Comparison of Compass and Humphrey perimeters in detecting glaucomatous defects.

PURPOSE: To compare the performance of Compass fundus automated perimetry (FAP) and Humphrey Field Analyzer (HFA) in glaucoma patients. METHODS: A total of 120 patients with glaucoma underwent 1 FAP and 1 HFA perimetric test over the central 24° on one eye. The chosen eye and sequence were randomized and only reliable examinations were considered for analysis. Mean deviation (MD), pattern standard deviation (PSD), visual field index (VFI), and the area of absolute scotoma were compared between perimeters. Glaucoma Staging System (GSS2) data were analyzed by means of k test. RESULTS: Mean sensitivity difference (FAP-HFA) was -1.0 ± 2.81 dB (p<0.001, 95% confidence interval [CI] -1.61, -0.60 dB), MD difference was +0.27 ± 2.84 dB (p = 0.36, 95% CI -5.30, 5.83 dB), PSD difference was +0.48 ± 1.95 dB (p = 0.0075, 95% CI -3.37, 4.33 dB), and VFI difference was +2.4% ± 8.4% (p = 0.003, 95% CI -14.0%, +18.8% dB). Weighted kappa for GSS2 was 0.87. Points with null sensitivities were 9.9 ± 10.2 with FAP and 8.2 ± 8.9 with HFA (difference: 1.7 ± 4.0 points, p = 0.013). CONCLUSIONS: Mean sensitivity with FAP is 1 dB lower than HFA, a finding due to different threshold strategies. Differences of global indices for FAP and HFA are small, which makes the 2 perimeters equivalent in the clinical setting. However, FAP seems more severe in evaluating glaucomatous damage, with absolute scotoma areas larger than with HFA. We raise the hypothesis that such difference may be the result of the active compensation of eye movements available with FAP.

Strategies to estimate the characteristics of 24-hour IOP curves of treated glaucoma patients during office hours.

BACKGROUND: It is known that office-hour measurements might not adequately estimate IOP mean, peaks and fluctuations in healthy subjects. The purpose of the present study is to verify whether office-hour measurements in patients in different body positions can estimate the characteristics of 24-hour intraocular pressure (IOP) in treated POAG patients. METHODS: The 24-hour IOP curves of 70 eyes of 70 caucasian patients with treated glaucoma were analyzed. Measurements were taken at 9 AM; 12, 3, 6, and 9 PM; and 12, 3, and 6 AM, both in the supine (TonoPen XL) and sitting (Goldmann tonometer) positions. The ability of five strategies to estimate IOP mean, peak and fluctuation was evaluated. Each method was analyzed both with regression of the estimate error on the real value and with "hit or miss" analysis. RESULTS: The least biased estimate of the Peak IOP was obtained using measurements from both supine and sitting positions, also yielding the highest rate of correct predictions (which was significantly different from 3 of the remaining 4 strategies proposed, p < 0.05). Strategies obtained from the combination of supine, sitting and peak measurements resulted to be least biased for the Mean IOP and the IOP Fluctuation estimate, but all strategies were not found significantly different in terms of correct prediction rate (the only significant difference being between the two strategies based on sitting or supine measurements only, with the former being the one with the highest correct prediction rate). CONCLUSIONS: The results of this study remark the concept that IOP is a dynamic parameter and that intensive measurement is helpful in determining its characteristics. All office-hour strategies showed a very poor performance of in correctly predicting the considered parameters within the thresholds used in this paper, all scoring a correct prediction rate below 52%.

Compass: clinical evaluation of a new instrument for the diagnosis of glaucoma.

AIMS: To evaluate Compass, a new instrument for glaucoma screening and diagnosis that combines scanning ophthalmoscopy, automated perimetry, and eye tracking. MATERIALS AND METHODS: A total of 320 human subjects (200 normal, 120 with glaucoma) underwent full ophthalmological evaluation and perimetric evaluation using the Humphrey SITA standard 24° test (HFA), and the Compass test that consisted of a full-threshold program on the central 24° with a photograph of the central 30° of the retina. A subgroup of normal subjects and glaucoma patients underwent a second Compass test during the same day in order to study test-retest variability. After exclusion of 30 patients due to protocol rules, a database was created to compare the Compass to the HFA, and to evaluate retinal image quality and fixation stability. RESULTS: The difference in mean sensitivity between Compass and HFA was -1.02 ± 1.55 dB in normal subjects (p<0.001) and -1.01 ± 2.81 dB in glaucoma (p<0.001). Repeatability SD for the average sensitivity was 1.53 for normal subjects and 1.84 for glaucoma. Test time with the Compass was 634±96 s (607±78 for normals, 678±108 for glaucoma). Compass analysis showed the percentage of fixation within the central 1° was 86.6% in normal subjects, and 79.3% in glaucoma patients. Color image quality was sufficient for diagnostic use in >65% of cases; Image-based diagnosis was in accordance with the initial diagnosis in 85% of the subjects. CONCLUSIONS: Based on preliminary results, Compass showed useful diagnostic characteristics for the study of glaucoma, and combined morphological information with functional data.

Corneal involvement in uneventful cataract surgery: an in vivo confocal microscopy study.

PURPOSE: To evaluate corneal subbasal layer changes after uneventful cataract surgery by means of in vivo confocal microscopy. METHODS: This prospective study included 30 patients. Before surgery, and 1, 3, 6, 8 and 10 months after cataract surgery, all patients underwent a complete ophthalmological and confocal microscopy examination in the central and temporal corneal areas. Number of fibers, beading, tortuosity and reflectivity were analyzed. RESULTS: Important changes were shown in the central cornea up to 3 months after surgery: a reduction in nerve fiber number (baseline: 4.4 ± 1.7; month 1: 1.2 ± 0.5, p < 0.0001; month 3: 2.5 ± 1.2, p < 0.005) and reflectivity (baseline: 3.6 ± 0.5; month 1: 1.4 ± 0.6, p < 0.0001; month 3: 1.9 ± 0.9, p < 0. 0001), and an increase in beading (baseline: 0.3 ± 0.5 beads/100 µm(2); month 1: 2.7 ± 0.6 beads/100 µm(2), p < 0.0001; month 3: 2.6 ± 0.5 beads/100 µm(2), p < 0. 0001). The confocal parameters completely progressively recovered thereafter (60% at 6 months, 87% at 8 and 10 months). The temporal plexus was absent at 1 month and fully recovered in all patients at month 8. CONCLUSION: Uneventful cataract surgery induces relevant corneal modifications when inspected by means of confocal microscopy.

Short- and long-term phasing of intraocular pressure in stable and progressive glaucoma.

AIMS: To evaluate short- (ST) and long-term (LT) intraocular pressure (IOP) in patients with stable (SG) and progressive glaucoma (PG). MATERIALS AND METHODS: Fifty-two patients with treated glaucoma received a baseline 24-hour IOP curve and, every 6 months for 2 years, office-hour curve plus visual field test. Based on field changes, they were divided into 24 SG and 28 PG. ST and LT IOP mean, peak and fluctuation (standard deviation of measurements) were calculated. Parameters determining progression were evaluated by logistic regression. RESULTS: At ST, SG and PG, respectively, had mean IOP of 16.8 ± 2.2 and 15.3 ± 1.8 mm Hg; peak of 19.7 ± 3.3, 17.4 ± 2.3 mm Hg; fluctuation of 2.3 ± 1.2, and 1.6 ± 0.6 mm Hg. LT parameters did not change in SG, whereas a significant increase of mean (+1.0 ± 1.5 mm Hg, p = 0.05), peak (2.0 ± 2.4 mm Hg, p = 0.0002), and fluctuation (0.5 ± 1.1 mm Hg, p = 0.008) occurred in PG. Mean, peak, and fluctuation were correlated, except mean and fluctuation in the long term. Association with progression was shown for change in mean IOP between ST and LT, and ST peak. CONCLUSIONS: SG and PG may show different IOP parameters when intensively measured at baseline and follow-up. Mean IOP change between ST and LT periods and ST peak were the parameters associated with progression.

An evaluation of therapeutic noninferiority of 0.005% latanoprost ophthalmic solution and xalatan in patients with glaucoma or ocular hypertension.

PURPOSE: To assess the therapeutic noninferiority of 0.005% latanoprost ophthalmic solution versus Xalatan in the treatment of patients with primary open-angle glaucoma or ocular hypertension. PATIENTS AND METHODS: This was a double-masked, randomized, multicenter study. A total of 184 patients with a diagnosis of unilateral or bilateral primary open-angle glaucoma or ocular hypertension were randomly assigned to either 0.005% latanoprost ophthalmic solution or Xalatan for 12 weeks. The primary end-point was the change in intraocular pressure (IOP) at 12 weeks in the 2 groups. Noninferiority was reached if the 2-sided 95% confidence intervals (CI) for the difference between adjusted treatment means were entirely within the interval from -1.5 to +1.5 mm Hg. RESULTS: The difference between treatments in the change of IOP from baseline to the end of treatment was 0.12 mm Hg (95% CI: -0.47, 0.71) in the intention-to-treat population and 0 mm Hg (95% CI: -0.58, 0.57) in the per protocol population. There was no statistically significant difference between the 2 groups in terms of drug-related adverse events. The most commonly reported drug-related local adverse events were: ocular hyperemia, eyelashes growth, and eye irritation. CONCLUSIONS: This study demonstrates that 0.005% latanoprost ophthalmic solution is noninferior to Xalatan in lowering IOP and is generally well tolerated.

The effects of topical coenzyme Q10 and vitamin E D-α-tocopheryl polyethylene glycol 1000 succinate after cataract surgery: a clinical and in vivo confocal study.

PURPOSE: To evaluate the postoperative effects of topical coenzyme Q(10) + vitamin E D-α-tocopheryl polyethylene glycol 1000 succinate (CoQ(10)) after cataract surgery. METHODS: 40 consecutive patients were randomized to receive CoQ(10) or saline solution (SS) twice daily for 9 months after uneventful cataract surgery with a temporal port. Before surgery, on day 14 and at months 3, 6 and 9, they underwent non-invasive break-up time (NIBUT) testing, Schirmer test, BUT, aesthesiometry as well as in vivo confocal microscopy of the subbasal nerve plexus of the cornea (SBP). The density of the subbasal nerves was calculated in the central (CFD) and temporal (TFD) cornea (number of fibres per field). RESULTS: On day 14, surgery reduced CFD and TFD, respectively, by 25-35 and 50%; indices of ocular surface stability were all impaired. The treatment with CoQ(10) was associated with faster nerve regeneration than SS (at month 3, CFD +1.5 ± 1.9 vs. +0.2 ± 1.8, p = 0.04, and TFD +2.5 ± 1.7 vs. +1.0 ± 1.6, p = 0.007; at month 6, TFD +2.7 ± 1.9 vs. +1.4 ± 1.5, p = 0.02) and better stability of ocular surface (NIBUT and BUT) throughout the study. No relevant side effects were found, apart from occasional burning in 10% of CoQ(10) patients. CONCLUSIONS: Changes of the corneal nerves occurring after cataract surgery may influence the integrity of the ocular surface. Treatment with topical CoQ(10) has a positive effect in restoring SBP anatomy and ocular surface stability.

Changes in corneal parameters at confocal microscopy in treated glaucoma patients.

BACKGROUND: The purpose of this study was to evaluate corneal parameters in treated glaucoma patients, nontreated glaucoma patients, and normal subjects using confocal microscopy. METHODS: Forty patients with primary open-angle glaucoma and 22 untreated controls underwent confocal microscopy of the cornea using the Heidelberg retinal tomograph cornea module. The glaucoma group was divided into two subgroups, ie, patients on medical treatment for at least two years before inclusion (with beta-blockers or prostaglandin analogs) and nontreated glaucoma patients. The following corneal parameters were evaluated: endothelial cell density and number, reflectivity, and tortuosity of sub-basal nerves. For reflectivity and tortuosity, a dedicated grading scale ranging from 0 to 4 was used. Differences between treatments were also evaluated in the treated glaucoma group. RESULTS: Number of fibers and reflectivity of the sub-basal plexus were significantly lower in glaucoma patients as compared with controls (2.5 ± 0.7 versus 2.9 ± 0.9, P = 0.006, and 2.3 ± 0.8 versus 2.7 ± 0.9, P = 0.04, respectively), whereas tortuosity was significantly higher (2.6 ± 1 versus 2.0 ± 0.8, P = 0.007). Endothelial cell density (measured as cells per mm(2)) was lower in the glaucoma group comparing treated patients with nontreated patients (2826 ± 285 versus 3124 ± 272, P = 0.0003). Comparing treated patients with nontreated patients, relevant differences were found in number (2.3 ± 0.7 versus 2.8 ± 0.8, P = 0.004), tortuosity (2.8 ± 1 versus 2.2 ± 0.8, P = 0.004), and reflectivity (2.2 ± 0.8 versus 2.6 ± 0.8, P = 0.04). No differences in corneal parameters were found between beta-blockers and prostaglandin analogs. CONCLUSION: This study shows that differences in corneal parameters between glaucoma patients and controls may be due to the medical treatments used for glaucoma. These data should be taken into consideration in long-standing medical glaucoma treatment and in potential candidates for surgery.

In vivo confocal microscopy in Terrien marginal corneal degeneration: a case report.

PURPOSE: To report an advanced case of Terrien marginal corneal degeneration (TMD) analyzed by means of confocal microscopy. METHODS: A 62-year-old woman with TMD underwent a routine ophthalmological examination and was evaluated for the disease by using in vivo laser scanning confocal microscopy with the Heidelberg Retina Tomograph 2 Rostock Cornea Module. RESULTS: The slit-lamp examination of the right eye showed an upper peripheral cornea thinning associated with a deposition of refractile yellow-white materials in the anterior stroma. Superficial radial vessels in the upper peripheral cornea were the only pathological findings of the left eye. Confocal microscopy of the right eye lesion showed deposition of hyperreflective material, and the stroma below presented a honeycomb-like pattern. Inflammatory cell infiltration, abnormal subbasal nerve plexus, epithelial basal membrane defects, irregular Bowman membrane, and the presence of activated keratocytes were observed in the cornea of both eyes. CONCLUSIONS: In vivo confocal microscopy can detect subtle corneal changes in an advanced case of TMD, which may be signs of subclinical inflammation.

Diagnostic assessment of normal and pale optic nerve heads by confocal scanning laser ophthalmoscope and stereophotography.

PURPOSE: To evaluate the diagnostic assessment of optic nerve heads (ONH) by stereophotography (SP) and Heidelberg retina tomograph (HRT) in patients with retinitis pigmentosa (RP). METHODS: This study involved 53 consecutive patients with RP and 24 controls who underwent ONH examination by SP and HRT. On the basis of the appearance at SP, RP ONH were divided in normal-colored (24/53) and pale (29/53). The measurements of vertical ONH diameter and vertical cup/disc ratio (VCDR) by SP and HRT were compared between the groups by means of t test and Bland-Altman plots. Diagnosis, ONH pallor and size, HRT image quality (image standard deviation, SD) were also inspected as sources of differences in the results by means of a multivariate analysis. RESULTS: Vertical diameter measurements were similar using SP and HRT, respectively (1.93±0.50 and 1.80±0.62 for normal-colored ONH, P=0.43; 2.02±0.65 and 1.90±0.40 for pale ONH, P=0.27; and 1.98±0.55 and 1.84±0.52 for controls, P=0.33). In normal-colored ONH, VCDR was 0.30±0.11 at SP and 0.31±0.21 at HRT (P=0.90); in controls, it was 0.29±0.13 at SP and 0.30±0.18 at HRT (P=0.77). In the group with pale ONH, VCDR was 0.34±0.14 at SP and 0.53±0.24 at HRT (P<0.001). HRT image quality was the only parameter which influenced the difference in VCDR estimates between SP and HRT (P=0.02). In patients with pale ONH, this difference was significantly higher, when images of acceptable quality were used for analysis (0.36±0.15 vs. 0.15±0.21 for images with good quality or better, P=0.03). CONCLUSIONS: In ONH diseases other than glaucoma, HRT may give misleading information when images of acceptable quality are considered for analysis. We therefore recommend the use of images with good quality or better (SD ≤30 µm) in these cases.

Corneal involvement in Crohn's disease: an in vivo confocal microscopy study.

PURPOSE: To evaluate the corneal changes of patients with Crohn's disease (CD) using confocal microscopy and to investigate the association among confocal parameters and CD activity and CD treatment. METHODS: Thirty consecutive patients (age: 42 ± 12 years; 19 women and 11 men) affected by CD and 30 control eyes (age matched and gender matched) underwent an ophthalmic examination and, in 1 eye chosen at random, confocal microscopy of the central cornea using the cornea module of Heidelberg Retina Tomograph. The following confocal parameters were evaluated: density of basal epithelial cells, epithelial dendritic cells, anterior and posterior stromal keratocytes, and endothelial cells; the subbasal plexus was assessed for number and tortuosity of the nerve fibers. RESULTS: Routine ophthalmic evaluation was normal in the whole population. At confocal microscopy, 40% of patients with CD had hyperreflective dots in the basal epithelium, which were absent in the control group. Activation of keratocytes was found in 86.6% of patients with CD and was absent in the control group. Compared with controls, patients with CD had lower density of dendritic cells (12.2 ± 26.3 vs. 50.3 ± 37.6 cells per square millimeter; P = 0.001). The other confocal parameters were similar in the 2 groups. No correlation between CD activity index and confocal changes was found. CONCLUSION: Confocal microscopy can detect subtle corneal changes in patients with CD, which may be signs of subclinical inflammation.

Long-term perimetric fluctuation in patients with different stages of glaucoma.

AIM: To evaluate the long-term perimetric fluctuation (LF) in patients with different stages of glaucoma according to the Glaucoma Staging System 2 (GSS2). METHODS: This multicentre retrospective study included 161 eyes of 161 stable glaucoma patients undergoing four visual-field tests (Humphrey SITA-Standard program over the central 24° or 30°) over a 2-year period. For each patient, the stage of the disease was classified according to GSS2. LF was then calculated as the mean of the standard deviations of point-to-point threshold sensitivities in the four repetitions. LF in GSS2 stages was compared using the t test. Results LF progressively increased from stage 0 to stage 4, and then decreased at stage 5. Stage 4 had a peak of 3.19 ± 0.94 dB, with statistically significant differences compared with all the other stages. The lowest LF (1.65 ± 0.60 dB) was found for normal subjects, whereas similar data were found for borderline patients and those at stages 1 and 5 (2.09 ± 0.58, 2.13 ± 0.57 and 2.22 ± 0.89 dB, respectively; p > 0.13). Visual fields with generalised defects had a lower LF (1.90 ± 0.81) than those with mixed (2.84 ± 0.87, p = 0.0003) and localised (2.63 ± 0.72, p = 0.004) defects. Conclusions In this study, the authors showed that the lower the visual-field defect, the lower was LF, except at stage 5 of GSS2. As test-retest changes exceeding LF could represent a sign of progression, the authors suggest that clinicians using this classification system calculate LF, in order to better differentiate true progression from variability.

Can mean central corneal thickness and its 24-hour fluctuation influence fluctuation of intraocular pressure?

PURPOSE: To evaluate the influence of central corneal thickness (CCT) and its 24-hour fluctuation on 24-hour intraocular pressure (IOP) fluctuation in primary open-angle glaucoma. METHODS: Forty consecutive patients underwent 24-hour evaluation (8 PM, midnight, 4 AM, 8 AM, noon, and 4 PM) of supine and sitting IOP, measured with handheld Perkins and Goldmann tonometer respectively, and of CCT measured using ultrasonic pachymeter. Thirty patients were treated with timolol 0.5% twice daily and latanoprost 0.005% once daily; 10 patients were untreated. Measurements were taken in both eyes, but only one eye per patient was used for analytical purposes. Three IOP curves were drawn: sitting position, supine position, and habitual body position (diurnal sitting measurements and nocturnal supine measurements). Fluctuation was calculated as the SD over the 24-hour curve. Differences in the 2 groups were inspected by means of t test; the correlations between IOP fluctuation and mean CCT, respectively, and its fluctuation were evaluated by means of regression analysis. RESULTS: Untreated patients had higher IOP than the treated group (habitual body position: 22.1+/-5.1 mm Hg vs. 16.0+/-3.0 mm Hg, P=0.004), but no differences were found for IOP fluctuations (habitual body position: 2.5+/-1.2 mm Hg vs. 2.3+/-0.8 mm Hg, P=0.32), mean CCT (542+/-38 microm vs. 534+/-39 microm, P=0.44), and CCT fluctuation (8.7+/-5.6 microm vs. 6.5+/-3.0 microm, P=0.09). The correlation between IOP fluctuation and mean CCT and its fluctuation was not statistically significant at supine, sitting and habitual body positions (P>or=0.07; R

Mild learning effect of short-wavelength automated perimetry using SITA program.

PURPOSE: To evaluate the learning effect at Short-wavelength Automated Perimetry (SWAP) using the Swedish Interactive Threshold Algorithm (SITA) program over the central 24 degrees on patients with ocular hypertension experienced with standard automated perimetry. METHODS: Twenty-seven patients underwent 5 SITA SWAP tests at intervals of 5+/-2 days in a randomized eye. Learning effect was defined as an improvement in results for duration, perimetric indices, foveal sensitivity, Glaucoma Hemifield Test, number of points with a P<5% and <1% in the total, and pattern deviation maps, total, central, paracentral, peripheral, and quadrant sensitivity. RESULTS: Learning effect was shown for foveal sensitivity (P=0.006, analysis of variance), which was significantly different only between the first (23.0 dB+/-4.1 dB) and the last test (24.7 dB+/-3.8 dB, P=0.003, t test) and was not affected by any demographic or ophthalmic characteristics of the population. All the other parameters did not show any significant learning effect. CONCLUSIONS: SITA SWAP is affected by a small learning effect interfering only with the first test, as opposite to full-threshold SWAP program, which previously showed severe learning artefacts. This fact may induce reconsideration of the clinical utilization of SWAP for the early diagnosis of glaucoma.

Retinal angiomatous proliferation: natural history and progression of visual loss.

PURPOSE: To investigate the natural history and visual outcome in eyes with untreated retinal angiomatous proliferation, a neovascular form of age-related macular degeneration. METHODS: Fourteen consecutive white patients (11 women, 78%; mean age, 74 years) with 16 eyes affected by retinal angiomatous proliferation were prospectively followed-up without treatment by means of complete ophthalmologic examinations at regular intervals, including best-corrected visual acuity and dynamic fluorescein and indocyanine green angiography using a scanning laser ophthalmoscope. RESULTS: The patients were observed for a mean of 20 months (range, 6-44 months). Mean visual acuity in the eyes with retinal angiomatous proliferation was 0.48 at the initial examination, decreased to 0.23 after 6 months, and was 0.19 at the final examination, with a mean decrease of 6 lines from baseline. In 13 eyes (81%), visual acuity deteriorated by 2 Early Treatment Diabetic Retinopathy Study lines or worse by the time of the 6-month examination, and 31% of the patients had experienced severe loss of vision; the remaining 3 eyes (19%) showed a relatively stable clinical course and visual acuity. By the time of the final examination, visual acuity had decreased to 0.1 or worse in 11 eyes (69%), and 5 of the 14 patients (36%) were legally blind. At the final examination, 10 eyes (62%) showed a subretinal fibrosis and 9 (56%) showed a retinal choroidal anastomosis. CONCLUSION: Retinal angiomatous proliferation is a distinct form of neovascular age-related macular degeneration with high vasogenic potential, having its own clinical course and visual prognosis. The poor visual outcome is because of the exudative nature of the retinal angiomatous proliferation, and progression to poor vision is common and rapid (within 3 months in faster cases, and within 1 year in slower cases). The treatment options for this type of neovascular lesion should be planned bearing in mind its unfavorable natural history.

Corneal subbasal nerves changes in patients with diabetic retinopathy: an in vivo confocal study.

PURPOSE: To study the subbasal corneal plexus (SCP) in patients with diabetic retinopathy (DR) treated or nontreated with panretinal Argon laser photocoagulation (ALP). METHOD: Fifty consecutive patients with DR and 50 age- and sex-matched normal control subjects were examined with retinal tomography by a masked evaluator. The following subbasal plexus nerves parameters were considered: number per frame, tortuosity, and reflectivity. Diabetic patients were divided into two groups, according to the presence of proliferative versus nonproliferative retinopathy, according to the Early Treatment of Diabetic Retinopathy Study (ETDRS) classification. RESULTS: The number of fibers per frame and reflectivity were significantly lower in diabetic patients compared with control subjects (2.4 +/- 1 vs. 2.9 +/- 0.8, P = 0.01 and 2.3 +/- 0.9 vs. 2.6 +/- 0.9, P = 0.04, respectively). Tortuosity was significantly higher in diabetic patients (2.5 +/- 0.9 vs. 2.0 +/- 0.8, P = 0.002). Number per frame and reflectivity were significantly lower in diabetic patients with proliferative diabetic retinopathy (PDR; respectively, 2.0 +/- 0.9 vs. 2.9 +/- 0.9, P = 0.001, and 2.0 +/- 0.8 vs. 2.6 +/- 0.7, P = 0.003). Tortuosity was significantly higher in the PDR group (2.2 +/- 0.8 vs. 2.8 +/- 0.9, P = 0.008). The PDR group treated with ALP had significantly lower subbasal nerves number compared with the nontreated group (P = 0.01). CONCLUSIONS: DR may induce substantial changes in the SCP. There is a difference between proliferative and nonproliferative retinopathy and in the former group between ALP treated and nontreated patients.

Reproducibility of the Heidelberg Retina Tomograph III Glaucoma Probability Score.

PURPOSE: To evaluate the intrasession reproducibility of the Heidelberg Retina Tomograph III (HRT III) Glaucoma Probability Score (GPS) and analyze the factors that may affect it. PATIENTS AND METHODS: Twenty normal subjects and 20 glaucomatous patients underwent 10 HRT III examinations of 1 randomly selected eye during the same session. The reproducibility of the GPS and its parameters was assessed by calculating the intraclass correlation coefficients (ICCs) and 95% confidence intervals of the study population as a whole, and of the 2 subgroups. The factors influencing individual reproducibility were evaluated by means of regression analysis. RESULTS: The reproducibility of the GPS parameters (at a confidence level of 95%) was almost perfect in the population as a whole (ICCs 0.964-0.856) and in the normal subjects (ICCs 0.976-0.897), but decreased in the glaucoma patients in whom it ranged from almost perfect to substantial (ICCs 0.922-0.705). The parameters were mainly influenced by image quality, but also by diagnosis and age, although the probability of glaucoma did not seem to depend on these variables. CONCLUSIONS: GPS is a highly reproducible diagnostic tool, especially in the case of "good" or better quality images as evaluated by the HRT software; moreover, the reproducibility of the GPS parameters was significantly better in normal subjects than in glaucoma patients.

The circadian curve of intraocular pressure: can we estimate its characteristics during office hours?

PURPOSE: To verify whether office-hour measurements in patients in different body positions can estimate the characteristics of 24-hour intraocular pressure (IOP). METHODS: The 24-hour IOP curves of 29 healthy subjects (10 young adults, 19 elderly) and 30 patients with untreated glaucoma were analyzed. Measurements were taken at 9 AM; 12, 3, 6, and 9 PM; and 12, 3, and 6 AM, both in the supine and sitting (Goldmann tonometer) positions. Peak, mean, and fluctuation of 24-hour IOP curves were compared with office-hour measurements obtained in subjects in the sitting position alone and with combined pressures obtained in the sitting and supine positions (four measurements in each body position from 9 AM to 6 PM). The percentage of subjects with estimates of all IOP parameters within a cutoff of +/-1 (peak and mean) and +/-2 mm Hg (fluctuation) was calculated. RESULTS: Office-hour sitting measurements correctly identified peak, mean, and IOP fluctuation in 10% of the young adults, 32% of the elderly control subjects, and 20% of the patients with glaucoma, whereas the combination of supine and sitting measurements correctly identified them in 30%, 85%, and 46% of cases, respectively. It is noteworthy that office-hour measurements did not characterize any 24-hour parameter in 20% of patients with glaucoma. CONCLUSIONS: Compared with sitting measurements alone, the collection of supine and sitting office-hour measurements may enhance the correct identification of 24-hour IOP characteristics in both control subjects and untreated patients with glaucoma, thus reducing the need for obtaining 24-hour curves to a minority of patients.