Christen, William G; Curhan, Gary; De Vivo, Immaculata; Fingert, John H; Foster, Paul J; Fuchs, Charles; Gaasterland, Douglas; Gaasterland, Terry; Hewitt, Alex W; Hu, Frank; Hunter, David J; Khawaja, Anthony P; Lee, Richard K; Li, Zheng; Lichter, Paul R; Mackey, David A; McGuffin, Peter; Mitchell, Paul; Moroi, Sayoko E; Perera, Shamira A; Pepper, Keating W; Qi, Qibin; Realini, Tony; Richards, Julia E; Ridker, Paul M; Rimm, Eric; Ritch, Robert; Ritchie, Marylyn; Schuman, Joel S; Scott, William K; Singh, Kuldev; Sit, Arthur J; Song, Yeunjoo E; Tamimi, Rulla M; Topouzis, Fotis; Viswanathan, Ananth C; Verma, Shefali Setia; Vollrath, Douglas; Wang, Jie Jin; Weisschuh, Nicole; Wissinger, Bernd; Wollstein, Gadi; Wong, Tien Y; Yaspan, Brian L; Zack, Donald J; Zhang, Kang; Study, Epic-Norfolk Eye; Weinreb, Robert N; Pericak-Vance, Margaret A; Small, Kerrin; Hammond, Christopher J; Aung, Tin; Liu, Yutao; Vithana, Eranga N; MacGregor, Stuart; Craig, Jamie E; Kraft, Peter; Howell, Gareth; Hauser, Michael A; Pasquale, Louis R; Haines, Jonathan L; Wiggs, Janey L

    2016-02-01

    Primary open-angle glaucoma (POAG) is a leading cause of blindness worldwide. To identify new susceptibility loci, we performed meta-analysis on genome-wide association study (GWAS) results from eight independent studies from the United States (3,853 cases and 33,480 controls) and investigated the most significantly associated SNPs in two Australian studies (1,252 cases and 2,592 controls), three European studies (875 cases and 4,107 controls) and a Singaporean Chinese study (1,037 cases and 2,543 controls). A meta-analysis of the top SNPs identified three new associated loci: rs35934224[T] in TXNRD2 (odds ratio (OR) = 0.78, P = 4.05 × 10(-11)) encoding a mitochondrial protein required for redox homeostasis; rs7137828[T] in ATXN2 (OR = 1.17, P = 8.73 × 10(-10)); and rs2745572[A] upstream of FOXC1 (OR = 1.17, P = 1.76 × 10(-10)). Using RT-PCR and immunohistochemistry, we show TXNRD2 and ATXN2 expression in retinal ganglion cells and the optic nerve head. These results identify new pathways underlying POAG susceptibility and suggest new targets for preventative therapies.

  6. Exome Sequencing Identifies a Missense Variant in EFEMP1 Co-Segregating in a Family with Autosomal Dominant Primary Open-Angle Glaucoma

    PubMed Central

    Mackay, Donna S.; Bennett, Thomas M.; Shiels, Alan

    2015-01-01

    Primary open-angle glaucoma (POAG) is a clinically important and genetically heterogeneous cause of progressive vision loss as a result of retinal ganglion cell death. Here we have utilized trio-based, whole-exome sequencing to identify the genetic defect underlying an autosomal dominant form of adult-onset POAG segregating in an African-American family. Exome sequencing identified a novel missense variant (c.418C>T, p.Arg140Trp) in exon-5 of the gene coding for epidermal growth factor (EGF) containing fibulin-like extracellular matrix protein 1 (EFEMP1) that co-segregated with disease in the family. Linkage and haplotype analyses with microsatellite markers indicated that the disease interval overlapped a known POAG locus (GLC1H) on chromosome 2p. The p.Arg140Trp substitution was predicted in silico to have damaging effects on protein function and transient expression studies in cultured cells revealed that the Trp140-mutant protein exhibited increased intracellular accumulation compared with wild-type EFEMP1. In situ hybridization of the mouse eye with oligonucleotide probes detected the highest levels of EFEMP1 transcripts in the ciliary body, cornea, inner nuclear layer of the retina, and the optic nerve head. The recent finding that a common variant near EFEMP1 was associated with optic nerve-head morphology supports the possibility that the EFEMP1 variant identified in this POAG family may be pathogenic. PMID:26162006

  7. Genome-wide association analysis identifies TXNRD2, ATXN2 and FOXC1 as susceptibility loci for primary open angle glaucoma

    PubMed Central

    Cooke Bailey, Jessica N.; Loomis, Stephanie J.; Kang, Jae H.; Allingham, R. Rand; Gharahkhani, Puya; Khor, Chiea Chuen; Burdon, Kathryn P.; Aschard, Hugues; Chasman, Daniel I.; Igo, Robert P.; Hysi, Pirro G.; Glastonbury, Craig A.; Ashley-Koch, Allison; Brilliant, Murray; Brown, Andrew A.; Budenz, Donald L.; Buil, Alfonso; Cheng, Ching-Yu; Choi, Hyon; Christen, William G.; Curhan, Gary; De Vivo, Immaculata; Fingert, John H.; Foster, Paul J.; Fuchs, Charles; Gaasterland, Douglas; Gaasterland, Terry; Hewitt, Alex W.; Hu, Frank; Hunter, David J.; Khawaja, Anthony P.; Lee, Richard K.; Li, Zheng; Lichter, Paul R.; Mackey, David A.; McGuffin, Peter; Mitchell, Paul; Moroi, Sayoko E.; Perera, Shamira A.; Pepper, Keating W.; Qi, Qibin; Realini, Tony; Richards, Julia E.; Ridker, Paul M; Rimm, Eric; Ritch, Robert; Ritchie, Marylyn; Schuman, Joel S.; Scott, William K.; Singh, Kuldev; Sit, Arthur J.; Song, Yeunjoo E.; Tamimi, Rulla M.; Topouzis, Fotis; Viswanathan, Ananth C.; Verma, Shefali Setia; Vollrath, Douglas; Wang, Jie Jin; Weisschuh, Nicole; Wissinger, Bernd; Wollstein, Gadi; Wong, Tien Y.; Yaspan, Brian L.; Zack, Donald J.; Zhang, Kang; Weinreb, Robert N.; Pericak-Vance, Margaret A.; Small, Kerrin; Hammond, Christopher J.; Aung, Tin; Liu, Yutao; Vithana, Eranga N.; MacGregor, Stuart; Craig, Jamie E.; Kraft, Peter; Howell, Gareth; Hauser, Michael A.; Pasquale, Louis R.; Haines, Jonathan L.; Wiggs, Janey L.

    2015-01-01

    Primary open angle glaucoma (POAG) is a leading cause of blindness world-wide. To identify new susceptibility loci, we meta-analyzed GWAS results from 8 independent studies from the United States (3,853 cases and 33,480 controls) and investigated the most significant SNPs in two Australian studies (1,252 cases and 2,592 controls), 3 European studies (875 cases and 4,107 controls) and a Singaporean Chinese study (1,037 cases and 2,543 controls). A meta-analysis of top SNPs identified three novel loci: rs35934224[T] within TXNRD2 (odds ratio (OR) = 0.78, P = 4.05×10−11 encoding a mitochondrial protein required for redox homeostasis; rs7137828[T] within ATXN2 (OR = 1.17, P = 8.73×10−10), and rs2745572[A] upstream of FOXC1 (OR = 1.17, P = 1.76×10−10). Using RT-PCR and immunohistochemistry, we show TXNRD2 and ATXN2 expression in retinal ganglion cells and the optic nerve head. These results identify new pathways underlying POAG susceptibility and suggest novel targets for preventative therapies. PMID:26752265

  8. Efficacy of combined administration of 0.2% brimonidine and 0.5% betaxolol in treatment of primary open angle glaucoma and ocular hypertension.

    PubMed

    Chi, Wei; Li, An; Wang, Shuqin; Zhu, Xuefei

    2013-12-01

    To observe the efficacy of combined use of brimonidine and betaxolol in treatment of primary open angle glaucoma (POAG) and ocular hypertension. A total of 54 patients (90 eyes) with POAG and ocular hypertension were randomly divided into three groups (receiving betaxolol, brimonidine and combined administration of betaxolol and brimonidine respectively). The administration was given twice daily in all groups (0.5% betaxolol, 0.2% brimonidine and 0.5% betaxolol combined with 0.2% brimonidine). The changes in intraocular pressure (IOP) were observed before, and 2, 4, 6, and 8 weeks after treatment. In addition, the adverse reactions were also recorded post-treatment. The mean IOPs at all the time points after treatment were significantly reduced compared with pre-treatment levels (P < 0.05). Patients receiving brimonidine had a greater reduction in IOP compared with their counterparts in the betaxolol group but the difference was not statistically significant. The IOP decline was significantly higher in the combined therapy group than in the other two groups (P < 0.01). Few cases presented with slight discomfort, such as sensation of foreign bodies, ocular irritation, dizziness, headache, fatigue, and dryness of mouth and nose. No severe adverse reactions were noted following administration. Combined use of brimonidine and betaxolol is an efficacious treatment of reducing IOP without severe side effects.

  9. [Effects of porcine pancreatic elastase-1 on elastin in human trabecular meshwork--immunohistochemical studies: Report 3. Primary open angle glaucoma].

    PubMed

    Hoya, T

    1994-06-01

    The aim of this study was to determine the location of elastin in the extracellular material and to estimate the influence of porcine pancreatic elastase-1 (PPE) on the elastin in human trabecular tissue. Trabecular tissues obtained from normal post-mortem eyes and trabeculectomy specimens of primary open angle glaucoma (POAG) were used in this study. The tissues were embedded in Lowicryl K4M and sectioned for electron microscopy. First, the sections were subjected to protein A-gold immunohistochemical staining to determine the location of elastin in the tissues. Second, the sections were exposed to PPE, before immunostaining, to evaluate the change of immunolocalization of the gold particles in the tissue. The results were as follows. In POAG specimens, gold particles indicating the presence of elastin were located in the area of fine fibrillar-like material in the subendothelial layers of Schlemm's canal in POAG specimens. In normal eyes, few gold particles were localized in the area. The density of gold particles in the area was reduced by PPE in POAG specimens. These results show that elastin is localized in the area of fine fibrillar-like material in the subendothelial layers of Schlemm's canal of POAG, and that PPE dissolves the elastin in the area.

  10. No association of genetic polymorphisms in CYP1B1 with primary open-angle glaucoma: a meta- and gene-based analysis

    PubMed Central

    Dong, Shuqian; Yang, Jingyun; Yu, Weihong; Kota, Pravina; Xia, Xiaobo

    2012-01-01

    Purpose To examine the effects of genetic polymorphisms in cytochrome P450, subfamily 1, polypeptide 1 (C1P1B1) on primary open-angle glaucoma (POAG). Methods A systematic literature search was performed, and random-effects meta-analyses were used to evaluate genetic polymorphisms in CYP1B1 with POAG. A gene-based analysis was conducted to investigate the cumulative effects of genetic polymorphisms in CYP1B1. Results A total of six studies from published papers were included in our analysis. Random-effects meta-analyses failed to detect any significant association of POAG with genetic polymorphisms in CYP1B1, including rs180040, rs1056836, rs10012, rs1056827, rs1056837, and rs2567206. The gene-based analysis indicated that the cumulative effect of genetic polymorphisms in CYP1B1 is not associated with POAG (p>0.50). Conclusions We did not find any evidence of strong association of POAG with CYP1B1 genetic polymorphisms and their cumulative effect. PMID:22509109

  11. The effects of beta-blockers on ocular blood flow in patients with primary open angle glaucoma: a color Doppler imaging study.

    PubMed

    Altan-Yaycioglu, R; Türker, G; Akdöl, S; Acunaş, G; Izgi, B

    2001-01-01

    To evaluate the effects of four commonly used beta-blockers on ocular blood flow in patients with primary open angle glaucoma (POAG). Eighty eyes of 40 subjects with POAG were included in the study. Subjects were randomly divided into four groups given timolol maleate 0.50%, betaxolol HCl 0.50%, carteolol 1% or levobunolol 0.50% drops, applied twice daily (one drug to each group). Before beginning the treatment and at the end of the first month ocular blood flow velocity was measured using the color Doppler imaging (CDI) method. In the ophthalmic artery (OA), central retinal artery (CRA) and temporal posterior ciliary artery (TPCA) the peak systolic (PS) and end-diastolic (ED) blood flow velocities were measured and resistive index (RI) values were calculated. The results within each group were analysed using the matched paired student's t-test. The data between groups was compared with one-way analysis of variance (ANOVA) and Tukey-Kramer multiple comparison tests. The timolol group showed a significant increase in RI values of TPCA. In the betaxolol group RI decreased significantly in CRA and TPCA, whereas in the carteolol group there was a significant decrease only in CRA. In the levobunolol group there was no change in any artery. CONCLUSIONS. Betaxolol seemed to have a greater vasodilator effect than carteolol, and levobunolol had no effect on the retinal and choroidal vasculature. Timolol may have some vasoconstrictive effect in the ciliary vasculature.

  12. Longterm effect of topical beta-blockers on intraocular pressure and visual field sensitivity in ocular hypertension and chronic open-angle glaucoma.

    PubMed

    Collignon-Brach, J

    1994-05-01

    In a prospective, randomized study, nineteen patients with ocular hypertension (n = 14) or chronic open-angle glaucoma (n = 5) were treated with either betaxolol 0.5% or timolol 0.5% in both eyes twice daily. Visual field sensitivity and intraocular pressure were assessed with the Octopus perimeter (program G1) and applanation tonometry, respectively, at 3, 6, 12, 24, 36, and 48 months during treatment. Four of the nineteen patients (two timolol-treated and two betaxolol-treated) were lost to follow-up after the 36-month examination. Whereas both drugs reduced the intraocular pressure, the decrease in the timolol-treated group was statistically more pronounced than in the betaxolol-treated group at month 3, 6, and 48 (p < 0.03). In both treatment groups, the visual field mean sensitivity (MS) index decreased slightly during the first six months of treatment, but remained so only in the timolol-treated group at all subsequent examinations. In the betaxolol-treated group, there was a statistically significant increase in MS at the 12, 24, 36, and 48 month visits (p < 0.01). These findings suggest that factors other than IOP alone may determine visual field outcome.

  13. The effect of prostaglandin analogues on central corneal thickness of patients with chronic open-angle glaucoma: a 2-year study on 129 eyes.

    PubMed

    Bafa, Maria; Georgopoulos, Gerasimos; Mihas, Constantinos; Stavrakas, Panagiotis; Papaconstantinou, Dimitrios; Vergados, Ioannis

    2011-08-01

    To evaluate the effect of prostaglandin analogues on the central corneal thickness (CCT) of patients with chronic open-angle glaucoma (COAG). One hundred and twenty-nine eyes were included in this study. Of these, 108 were treated with prostaglandin analogues (latanoprost, travoprost and bimatoprost), while 21 eyes treated with β-blockers were used as controls. CCT was measured before treatment and at 3-month intervals. A slight but significant increase in CCT was recorded in the bimatoprost and latanoprost groups. Treatment with bimatoprost produced a constant increase (1.85-8.83 μm) in CCT at all time-points of the study. The CCT rise found in the latanoprost group was significant for the first year. Treatment with travoprost did not affect CCT. The possibility of corneal thickening under prolonged, local prostaglandin treatment should be investigated further. However, in clinical practice, CCT changes may sometimes influence intraocular pressure measurements significantly. © 2009 The Authors. Journal compilation © 2009 Acta Ophthalmol.

  14. Structural and functional brain changes in early- and mid-stage primary open-angle glaucoma using voxel-based morphometry and functional magnetic resonance imaging

    PubMed Central

    Jiang, Ming-Ming; Zhou, Qing; Liu, Xiao-Yong; Shi, Chang-Zheng; Chen, Jian; Huang, Xiang-He

    2017-01-01

    Abstract To investigate structural and functional brain changes in patients with primary open-angle glaucoma (POAG) by using voxel-based morphometry based on diffeomorphic anatomical registration through exponentiated Lie algebra (VBM-DARTEL) and blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI), respectively. Thirteen patients diagnosed with POAG and 13 age- and sex-matched healthy controls were enrolled in the study. For each participant, high-resolution structural brain imaging and blood flow imaging were acquired on a 3.0-Tesla magnetic resonance imaging (MRI) scanner. Structural and functional changes between the POAG and control groups were analyzed. An analysis was carried out to identify correlations between structural and functional changes acquired in the previous analysis and the retinal nerve fiber layer (RNFL). Patients in the POAG group showed a significant (P < 0.001) volume increase in the midbrain, left brainstem, frontal gyrus, cerebellar vermis, left inferior parietal lobule, caudate nucleus, thalamus, precuneus, and Brodmann areas 7, 18, and 46. Moreover, significant (P < 0.001) BOLD signal changes were observed in the right supramarginal gyrus, frontal gyrus, superior frontal gyrus, left inferior parietal lobule, left cuneus, and left midcingulate area; many of these regions had high correlations with the RNFL. Patients with POAG undergo widespread and complex changes in cortical brain structure and blood flow. (ClinicalTrials.gov number: NCT02570867). PMID:28248867

  15. Recombinational and physical mapping of the locus for primary open-angle glaucoma (GLC1A) on chromosome 1q23-q25

    SciTech Connect

    Belmouden, A.; Adam, M.F.; De Dinechin, S.D. |

    1997-02-01

    Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness in industrialized countries. A locus for juvenile-onset POAG, GLC1A, has been mapped to 1q21-q31 in a 9-cM interval. With recombinant haplotypes, we have now reduced the GLC1A interval to a maximum of 3 cM, between the D1S452/NGA1/D1S210 and NGA5 loci. These loci are 2.8 Mb apart on a 4.7-Mb contig that we have completed between the D1S2851 and D1S218 loci and that includes 96 YAC clones and 48 STSs. The new GLC1A interval itself is now covered by 25 YACs, 30 STSs, and 16 restriction enzyme site landmarks. The lack of a NotI site suggests that the region has few CpG islands and a low gene content. This is compatible with its predominant cytogenetic location on the 1q24 G-band. Finally, we have excluded important candidate genes, including genes coding for three ATPases (AMB1, ATP2B4, ATPlA2), an ion channel (VDAC4), antithrombine III (AT3), and prostaglandin synthase (PTGS2). Our results provide a basis to identify the GLC1A gene. 59 refs., 3 figs., 3 tabs.

  16. Recombinational and physical mapping of the locus for primary open-angle glaucoma (GLC1A) on chromosome 1q23-q25.

    PubMed

    Belmouden, A; Adam, M F; Dupont de Dinechin, S; Brézin, A P; Rigault, P; Chumakov, I; Bach, J F; Garchon, H J

    1997-02-01

    Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness in industrialized countries. A locus for juvenile-onset POAG, GLC1A, has been mapped to 1q21-q31 in a 9-cM interval. With recombinant haplotypes, we have now reduced the GLC1A interval to a maximum of 3 cM, between the D1S452/NGA1/D1S210 and NGA5 loci. These loci are 2.8 Mb apart on a 4.7-Mb contig that we have completed between the D1S2851 and D1S218 loci and that includes 96 YAC clones and 48 STSs. The new GLC1A interval itself is now covered by 25 YACs, 30 STSs, and 16 restriction enzyme site landmarks. The lack of a NotI site suggests that the region has few CpG islands and a low gene content. This is compatible with its predominant cytogenetic location on the 1q24 G-band. Finally, we have excluded important candidate genes, including genes coding for three ATPases (ATP1B1, ATP2B4, ATP1A2), an ion channel (VDAC4), antithrombine III (AT3), and prostaglandin synthase (PTGS2). Our results provide a basis to identify the GLC1A gene.

  17. Structural and functional brain changes in early- and mid-stage primary open-angle glaucoma using voxel-based morphometry and functional magnetic resonance imaging.

    PubMed

    Jiang, Ming-Ming; Zhou, Qing; Liu, Xiao-Yong; Shi, Chang-Zheng; Chen, Jian; Huang, Xiang-He

    2017-03-01

    To investigate structural and functional brain changes in patients with primary open-angle glaucoma (POAG) by using voxel-based morphometry based on diffeomorphic anatomical registration through exponentiated Lie algebra (VBM-DARTEL) and blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI), respectively.Thirteen patients diagnosed with POAG and 13 age- and sex-matched healthy controls were enrolled in the study. For each participant, high-resolution structural brain imaging and blood flow imaging were acquired on a 3.0-Tesla magnetic resonance imaging (MRI) scanner. Structural and functional changes between the POAG and control groups were analyzed. An analysis was carried out to identify correlations between structural and functional changes acquired in the previous analysis and the retinal nerve fiber layer (RNFL).Patients in the POAG group showed a significant (P < 0.001) volume increase in the midbrain, left brainstem, frontal gyrus, cerebellar vermis, left inferior parietal lobule, caudate nucleus, thalamus, precuneus, and Brodmann areas 7, 18, and 46. Moreover, significant (P < 0.001) BOLD signal changes were observed in the right supramarginal gyrus, frontal gyrus, superior frontal gyrus, left inferior parietal lobule, left cuneus, and left midcingulate area; many of these regions had high correlations with the RNFL.Patients with POAG undergo widespread and complex changes in cortical brain structure and blood flow. (ClinicalTrials.gov number: NCT02570867).

  18. Distribution of COL8A2 and COL8A1 gene variants in Caucasian primary open angle glaucoma patients with thin central corneal thickness

    PubMed Central

    Desronvil, T.; Logan-Wyatt, D.; Abdrabou, W.; Triana, M.; Jones, R.; Taheri, S.; Del Bono, E.; Pasquale, L.R.; Olivier, M.; Haines, J.L.; Fan, B.J.

    2010-01-01

    Purpose One approach to identify genes that contribute to common complex ocular disorders such as primary open angle glaucoma (POAG) is to study the genetic determinates of endophenotypes that are defined by underlying pre-disposing heritable quantitative traits such as central corneal thickness (CCT). Collagen VIII is a major component of Descemet’s membrane and studies in mice have indicated that targeted inactivation of the genes encoding the collagen type 8 alpha1 (Col8a1) and collagen type 8 alpha2 (Col8a2) subunits (COL8A1 and COL8A2) results in thinning of the corneal stroma and of Descemet’s membrane. The purpose of this study is to evaluate COL8A1 and COL8A2 as candidate genes for thin CCT in human POAG patients. Methods 100 Caucasian POAG patients were enrolled in this study. The entire COL8A1 and COL8A2 coding sequence was determined in 8 patients with CCT<513 µm (one standard deviation (36 microns) below the mean (550 microns) and 8 patients with CCT>586 µm (one standard deviation above the mean). Selected COL8A2 exons containing variants of interest were sequenced in the full POAG cohort. Association and quantitative trait analyses were performed. Results Three patients with CCT less than 513 µm and advanced POAG were found to have missense changes in COL8A2; two patients had a previously identified mutation, R155Q and one had a novel change, P678L (p=0.0035, Fisher’s exact test). Missense changes were not found in any of the patients with CCT>513 µm and missense changes in the COL8A1 gene were not found in any patient. One common COL8A2 SNP, rs274754 was also statistically associated with CCT (p=0.018). Conclusions In this study we have identified COL8A2 missense changes in a group of Caucasian patients with very thin CCT and advanced POAG. These results suggest that DNA sequence variants in the COL8A2 gene may be associated with thin corneas in some glaucoma patients. Further study of COL8A2 variants in other patient populations, especially

  19. Baseline factors predicting the risk of conversion from ocular hypertension to primary open-angle glaucoma during a 10-year follow-up.

    PubMed

    Salvetat, M L; Zeppieri, M; Tosoni, C; Brusini, P

    2016-06-01

    PurposeTo evaluate the ability of baseline clinical, morphological, and functional factors to predict the conversion to primary open-angle glaucoma (POAG) in ocular hypertensive (OHT) patients.MethodsThis single-center prospective longitudinal observational study included 116 eyes of 116 OHT patients followed for a 10-year period. All patients had intraocular pressure (IOP) ≥24 mm Hg in one eye and >21 mm Hg in the other eye, normal visual fields (VFs) and normal optic disc (OD) appearance in both eyes at baseline. All OHT patients were untreated at baseline with subsequent treatment upon need according to clinical judgement. Only one eye per subject was randomly selected. Patient age, gender, IOP, central corneal thickness (CCT), and ibopamine test results were collected at baseline. All patients underwent standard automated perimetry, short-wavelength automated perimetry (SWAP), frequency-doubling technology, confocal scanning laser ophthalmoscopy (CSLO), and scanning laser polarimetry (SLP) at baseline and every 6 months thereafter. Main outcome measure was the conversion to POAG, defined as the development of reproducible VF and/or OD abnormalities attributable to glaucoma. Cox proportional hazards models were used to identify the baseline factors predictive of POAG conversion.ResultsDuring the 10-year follow-up, 25% of eyes converted to POAG. In multivariate Cox models, baseline factors that were significant predictors of POAG development included: older age (hazard ratio (HR) 1.0, 99% confidence intervals (CIs) 1.0-1.2, per 1 year older); SWAP Glaucoma Hemifield test 'outside normal limits' (HR 4.3, 99% CIs 1.2-17.9); greater SLP 'Inter-eye Symmetry' (HR 1.1, 99% CIs 0.4-3.0, per 1 unit lower); lower CSLO Rim Volume (HR 1.1, 99% CIs 0.3-3.2, per 0.1 mm(3) lower); and greater CSLO cup-to-disc ratio (HR 6.0, 99% CIs 3.6-16.8, per 0.1 unit greater).ConclusionsThe baseline parameters that proved to be useful in assessing the likelihood of an OHT

  20. Comparative Effectiveness of First-line Medications for Primary Open Angle Glaucoma – A Systematic Review and Network Meta-analysis

    PubMed Central

    Li, Tianjing; Lindsley, Kristina; Rouse, Benjamin; Hong, Hwanhee; Shi, Qiyuan; Friedman, David S.; Wormald, Richard; Dickersin, Kay

    2015-01-01

    Topic Primary open angle glaucoma (POAG) is a highly prevalent condition worldwide and the most common cause of irreversible sight loss. The objective is to assess the comparative effectiveness of first line medical treatments in patients with POAG or ocular hypertension through a systematic review and network meta-analysis, and to provide relative rankings of these treatments. Clinical Relevance Treatment for POAG currently relies completely on lowering the intraocular pressure (IOP). While topical drops, lasers, and surgeries can be considered in the initial treatment of glaucoma, most patients elect to start treatment with eye drops. Methods We included randomized controlled trials that compared a single active topical medication with no treatment/placebo or another single topical medication. We searched CENTRAL, MEDLINE, EMBASE and the Food and Drug Administration's website. Two individuals independently assessed trial eligibility, abstracted data, and assessed the risk of bias. We performed Bayesian network meta-analyses. Results We included 114 randomized controlled trials with data from 20,275 participants. The overall risk of bias of the included trials is mixed. The mean reductions (95% credible intervals) in IOP in mmHg at 3 months, ordered from the most to least effective drugs were: bimatoprost 5·61 (4·94; 6·29), latanoprost 4·85 (4·24; 5·46), travoprost 4·83 (4·12; 5·54), levobunolol 4·51 (3·85; 5·24), tafluprost 4·37 (2·94; 5·83), timolol 3·7 (3·16; 4·24), brimonidine 3·59 (2·89; 4·29), carteolol 3·44 (2·42; 4·46), levobetaxolol 2·56 (1·52; 3·62), apraclonidine 2·52 (0·94; 4·11), dorzolamide 2·49 (1·85; 3·13), brinzolamide 2·42 (1·62; 3·23), betaxolol 2·24 (1·59; 2·88), and unoprostone 1·91 (1·15; 2·67). Conclusions All active first-line drugs are effective compared to placebo in reducing IOP at 3 months. Bimatoprost, latanoprost, and travoprost are among the most efficacious drugs, although the within class

  1. [Selective Laser Trabeculoplasty in the treatment of chronic open-angle glaucoma: retrospective analysis 12 years after treatment in a cohort of 28 patients].

    PubMed

    Giocanti-Aurégan, A; Abitbol, O; Bensmail, D; Bensaid, A; Lachkar, Y

    2014-12-01

    To determine long-term efficacy of selective Laser Trabeculoplasty (SLT) over 12 years in chronic open-angle glaucoma (OAG) patients. In this retrospective study, all patients treated by SLT between 1997 and 1999 for OAG were included and followed up every 6 months. The procedure was performed with a Coherent Selecta 7000 Nd:YAG with 100 ± 10 non overlapping 400 μm spots over 360 degrees centered on the trabecular meshwork. Patients were excluded in the case of prior filtration surgery or Argon laser trabeculoplasty. Our primary study parameter was the number of patients requiring filtration surgery within the follow-up period. Our secondary parameters were intraocular pressure (IOP) and SLT-related complications. We included 46 eyes of 28 patients. The 12-year success rate was 26.1%. Thirty-nine percent of all eyes underwent filtration surgery (failure) during the follow-up period, and 34.8% were lost to follow-up. In the pigmentary glaucoma (PG) subgroup, the 12-year success rate was 16%, while it was 37.5% in the Primary OAG subgroup. The overall mean IOP was 22.8 mm Hg (D.S. 3.78) prior to laser, 16.08 mm Hg (D.S. 2.7) at 1 year and 15 mm Hg (D.S. 1.8) at 12 years. The mean number of medications was 1.6 (D.S. 0.8) prior to SLT, 1.36 (D.S. 0.8) at 1 year, and 1.3 (D.S. 1.2), 12 years after SLT respectively. No patients had a second SLT treatment. No significant complications occurred during follow-up. Selective laser trabeculoplasty may at times be a useful resource to lower IOP in patients with OAG. Nonetheless, the failure rate is significant especially in PG, which requires confirmation by larger prospective studies. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  2. Association of Toll-like receptor 4 single-nucleotide polymorphisms Asp299Gly and Thr399Ile with the risk of primary open angle glaucoma.

    PubMed

    Navarro-Partida, Jose; Martinez-Rizo, Abril Bernardette; Ramirez-Barrera, Pedro; Velazquez-Fernandez, Jesus Bernardino; Mondragon-Jaimes, Veronica A; Santos-Garcia, Arturo; Benites-Godinez, Veronica

    2017-05-01

    Toll-like receptor 4 (TLR4) is a transmembrane receptor that mediates immune responses to exogenous and endogenous ligands. Previously, non-coding single nucleotide polymorphisms (SNPs) in the TLR4 gene were related to primary open angle glaucoma (POAG). This study was undertaken to investigate whether coding TLR4 Asp299Gly (rs4986790 A/G) and Thr399Ile (rs4986791 C/T) are associated with POAG in a Mexican population. One hundred and eighty-seven unrelated Mexican patients with POAG (94 men and 95 women; mean age 66.49 ± 14.3 years) and 109 control subjects (40 men and 69 women; age, 63.28 ± 7.93 years) were included. SNPs Asp299Gly (rs4986790 A/G) and Thr399Ile (rs4986791 C/T) were genotyped by a Taqman® Allelic Discrimination Assayand. Allelic, genotypic, haplotypic, and model-based (dominant, recessive, and codominant) associations of the SNPs with POAG were analyzed using Chi-squared tests or Fisher exact tests and logistic regression. Strong linkage disequilibrium was observed among the SNPs (D' = 0.8692), which were located in one haplotype block. With respect to allelic diversity, the minor allele of both SNPs generates a significantly increased risk of POAG. The minor allele of Asp299Gly conferred the highest increased risk of POAG (P = 0.0054, OR = 4.47, 95% CI = 1.46-13.70). With regard to genotypic diversity, individuals carrying the minor allele of Asp299Gly and Thr399Ile had a significant increased risk for POAG with OR of 4.47 (P = 0.054, 95% CI = 1.30-15.35) and 3.5, respectively (P = 0.012, 95% CI = 1.17-10.44). Haplotype analysis was non-significant. TLR4 coding SNPs Asp299Gly and Thr399Ile might be used as genetic susceptibility alleles for POAG in Mexican population. Our findings support the role of TLR4 in the pathophysiology of glaucoma.

  3. Age at natural menopause genetic risk score in relation to age at natural menopause and primary open-angle glaucoma in a US-based sample

    PubMed Central

    Pasquale, Louis R.; Aschard, Hugues; Kang, Jae H.; Bailey, Jessica N. Cooke; Lindström, Sara; Chasman, Daniel I.; Christen, William G.; Allingham, R. Rand; Ashley-Koch, Allison; Lee, Richard K.; Moroi, Sayoko E.; Brilliant, Murray H.; Wollstein, Gadi; Schuman, Joel S.; Fingert, John; Budenz, Donald L.; Realini, Tony; Gaasterland, Terry; Gaasterland, Douglas; Scott, William K.; Singh, Kuldev; Sit, Arthur J.; Igo, Robert P.; Song, Yeunjoo E.; Hark, Lisa; Ritch, Robert; Rhee, Douglas J.; Gulati, Vikas; Havens, Shane; Vollrath, Douglas; Zack, Donald J.; Medeiros, Felipe; Weinreb, Robert N.; Pericak-Vance, Margaret A.; Liu, Yutao; Kraft, Peter; Richards, Julia E.; Rosner, Bernard A.; Hauser, Michael A.; Haines, Jonathan L.; Wiggs, Janey L.

    2017-01-01

    Abstract Objective: Several attributes of female reproductive history, including age at natural menopause (ANM), have been related to primary open-angle glaucoma (POAG). We assembled 18 previously reported common genetic variants that predict ANM to determine their association with ANM or POAG. Methods: Using data from the Nurses’ Health Study (7,143 women), we validated the ANM weighted genetic risk score in relation to self-reported ANM. Subsequently, to assess the relation with POAG, we used data from 2,160 female POAG cases and 29,110 controls in the National Eye Institute Glaucoma Human Genetics Collaboration Heritable Overall Operational Database (NEIGHBORHOOD), which consists of 8 datasets with imputed genotypes to 5.6+ million markers. Associations with POAG were assessed in each dataset, and site-specific results were meta-analyzed using the inverse weighted variance method. Results: The genetic risk score was associated with self-reported ANM (P = 2.2 × 10–77) and predicted 4.8% of the variance in ANM. The ANM genetic risk score was not associated with POAG (Odds Ratio (OR) = 1.002; 95% Confidence Interval (CI): 0.998, 1.007; P = 0.28). No single genetic variant in the panel achieved nominal association with POAG (P ≥0.20). Compared to the middle 80 percent, there was also no association with the lowest 10th percentile or highest 90th percentile of genetic risk score with POAG (OR = 0.75; 95% CI: 0.47, 1.21; P = 0.23 and OR = 1.10; 95% CI: 0.72, 1.69; P = 0.65, respectively). Conclusions: A genetic risk score predicting 4.8% of ANM variation was not related to POAG; thus, genetic determinants of ANM are unlikely to explain the previously reported association between the two phenotypes. PMID:27760082

  4. Factors Influencing the Placebo Effect in Patients with Primary Open-Angle Glaucoma or Ocular Hypertension: An Analysis of Two Randomized Clinical Trials

    PubMed Central

    Kawamura, Taichi; Sato, Izumi; Kawakami, Koji

    2016-01-01

    Objective To explore factors related to the placebo effect in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OH). Methods This was a retrospective cohort study of patients with POAG and patients with OH who were treated with placebo. The patients’ data were extracted from two randomized, double-masked, parallel, multicenter clinical trials (trial 1 and trial 2) in Japan. We explored the baseline factors that were associated with the intraocular pressure (IOP)-lowering effect of placebo ophthalmic solution after 4 weeks of instillation treatment at two time points by using multivariable models. The time points were Hour 0 (between 08:30 and 10:30 before instillation) and Hour 2 (within 1.5 to 2.5 h after instillation and by 12:30) at the baseline date and after 4 weeks. The changes in IOP from baseline to 4 weeks at the two time points were evaluated for the IOP-lowering effect induced by placebo instillation. Results Of the 330 patients included in the two trials, 89 patients were eligible for the analysis. The results of the multivariable analysis for Hour 0 indicated a high IOP at the baseline date (coefficient: 0.24, 95% confidence interval (CI): 0.02 to 0.46, P = 0.03), and the magnitude of the IOP fluctuation at the baseline date (coefficient: 0.57, 95% CI: 0.24 to 0.90, P = 0.001) was associated with the IOP-lowering effect after 4 weeks. With respect to Hour 2, the trial type was associated with the IOP-lowering effect (coefficient: -1.15, 95% CI: -2.14 to -0.16, P = 0.02). Conclusions A large fluctuation in IOP during the day is associated with the IOP-lowering effect induced by placebo in patients with POAG or OH. This finding would be helpful to researchers when designing studies related to glaucoma in the early stages of clinical development of drugs. PMID:27254076

  5. Comparative Effectiveness of First-Line Medications for Primary Open-Angle Glaucoma: A Systematic Review and Network Meta-analysis.

    PubMed

    Li, Tianjing; Lindsley, Kristina; Rouse, Benjamin; Hong, Hwanhee; Shi, Qiyuan; Friedman, David S; Wormald, Richard; Dickersin, Kay

    2016-01-01

    Primary open-angle glaucoma (POAG) is a highly prevalent condition worldwide and the most common cause of irreversible sight loss. The objective is to assess the comparative effectiveness of first-line medical treatments in patients with POAG or ocular hypertension through a systematic review and network meta-analysis, and to provide relative rankings of these treatments. Treatment for POAG currently relies completely on lowering the intraocular pressure (IOP). Although topical drops, lasers, and surgeries can be considered in the initial treatment of glaucoma, most patients elect to start treatment with eye drops. We included randomized controlled trials (RCTs) that compared a single active topical medication with no treatment/placebo or another single topical medication. We searched CENTRAL, MEDLINE, EMBASE, and the Food and Drug Administration's website. Two individuals independently assessed trial eligibility, abstracted data, and assessed the risk of bias. We performed Bayesian network meta-analyses. We included 114 RCTs with data from 20 275 participants. The overall risk of bias of the included trials is mixed. The mean reductions (95% credible intervals) in IOP in millimeters of mercury at 3 months ordered from the most to least effective drugs were as follows: bimatoprost 5.61 (4.94; 6.29), latanoprost 4.85 (4.24; 5.46), travoprost 4.83 (4.12; 5.54), levobunolol 4.51 (3.85; 5.24), tafluprost 4.37 (2.94; 5.83), timolol 3.70 (3.16; 4.24), brimonidine 3.59 (2.89; 4.29), carteolol 3.44 (2.42; 4.46), levobetaxolol 2.56 (1.52; 3.62), apraclonidine 2.52 (0.94; 4.11), dorzolamide 2.49 (1.85; 3.13), brinzolamide 2.42 (1.62; 3.23), betaxolol 2.24 (1.59; 2.88), and unoprostone 1.91 (1.15; 2.67). All active first-line drugs are effective compared with placebo in reducing IOP at 3 months. Bimatoprost, latanoprost, and travoprost are among the most efficacious drugs, although the within-class differences were small and may not be clinically meaningful. All factors

  6. Network Meta-analysis for Clinical Practice Guidelines: A Case Study on First-Line Medical Therapies for Primary Open-Angle Glaucoma.

    PubMed

    Rouse, Benjamin; Cipriani, Andrea; Shi, Qiyuan; Coleman, Anne L; Dickersin, Kay; Li, Tianjing

    2016-05-17

    Network meta-analysis compares multiple treatment options for the same condition and may be useful for developing clinical practice guidelines. To compare treatment recommendations for first-line medical therapy for primary open angle-glaucoma (POAG) from major updates of American Academy of Ophthalmology (AAO) guidelines with the evidence available at the time, using network meta-analysis. MEDLINE, Embase, and the Cochrane Library were searched on 11 March 2014 for randomized, controlled trials (RCTs) of glaucoma monotherapies compared with placebo, vehicle, or no treatment or other monotherapies. The AAO Web site was searched in August 2014 to identify AAO POAG guidelines. Eligible RCTs were selected by 2 independent reviewers, and guidelines were selected by 1 person. One person abstracted recommendations from guidelines and a second person verified. Two people independently abstracted data from included RCTs. Guidelines were grouped together on the basis of literature search dates, and RCTs that existed at 1991, 1995, 1999, 2004, and 2009 were analyzed. The outcome of interest was intraocular pressure (IOP) at 3 months. Only the latest guideline made a specific recommendation: prostaglandins. Network meta-analyses showed that all treatments were superior to placebo in decreasing IOP at 3 months. The mean reductions (95% credible intervals [CrIs]) for the highest-ranking class compared with placebo were as follows: 1991: β-blockers, 4.01 (CrI, 0.48 to 7.43); 1995: α2-adrenergic agonists, 5.64 (CrI, 1.73 to 9.50); 1999: prostaglandins, 5.43 (CrI, 3.38 to 7.38); 2004: prostaglandins, 4.75 (CrI, 3.11 to 6.44); 2009: prostaglandins, 4.58 (CrI, 2.94 to 6.24). When comparisons are informed by a small number of studies, the treatment effects and rankings may not be stable. For timely recommendations when multiple treatment options are available, guidelines developers should consider network meta-analysis. National Eye Institute, National Institutes of Health.

  7. Global variations and time trends in the prevalence of primary open angle glaucoma (POAG): a systematic review and meta-analysis

    PubMed Central

    Kapetanakis, Venediktos V; Chan, Michelle P Y; Foster, Paul J; Cook, Derek G; Owen, Christopher G; Rudnicka, Alicja R

    2016-01-01

    Systematic review of published population based surveys to examine the relationship between primary open angle glaucoma (POAG) prevalence and demographic factors. A literature search identified population-based studies with quantitative estimates of POAG prevalence (to October 2014). Multilevel binomial logistic regression of log-odds of POAG was used to examine the effect of age and gender among populations of different geographical and ethnic origins, adjusting for study design factors. Eighty-one studies were included (37 countries, 216 214 participants, 5266 POAG cases). Black populations showed highest POAG prevalence, with 5.2% (95% credible interval (CrI) 3.7%, 7.2%) at 60 years, rising to 12.2% (95% CrI 8.9% to 16.6%) at 80 years. Increase in POAG prevalence per decade of age was greatest among Hispanics (2.31, 95% CrI 2.12, 2.52) and White populations (1.99, 95% CrI 1.86, 2.12), and lowest in East and South Asians (1.48, 95% CrI 1.39, 1.57; 1.56, 95% CrI 1.31, 1.88, respectively). Men were more likely to have POAG than women (1.30, 95% CrI 1.22, 1.41). Older studies had lower POAG prevalence, which was related to the inclusion of intraocular pressure in the glaucoma definition. Studies with visual field data on all participants had a higher POAG prevalence than those with visual field data on a subset. Globally 57.5 million people (95% CI 46.4 to 73.1 million) were affected by POAG in 2015, rising to 65.5 million (95% CrI 52.8, 83.2 million) by 2020. This systematic review provides the most precise estimates of POAG prevalence and shows omitting routine visual field assessment in population surveys may have affected case ascertainment. Our findings will be useful to future studies and healthcare planning. PMID:26286821

  8. Network Meta-analysis for Clinical Practice Guidelines: A Case Study on First-Line Medical Therapies for Primary Open-Angle Glaucoma

    PubMed Central

    Rouse, Benjamin; Cipriani, Andrea; Shi, Qiyuan; Coleman, Anne L.; Dickersin, Kay; Li, Tianjing

    2016-01-01

    Background Network meta-analysis compares multiple treatment options for the same condition and may be useful for developing clinical practice guidelines. Purpose To compare treatment recommendations for first-line medical therapy for primary open angle-glaucoma (POAG) from major updates of American Academy of Ophthalmology (AAO) guidelines with the evidence available at the time, using network meta-analysis. Data Sources MEDLINE, Embase, and the Cochrane Library were searched on 11 March 2014 for randomized, controlled trials (RCTs) of glaucoma monotherapies compared with placebo, vehicle, or no treatment or other monotherapies. The AAO Web site was searched in August 2014 to identify AAO POAG guidelines. Study Selection Eligible RCTs were selected by 2 independent reviewers, and guidelines were selected by 1 person. Data Extraction One person abstracted recommendations from guidelines and a second person verified. Two people independently abstracted data from included RCTs. Data Synthesis Guidelines were grouped together on the basis of literature search dates, and RCTs that existed at 1991, 1995, 1999, 2004, and 2009 were analyzed. The outcome of interest was intraocular pressure (IOP) at 3 months. Only the latest guideline made a specific recommendation: prostaglandins. Network meta-analyses showed that all treatments were superior to placebo in decreasing IOP at 3 months. The mean reductions (95% credible intervals [CrIs]) for the highest-ranking class compared with placebo were as follows: 1991: β-blockers, 4.01 (CrI, 0.48 to 7.43); 1995: α2-adrenergic agonists, 5.64 (CrI, 1.73 to 9.50); 1999: prostaglandins, 5.43 (CrI, 3.38 to 7.38); 2004: prostaglandins, 4.75 (CrI, 3.11 to 6.44); 2009: prostaglandins, 4.58 (CrI, 2.94 to 6.24). Limitation When comparisons are informed by a small number of studies, the treatment effects and rankings may not be stable. Conclusion For timely recommendations when multiple treatment options are available, guidelines developers

  9. Association of single nucleotide polymorphisms in the CYP1B1 gene with the risk of primary open-angle glaucoma: a meta-analysis.

    PubMed

    Wang, Z; Li, M; Li, L; Sun, H; Lin, X Y

    2015-12-17

    Mutations in the CYP1B1 gene were detected in primary open-angle glaucoma (POAG) patients. However, the association between these mutations and the incidence of POAG remains to be elucidated. Here, we have conducted a meta-analysis to analyze this correlation, using relevant studies obtained from an extensive search of various electronic databases, including EMBase, Web of Science, and PubMed. The extracted studies were selected for the meta-analysis based on the inclusion and exclusion criteria. The quality of each included study was assessed by the Newcastle-Ottawa scale (NOS), and the I2 value was calculated to evaluate the heterogeneity between studies. The combined effect size was presented as the odds ratio (OR), and confidence intervals (CI) were used to assess the association between POAG and CYP1B1 mutations. Eight studies, each with a high NOS score, were included in the analysis. Compared to the mutant allele, the wild-type allele of the rs180040 polymorphism in POAG patients showed a 12% decrease in OR (OR = 0.88, 95%CI = 0.76- 1.00); also, the wild-type allele of rs1056827 showed a 23% decrease in OR of the incidence of POAG (OR = 0.77, 95%CI = 0.60-0.99). However, the latter result was controversial. Polymorphisms at rs1056836, rs10012, and rs1056837 were not correlated with the incidence of POAG (using any evaluation model). In conclusion, three of the tested SNPs in the CYP1B1 gene were correlated with POAG; however, the SNPs rs180040 and rs1056827 showed an association with risk of POAG. These results must be further validated with larger-scale evaluations.

  10. Genetic Variants Associated with Optic Nerve Vertical Cup-to-Disc Ratio Are Risk Factors for Primary Open Angle Glaucoma in a US Caucasian Population

    PubMed Central

    Fan, Bao Jian; Wang, Dan Yi; Pasquale, Louis R.; Haines, Jonathan L.

    2011-01-01

    Purpose. Genetically complex disorders, such as primary open angle glaucoma (POAG), may include highly heritable quantitative traits as part of the overall phenotype, and mapping genes influencing the related quantitative traits may effectively identify genetic risk factors predisposing to the complex disease. Recent studies have identified SNPs associated with optic nerve area and vertical cup-to-disc ratio (VCDR). The purpose of this study was to evaluate the association between these SNPs and POAG in a US Caucasian case-control sample. Methods. Five SNPs previously associated with optic disc area, or VCDR, were genotyped in 539 POAG cases and 336 controls. Genotype data were analyzed for single SNP associations and SNP interactions with VCDR and POAG. Results. SNPs associated with VCDR rs1063192 (CDKN2B) and rs10483727 (SIX1/SIX6) were also associated with POAG (P = 0.0006 and P = 0.0043 for rs1063192 and rs10483727, respectively). rs1063192, associated with smaller VCDR, had a protective effect (odds ratio [OR] = 0.73; 95% confidence interval [CI], 0.58–0.90), whereas rs10483727, associated with larger VCDR, increased POAG risk (OR = 1.33; 95% CI, 1.08–1.65). POAG risk associated with increased VCDR was significantly influenced by the C allele of rs1900004 (ATOH7), associated with increased optic nerve area (P-interaction = 0.025; OR = 1.89; 95% CI, 1.22–2.94). Conclusions. Genetic variants influencing VCDR are associated with POAG in a US Caucasian population. Variants associated with optic nerve area are not independently associated with disease but can influence the effects of VCDR variants suggesting that increased optic disc area can significantly contribute to POAG risk when coupled with risk factors controlling VCDR. PMID:21398277

  11. Choroidal area assessment in various fundus sectors of patients at different stages of primary open-angle glaucoma by using enhanced depth imaging optical coherence tomography

    PubMed Central

    Li, Mu; Yan, Xiao-Qin; Song, Yin-Wei; Guo, Jing-Min; Zhang, Hong

    2017-01-01

    Abstract To compare the choroidal area in different eye fundus sectors of subjects with normal eyes, early-stage primary open-angle glaucoma (POAG) eyes, and 10° tubular visual field POAG eyes using enhanced depth imaging optical coherence tomography. Twenty-five normal, 25 early-stage POAG, and 25 ten-degree tubular visual field POAG eyes were recruited. Enhanced depth imaging optical coherence tomography was used to measure the choroidal area in different fundus sectors (fovea; 10° superior, inferior, temporal, and 24° superior, inferior, temporal, nasal to the fovea) and the peripapillary sector. There were neither significant differences in the choroidal area at any of the 8 measured fundus sectors, nor significant differences in the percentage change between the choroidal area of the fovea and other 7 measured fundus sectors among the 3 groups (all P > 0.05). For the total peripapillary choroidal area, no significant difference was found among the 3 groups (P > 0.05); however, the temporal peripapillary choroidal area of 10° tubular visual field POAG eyes was significantly thicker than that of normal eyes (4,46,213 ± 1,16,267 vs 3,74,164 ± 1,21,658 μm2; P = 0.048). Our study showed that there was no significant difference in the choroidal area of the 8 measured fundus sectors among normal, early-stage POAG, and 10° tubular visual field POAG eyes, suggesting that there might be no blood redistribution from the peripheral choroid to the subfoveal choroid. However, the thicker temporal peripapillary choroidal area might play a role in the central visual acuity protection in patients with POAG. PMID:28272255

  12. Properties of pattern standard deviation in open-angle glaucoma patients with hemi-optic neuropathy and bi-optic neuropathy

    PubMed Central

    Heo, Dong Won; Kim, Kyoung Nam; Lee, Min Woo; Lee, Sung Bok; Kim, Chang-sik

    2017-01-01

    Purpose To evaluate the properties of pattern standard deviation (PSD) according to localization of the glaucomatous optic neuropathy. Methods We enrolled 242 eyes of 242 patients with primary open-angle glaucoma, with a best-corrected visual acuity ≥ 20/25, and no media opacity. Patients were examined via dilated fundus photography, spectral-domain optical coherence tomography, and Humphrey visual field examination, and divided into those with hemi-optic neuropathy (superior or inferior) and bi-optic neuropathy (both superior and inferior). We assessed the relationship between mean deviation (MD) and PSD. Using broken stick regression analysis, the tipping point was identified, i.e., the point at which MD became significantly associated with a paradoxical reversal of PSD. Results In 91 patients with hemi-optic neuropathy, PSD showed a strong correlation with MD (r = −0.973, β = −0.965, p < 0.001). The difference between MD and PSD (“−MD−PSD”) was constant (mean, −0.32 dB; 95% confidence interval, −2.48~1.84 dB) regardless of visual field defect severity. However, in 151 patients with bi-optic neuropathy, a negative correlation was evident between “−MD−PSD” and MD (r2 = 0.907, p < 0.001). Overall, the MD tipping point was −14.0 dB, which was close to approximately 50% damage of the entire visual field (p < 0.001). Conclusions Although a false decrease of PSD usually begins at approximately 50% visual field damage, in patients with hemi-optic neuropathy, the PSD shows no paradoxical decrease and shows a linear correlation with MD. PMID:28249022

  13. Comparison of the efficacy and safety of travoprost with a fixed-combination of dorzolamide and timolol in patients with open-angle glaucoma or ocular hypertension.

    PubMed

    Suzuki, Emilio Rintaro; Franklin, Luciana Meirelles; da Silva, Luciano José Basilio; Figueiredo, Carlos R L; Netto, Joao Agostini; Batista, Wagner Duarte

    2006-09-01

    The purpose of this study was to compare travoprost (TRAV; travoprost 0.004%) and the fixed-combination of dorzolamide/timolol (DTFC; dorzolamide 2.0%/timolol maleate 0.5%) ophthalmic solutions for reducing intraocular pressure (IOP) in patients with primary open-angle glaucoma (OAG) or ocular hypertension (OHT). This was a randomized single masked, study with parallel controls. The TRAV group (n = 29) dosed once daily at 9:00 PM while the DTFC group (n = 27) dosed twice daily at 9:00 AM and 9:00 PM. IOP was measured at baseline, and following 3 weeks and 6 weeks of treatment at 8:00 AM, 12:00 PM, 4:00 PM, and 8:00 PM. Mean average IOP reductions from baseline during the course of the day were 7.5 (32.7%) and 7.1 (30.7%) mmHg for TRAV and 4.8 (23.1%) and 4.5 (21.7%) mmHg for DTFC at 3 weeks and 6 weeks, respectively. The greater IOP reduction for patients receiving TRAV was statistically significant at both the 3 and 6 week visits when averaged across all four time points (p < 0.01). The two products were well-tolerated over the course of the 6 week study. Some factors such as taste perversion were reported more often in the DTFC group. Travoprost monotherapy provided better efficacy in terms of IOP reduction and percentage of IOP reduction compared to dorzolamide 2.0%/timolol maleate 0.5% fixed combination.

  14. An observational study of bimatoprost 0.01% in treatment-naïve patients with primary open angle glaucoma or ocular hypertension: the CLEAR trial

    PubMed Central

    Nixon, Donald R; Simonyi, Susan; Bhogal, Meetu; Sigouin, Christopher S; Crichton, Andrew C; Discepola, Marino; Hutnik, Cindy ML; Yan, David B

    2012-01-01

    Background This study was designed to evaluate the occurrence and severity of ocular hyperemia in subjects with elevated intraocular pressure (IOP) due to primary open angle glaucoma (POAG) or ocular hypertension (OHT) following treatment with bimatoprost 0.01% in a real-world clinical setting. Methods This was an open-label, observational study conducted at 67 centers in Canada. Subjects with elevated IOP due to POAG or OHT instilled bimatoprost 0.01% topically as monotherapy once daily. Ocular hyperemia was graded by the investigator at baseline and weeks 6 and 12 using a photographic five-point grading scale. Change in IOP from baseline was also evaluated at these time points. This analysis includes only the subgroup of 522 subjects who were naïve to IOP-lowering medication prior to the study. Results After 12 weeks of treatment with bimatoprost 0.01%, hyperemia was graded as none-to-mild (grades 0, +0.5, or +1) for 93.3% of subjects and as moderate-to-severe (grades +2 or +3) for 6.7%. At weeks 6 and 12, most subjects (93.2% and 93.5%) had no change in hyperemia grade from baseline. IOP was reduced by 7.4 mmHg (29.8%) at week 6 and 7.7 mmHg (30.9%) at week 12 from baseline. Conclusion This real-world, observational study found that bimatoprost 0.01% instilled once daily reduced IOP by a mean of 30% from baseline without moderate or severe ocular hyperemia in 93% of treatment-naïve subjects with POAG or OHT. PMID:23269858

  15. A Comparative Study of the Water Drinking Test in Eyes With Open-Angle Glaucoma and Prior Trabeculectomy or Tube Shunt.

    PubMed

    Martinez, Patricia; Trubnik, Valerie; Leiby, Benjamin E; Hegarty, Sarah E; Razeghinejad, Reza; Savant, Shravan; Myers, Jonathan S

    2017-02-01

    To compare the intraocular pressure (IOP) response after the water drinking test (WDT) in patients who have undergone trabeculectomy or tube shunt surgery. This prospective study examined 40 eyes of 34 open-angle glaucoma subjects who had undergone trabeculectomy (n=20) or tube shunt surgery (n=20). Both groups were matched by IOP range and by number of topical antiglaucoma medications used. After a baseline IOP assessment, subjects drank 10 mL water per kg body weight over 15 minutes. IOP was then measured with a Goldman tonometer every 15 minutes over a 1-hour period. Outcomes measures were IOP peak, fluctuation, mean, and range. No significant differences in baseline demographics, baseline clinical characteristics or IOP changes during the WDT were observed between the 2 surgical procedure groups. Mean baseline IOPs for the tube shunt and trabeculectomy groups were 12.55±4.23 and 12.3±4.28 mm Hg, respectively (P=0.854). In the trabeculectomy and tube shunt groups, respectively, peak IOP was 16.25±5.55 and 16.15±5.36 mm Hg (P=0.954); IOP fluctuation (IOP max-IOP baseline) was 3.95±2.17 and 3.6±2.23 mm Hg (P=0.618), and IOP range was 2.78±1.56 and 2.8±1.47 mm Hg (P=0.959). Statistical analysis of IOP fluctuation associations using multivariable linear regression determined that the use of systemic antihypertensive blood pressure medication was associated with an increase in IOP fluctuation of approximately 2 mm Hg. Subjects who had undergone either trabeculectomy or tube shunt surgery showed a similar IOP response to the WDT. Subjects on systemic antihypertensive medications experienced significantly greater IOP fluctuations during the test.

  16. A randomised, controlled comparison of latanoprostene bunod and latanoprost 0.005% in the treatment of ocular hypertension and open angle glaucoma: the VOYAGER study

    PubMed Central

    Weinreb, Robert N; Ong, Tuyen; Scassellati Sforzolini, Baldo; Vittitow, Jason L; Singh, Kuldev; Kaufman, Paul L

    2015-01-01

    Aim To assess the efficacy and safety of latanoprostene bunod (LBN) compared with latanoprost 0.005%, and to determine the optimum drug concentration(s) of LBN in reducing intraocular pressure (IOP) in subjects with open angle glaucoma or ocular hypertension. Methods Randomised, investigator-masked, parallel-group, dose-ranging study. Subjects instilled one drop of study medication in the study eye once daily each evening for 28 days and completed five study visits. The primary efficacy endpoint was the reduction in mean diurnal IOP at Day 28. Results Of the 413 subjects randomised (LBN 0.006%, n=82; LBN 0.012%, n=85; LBN 0.024%, n=83; LBN 0.040%, n=81; latanoprost, n=82), 396 subjects completed the study. Efficacy for LBN was dose-dependent reaching a plateau at 0.024%–0.040%. LBN 0.024% led to significantly greater reductions in diurnal IOP compared with latanoprost at the primary endpoint, Day 28 (p=0.005), as well as Days 7 (p=0.033) and 14 (p=0.015). The incidence of adverse events, mostly mild and transient, was numerically higher in the LBN treatment groups compared with the latanoprost group. Hyperaemia was similar across treatments. Conclusions LBN 0.024% dosed once daily was the lower of the two most effective concentrations evaluated, with significantly greater IOP lowering and comparable side effects relative to latanoprost 0.005%. LBN dosed once daily for 28 days was well tolerated. Clinical trial number NCT01223378. PMID:25488946

  17. A randomised, controlled comparison of latanoprostene bunod and latanoprost 0.005% in the treatment of ocular hypertension and open angle glaucoma: the VOYAGER study.

    PubMed

    Weinreb, Robert N; Ong, Tuyen; Scassellati Sforzolini, Baldo; Vittitow, Jason L; Singh, Kuldev; Kaufman, Paul L

    2015-06-01

    To assess the efficacy and safety of latanoprostene bunod (LBN) compared with latanoprost 0.005%, and to determine the optimum drug concentration(s) of LBN in reducing intraocular pressure (IOP) in subjects with open angle glaucoma or ocular hypertension. Randomised, investigator-masked, parallel-group, dose-ranging study. Subjects instilled one drop of study medication in the study eye once daily each evening for 28 days and completed five study visits. The primary efficacy endpoint was the reduction in mean diurnal IOP at Day 28. Of the 413 subjects randomised (LBN 0.006%, n=82; LBN 0.012%, n=85; LBN 0.024%, n=83; LBN 0.040%, n=81; latanoprost, n=82), 396 subjects completed the study. Efficacy for LBN was dose-dependent reaching a plateau at 0.024%-0.040%. LBN 0.024% led to significantly greater reductions in diurnal IOP compared with latanoprost at the primary endpoint, Day 28 (p=0.005), as well as Days 7 (p=0.033) and 14 (p=0.015). The incidence of adverse events, mostly mild and transient, was numerically higher in the LBN treatment groups compared with the latanoprost group. Hyperaemia was similar across treatments. LBN 0.024% dosed once daily was the lower of the two most effective concentrations evaluated, with significantly greater IOP lowering and comparable side effects relative to latanoprost 0.005%. LBN dosed once daily for 28 days was well tolerated. NCT01223378. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. New insights into the genetics of primary open-angle glaucoma based on meta-analyses of intraocular pressure and optic disc characteristics.

    PubMed

    Springelkamp, Henriët; Iglesias, Adriana I; Mishra, Aniket; Höhn, René; Wojciechowski, Robert; Khawaja, Anthony P; Nag, Abhishek; Wang, Ya Xing; Wang, Jie Jin; Cuellar-Partida, Gabriel; Gibson, Jane; Bailey, Jessica N Cooke; Vithana, Eranga N; Gharahkhani, Puya; Boutin, Thibaud; Ramdas, Wishal D; Zeller, Tanja; Luben, Robert N; Yonova-Doing, Ekaterina; Viswanathan, Ananth C; Yazar, Seyhan; Cree, Angela J; Haines, Jonathan L; Koh, Jia Yu; Souzeau, Emmanuelle; Wilson, James F; Amin, Najaf; Müller, Christian; Venturini, Cristina; Kearns, Lisa S; Kang, Jae Hee; Tham, Yih Chung; Zhou, Tiger; van Leeuwen, Elisabeth M; Nickels, Stefan; Sanfilippo, Paul; Liao, Jiemin; van der Linde, Herma; Zhao, Wanting; van Koolwijk, Leonieke M E; Zheng, Li; Rivadeneira, Fernando; Baskaran, Mani; van der Lee, Sven J; Perera, Shamira; de Jong, Paulus T V M; Oostra, Ben A; Uitterlinden, André G; Fan, Qiao; Hofman, Albert; Tai, E-Shyong; Vingerling, Johannes R; Sim, Xueling; Wolfs, Roger C W; Teo, Yik Ying; Lemij, Hans G; Khor, Chiea Chuen; Willemsen, Rob; Lackner, Karl J; Aung, Tin; Jansonius, Nomdo M; Montgomery, Grant; Wild, Philipp S; Young, Terri L; Burdon, Kathryn P; Hysi, Pirro G; Pasquale, Louis R; Wong, Tien Yin; Klaver, Caroline C W; Hewitt, Alex W; Jonas, Jost B; Mitchell, Paul; Lotery, Andrew J; Foster, Paul J; Vitart, Veronique; Pfeiffer, Norbert; Craig, Jamie E; Mackey, David A; Hammond, Christopher J; Wiggs, Janey L; Cheng, Ching-Yu; van Duijn, Cornelia M; MacGregor, Stuart

    2017-01-15

    Primary open-angle glaucoma (POAG), the most common optic neuropathy, is a heritable disease. Siblings of POAG cases have a ten-fold increased risk of developing the disease. Intraocular pressure (IOP) and optic nerve head characteristics are used clinically to predict POAG risk. We conducted a genome-wide association meta-analysis of IOP and optic disc parameters and validated our findings in multiple sets of POAG cases and controls. Using imputation to the 1000 genomes (1000G) reference set, we identified 9 new genomic regions associated with vertical cup-disc ratio (VCDR) and 1 new region associated with IOP. Additionally, we found 5 novel loci for optic nerve cup area and 6 for disc area. Previously it was assumed that genetic variation influenced POAG either through IOP or via changes to the optic nerve head; here we present evidence that some genomic regions affect both IOP and the disc parameters. We characterized the effect of the novel loci through pathway analysis and found that pathways involved are not entirely distinct as assumed so far. Further, we identified a novel association between CDKN1A and POAG. Using a zebrafish model we show that six6b (associated with POAG and optic nerve head variation) alters the expression of cdkn1a. In summary, we have identified several novel genes influencing the major clinical risk predictors of POAG and showed that genetic variation in CDKN1A is important in POAG risk. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. Effects of coenzyme Q10 in conjunction with vitamin E on retinal-evoked and cortical-evoked responses in patients with open-angle glaucoma.

    PubMed

    Parisi, Vincenzo; Centofanti, Marco; Gandolfi, Stefano; Marangoni, Dario; Rossetti, Luca; Tanga, Lucia; Tardini, Mariagrazia; Traina, Salvatore; Ungaro, Nicola; Vetrugno, Michele; Falsini, Benedetto

    2014-08-01

    To evaluate pattern-evoked retinal and cortical responses [pattern electroretinogram (PERG) and visual-evoked potential (VEP), respectively] after treatment with coenzyme Q10 in conjunction with vitamin E in open-angle glaucoma (OAG) patients. Forty-three OAG patients (mean age, 52.5±5.29 y; intraocular pressure <18 mm Hg with β-blocker monoterapy only) were enrolled. At baseline and after 6 and 12 months, simultaneous recordings of PERG and VEPs were obtained from 22 OAG patients who underwent treatment consisting of coenzyme Q10 and vitamin E (Coqun, 2 drops/d) in addition to β-blocker monoterapy (GC group), and from 21 OAG patients who were only treated with β-blockers (GP group). At baseline, intraocular pressure, PERG, and VEP parameters were similar in both GC and GP groups (analysis of variance, P>0.05). After 6 and 12 months, PERG and VEP response parameters of GP patients were unchanged when compared to baseline. In GC patients, PERG P50 and VEP P100 implicit times were decreased, whereas PERG P50-N95 and VEP N75-P100 amplitudes were increased (P<0.01) when compared to baseline. In the GC group, the differences in implicit times and amplitudes with respect to baseline were significantly larger (P<0.01) than those recorded in the GP group. The improvement (12 mo minus baseline) of VEP implicit time was significantly correlated with the changes of PERG P50-N95 amplitude (r=-0.66171, P=0.0008) and P50 implicit time (r=0.68364, P=0.00045) over a period of 12 months. Coenzyme Q10 associated with vitamin E administration in OAG shows a beneficial effect on the inner retinal function (PERG improvement) with consequent enhancement of the visual cortical responses (VEP improvement).

  20. The effects of dorzolamide 2% and dorzolamide/timolol fixed combination on retinal and optic nerve head blood flow in primary open-angle glaucoma patients.

    PubMed

    Rolle, T; Tofani, F; Brogliatti, B; Grignolo, F M

    2008-09-01

    To compare the effect of dorzolamide hydrochloride 2%, timolol maleate 0.5%, and their fixed combination on intraocular pressure (IOP)and retinal and optic nerve head haemodynamics in primary open-angle glaucoma patients. Twenty-eight patients with early moderate glaucomatous damage treated with β-blockers (>6 months) with IOP values ranging from 18 to 22 mmHg at trough participated in this trial. After a 4-week washout period,patients were randomised in two groups: group I started with dorzolamide 2% monotherapy and group II with timolol 0.50% monotherapy for 4 weeks. After this period, both groups switched to dorzolamide/timolol fixed combination for 4 weeks. IOP, ocular diastolic perfusion pressure, heart rate, and Scanning Laser Doppler Flowmetry measurements at the peripapillary retina and neuroretinal rim were taken at T0 (enrolment), T1 (wash out), T2(monotherapy), and T3 (dorzolamide/timolol).Data were compared between different study times. Statistical analysis was conducted using a paired t-test. Between T1 and T3, IOP decreased significantly in group I (-21.40%) (P<0.001)and in group II (-21.25%) (P<0.001). At the same time intervals, blood flow increased significantly at rim level for group I (+30.03%)(P<0.05) and also when all patients were considered (rim +20.81%) (P<0.05). Between T1 and T3, we also observed a significant increase of ODPP in group I (+7.24%) (P<0.01)and in group II (+6.08%) (P<0.05) and when all patients were considered (+6.71%)(P<0.001) [corrected]. Dorzolamide/timolol fixed combination increased blood flow significantly at the neuroretinal rim showing a combination of hypotensive and haemodynamic effects.

  1. Efficacy of Garcinia kola 0.5% Aqueous Eye Drops in Patients with Primary Open-Angle Glaucoma or Ocular Hypertension

    PubMed Central

    Adefule-Ositelu, Adebukunola O.; Adegbehingbe, Bernice O.; Adefule, Adebayo K.; Adegbehingbe, Olayinka O.; Samaila, Elsie; Oladigbolu, Kehinde

    2010-01-01

    Purpose: To evaluate the intraocular pressure (IOP) lowering efficacy of Garcinia kola 0.5% aqueous solution eye drops in patients with newly diagnosed primary open-angle glaucoma or ocular hypertension (POAG/OH). Materials and Methods: A randomized, double-masked, multicenter, active-controlled prospective study. Patients who met the inclusion criteria were randomly assigned in equal numbers to receive Timolol 0.5% eye drops as a control medication (A = Group 1 eyes) or Garcinia kola 0.5% eye drops as the study medication (B = Group 2 eyes). All drops were instilled at 6 am and 6 pm daily. Goldman applanation tonometry was performed at 9 am, 12 pm and 3 pm at baseline, week-6, week-12 and week-24 visits. Voluntary and actively elicited reports of adverse events were documented. The mean change in IOP over 24 weeks was the primary outcome measure. Both groups were compared for statistically significant differences at all visits. A P < 0.05 was considered statistically significant. Results: A total of 178 patients were randomly assigned to G. kola and Timolol groups. At baseline there were no differences in mean IOP between groups, based on age, sex, or diagnosis. At the end of the study period (24th week), the mean (± SD) reduction in IOP was 12.93 ± 2.3 mmHg (47.8% ± 0.8% reduction) in G. Kola group and 13.09 ± 2.8 mm Hg (48.2% ± 1.03% reduction) in the Timolol group (P > 0.05). Adverse events were mild in nature with no statistically significant differences between groups (P > 0.05). Conclusions: Garcinia kola ophthalmic solution significantly reduces IOP as compared to baseline. The IOP lowering effect of both treatments was equivalent. PMID:20543944

  2. Fixed combination of travoprost and timolol maleate reduces intraocular pressure in Japanese patients with primary open-angle glaucoma or ocular hypertension: analysis by prostaglandin analogue

    PubMed Central

    Nakano, Tadashi; Mizoue, Shiro; Fuse, Nobuo; Iwase, Aiko; Matsumoto, Shun; Yoshikawa, Keiji

    2017-01-01

    Background We have shown a decrease in mean intraocular pressure (IOP) by switching to travoprost/timolol fixed combination (TTFC) in subjects receiving prostaglandin analogue (PGA) monotherapy and requiring additional medication in a previous report. For analyzing factors affecting IOP reduction, baseline IOP and preceding PGA were selected as statistically and clinically significant factors. In this report, we examine IOP-lowering effect and adverse drug reactions by preceding PGA. Methods Patients with primary open angle glaucoma or ocular hypertension who received monotherapy with one of four PGAs (travoprost, latanoprost, tafluprost, or bimatoprost) for at least 3 months at 26 institutions and were determined to require additional medication by their primary physician were included. IOP reduction and adverse events were examined at 4, 8, and 12 weeks for each of four PGAs after switching to TTFC. Results In total, 157 patients who could be followed up for at least 4 weeks after switching to TTFC were included in the efficacy analysis. Multiple regression analysis was performed, and baseline IOP and PGA were found to be significant factors to IOP reduction. IOP reduction at week 12, adjusted with the regression model, was −3.5, −1.8, and −1.4 mmHg in the tafluprost, latanoprost, and travoprost groups, whereas it was −0.5 mmHg in the bimatoprost group. Along with differences in baseline IOP between groups, an IOP-lowering effect of >1 mmHg was noted in the tafluprost, latanoprost, and travoprost groups after the switch. IOP was maintained at 13.8–14.8 mmHg throughout the follow-up period. No serious adverse events or noteworthy issues were observed in any group after the switch. Conclusion Clinically significant IOP-reducing effects of TTFC were observed in the latanoprost, travoprost, and tafluprost groups when switching from each PGA monotherapy, while there were some differences in effects between groups, with minimal safety concerns. PMID:28053501

  3. Phacoemulsification versus phacoemulsification with micro-bypass stent implantation in primary open-angle glaucoma: randomized double-masked clinical trial.

    PubMed

    Fea, Antonio M

    2010-03-01

    To compare phacoemulsification alone and phacoemulsification with micro-bypass stent implantation in eyes with primary open-angle glaucoma. Instituto di Fisiopatologia Clinica, Clinica Oculistica, Universita' di Torino, Torino, Italy. In this prospective double-masked randomized clinical trial, patients had phacoemulsification alone (control group) or phacoemulsification with iStent implantation (combined group). Primary outcomes were intraocular pressure (IOP) and reduction in medication use over 15 months and IOP after a 1-month washout of ocular hypotensive agents (ie, 16 months postoperatively). The baseline IOP was similar between groups (combined group: 17.9 mm Hg +/- 2.6 [SD]; control group: 17.3 +/- 3.0 mm Hg) (P = .512). Three patients in the control group were lost to follow-up. The mean IOP was 14.8 +/- 1.2 mm Hg in the combined group and 15.7 +/- 1.1 mm Hg in the control group at 15 months and 16.6 +/- 3.1 mm Hg and 19.2 +/- 3.5 mm Hg, respectively, after washout; the IOP was statistically significantly lower in the combined group than in the control group at both time points (P = .031 and P = .042, respectively). At 15 months, the mean number of medications was lower in the combined group than in the control group (0.4 +/- 0.7 and 1.3 +/- 1.0, respectively; P = .007), as was the proportion of patients on ocular hypotensive medication (33% and 76%, respectively). Phacoemulsification with stent implantation was more effective in controlling IOP than phacoemulsification alone; the safety profiles were similar. Copyright 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  4. Oral Administration of Forskolin, Homotaurine, Carnosine, and Folic Acid in Patients with Primary Open Angle Glaucoma: Changes in Intraocular Pressure, Pattern Electroretinogram Amplitude, and Foveal Sensitivity.

    PubMed

    Mutolo, Maria Giulia; Albanese, Giuseppe; Rusciano, Dario; Pescosolido, Nicola

    2016-04-01

    To evaluate the effects of a food supplement containing forskolin, homotaurine, carnosine, folic acid, vitamins B1, B2, B6, and magnesium in patients with primary open angle glaucoma (POAG) already in treatment and compensated by intraocular pressure (IOP)-lowering drugs, during a period of 12 months. Twenty-two patients (44 eyes) with POAG, with their IOP compensated by topical drugs, were enrolled and randomly assigned to the food supplement or control treatment group. The additional food supplement treatment consisted of 2 tablets per day (1 in the morning, 1 in the evening) given for 1 year of a balanced association of homotaurine, Coleus forskohlii root extract, L-carnosine, folic acid, vitamins B1, B2, B6, and magnesium. Pattern Electroretinogram (PERG) amplitude, foveal sensitivity obtained with the visual field analyzer frequency doubling technology, and IOP were detected at enrollment (T0), 3 months (T1), 6 months (T2), 9 months (T3), and 12 months (T4). We observed in treated patients a significant further decrease of IOP and an improvement of PERG amplitude at 6, 9, and 12 months, and foveal sensitivity at 12 months. All values remained substantially stable in control patients. The results of the present pilot study indicate that the components of the food supplement reach the eye in a detectable manner, as evidenced by the effects on the IOP. Moreover, they suggest a short-term neuroactive effect, as indicated by the improvement of PERG amplitude and foveal sensitivity in treated, but not in control patients.

  5. Predicting Future Self-Reported Motor Vehicle Collisions in Subjects with Primary Open-Angle Glaucoma Using the Penalized Support Vector Machine Method.

    PubMed

    Yuki, Kenya; Asaoka, Ryo; Awano-Tanabe, Sachiko; Ono, Takeshi; Shiba, Daisuke; Murata, Hiroshi; Tsubota, Kazuo

    2017-06-01

    We predict the likelihood of a future motor vehicle collision (MVC) from visual function data, attitudes to driving, and past MVC history using the penalized support vector machine (pSVM) in subjects with primary open-angle glaucoma (POAG). Patients with POAG were screened prospectively for eligibility and 185 were analyzed in this study. Self-reported MVCs of all participants were recorded for 3 years from the baseline using a survey questionnaire every 12 months. A binocular integrated visual field (IVF) was calculated for each patient by merging a patient's monocular Humphrey Field Analyzer (HFA) visual fields (VFs). The IVF was divided into six regions, based on eccentricity and the right or left hemifield, and the average of the total deviation (TD) values in each of these six areas was calculated. Then, the future MVCs were predicted using various variables, including age, sex, 63 variables of 52 TD values, mean of the TD values, visual acuities (VAs), six sector average TDs with (predpenSVM_all) and without (predpenSVM_basic) the attitudes in driving, and also past MVC history, using the pSVM method, applying the leave-one-out cross validation. The relationship between predpenSVM_basic and the future MVC approached significance (odds ratio = 1.15, [0.99-1.29], P = 0.064, logistic regression). A significant relationship was observed between predpenSVM_all and the future MVC (odds ratio = 1.21, P = 0.0015). It was useful to predict future MVCs in patients with POAG using visual function metrics, patients' attitudes to driving, and past MVC history, using the pSVM. Careful consideration is needed when predicting future MVCs in POAG patients using visual function, and without driving attitude and MVC history.

  6. The impact of chronic use of prostaglandin analogues on the biomechanical properties of the cornea in patients with primary open-angle glaucoma

    PubMed Central

    Meda, Roman; Wang, Qianqian; Paoloni, David; Harasymowycz, Paul; Brunette, Isabelle

    2017-01-01

    Aims To determine the influence of prostaglandin analogues (PGAs) on corneal biomechanical properties in patients undergoing chronic treatment for primary open-angle glaucoma (POAG). Methods Prospective, interventional case–control study. 70 eyes from 35 patients with POAG on chronic PGA therapy were recruited. One eye per patient underwent PGA cessation for 6 weeks while the contralateral eye continued to receive the treatment. Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOP) (IOPcc), central corneal thickness (CCT) and Goldmann tonometry (Haag-Streit AG, Koeniz, Switzerland) IOP (IOPGAT) were measured at baseline (visit 1), 6 weeks after PGA cessation (visit 2) and 6 weeks after PGAs reinitiation (visit 3) and were analysed using a linear mixed-effect model. The discrepancy between IOPcc and IOPGAT was defined as IOP bias (IOPcc—IOPGAT). Results Baseline characteristics were comparable between the two groups. In the study eyes, significant increases (p<0.0001) were detected at visit 2 in CH (9.0±1.8 vs 10.3±1.7 mm Hg), CRF (10.5±2.1 vs 11.7±2.1 mm Hg), CCT (541.8±43.2 vs 551.9±41.9 μm) and IOPGAT (15.4±3.0 vs 18.4±3.8 mm Hg). IOP bias in this group was significantly lowered at visit 2 (p<0.0001). These effects were reversed at visit 3. The control eyes did not demonstrate any significant changes over the study period. Conclusion Topical PGAs induce reversible reduction in CH, CRF and CCT in patients with POAG. These changes contribute to underestimation of the IOP measured by Goldmann applanation tonometry and warrant caution when assessing response to treatment. Trial registration number NCT02388360, Results. PMID:27162226

  7. Leu432Val polymorphism in CYP1B1 as a susceptible factor towards predisposition to primary open-angle glaucoma

    PubMed Central

    Banerjee, Deblina; Mookherjee, Suddhasil; Banerjee, Antara; Sen, Abhijit; Variation Consortium, the Indian Genome

    2008-01-01

    Purpose Defects in cytochrome P450 1B1 (CYP1B1) cause primary congenital glaucoma. However, defects in the gene have also been reported in primary open-angle glaucoma (POAG). Since POAG is primarily a complex disease, we examined the potential of coding single nucleotide polymorphisms (cSNPs) in the gene for association with the disease. Methods Five coding SNPs – c.514 C>G (Arg48Gly), c.727 G>T (Ala119Ser), c.1666 C>G (Leu432Val), c.1719 C>T (Asp449Asp), and c.1730 A>G (Asn453Ser) – were genotyped in 264 unrelated POAG patients and 95 controls. In addition, 542 normal individuals selected from various ethnic groups representing the Indian population were also genotyped for these cSNPs. The patterns of linkage disequilibrium between the SNPs and haplotype variations for comparison between POAG patients and controls as well as different ethnic groups of the Indian population were determined using Haploview. Allelic variants of Leu432Val were cloned by site-directed mutagenesis of normal CYP1B1 cDNA, which were used for transfection of retinal pigment epithelium (RPE) cells. The generation of reactive oxygen species (ROS) was quantified by measuring fluorescence emission by degradation of CM-H2DCFDA using a fluoremeter. Results The c.1666G allele of the Leu432Val in CYP1B1 showed a statistically significant higher representation among POAG patients compared to controls (p=0.0001; Odds ratio=6.027; 95% CI: 3.863–9.401) suggesting it to be a potential risk allele toward disease predisposition. Analysis of genotype frequencies of the polymorphism between the two groups demonstrated GG as a potential risk genotype (p=0.0001; Odds ratio=15.505; 95% CI: 5.529–43.474) for the disease. CYP1B1 Val432 was estimated to generate higher ROS in RPE cells compared to its allelic variant (Leu432; p=0.0245 for 15 min and p=0.0197 for 30 min). Comparison of haplotype diversities revealed CGGTA as the risk haplotype for the disease (p=0.0001, by Fisher’s exact test

  8. African Americans and Glaucoma

    MedlinePlus

    ... Latinos at Increased Glaucoma Risk Glaucoma Facts and Stats Glaucoma Risk Increases in Families: Spread the Word ... Anatomy Five Common Glaucoma Tests Glaucoma Facts and Stats Glossary Symptoms of Open-Angle Glaucoma Types of ...

  9. Fixed-dose combination of AR-13324 and latanoprost: a double-masked, 28-day, randomised, controlled study in patients with open-angle glaucoma or ocular hypertension.

    PubMed

    Lewis, Richard A; Levy, Brian; Ramirez, Nancy; Kopczynski, Casey C; Usner, Dale W; Novack, Gary D

    2016-03-01

    To evaluate the ocular hypotensive efficacy of fixed-dose combinations of the Rho kinase inhibitor and norepinephrine transport inhibitor AR-13324 (0.01% and 0.02%) and latanoprost (PG324 Ophthalmic Solution) relative to the active components AR-13324 0.02% and latanoprost 0.005%, used bilaterally at night. This was a double-masked, randomised, parallel comparison study in patients with open-angle glaucoma or ocular hypertension. After washout, patients were randomised to one of four treatment arms and treated for 28 days. The primary efficacy variable was mean diurnal intraocular pressure (IOP) at day 29. We randomised 298 patients, of whom 292 (98%) completed the study. Mean unmedicated diurnal IOPs (study eye) was 25.1, 25.1, 26.0 and 25.4 in the PG324 0.01%, PG324 0.02%, latanoprost and AR-13324 0.02% groups, respectively. On day 29, mean diurnal IOP decreased to 17.3, 16.5, 18.4 and 19.1 mm Hg, respectively. For the primary efficacy variable of mean diurnal IOP at day 29, PG324 0.02% met the criterion for statistical superiority relative to both latanoprost and AR-13324 0.02% (p<0.0001), providing additional IOP lowering of 1.9 and 2.6 mm Hg, respectively. PG324 0.01% also met the criterion for superiority. The most frequently reported adverse event was conjunctival hyperaemia with an incidence of 41% (30/73), 40% (29/73), 14% (10/73) and 40% (31/78) in the PG324 0.01%, PG324 0.02%, latanoprost and AR-13324 0.02% groups, respectively. In this short-term study, the fixed-dose combination of AR-13324 0.02% and latanoprost 0.005% in PG324 Ophthalmic Solution provides clinically and statistically superior ocular hypotensive efficacy relative to its individual active components at the same concentrations. The only safety finding of note was transient asymptomatic conjunctival hyperaemia which was typically of mild severity. NCT02207491. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please

  10. Long-term Safety and Efficacy of Latanoprostene Bunod 0.024% in Japanese Subjects with Open-Angle Glaucoma or Ocular Hypertension: The JUPITER Study.

    PubMed

    Kawase, Kazuhide; Vittitow, Jason L; Weinreb, Robert N; Araie, Makoto

    2016-09-01

    Latanoprostene bunod (LBN) is a novel nitric oxide (NO)-donating prostaglandin F2α analog. We evaluated the long-term safety and intraocular pressure (IOP)-lowering efficacy of LBN ophthalmic solution 0.024% over 1 year in Japanese subjects with open-angle glaucoma (OAG) or ocular hypertension (OHT). This was a single-arm, multicenter, open-label, clinical study. Subjects aged 20 years and older with a diagnosis of OAG or OHT instilled 1 drop of LBN ophthalmic solution 0.024% in the affected eye(s) once daily in the evening for 52 weeks and were evaluated every 4 weeks. Safety assessments included vital signs, comprehensive ophthalmic exams, and treatment-emergent adverse events (AEs). Absolute and percent reductions from baseline in IOP were also determined. Of 130 subjects enrolled, 121 (93.1%) completed the study. Mean age was 62.5 years, and mean (standard deviation) baseline IOP was 19.6 (2.9) and 18.7 (2.6) mmHg in study eyes and treated fellow eyes, respectively. Overall, 76/130 (58.5%) and 78/126 (61.9%) subjects experienced ≥1 AEs in study eyes and treated fellow eyes, respectively. In both study eyes and treated fellow eyes, the most common AEs were conjunctival hyperemia, growth of eyelashes, eye irritation, and eye pain. At 52 weeks, 9% of treated eyes had an increase in iris pigmentation compared with baseline based on iris photographs. No safety concerns emerged based on vital signs or other ocular assessments. Mean reductions from baseline in IOP of 22.0% and 19.5% were achieved by week 4 in study and treated fellow eyes, respectively. These reductions were maintained through week 52 (P < 0.001 vs. baseline at all visits). Once daily LBN ophthalmic solution 0.024% was safe and well-tolerated in Japanese subjects with OAG or OHT when used for up to 1 year. Long-term treatment with LBN ophthalmic solution 0.024% provided significant and sustained IOP reduction. ClinicalTrials.gov identifier, NCT01895972. Bausch & Lomb, Inc. a division of

  11. Prospective unmasked randomized evaluation of the iStent inject® versus two ocular hypotensive agents in patients with primary open-angle glaucoma

    PubMed Central

    Fea, Antonio M; Belda, Jose I; Rękas, Marek; Jünemann, Anselm; Chang, Lydia; Pablo, Luis; Voskanyan, Lilit; Katz, L Jay

    2014-01-01

    Purpose The purpose of this study was to compare outcomes of subjects with open-angle glaucoma (OAG) not controlled on one medication who underwent either implantation of two iStent inject® trabecular micro-bypass devices or received medical therapy consisting of a fixed combination of latanoprost/timolol. Patients and methods Of 192 subjects who qualified for the study and were enrolled, 94 were randomized to surgery with implantation of two iStent inject® devices in the treated eye and 98 to receive medical therapy. Results At the month 12 visit, 94.7% of eyes (89/94) in the stent group reported an unmedicated intraocular pressure (IOP) reduction of ≥20% versus baseline unmedicated IOP, and 91.8% of eyes (88/98) in the medical therapy group reported an IOP reduction ≥20% versus baseline unmedicated IOP. A 17.5% between-group treatment difference in favor of the iStent inject group was statistically significant (P=0.02) at the ≥50% level of IOP reduction. An IOP ≤18 mmHg was reported in 92.6% of eyes (87/94) in the iStent inject group and 89.8% of eyes (88/98) in the medical therapy group. Mean (standard deviation) IOP decreases from screening of 8.1 (2.6) mmHg and 7.3 (2.2) mmHg were reported in the iStent inject and medical therapy groups, respectively. A high safety profile was also noted in this study in both the iStent inject and medical therapy groups, as measured by stable best corrected visual acuity, cup-to-disc ratio, and adverse events. Conclusion These data show that the use of iStent inject is at least as effective as two medications, with the clinical benefit of reducing medication burden and assuring continuous treatment with full compliance to implant therapy as well as having a highly favorable safety profile. PMID:24855336

  12. Prospective, randomized study of one, two, or three trabecular bypass stents in open-angle glaucoma subjects on topical hypotensive medication

    PubMed Central

    Katz, L Jay; Erb, Carl; Carceller, Guillamet Amadeu; Fea, Antonio M; Voskanyan, Lilit; Wells, Jeffrey M; Giamporcaro, Jane Ellen

    2015-01-01

    Purpose To assess the safety and efficacy of one, two, or three trabecular microbypass stents in eyes with primary open-angle glaucoma (OAG) not controlled on ocular hypotensive medication. A total of 119 subjects were followed for 18 months postoperatively. Materials and methods Subjects with medicated intraocular pressure (IOP) 18–30 mmHg and postmedication-washout baseline IOP 22–38 mmHg were randomized to implantation of one, two, or three stents. Ocular hypotensive medication was to be used if postoperative IOP exceeded 18 mmHg. Results A total of 38 subjects were implanted with one stent, 41 subjects with two stents, and 40 subjects with three stents. Both month 12 IOP reduction ≥20% without ocular hypotensive medication vs baseline unmedicated IOP and month 12 unmedicated IOP ≤18 mmHg were achieved by 89.2%, 90.2%, and 92.1% of one-, two-, and three-stent eyes, respectively. Furthermore, 64.9%, 85.4%, and 92.1% of the three respective groups achieved unmedicated IOP ≤15 mmHg. Over the 18-month follow-up period, medication was required in seven one-stent subjects, four two-stent subjects, and three three-stent subjects. At 18 months, mean unmedicated IOP was 15.9±0.9 mmHg in one-stent subjects, 14.1±1.0 mmHg in two-stent subjects, and 12.2±1.1 mmHg in three-stent subjects. Month 18 IOP reduction was significantly greater (P<0.001) with implantation of each additional stent, with mean differences in reduction of 1.84 mmHg (95% confidence interval 0.96–2.73) for three-stent vs two-stent groups and 1.73 mmHg (95% confidence interval 0.83–2.64) for two-stent vs one-stent groups. Adverse events through 18 months were limited to cataract progression with best-corrected visual acuity loss and subsequent cataract surgery. Conclusion In this series, implantation of each additional stent resulted in significantly greater IOP reduction with reduced medication use. Titratability of stents as a sole procedure was shown to be effective and safe, with

  13. Cost-comparison of two trabecular micro-bypass stents versus selective laser trabeculoplasty or medications only for intraocular pressure control for patients with open-angle glaucoma.

    PubMed

    Berdahl, John P; Khatana, Anup K; Katz, L Jay; Herndon, Leon; Layton, Andrew J; Yu, Tiffany M; Bauer, Matthew J; Cantor, Louis B

    2017-07-01

    Patients with open-angle glaucoma (OAG) whose intraocular pressure is not adequately controlled by one medication have several treatment options in the US. This analysis evaluated direct costs of unilateral eye treatment with two trabecular micro-bypass stents (two iStents) compared to selective laser trabeculoplasty (SLT) or medications only. A population-based, annual state-transition, probabilistic, cost-of-care model was used to assess OAG-related costs over 5 years. Patients were modeled to initiate treatment in year zero with two iStents, SLT, or medications only. In years 1-5, patients could remain on initial treatment or move to another treatment option(s), or filtration surgery. Treatment strategy change probabilities were identified by a clinician panel. Direct costs were included for drugs, procedures, and complications. The projected average cumulative cost at 5 years was lower in the two-stent treatment arm ($4,420) compared to the SLT arm ($4,730) or medications-only arm ($6,217). Initial year-zero costs were higher with two iStents ($2,810) than with SLT ($842) or medications only ($996). Average marginal annual costs in years 1-5 were $322 for two iStents, $777 for SLT, and $1,044 for medications only. The cumulative cost differences between two iStents vs SLT or medications only decreased over time, with breakeven by 5 or 3 years post-initiation, respectively. By year 5, cumulative savings with two iStents over SLT or medications only was $309 or $1,797, respectively. This analysis relies on clinical expert panel opinion and would benefit from real-world evidence on use of multiple procedures and treatment switching after two-stent treatment, SLT, or polypharmaceutical initial approaches. Despite higher costs in year zero, annual costs thereafter were lowest in the two-stent treatment arm. Two-stent treatment may reduce OAG-related health resource use, leading to direct savings, especially over medications only or at longer time horizons.

  14. Safety and efficacy of fixed-combination travoprost/timolol in patients with open-angle glaucoma or ocular hypertension not controlled with timolol monotherapy

    PubMed Central

    Jordão, Marcelo Lopes da Silva; Hatanaka, Marcelo; Ogundele, Abayomi; de Moraes Silva, Maria Rosa Bet; Vessani, Roberto Murad

    2014-01-01

    Objective To assess the intraocular pressure (IOP)-lowering effect of travoprost 0.004%/timolol 0.5% fixed-dose combination (TRAV/TIM–FC) in patients not achieving the target IOP of ≤18 mmHg while on timolol 0.5% (TIM) monotherapy. Methods A multicenter, prospective, open-label study (NCT01336569) was conducted in patients with open-angle glaucoma or ocular hypertension. Eligible patients were receiving TIM monotherapy with a screening/baseline IOP of 19–35 mmHg in ≥1 eye. TIM was discontinued on the baseline visit day (no washout period) and TRAV/TIM–FC was initiated and administered once daily at 8 pm for 4–6 weeks. The primary efficacy variable was mean change in IOP from TIM-treated baseline to study end, measured by Goldmann applanation tonometry. Results were analyzed by analysis of variance and paired samples t-test (5% significance). Results A total of 49 patients were enrolled (mean age, 63 [range, 42–82] years; 55.1% White; 73.5% women), and 45 were included in the intent-to-treat (ITT) population. Mean duration of treatment with TRAV/TIM–FC was 31 days. Mean ± standard deviation IOP reduction from baseline (TIM) to the follow-up visit (TRAV/TIM–FC) was −5.0±3.6 mmHg. IOP decreased significantly (P<0.0001) from baseline (22.1±2.6 mmHg) to study end (17.1±3.9 mmHg) in the ITT population, with a mean IOP reduction of 22.3%. Most patients (n=33/45; 73.3%) achieved IOP ≤18 mmHg. Two patients experienced a total of four adverse events (AEs), including a patient who reported one serious AE (enterorrhagia) that was considered unrelated to treatment, and a patient who reported one event each of drug-related redness, pruritus, and foreign body sensation. Most patients (n=47/49; 95.9%) reported no AEs. Conclusions TRAV/TIM–FC lowered IOP in patients who were not at target IOP while receiving TIM monotherapy, with most patients achieving an IOP ≤18 mmHg with TRAV/TIM–FC. TRAV/TIM–FC was well tolerated in this population. PMID

  15. Safety and efficacy of fixed-combination travoprost/timolol in patients with open-angle glaucoma or ocular hypertension not controlled with timolol monotherapy.

    PubMed

    Jordão, Marcelo Lopes da Silva; Hatanaka, Marcelo; Ogundele, Abayomi; de Moraes Silva, Maria Rosa Bet; Vessani, Roberto Murad

    2014-01-01

    To assess the intraocular pressure (IOP)-lowering effect of travoprost 0.004%/timolol 0.5% fixed-dose combination (TRAV/TIM-FC) in patients not achieving the target IOP of ≤18 mmHg while on timolol 0.5% (TIM) monotherapy. A multicenter, prospective, open-label study (NCT01336569) was conducted in patients with open-angle glaucoma or ocular hypertension. Eligible patients were receiving TIM monotherapy with a screening/baseline IOP of 19-35 mmHg in ≥1 eye. TIM was discontinued on the baseline visit day (no washout period) and TRAV/TIM-FC was initiated and administered once daily at 8 pm for 4-6 weeks. The primary efficacy variable was mean change in IOP from TIM-treated baseline to study end, measured by Goldmann applanation tonometry. Results were analyzed by analysis of variance and paired samples t-test (5% significance). A total of 49 patients were enrolled (mean age, 63 [range, 42-82] years; 55.1% White; 73.5% women), and 45 were included in the intent-to-treat (ITT) population. Mean duration of treatment with TRAV/TIM-FC was 31 days. Mean ± standard deviation IOP reduction from baseline (TIM) to the follow-up visit (TRAV/TIM-FC) was -5.0±3.6 mmHg. IOP decreased significantly (P<0.0001) from baseline (22.1±2.6 mmHg) to study end (17.1±3.9 mmHg) in the ITT population, with a mean IOP reduction of 22.3%. Most patients (n=33/45; 73.3%) achieved IOP ≤18 mmHg. Two patients experienced a total of four adverse events (AEs), including a patient who reported one serious AE (enterorrhagia) that was considered unrelated to treatment, and a patient who reported one event each of drug-related redness, pruritus, and foreign body sensation. Most patients (n=47/49; 95.9%) reported no AEs. TRAV/TIM-FC lowered IOP in patients who were not at target IOP while receiving TIM monotherapy, with most patients achieving an IOP ≤18 mmHg with TRAV/TIM-FC. TRAV/TIM-FC was well tolerated in this population.

  16. A 7 year prospective comparative study of three topical β blockers in the management of primary open angle glaucoma

    PubMed Central

    Watson, P; Barnett, M; Parker, V; Haybittle, J

    2001-01-01

    AIM—To determine the long term efficacy of monotherapy with topically applied β blocking agents and to determine whether selective β blockers were able to preserve the visual field more effectively than non-selective agents.
METHOD—A prospective randomised, open, comparative study of three topically applied β blockers—timolol, betaxolol, and carteolol—was carried out on 153 patients (280 eyes) with newly diagnosed open angle glaucoma. Those patients who were not withdrawn were followed by the same observers for a minimum of 2 years and a maximum of 7 years, with clinical observations, Goldmann tonometry and 24.2 Humphrey visual field analysis.
RESULTS—All three drugs lowered the IOP significantly from untreated levels but betaxolol took up to 12 months in some instances to reach the maximum pressure reduction. After 7 years only 43% of the eyes begun on timolol, 34% of those started on carteolol, and 29% of those on betaxolol were still being treated with these medications alone. Visual fields were analysed throughout the trial by CPSD and MD and at the end by linear regression analysis (PROGRESSOR). The visual fields remained the same without apparent improvement or deterioration throughout the period of follow up. Eight patients (11 eyes) were withdrawn because of continuing field loss in spite of reduction in IOP (six using carteolol and five using betaxolol).
CONCLUSIONS—Analysis shows that less than half the eyes initially treated with topical β blockers might be expected to still be being treated with their original medication after 5 years. The rest required either additional medication or trabeculectomy. There was no statistically significant improvement or deterioration in the visual fields over a 7 year period. On the evidence of this trial there are no particular advantages in using selective β blockers.

 PMID:11466256

  17. Retinal nerve fiber layer in primary open-angle glaucoma with high myopia determined by optical coherence tomography and scanning laser polarimetry.

    PubMed

    Wang, Xiao-en; Wang, Xiao-yu; Gu, Yang-shun; Huang, Zhu

    2013-01-01

    Fundus changes associated with high myopia (HM) may mask those associated with primary open-angle glaucoma (POAG). This study aim to determine the characteristics of RNFL thickness changes in patients with both POAG and HM and compare these to changes in patients with only HM. The diagnostic capabilities of both OCT and GDxVCC in this subset of patients are also evaluated. Twenty-two eyes with POAG and HM (spherical equivalent (SE) between -6.0 and -12.0 D) were evaluated, and 22 eyes with HM were used for comparison. Characteristic retinal nerve fiber layer (RNFL) thickness profiles in patients with POAG and HM were examined using optical coherence tomography (OCT) and scanning laser polarimetry with variable corneal compensation (GDxVCC), and the diagnostic capabilities of these imaging modalities were compared. RNFL parameters evaluated included superior average (Savg-GDx), inferior average (Iavg-GDx), temporal-superior-nasal- inferior-temporal (TSNIT) average, and nerve fiber indicator (NFI) on GDxVCC and superior average (Savg-OCT), inferior average (Iavg-OCT), nasal average (Navg-OCT), temporal average (Tavg-OCT), and average thickness (AvgThick-OCT) on OCT (fast RNFL scan). Visual field testing was performed and defects were evaluated using mean defect (MD) and pattern standard deviation (PSD). The RNFL parameters (P < 0.05) significantly different between groups included Savg-GDx, Iavg-GDx, TSNIT average, NFI, Savg-OCT, Iavg-OCT, Tavg-OCT, and AvgThick-OCT. Significant correlations existed between TSNIT average and AvgThick-OCT (r = 0.778), TSNIT average and MD (r = 0.749), AvgThick-OCT and MD (r = 0.647), TSNIT average and PSD (r = -0.756), and AvgThick-OCT and PSD (r = -0.784). The area under the receiver operating characteristic curve (AUROC) values of TSNIT average, Savg-GDx, Iavg-GDx, NFI, Savg-OCT, Iavg-OCT, Navg-OCT, Tavg-OCT, and AvgThick-OCT were 0.947, 0.962, 0.973, 0.994, 0.909, 0.917, 0.511, 0.906, and 0.913, respectively. The NFI AUROC was the

  18. Efficacy of two trabecular micro-bypass stents combined with topical travoprost in open-angle glaucoma not controlled on two preoperative medications: 3-year follow-up

    PubMed Central

    Chang, David F; Donnenfeld, Eric D; Katz, L Jay; Voskanyan, Lilit; Ahmed, Iqbal Ike K; Samuelson, Thomas W; Giamporcaro, Jane Ellen; Hornbeak, Dana M; Solomon, Kerry D

    2017-01-01

    Purpose To evaluate the long-term intraocular pressure (IOP)-lowering effect and safety parameters following treatment with two trabecular micro-bypass stents and topical prostaglandin in phakic eyes with open-angle glaucoma (OAG) not controlled on two preoperative medications. Methods This prospective, single-arm, unmasked study enrolled 39 qualified phakic eyes with OAG not controlled on 2 medications, preoperative medicated IOP of 18–30 mmHg, and IOP following medication washout of 22–38 mmHg. Two trabecular micro-bypass stents were implanted as a standalone procedure, and travoprost was started on postoperative day 1. Evaluations included IOP, best-corrected visual acuity, medication use, fundus and slit-lamp examinations, visual field, cup:disc ratio, central corneal thickness, and ocular complications. Data through 18 months were summarized previously. Thirty-seven of the original 39 subjects have been followed for 3 years postoperatively; follow-up is continuing for 5 years. Results At 3 years postoperative, 97% of eyes had achieved an IOP reduction of ≥20% from baseline with a reduction of 1 medication. Eighty-six percent of eyes had IOP of ≤18 mmHg with a reduction of 1 medication. Mean medicated IOP decreased to 14.0±2.6 mmHg on 1 medication versus 22.4±2.3 mmHg on 2 medications preoperatively. The mean unmedicated IOP decreased to 17.7±1.7 mmHg at 37 months from 25.3±1.9 mmHg preoperatively. Long-term postoperative adverse events included cataract surgery in 3 eyes due to cataract progression, and trabeculectomy in 1 eye due to uncontrolled IOP of 23 mmHg. No intraoperative or device-related adverse events occurred. Conclusion Significant and sustained reduction in IOP and medications with a favorable safety profile was shown through 3 years after implantation of 2 trabecular micro-bypass stents combined with postoperative travoprost in phakic OAG eyes uncontrolled on 2 preoperative medications. These findings demonstrate the long

  19. Color Doppler imaging study in patients with primary open-angle glaucoma treated with timolol 0.5% and carteolol 2%.

    PubMed

    Montanari, P; Marangoni, P; Oldani, A; Ratiglia, R; Raiteri, M; Berardinelli, L

    2001-01-01

    To evaluate with color Doppler imaging (CDI), in patients with primary open-angle glaucoma (PDAG), the possible influence on ocular hemodynamics of a beta-blocking agent with intrinsic sympathomimetic acitivity (carteolol 2%) compared to a beta-blocker agent without this activity. A study was carried out on 20 patients, with bilateral POaG, intraocular pressure (IOP) < or = 20 mmHg, all treated twice a day with timolol maleate 0.5% ophthalmic solution. The visual field was evaluated (Octopus 2000 perimeter, G1 program) examining the mean sensitivity (MS) and the mean defect (MD). CDI was carried out to evaluate the resistance index of the internal carotid artery (ICA), the ophthalmic artery (OA), the central retinal artery (CRA), and the short posterior ciliary arteries (SPCA). After these examinations, the therapy was changed to carteolol 2% twice a day. After six months of treatment the examinations were repeated. The data were analysed statistically using Student's t test. The mean intraocular pressure during treatment with timolol 0.5% was 16.7 +/- 1.67 mmHg and 16.33 +/- 1.72 mmHg after treatment with carteolol 2%, the difference not being significant (p=0.494). After six months of treatment with carteolol 2% the MS increased significantly from 22.4 +/- 2.5 dB to 24.1 +/- 1.8 dB (p=0.018), and the mean defect (MD) fell from 5.3 +/- 0.8 dB to 4.7 +/- 0.6 dB (p=0.011). There was no significant difference in the resistance index of the CA, the OA and the CRA with the two treatments, whereas the resistance index of the SPCA dropped significantly, from 0.80 +/- 0.05 to 0.77 +/- 0.02 (p = 0.017). CDI did not show significant differences in the resistance indexes of the internal CA, the OA, and the CRA after treatment with carteolol 2% but the resistance index of the SPCA was significantly reduced. Carteolol 2% induced significant changes in the perimetric indexes examined, with an increase in MS and a decrease in MD. These findings suggest that the intrinsic

  20. Association of Myopic Optic Disc Deformation with Visual Field Defects in Paired Eyes with Open-Angle Glaucoma: A Cross-Sectional Study

    PubMed Central

    Sawada, Yu; Hangai, Masanori; Ishikawa, Makoto; Yoshitomi, Takeshi

    2016-01-01

    Purpose To examine the association of myopia with the visual field (VF) defects in open-angle glaucoma (OAG) using paired eyes to eliminate the effect of unknown confounding factors that are diverse among individuals. Methods One hundred eighteen eyes of 59 subjects with myopia (spherical equivalent [SE] ≥ -2 diopter [D] and axial length ≥ 24.0 mm) whose intra-ocular pressure between paired eyes was similar and the mean deviation (MD) of the Humphrey VF test differed by more than 6 dB were included. Refractive errors (SE, axial length) and parameters associated with the papillary and parapapillary myopic deformation (tilt ratio, torsion angle, and β-zone parapapillary atrophy [PPA] area without Bruch’s membrane) were measured in each eye. The paired eyes were divided into worse and better eyes according to the MD of the VF, and parameters were compared between them. Further, multiple linear regression analysis was performed to examine the correlation of the difference in various parameters with the MD difference between paired eyes. Results The SE of all eyes was -6.39 ± 2.15 D (mean ± standard deviation) and axial length was 26.42 ± 1.07 mm. MD of the worse and better VF eyes were -13.56 ± 6.65 dB and -4.87 ± 5.32 dB, respectively. Eyes with worse VFs had significantly greater SE, axial length, tilt ratio, and PPA area without Bruch’s membrane than those with better VFs (all P < 0.05). In multiple linear regression analysis, the difference of the MD between paired eyes was significantly correlated with the difference in the tilt ratio and PPA area without Bruch’s membrane. Conclusion The myopic papillary and parapapillary deformations, but not refractive error itself, were related to the worse VF in paired eyes with OAG. This suggests that myopia influences the severity of the glaucomatous VF defects via structural deformation. PMID:27571303

  1. Transient Ciliochoroidal Detachment After Ab Interno Trabeculotomy for Open-Angle Glaucoma: A Prospective Anterior-Segment Optical Coherence Tomography Study.

    PubMed

    Akagi, Tadamichi; Nakano, Eri; Nakanishi, Hideo; Uji, Akihito; Yoshimura, Nagahisa

    2016-03-01

    Although trabeculotomy is a glaucoma surgical procedure for modest intraocular pressure (IOP) reduction, some eyes exhibit very low IOP during the early postoperative period. To our knowledge, the reason and its effect have not been investigated. To investigate ciliochoroidal detachment (CCD) immediately after ab interno trabeculotomy and evaluate its effect on IOP immediately after surgery. This prospective, observational, case series was conducted at Kyoto University Hospital, Kyoto, Japan. Patients with open-angle glaucoma who underwent ab interno trabeculotomy using a microsurgical device by a single surgeon between July 1, 2014, and May 31, 2015, were included. Thirty-seven consecutive patients were enrolled, 33 of whom were included in the analysis. The dates of the analysis were August 1 to August 15, 2015. Imaging of CCD using anterior-segment optical coherence tomography (AS-OCT). The incidence of CCD immediately after ab interno trabeculotomy and its effect on IOP in the early postoperative period. The study cohort comprised 33 patients. Their mean (SD) age was 69.4 (13.2) years, and 19 (58%) were male. At postoperative day 3, CCD was detected in 14 of 33 eyes (42%) (CCD group) using AS-OCT. The CCD group had shorter axial length (mean [SD], 23.66 [1.67] vs 25.16 [1.59] mm) and thinner central corneal thickness (mean [SD], 505.9 [35.8] vs 533.9 [39.1] μm) than the non-CCD group. Only 5 eyes had CCD at postoperative day 10, and 4 of these eyes had CCD at 1 month after surgery. The postoperative IOPs at all follow-up periods were lower in the CCD group than in the non-CCD group, but the difference in the postoperative IOPs between the groups decreased as time passed. The mean (SD) IOPs for the CCD group vs the non-CCD group were 9.1 (3.0) vs 14.2 (5.8) mm Hg at day 1, 8.4 (2.4) vs 13.4 (5.0) mm Hg at day 3, 11.0 (3.0) vs 15.5 (6.3) mm Hg at day 10, 13.4 (2.4) vs 15.5 (3.3) mm Hg at 1 month, and 13.9 (3.4) vs 15.5 (4.0) mm Hg at 3 months. In several eyes in

  2. Implantation of two second-generation trabecular micro-bypass stents and topical travoprost in open-angle glaucoma not controlled on two preoperative medications: 18-month follow-up.

    PubMed

    Berdahl, John; Voskanyan, Lilit; Myers, Jonathan S; Hornbeak, Dana M; Giamporcaro, Jane Ellen; Katz, L Jay; Samuelson, Thomas W

    2017-04-06

    Additional data are sought regarding treatment options for glaucoma, a major cause of global blindness. The study assessed outcomes following standalone implantation of two second-generation trabecular micro-bypass stents and postoperative topical prostaglandin in eyes with open-angle glaucoma not controlled on two preoperative medications. The study design is a prospective, nonrandomized, open-label study at a tertiary-care ophthalmology centre. Subjects had open-angle glaucoma with preoperative intraocular pressure of 18-30 mmHg on two medications, a medication washout phase, and post-washout intraocular pressure of 22-38 mmHg. All subjects (N = 53) have been followed for 18 months. One day following implantation of two second-generation trabecular micro-bypass stents, subjects started topical travoprost. Medication washout was repeated at month 12. The main outcome measure was the proportion of eyes with intraocular pressure reduction ≥ 20% versus medicated baseline intraocular pressure with reduction of one medication at 12 months. At 12 months, 91% of eyes achieved intraocular pressure reduction ≥ 20% with reduction of one medication. All eyes had intraocular pressure ≤ 18 mmHg with reduction of one medication, and 87% had intraocular pressure ≤ 15 mmHg. Mean intraocular pressure on one medication was ≤ 13.0 mmHg (≥ 34% reduction) through 18 months. Mean post-washout intraocular pressure at month 13 was 33% lower than preoperative unmedicated intraocular pressure. No adverse events occurred through 18 months. In open-angle glaucoma eyes on two preoperative medications, treatment with two second-generation trabecular stents and one postoperative prostaglandin resulted in mean intraocular pressure ≤ 13 mmHg with reduction of one medication, with favourable safety. These findings show the utility of second-generation trabecular bypass with postoperative prostaglandin in patients with open-angle glaucoma. © 2017 The Authors

  3. Glaukos iStent inject® Trabecular Micro-Bypass Implantation Associated with Cataract Surgery in Patients with Coexisting Cataract and Open-Angle Glaucoma or Ocular Hypertension: A Long-Term Study

    PubMed Central

    Martinez-de-la-Casa, Jose Maria; Diaz-Valle, David; Morales-Fernandez, Laura; Fernandez-Perez, Cristina; Garcia-Feijoo, Julian

    2016-01-01

    Purpose. To evaluate the long-term efficacy and safety of the iStent inject device (Glaukos Corporation, Laguna Hills, CA) combined with phacoemulsification in patients with coexistent cataract and open-angle glaucoma or ocular hypertension (OHT). Methods. A prospective, uncontrolled, nonrandomized, interventional case series study was conducted in patients with both mild or moderate open-angle glaucoma or OHT and cataract. Patients underwent cataract surgery along with the implant of two iStent inject devices. Outcome measures were intraocular pressure (IOP), topical hypotensive medications required, and best-corrected visual acuity (BCVA). Results. 20 patients were enrolled. Mean follow-up was 47.4 ± 18.46 months. Mean baseline IOP was 19.95 ± 3.71 mmHg with medication and 26 ± 3.11 mmHg after washout. Mean end-follow-up IOP was 16.25 ± 1.99 mmHg, representing an IOP decrease of 36.92%, 9.74 ± 3.14 mmHg (P < 0.001), from baseline washout IOP. The mean number of medications was significantly reduced from 1.3 ± 0.66 to 0.75 ± 0.79 (P = 0.017). 45% of patients were medication-free by the end of follow-up. Mean log⁡MAR BCVA improved significantly from 0.42 ± 0.16 to 0.18 ± 0.16 (P < 0.001). No complications of surgery were observed. Conclusion. The iStent inject device combined with cataract surgery served to significantly reduce both IOP and medication use in the long term in patients with coexistent open-angle glaucoma or ocular hypertension (OHT) and cataract. PMID:27882243

  4. Comparison of timolol 0.5% + brimonidine 0.2% + dorzolamide 2% versus timolol 0.5% + brimonidine 0.2% in a Mexican population with primary open-angle glaucoma or ocular hypertension

    PubMed Central

    Baiza-Durán, Leopoldo Martín; Llamas-Moreno, Juan Francisco; Ayala-Barajas, Clotilde

    2012-01-01

    Background The purpose of this study was to evaluate the efficacy and safety of two fixed combinations, ie, timolol 0.5% + brimonidine 0.2% + dorzolamide 2% (TBD) versus timolol 0.5% + brimonidine 0.2% (TB) in patients with primary open-angle glaucoma or ocular hypertension. Methods We performed a 3-month, randomized, double-blind study in patients with primary open-angle glaucoma or ocular hypertension and an intraocular pressure of 21–30 mmHg. Patients were randomly assigned to receive one drop of TBD or TB twice a day. The primary efficacy endpoint was change in intraocular pressure after 3 months of treatment. Safety measures were assessed by the presence of adverse events. Results Mean baseline intraocular pressure was similar at 8 am and 4 pm in the treatment groups (TBD 22.3 ± 0.9 mmHg, TB 22.4 ± 1.8 mmHg, P = 0.558; TBD 19.02 ± 1.3, TB 19.08 ± 1.2, P = 0.536, respectively). At the end of the study, the mean intraocular pressure was significantly lower in the TBD group at both 8 am (16.19 ± 2.0 mmHg versus 18.35 ± 1.4 mmHg, P = 0.000) and 4 pm (14.74 ± 2.4 mmHg versus 16.77 ± 1.4 mmHg, P = 0.000). Conclusion Fixed-combination TBD was more effective than fixed-combination TB for reducing IOP in patients with primary open-angle glaucoma. PMID:22848147

  5. Association of dietary nitrate intake with primary open-angle glaucoma: a prospective analysis from the Nurses' Health Study and Health Professionals Follow-up Study

    PubMed Central

    Kang, Jae H.; Willett, Walter C.; Rosner, Bernard; Buys, Emmanuel; Wiggs, Janey L.; Pasquale, Louis R.

    2016-01-01

    Importance Nitric oxide (NO) signaling alterations in outflow facility and retinal blood flow autoregulation are implicated in primary open-angle glaucoma (POAG). NO donation has emerged as a POAG therapeutic target. An exogenous source of NO is dietary nitrates. Objective We evaluated the association between dietary nitrate intake, derived mainly from green leafy vegetables, and POAG. Design, Setting, Participants We followed biennially participants of the prospective cohorts, Nurses' Health Study (63,893 women; 1984-2012) and Health Professionals Follow-up Study (41,094 men; 1986-2012); at each 2-year risk period, eligible participants were 40+ years old, free of POAG, and reported eye examinations. Exposure Dietary nitrate intake. Information on diet and potential confounders were updated with validated questionnaires. Main outcome measure Incidence of POAG and POAG subtypes; 1,483 cases were confirmed with medical records and classified into subtypes defined by intraocular pressure (IOP) (≥ or < 22 mm Hg) or by visual field (VF) loss pattern at diagnosis (peripheral loss only or early paracentral loss). Cohort-specific and pooled multivariable rate ratios (MVRR) and 95% confidence intervals (CIs) were estimated. Results Compared with the lowest quintile of dietary nitrate intake (Q1;∼80 mg/day), the pooled MVRR for the highest quintile (Q5;∼240 mg/day) was 0.79 (95%CI, 0.66,0.93; p for trend [p-trend]=0.02). The dose-response was stronger (p for heterogeneity [p-het]=0.01) for POAG with early paracentral VF loss (433 cases; Q5 vs. Q1 MVRR=0.56; 95%CI, 0.40,0.79; p-trend=0.0003) than for POAG with peripheral VF loss only (835 cases; Q5 vs. Q1 MVRR=0.85; 95%CI, 0.68,1.06; p-trend=0.50). The association did not differ (p-het=0.75) by POAG subtypes defined by IOP (997 cases with IOP≥22 mm Hg: Q5 vs. Q1 MVRR=0.82; 95%CI, 0.67,1.01; p-trend=0.11 vs. 486 cases with IOP<22 mm Hg: Q5 vs. Q1 MVRR=0.71; 95%CI, 0.53,0.96; p-trend=0.12). Green leafy vegetables

  6. The one-month effects of topical betaxolol, dorzolamide and apraclonidine on ocular blood flow velocities in patients with newly diagnosed primary open-angle glaucoma.

    PubMed

    Avunduk, A M; Sari, A; Akyol, N; Oztürk, O; Kapicioglu, Z; Erdöl, H; Imamoglu, H I

    2001-01-01

    This double-masked, prospective and randomized clinical trial was planned to investigate with color Doppler imaging the 1-month vascular effects of betaxolol, dorzolamide and apraclonidine treatment on patients with newly diagnosed primary open-angle glaucoma (POAG). 22 consecutive patients with newly diagnosed POAG between the ages of 46 and 72 years were enrolled in this study. All patients were newly diagnosed cases and had not received any antiglaucoma medication before. Patients who had a systemic vascular disease (including systemic hypertension) or were taking beta-blockers, nitrates or calcium channel blockers were excluded from the study. The patients were randomly divided into three groups. Groups A and B contained 7 patients, group C contained 8 patients. Group A patients were treated with topical betaxolol, group B patients received topical dorzolamide eye drops, and group C patients were treated with topical apraclonidine eye drops. Peak systolic velocities (PSV), end-diastolic velocities (EDV) and resistive indices (RI) in the right ophthalmic arteries (OA), central retinal arteries (CRA) and posterior ciliary arteries (PCA) were measured at baseline by using color Doppler imaging on a masked basis. On days 15 and 30 of treatment, the same measurements were repeated. The inter- and intragroup results were compared statistically. Compared to pretreatment measurements, topical betaxolol therapy significantly decreased PSV only in the PCA and only on day 30 of treatment (p = 0.011). On days 15 and 30, dorzolamide decreased RI measurements in the PCA compared to pretreatment measurement (p = 0.013 and p = 0.011, respectively). Apraclonidine also decreased PSV in the OA on days 15 and 30 of treatment when compared to pretreatment values (p = 0.013 and p = 0.012, respectively). When 15-day measurements were compared between the groups, PSV in the OA were significantly higher in dorzolamide-treated patients compared to other groups (p = 0.01 and p = 0

  7. A double-masked randomized comparison of the efficacy and safety of unoprostone with timolol and betaxolol in patients with primary open-angle glaucoma including pseudoexfoliation gla