An Update on the Diagnosis and Management Options of Glaucoma

Topic Information

Dear Colleagues,

Glaucoma remains one of the major causes of blindness worldwide, while a substantial proportion of cases is undiagnosed, especially in the developing world. Early diagnosis and appropriate treatment is of paramount importance to prevent visual loss and maintain quality of life for patients. Substantial improvements in diagnostic tools, new medications along with sustained delivery devices, and novel surgical approaches are promising tools in the effort to limit the burden of the disease to patients and the society. Medical treatment in the form of daily administered eyedrops is still in most instances the first line of treatment. However, poor adherence and side effects significantly influence the efficacy of this approach. Alternative approaches in the form of laser treatments or implantation of sustained delivery devices may overcome the obstacle of poor adherence and have been proven to be beneficial for some categories of the disease. Furthermore, surgical options that are less invasive and therefore safer have emerged to bridge the gap between medical/laser treatment and traditional filtration surgery, which is certainly effective but associated with complications and is therefore reserved for more advanced disease.

The aim of this topic is through incorporating several articles pertinent to the diagnosis and treatment of glaucoma to update the readers regarding the several diagnostic tools that have been added to our armamentarium and the newer treatment options that are at our disposal. The scope of this Special Issue is not limited only to review articles. Papers that address a single diagnostic tool or therapeutic intervention are welcome as long as the discussion part of the paper provides a comprehensive overview of similar modalities and explains where these fit in the diagnostic or therapeutic algorithm.

Dr. Stylianos Kandarakis
Dr. Eythimios Karmiris
Dr. Sotiria Palioura
Dr. Theodoros Filippopoulos
Topic Editors

Keywords

Participating Journals

Journal Name	Impact Factor	CiteScore	Launched Year	First Decision (median)	APC
Biomedicines biomedicines	4.7	3.7	2013	15.4 Days	CHF 2600
Journal of Clinical & Translational Ophthalmology jcto	-	-	2023	15.0 days *	CHF 1000
Journal of Clinical Medicine jcm	3.9	5.4	2012	17.9 Days	CHF 2600
Medicina medicina	2.6	3.6	1920	19.6 Days	CHF 1800
International Journal of Environmental Research and Public Health ijerph	-	5.4	2004	29.6 Days	CHF 2500

* Median value for all MDPI journals in the second half of 2023.

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Published Papers (10 papers)

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7 pages, 451 KiB  

Open AccessBrief Report

An Exploratory Retrospective Data Analysis Comparing the Outcomes of Selective Laser Trabeculoplasty and Argon Laser Trabeculoplasty in Patients with Open-Angle Glaucoma or Ocular Hypertension in Vienna, Austria, from the Year 2012 to 2022

by Doreen Schmidl, Nikolaus Hommer and Anton Hommer

Medicina 2023, 59(12), 2075; https://doi.org/10.3390/medicina59122075 - 24 Nov 2023

Viewed by 908

Abstract

Background and Objectives: The aim of the present study was to compare the short-term outcomes of selective laser trabeculoplasty (SLT) with argon laser trabeculoplasty (ALT) in patients with glaucoma in a real-world setting. Materials and Methods: The present study was conducted [...] Read more.

Background and Objectives: The aim of the present study was to compare the short-term outcomes of selective laser trabeculoplasty (SLT) with argon laser trabeculoplasty (ALT) in patients with glaucoma in a real-world setting. Materials and Methods: The present study was conducted as a retrospective case–control study. The main outcome was the change in intraocular pressure (IOP) three months after laser surgery. In addition, the number of substances used for lowering of IOP and adverse events (AEs) were assessed. Results: Charts from 25 patients were included in the present study, of which 12 had received ALT and 13 SLT. In both groups, IOP significantly decreased from baseline values 6 weeks and 3 months after laser treatment (p < 0.01 vs. baseline at each timepoint for both groups). While after 6 weeks, no difference between groups was found, after 3 months, the decrease in IOP was significantly more pronounced in the SLT group (−26 ± 21% in the ALT group vs. −41 ± 14% in the SLT group, p = 0.018 between groups, ANOVA). Three months after laser treatment, the number of IOP-lowering substances used by each patient had decreased with no difference between groups (ALT: from 2.7 ± 0.8 to 2.3 ± 0.9 substances; SLT: from 1.8 ± 1.2 to 1.3 ± 1.1 substances, p = 0.386). Only a few AEs were observed. Two patients in the ALT and one patient in the SLT group required trabeculectomy within 1 year after laser treatment due to IOP decompensation. Conclusions: In the present study, SLT was at least as effective as ALT with fewer AEs and a similar reduction in concomitant IOP-lowering medication. Full article

(This article belongs to the Topic An Update on the Diagnosis and Management Options of Glaucoma)

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10 pages, 683 KiB  

Open AccessArticle

Particular Anatomy of the Hyperopic Eye and Potential Clinical Implications

by Maria-Cristina Marinescu, Dana-Margareta-Cornelia Dascalescu, Mihaela-Monica Constantin, Valeria Coviltir, Vasile Potop, Dan Stanila, Farah Constantin, Cristina Alexandrescu, Radu-Constantin Ciuluvica and Liliana-Mary Voinea

Medicina 2023, 59(9), 1660; https://doi.org/10.3390/medicina59091660 - 14 Sep 2023

Viewed by 803

Abstract

Background and Objectives: Hyperopia is a refractive error which affects cognitive and social development if uncorrected and raises the risk of primary angle-closure glaucoma (PACG). Materials and Methods: The study included only the right eye—40 hyperopic eyes in the study group [...] Read more.

Background and Objectives: Hyperopia is a refractive error which affects cognitive and social development if uncorrected and raises the risk of primary angle-closure glaucoma (PACG). Materials and Methods: The study included only the right eye—40 hyperopic eyes in the study group (spherical equivalent (SE) under pharmacological cycloplegia over 0.50 D), 34 emmetropic eyes in the control group (SE between −0.50 D and +0.50 D). A complete ophthalmological evaluation was performed, including autorefractometry to measure SE, and additionally we performed Ocular Response Analyser: Corneal Hysteresis (CH), Corneal Resistance Factor (CRF); specular microscopy: Endothelial cell density (CD), Cell variability (CV), Hexagonality (Hex), Aladdin biometry: Anterior Chamber Depth (ACD), Axial Length (AL), Central Corneal Thickness (CCT). IBM SPSS 26 was used for statistical analysis. Results: The mean age of the entire cohort was 22.93 years (SD ± 12.069), 66.22% being female and 33.78% male. The hyperopic eyes had significantly lower AL, ACD, higher SE, CH, CRF. In the hyperopia group, there are significant, negative correlations between CH and AL (r −0.335), CRF and AL (r −0.334), SE–AL (r −0.593), ACD and CV (r −0.528), CV and CRF (r −0.438), CH (r −0.379), and positive correlations between CCT and CH (r 0.393) or CRF (r 0.435), CD and ACD (r 0.509) or CH (0.384). Age is significantly, negatively correlated with ACD (r −0.447), CH (r −0.544), CRF (r −0.539), CD (r −0.546) and positively with CV (r 0.470). Conclusions: Our study suggests a particular biomechanical behavior of the cornea in hyperopia, in relation with morphological and endothelial parameters. Moreover, the negative correlation between age and ACD suggests a shallower anterior chamber as patients age, increasing the risk for PACG. Full article

(This article belongs to the Topic An Update on the Diagnosis and Management Options of Glaucoma)

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11 pages, 532 KiB  

Open AccessArticle

Importance of Pattern Standard Deviation of Humphrey 10-2 Visual Field to Evaluate Central Visual Function in Patients with Early-Stage Glaucoma

by Hee Jong Shin, Si Eun Oh, Chan Kee Park and Hae-Young Lopilly Park

J. Clin. Med. 2023, 12(15), 5091; https://doi.org/10.3390/jcm12155091 - 02 Aug 2023

Viewed by 948

Abstract

To explore various parameters that can evaluate the central visual impairment in patients with early-stage glaucoma, we included patients into a study with central visual impairments with an MD value greater than −6.0 dB on the 24-2 VF test. A possible association between [...] Read more.

To explore various parameters that can evaluate the central visual impairment in patients with early-stage glaucoma, we included patients into a study with central visual impairments with an MD value greater than −6.0 dB on the 24-2 VF test. A possible association between structural parameters acquired by OCT and functional parameters of VF and PERG was determined. A total of 70 eyes of patients with suspected glaucoma or NTG underwent VF, OCT, and PERG examinations. The patients were classified into two groups according to the MD of the 24-2 VF test. We used Pearson correlation analysis to evaluate the relationships between GCIPL thickness/RNFL thickness and visual functional parameters, such as PERG and perimetry. Linear regression analyses were conducted to evaluate the significant factors affecting the PSD of VF 10-2. In the low MD group, the P50 amplitude presented significant correlations (r = 0.346, p = 0.048) with GCIPL thickness. In the correlation analysis of the high MD group, it was found that only the PSD of 10-2 uniquely presented borderline significant correlations with GCIPL thickness (r = −0.327, p = 0.055), and no other functional parameter showed significant correlation. Univariate and multivariate analyses revealed that GCIPL thickness was significantly associated with a PSD of 10-2 VF (p < 0.001 and 0.013, respectively). Among various parameters, the P50 amplitude and 10-2 PSD demonstrated statistically borderline significant structure-function relationships with GCIPL thickness in early-stage glaucoma. Full article

(This article belongs to the Topic An Update on the Diagnosis and Management Options of Glaucoma)

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9 pages, 918 KiB  

Open AccessReview

Pseudoexfoliation Syndrome—Clinical Characteristics of Most Common Cause of Secondary Glaucoma

by Martyna Tomczyk-Socha, Wojciech Tomczak, Weronika Winkler-Lach and Anna Turno-Kręcicka

J. Clin. Med. 2023, 12(10), 3580; https://doi.org/10.3390/jcm12103580 - 21 May 2023

Cited by 2 | Viewed by 2562

Abstract

Pseudoexfoliation syndrome (XFS) is a condition in which excess material builds up not only in the structures of the anterior chamber but also throughout the body. The frequency of the syndrome varies significantly (0.3–18%) depending on the region and the method of examination. [...] Read more.

Pseudoexfoliation syndrome (XFS) is a condition in which excess material builds up not only in the structures of the anterior chamber but also throughout the body. The frequency of the syndrome varies significantly (0.3–18%) depending on the region and the method of examination. Environmental risk factors for XFS include a large number of sunny days, proximity to the equator, dietary factors such as higher consumption of coffee and tea, long-term alcohol consumption, exposure to UV, and outdoor work. The pathognomonic sign of XFS is the presence of white material on the lens capsule and other anterior chamber components. In addition, a characteristic Sampaolesi line can be observed during gonioscopy. Systemic alterations indicative of XFS have been observed in the extracellular matrix of the eyelid skin, the heart, lungs, liver, kidneys, gallbladder, meninges, and endothelium of the blood vessels. XFS is the most common cause of secondary open-angle glaucoma, which is called pseudoexfoliative glaucoma and is more severe than primary open-angle glaucoma. It is plausible that a combination of environmental factors and genetic alterations promotes the onset of pseudoexfoliation syndrome, which requires additional research. Full article

(This article belongs to the Topic An Update on the Diagnosis and Management Options of Glaucoma)

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11 pages, 1175 KiB  

Open AccessArticle

Posture-Induced Intraocular Pressure Changes after iStent Inject W Combined with Phacoemulsification in Open Angle Glaucoma Patients

by Kentaro Iwasaki, Shogo Arimura, Yusuke Orii and Masaru Inatani

Medicina 2023, 59(3), 423; https://doi.org/10.3390/medicina59030423 - 21 Feb 2023

Viewed by 1391

Abstract

Background and Objectives: The purpose of this study was to evaluate the posture-induced intraocular pressure (IOP) changes after iStent inject W combined with phacoemulsification procedure in Japanese patients with open-angle glaucoma. Materials and Methods: We prospectively evaluated the posture-induced IOP changes [...] Read more.

Background and Objectives: The purpose of this study was to evaluate the posture-induced intraocular pressure (IOP) changes after iStent inject W combined with phacoemulsification procedure in Japanese patients with open-angle glaucoma. Materials and Methods: We prospectively evaluated the posture-induced IOP changes after surgery. The primary outcome was the posture-induced IOP changes postoperatively. Secondary outcome measures included postoperative complications, visual acuity, visual field, and corneal endothelial cell density. Results: This study completed the prospective observation for 15 eyes (15 patients). The mean preoperative IOP with the Goldmann applanation tonometer was 16.0 ± 2.6 mm Hg with a mean glaucoma medication usage of 2.5 ± 1.2, which decreased to 14.4 ± 2.4 mm Hg (p = 0.14) and 0.5 ± 0.9 medications (p < 0.01), respectively, 12 months postoperatively. The mean baseline IOP with the ICare was 12.0 ± 2.7 mmHg in the sitting position, which significantly increased to 15.2 ± 3.8 mmHg in the lateral decubitus position (p < 0.01). This postural IOP difference was 3.2 ± 2.2 mmHg and 3.2 ± 2.4 mmHg at baseline and 12 months postoperatively, respectively, with no significant changes (p > 0.99). Conclusions: iStent inject W combined with cataract surgery reduced the IOP and the number of glaucoma medications during short-term follow-ups with high safety. However, iStent inject W did not affect the degree of posture-induced IOP changes. Full article

(This article belongs to the Topic An Update on the Diagnosis and Management Options of Glaucoma)

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19 pages, 1992 KiB  

Open AccessArticle

Survival of Visual Function in Patients with Advanced Glaucoma after Standard Guarded Trabeculectomy with MMC

by Theodoros Filippopoulos, Dimitrios Tsoukanas, Stylianos A. Kandarakis, Angeliki Salonikiou, Michalis Georgiou and Fotis Topouzis

J. Clin. Med. 2023, 12(4), 1639; https://doi.org/10.3390/jcm12041639 - 18 Feb 2023

Cited by 1 | Viewed by 1396

Abstract

Surgical intervention in patients with severe glaucoma remains controversial, especially in unilateral cases with a minimally affected fellow eye. Many question the benefit of trabeculectomy in such cases due to high complication rates and prolonged recovery. In this retrospective, non-comparative, interventional case series [...] Read more.

Surgical intervention in patients with severe glaucoma remains controversial, especially in unilateral cases with a minimally affected fellow eye. Many question the benefit of trabeculectomy in such cases due to high complication rates and prolonged recovery. In this retrospective, non-comparative, interventional case series we aimed to determine the effect of trabeculectomy or combined phaco-trabeculectomy on the visual function of advanced glaucoma patients. Consecutive cases with perimetric mean deviation loss worse than −20 dB were included. Survival of visual function according to five predetermined visual acuity and perimetric criteria was set as the primary outcome. Qualified surgical success utilizing two different sets of criteria commonly used in the literature constituted secondary outcomes. Forty eyes with average baseline visual field mean deviation −26.3 ± 4.1 dB were identified. The average pre-operative intraocular pressure was 26.5 ± 11.4 mmHg and decreased to 11.4 ± 4.0 mmHg (p < 0.001) after an average follow-up of 23.3 ± 15.5 months. Visual function was preserved at two years in 77% or 66% of eyes respectively according to two different sets of visual acuity and perimetric criteria. Qualified surgical success was 89%, 72% at 1 and 3 years respectively. Trabeculectomy and/or phaco-trabeculectomy is associated with meaningful visual outcomes in patients with uncontrolled advanced glaucoma. Full article

(This article belongs to the Topic An Update on the Diagnosis and Management Options of Glaucoma)

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11 pages, 1753 KiB  

Open AccessArticle

The Effect of the Water Drinking Test on Ocular Parameters and Choroidal Thickness in Glaucoma Suspects

by Stylianos A Kandarakis, Andreas Katsimpris, Persefoni Kourti, Filippos Psinakis, Efthymios Karmiris, Evangelia Papakonstantinou, Konstantinos Andreanos, Petros Petrou and Ilias Georgalas

Medicina 2023, 59(2), 381; https://doi.org/10.3390/medicina59020381 - 16 Feb 2023

Cited by 1 | Viewed by 1486

Abstract

Background and objectives: We aimed to evaluate the effects of the water drinking test (WDT) on several systemic and ocular parameters, including choroidal thickness, which was assessed through optical coherence tomography angiography (OCTA), in glaucoma suspects. Materials and Methods: A total [...] Read more.

Background and objectives: We aimed to evaluate the effects of the water drinking test (WDT) on several systemic and ocular parameters, including choroidal thickness, which was assessed through optical coherence tomography angiography (OCTA), in glaucoma suspects. Materials and Methods: A total of 40 eyes from 20 glaucoma suspects without any systemic or ocular diseases were included in this prospective observational study. All the participants undertook the WDT, which required the drinking of 1 L of table water in 5 min. The outcome measures included IOP, systolic and diastolic blood pressure (SBP and DBP), mean arterial pressure (MAP), mean ocular perfusion pressure (MOPP), ocular pulse amplitude (OPA), and subfoveal and peripapillary choroidal thickness, which were assessed at baseline and at four 15 min intervals after the WDT. Generalized least squares models and mixed model analyses that take into account repeated measurements were used to assess the changes over time of these parameters. Results: All the ocular and systemic parameters showed statistically significant changes at all time points compared to baseline apart from choroidal thickness. The peak changes were an IOP of 20.1 mmHg versus 17.3 mmHg at 45 min, an SBP of 137.6 mmHg versus 125 mmHg at 30 min, a DBP of 95.9 mmHg versus 85.7 mmHg at 15 min, and an MOP of 53.51 mmHg versus 48.89 mmHg at 15 min. Conclusions: Despite elevations in IOP and significant changes in all the assessed systemic parameters, the WDT was not associated with changes in choroidal thickness in glaucoma suspects. Full article

(This article belongs to the Topic An Update on the Diagnosis and Management Options of Glaucoma)

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14 pages, 2784 KiB  

Open AccessReview

A Review of Neovascular Glaucoma: Etiology, Pathogenesis, Diagnosis, and Treatment

by Danielė Urbonavičiūtė, Dovilė Buteikienė and Ingrida Janulevičienė

Medicina 2022, 58(12), 1870; https://doi.org/10.3390/medicina58121870 - 18 Dec 2022

Cited by 5 | Viewed by 4815

Abstract

Neovascular glaucoma (NVG) is a rare, aggressive, blinding secondary glaucoma, which is characterized by neovascularization of the anterior segment of the eye and leading to elevation of the intraocular pressure (IOP). The main etiological factor is retinal ischemia leading to an impaired homeostatic [...] Read more.

Neovascular glaucoma (NVG) is a rare, aggressive, blinding secondary glaucoma, which is characterized by neovascularization of the anterior segment of the eye and leading to elevation of the intraocular pressure (IOP). The main etiological factor is retinal ischemia leading to an impaired homeostatic balance between the angiogenic and antiangiogenic factors. High concentrations of vasogenic substances such as vascular endothelial growth factor (VEGF) induce neovascularization of the iris (NVI) and neovascularization of the angle (NVA) that limits the outflow of aqueous humor from the anterior chamber and increases the IOP. NVG clinical, if untreated, progresses from secondary open-angle glaucoma to angle-closure glaucoma, leading to irreversible blindness. It is an urgent ophthalmic condition; early diagnosis and treatment are necessary to preserve vision and prevent eye loss. The management of NVG requires the cooperation of retinal and glaucoma specialists. The treatment of NVG includes both control of the underlying disease and management of IOP. The main goal is the prevention of angle-closure glaucoma by combining panretinal photocoagulation (PRP) and antiangiogenic therapy. The aim of this review is to summarize the current available knowledge about the etiology, pathogenesis, and symptoms of NVG and determine the most effective treatment methods. Full article

(This article belongs to the Topic An Update on the Diagnosis and Management Options of Glaucoma)

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8 pages, 304 KiB  

Open AccessArticle

A-Scan Parameters and the Risk of Phacomorphic Glaucoma in the Kazakh Population

by Farida Erkulovna Zhumageldiyeva, Zaure Dzhumataeva, Daniyar Dauletbekov, Marat Suleymenov, Zauresh Utelbayeva, Zhanar Meyermanova and Tynyskul Teleuova

Medicina 2022, 58(11), 1544; https://doi.org/10.3390/medicina58111544 - 28 Oct 2022

Viewed by 1244

Abstract

Background and Objectives: The aim of our study was to identify risk factors associated with phacomorphic glaucoma (PG) by comparing the biometric parameters of contralateral eyes of patients with PG with the eyes of patients with a mature cataract. Methods: This retrospective [...] Read more.

Background and Objectives: The aim of our study was to identify risk factors associated with phacomorphic glaucoma (PG) by comparing the biometric parameters of contralateral eyes of patients with PG with the eyes of patients with a mature cataract. Methods: This retrospective case–control study included 71 eyes affected with PG, 311 eyes of control participants, and 71 contralateral eyes of patients with PG. All participants were ethnically Kazakh. Axial lengths (AL), anterior chamber depths (ACD), and lens thicknesses (LT) were measured using A-scan ultrasound biometry. To determine the threshold value of the A-scan parameters associated with PG, we performed ROC analysis. Results: The eyes with PG had smaller AL and ACD values and larger LT values, followed by the fellow eyes with PG and the control eyes. There were no differences in age and sex between patients with PG and mature cataracts. After adjustment for age and other A-scan parameters, continuous measures of ACD and LT were associated with PG (OR 0.57, 95% CI 0.38–0.73, p < 0.001; OR 3.36, 95% CI 1.64–6.912, p = 0.001). When A-scan parameters were dichotomized according to the identified threshold, an ACD of less than 2.5 mm (OR 3.113, 95% CI 1.562–6.204, p = 0.001) and an LT thicker than 4.75 mm (OR 26.368, 95% CI 9.130–76.158, p < 0.001) were found to be related to PG. Conclusions: We found that a thicker lens and, possibly, a shallow ACD are risk factors for PG. Full article

(This article belongs to the Topic An Update on the Diagnosis and Management Options of Glaucoma)

8 pages, 251 KiB  

Open AccessArticle

Cognitive Performance on the Montreal Cognitive Assessment Test and Retinal Structural and Functional Measures in Glaucoma

by Solmaz Bastani Viarsagh, Min Er Zhang, Sahar Shariflou, Ashish Agar and S. Mojtaba Golzan

J. Clin. Med. 2022, 11(17), 5097; https://doi.org/10.3390/jcm11175097 - 30 Aug 2022

Cited by 1 | Viewed by 1190

Abstract

Background: Glaucoma, the leading cause of irreversible blindness, is classified as a neurodegenerative disease, and its incidence increases with age. Pathophysiological changes, such as the deposition of amyloid-beta plaques in the retinal ganglion cell layer, as well as neuropsychological changes, including cognitive decline, [...] Read more.

Background: Glaucoma, the leading cause of irreversible blindness, is classified as a neurodegenerative disease, and its incidence increases with age. Pathophysiological changes, such as the deposition of amyloid-beta plaques in the retinal ganglion cell layer, as well as neuropsychological changes, including cognitive decline, have been reported in glaucoma. However, the association between cognitive ability and retinal functional and structural measures in glaucoma, particularly glaucoma subtypes, has not been studied. We studied the association between cognitive ability and the visual field reliability indices as well as the retinal ganglion cell (RGC) count estimates in a cohort of glaucoma patients. Methods: A total of 95 eyes from 61 glaucoma patients were included. From these, 20 were normal-tension glaucoma (NTG), 25 were primary open-angle glaucoma (POAG), and 16 were glaucoma suspects. All the participants had a computerised Humphrey visual field (HVF) assessment and optical coherence tomography (OCT) scan and were administered the written Montreal Cognitive Assessment (MoCA) test. RGC count estimates were derived based on established formulas using the HVF and OCT results. A MoCA cut-off score of 25 and less was designated as cognitive impairment. Student’s t-test was used to assess differences between the groups. The Pearson correlation coefficient was used to assess the association between MoCA scores and retinal structural and functional measures. Results: Significant associations were found between MoCA scores and the false-negative and pattern standard deviation indices recorded on the HVF (r = −0.19, r = −0.22, p < 0.05). The mean IOP was significantly lower in the cognitively impaired group (i.e., MOCA ≤ 25) (13.7 ± 3.6 vs. 15.7 ± 4.5, p < 0.05). No significant association was found between RGC count estimates and MoCA scores. Analysis of these parameters in individual glaucoma subtypes did not reveal any group-specific significant associations either. Full article

(This article belongs to the Topic An Update on the Diagnosis and Management Options of Glaucoma)

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