Purpose To evaluate the role of corneal hysteresis (CH) as a risk factor for the rate of visual field progression in a cohort of glaucoma patients followed prospectively over time. Design Prospective observational cohort study. Participants The study group included 114 eyes of 68 glaucoma patients followed for an average of 4.0 ± 1.1 years. Visual fields were obtained with standard automated perimetry. Included eyes had a median number of 7 (range: 5 to 12) tests during follow-up. Methods CH measurements were acquired at baseline using the Ocular Response Analyzer (Reichert Instruments, Depew, NY, USA). Evaluation of rates of visual field change during follow-up was performed using the Visual Field Index (VFI). Linear mixed models were used to investigate the relationship between rates of visual field loss and baseline CH, baseline intraocular pressure (IOP) and central corneal thickness (CCT), while adjusting for potentially confounding factors. An interaction term between IOP and CH was included in the model to investigate whether the effect of IOP on rates of progression depended on the level of CH. Main Outcome Measures Effects of CH, IOP and CCT on rates of VFI loss over time. Results CH had a significant effect on rates of visual field progression over time. In the univariable model including only CH as a predictive factor along with time and their interaction, each 1mmHg lower CH was associated with 0.25%/year faster rate of VFI decline over time (P<0.001). The multivariable model showed that the effect of IOP on rates of progression depended on CH. Eyes with high IOP and low CH were at increased risk for having fast rates of disease progression. CH explained a larger proportion of the variation in slopes of VFI change than CCT (17.4% versus 5.2%, respectively). Conclusion CH measurements were significantly associated with risk of glaucoma progression. Eyes with lower CH had faster rates of visual field loss than those with higher CH. The prospective longitudinal design of this study supports the role of CH as an important factor to be considered in the assessment of the risk of progression in glaucoma patients.

The results demonstrate that approximately 10% of the senior population in the Shihpai district has a correctable visual impairment. Thus, it is important to educate the public about the importance of regular examination and the possibility of improving visual acuity by wearing glasses.

To investigate the association between body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) and cataract in a metropolitan Asian elderly population. Design: Population-based cross-sectional study. Agerelated cataract was defined as any type of lens opacity (ie, nuclear, cortical, and posterior subcapsular opacity) with a Lens Opacities Classification System III grade of more than 2 in one or both eyes. Weight and height were measured by intensively trained interviewers. Results: A total of 2045 subjects 65 years and older in Shihpai, Taipei, were invited to participate, and 1361 (66.6%) completed the survey. Of the subjects, 806 were diagnosed as having age-related cataracts. With a BMI of less than 21.3 as a reference point (odds ratio [OR], 1.00), a U-shaped relationship between BMI and nuclear opacity was demonstrated. A reverse U-shaped relationship was shown for cortical opacity. In the final multiple logistic regression models, BMI and BMI 2 were significantly related to nuclear opacity (BMI data: OR, 0.73 [95% confidence interval {CI}, 0.54-0.98]; and BMI 2 data: OR, 1.01 [95% CI, 1.00-1.01]) and cortical opacity (BMI data: OR, 1.52 [95% CI, 1.04-2.34]; and BMI 2 data: OR, 0.99 [95% CI, 0.98-0.99]). Neither BMI nor BMI 2 was related to posterior subcapsular opacity. Conclusion: Body mass index is an independent risk factor for nuclear and cortical opacities, but in reverse direction to each other.

No abstract

Falls were significantly associated with a best-corrected Snellen visual acuity of less than 6/12.

Purpose To evaluate the ability of longitudinal frequency doubling technology (FDT) to predict development of glaucomatous visual field loss on standard automated perimetry (SAP) in glaucoma suspects. Design Prospective observational cohort study. Participants The study included 587 eyes of 367 patients with suspected glaucoma at baseline selected from the Diagnostic Innovations in Glaucoma Study (DIGS) and the African Descent and Glaucoma Evaluation Study (ADAGES). These eyes had an average of 6.7±1.9 FDT tests during a mean follow-up time of 73.1±28.0 months. Methods Glaucoma suspects had either intraocular pressure >21mmHg or an optic disc appearance suspicious of glaucoma. All patients had either normal or non-repeatable abnormal SAP at baseline. Humphrey Matrix FDT testing was performed within 6 months of SAP testing. The study endpoint was the development of 3 consecutive abnormal SAP tests. Joint longitudinal survival models were used to evaluate the ability of rates of FDT pattern standard deviation (PSD) change to predict development of visual field loss on SAP, adjusting for confounding variables (baseline age, mean intraocular pressure, corneal thickness, and follow-up measurements of SAP PSD). Main Outcome Measures The R2 index was used to evaluate and compare the predictive abilities of the model containing longitudinal FDT PSD data with the model containing only baseline data. Results Sixty-three of 587 (11%) eyes developed SAP visual field loss during follow-up. The mean rate of FDT PSD change in eyes that developed SAP visual field loss was 0.07dB/year versus 0.02dB/year in those that did not (P<0.001). Baseline FDT PSD and slopes of FDT PSD change were significantly predictive of progression, with hazard ratios of 1.11 per 0.1dB higher (95% confidence interval [CI]: 1.04 - 1.18; P=0.002) and 4.40 per 0.1dB/year faster (95%CI: 1.08 - 17.96; P=0.04), respectively. The longitudinal model performed significantly better than the baseline model with R2 of 82% (95%CI: 74% - 89%) vs. 11% (95%CI: 2% - 24%), respectively. Conclusion Rates of FDT PSD change were highly predictive of development of SAP visual field loss in glaucoma suspects. This finding suggests that longitudinal FDT evaluation may be useful for risk stratification of patients suspected of having glaucoma.

there is distinct pathogenesis between primary open-angle glaucoma (poAG) and primary angleclosure glaucoma (pAcG). Although elevated intraocular pressure (iop) is the major risk factor for glaucoma, non-IOP risk factors such as vascular abnormalities and lower systolic/diastolic perfusion pressure may play a role in the pathogenic process. this study aimed to compare the vessel density (VD) in the optic disc and macula using optical coherence tomography angiography (octA) between poAG and PACG eyes. Thirty-two POAG eyes, 30 PACG eyes, and 39 control eyes were included. All the optic disc VD parameters except the inside disc VD were significantly lower in glaucomatous eyes than in control eyes. Compared with PACG eyes, only the inferior temporal peripapillary VD was significantly lower in POAG eyes. The parafoveal VD was significantly lower in each quadrant in glaucomatous eyes than in control eyes. The central macular and parafoveal VD did not differ between POAG and PACG eyes. In conclusion, the inferior temporal peripapillary VD was significantly reduced in POAG eyes compared with PACG eyes, while PACG eyes showed a more evenly distributed reduction in the peripapillary VD. The distinct patterns of VD change may be associated with the different pathogenesis between poAG and pAcG. Glaucoma is an optic neuropathy characterised by progressive loss of retinal ganglion cells and their axons accompanied by corresponding visual field (VF) defects. Primary glaucoma is classified according to the anatomy of the anterior chamber angle into primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Elevated intraocular pressure (IOP) is the major risk factor for glaucoma. In PACG, elevated IOP secondary to angle closure is considered the primary mechanism. On the other hand, other non-IOP risk factors such as vascular abnormalities and lower systolic/diastolic perfusion pressure have been proposed in POAG 1-4. The characteristics of the optic disc are also different between POAG and PACG eyes. There may be enlarged cupping and/or optic disc rim notching in POAG eyes, whereas pallor of the optic disc either from an acute attack of angle closure or in the chronic clinical course may be observed in PACG eyes 5,6. All these findings indicate the distinct pathogenesis between POAG and PACG and reflect the feature of microvascular damage. Optical coherence tomography angiography (OCTA) is a reliable technique to perform in vivo imaging of the optic nerve head (ONH) and retinal microcirculation 7-11. Previous studies have reported reduced vessel density (VD) in the ONH, peripapillary area, and macula in glaucomatous eyes 12-17. Most of the studies investigated POAG eyes and had limited analyses for the microcirculation in PACG eyes 18-21. The diagnostic ability of VD as well as the relationship of peripapillary VD with VF and/or retinal nerve fibre layer (RNFL) thickness in POAG and PACG have been reported 18-28. To date, no reports have compared the pattern of regional VD change in the optic disc or macula b...

Physicians should weigh the benefits against the risks of mitomycin C application in performing trabeculectomies.