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Glaucoma: New Diagnostic and Therapeutic Approaches, 2nd Edition

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A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Molecular and Translational Medicine".

Deadline for manuscript submissions: 31 May 2025 | Viewed by 10592

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Dr. Da-Wen Lu

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Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
Interests: glaucoma; ocular pharmacology; cataract
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We are delighted to present a Special Issue, entitled "Glaucoma: New Diagnostic and Therapeutic Approaches, 2nd Edition ," focusing on the latest advancements in the field of glaucoma management. Glaucoma remains one of the leading causes of irreversible blindness worldwide, necessitating the continuous exploration of novel approaches to improve patient outcomes. This Special Issue aims to provide a comprehensive overview of cutting-edge research and innovations in glaucoma management, highlighting emerging techniques and interventions that hold promise in the diagnosis, monitoring, and treatment of this complex ocular disease.

This Special Issue seeks to foster collaboration among researchers, clinicians, and industry professionals, facilitating the dissemination of knowledge and the exchange of ideas in the field of glaucoma. We invite original research articles, comprehensive reviews, and perspectives that cover a broad range of topics, including, but not limited to, the following:

Novel diagnostic techniques—articles elucidating the development and clinical application of innovative imaging modalities, genetic testing, and biomarkers for early detection and accurate diagnosis;
Advanced therapeutic interventions—pharmacological advancements and emerging therapies for glaucoma management, with an emphasis on their efficacy, safety, and long-term outcomes;
Artificial intelligence and digital health—research exploring the integration of artificial intelligence, machine learning, and digital health technologies in glaucoma screening, monitoring, and personalized treatment approaches.

Dr. Da-Wen Lu
Guest Editor

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Keywords

glaucoma
ocular pharmacology
ocular disease

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Published Papers (9 papers)

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Research

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11 pages, 471 KiB

Open AccessArticle

Heart Rate Variability Time-Domain Analysis Across Glaucoma Subtypes

by Yuto Yoshida, Hinako Takei, Misaki Ukisu, Keigo Takagi and Masaki Tanito

Biomedicines 2025, 13(4), 893; https://doi.org/10.3390/biomedicines13040893 - 7 Apr 2025

Viewed by 283

Abstract

Background/Objectives: The association between glaucoma and autonomic nervous system (ANS) function remains unclear. Primary open-angle glaucoma (POAG) and exfoliation glaucoma (EXG) have distinct pathophysiological mechanisms, which may lead to different ANS alteration. This study aimed to investigate the association between different glaucoma subtypes and the following time-domain heart rate variability (HRV) parameters: the standard deviation of normal-to-normal intervals (SDNN), the square root of the mean of the sum of the squared differences between adjacent normal-to-normal intervals (RMSSD), and the coefficient of variation of R-R intervals (CVRR). Methods: A total of 809 eyes from 809 patients with POAG, EXG, and controls were included. HRV was measured from the participants’ fingertips using a sphygmograph (TAS9 Pulse Analyzer Plus View; YKC Corp., Tokyo, Japan). Comparisons of time-domain HRV parameters among the groups were conducted. To evaluate the associations between time-domain HRV parameters and other variables, linear regression analyses were conducted. Results: This study included 522 participants with POAG, 191 participants with EXG, and 96 participants in the control group. There was a significant difference in CVRR among the groups (the control group: 4.04 ± 2.08%, the POAG group: 3.86 ± 1.87%, the EXG group: 3.57 ± 2.02%; p = 0.010), whereas no significant differences were found in SDNN and RMSSD. The EXG group had significantly lower values of SDNN and CVRR values compared to the POAG group (p = 0.0156 and p = 0.0037, respectively). In multivariate linear regression analysis, the highest recorded intraocular pressure (IOP) was significantly associated with CVRR. Conclusions: HRV parameters may reflect ANS alterations in glaucoma subtypes. Full article

(This article belongs to the Special Issue Glaucoma: New Diagnostic and Therapeutic Approaches, 2nd Edition)

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17 pages, 2865 KiB

Open AccessArticle

Proteome-Wide Analysis of Autoantibodies in Open-Angle Glaucoma in Japanese Population: A Pilot Study

by Naoko Takada, Makoto Ishikawa, Kota Sato, Hiroshi Kunikata, Takahiro Ninomiya, Akiko Hanyuda, Eriko Fukuda, Kei Yamaguchi, Chihiro Ono, Tomoko Kirihara, Chie Shintani, Chihiro Tsusu, Aki Osanai, Naoki Goshima, Yukitoshi Izumi, Charles F. Zorumski and Toru Nakazawa

Biomedicines 2025, 13(3), 718; https://doi.org/10.3390/biomedicines13030718 - 14 Mar 2025

Viewed by 638

Abstract

Objectives: The objective of this study was to identify novel autoantibodies specific for open-angle glaucoma (OAG), including normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG), using proteome-wide autoantibody screening and to determine their utility for diagnosis. Methods: We conducted proteome-wide autoantibody screening by wet protein arrays. Autoantibody reactivity in the plasma of OAG patients (50 NTG and 69 POAG patients) was quantitatively analyzed and compared to that of controls (35 cataract patients). The area under the curve (AUC) of the receiver operating characteristic (ROC) and multivariate analyses were used to determine diagnostic potential in patients with OAG. Results: Based on differences in autoantibody titers and positivity rates, four autoantibodies against ETNK1, VMAC, NEXN, and SUN1 were selected as potential biomarkers to discriminate OAG and cataract. In discrimination between POAG and cataract, the AUCs of ETNK1 and VMAC were calculated to be 0.820 (95%CI: 0.733–0.907) and 0.889 (95%CI: 0.818–0.959), respectively. Furthermore, the combination of these four antibodies demonstrated diagnostic potential for OAG with an AUC of 0.828 (95%CI: 0.757–0.898) by multivariate analysis. Conclusions: Four new glaucoma-associated autoantibodies were identified in this study. The differences in autoantibody patterns in the plasma between glaucoma and cataract patients support their potential utility as biomarkers for glaucoma screening. Full article

(This article belongs to the Special Issue Glaucoma: New Diagnostic and Therapeutic Approaches, 2nd Edition)

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11 pages, 2022 KiB

Open AccessArticle

Preserflo-MicroShunt: Postoperative Effects on Endothelial Cell Density and Corneal Thickness

by Sebastian Dierse, Eliane Luisa Esser, Ralph-Laurent Merté, Sami Al-Nawaiseh, Martin Dominik Leclaire, Nicole Eter and Viktoria Constanze Brücher

Biomedicines 2025, 13(2), 364; https://doi.org/10.3390/biomedicines13020364 - 5 Feb 2025

Cited by 1 | Viewed by 727

Abstract

Background: The aim of this study was to evaluate the effects of Preserflo implantation on endothelial cell density (ECD), corneal thickness, intraocular pressure (IOP), and the use of antiglaucoma medications over a 12-month follow-up period. Methods: A total of 53 eyes from 53 patients undergoing Preserflo implantation were included in this prospective study. ECD, corneal thickness, IOP, and the number of antiglaucoma medications were measured at baseline, 3 months, and 12 months postoperatively. Statistical analysis was performed using paired t-tests and Wilcoxon signed-rank tests for non-normally distributed data. Results: There was no significant reduction in ECD at 3 months (p = 0.695) or 12 months (p = 0.229) compared to baseline. However, a significant reduction in corneal thickness was observed at 3 months (p = 0.008), with no significant change at 12 months (p = 0.118). A significant reduction in IOP was noted at both 3 months (from a preoperative median of 23.5 mmHg to 11.5 mmHg, p < 0.001) and 12 months (from 23.5 mmHg to 13.0 mmHg, p < 0.001). Additionally, there was a significant decrease in the use of antiglaucoma medications, from a preoperative median of 3.0 medication classes to 0.0 classes at both 3 months (p < 0.001) and 12 months (p < 0.001). Conclusions: Preserflo implantation resulted in a significant reduction in IOP and the need for antiglaucoma medications, with no significant impact on endothelial cell density and corneal thickness after 12 months. These findings suggest that Preserflo implantation is an effective procedure for IOP control and medication reduction, with favorable outcome for corneal health after one year. Full article

(This article belongs to the Special Issue Glaucoma: New Diagnostic and Therapeutic Approaches, 2nd Edition)

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10 pages, 1148 KiB

Open AccessArticle

Refining Glaucoma Management: Korean Population-Specific Findings from Visual Field and Optical Coherence Tomography Testing

by Sun Jung Lee, Sung Hun Jang and Jae Kyung Kim

Biomedicines 2025, 13(2), 318; https://doi.org/10.3390/biomedicines13020318 - 29 Jan 2025

Viewed by 797

Abstract

Background/Objectives: This study aimed to serve as a reference for establishing glaucoma evaluation standards for the Korean by analyzing the results of visual field tests and optical coherence tomography (OCT). We also determined the correlation between these test results and patient demographics, such as age and sex, which is crucial for early glaucoma detection and management. Methods: This study was conducted at a national hospital in Seoul and analyzed 1510 visual field tests and 1337 OCT tests. The patients underwent the Humphrey automated visual field test and OCT measurements. Glaucoma was classified into early, moderate, and advanced stages based on the mean deviation (MD) value. Statistical analyses were performed to assess the relationships between age, sex, and test results. Results: The visual field test results showed that the visual field index and MD values decreased as age increased for both males and females, with a more significant decrease observed in males. The OCT findings revealed gradual thinning of the ganglion cell–inner plexiform layer (GCIPL) and retinal nerve fiber layer (RNFL) with increasing age, although, compared to males, thicker GCIPLs and RNFLs were maintained in females until their 60s. Conclusion: This study indicates that there may be an association between age and sex in glaucoma progression and provides valuable insights for establishing diagnostic and management modalities specifically for Korean patients. These findings support the use of both visual field testing and OCT in glaucoma diagnosis, emphasizing the importance of early detection and personalized treatment strategies for effective glaucoma management in Korea. Full article

(This article belongs to the Special Issue Glaucoma: New Diagnostic and Therapeutic Approaches, 2nd Edition)

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Review

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27 pages, 478 KiB

Open AccessReview

Advancing Glaucoma Treatment During Pregnancy and Breastfeeding: Contemporary Management Strategies and Prospective Therapeutic Developments

by Maria Letizia Salvetat, Mario Damiano Toro, Francesco Pellegrini, Paolo Scollo, Roberta Malaguarnera, Mutali Musa, Liliana Mereu, Daniele Tognetto, Caterina Gagliano and Marco Zeppieri

Biomedicines 2024, 12(12), 2685; https://doi.org/10.3390/biomedicines12122685 - 25 Nov 2024

Viewed by 1618

Abstract

The management of glaucoma in pregnancy and breastfeeding requires a careful evaluation of treatment choices to guarantee the well-being of both the mother and the developing fetus. This review explores the intricacies of controlling glaucoma in pregnant and breastfeeding women, including a comprehensive overview of existing glaucoma treatment methods, clinical guidelines, and future therapeutic approaches. The efficacy and safety profiles of traditional treatment approaches, such as topical and systemic medicines and surgical treatments, are evaluated specifically about their use during pregnancy and breastfeeding. The significance of personalized treatment programs to achieve a balance between controlling intraocular pressure and ensuring the safety of the fetus and the newborn and the importance of a multidisciplinary approach that includes ophthalmologists, obstetricians, and other healthcare experts are underlined. Non-pharmacological therapies, lifestyle adjustments, and the importance of patient education in the management of glaucoma during pregnancy and the post-partum period are also examined. Advancing our comprehension of and strategy toward glaucoma can reduce the effects of glaucoma on maternal, fetal, and newborn well-being. Full article

(This article belongs to the Special Issue Glaucoma: New Diagnostic and Therapeutic Approaches, 2nd Edition)

16 pages, 348 KiB

Open AccessReview

Glaucoma: Current and New Therapeutic Approaches

by Hsin-Pei Lee, Ta-Hsin Tsung, Yu-Chien Tsai, Yi-Hao Chen and Da-Wen Lu

Biomedicines 2024, 12(9), 2000; https://doi.org/10.3390/biomedicines12092000 - 3 Sep 2024

Viewed by 1641

Abstract

Glaucoma is identified by the loss of retinal ganglion cells (RGCs). The primary approach to managing glaucoma is to control intraocular pressure (IOP). Lately, there has been an increasing focus on neuroprotective therapies for glaucoma because of the limited effectiveness of standard methods in reducing IOP and preventing ongoing vision deterioration in certain glaucoma patients. Various drug-based techniques with neuroprotective properties have demonstrated the ability to decrease the mortality of retinal ganglion cells. This study will analyze the currently recommended drug-based techniques for neuroprotection in the prospective treatment of glaucoma. Full article

(This article belongs to the Special Issue Glaucoma: New Diagnostic and Therapeutic Approaches, 2nd Edition)

Other

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26 pages, 3315 KiB

Open AccessSystematic Review

Deep Learning in Glaucoma Detection and Progression Prediction: A Systematic Review and Meta-Analysis

by Xiao Chun Ling, Henry Shen-Lih Chen, Po-Han Yeh, Yu-Chun Cheng, Chu-Yen Huang, Su-Chin Shen and Yung-Sung Lee

Biomedicines 2025, 13(2), 420; https://doi.org/10.3390/biomedicines13020420 - 10 Feb 2025

Viewed by 1475

Abstract

Purpose: To evaluate the performance of deep learning (DL) in diagnosing glaucoma and predicting its progression using fundus photography and retinal optical coherence tomography (OCT) images. Materials and Methods: Relevant studies published up to 30 October 2024 were retrieved from PubMed, Medline, EMBASE, Cochrane Library, Web of Science, and ClinicalKey. A bivariate random-effects model was employed to calculate pooled sensitivity, specificity, positive and negative likelihood ratios, and area under the receiver operating characteristic curve (AUROC). Results: A total of 48 studies were included in the meta-analysis. DL algorithms demonstrated high diagnostic performance in glaucoma detection using fundus photography and OCT images. For fundus photography, the pooled sensitivity and specificity were 0.92 (95% CI: 0.89–0.94) and 0.93 (95% CI: 0.90–0.95), respectively, with an AUROC of 0.90 (95% CI: 0.88–0.92). For the OCT imaging, the pooled sensitivity and specificity were 0.90 (95% CI: 0.84–0.94) and 0.87 (95% CI: 0.81–0.91), respectively, with an AUROC of 0.86 (95% CI: 0.83–0.90). In predicting glaucoma progression, DL models generally showed less robust performance, with pooled sensitivities and specificities ranging lower than in diagnostic tasks. Internal validation datasets showed higher accuracy than external validation datasets. Conclusions: DL algorithms achieve excellent performance in diagnosing glaucoma using fundus photography and OCT imaging. To enhance the prediction of glaucoma progression, future DL models should integrate multimodal data, including functional assessments, such as visual field measurements, and undergo extensive validation in real-world clinical settings. Full article

(This article belongs to the Special Issue Glaucoma: New Diagnostic and Therapeutic Approaches, 2nd Edition)

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12 pages, 499 KiB

Open AccessSystematic Review

A Systematic Review of Micropulse Laser Trabeculoplasty (MLT) in Primary Open-Angle Glaucoma (POAG) Management: Efficacy, Safety, and Future Perspectives

by Filippo Confalonieri, Barbara Casarini, Annalaura Papapicco, Fabio Stiro, Raffaele Piscopo, Luca D’Andrea, Goran Petrovski and Tommaso Verdina

Biomedicines 2025, 13(1), 211; https://doi.org/10.3390/biomedicines13010211 - 16 Jan 2025

Viewed by 1362

Abstract

Background/Objectives: Micropulse laser trabeculoplasty (MLT) is gaining attention as a non-invasive treatment option for primary open-angle glaucoma (POAG), offering an alternative to traditional surgeries and medications. This systematic review evaluates the effectiveness, safety, and potential of MLT in glaucoma management. Methods: This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The strength of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, following the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) recommendations. Results: We identified 79 articles, and after removing duplicates and screening abstracts, 56 articles were eligible for further review. A detailed full-text analysis was conducted on 26 articles, of which 15 met the predefined inclusion criteria. Conclusions: MLT shows promise as a primary or adjunctive treatment for reducing intraocular pressure (IOP) in glaucoma and ocular hypertension patients. Current evidence supports its efficacy and safety; however, additional long-term studies are needed to confirm its durability and compare its effectiveness with traditional surgical and pharmacological approaches. Standardizing treatment protocols and refining patient selection criteria could enhance MLT’s clinical value and support its broader adoption in glaucoma care. Full article

(This article belongs to the Special Issue Glaucoma: New Diagnostic and Therapeutic Approaches, 2nd Edition)

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8 pages, 593 KiB

Open AccessBrief Report

Selective Laser Trabeculoplasty after a Previous Glaucoma Treatment

by Patrick Thelen, Daniel Böhringer, Philip Keye, Thomas Reinhard and Jan Lübke

Biomedicines 2024, 12(10), 2212; https://doi.org/10.3390/biomedicines12102212 - 27 Sep 2024

Viewed by 1267

Abstract

Background/Objectives: Recent prospective studies have shown that selective laser tra-beculoplasty (SLT) is a safe and cost-effective alternative to pressure-reducing eye drop therapy as a first-line treatment for ocular hypertension or open-angle glaucoma. In addition to its comparable efficacy to eye drop therapy, SLT has been particularly effective in delaying the time until a surgical intervention is needed. The aim of our evaluation is to analyze patients who have received SLT following a pressure-reducing procedure. The primary endpoint is the duration until a subsequent interventional or surgical procedure is required. Methods: A retrospective analysis of 98 patients who underwent selective laser trabeculoplasty following a previous pressure-reducing procedure between 2017 and 2023. The statistical analyses included Cox regression and Kaplan–Meier survival estimations. Results: In total, 122 eyes of 98 patients received selective laser trabeculoplasty following a previous pressure-reducing procedure at the Department of Ophthalmology in Freiburg. The median follow-up period was 381.5 days (range 43.25–862.75 days). Approximately 68% of the eyes did not require another pressure-reducing procedure 365 days after the intervention, while about 58% of the eyes remained without another procedure after 730 days, according to Kaplan–Meier analysis. No significant difference was found between the different types of glaucoma regarding the duration until a subsequent pressure-reducing procedure was needed. The study indicated a tendency for patients with pseudoexfoliation glaucoma to undergo a secondary intervention earlier compared to those with primary open-angle glaucoma (p = 0.16). The intraocular pressure before SLT had a significant impact on the duration until the subsequent operation (p = 0.005). Conclusions: SLT is an effective method even after a previous pressure-reducing procedure for patients in whom further pressure-reducing interventions need to be delayed. Full article

(This article belongs to the Special Issue Glaucoma: New Diagnostic and Therapeutic Approaches, 2nd Edition)

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