New Developments in Glaucoma Diagnostics and Therapeutics

Background: To evaluate the association between glaucomatous visual field loss and self-reported driving limitation, and to explore potential threshold ranges of visual field loss associated with an increased likelihood of driving restriction. Methods: In this cross-sectional study, 100 patients with primary open-angle glaucoma underwent standard automated perimetry. Visual function was assessed using Mean Deviation (MD) and Visual Field Index (VFI) from the better eye. Driving status, driving limitation, and self-reported driving difficulties were assessed using a structured questionnaire. Multivariable logistic regression was performed to determine independent associations between visual field parameters and driving limitation, adjusting for age, sex, cataract status, and systemic comorbidities. Because MD and VFI are closely related indices of visual field loss, separate multivariable models were constructed for each parameter. Receiver operating characteristic (ROC) analysis was used to explore threshold values associated with driving limitation. Results: Driving limitation increased progressively with worsening functional severity, affecting 17% of participants with preserved function, 48% of those with borderline impairment, and 72% of those with definite impairment (p < 0.001). Reduced VFI was independently associated with driving limitation (OR = 0.972, 95% CI: 0.948–0.996; p = 0.021). In a separate model, more negative MD was also independently associated with driving limitation (OR = 0.924, 95% CI: 0.875–0.976; p = 0.004). Male sex was associated with a lower likelihood of driving limitation. ROC analysis identified threshold values of VFI ≤ 71% (AUC = 0.663) and MD ≤ −13.36 dB (AUC = 0.650), both characterized by high specificity but limited sensitivity. Participants who had ceased driving demonstrated worse visual field indices than active drivers, whereas never-drivers showed no consistent association with visual field loss. Conclusions: Glaucomatous visual field loss was significantly associated with self-reported driving limitation and behavioural self-regulation. Objective perimetric parameters, particularly VFI and MD in the better eye, may help identify patients more likely to report driving difficulties. The reported threshold values should be interpreted as exploratory reference points rather than clinically actionable criteria and require further validation before clinical application. Full article

Background and Objectives: Primary open-angle glaucoma (POAG) is one of the leading ocular diseases leading to irreversible blindness and is often asymptomatic until advanced cases. While intraocular pressure reduction remains the cornerstone of treatment, neuroprotective strategies targeting retinal ganglion cell metabolism are actively investigated. Niacinamide (nicotinamide, vitamin B3), a precursor of NAD+, has shown neuroprotective potential in preclinical models. This exploratory study evaluated the short-term functional, structural, and electrophysiological effects of oral niacinamide supplementation in POAG. Materials and Methods: In this interventional study, patients with POAG received oral niacinamide 500 mg daily for six months. Visual field (VF) global and localized sensitivity (Mean Deviation [MD], Pattern Standard Deviation [PSD]), Optic Coherence Tomography (OCT)-derived peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC), and Visual evoked potentials (VEP) latency parameters (P2 1.4 Hz, P100 1°, and P100 15′) were assessed at baseline and at six months. Because both eyes from some participants were included, primary longitudinal inference was based on clustered analyses using generalized estimating equations and linear mixed-effects models to account for inter-eye correlation. Eye-level paired analyses were used for exploratory comparison. Change–change relationships across modalities were explored using Spearman correlation. Results: After accounting for inter-eye correlation, no statistically significant change in MD was detected (mean ΔMD +0.43 dB; GEE p = 0.099; LME p = 0.101), and PSD remained stable. RNFL thickness showed a small decrease (−1.26 µm; GEE p = 0.046), while GCC did not change significantly. VEP P100 latencies remained stable, whereas P2 latency showed a small increase (+3.9 ms; GEE p = 0.039). Correlation analysis revealed a moderate association between changes in GCC and MD (ρ = 0.44), suggesting concordance between macular structural stability and global visual field performance. Conclusions: When inter-eye correlation is appropriately accounted for, six months of niacinamide supplementation in POAG is associated with overall functional, structural, and electrophysiological stability, without evidence of clinically meaningful improvement or progression. These findings support short-term safety and highlight the importance of clustered analytical approaches and macular-centered biomarkers in future glaucoma neuroprotection trials. Full article