OBJECTIVE\nTo determine if central corneal thickness (CCT) is related to the level of glaucoma severity at the initial examination.\n\n\nMETHODS\nThe initial visit to a glaucoma specialist by consecutive patients with primary open-angle glaucoma from 1997 to 2002 was reviewed retrospectively. Each patient's age, sex, race, family history of glaucoma, number of glaucoma medications, visual acuity, spherical equivalent, intraocular pressure, CCT, visual field data, and vertical and horizontal cup-disc ratios were analyzed.\n\n\nRESULTS\nThree hundred fifty eyes of 190 patients met the inclusion and exclusion criteria. Central corneal thickness was significantly lower in blacks (mean, 537 microm) than in whites (mean, 556 microm). Lower CCT was significantly associated with worsened Advanced Glaucoma Intervention Study score, worsened mean deviation of visual field, increased vertical and horizontal cup-disc ratios, and increased number of glaucoma medications. In multivariate analysis, lower CCT was significantly associated with worsened Advanced Glaucoma Intervention Study score, worsened mean deviation of visual field, and increased vertical and horizontal cup-disc ratios.\n\n\nCONCLUSIONS\nCentral corneal thickness is a powerful clinical factor in determining glaucoma severity at the initial examination by a specialist. Measuring CCT may aid the ophthalmologist in identification of glaucoma patients at high risk for progression.

Central Corneal Thickness as a Risk Factor for Advanced Glaucoma Damage

Incomplete response to Anti-VEGF therapy in neovascular AMD: Exploring disease mechanisms and therapeutic opportunities.

Purpose of reviewGlaucoma is a leading cause of irreversible blindness worldwide. It is estimated that roughly 60.5 million people had glaucoma in 2010 and that this number is increasing. Many patients continue to lose vision despite apparent disease control according to traditional risk factors. Th

/pdf/corneal-hysteresis-and-its-relevance-to-glaucoma-42ox7qzgwm.pdf

Corneal hysteresis and its relevance to glaucoma.

Risk factors for rapid glaucoma disease progression

PurposeTo describe the efficacy of intravitreal aflibercept on 12-month visual and anatomical outcomes in patients with neovascular age-related macular degeneration (AMD) recalcitrant to prior monthly intravitreal bevacizumab or ranibizumab.MethodsNon-comparative case series of 21 eyes of 21 AMD patients with evidence of persistent exudation (intraretinal fluid/cysts, or subretinal fluid (SRF), or both) on spectral domain OCT despite ≥6 prior intravitreal 0.5 mg ranibizumab or 1.25 mg bevacizumab (mean 29.8±17.1 injections) over 31.6±17.4 months who were transitioned to aflibercept.ResultsAt baseline, best-corrected visual acuity (BCVA) was 0.42±0.28 logarithm of minimum-angle of resolution (logMAR), central foveal thickness (CFT) was 329.38±102.67 μm and macular volume (MV) was 7.71±1.32 mm3. After 12 months of aflibercept (mean 10.2±1.2 injections), BCVA was 0.40±0.28 logMAR (P=0.5), CFT decreased to 292.71±91.35 μm (P=0.038) and MV improved to 7.33±1.27 mm3 (P=0.003). In a subset of 15 eyes with a persistent fibrovascular or serous pigment epithelial detachment (PED), mean baseline PED greatest basal diameter (GBD) was 2350.9±1067.6 μm and mean maximal height (MH) was 288.7±175.9 μm. At 12 months, GBD improved to 1896.3±782.3 μm (P=0.028), while MH decreased to 248.27±146.2 μm (P=0.002).ConclusionIn patients with recalcitrant AMD, aflibercept led to anatomic improvement at 12 months, reduction in proportion of eyes with SRF and reduction in PED, while preserving visual acuity.

Visual And Anatomical Outcomes Following Intravitreal Aflibercept In Eyes With Recalcitrant Neovascular Age Related Macular Degeneration

Preservatives in multidose formulations of topical ophthalmic medications are crucial for maintaining sterility but can be toxic to the ocular surface. Benzalkonium chloride (BAK)-used in approximately 70% of ophthalmic formulations-is well known to cause cytotoxic damage to conjunctival and corneal epithelial cells, resulting in signs and symptoms of ocular surface disease (OSD) including ocular surface staining, increased tear break-up time, and higher OSD symptom scores. These adverse effects are more problematic with chronic exposure, as in lifetime therapy for glaucoma, but can also manifest after exposure as brief as seven days. Multiple strategies are available to minimize or eliminate BAK exposure, among them alternative preservatives, preservative-free formulations including sustained release drug delivery platforms, and non-pharmacological therapies for common eye diseases and conditions. In this paper, we review the cytotoxic and clinical effects of BAK on the ocular surface and discuss existing and emerging options for ocular disease management that can minimize or eliminate BAK exposure.

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Ocular benzalkonium chloride exposure: problems and solutions.

Corneal hysteresis (CH) has been associated with visual field damage in glaucoma and is related to the velocity of perimetric glaucoma progression. We undertook this investigation to determine whether CH is associated with structural markers of glaucoma damage on spectral domain optical coherence tomography (SD-OCT). In this retrospective study, 131 patients under glaucoma evaluation were evaluated with SD-OCT (Cirrus; Carl Zeiss Meditec, Dublin, CA) and had CH measurements with the ocular response analyzer (Reichert, Inc., Buffalo, NY). Pearson and partial correlation adjusting for age were preformed to examine the association between CH and variables of interest. Generalized estimating equations were used to construct simple and multiple linear models. While Pearson correlations were modest overall, CH best correlated with mean deviation (MD; r = 0.19) followed by average retinal nerve fiber layer (RNFL) thickness (r = 0.18) and vertical cup to disc ratio (r = −0.11) in the open angle glaucoma group. In univariable models, CH varied as a function of MD (s = 0.1, 95 % CI 0.03, 0.1; p < 0.001) and of average RNFL thickness (s = 0.2, 95 % CI 0.1, 0.4; p = 0.001). In a multivariable analysis including MD, age, average RNFL thickness, and glaucoma status, MD (p = 0.001) and age (p < 0.001) retained significant associations with CH. In patients under evaluation and treatment for glaucoma, CH was more closely related to visual field MD than to structural markers of glaucoma damage as measured by SD-OCT.

Relationship between corneal hysteresis and optic nerve parameters measured with spectral domain optical coherence tomography

Agreement of flicker chronoscopy for structural glaucomatous progression detection and factors associated with progression.

Background Vascular risk factors have been associated with glaucomatous visual field progression. Aim We determined the relationship between vascular risk factors and structural glaucomatous progression using serial flicker chronoscopy images. Methods Two glaucoma fellowship-trained ophthalmologists, masked to temporal sequence, independently graded serial flicker chronoscopy images from one eye of a cohort of glaucoma patients for features of structural progression in this retrospective cohort study. After adjudication, simple and multiple logistic models were constructed to determine variables associated with increased odds of progression, including systolic blood pressure (BP), diastolic BP and mean ocular perfusion pressure. Results Seventy-two eyes of 72 patients were analysed. Patients with any form of structural progression (n=40) were older (67.0 vs 58.8 years; p=0.005) and had lower diastolic BP (71.8 vs 76.5 mm Hg; p=0.02) than patients without progression (n=32). In the univariable model, diastolic BP was associated with progressive retinal nerve fibre layer (RNFL) loss (OR=0.2 per 10 mm Hg, 95% CI 0.1 to 0.6, p Conclusions This study is the first to use structural progression and flicker chronoscopy to identify vascular glaucoma risk factors. Older age and lower diastolic BP were associated with progression. By multivariable analysis diastolic BP was associated with RNFL and neuroretinal rim loss. These findings suggest that diastolic BP is associated with structural glaucomatous progression which may have implications for management.

https://bjo.bmj.com/content/bjophthalmol/early/2013/09/24/bjophthalmol-2013-303655.full.pdf

Association of blood and ocular perfusion pressure with structural glaucomatous progression by flicker chronoscopy

BACKGROUND AND OBJECTIVE Evaluate capillary perfusion density (CPD) in patients with diabetic macular edema (DME) undergoing fixed intravit-real aflibercept injections (IAI) through 24 months. PATIENTS AND METHODS Prospective, interventional, single-arm study enrolling 20 patients with persistent DME. Patients received IAI every 4 weeks until DME resolution followed by extension to every 8 weeks. Optical coherence tomography angiography was obtained at baseline, 6, 12, and 24 months. RESULTS Sixteen of 20 eyes completed the study. Baseline mean central subfield thickness was 420 µm, which improved to 251 µm (P < .001). The mean best-corrected visual acuity (BCVA) improved by 5.5 letters (P = .042). The whole superficial CPD decreased by 5.3% (P = .001) and the deep CPD decreased by 4.4% (P = .009). Better BCVA correlated with less CPD loss within the superficial parafovea (r = +0.66 [0.23, 0.88]; P = .006) and whole (r = +0.60 [0.12, 0.85]; P = .017) areas. CONCLUSION Superficial and deep CPD decreased despite fixed IAI through 24 months. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:448-455.].

Fabiana Q. Silva

Papers

Ocular benzalkonium chloride exposure: problems and solutions.

Relationship between corneal hysteresis and optic nerve parameters measured with spectral domain optical coherence tomography

Agreement of flicker chronoscopy for structural glaucomatous progression detection and factors associated with progression.

Association of blood and ocular perfusion pressure with structural glaucomatous progression by flicker chronoscopy

Twenty-Four-Month OCTA Assessment in Diabetic Patients Undergoing Fixed-Interval Intravitreal Aflibercept Therapy.