Summary Background Primary open angle glaucoma and ocular hypertension are habitually treated with eye drops that lower intraocular pressure. Selective laser trabeculoplasty is a safe alternative but is rarely used as first-line treatment. We compared the two. Methods In this observer-masked, randomised controlled trial treatment-naive patients with open angle glaucoma or ocular hypertension and no ocular comorbidities were recruited between 2012 and 2014 at six UK hospitals. They were randomly allocated (web-based randomisation) to initial selective laser trabeculoplasty or to eye drops. An objective target intraocular pressure was set according to glaucoma severity. The primary outcome was health-related quality of life (HRQoL) at 3 years (assessed by EQ-5D). Secondary outcomes were cost and cost-effectiveness, disease-specific HRQoL, clinical effectiveness, and safety. Analysis was by intention to treat. This study is registered at controlled-trials.com (ISRCTN32038223). Findings Of 718 patients enrolled, 356 were randomised to the selective laser trabeculoplasty and 362 to the eye drops group. 652 (91%) returned the primary outcome questionnaire at 36 months. Average EQ-5D score was 0·89 (SD 0·18) in the selective laser trabeculoplasty group versus 0·90 (SD 0·16) in the eye drops group, with no significant difference (difference 0·01, 95% CI −0·01 to 0·03; p=0·23). At 36 months, 74·2% (95% CI 69·3–78·6) of patients in the selective laser trabeculoplasty group required no drops to maintain intraocular pressure at target. Eyes of patients in the selective laser trabeculoplasty group were within target intracoluar pressure at more visits (93·0%) than in the eye drops group (91·3%), with glaucoma surgery to lower intraocular pressure required in none versus 11 patients. Over 36 months, from an ophthalmology cost perspective, there was a 97% probability of selective laser trabeculoplasty as first treatment being more cost-effective than eye drops first at a willingness to pay of £20 000 per quality-adjusted life-year gained. Interpretation Selective laser trabeculoplasty should be offered as a first-line treatment for open angle glaucoma and ocular hypertension, supporting a change in clinical practice. Funding National Institute for Health Research, Health and Technology Assessment Programme.

The proposed algorithms are simple and can significantly improve the quality of ONH images clinically captured with OCT. This study has important implications, as it will help improve our ability to perform automated segmentation of the ONH; quantify the morphometry and biomechanics of ONH tissues in vivo; and identify potential risk indicators for glaucoma.

Longitudinal SDOCT imaging can detect deep ONH changes in EG eyes, the earliest of which are present at the onset of HRT-detected ONH surface height depression. These parameters represent realistic targets for SDOCT detection of glaucomatous progression in human subjects.

Identifing potential screening tests for future cognitive decline is a priority for developing treatments for and the prevention of dementia. OBJECTIVE To examine the potential of retinal nerve fiber layer (RNFL) thickness measurement in identifying those at greater risk of cognitive decline in a large community cohort of healthy people. DESIGN, SETTING, AND PARTICIPANTS UK Biobank is a prospective, multicenter, community-based study of UK residents aged 40 to 69 years at enrollment who underwent baseline retinal optical coherence tomography imaging, a physical examination, and a questionnaire. The pilot study phase was conducted from March 2006 to June 2006, and the main cohort underwent examination for baseline measures from April 2007 to October 2010. Four basic cognitive tests were performed at baseline, which were then repeated in a subset of participants approximately 3 years later. We analyzed eyes with high-quality optical coherence tomography images, excluding those with eye disease or vision loss, a history of ocular or neurological disease, or diabetes. We explored associations between RNFL thickness and cognitive function using multivariable logistic regression modeling to control for demographic as well as physiologic and ocular variation. MAIN OUTCOMES AND MEASURES Odds ratios (ORs) for cognitive performance in the lowest fifth percentile in at least 2 of 4 cognitive tests at baseline, or worsening results on at least 1 cognitive test at follow-up. These analyses were adjusted for age, sex, race/ethnicity, height, refraction, intraocular pressure, education, and socioeconomic status. RESULTS A total of 32 038 people were included at baseline testing, for whom the mean age was 56.0 years and of whom 17 172 (53.6%) were women. A thinner RNFL was associated with worse cognitive performance on baseline assessment. A multivariable regression controlling for potential confounders showed that those in the thinnest quintile of RNFL were 11% more likely to fail at least 1 cognitive test (95% CI, 2.0%-2.1%; P = .01). Follow-up cognitive tests were performed for 1251 participants (3.9%). Participants with an RNFL thickness in the 2 thinnest quintiles were almost twice as likely to have at least 1 test score be worse at follow-up cognitive testing (quintile 1: OR, 1.92; 95% CI, 1.29-2.85; P < .001; quintile 2: OR, 2.08; 95% CI, 1.40-3.08; P < .001). CONCLUSIONS AND RELEVANCE A thinner RNFL is associated with worse cognitive function in individuals without a neurodegenerative disease as well as greater likelihood of future cognitive decline. This preclinical observation has implications for future research, prevention, and treatment of dementia.

The measured IOP was successfully measured continuously by using a new, fully implantable IOP telemetry system. IOP fluctuates as much as 10 mm Hg from day to day and hour to hour in unrestrained nonhuman primates, which indicates that snapshot IOP measurements may be inadequate to capture the true dynamic character of IOP. The distributions, magnitudes, and patterns of IOP are not reproducible from day to day within animals, but IOP tends to be slightly higher at night when IOP data are averaged across multiple 24-hour periods within animals.

SDOCT ONH change detection commonly precedes or coincides with CSLT ONH surface change detection, and consistently precedes RNFLT, SLP, and mfERG change detection in monkey experimental glaucoma.

Purpose To investigate spectral domain optical coherence tomography (SD-OCT) detected optic disc margin anatomy in the monkey eye by co-localizing disc photographs to SD-OCT scans acquired from the same eyes. Methods The neural canal opening (NCO) was delineated within 40 digital radial sections generated from SD-OCT volumes acquired from 33 normal monkey eyes (15°, 290 × 768 horizontal grid pattern, Heidelberg Spectralis). Each volume was co-localized to its disc photograph by matching the retinal vessels within each photograph to vessel outlines visible within en face SD-OCT images. Border Tissue was delineated where it extended internal to the NCO. A clinician (masked to delineated points) marked the disc margin onto each photograph whilst viewing the relevant stereophotograph pair. Alignment of the clinician-ascribed disc margin to the NCO and Border Tissue delineations was assessed. The process was repeated in a single myopic human eye. Results In 23 eyes, the NCO aligned to the disc margin. In 10 eyes, externally oblique Border Tissue was detectable in the temporal disc. In these regions of the disc, the termination of Border Tissue was the disc margin. An exaggerated form of this phenotype was observed in the myopic human eye. In this case, temporal Border Tissue terminated at the anterior scleral canal opening, which was detected as the disc margin. Conclusions The termination of Bruch’s Membrane, Border Tissue and the anterior scleral canal opening may constitute the disc margin within the same eye depending upon the Border Tissue architecture; this anatomy is consistently visualized by SD-OCT.

PURPOSE To compare serial optic nerve head (ONH) histology with interpolated B-scans generated from a three-dimensional (3D) spectral domain OCT (SD-OCT) ONH volume acquired in vivo from the same normal monkey eye. METHODS A 15°, ONH SD-OCT volume was acquired in a normal monkey eye, with IOP controlled at 10 mmHg, using the Heidelberg Spectralis. Following perfusion fixation at 10 mmHg, the ONH was trephined, embedded in a paraffin block and sagittal sections were cut at 4 μm intervals. The location of each section was identified within the optic disc photograph by matching the position of the retinal vessels and of Bruch’s membrane opening. By altering the angles of rotation and incidence, “interpolated” B-scans matching the location of the histologic sections were generated using custom software. Structures identified in the histologic sections were compared to signals identified in matched B-scans. RESULTS Close matches between histologic sections and interpolated B-scans were identified throughout the extent of the ONH. SD-OCT identified the neural canal opening as the termination of the Bruch’s membrane/retinal pigment complex and Border Tissue as the innermost termination of the choroidal signal. The anterior lamina cribrosa and its continuity with the prelaminar glial columns were also detected. CONCLUSIONS Volumetric SD-OCT imaging of the ONH was capable of generating interpolated B-scans which accurately matched serial histologic sections. In this single monkey ONH, SD-OCT captured the anterior laminar surface, which is likely to be a key structure in the detection of early ONH structural damage in ocular hypertension and glaucoma.