Purpose : To assess perceptions and implications of COVID-19 across the spectrum of visual impairment (VI) and normally-sighted individuals Design : Prospective cross-sectional comparative study. Method : XXXXXX Setting : Institutional. Patients : 232 patients and their caregivers. Four groups were created based on better eye characteristics: blind (best-corrected distance visual acuity (BCDVA) < 3/60 or visual field < 10 central degrees), severe VI (3/60 ≤ BCDVA < 6/60, vertical cup-to-disc ratio ≥ 0.85 or neuroretinal rim width ≤ 0.1), moderate VI (6/60 ≤ BCDVA < 6/18), or no/mild VI (controls, BCDVA ≥ 6/18) based on International Classification of Diseases-10 criteria and Foster and Quigley's consensus definition of glaucoma. Procedure : Telephone questionnaires. Main Outcomes and Measures : Differences in perceptions and implications of COVID-19 across various levels of VI. Caregiver perceptions were a secondary outcome measure. Results : Survey was completed by 232 participants, with 58 participants in each VI group. Mean age was 58.9 years ± 13.2. Greater degrees of VI were associated with older age (P=0.008) and lower education level (P=0.046). Blind participants more commonly perceived vision as a risk factor for contracting COVID-19 (P=0.045), were concerned about access to healthcare (P<0.001), obtained news through word of mouth (P<0.001), and less commonly wore masks (P=0.003). Controls more commonly performed frequent handwashing (P=0.001), were aware of telemedicine (P=0.029), and had fewer concerns about social interactions (P=0.020) compared to groups with substantial VI. All caregivers reported more frequent patient care since COVID-19 began. Conclusions : The pandemic may have a disproportionate impact on the visually-impaired, and evidence-based assessments of COVID-19 health outcomes in this population are warranted.

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Purpose: To describe the efficacy and safety of open versus closed conjunctival implantation of the XEN45 Gel Stent (Allergan Inc). Design: Retrospective, multicenter study. Participants: A total of 137 patients with glaucoma who underwent XEN45 implantation via open or closed conjunctival methods. The XEN45 was implanted as a stand-alone procedure or at the time of cataract surgery by 5 surgeons. Methods: Patient demographics, diagnoses, preoperative and postoperative clinical data, outcome measures including intraocular pressure (IOP), use of glaucoma medications, visual acuity, and complications were collected. Statistical analyses were performed with P < 0.05 as significant. Main Outcome Measures: Failure was defined as less than 20% reduction of IOP from medicated baseline or IOP >21 mmHg at 2 consecutive visits at postoperative month 1 and beyond, the need for subsequent operative intervention or additional glaucoma surgery, or a catastrophic event such as loss of light perception. Eyes that had not failed by these criteria and were not on glaucoma medications were considered complete successes. Eyes that had not failed but required glaucoma medications were defined as qualified successes. Results: Complete success was achieved in 31% and 56% of the closed and open groups, respectively ( P = 0.01). Qualified success was achieved in 53% and 71% of the closed and open groups, respectively ( P = 0.06). At postoperative month 12, the open conjunctiva group was using fewer glaucoma medications than the closed group (0.9 vs. 1.8, respectively; P = 0.02). At postoperative month 12, the open group had a significantly greater percentage of IOP reduction compared with the closed group (43.1% vs. 24.8%, respectively; P = 0.02). Postoperative needling rates were higher in the closed group compared with the open group (36.1% vs. 11.8%, P = 0.001). Conclusions: Implantation of the XEN45 with opening of the conjunctiva is a safe and efficacious procedure to lower IOP with comparable success rate and lower needling rate compared with the closed conjunctiva technique. Prospective evaluation of the various methods for XEN45 implantation will allow for further comparison.

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In this prospective cohort study, disc hemorrhages were associated with more severe central damage on 24-2 and 10-2 visual fields (VFs), and faster progression globally on 24-2 VFs and centrally on 10-2 VFs. Purpose: To study the relationship between disc hemorrhage (DH) and the presence and progression of glaucomatous central VF damage. Methods: Cross-sectional and longitudinal analyses were performed on data from the African Descent and Glaucoma Evaluation Study (ADAGES) cohort. Two masked investigators reviewed disc photographs for the presence and location of DH. 24-2 central VF damage was based on the number of test locations within the central 10 degrees of the 24-2 field pattern deviation and their mean total deviation (MTD). 10-2 central VF damage was based on pattern deviation and MTD. Main outcome measures were the association between DH and presence of central VF damage and between DH and worsening of VF. Results: DH was detected in 21 of 335 eyes (6.2%). In the crosssectional analysis, DH was significantly associated with more severe central damage on 24-2 [incidence rate ratio = 1.47; 95% confidence interval (CI) = 1.02-2.12; P = 0.035] and 10-2 VFs (incidence rate ratio = 1.81; 95% CI = 1.26-2.60; P = 0.001). In the longitudinal analysis, DH eyes progressed faster than non-DH eyes based on 24-2 global MTD rates (difference in slopes, β = −0.06; 95% CI = −0.11 to −0.01; P = 0.009) and 10-2 MTD rates (β = −0.10; 95% CI = −0.14 to −0.06; P < 0.001), but not 24-2 central MTD rates (β = −0.02; 95% CI = −0.078 to 0.026; P = 0.338). Conclusion: DH was associated with the presence and progression of central VF defects. DH identification should prompt intensive central VF monitoring and surveillance with 10-2 fields to detect progression.

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Purpose: To describe the demographic profiles, clinical characteristics, and clinical outcomes of patients presenting with glaucoma emergencies during the COVID-19 lockdown in India. Methods: This retrospective, cross-sectional, observational case series involved review of medical records of all patients presenting to the glaucoma service during the COVID-19 lockdown period and comparison with the previous year (March 23 to June 23, 2020 Vs 2019) in a tertiary center in India. Results: We found a 78.9% reduction in overall outpatient visits (54,345 vs. 257,339; P < 0.001) and 80.9% reduction in the number of glaucoma outpatient visits (4,788 vs. 25,083; P < 0.001). Additionally, the proportion of true glaucoma emergency visits significantly increased by 62.4% in 2020 Vs 2019 (1,408/4,788 (29.4%) vs. 4,542/25,083 (18.1%); P < 0.001). Lens-induced glaucomas were the most common glaucoma surgical emergency (13.4%) in 2020. Moreover, comparison of procedures demonstrated a proportionate decrease in incisional glaucoma surgeries (70/115 (60.86%) vs. 806/939 (85.83%); P < 0.001) and an increase in the proportion of emergency cataract surgeries (129/475 (27.15%) vs. 170/2715 (6.26%); P < 0.001) and transscleral cyclophotocoagulation (45/115 (39.13%) vs. 133/939 (14.16%); P = 0.0001) during 2020 vs. 2019. Conclusion: Our study demonstrated a 62% increase in the proportion of visits that were true glaucoma emergencies. Additionally, the proportions of emergency cataract surgeries increased by 4.3 times and the proportion of transscleral cyclophotocoagulation increased by 2.8 times during the pandemic. More nonincisional procedures and less diagnostic testing were performed to minimize postoperative visits and virus transmission. Further understanding of the profile of emergencies may help in developing novel strategies to anticipate future challenges in managing glaucoma care during subsequent waves of the pandemic.