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Supharat Jariyakosol,1,2,&ast; Patcharaporn Jaru-ampornpan,1,2,&ast; Anita Manassakorn,1,2 Rath Itthipanichpong,1,2 Parima Hirunwiwatkul,1,2 Visanee Tantisevi,1,2 Thanapong Somkijrungroj,1,2 Prin Rojanapongpun1,2 1Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 2Ophthalmology Department, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand&ast;These authors contributed equally to this workCorrespondence: Supharat Jariyakosol Email jsupharat@gmail.comPurpose: To assess the diagnostic accuracy of visual field results generated by the newly developed software (CU-VF) and the standard automated perimetry (SAP) for detecting hemianopia.Patients and Methods: Forty-three subjects with hemianopia and 33 controls were tested with the CU-VF software on a personal computer and SAP. Hemianopia was defined as the presence of a hemianopic field respecting the vertical meridian on SAP with the corresponding neuroimaging pathology as evaluated by 2 neuro-ophthalmologists. Results of CU-VF were independently evaluated by 2 neuro-ophthalmologists, 1 general ophthalmologist, and 1 general practitioner in terms of the presence of hemianopia. Sensitivity, specificity, and kappa coefficient for inter-observer reliability were calculated. Satisfaction and ease of use were evaluated with a visual analog-scale questionnaire and analyzed using paired t-test.Results: The sensitivity (95% CI) and specificity (95% CI) of the CU-VF to detect hemianopia was 74.42% (58.53– 85.96) and 93.94% (78.38– 99.94). Kappa coefficient between neuro-ophthalmologists versus general ophthalmologist and general practitioner were 0.71 and 0.84, respectively. The mean (SD) test duration was 2.25 (0.002) minutes for the CU-VF and 5.38 (1.34) minutes for SAP (p < 0.001). Subjects reported significantly higher satisfaction and comfort using the CU-VF software compared to SAP.Conclusion: The CU-VF screening software showed good validity and reliability to detect hemianopia, with shorter test duration and higher subject satisfaction compared to SAP.Keywords: hemianopia, visual field, screening software

Abstract We investigate the development of ciliochoroidal effusion following micropulse transscleral laser therapy (MPTLT) and evaluate the relationship between the early postoperative ciliochoroidal effusion (ECE) and short-term treatment outcomes. Glaucoma patients who underwent MPTLT were assessed for ciliochoroidal effusion by anterior segment optical coherence tomography (AS-OCT) at postoperative 1, 4, 12 weeks. The subjects were classified based on AS-OCT findings at postoperative 1 week into eyes with and without ECE. The absolute intraocular pressure (IOP), IOP reduction and number of antiglaucoma medications were compared between eyes with and without ECE. A total of 50 eyes were included, of which 23 (46%) developed ciliochoroidal effusion at postoperative 1 week. Almost all effusion resolved at 4 weeks. At 12 weeks, the mean IOP (SD) significantly decreased from 28.5 (12.8) mmHg to 17.8 (10.5) mmHg (p

Purpose: To evaluate the clinical characteristics and treatment outcomes of patients with childhood glaucoma. Methods: We retrospectively reviewed the data of patients with childhood glaucoma who visited the glaucoma clinics at the Queen Sirikit National Institute of Child Health and the King Chulalongkorn Memorial Hospital between January 2008 and January 2018. The diagnosis was based on the Childhood Glaucoma Research Network classification. We recorded their clinical characteristics and requirement of any glaucoma interventions. Results: A total of 691 eyes from 423 patients were included in this study. The patients predominantly comprised boys. The average follow-up duration was 71.3±63.8 months. The mean age at presentation was 3.9±4.4 years. Most patients presented with a high initial intraocular pressure (IOP). The average intial IOP of all patients was 28.5±11.2 mmHg. Glaucoma associated with non-acquired ocular anomalies (22.9%) was the most common subtype, followed by primary congenital glaucoma (20.8%). We recorded a family history of glaucoma in 6.4% of patients of the 234 patients with an available family history. Most patients had bilateral glaucoma (63.4%) and required at least one intervention (51.5%). The average IOP at the latest follow-up visit was 19.1±10.8 mmHg. All glaucoma types had significantly lower IOP, compared to that at their baselines (all p Conclusions: Secondary glaucoma associated with non-acquired ocular anomalies is the most common subtype of glaucoma. The majority of patients had unfavourable visual outcomes. These real-world findings are fundamental to acquire a better understanding of childhood glaucoma.

Purpose: To evaluate the clinical characteristics and treatment outcomes of patients with childhood glaucoma. Methods: We retrospectively reviewed the data of patients with childhood glaucoma who visited the glaucoma clinics at the Queen Sirikit National Institute of Child Health and the King Chulalongkorn Memorial Hospital between January 2008 and January 2018. The diagnosis was based on the Childhood Glaucoma Research Network classification. We recorded their clinical characteristics and requirement of any glaucoma interventions. Results: A total of 691 eyes from 423 patients were included in this study. The patients predominantly comprised boys. The average follow-up duration was 71.3±63.8 months. The mean age at presentation was 3.9±4.4 years. Most patients presented with a high initial intraocular pressure (IOP) of 28.5±11.2 mmHg. Glaucoma associated with non-acquired ocular anomalies (22.9%) was the most common subtype, followed by primary congenital glaucoma (20.8%). We recorded a family history of glaucoma in 6.4% of patients. Most patients had bilateral glaucoma (63.4%) and required at least one intervention (51.5%). The average IOP at the latest follow-up visit was 19.1±10.8 mmHg. All glaucoma types had significantly lower IOP, compared to that at their baselines (all p Conclusions: Secondary glaucoma associated with non-acquired ocular anomalies is the most common subtype of glaucoma. All subtypes, including primary glaucoma, were sporadic. The majority of patients had unfavourable visual outcomes. These real-world findings are fundamental to acquire a better understanding of childhood glaucoma.

Background/Aims. Epigenetic mechanisms via DNA methylation may be related to glaucoma pathogenesis. This study aimed to determine the global DNA methylation level of the trabeculectomy specimens among patients with different types of glaucoma and normal subjects. Methods. Trabeculectomy sections from 16 primary open-angle glaucoma (POAG), 12 primary angle-closure glaucoma (PACG), 16 secondary glaucoma patients, and 10 normal controls were assessed for DNA methylation using combined-bisulfite restriction analysis. The percentage of global methylation level of the interspersed repetitive sequences for LINE-1, Alu, HERV-E, and HERV-K were compared between the 4 groups. Results. There were no significant differences in the methylation for LINE-1 and HERV-E between patients and normal controls. For the Alu marker, the methylation was significantly lower in all types of glaucoma patients compared to controls (POAG 52.19% versus control 52.83%, p=0.021; PACG 51.50% versus control, p=0.005; secondary glaucoma 51.95% versus control, p=0.014), whereas the methylation level of HERV-K was statistically higher in POAG patients compared to controls (POAG 49.22% versus control 48.09%, p=0.017). Conclusions. The trabeculectomy sections had relative DNA hypomethylation of Alu in all glaucoma subtypes and relative DNA hypermethylation of HERV-K in POAG patients. These methylation changes may lead to the fibrotic phenotype in the trabecular meshwork.

Background: This study aimed to assess the pain experienced during micropulse transscleral laser therapy (MPTLT) and overnight thereafter and explore the factors associated with the pain. Methods: This prospective study included 100 eyes of 81 glaucoma patients undergoing MPTLT under retrobulbar anesthesia. All patients were asked to rate both types of pain using a numerical rating scale (NRS). The risk factors were explored using multivariable mixed-effects ordinal logistic regression. Results: The mean (SD) NRS pain score during the procedure was 3.57 (3.41) (range 0–10), which included no, mild, moderate, and severe pain in 30 (30%), 33 (33%), 17 (17%), and 20 (20%) eyes, respectively. The mean (SD) NRS score of overnight pain was 2.99 (2.28) (range 0–9), which included no, mild, moderate, and severe pain in 17 (17%), 59 (59%), 17 (17%), and 7 (7%) eyes, respectively. Twenty-seven (27%) eyes reported worse pain overnight than during the procedure. Increased age, initial intraocular pressure, and pain during the procedure were significantly associated with increased overnight pain (p < 0.05). Conclusions: Up to a fourth of eyes had worse pain after discharge. Older age, initial intraocular pressure, and pain during the procedure were risk factors for higher levels of overnight pain. [ABSTRACT FROM AUTHOR]

Purpose: The effect of statins on wound healing is controversial, and their effect on trabeculectomy outcomes remains unclear. This study aimed to examine the relationship between oral statin use and trabeculectomy outcomes. Methods: Medical records of patients who underwent primary mitomycin-C augmented trabeculectomy with 2 years of follow-up were reviewed. Pre- and postoperative intraocular pressures (IOP) and numbers of medications, subconjunctival 5-fluorouracil (5-FU) injections, and bleb-needling procedures were compared between statin users and nonusers. Failure was defined as an eye that failed to achieve a 20% lowering of IOP from baseline or had an IOP > 21 mm Hg, as well as an eye that required further surgical intervention, developed hypotony, or had no light perception visual acuity. Results: In total, 158 subjects were enrolled, with 47 eyes from statin users and 111 eyes from statin nonusers. The 24-month cumulative probability of failure was 78.7% for statin users and 60.4% for nonusers (P =.013). Cox proportional-hazards modeling showed a significantly higher hazard risk in statin users (adjusted hazard ratio 1.61, P =.026). There were no significant between-group differences in mean IOPs or number of medications (both P >.05) at 24 months. Multivariable Poisson regression analysis that statin use was associated with increased numbers of 5-FU injections (P =.014) and bleb-needling procedures (P =.031). Conclusions: This study demonstrated that oral statin use was associated with higher rates of trabeculectomy failure and increased numbers of 5-FU injections and bleb-needling procedures. [ABSTRACT FROM AUTHOR]

Purpose. To compare corneal deformation characteristics using ultra-high-speed Scheimpflug camera (Corvis ST) in patients with nonmyopic (NM), mild-to-moderate nonaxial myopic (MM), and high axial myopic (HM) eyes. Methods. In this cross-sectional study, normal subjects aged >40 years with no history of ocular laser/surgery were classified according to axial length (AL) and spherical equivalence (SE) into three groups: (1) NM (SE > −0.50 D and AL < 26 mm), (2) MM (SE −6.00 D to −0.50 D and AL < 26 mm), and (3) HM (SE ≤ −6.00 D and AL ≥ 26 mm). Seven parameters including corneal deformation amplitude (CDA), inward/outward corneal applanation length, inward/outward corneal velocity (ICV and OCV), peak distance, and radius were measured. Pearson correlation and linear mixed-effects model were done. Results. A total of 180 eyes were recruited. 98 eyes were NM, 30 eyes were MM, and 52 eyes were HM. There were significant correlations of OCV to the degree of refractive error (r = 0.203, p < 0.001) and AL (r = −0.242, p < 0.001). After adjusting for age, sex, intraocular pressure, and corneal thickness, there was significantly higher CDA (β = 0.07, p < 0.001), faster OCV (β = −0.08, p < 0.001), and smaller radius (β = −0.39, p = 0.01) in the HM group compared to the NM group. Conclusion. The higher CDA, faster OCV, and smaller radius found in the HM may suggest that these eyes have reduced ocular stiffness and may be less stable and more prone to stress. [ABSTRACT FROM AUTHOR]

Background/Aims. Epigenetic mechanisms via DNA methylation may be related to glaucoma pathogenesis. This study aimed to determine the global DNA methylation level of the trabeculectomy specimens among patients with different types of glaucoma and normal subjects. Methods. Trabeculectomy sections from 16 primary open-angle glaucoma (POAG), 12 primary angle-closure glaucoma (PACG), 16 secondary glaucoma patients, and 10 normal controls were assessed for DNA methylation using combined-bisulfite restriction analysis. The percentage of global methylation level of the interspersed repetitive sequences for LINE-1, Alu, HERV-E, and HERV-K were compared between the 4 groups. Results. There were no significant differences in the methylation for LINE-1 and HERV-E between patients and normal controls. For the Alu marker, the methylation was significantly lower in all types of glaucoma patients compared to controls (POAG 52.19% versus control 52.83%, p=0.021; PACG 51.50% versus control, p=0.005; secondary glaucoma 51.95% versus control, p=0.014), whereas the methylation level of HERV-K was statistically higher in POAG patients compared to controls (POAG 49.22% versus control 48.09%, p=0.017). Conclusions. The trabeculectomy sections had relative DNA hypomethylation of Alu in all glaucoma subtypes and relative DNA hypermethylation of HERV-K in POAG patients. These methylation changes may lead to the fibrotic phenotype in the trabecular meshwork. [ABSTRACT FROM AUTHOR]

Background. Assessment of color disc photograph (C-DP) is affected by image quality, which decreases the ability to detect glaucoma. High-dynamic-range (HDR) imaging provides a greater range of luminosity. Therefore, the objective of this study was to evaluate the capability of ophthalmology residents to detect glaucoma using HDR-concept disc photography (HDR-DP) compared to C-DP. Design. Cross-sectional study. Methods. Twenty subjects were classified by 3 glaucoma specialists as either glaucoma, glaucoma suspect, or control. All C-DPs were converted to HDR-DPs and randomly presented and assessed by 10 first-year ophthalmology residents. Sensitivity and specificity of glaucoma detection were compared. Results. The mean ± SD of averaged retinal nerve fiber layer (RNFL) thickness was 74.0 ± 6.1 μm, 100.2 ± 9.6 μm, and 105.8 ± 17.2 μm for glaucoma, glaucoma suspect, and controls, respectively. The diagnostic sensitivity of HDR-DP was higher than that of C-DP (87% versus 68%, mean difference: 19.0, 95% CI: 4.91 to 33.1; p=0.014). Regarding diagnostic specificity, HDR-DP and C-DP yielded 46% and 75% (mean difference: 29.0, 95% CI: 13.4 to 44.6; p=0.002). Conclusions. HDR-DP statistically increased diagnostic sensitivity but not specificity. HDR-DP may be a screening tool for nonexpert ophthalmologists. [ABSTRACT FROM AUTHOR]

Background: Intraocular tuberculosis is uncommon and has various clinical presentations. Lack of specific clinical clues can make the diagnosis challenging. The purpose of this study is to report a clinical presentation of tuberculous iridocyclitis that mimics phacolytic glaucoma and has a distinctive inflammatory deposit in the inner side of the cornea. This report is the first to describe the progression of tuberculous iridocyclitis to nodular scleritis without evidence for extraocular tuberculous infection. Case presentation: A 78-year-old, immunocompetent woman presented with subacute intraocular inflammation with high intraocular pressure, mimicking phacolytic glaucoma. Distinct pigment keratic precipitates were noted on the first visit. Even though the cataract extraction was uneventful and adequate anti-inflammatory drugs were given, the inflammation did not subside as expected. Seven weeks later, she developed two scleral abscesses, which were subsequently explored for microbiological investigation. The smears of the pus revealed positive acid-fast bacilli stain and PCR for Mycobacterium tuberculosis complex. Eventually, the pus culture grew Mycobacterium tuberculosis. Antituberculosis medications were prescribed. After 1 month of treatment, the abscesses were cured. However, her visual acuity did not improve at the last visit. Conclusions: This case revealed an unusual presentation and untreated course of tuberculosis iridocyclitis. Pattern of keratic precipitates may indicate the presence of tuberculosis. [ABSTRACT FROM AUTHOR]

Abstract Purpose  To investigate the distribution of retinal nerve fiber layer (RNFL) and macular retinal thickness measured by optical coherence tomography (OCT) in a Thai population. Methods  We studied one eye each of 250 healthy subjects [age ≥ 18 years; spherical refractive error within ±6 diopters (D); astigmatism ≤3 D; no ocular pathology]. A complete eye examination, standard automated perimetry, and fast RNFL and macular thickness measurement by OCT were performed, and a disc photograph was taken. The distributions of both thicknesses, including their relationship with demographic data, were analyzed. Results  The mean ± SD age of the study population was 44.7 ± 12.2 years. The mean ± SD RNFL thickness was 109.3 ± 10.5 m, which was 10% thicker than that in the OCT normative database. RNFL decreased 2.3 m per decade (P P P P Conclusions  RNFL thickness in the measured Thai population was about 10% thicker than that in the original normative database. Macular thickness and RNFL thickness in the superior and inferior quadrants decreased with advancing age. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical characteristics and treatment outcomes of patients with childhood glaucoma. Methods: We retrospectively reviewed the data of patients with childhood glaucoma who visited the glaucoma clinics at the Queen Sirikit National Institute of Child Health and the King Chulalongkorn Memorial Hospital between January 2008 and January 2018. The diagnosis was based on the Childhood Glaucoma Research Network classification. We recorded their clinical characteristics and requirement of any glaucoma interventions. Results: A total of 691 eyes from 423 patients were included in this study. The patients predominantly comprised boys. The average follow-up duration was 71.3±63.8 months. The mean age at presentation was 3.9±4.4 years. Most patients presented with a high initial intraocular pressure (IOP). The average intial IOP of all patients was 28.5±11.2 mmHg. Glaucoma associated with non-acquired ocular anomalies (22.9%) was the most common subtype, followed by primary congenital glaucoma (20.8%). We recorded a family history of glaucoma in 6.4% of patients of the 234 patients with an available family history. Most patients had bilateral glaucoma (63.4%) and required at least one intervention (51.5%). The average IOP at the latest follow-up visit was 19.1±10.8 mmHg. All glaucoma types had significantly lower IOP, compared to that at their baselines (all p

Purpose: To report a case of ciliary body metastasis with uncontrolled glaucoma that was successfully treated with micropulse transscleral laser therapy (MPTLT). Observations: A case of a 44-year-old female with uncontrolled glaucoma secondary to ciliary body metastasis from pulmonary adenocarcinoma. Antiglaucoma medications, intravitreal ranibizumab injection and local radiotherapy were ineffective in reducing her intraocular pressure (IOP) and ocular pain. MPTLT using a power setting of 2,000 mW, 31.3% duty cycle, and 140 seconds over 180 degrees demonstrated favorable IOP reduction (from 31 to 8 mmHg) on the first postoperative day without either ocular pain or postoperative complications. IOP remained controlled until she died from hemoperitoneum 18 days after hospital discharge. Conclusions and importance: MPTLT can be a safe and effective procedure for IOP control in intraocular metastasis patients with uncontrolled glaucoma.

Purpose: To report a case of daratumumab-induced bilateral angle closure glaucoma and myopia that showed no recurrence after repeated drug administration with prophylactic cycloplegia. Observations: A 63-year-old man with relapsing multiple myeloma presented with acute bilateral eye pain and blurred vision 14 hours after first daratumumab infusion. Eye examination revealed raised intraocular pressure and shallow anterior chamber. Anterior segment ocular coherence tomography and ultrasound biomicroscopy showed ciliochoroidal effusions in both eyes. The diagnosis of bilateral acute angle closure glaucoma and induced myopia was made. Cycloplegia- and intraocular-pressure-lowering medications were given, which gradually deepened the anterior chambers and normalized intraocular pressure and refraction. The ciliochoroidal effusions completely resolved on day 14. The cycloplegic was given as a premedication for subsequent infusions. There was no recurrence of effusion throughout his 6-month daratumumab treatment course. Conclusions and importance: Daratumumab can induce ciliochoroidal effusion, which results in acute secondary angle closure and myopia. The potential prophylactic effect of the cycloplegic drug may enable continuation of daratumumab infusion under close monitoring.

PurposeThe effect of statins on wound healing is controversial, and their effect on trabeculectomy outcomes remains unclear. This study aimed to examine the relationship between oral statin use and trabeculectomy outcomes.MethodsMedical records of patients who underwent primary mitomycin-C augmented trabeculectomy with 2 years of follow-up were reviewed. Pre- and postoperative intraocular pressures (IOP) and numbers of medications, subconjunctival 5-fluorouracil (5-FU) injections, and bleb-needling procedures were compared between statin users and nonusers. Failure was defined as an eye that failed to achieve a 20% lowering of IOP from baseline or had an IOP > 21 mm Hg, as well as an eye that required further surgical intervention, developed hypotony, or had no light perception visual acuity.ResultsIn total, 158 subjects were enrolled, with 47 eyes from statin users and 111 eyes from statin nonusers. The 24-month cumulative probability of failure was 78.7% for statin users and 60.4% for nonusers (P = .013). Cox proportional-hazards modeling showed a significantly higher hazard risk in statin users (adjusted hazard ratio 1.61, P = .026). There were no significant between-group differences in mean IOPs or number of medications (both P > .05) at 24 months. Multivariable Poisson regression analysis that statin use was associated with increased numbers of 5-FU injections (P = .014) and bleb-needling procedures (P = .031).ConclusionsThis study demonstrated that oral statin use was associated with higher rates of trabeculectomy failure and increased numbers of 5-FU injections and bleb-needling procedures.

Background. Assessment of color disc photograph (C-DP) is affected by image quality, which decreases the ability to detect glaucoma. High-dynamic-range (HDR) imaging provides a greater range of luminosity. Therefore, the objective of this study was to evaluate the capability of ophthalmology residents to detect glaucoma using HDR-concept disc photography (HDR-DP) compared to C-DP. Design. Cross-sectional study. Methods. Twenty subjects were classified by 3 glaucoma specialists as either glaucoma, glaucoma suspect, or control. All C-DPs were converted to HDR-DPs and randomly presented and assessed by 10 first-year ophthalmology residents. Sensitivity and specificity of glaucoma detection were compared. Results. The mean ± SD of averaged retinal nerve fiber layer (RNFL) thickness was 74.0 ± 6.1 μm, 100.2 ± 9.6 μm, and 105.8 ± 17.2 μm for glaucoma, glaucoma suspect, and controls, respectively. The diagnostic sensitivity of HDR-DP was higher than that of C-DP (87% versus 68%, mean difference: 19.0, 95% CI: 4.91 to 33.1; p=0.014). Regarding diagnostic specificity, HDR-DP and C-DP yielded 46% and 75% (mean difference: 29.0, 95% CI: 13.4 to 44.6; p=0.002). Conclusions. HDR-DP statistically increased diagnostic sensitivity but not specificity. HDR-DP may be a screening tool for nonexpert ophthalmologists.

This study demonstrates the 3D visualization of the lamina cribrosa (LC) structure and its correlation with volumetric data, pore volume, and disc area in glaucomatous and non-glaucomatous eyes. The participant cohort included 65 glaucomatous and 58 non-glaucomatous eyes (13 suspected glaucoma and 45 normal). An ophthalmologist diagnosed glaucoma patients and all subjects were over 18 years old, passed a visual field test, and underwent optical coherence tomography (OCT) examinations. LC images were obtained using the DRI OCT Triton, while optic disc images were obtained from the enface image of the Cirrus HD-OCT 5000. Since LC images alone did not provide clear edge information, we used optic disc images as a reference for edge detection. To achieve this, we employed a fine-tuned model, specifically a pre-trained U-shaped Encoder-Decoder Network with Attention. This model was used to obtain a segmented mask, which was then aligned and utilized to locate the edge of the LC in the LC images. A blood vessel mask was created to remove blood vessels, as they can interfere with the accurate visualization and analysis of LC characteristics. This step allowed for the 3D reconstruction of the LC structure without the presence of blood vessels. Correlations between LC volume, pore volume, and pore volume to LC volume were calculated separately for glaucomatous and non-glaucomatous eyes. We divided the areas for considering the LC structure into three types: overall, quadrants, and 12-clock-hour sectors. Based on the experimental results, we found that the pore volume and pore-to-LC volume were different between glaucoma and normal across all areas considered. In conclusion, this research generated 3D images of the LC from OCT images using computer techniques, showcasing a microstructure that closely resembles the actual LC. Statistical methods were employed to calculate and analyze the differences observed between the two groups of samples., Competing Interests: The authors declare no conflicts of interest., (© 2023 Optica Publishing Group under the terms of the Optica Open Access Publishing Agreement.)

Early detection of glaucoma, a widespread visual disease, can prevent vision loss. Unfortunately, ophthalmologists are scarce and clinical diagnosis requires much time and cost. Therefore, we developed a screening Tri-Labeling deep convolutional neural network (3-LbNets) to identify no glaucoma, glaucoma suspect, and glaucoma cases in global fundus images. 3-LbNets extracts important features from 3 different labeling modals and puts them into an artificial neural network (ANN) to find the final result. The method was effective, with an AUC of 98.66% for no glaucoma, 97.54% for glaucoma suspect, and 97.19% for glaucoma when analysing 206 fundus images evaluated with unanimous agreement from 3 well-trained ophthalmologists (3/3). When analysing 178 difficult to interpret fundus images (with majority agreement (2/3)), this method had an AUC of 80.80% for no glaucoma, 69.52% for glaucoma suspect, and 82.74% for glaucoma cases.Clinical relevance-This establishes a robust global fundus image screening network based on the ensemble method that can optimize glaucoma screening to alleviate the toll on those with glaucoma and prevent glaucoma suspects from developing the disease.

Glaucoma is the second most common cause of blindness. A glaucoma suspect has risk factors that increase the possibility of developing glaucoma. Evaluating a patient with suspected glaucoma is challenging. The "donut method" was developed in this study as an augmentation technique for obtaining high-quality fundus images for training ConvNeXt-Small model. Fundus images from GlauCUTU-DATA, labelled by randomizing at least 3 well-trained ophthalmologists (4 well-trained ophthalmologists in case of no majority agreement) with a unanimous agreement (3/3) and majority agreement (2/3), were used in the experiment. The experimental results from the proposed method showed the training model with the "donut method" increased the sensitivity of glaucoma suspects from 52.94% to 70.59% for the 3/3 data and increased the sensitivity of glaucoma suspects from 37.78% to 42.22% for the 2/3 data. This method enhanced the efficacy of classifying glaucoma suspects in both equalizing sensitivity and specificity sufficiently. Furthermore, three well-trained ophthalmologists agreed that the GradCAM++ heatmaps obtained from the training model using the proposed method highlighted the clinical criteria.Clinical relevance- The donut method for augmentation fundus images focuses on the optic nerve head region for enhancing efficacy of glaucoma suspect screening, and uses Grad-CAM++ to highlight the clinical criteria.

This study proposed a virtual reality (VR) head-mounted visual field (VF) test system, or also known as the GlauCUTU VF test, for a reaction time (RT) perimetry with moving visual stimuli that progressively increase in intensity. The test entailed 24-2 VF protocol and was examined on 2 study groups, controls with normal fields and subjects with glaucoma. To collect reaction times, participants were urged to respond to the stimulus by pressing on the clicker as fast as possible. Performance of the GlauCUTU VF test was compared to the gold standard Humphrey Visual Field Analyzer (HFA). The HFA showed a significant difference between the GlauCUTU and HFA with mean duration of 254.41 and 609, respectively [t(16) = 15.273, p<0.05]. Likewise, our system also effectively differentiated glaucomatous eyes from normal eyes for the left eye and right eye, respectively. When compared to the HFA, the GlauCUTU test produced a significantly shorter average test duration by 354 seconds which reduced test-induced eye fatigue. The portable and inexpensive GlauCUTU perimetry system proves to be a promising method for increasing accessibility to glaucoma screening.Clinical relevance- GlauCUTU, an automated head-mounted VR perimetry device for VF test, is portable, cost-effective, and suitable for low resource settings. Unlike the conventional HFA test, GlauCUTU VF test reports in terms of subjects RT which is reportedly higher in glaucoma patients.

Purpose : To evaluate the clinical characteristics and treatment outcomes of patients with childhood glaucoma. Methods : We retrospectively reviewed the data of patients with childhood glaucoma who visited the glaucoma clinics at the Queen Sirikit National Institute of Child Health and the King Chulalongkorn Memorial Hospital between January 2008 and January 2018. The diagnosis was based on the Childhood Glaucoma Research Network classification. We recorded their clinical characteristics and requirement of any glaucoma interventions. Results : A total of 691 eyes from 423 patients were included in this study. The patients predominantly comprised boys. The average follow-up duration was 71.3±63.8 months. The mean age at presentation was 3.9±4.4 years. Most patients presented with a high initial intraocular pressure (IOP) of 28.5±11.2 mmHg. Glaucoma associated with non-acquired ocular anomalies (22.9%) was the most common subtype, followed by primary congenital glaucoma (20.8%). We recorded a family history of glaucoma in 6.4% of patients. Most patients had bilateral glaucoma (63.4%) and required at least one intervention (51.5%). The average IOP at the latest follow-up visit was 19.1±10.8 mmHg. All glaucoma types had significantly lower IOP, compared to that at their baselines (all p<0.001). Moreover, most patients had an unfavourable visual acuity (49.5%) at their latest visit. Conclusions : Secondary glaucoma associated with non-acquired ocular anomalies is the most common subtype of glaucoma. All subtypes, including primary glaucoma, were sporadic. The majority of patients had unfavourable visual outcomes. These real-world findings are fundamental to acquire a better understanding of childhood glaucoma., Competing Interests: No competing interests were disclosed., (Copyright: © 2021 Surukrattanaskul S et al.)

Glaucoma is the second leading cause of blindness worldwide. This paper proposes an automated glaucoma screening method using retinal fundus images via the ensemble technique to fuse the results of different classification networks and the result of each classification network was fed as an input to a simple artificial neural network (ANN) to obtain the final result. Three public datasets, i.e., ORIGA-650, RIM-ONE R3, and DRISHTI-GS were used for training and evaluating the performance of the proposed network. The experimental results showed that the proposed network outperformed other state-of-art glaucoma screening algorithms with AUC of 0.94. Our proposed algorithms showed promising potential as a medical support system for glaucoma screening especially in low resource countries.

Purpose: We evaluated the impact of myopia on corneal biomechanical properties in primary open-angle glaucoma (POAG) and nonglaucoma patients, and the effect of modification of glaucoma on myopic eyes., Methods: This cross-sectional study included 66 POAG eyes (33 myopia, 33 nonmyopia) and 66 normal eyes (33 myopia, 33 nonmyopia). Seven corneal biomechanical parameters were measured by ultra-high-speed Scheimpflug imaging, including corneal deformation amplitude (CDA), inward/outward corneal applanation length (ICA, OCA), inward/outward corneal velocity (ICV, OCV), radius, and peak distance (PD)., Results: Mean age (SD) of the 65 male (49%) and 67 female (51%) patients was 59 (9.82) years. Myopia was associated with significantly higher CDA (adjusted effect = 0.104, P = 0.001) and lower OCV (adjusted effect = -0.105, P < 0.001) in the POAG group. Within the nonglaucoma group, myopic eyes had a significantly lower OCV (adjusted effect = -0.086, P < 0.001) and higher CDA (adjusted effect = 0.079, P = 0.001). All parameters except PD suggested that glaucoma modified the effect of myopia on corneal biomechanics. Percentage differences in the adjusted myopic effect between POAG and nonglaucoma patients was 31.65, 27.27, 31.65, 50.00, 22.09, and 60.49 for CDA, ICA, OCA, ICV, OCV, and radius, respectively., Conclusions: Myopia had a significant impact on corneal biomechanical properties in the POAG and nonglaucoma groups. The differences in corneal biomechanical parameters suggest that myopia is correlated with significantly lower ocular rigidity. POAG may enhance the effects of myopia on most of these parameters.

Primary angle closure glaucoma (PACG) is a major cause of blindness worldwide. We conducted a genome-wide association study (GWAS) followed by replication in a combined total of 10,503 PACG cases and 29,567 controls drawn from 24 countries across Asia, Australia, Europe, North America, and South America. We observed significant evidence of disease association at five new genetic loci upon meta-analysis of all patient collections. These loci are at EPDR1 rs3816415 (odds ratio (OR) = 1.24, P = 5.94 × 10(-15)), CHAT rs1258267 (OR = 1.22, P = 2.85 × 10(-16)), GLIS3 rs736893 (OR = 1.18, P = 1.43 × 10(-14)), FERMT2 rs7494379 (OR = 1.14, P = 3.43 × 10(-11)), and DPM2-FAM102A rs3739821 (OR = 1.15, P = 8.32 × 10(-12)). We also confirmed significant association at three previously described loci (P < 5 × 10(-8) for each sentinel SNP at PLEKHA7, COL11A1, and PCMTD1-ST18), providing new insights into the biology of PACG.

At present, Van Herick's method is a standard technique used to screen a Narrow Anterior Chamber Angle (NACA) and Angle-Closure Glaucoma (ACG). It can identify a patient who suffers from NACA and ACG by considering the width of peripheral anterior chamber depth (PACD) and corneal thickness. However, the screening result of this method often varies among ophthalmologists. So, an automatic screening of NACA and ACG based on slit-lamp image analysis by using Support Vector Machine (SVM) is proposed. SVM can automatically generate the classification model, which is used to classify the result as an angle-closure likely or an angle-closure unlikely. It shows that it can improve the accuracy of the screening result. To develop the classification model, the width of PACD and corneal thickness from many positions are measured and selected to be features. A statistic analysis is also used in the PACD and corneal thickness estimation in order to reduce the error from reflection on the cornea. In this study, it is found that the generated models are evaluated by using 5-fold cross validation and give a better result than the result classified by Van Herick's method.

Purpose: To compare the performance of point-wise linear regression analysis (PLR) with total deviation (TD) versus corrected or pattern deviation (PD) threshold sensitivities for detection of visual field progression., Methods: Four hundred two eyes (402 patients) enrolled in the Advanced Glaucoma Intervention Study (AGIS) were selected. Criteria for progression according to PLR were a slopeor=2 worsening points within the same Glaucoma Hemifield Test cluster. PLR was performed on TD and PD threshold sensitivities and compared to clinical evaluation. Eyes were classified into three groups based on mean deviation (MD): mild (MD>or=-6 dB), moderately advanced (-6 dB>MD>or=-12 dB), and advanced (MD<-12 dB) glaucoma., Results: Visual field progression was observed in 154 (38%), 85 (21%), and 175 (44%) eyes, according to PLR(TD) and PLR(PD), and clinical evaluation. The pair-wise agreement between clinicians and PLR(TD) was significantly greater than that of clinicians and PLR(PD) (kappa=0.48, 95% CI: 0.44-0.52 vs. kappa=0.31, 95% CI: 0.27-0.35). Agreement between PLR(TD) and PLR(PD) decreased with increasing glaucoma severity: kappa (95% CI)=0.60 (0.52-0.67), 0.41 (0.35-0.47), and 0.33 (0.27-0.40) for mild, moderately advanced, and advanced glaucoma, respectively., Conclusions: Point-wise linear regression analysis on TD threshold sensitivities performed better than the same analysis on PD when clinical evaluation was used as a reference. Agreement between the two methods was less in moderately advanced and advanced glaucoma.

Objective: To assess the prevalence of visual impairment and ocular abnormalities among schoolchildren in Chiang Mai., Design: A community-based survey., Subjects and Method: The vision screening project was conducted from June 2000 to March 2002. Students in grade I in the Chiang Mai municipal area were examined for visual acuity (VA), color vision, ocular alignment, anterior segment and fundus. Subjective refraction was done in students with subnormal vision (VA 20/30 or less). Referral to the hospital for further evaluation and treatment was made for students with strabismus, amblyopia and other ocular abnormalities., Results: A total of 3,431 and 3,467 students were enrolled in 2000 and 2001, respectively. The prevalence of normal vision (VA 20/20), VA 20/30 or better in at least one eye and 20/40 or less in at least one eye were similar in both years (87%, 5.7%, 7.3% and 85%, 6.4%, 8.7%, respectively). There was no statistically significant difference in visual acuity among boys and girls in either year (p = 0.6 and p = 0.2). Prevalence of abnormal color vision was 4.2%. Other causes of visual impairment in both years included strabismus (1.5% and 6.2%), amblyopia (1.1% and 1.4%) and some congenital abnormalities. Most cases of amblyopia were due to uncorrected refractive errors., Conclusion: The authors found that over 10% of school-aged children had subnormal vision. The important causes of visual deterioration came from refractive errors, strabismus and amblyopia. The authors concluded that vision screening is a cost-effective way of reducing visual morbidity from preventable visual impairment, which is a tragedy that cannot be ignored.

Purpose: To present the benefit of preserved sclera for immediately repairing perforated corneal ulcer and report the clinical outcome of patients undergoing penetrating keratoplasty after scleral patch graft., Patients and Method: The results of perforated corneal ulcer patients, who underwent penetrating keratoplasty after scleral patch graft between January 1996 and December 2002, were reviewed retrospectively. The causes of the corneal ulcer were also included., Results: Penetrating keratoplasty was performed after scleral patch graft for perforated corneal ulcer on four patients, three males and one female. The culture results from corneal scraping showed Fusarium spp in two cases and Streptococus pneumoniae in one. One patient had a presumed bacterial corneal ulcer. The post-penetrating keratoplasty visual acuity ranged from hand motions to 20/40., Conclusion: The scleral patch graft procedure for perforated corneal ulcer may benefit in circumstances of unavailable corneal donors. The results of penetrating keratoplasty after scleral patch graft were favorable.