Repeatability of Online Circular Contrast Perimetry Compared to Standard Automated Perimetry.

PRCIS: Online circular contrast perimetry provides visual field assessment on any computer or tablet with no extra hardware. It has good test repeatability and reliability that is comparable with standard automated perimetry. It holds promise for use in disease screening and surveillance to expand the provision of glaucoma care. PURPOSE: To evaluate the repeatability of online circular contrast perimetry (OCCP) compared to standard automated perimetry (SAP) in normal participants and patients with stable glaucoma over 18 weeks. METHODS: Thirty-six participants (13 normal controls and 23 patients with open angle glaucoma) were recruited. OCCP and SAP perimetry tests were performed twice at baseline, then at 6, 12, and 18 weeks. Global perimetric indices were compared between perimetry types and analyzed for short-term and intermediate-term repeatability. RESULTS: There were no statistically significant changes over time for both OCCP and SAP across all groups for mean deviation (MD), pattern standard deviation, and visual index/visual field index ( P >0.05). Test-retest intraclass correlation coefficients (ICCs) for OCCP MD were excellent at baseline (0.98, 95% CI: 0.89-0.99) and good at 18 weeks (0.88, 95% CI: 0.51-0.98). SAP test-retest ICCs were excellent at baseline (0.94, 95% CI: 0.70-0.99) and 18 weeks (0.97, 95% CI: 0.84-0.99). Inter-test ICCs were good, ranging from 0.84 to 0.87. OCCP testing time was shorter than SAP (5:29 ± 1:24 vs. 6:00 ± 1:05, P <0.001). OCCP had similar false-positive (3.84 ± 3.32 vs. 3.66 ± 4.53, P =0.48) but lower false-negative (0.73 ± 1.52 vs. 4.48 ± 5.00, P <0.001) and fixation loss responses (0.91 ± 1.32 vs. 2.02 ± 2.17, P <0.001). CONCLUSIONS: OCCP allows visual field assessment on any computer screen with no additional hardware. It demonstrated good repeatability and reliability with similar performance indices to SAP in both the short term and intermediate term. OCCP has the potential to be utilized as a glaucoma screening and surveillance tool for in-clinic and at-home testing, expanding the provision of care.

Online Circular Contrast Perimetry via a Web-Application: Establishing a Normative Database for Central 10-Degree Perimetry.

Purpose: To establish a normative database using a central 10-degree grid pattern for the online circular contrast perimetry (OCCP) application. Participants: Fifty participants with mean age 65 ± 13 years were selected for this study. One eye from each participant that met inclusion criteria was randomly included in the cohort. Methods: The web-application delivered online 52-loci perimetry in a central 10-degree pattern using circular flickering targets. These targets consist of concentric sinusoidal alternating contrast rings. Users were guided by the application to the correct viewing distance and head position using in-built blind spot localization and webcam monitoring. A spinning golden star was used as the fixation target and patients performed the test in a darkened room following standard automated perimetry (SAP). Results: The reliability rates and global indices for OCCP were similar to SAP. OCCP mean sensitivity reduced with age at a similar rate to SAP. Mean sensitivity per loci of 10-degree OCCP was greater than SAP by 1.24 log units (95% CI 1.23 to 1.26) and obeyed a physiological hill of vision. Small differences existed in mean sensitivities between OCCP and SAP which increased with increasing spot eccentricity. Mean deviation (MD) displayed good agreement between the two tests. Conclusion: Central 10-degree online circular contrast perimetry via a computer-based application has comparable perimetric results to standard automated perimetry in a normal cohort.

Characterising the diagnosis of genetic maculopathies in a real-world private tertiary retinal practice in Australia: protocol for a retrospective clinical audit.

PURPOSE: Accurate diagnosis of macular atrophy is paramount to enable appropriate treatment when novel treatments for geographic atrophy and macular dystrophies become available. Genetic testing is useful in distinguishing between the two conditions but is not feasible for the majority of patients in real-world clinical practice. Therefore, we aimed to investigate the potential misdiagnosis of inherited macular dystrophy as age-related macular degeneration (AMD) in real-world ophthalmic practice to assist in the development of guidelines to improve diagnostic accuracy while minimizing genetic testing for targeted patients. METHODS: Retrospective review of the medical records of patients diagnosed with AMD, which included imaging, between 1995 and 2023 from a large multidisciplinary private ophthalmic practice in Australia. We will use a stepwise method to screen for probable cases of macular dystrophy, followed by a consensus review by an expert panel. The outcomes are (1) to determine the potential misdiagnosis rate of macular dystrophy as atrophic AMD by retinal specialists and general ophthalmologists; (2) to identify clinical imaging modalities that are most useful for differentiating macular dystrophy from atrophic AMD; and (3) to establish preliminary guidance for clinicians to improve the diagnosis of macular atrophy from AMD in practice, and thereby target cost-efficient genetic testing. DISCUSSION: Improving the diagnostic accuracy of both AMD and macular dystrophy, while ensuring cost-efficient genetic testing, will improve the targeted treatment of macular diseases when emerging treatments become available.

Online Circular Contrast Perimetry: A Comparison to Standard Automated Perimetry.

PURPOSE: The aim was to validate and compare the diagnostic accuracy of a novel 24-degree, 52-loci online circular contrast perimetry (OCCP) application to standard automated perimetry (SAP). DESIGN: Prospective cohort study. METHODS: Two hundred and twenty participants (125 normal controls, 95 open angle glaucoma patients) were included. Agreement, correlation, sensitivity, specificity, and area under receiver operating curves (AUC) were compared for parameters of OCCP, SAP, and optical coherence tomography (OCT) for the retinal nerve fiber layer and macular ganglion cell complex inner plexiform layer. RESULTS: Pointwise sensitivity for OCCP was greater than SAP by 1.02 log units (95% CI: 0.95-1.08); 95% limits of agreement 0.860 to 1.17. Correlation and agreement for global indices and regional zones between OCCP and SAP were strong. OCCP mean deviation (MD) AUC was 0.885±0.08, similar to other instruments' parameters with the highest AUC: SAP MD (0.851±0.08), OCT retinal nerve fiber layer inferior thickness (0.908±0.07), OCT ganglion cell complex inner plexiform layer inferior thickness (0.849±0.08), P>0.05. At best cutoff, OCCP MD sensitivity/specificity were comparable to SAP MD (90/74 vs 94/65%). CONCLUSIONS: OCCP demonstrates similar perimetric sensitivities to SAP and similar AUC to SAP and OCT in distinguishing glaucoma patients from controls. OCCP holds promise as a glaucoma surveillance and screening tool, with the potential to be utilized for in-clinic and at-home perimetry and expand community testing.

Online circular contrast perimetry via a web-application: optimising parameters and establishing a normative database.

PURPOSE: To establish a normative database and optimise parameters for personal-computer based perimetry via a web-application using circular contrast targets. METHODS: Online 24-degree 52-loci perimetry was delivered through a web-application using circular flickering contrast targets. Embedding contrast differentials within targets allows calculation of relative decibel (rdB) per 256-bit greyscale level differential. Target light-band maximum brightness colour was fixed, while the dark-band varied to achieve the desired rdB level. A staircase system was used with two reversals ranging from 0 to 36 rdB levels. Blind spot localisation at the start of the test was used to optimise viewing distance and subsequently count fixation losses. Gaze was maintained on a spinning golden star which moves mid-test to maximise sampling area. Patients performed the test to each eye separately using a computer in a darkened room at 40-45 cm. RESULTS: 158 eyes of 101 patients completed the Online Circular Contrast Perimetry (OCCP) test. Mean age was 62.9 ± 14.3 years old. Mean sensitivity reduced with age, at 1.0 relative decibel per decade. Mean sensitivity per locus correlated with standard automated perimetry (SAP) in a physiological hill of vision, with an average difference of 4.02 decibels (95% confidence interval (CI) = 3.77-4.27, p < 0.001) and good agreement between tests. CONCLUSIONS: Online circular contract perimetry provides accurate perimetric testing with comparable results to standard automated perimetry.

Circular Contrast Perimetry via Web Application: A Patient Appraisal and Comparison to Standard Automated Perimetry.

Purpose: The purpose of the study was to compare a novel, 24°, 52-locus online circular contrast perimetry (OCCP) application against standard automated perimetry (SAP) in terms of both diagnostic accuracy and patient attitudes. Design: This was a cross-sectional study. Subjects: Ninety-five participants (42 controls and 53 open-angle glaucoma patients) were included. Methods: Participants performed both perimetry tests and then completed an online survey. Subjective feedback responses were collected. Main Outcome Measures: Agreement, sensitivity, specificity, and area under receiver operating curves (AUCs) were compared for the parameters of OCCP, SAP, and OCT for the retinal nerve fiber layer (RNFL) and macular ganglion cell complex inner plexiform layer (GCC + IPL). Participant attitudes toward the OCCP test versus the SAP test, in both glaucoma patients and controls, were compared. Rasch analysis assessed the psychometric properties of the survey and intergroup variability. Results: The AUC for OCCP mean deviation (MD) was 0.959 ± 0.02. Compared with other instruments' parameters with the highest AUC, it was superior to SAP MD (0.871 ± 0.04, P = 0.03) and OCT GCC + IPL (0.871 ± 0.04, P = 0.03) and similar to OCT RNFL inferior thickness (IT) (0.917 ± 0.03, no significance). Online circular contrast perimetry pointwise sensitivity was less than SAP by 4.30 dB (95% confidence interval = 4.02-4.59); 95% limits of agreement ranged from -6.28 to -2.33 dB. At the best cutoff, the OCCP MD had a sensitivity of 98% and specificity of 85% for detecting glaucoma. Cohen's kappa demonstrated good agreement with SAP MD (0.69) and OCT RNFL IT (0.62) and moderate agreement with OCT GCC + IPL IT (0.57). Participants preferred OCCP across most survey parameters (P < 0.0001). Rasch analysis demonstrated no differential item functioning for clinical group, gender, or age. Conclusions: With similar diagnostic metrics to SAP, OCCP offers an improved user experience with the potential to increase the provision of care and improve disease surveillance outcomes.

Multicenter Effectiveness and Disease Stability Through 3 Years After iStentTrabecular Micro-Bypass with Phacoemulsification in Glaucoma and Ocular Hypertension.

Purpose: To evaluate 3-year safety and efficacy of two second-generation trabecular micro-bypass stents. (iStent inject ®) with phacoemulsification. Materials and Methods: This multicenter retrospective study of iStent inject implantation with phacoemulsification included data from eight surgeons across Australia. Eyes with cataract and mild to advanced glaucoma [predominantly primary open-angle (POAG), primary angle closure (PAC), or normal-tension (NTG) glaucoma] or ocular hypertension (OHT) were included. Study assessments included intraocular pressure (IOP); number of ocular hypotensive medications; proportions of eyes with 0, 1, 2, or ≥3 IOP-lowering medications; IOP ≤15 mmHg or ≤18 mmHg; visual fields (VF); retinal nerve fiber layer thickness (RNFL); central corneal thickness (CCT); intraoperative complications; adverse events; and secondary surgeries. Results: A total of 273 eyes underwent surgery and had 36-month follow-up. At 36 months versus preoperative, mean IOP decreased by 15.5% (16.4±4.6 mmHg to 13.9±3.5 mmHg; p<0.001), and 70.3% of eyes achieved IOP of ≤15 mmHg (versus 49.1% preoperatively; p<0.001). The mean medication burden decreased by 68.5% (from 1.51±1.17 to 0.48±0.89 medications; p<0.001); 71.4% of eyes were medication-free (versus 21.6% preoperatively; p<0.001), while 6.2% of eyes were on ≥3 medications (versus 22.3% preoperatively; p<0.001); 96.3% of eyes maintained or reduced medications vs preoperative. Significant IOP and medication reductions occurred across glaucoma subtypes (POAG, PAC, NTG, OHT): 13-22% for IOP (p<0.05 for all) and 42-94% for medication (p<0.05 for all). Favorable safety included few adverse events; stable VF, RNFL, and CCT; and filtering surgery in only 8 eyes (2.9%) over 3 years. Conclusion: In this multicenter cohort from 8 surgeons across Australia, significant IOP and medication reductions were sustained through 3 years after iStent inject implantation with phacoemulsification. Results were favorable across different glaucoma subtypes (including POAG, PAC, NTG, OHT), severities, and surgeons, thereby underscoring the real-world relevance and efficacy of iStent inject implantation for glaucoma treatment.

Psychometric Evaluation of Glaucoma Quality of Life Item Banks (GlauCAT) and Initial Assessment Using Computerized Adaptive Testing.

Purpose: To evaluate the psychometric properties of glaucoma-specific quality of life (QoL) item banks (GlauCAT) and assess their performance using computerized adaptive testing (CAT) simulations. Methods: In this cross-sectional study, 293 participants with glaucoma (mean age ± SD, 70.7 ± 13.2 years; 45% female) answered 342 items in 12 QoL item banks (IBs): Activity Limitation (AL); Driving (DV); Convenience (CV); Economic (EC); Emotional (EM); General Symptoms (GS); Health Concerns (HC); Lighting (LT); Mobility (MB); Ocular Surface Symptoms (OS); Social (SC); and Visual Symptoms (VS). These IBs were assessed using Rasch analysis, and CAT simulations with 1000 simulated respondents were utilized to determine the average number of items to be administered to achieve moderate and high precision levels. Results: The AL, DV, EM, HC, LT, MB, EC, OS, SC, and VS IBs required relatively minor amendments to achieve satisfactory psychometric fit. To resolve multidimensionality, we split CV into Treatment Convenience (TCV) and General Convenience (GCV). Due to poor measurement precision, the GS IB was not pursued further. This resulted in 12 total IBs. In CAT simulations, an average of 3.7 and 7.3 items per IB were required to attain measurement at moderate and high precision, respectively. Conclusions: Following rigorous psychometric assessment, we developed 12 valid glaucoma-specific QoL domains that can obtain highly precise person measure estimates using a small number of items. Translational Relevance: GlauCAT will enable researchers and clinicians to quickly and comprehensively assess the impact of glaucoma and its associated interventions across a range of QoL domains.

Genetic Testing of Inherited Retinal Disease in Australian Private Tertiary Ophthalmology Practice.

Background: To assess the prevalence of genetic testing for inherited retinal diseases (IRDs) in a tertiary practice setting. Methods: Single-centre retrospective analysis of patients with diagnosed or suspected IRD. Results: Four hundred and sixty-four patient records were analysed. Patients had received care for different IRDs grouped as follows: panretinal pigmentary retinopathies (283, 61%), macular dystrophies (136, 29.3%), stationary diseases (23, 5%), hereditary vitreoretinopathies (14, 3%), and other IRDs (8, 1.7%). The suspected pattern of inheritance of patients' IRD was predominantly autosomal recessive (205, 44.2%). Genetic testing was performed with the corresponding results available for 44 patients (9.5%). Diagnostic yield was 65.9% for the results received. Genetic test results were available mostly for younger patients (13.1% for <45 years vs 6.2% ≥45 years of age, p = 0.01) and those who received greater than 12 months of care (16% for ≥12 months vs 4% for <12 months, p < 0.01). For patients without genetic testing results, reasons include awaiting a geneticist consultation (17.9%), awaiting test results (4.5%), or patient refusal (8.4%). Most clinical records (69.2%) did not document genetic testing status. Conclusion: Genetic testing is increasingly being utilised in the work-up for patients with IRD worldwide. This large Australian private practice IRD cohort shows a low uptake of testing (around 10%), reflecting historical management patterns and accessibility of genetic counselling and testing. The results show that younger patients and those with a longer duration of care were more likely to have received genetic testing. As the importance of IRD genetic testing continues to increase, we expect to see a change in patient management within the Australian private ophthalmology system and testing rates to increase. Further research is required to identify and address clinician and patient barriers to improving genetic testing rates for IRD.

Efficient capture of high-quality real-world data on treatments for glaucoma: the Fight Glaucoma Blindness! Registry.

OBJECTIVE: To describe the development and implementation of a web-based high-quality data collection tool to track the outcomes of glaucoma treatments in routine practice. METHODS AND ANALYSIS: This is a prospective observational registry study. An international steering committee undertook an iterative structured process to define a minimum, patient-centred data set designed to track outcomes of glaucoma treatment. The outcomes were coded into a web-based programme allowing easy access for rapid data entry. Clinicians receive personal reports enabling instant audit of their outcomes. Analyses of aggregated anonymised data on real-world outcomes are analysed and periodically reported with the goal of improving patient care. RESULTS: The minimum data set developed by the international steering committee includes the following: a baseline visit captures 13 mandatory fields in order to accurately phenotype each patient's subtype of glaucoma and to allow comparison between services, and a follow-up visit includes only four mandatory fields to allow completion within 30 s.Currently, there are 157 surgeons in 158 ophthalmology practices across Australia and New Zealand who are registered. These surgeons are tracking 5570 eyes of 3001 patients and have recorded 67 074 visits. The median number of eyes per surgeon is 22 eyes with a range of 1-575. The most common glaucoma procedure, excluding cataract surgery, is iStent inject, with 2316 cases. CONCLUSION: This software tool effectively facilitates data collection on safety and efficacy outcomes of treatments for different subgroups of glaucoma within a real-world setting. It provides a template to evaluate new treatments as they are introduced into practice.

Comparison of perimetric Glaucoma Staging Systems in Asians with primary glaucoma.

BACKGROUND: To compare functional staging classifications in Vietnamese patients with primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (PACG). METHODS: A retrospective cross-section study was conducted at a national setting. Two hundred seven eyes of 207 patients were recruited. Patients were tested with standard automated perimetry. Field loss was generally classified in four stages (normal, early, moderate, and severe), using four classification strategies: (1) Hodapp-Parrish-Anderson (HPA), (2) enhanced Glaucoma Staging System (eGSS), (3) modified Glaucoma Staging System (mGSS) and (4) the Advanced Glaucoma Intervention Study (AGIS). AGIS as a standard method was used to judge the staging performance of the other three classifications in terms of agreement (Cohen Kappa-K) and association (Chi-Square Test-Cramer's V). RESULTS: The agreement between AGIS and mGSS (K = 0.687; p < 0.001) and HPA (K = 0.686; p < 0.001) was substantial while that between AGIS and eGSS was slight (K = 0.103; p < 0.001). The association between AGIS and mGSS (V = 0.748; p < 0.001) and HPA (V = 0.748; p < 0.001) was greater than eGSS (V = 0.594; p < 0.001). CONCLUSIONS: MGSS and HPA showed stronger agreement and closer association with AGIS than eGSS. We recommend mGSS should be used in managing a glaucoma clinic because of its simplicity and convenience over HPA and AGIS.

The Computerized Glaucoma Visual Function Test: A Pilot Study Evaluating Computer-Screen Based Tests of Visual Function in Glaucoma.

Purpose: We aimed to develop and evaluate the Computerized Glaucoma Visual Function Test (CoGVFT), among a cohort of glaucoma patients, and identify potential new items to optimize the test. Method: A cross-sectional study involving 84 patients with open-angle glaucoma of varying severity and 18 controls without glaucoma were recruited. Better and worse eye visual field parameters, visual acuity, contrast sensitivity, 6-Part Cognitive Impairment Test (6CIT) and Glaucoma Activity Limitation-9 (GAL-9) questionnaire responses were recorded. The CoGVFT was administered to all participants. Rasch analysis was used to assess the psychometric properties of the CoGVFT, which was then evaluated with criterion, convergent, and divergent validity tests. Regression modeling determined factors predictive of CoGVFT performance. Results: The 38-item CoGVFT demonstrated convergent validity with statistically significant differences in glaucoma severity groups (P < 0.001, analysis of variance). The correlation coefficient for CoGVFT person measures (logits) with GAL-9 person measures (logits) and better eye (BE) mean deviation was 0.528 (P < 0.001) and 0.762 (P < 0.001), respectively, demonstrating convergent validity. Divergent validity was suboptimal as the 6CIT score demonstrated moderate correlation (r = 0.463, P < 0.001) with CoGVFT person measures (logits). Multivariable analysis revealed that better BE contrast sensitivity, lower age, and better BE visual acuity were associated with better CoGVFT performance (P < 0.001). Conclusions: The CoGVFT retains most of the features of its predecessor to estimate vision-based activity limitation related to glaucoma. Translational Relevance: The CoGVFT is an easily accessible tool that can potentially be used in the community to help detect undiagnosed glaucoma in the population.

Two-Year Multicenter Outcomes of iStent inject Trabecular Micro-Bypass Stents Combined with Phacoemulsification in Various Types of Glaucoma and Ocular Hypertension.

PURPOSE: This multicenter study evaluated 2-year effectiveness and safety following implantation of two second-generation trabecular micro-bypass stents (iStent inject ®) with phacoemulsification. MATERIALS AND METHODS: This was a retrospective study of iStent inject implantation with phacoemulsification by nine surgeons across Australia. Eyes had mild to advanced glaucoma (predominantly primary open-angle/POAG, appositional angle-closure/ACG, or normal-tension/NTG) or ocular hypertension (OHT), and cataract. Evaluations included intraocular pressure (IOP); medications; proportions of eyes with 0 or ≥2 medications, reduced/stable medications versus preoperative, and IOP ≤15 mmHg; visual acuity; cup-to-disc ratio (CDR); visual fields (VF); adverse events; and secondary surgery. RESULTS: A total of 340 eyes underwent surgery and had 24-month follow-up data. At 24 months, mean IOP decreased by 16% from 16.4±4.7 mmHg preoperatively to 13.7±3.1 mmHg (p<0.001), and 77% of eyes achieved IOP of ≤15 mmHg versus 49% preoperatively (p<0.001). Mean number of medications decreased by 67% to 0.49±0.95 versus 1.49±1.20 preoperatively (p<0.001), with 74% of eyes medication-free versus 25% preoperatively (p<0.001), and 14% of eyes on ≥2 medications versus 46% preoperatively (p<0.001). Medication burden was reduced or stable in 98% of eyes versus preoperative. Stratified analyses showed significant IOP and medication reductions across glaucoma subtypes (POAG, ACG, NTG, OHT): 13-22% for IOP (p<0.01 for all) and 62-100% for medication (p<0.001 for all). Favorable safety included few adverse events; stable CDR, VF, and visual acuity; and filtering surgery in only 8 eyes (2.4%) over 2 years. CONCLUSION: This 340-eye multicenter dataset provides robust evidence of the safety and efficacy of iStent inject implantation with phacoemulsification, with significant and sustained IOP and medication reductions through 2 years. Results were similarly favorable across glaucoma subtypes (including POAG, ACG, NTG, OHT) and were attained across various glaucoma severities, clinical sites, and surgeons, highlighting the real-world versatility and utility of this treatment modality.

Combined iStent® Inject Trabecular Micro-Bypass and Phacoemulsification in Australian Patients with Open-Angle Glaucoma.

PURPOSE: This retrospective audit aimed to evaluate the impact of combined iStent® Inject (iSI) and phacoemulsification on medication number in Australians with open-angle glaucoma. Secondary outcomes included intraocular pressure (IOP), best-corrected visual acuity, refraction and visual fields. PATIENTS AND METHODS: Patients with glaucoma that received combined iSI and phacoemulsification by the same surgeon between 1 February 2016 and 1 February 2018 were audited for postoperative medication number, pressures after 1 day, 1 week, 4 weeks and 6, 12, 18 and 24 months, visual acuity, refraction and visual fields. These parameters were compared to baseline levels and with those from a separate cohort of patients without glaucoma that received standalone phacoemulsification. RESULTS: Forty-one patients (63 eyes) received the combined procedure. Thirty-four patients (59 eyes) received standalone phacoemulsification. Four weeks after receiving combined iSI and phacoemulsification the mean medication number was significantly reduced by 1.3 (p < 0.001) for those on medication at baseline and by 0.5 (p = 0.002) overall. Mean IOP was significantly reduced from baseline after 6 months (-16%; p = 0.012; n = 35) and 12 months (-29%; p = 0.004; n = 16). Patients receiving standalone phacoemulsification had short-term reductions in IOP at 4 weeks (-8%; p < 0.001; n = 57) and 6 months (-16%; p < 0.001; n = 32). These patients without glaucoma had lower pressures overall compared to those with glaucoma that received the combined procedure (p = 0.019). There were no differences in final visual acuity or refractive outcomes between groups. CONCLUSION: This audit suggests that iSI and phacoemulsification are at least as effective in controlling IOP as medical therapy. It may have an important role in reducing the medication burden in Australians with cataract and glaucoma. This study is one of the first to confirm refractive stability in concomitant iSI and phacoemulsification.

Health Economic Analysis in Glaucoma.

The pressure on glaucoma services is ever-growing, and policymakers seek robust cost-effectiveness arguments in their decisions around resource allocation. The benefits of glaucoma are in preventing or delaying a future loss of vision and associated quality of life, and this expectation is quantified using a metric called utility which can be compared against other disease states. In recent clinical trials lasting up to 3 years, it has been difficult to show a difference in utility between glaucoma treatments in this limited period of time. When it comes to cost, the direct medical costs are only part of the broad range of costs that glaucoma brings to patients and communities, and the estimation of these costs can be difficult and imprecise. While the cost-effectiveness of glaucoma care, in general, is not in dispute, especially over longer time frames, the inability to measure changes in utility in shorter time frames impedes the uptake of innovations around the world. A number of approaches to improve the sensitivity and specificity of utility measurements are under investigation.

Bilateral Scheie's procedure with Ophthalmic Viscoelastic Device and 5-Fluorouracil.

INTRODUCTION: The surgical management of glaucoma has evolved over time. CASE REPORT: This report describes the first ever case, to our knowledge, of bilateral Scheie's procedures performed with retention of an ophthalmic viscoelastic device and intraoperative and post-operative 5-fluorouracil injections. DISCUSSION: These procedures have now successfully controlled the intraocular pressure in both of the patient's eyes for more than 17 years.

Novel Means of Clinical Visual Function Testing among Glaucoma Patients, Including Virtual Reality.

Computed perimetry remains the gold standard of visual field measurement among glaucoma patients. However, several emerging technologies, made possible by advances in computer programming, smartphone, tablet, or virtual reality, allow alternative means of visual function assessment. These new visual tests may one day have a useful complementary role in visual field testing and to bridge the gap between perimetry and daily experience. Many of these emerging technologies have distinct practical advantages over Ganzfield bowl-based computed perimetry. This paper outlines a discussion of some of these emerging techniques in visual function assessment in glaucoma. HOW TO CITE THIS ARTICLE: Skalicky SE, Kong GYX. Novel Means of Clinical Visual Function Testing among Glaucoma Patients, Including Virtual Reality. J Curr Glaucoma Pract 2019;13(3):83-87.

Patient-reported Outcomes, Functional Assessment, and Utility Values in Glaucoma.

In clinical glaucoma research, the measurement of patient reported outcomes, functional assessment of disability, and health economic impact is critical. However, valid, time-efficient and comprehensive tools are not available and several current instruments lack in the appropriate precision for measuring the various dimensions of glaucoma-related quality of life (QoL), including functioning and mobility. Furthermore, statistical methods are inconsistently and sometimes incorrectly used in otherwise sound clinical studies. Standardizing and improving methods of patient-centered data collection and analysis in glaucoma studies are imperative. This paper outlines recommendations and provides a discussion of some of the pertinent issues relating to the optimization of patient-reported outcomes research in glaucoma.