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Purpose: To evaluate frequency, conversion rate, and risk factors for blindness in glaucoma patients treated in European Universities., Methods: This multicenter retrospective study included 2402 consecutive patients with glaucoma in at least one eye. Medical charts were inspected and patients were divided into those blind and the remainder ('controls'). Blindness was defined as visual acuity≤0.05 and/or visual field loss to less than 10°., Results: Unilateral and bilateral blindness were respectively 11.0% and 1.6% at the beginning, and 15.5% and 3.6% at the end of the observation period (7.5±5.5 years, range:1-25 years); conversion to blindness (at least unilateral) was 1.1%/year. 134 eyes (97 patients) developed blindness by POAG during the study. At the first access to study centre, they had mean deviation (MD) of -17.1±8.3 dB and treated intraocular pressure (IOP) of 17.1±6.6 mmHg. During follow-up the IOP decreased by 14% in these eyes but MD deteriorated by 1.1±3.5 dB/year, which was 5-fold higher than controls (0.2±1.6 dB/year). In a multivariate model, the best predictors for blindness by glaucoma were initial MD (p<0.001), initial IOP (p<0.001), older age at the beginning of follow-up (p<0.001), whereas final IOP was found to be protective (p<0.05)., Conclusions: In this series of patients, blindness occurred in about 20%. Blindness by glaucoma had 2 characteristics: late diagnosis and/or late referral, and progression of the disease despite in most cases IOP was within the range of normality and target IOP was achieved; it could be predicted by high initial MD, high initial IOP, and old age.

Introduction: The aim of the present study was to compare the confocal and clinical features of newly diagnosed glaucoma patients receiving unpreserved prostaglandins (tafluprost) versus preserved prostaglandins (latanoprost)., Materials and Methods: 40 patients were randomized to tafluprost 0.0015% (20 patients; 32 eyes) or latanoprost 0.005% + benzalkonium chloride 0.02% (20 patients; 35 eyes) once daily for 1 year. Inclusion criteria were new glaucoma diagnosis, and no ocular treatments for 6 months before the study. Patients were evaluated at baseline and every 3 months with a complete ophthalmologic evaluation, Schirmer's test, break-up time test, confocal microscopy of the central cornea, and measurement of intraocular pressure (IOP). Investigators were masked to treatment. Both eyes were analyzed if they fulfilled inclusion criteria. Treatments and changes between follow-up and baseline were compared by analysis of variance (ANOVA), t test and Chi-square test., Results: At baseline, the two groups had similar age, ocular surface and confocal findings; keratocyte activation was present in 40%, branching pattern in 85%, and beading in 75%, with no inter-group differences. At follow-up, no significant clinical changes were detected, apart from a drop of IOP by 3.6-4.2 mmHg in the two groups (p < 0.001, with no difference between treatments). Despite inter-treatment ANOVA for confocal microscopy being negative, subtle changes were present. During follow-up, all eyes without nerve branching pattern at baseline progressively developed it when treated with latanoprost, whereas no change occurred using tafluprost treatment (p = 0.05). None of the eyes without beading at baseline developed it at the end of the study in the tafluprost group, whereas beading did occur in 75% of patients treated with latanoprost (p = 0.05). Both treatments were associated with increased keratocyte activation at follow-up; the change from baseline was statistically significant after month 3 with latanoprost (p = 0.02) and after month 6 with tafluprost (p = 0.04)., Conclusions: The two study treatments had similar clinical effects, but tafluprost had a more favorable profile for some confocal parameters of the cornea., Funding: Merck Sharp & Dohme International.

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.

Purpose: To evaluate the strength and pattern of the relationship between visual field (VF) sensitivity and retinal nerve fiber layer (RNFL) thickness measurements by scanning laser polarimetry (SLP)., Methods: Fifty-four eyes of 54 normal subjects (age, 42 +/- 15 years; VF mean deviation [MD], -0.69 +/- 1.01 dB) and 51 eyes of 51 glaucoma patients (age, 66 +/- 14 years; VF MD, -6.92 +/- 5.43 dB) were imaged with an SLP using fixed corneal compensation (FCC) and variable corneal compensation (VCC). VF sensitivity was recorded in the dB and the 1/L scales. Linear and logarithmic relationships were sought globally and in six VF sectors. Relationships of VF and RNFL thickness with age were sought in normal subjects., Results: Both VF sensitivity and RNFL thickness declined with age (as determined by the regression slope): -0.13% (P = 0.0005) and -0.64% (P = 0.0001) per year for dB and 1/L VF sensitivity, respectively, and -0.25% (P = 0.003) per year for VCC RNFL thickness. FCC RNFL thickness was not statistically significantly related to age. The relationship of VF sensitivity to VCC global (R(2) = 0.49) and sectoral (R(2) = 0.00-0.47) RNFL thickness was greater than for FCC global (R(2) = 0.12) and sectoral (R(2) = 0.00-0.21) RNFL thickness. Relationships were curvilinear with the dB scale, with logarithmic regression of dB VF sensitivity against RNFL thickness being significantly better than linear regression. Logarithmic regression of 1/L VF sensitivity against RNFL thickness was no better than linear regression for all sectors. There was no relationship between VF sensitivity and RNFL thickness in the temporal peripapillary RNFL sector., Conclusions: The strength of the structure/function relationships compare well with previous reports in the literature. The relationships were curvilinear with the dB scale and linear with the 1/L scale, and were much stronger with VCC than with FCC RNFL thickness measurements.

Purpose: To describe the influence of cataract surgery with implantation of different intraocular lenses on scanning laser tomography (SLT) and scanning laser polarimetry (SLP) and to measure the birefringent properties of intraocular lenses in a laboratory setting., Design: Prospective cohort study., Methods: The influence of phacoemulsification cataract surgery with intraocular lens implantation (56 polymethylmethacrylate [PMMA; 31 Pharmacia/Upjohn 811 B and 25 Domilens Flex 60]; 25 hydroxyethylmethacrylate/methylmethacrylate (HEMA/MMA) [Technomed, Memory Lens]; 32 silicone [Allergan Si40]; 25 acrylic [Storz Hydroview]) on SLP and SLT measurements was evaluated preoperatively and 3 to 4 weeks postoperatively in 138 eyes of otherwise healthy patients. Lens opacities were classified according to the Lens Opacities Classification System III (LOCS III). Imaging was performed with TopSS and GDx (Laser Diagnostic Technologies, San Diego, California, USA) for SLT and SLP, respectively. Additionally, birefringent properties of intraocular lenses were measured in a laboratory setting., Results: Our results show that imaging with SLT and SLP is possible with lens opacity-induced visual acuity reductions down to 0.2 and 0.16, respectively. There were no significant differences in the topographic parameters assessed before and after cataract surgery with SLT. However, standard deviations between three within-session single measurements were smaller postoperatively. Nerve fiber layer patterns were similar before and after cataract surgery with SLP, whereas certain total nerve fiber layer thickness values were significantly higher postoperatively. As a consequence, "the number" is significantly lower in the Domilens Flex 60 group (P =.01) and in the Storz Hydroview group (P =.02), and with a tendency also in the other groups as well. Measurements with a high-resolution optical bench revealed no birefringent properties of the implanted lenses., Conclusions: Our results indicate that after cataract surgery with intraocular lens implantation some SLP values are altered significantly, whereas SLT parameters are not influenced. These findings are of clinical interest, especially in the follow-up of glaucoma patients.