Mitomycin C 0.2 mg/ml vs. Mitomycin C 0.4mg/ml during the implantation of an ab externo SIBS microshunt: A mega-analysis.

PURPOSE: To compare the effectiveness and adverse event profile of standalone SIBS microshunt implantation with adjunct MMC 0.2 mg/ml and MMC 0.4 mg/ml. DESIGN: Mega-analysis using individual patient data from international prospective and retrospective clinical studies. STUDY POPULATION: Patients with glaucoma who underwent implantation of a SIBS microshunt with MMC as a standalone procedure. METHODS: A comparison of eyes that received MMC 0.2 mg/ml or 0.4 mg/ml MAIN OUTCOMES MEASURES: Primary outcome was complete success defined as the proportion of eyes at one year with all of the following: (1) no two consecutive IOPs > 17 mmHg; (2) no clinical hypotony (3) ≥20% IOP reduction from baseline and (4) no use of glaucoma medications. Secondary outcomes included IOP thresholds of 12 mmHg,14 mm Hg and 21mmHg, median IOP, number of medications, risk factors for failure, interventions, adverse events, and reoperations. RESULTS: At 1 year, the complete success rate was significantly higher (71.3% vs 50.46%, p<0.001) and the median IOP significantly lower (13.0 vs. 14.2 mmHg, p<0.05) in the MMC 0.4 mg/ml group. MMC 0.2 mg/ml was found to be a significant risk factor for failure (HR 1.75 95%CI 1.14 to 2.67). Needling and surgical revision occurred at a lower rate in the MMC 0.4 mg/ml group (7% vs. 18.8%, p= 0.002 and 4.3% vs.13.7% p= 0.0087, respectively). Adverse events occurred at a similar frequency in both groups (26.6% MMC 0.2 mg/ml vs. 29.6% MMC 0.4 mg/ml, p=0.46), most of which were early and transient. CONCLUSION: SIBS microshunt implantation with MMC 0.4 mg/ml resulted in a higher success rate with greater IOP reduction compared to MMC 0.2 mg/ml. Higher MMC concentration was not associated with increased serious adverse events.

Treatment of Primary Angle-Closure Suspect.

This article discusses treatment options for suspects of primary angle-closure disease.

Trabeculectomy in Eyes With High Myopia.

PRCIS: Primary trabeculectomy was safe and effective at lowering intraocular pressure (IOP) in patients with primary open angle glaucoma and high myopia. PURPOSE: To investigate the efficacy and safety of trabeculectomy in patients with glaucoma and high myopia. PATIENT AND METHODS: Retrospective case-control study. Glaucomatous patients with high myopia undergoing primary trabeculectomy surgery with at least 1 year of follow-up were compared with an age-matched control group without high myopia undergoing the same procedure. Surgical success was defined as: IOP ≤ 15 mm Hg with (qualified) or without (complete) antiglaucoma medications and at least 20% reduction from baseline IOP at the end of 48 months of follow-up. RESULTS: We included a total of 90 eyes from 90 patients (45 eyes with high myopia and 45 controls). Within the 90 eyes, 70 eyes underwent trabeculectomy and 20 eyes underwent combined phacoemulsification and trabeculectomy. Although patients with high myopia had higher chances for failure (37% vs. 22%) compared with controls, the difference was not statistically significant ( P =0.067). In the multivariable analysis, patients of African descent ( P =0.043) and those with juvenile glaucoma ( P =0.001) had more chances of failure, even after adjusting for myopia. There was no statistically significant difference between complication rates in both groups. CONCLUSION: Trabeculectomy was effective in reducing IOP in patients with high myopia and glaucoma, without the additional risk of complications compared with a control group.

Minimum Rim Width and Peripapillary Retinal Nerve Fiber Layer Thickness for Diagnosing Early to Moderate Glaucoma.

PRCIS: In a cross-sectional study from a Brazilian multiracial population, minimum rim width (MRW) and peripapillary retinal nerve fiber layer thickness measurements from OCT showed comparable diagnostic performance in discriminating early to moderate glaucoma from healthy eyes. PURPOSE: The purpose of this study is to compare the ability of MRW and peripapillary retinal nerve fiber layer thickness (RNFLT) measurements in discriminating early to moderate glaucoma from healthy eyes in a Brazilian population. METHODS: A total of 155 healthy controls and 118 patients with mild to moderate glaucoma (mean deviation >-12 dB) underwent MRW and RNFLT measurements with optical coherence tomography. Only 1 eye per patient was included in the analysis. A receiver operating characteristic (ROC) regression model was used to evaluate the diagnostic accuracy of MRW and RNFLT, whereas adjusting for age and Bruch membrane opening area. Sensitivities at fixed specificities of 95% were calculated for each parameter. RESULTS: Global RNFLT and MRW showed comparable area under the ROC curves [0.93 (0.91-0.96) and 0.93 (0.89-0.96), respectively; P =0.973]. Both parameters had similar sensitivities (75% vs. 74%, respectively; P =0.852) at a fixed specificity of 95%. The best sector for diagnosing glaucoma for both parameters was the temporal inferior sector, which showed an area under the ROC curve of 0.93 (0.87-0.96) for RNFLT and 0.91 (0.86-0.95) for MRW ( P =0.320). The temporal inferior sector showed similar sensitivities for RNFLT and MRW measurements (83% vs. 77%, respectively) at a fixed specificity of 95% (P =0.230). CONCLUSIONS: MRW and RNFLT measurements showed comparable diagnostic performance in discriminating early to moderate glaucoma from healthy eyes in a Brazilian multiracial population.

24-2 SITA Standard versus 24-2 SITA Faster in Perimetry-Naive Normal Subjects.

PURPOSE: To compare the Swedish Interactive Thresholding Algorithm (SITA) Standard (SS) and SITA Faster (SFR) strategies in normal individuals undergoing standard automated perimetry (SAP) for the first time. DESIGN: Randomized, comparative, observational case series. PARTICIPANTS: Seventy-four perimetry-naive healthy individuals. METHODS: All individuals underwent SAP 24-2 testing with the Humphrey Field Analyzer III (model 850 Zeiss) using the SS and SFR strategies. One eye of each individual was tested. Test order between strategies was randomized, and an interval of 15 minutes was allowed between the tests. MAIN OUTCOME MEASURES: The following variables were compared: test time, foveal threshold, false-positive errors, number of unreliable tests, mean deviation (MD), visual field index (VFI), pattern standard deviation (PSD), glaucoma hemifield test (GHT), and number of depressed points deviating at P < 5%, P < 2%, P < 1%, and P < 0.5% on the total and pattern deviation probability maps. Specificity of the SS and SFR strategies were compared using Anderson's criteria for abnormal visual fields. RESULTS: The SFR tests were 60.4% shorter in time compared with SS (P < 0.001) and were associated with a significantly lower PSD (1.75 ± 0.80 decibel [dB] vs. 2.15 ± 1.25 dB; P = 0.016). There were no significant differences regarding the MD, VFI, foveal threshold, GHT, and number of points depressed at P < 5%, P < 2%, P < 1%, and P < 0.5% on the total deviation and pattern deviation probability maps between SS and SFR. When all exams were analyzed and any of Anderson's criteria was applied, the specificity was 68% with SFR and 61% with SS (P = 0.250). The specificities observed with SFR and SS when only the first or second exams were analyzed were also similar (63% vs. 64% and 72% vs. 58%, respectively, P > 0.05). CONCLUSIONS: The SS and SFR were associated with similar specificities in perimetry-naive individuals. The SFR did not increase the number of depressed points in the total and pattern deviation probability maps. Ophthalmologists should be aware that both strategies are associated with disturbingly high false-positive rates in perimetry-naive individuals. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

OCT detected optic nerve head remodeling in a young adult with early progressive myopia.

Purpose: To report a longitudinal OCT study of optic nerve head (ONH) neural canal remodeling in a young adult subject's eyes through the progression of early refractive myopia. Observations: Deep ONH changes early in the progression of myopia included enlargement of the Bruch's membrane opening, progressive temporal displacement of BMO relative to the anterior scleral canal opening, choroidal border tissue remodeling and exposure of the temporal scleral flange within the ONH neural canal of both eyes. Conclusions and Importance: Longitudinal OCT imaging of a young adult subject suggest that OCT is able to detect ONH neural canal remodeling early in the progression of refractive myopia that shares key features previously described only in more highly myopic eyes.

Gonioscopy-Assisted Transluminal Trabeculotomy for Glaucoma: 1-Year Outcomes and Success Predictors.

PRCIS: Our results suggest gonioscopy-assisted transluminal trabeculotomy (GATT) as an effective and safe option for the surgical management of open-angle glaucoma (OAG). Older age was the only risk factor for failure in our analysis. PURPOSE: To report 12-month clinical outcomes, safety profile and success predictors of GATT in patients with OAG. PATIENTS AND METHODS: A retrospective study of patients (18 y old and above) with medically uncontrolled OAG who underwent GATT as a solo procedure or combined with phacoemulsification (PHACO-GATT) between January 2018 and January 2020. Success at 12 months (primary outcome) was defined as intraocular pressure (IOP) <15 mm Hg, with an IOP reduction of at least 20%, OR a reduction of at least 2 glaucoma medications, compared with baseline. Secondary outcomes were success predictors and safety parameters. RESULTS: A total of 73 eyes (GATT=38; PHACO-GATT=35) from 58 patients with a mean age of 54.8±11.6 years were included. Overall, after 12 months of follow-up, the mean IOP was reduced from 24.9±8.5 to 12.1±2.1 mm Hg (P<0.001). The mean number of glaucoma medications was reduced from 3.5±0.7 to 1.2±1.2 (P<0.001). The success rate was 87% at 12 months, with no significant differences between GATT (85%) and PHACO-GATT (91%) eyes (P=0.330). Age was the only factor significantly associated with surgical success (hazard ratio=1.35; P=0.012; after adjusting for preoperative IOP and number of glaucoma medications). Patients older than 60 years had a significant greater chance of failure (hazard ratio=10.96; P=0.026) compared with those younger than 60 years. The most common postoperative complication was transient hyphema (39%; median duration, 5 d). No sight-threatening adverse event was documented. CONCLUSIONS: GATT was effective and safe at lowering IOP with or without cataract extraction in OAG. Patients 60 years or older had a higher risk of failure compared with those younger in age.

Blood Pressure and Glaucomatous Progression in a Large Clinical Population.

PURPOSE: To investigate the effect of systemic arterial blood pressure (BP) on rates of progressive structural damage over time in glaucoma. DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 7501 eyes of 3976 subjects with glaucoma or suspected of glaucoma followed over time from the Duke Glaucoma Registry. METHODS: Linear mixed models were used to investigate the effects of BP on the rates of retinal nerve fiber layer (RNFL) loss from spectral-domain OCT (SD-OCT) over time. Models were adjusted for intraocular pressure (IOP), gender, race, diagnosis, central corneal thickness (CCT), follow-up time, and baseline disease severity. MAIN OUTCOME MEASURE: Effect of mean arterial pressure (MAP), systolic arterial pressure (SAP), and diastolic arterial pressure (DAP) on rates of RNFL loss over time. RESULTS: A total of 157 291 BP visits, 45 408 IOP visits, and 30 238 SD-OCT visits were included. Mean rate of RNFL change was -0.70 µm/year (95% confidence interval, -0.72 to -0.67 µm/year). In univariable models, MAP, SAP, and DAP during follow-up were not significantly associated with rates of RNFL loss. However, when adjusted for mean IOP during follow-up, each 10 mmHg reduction in mean MAP (-0.06 µm/year; P = 0.007) and mean DAP (-0.08 µm/year; P < 0.001) but not SAP (-0.01 µm/year; P = 0.355) was associated with significantly faster rates of RNFL thickness change over time. The effect of the arterial pressure metrics remained significant after additional adjustment for baseline age, diagnosis, sex, race, follow-up time, disease severity, and corneal thickness. CONCLUSIONS: When adjusted for IOP, lower MAP and DAP during follow-up were significantly associated with faster rates of RNFL loss, suggesting that levels of systemic BP may be a significant factor in glaucoma progression.

Predicting Age From Optical Coherence Tomography Scans With Deep Learning.

Purpose: To assess whether age can be predicted from deep learning analysis of peripapillary spectral-domain optical coherence tomography (SD-OCT) B-scans and to determine the importance of specific retinal areas on the predictions. Methods: Deep learning (DL) convolutional neural networks were developed to predict chronological age in healthy subjects using peripapillary SD-OCT B-scan images. Models were built using the whole B-scan, as well as using specific regions through image ablation. Cross-validation was used for training and testing the model. Mean absolute error (MAE) and correlations between predicted and observed age were used to evaluate model performance. Results: A total of 7271 images from 542 eyes of 278 healthy subjects were included. DL predictions of age using the whole B-scan were strongly correlated with chronological age (MAE = 5.82 years; r = 0.860, P < 0.001). The model also accurately discriminated between the lowest and highest tertiles of age, with an area under the receiver operating characteristic curve of 0.962. In general, class activation maps tended to show a diffuse pattern of activation throughout the scan image. For specific structures of the B-scan, the layers with the strongest correlations with chronological age were the choroid and vitreous (both r = 0.736), whereas retinal nerve fiber layer had the lowest correlation (r = 0.492). Conclusions: A DL algorithm was able to accurately predict age from whole peripapillary SD-OCT B-scans. Translational Relevance: DL models applied to SD-OCT scans suggest that aging appears to affect several layers in the posterior eye segment.

The Effect of Age on Increasing Susceptibility to Retinal Nerve Fiber Layer Loss in Glaucoma.

Purpose: To determine whether aging modifies the effect of intraocular pressure (IOP) on progressive glaucomatous retinal nerve fiber layer (RNFL) thinning over time. Methods: This was a retrospective cohort study involving patients with glaucoma or suspected of having glaucoma who were followed over time from the Duke Glaucoma Registry. Rates of RNFL loss from spectral-domain optical coherence tomography (SD-OCT) were used to assess disease progression. Generalized estimating equations with robust sandwich variance estimators were used to investigate the effects of the interaction of age at baseline and mean IOP on rates of RNFL loss over time. Models were adjusted for gender, race, diagnosis, central corneal thickness, follow-up time, and baseline disease severity. Results: The study included 85,475 IOP measurements and 60,026 SD-OCT tests of 14,739 eyes of 7814 patients. Eyes had a mean follow-up time of 3.5 ± 1.9 years. The average rate of change in RNFL thickness was -0.70 µm/year (95% confidence interval, -0.72 to -0.67). There was a significant interaction between age and mean IOP and the rate of RNFL loss (P = 0.001), with older eyes having significantly faster rates of RNFL loss than younger ones for the same level of IOP. The effect of IOP on rates of change was greater in the inferior and superior regions of the optic disc. Conclusions: Age is a significant modifier of the relationship between IOP and glaucomatous loss in RNFL thickness over time. Older patients may be more susceptible to glaucomatous progression than younger patients at the same level of IOP.

Current and emerging fixed combination therapies in glaucoma: a safety and tolerability review.

INTRODUCTION: Fixed dose combinations (FCs) represent a potentially valuable treatment strategy in glaucoma management. Fixed combinations not only improve adherence by reducing the medication burden, but also decrease the total amount of potentially deleterious preservatives an eye is exposed to. AREAS COVERED: We provide a critical review of selected evidence on both the safety and tolerability of presently available and emerging glaucoma FCs. There is convincing short-term safety and tolerability evidence on intraocular pressure (IOP)-lowering FCs compared to that of monotherapies and, to a lesser degree, to that of concomitant, equivalent combination therapies. In contrast, there is a scarcity of trials evaluating the long-term efficacy and safety of glaucoma FCs and no conclusive data on the reduction of adverse events with FCs. EXPERT OPINION: It is vital for clinicians to carefully weigh the efficacy, safety, tolerability, and adherence of IOP-lowering FCs. Given the number of currently available and emerging FC therapy options in glaucoma, as well as the complexities of incorporating them in the various combination therapy regimens, successful stepwise therapy remains often elusive.

Can Psychologic Stress Elevate Intraocular Pressure in Healthy Individuals?

PURPOSE: To investigate if a stress event can influence intraocular pressure (IOP) in a group of healthy individuals. DESIGN: Case-control study. PARTICIPANTS: A total of 28 healthy subjects were included: 17 in the stress group and 11 in the control group. METHODS: The Trier Social Stress Test (TSST) is a tool to evaluate cortisol response to psychologic stimulation based on the stress induced by public speaking. All participants underwent a modified diurnal tension curve (DTC) 1 week before the TSST, with 3 IOP measurements performed between 8:00 am and 2:00 pm. We evaluated the response to the TSST measuring the levels of salivary cortisol, IOP, and heart rate before, immediately after, and 40 minutes after TSST. The State Trait Anxiety Inventory (STAI) was applied to evaluate the levels of anxiety at the same time intervals. MAIN OUTCOME MEASURES: Changes in IOP (mmHg), salivary cortisol, heart rate, and STAI scores. RESULTS: At baseline, there were no significant differences between case and controls regarding age (52.2 ± 6.26 vs. 53.8 ± 8.4 years, P = 0.661), gender (52.94% male vs. 45.45% female, P = 0.669), and ethnicity. Salivary cortisol (6.8 nmol/l, P < 0.001) and heart rate (7.2 beats/min, P = 0.035) increased significantly after the TSST. We observed a mean IOP increase of 1.0 mmHg (right eye, P = 0.003) and 1.1 mmHg (left eye, P = 0.004) when comparing IOP measurements obtained during the DTC and immediately after TSST. In addition, 35% (6/17) of the subjects in the TSST group showed an IOP increase higher than 2 mmHg after the test compared with 18% (2/11) in the control group. The STAI state score significantly increased after the stress event compared with baseline (P = 0.026) and decreased from poststress to the recovery period (P = 0.006) in the TSST group. The control group did not show significant changes in IOP, heart rate, salivary cortisol levels, and STAI scores. CONCLUSIONS: Significant elevations of IOP, salivary cortisol, STAI scores, and heart rate occurred after inducing psychologic stress with TSST in a group of healthy individuals.

Comparison of Silicone- and Porous-Plate Ahmed Glaucoma Valves.

PURPOSE: Our aim was to evaluate and compare the clinical outcomes after implantation of the silicone-plate (model FP7) and porous polyethylene-plate (model M4) Ahmed Glaucoma Valves. PATIENTS AND METHODS: This was a prospective, multicenter, comparative series. A total of 52 eyes (52 patients) were treated with either the silicone or porous plate Ahmed Glaucoma Valve implant. Hypertensive phase was defined as intraocular pressure >21 mmHg during the first 3 months postoperatively. Success was defined as 5 mmHg ≤intraocular pressure ≤21 mmHg (with or without additional glaucoma medications), without loss of light perception and without additional glaucoma procedures. Patients were monitored for 1 year after surgery. RESULTS: The pre-operative intraocular pressure was 29.9 ± 6.6 mmHg and 33.8 ± 10.5 in the silicone-plate and porous-plate groups, respectively (P = 0.118). At 12 months after surgery, the mean intraocular pressure was 13.6 ± 4.7 mmHg in the silicone-plate group and 17.9 ± 10.9 mmHg in the porous-plate group (P = 0.141). The mean number of glaucoma medications at 12 months was 1.64 ± 1.40 mmHg and 1.89 ± 1.54 mmHg in the silicone- and porous-plate groups, respectively (P = 0.605). Hypertensive phase was not significantly different in the two groups (50.0% of the silicone-plate and 57.7% of the porous-plate groups, P = 0.578). At 12 months after surgery, the percent success for the silicone-plate and porous-plate groups was 88.5% and 53.8%, respectively (P = 0.005). Complications were similar in the two groups. CONCLUSION: The porous-plate Ahmed Glaucoma Valve showed similar average intraocular pressure reduction compared with the silicone-plate model. At 12 months after surgery, there was a significantly lower success rate in the porous-plate compared with the silicone-plate group.

Clear lens extraction in eyes with primary angle closure and primary angle-closure glaucoma.

The crystalline lens plays an important role in the pathophysiology of primary angle closure and primary angle-closure glaucoma. The aging process is associated with a progressive enlargement of the lens, resulting in greater iridolenticular and iridotrabecular contact, which exacerbates both pupillary block and appositional angle closure, irrespective of the cataract status of the lens. Cataract surgery has been shown to widen the angle and reduce intraocular pressure in eyes with primary angle closure or primary angle-closure glaucoma. Recently, clear lens phacoemulsification has been suggested as a treatment modality in such eyes. We review the literature on clear lens extraction in eyes with angle closure and discuss its efficacy, safety, and indications. Although it is evident that clear lens extraction is beneficial in eyes with primary angle closure and primary angle-closure glaucoma, it is technically challenging and should be performed by experienced surgeons who not only master the procedure but are also able to deal with potential complications. Since the follow-up of the reviewed studies is relatively short, long-term follow-up (>10 years) of patients who undergo this procedure is needed to evaluate the safety and confirm the early benefits reported.

Evaluation of contrast sensitivity in patients with advanced glaucoma: comparison of two tests.

AIMS: To evaluate contrast sensitivity (CS) in patients with advanced glaucomatous visual field damage, and to compare two clinical CS tests. METHODS: This was a cross-sectional test-retest study. Twenty-eight patients with open-angle glaucoma, visual acuity (VA) better than 20/40 and visual field mean deviation (MD) worse than -15 dB were enrolled. Patients underwent VA, visual field and CS testing with the Pelli-Robson (PR) chart and the Freiburg Visual Acuity and Contrast Test (FrACT). Retest measurements were obtained within 1 week to 1 month. RESULTS: Median (IQR) age and MD were 61.5 (55.5 to 69.2) years and -27.7 (-29.7 to -22.7) dB, respectively. Median (IQR) VA was 0.08 logarithm minimum angle of resolution (0.02 to 0.16), corresponding to 20/25 (20/20 to 20/30). Median (IQR) CS was 1.35 (1.11 to 1.51) log units with the PR chart and 1.39 (1.24 to 1.64) log units with FrACT. VA explained less than 40% of the variance in CS (adjusted R2=0.36). CS estimates of both tests were closely related (rho=0.88, p=0.001), but CS was 0.09 log units higher with FrACT compared with the PR chart, and the 95% repeatability intervals (Bland-Altman) were 46% tighter with the PR chart. CONCLUSIONS: Despite near-normal VA, almost all patients showed moderate to profound deficits in CS. CS measurement provides additional information on central visual function in patients with advanced glaucoma.

Human Versus Machine: Comparing a Deep Learning Algorithm to Human Gradings for Detecting Glaucoma on Fundus Photographs.

PURPOSE: To compare the diagnostic performance of human gradings vs predictions provided by a machine-to-machine (M2M) deep learning (DL) algorithm trained to quantify retinal nerve fiber layer (RNFL) damage on fundus photographs. DESIGN: Evaluation of a machine learning algorithm. METHODS: An M2M DL algorithm trained with RNFL thickness parameters from spectral-domain optical coherence tomography was applied to a subset of 490 fundus photos of 490 eyes of 370 subjects graded by 2 glaucoma specialists for the probability of glaucomatous optical neuropathy (GON), and estimates of cup-to-disc (C/D) ratios. Spearman correlations with standard automated perimetry (SAP) global indices were compared between the human gradings vs the M2M DL-predicted RNFL thickness values. The area under the receiver operating characteristic curves (AUC) and partial AUC for the region of clinically meaningful specificity (85%-100%) were used to compare the ability of each output to discriminate eyes with repeatable glaucomatous SAP defects vs eyes with normal fields. RESULTS: The M2M DL-predicted RNFL thickness had a significantly stronger absolute correlation with SAP mean deviation (rho=0.54) than the probability of GON given by human graders (rho=0.48; P < .001). The partial AUC for the M2M DL algorithm was significantly higher than that for the probability of GON by human graders (partial AUC = 0.529 vs 0.411, respectively; P = .016). CONCLUSION: An M2M DL algorithm performed as well as, if not better than, human graders at detecting eyes with repeatable glaucomatous visual field loss. This DL algorithm could potentially replace human graders in population screening efforts for glaucoma.

Influence of Bruch's Membrane Opening Area in Diagnosing Glaucoma With Neuroretinal Parameters From Optical Coherence Tomography.

PURPOSE: To determine whether the glaucoma diagnostic accuracy of age- and Bruch membrane opening area (BMOA)-adjusted normative classifications of minimum rim width (MRW) and retinal nerve fiber layer thickness (RNFLT) is dependent on BMOA, in a European descent population. DESIGN: Retrospective, cross-sectional study. METHODS: We included 182 glaucoma patients and 166 healthy controls for the primary study, and 105 glaucoma patients in a second sample used for a replication study. Optical coherence tomography (Spectralis) measurements of BMOA, global MRW, and RNFLT and normative classifications from the device software were exported for analysis. Sensitivity and specificity were calculated for a conservative criterion (abnormal = "outside normal limits" classification) and a liberal criterion (abnormal = "outside normal limits" or "borderline" classifications). The dependence of sensitivity and specificity on BMOA was analyzed with comparison among subgroups divided by tertiles of BMOA, and with logistic regression. RESULTS: For the conservative criterion, MRW sensitivity was independent of BMOA (P ≥ .76), while RNFLT sensitivity increased in the large BMOA subgroup (P = .04, odds ratio: 1.2 per mm2 [P = .02]). For the liberal criterion, MRW and RNFLT sensitivities were independent of BMOA (P ≥ .53). Specificities were independent of BMOA (P ≥ .07). For the replication sample, which included younger patients with larger BMOA and worse visual field damage than the primary sample, sensitivities were independent of BMOA for both criteria (P ≥ .10). CONCLUSIONS: RNFLT sensitivity was higher in eyes with larger BMOA; however, age and visual field damage may influence that association. MRW diagnostic accuracy was not dependent on BMOA.

Detecting Retinal Nerve Fibre Layer Segmentation Errors on Spectral Domain-Optical Coherence Tomography with a Deep Learning Algorithm.

In this study we developed a deep learning (DL) algorithm that detects errors in retinal never fibre layer (RNFL) segmentation on spectral-domain optical coherence tomography (SDOCT) B-scans using human grades as the reference standard. A dataset of 25,250 SDOCT B-scans reviewed for segmentation errors by human graders was randomly divided into validation plus training (50%) and test (50%) sets. The performance of the DL algorithm was evaluated in the test sample by outputting a probability of having a segmentation error for each B-scan. The ability of the algorithm to detect segmentation errors was evaluated with the area under the receiver operating characteristic (ROC) curve. Mean DL probabilities of segmentation error in the test sample were 0.90 ± 0.17 vs. 0.12 ± 0.22 (P < 0.001) for scans with and without segmentation errors, respectively. The DL algorithm had an area under the ROC curve of 0.979 (95% CI: 0.974 to 0.984) and an overall accuracy of 92.4%. For the B-scans with severe segmentation errors in the test sample, the DL algorithm was 98.9% sensitive. This algorithm can help clinicians and researchers review images for artifacts in SDOCT tests in a timely manner and avoid inaccurate diagnostic interpretations.

What Is the Amount of Visual Field Loss Associated With Disability in Glaucoma?

PURPOSE: To propose a new methodology for classifying patient-reported outcomes in glaucoma and for quantifying the amount of visual field damage associated with disability in the disease. DESIGN: Cross-sectional study. METHODS: A total of 263 patients with glaucoma were included. Vision-related disability was assessed by the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). A latent class analysis (LCA) model was applied to analyze NEI VFQ-25 data and patients were divided into mutually exclusive classes according to their responses to the questionnaires. Differences in standard automated perimetry (SAP) mean deviation (MD) and integrated binocular mean sensitivity (MS) values between classes were investigated. The optimal number of classes was defined based on goodness-of-fit criteria, interpretability, and clinical utility. RESULTS: The model with 2 classes, disabled and nondisabled, had the best fit with an entropy of 0.965, indicating excellent separation of classes. The disabled group had 48 (18%) patients, whereas 215 (82%) patients were classified as nondisabled. The average MD of the better eye in the disabled group was -5.98 dB vs -2.51 dB in the nondisabled group (P < .001). For the worse eye, corresponding values were -13.36 dB and -6.05 dB, respectively (P < .001). CONCLUSION: Application of an LCA model allowed categorization of patient-reported outcomes and quantification of visual field levels associated with disability in glaucoma. A damage of approximately -6 dB for SAP MD, indicating relatively early visual field loss, may already be associated with significant disability if occurring in the better eye.