Prata, Tiago S.

Précis: Glaucoma patients of similar age and educational level, compared with healthy individuals, exhibit a greater number of saccades and fixations during eye-tracking-aloud reading, resulting in reduced reading speed. Purpose: To evaluate reading performance in patients with glaucoma compared with controls using an eye tracker and to explore the potential confounding effects of patients’ contrast sensitivity and cognition. Materials and Methods: A cross-sectional study was conducted with 111 participants (57 with glaucoma and 54 controls) with a best-corrected visual acuity of ≥0.5 logMAR. Cognition was assessed using the Montreal Cognitive Assessment, and contrast sensitivity was measured with the Freiburg Visual Acuity and Contrast Test. A reading performance evaluation was conducted using the Minnesota Low Vision Reading Test displayed on slides on a computer screen. Reading speed was calculated in words per minute, and an eye tracker was used to analyze saccade and fixation patterns during the reading task. Results: Mean age was 61.8 (±11.6) and 66.5 (±13.7) in the glaucoma and control groups, respectively ( P =0.05). Best-corrected visual acuity was 0.18 (±0.16) and 0.04 (±0.10) logMAR in the glaucoma and control groups, respectively ( P <0.001). Montreal Cognitive Assessment score was 21.8 (±3.5) in the glaucoma and 21.4 (±4.0) in the control group ( P =0.566). A total of 26% of the glaucoma group and 33% of the control group had at least a primary education. Controls read faster and showed fewer saccades and fixations than patients with glaucoma ( P <0.05) across all 5 slides. Conclusions: Patients with glaucoma exhibit poorer reading performance, as evidenced by eye-tracking data, compared with controls of similar age, cognitive function, and educational level.

Précis: Micropulse transscleral laser treatment (MP-TLT) and continuous wave transscleral cyclophotocoagulation demonstrated comparable intraocular pressure across all follow-ups. MP-TLT was associated with significantly lower risks of ocular complications, such as hypotony, prolonged inflammation, and phthisis bulbi. Purpose: To compare the efficacy and safety of micropulse transscleral laser treatment (MP-TLT) and continuous wave transscleral cyclophotocoagulation (CW-TSCPC) for the treatment of glaucoma or ocular hypertension. Methods: A systematic search was conducted in PubMed, Cochrane Library, Embase, and ClinicalTrials.gov. Randomized controlled trials (RCTs) or cohort studies comparing MP-TLT and CW-TSCPC were included. Weighted mean differences (MDs) were computed for continuous endpoints and risk ratios (RRs) for binary endpoints, with 95% CIs. Heterogeneity was assessed with I 2 statistics. Software R, version 4.4.0, was used for statistical analyses. Subgroup analyses were conducted on glaucoma types. Results: Eleven studies encompassing 1054 eyes from 986 patients were included, with 47.4% receiving MP-TLT. There were no significant differences in IOP between CW-TSCPC and MP-TLT at 1 week, 1 month, 3 months, 6 months, 12 months, and 18 months of follow-up. The MP-TLT group required a significantly higher number of hypotensive medications but displayed significantly reduced risks of overall complications, ocular hypotony, prolonged inflammation, and phthisis bulbi compared with CW-TSCPC. Conclusion: MP-TLT and CW-TSCPC showed similar efficacy in IOP control. However, MP-TLT demonstrated a greater safety profile, suggesting its potential suitability for patients requiring repeat interventions or those with lower tolerance for ocular complications.

Précis: Patients with clinically uncontrolled open angle glaucoma submitted to isolated gonioscopy-assisted transluminal trabeculotomy or combined with phacoemulsification not only achieved low mean IOPs, but also demonstrated stable IOP patterns during a 24-month follow-up. Purpose: To assess the impact of gonioscopy-assisted transluminal trabeculotomy (GATT) on long-term intraocular pressure (IOP) variation. Patients and Methods: An unicentric retrospective study including 169 consecutive patients who had undergone standalone GATT or combined with phacoemulsification (PHACOGATT) due to clinically uncontrolled open angle glaucoma, with at least 12 months of follow-up was conducted. Long-term mean IOP, long-term IOP peak, long-term IOP fluctuation, coefficient of variation, mean-positive IOP variation, sustained clinically significant positive IOP variation, and number of follow-up visits with IOP ≥15 mm Hg were investigated. Results: One hundred sixty-nine eyes from 169 patients were included (GATT group=101 patients; PHACOGATT group=68 patients). Mean long term IOP (12.0±1.8 vs. 11.2±2.0 mm Hg), mean long-term IOP peak (12.9±2.6 vs. 11.8±3.5 mm Hg), and mean coefficient of variation (0.07±0.08 vs. 0.05±0.09) were lower in the PHACOGATT group, while mean IOP fluctuation (1.0±3.7 vs. 1.2±1.8 mm Hg) was lower in the GATT group. In addition, the overall mean-positive IOP variation was 0.79±1.64 mm Hg. Finally, only 6.5% of the patients presented sustained clinically significant positive IOP variation and IOP was ≥15 mm Hg in 5.9% of the follow-up visits. Conclusions: Patients with clinically uncontrolled open angle glaucoma submitted to GATT or PHACOGATT achieved low mean IOPs and demonstrated stable IOP patterns. Our results provide additional evidence supporting GATT and PHACOGATT as viable options for the treatment of medically uncontrolled glaucoma patients requiring low and stable IOPs.

Précis: Automated optic nerve head hemoglobin measurements through change over time in the Globin Individual Pointer (GIP) index, provided by the Laguna ONhE software, can be useful to evaluate structural progression in glaucoma. Purpose: To assess the performance of automated optic nerve head hemoglobin measurements (ONH Hb) for detection of structural progression in glaucoma patients using event analysis. Patients and Methods: Treated glaucoma patients were included in this cross-sectional study. Two experienced examiners classified patients into progressors and non-progressors (controls) based on serial color retinographies (CR). Progressors were then subdivided in structural changes of the neuroretinal rim (NR) or retinal nerve fiber layer (RNFL). Globin individual pointer (GIP) index, derived from ONH Hb measurements, was calculated for each CR using the Laguna ONhE software. Differences in GIP values, ​​between baseline and last visit CRs, were used to assess structural progression. Sensitivity at a fixed specificity (50%; median GIP difference in controls) and areas under receiver operating characteristic curves (AUROC) were calculated. Results: Eight-seven eyes (35 progressors and 52 controls) from 64 patients were enrolled. Mean GIP reduction over time was greater in progressors (−13.0±18.6) than controls (−2.9±10.4; P=0.001). In progressors, mean GIP reduction was greater in patients with NR changes (−19.6±19.5) than RNFL changes (−3.1±12.1; P=0.008). GIP difference correctly identified 69% of the progressors (AUROC: 0.66), being 76% of these progressions related to NR changes (AUROC: 0.76) and 57% to RNFL changes (AUROC: 0.52). Conclusions: The GIP index, based on automated ONH Hb measurements demonstrated good sensitivity to differentiate progressors from controls, especially in cases in which progression was documented through structural NR changes. Using only 2 CRs and event analysis, GIP changes over time can be a useful screening tool to evaluate structural progression.

Abstract Purpose: To compare vascular parameters, assessed by endothelin-1 (ET-1) blood levels, Laser Doppler Imaging (LDI) of distal phalanx, and nailfold capillaroscopy (NC), between open-angle glaucoma (OAG) patients with low (LTDH) and high-tension optic disc hemorrhages (HTDH). Methods: In this prospective study, patients were classified as LTDH if presenting an IOP<16 mmHg and HTDH if an IOP³16 mmHg at the time of DH detection. Demographic and ophthalmological data, ET-1 concentration, LDI (before and after 1, 10 and 20 minutes after cold stimulation) and NC findings were evaluated. Results: Thirty-tree patients were included (mean age, 62.3±13 years). Regarding ET-1 blood level, it was 65% higher in the LTDH group (2.27±1.46 pg/ml) compared to the HTDH (1.37±0.57 pg/ml; p=0.03). In addition, there was a significant negative correlation between ET-1 blood concentration and IOP at the time of DH detection (r=-0.45; p=0.02). Blood flow measurement in LTDH patients were lower than those observed in patients with HTDH 10 and 20 minutes after cold stimulus (p<0.01). Conclusion: Patients developing DH with lower IOPs have higher ET-1 blood levels and more peripheral vascular dysfunction (than those with higher IOPs), as estimated by LDI. These findings suggest that distinct underling mechanisms maybe involved in patients developing DH with different IOP ranges.

Precis: Although this sample with glaucoma had preserved central vision, they presented worse reading performance compared with similarly aged controls. Objective: To determine whether patients with glaucoma with preserved central vision have impaired reading performance compared with healthy controls. Methods: A cross-sectional study of 35 patients with glaucoma and 32 similarly aged controls with visual acuity better than 0.4 logMAR in both eyes. Each participant had a detailed ophthalmological examination followed by a 5-chart reading performance test using a Portuguese version of the Minnesota Low Vision Reading Test (MNREAD). Correlation between reading performance (reading speed) and ocular parameters was investigated. Results: Participants had an average age of 63.0±12.6 years. In the glaucoma group, mean deviation in the better and worse eyes was −6.29±6.36 and −11.08±0.23 dB, respectively. There was no significant difference in age, sex, rage, education, visual acuity, or systemic comorbidities between groups. Participants with glaucoma had significantly slower reading speeds, with an average of 83.2±25.12 compared with 102.29±29.57 words per minute in controls (P=0.006). Reading speed was slower for all 5 charts. Odds of glaucoma increased by 1.29 (95% confidence interval, 1.07-1.56; P=0.009) for each 10 words per minute decrease in average reading speed, with this relationship maintained after accounting for age, schooling, and visual acuity. Conclusions: Patients with mild to moderate glaucoma had worse reading performance compared with similarly aged controls, despite both having preserved central vision.

SUMMARY OBJECTIVES To bring summarized information about what has been published so far regarding Covid-19, facilitating the access to information and a better understanding of this pandemic, and to contribute to the medical community in the decision-making against this virus. METHODS This review article brings collected information from different articles published since the beginning of the pandemic of the 2019 novel coronavirus. KEY RESULTS This paper aggregates and consolidates some epidemiological parameters and clinical knowledge about the novel coronavirus and brings what is new in the search for pandemic control. MAJOR CONCLUSIONS Governments and health authorities are under increased pressure to control the COVID-19 spreading. In this scenario, the scientific community is working hard to produce relevant papers which will help in the next steps against coronavirus. Our review summarized the latest news about SARS-CoV2, evidencing what we know about COVID-19 until now.

Purpose: To compare provocative test-based and long-term intraocular pressure variation parameters in patients with stable open-angle glaucoma. Methods: A prospective observational study was carried out in which stable open-angle glaucoma patients (⩾3 years of follow-up without any changes on current medical regimen) were consecutively enrolled. All patients were submitted to a water-drinking test. Long-term intraocular pressure parameters were obtained from isolated intraocular pressure measurements from each visit (⩾5 visits). We investigated the correlation and agreement between the following water-drinking test and long-term intraocular pressure parameters: mean, peak, and fluctuation. In addition, the percentage of eyes with significant intraocular pressure peaks during the water-drinking test (defined as a difference ⩾25% between water-drinking test intraocular pressure peak and mean long-term intraocular pressure) was assessed. Results: Sixty-three eyes from 63 open-angle glaucoma patients (mean age, 60.7 ± 11.8 years) were included. Mean and water-drinking test intraocular pressure peak correlated significantly with mean ( r = 0.67) and maximum long-term intraocular pressure ( r = 0.52), respectively ( p < 0.01). The correlation between water-drinking test intraocular pressure fluctuation and long-term intraocular pressure fluctuation was not significant ( p = 0.45). Limits of agreement from Bland–Altman plots exceeded the maximum allowed difference between methods (3 mm Hg) for all the intraocular pressure parameters analyzed, suggesting poor agreement between water-drinking test–derived and long-term intraocular pressure values. Overall, significant water-drinking test intraocular pressure peaks were observed in 39.7% of these eyes with stable open-angle glaucoma. Conclusion: Although some water-drinking test–based and long-term intraocular pressure parameters correlate significantly, water-drinking test results may not reflect the long-term intraocular pressure profile of stable open-angle glaucoma patients, as their agreement is poor. Many of these patients may experience significant water-drinking test intraocular pressure peaks, despite long-standing stable disease and unchanged medical regimen.

Purpose. To evaluate factors associated with midterm visual field (VF) variability in stable glaucoma patients in Brazil.Methods. This retrospective observational study included 59 eyes of 39 stable glaucoma patients. Baseline data assessed were age, gender, educational level, intraocular pressure (IOP), central corneal thickness, best-corrected visual acuity, spherical equivalent, number of hypotensive eye drops, type of glaucoma, number of VFs performed, follow-up in years, lens status, visual field index (VFI) values from the last 5 VF (standard automated perimetry (SAP)) tests, the presence or absence of central scotoma in the VF test, and the level of glaucomatous damage according to the VF mean deviation (MD) index of the last VFs. The 5 latest VFI scores were used to calculate the mean, the standard deviation (SD), and the coefficient of variation (CV). We divided the eyes into 2 groups, being group 1 comprised by the 29 eyes presenting the lowest CV values and group 2 comprised by the 30 eyes presenting the highest CV values. GEE models were used to compare the CV and demographic and clinical parameters of all participants.Results. Mean age of all subjects was 65.8 ± 10.1 years. 54.0% were women. Average SAP MD values for groups 1 and 2 were −2.8 ± 3.1 dB and −6.2 ± 4.1 dB, respectively (P=0.006). Average SAP VFI values for groups 1 and 2 were 95.6 ± 5.9% and 85.9 ± 11.3%, respectively (P=0.002). There was a statistically significant association between CV and SAP MD values (P=0.006). A worse SAP MD and VFI were associated with a higher CV. In addition, even adjusting for potential confounding factors (age and level of education), the association between CV and the SAP MD and between CV and VFI remained significant (P≤0.010).Conclusion. Glaucomatous patients with worse VF sensitivity scores (both MD and VFI indices) present higher VF test variability.