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Objective: to analyze the tonometric data, obtained with standard contactless tonometry and corneal-compensated tonometry, examined by the Oculus CorVis ST device in different groups of patients of the Tri-Z Krasnodar Clinic.Patients and Methods. The study included 42 eyes of patients, with glaucoma — 55 %, with suspected glaucoma — 45 %, mean age — 63.19 ± 1.7 years, men were 20 (47.5 %), women — 22 (52.5 %), the central corneal thickness was 554.43 ± 5.28 microns. Corneal tomography and biomechanical parameters were measured using Pentacam (Oculus) and Corvus ST, respectively.Results. IOP in people aged over 60 years was lower according to CorVis ST (Po 22.07 = 2.25, Pcс 18.63 ± 1.30, p = 0.007). IOP differed only in patients with a CCT of more than 580 µm (Po 22.4 ± 2.9, Pcc 18.21 ± 2.16, p = 0.012). IOP in patients with glaucoma was Ро 26.19 ± 3.5 and Рсс 21.3 ± 2.0, p = 0.008, without glaucoma — Ро 17.83 ± 9.60; Pсс 16.1 ± 5.5; p = 0.063. IOP in patients with compensated glaucoma Ро 17.34 ± 1.10, Pсс 16.6 ± 1.1, p = 0.354, with decompensated Ро 42.78 ± 6.8, Pсс 30.08 ± 4.10, p = 0.005. In the initial stage of glaucoma, Рo 22.5 ± 2.3, Рсс 20.0 ± 1.0, p = 0.297, in the advanced stage — Рo 20.7 ± 2.7, Рсс 17.6 ± 1.9, p = 0.027.Conclusion. Standard non-contact tonometry can be used in persons aged under 60 years, persons without glaucoma and with initial compensated glaucoma. In all other cases, the Oculus CorVis ST values are more accurate.

Purpose:To compare the intraocular pressure (IOP) measured with the Goldmann tonometer as the current standard of clinics with five different tonometers in healthy people, and to investigate the effect of corneal thickness and biomechanical properties on measurements.Methods:In this cross-sectional study, IOP was measured in 94 eyes of 94 healthy subjects with the Goldmann, manual applanation resonance, Icare, Topcon non-contact, Ocular Response Analyzer and Corvis’s tonometers. Comparison of the IOPs measured with different techniques was done using the repeated measures analysis of variance while the central corneal thickness as a covariate. The Bland-Altman plots and intraclass correlation coefficients were used to assess the agreement between the measurements. Limits of agreement were determined as the mean difference ±1.96 SD. Regression analysis was used to estimate the effect of central corneal thickness, corneal hysteresis, and corneal resistance factor on IOPs obtained using different tonometers.Results:The lowest mean IOP was obtained with the Goldmann tonometer (13.1 ± 2.6 mmHg) and the highest with the Topcon non-contact tonometer (17.3 ± 2.5 mm Hg). There was a statistically significant difference between the pressure measured by Goldmann's tonometer and other tonometers. The mean IOP measured using Icare (14.6 ± 3.4 mmHg) demonstrated the smallest mean difference and the highest agreement with the Goldmannn tonometer results. Central corneal thickness significantly affected all IOPs except the cornea-compensated IOP (IOPcc). The highest influence of IOP on the corneal resistance factor was related to Topcon non-contact tonometer and Goldmann correlated IOP (IOPg), while the lowest was seen with IOPcc and Goldmann.Conclusions:The Icare tonometer had the highest agreement among the different tonometers with the Goldmann tonometer. The central thickness of the cornea affects the results of all tonometers except IOPcc. Among the two evaluated corneal biomechanical parameters, the corneal resistance factor was the only biomechanical parameter effective on IOPs measured with all devices.

Myotonometry is a relatively novel method used to quantify the biomechanical and viscoelastic properties (stiffness, compliance, tone, elasticity, creep, and mechanical relaxation) of palpable musculotendinous structures with portable mechanical devices called myotonometers. Myotonometers obtain these measures by recording the magnitude of radial tissue deformation that occurs in response to the amount of force that is perpendicularly applied to the tissue through a device's probe. Myotonometric parameters such as stiffness and compliance have repeatedly demonstrated strong correlations with force production and muscle activation. Paradoxically, individual muscle stiffness measures have been associated with both superior athletic performance and a higher incidence of injury. This indicates optimal stiffness levels may promote athletic performance, whereas too much or too little may lead to an increased risk of injury. Authors of numerous studies suggested that myotonometry may assist practitioners in the development of performance and rehabilitation programs that improve athletic performance, mitigate injury risk, guide therapeutic interventions, and optimize return-to-activity decision-making. Thus, the purpose of our narrative review was to summarize the potential utility of myotonometry as a clinical tool that assists musculoskeletal clinicians with the diagnosis, rehabilitation, and prevention of athletic injuries. [ABSTRACT FROM AUTHOR]

Purpose: To find out correlation between Central Corneal Thickness (CCT) and Intra Ocular Pressure (IOP). Study Design: Observational Correlational study. Place and Duration of Study: This study was conducted in Ophthalmology Clinic Primasatya Husada Citra Hospital Surabaya from September 2021 to October 2021. Methods: One hundred and fifteen subjects were selected through consecutive sampling. Patients of 20 – 60 years age and visiting ophthalmology clinic were included. Patients with history of glaucoma, hypertension, body mass index (BMI) above 30 kg/m2, under steroid treatment (topical, systemic, peri ocular, inhalation), undergone eye surgery including corneal and refractive surgery, smoker (> 100 cigarettes in his/her life and is still smoking), Alcoholic (> 1 time/month), chronic kidney disease (CKD) and myopia (> 6 diopters) were excluded. Association between CCT and IOP was calculated using Pearson's correlation coefficient. Results: A total 115 patients were included, 69 (60%) females and 46 (40.0%) males. Mean age was 35.78 ± 11.64 years old. Mean CCT was 550.26 ± 31.66 µm and 551.43 ± 34.92 µm for right and left eye respectively. IOP was 16.06 ± 3.71 mmHg and 15.76 ± 3.52 mmHg in right and left eyes respectively. There was a moderate positive relationship of CCT and IOP. There was a good relationship between right and left “IOP (R = 0.830, p = 0.000) and CCT (R = 0.856, p = 0.000).” Conclusion: CCT had a moderate positive correlation with IOP (right eyes: R = 0.355, p = 0.000; left eyes: R = 0.381, P = 0.000). There is a positive relationship between CCT and IOP in both eyes (p = 0.000). [ABSTRACT FROM AUTHOR]

Purpose: Myotonic dystrophy type 1 is the most common muscular dystrophy in adulthood, caused by a triplet repeat in chromosome 19q13.3. The present study investigates the frequency of the different ocular alterations in Spanish patients with DM1 and its relationship with the severity of the genetic alteration. Methods: Cross-sectional and multicenter study was conducted on patients with genetically confirmed DM1. Ophthalmologic examinations included visual acuity assessment, manifest refraction, slit-lamp biomicroscopy, tonometry, ocular motility, corneal tomography, and macular and optic nerve optical coherence tomography. Results: A total of 42 patients (84 eyes) were included. Mean age was 46.9 ± 13.4 (SD) years, and 57.1% were women. Fifteen patients had undergone cataract surgery in at least one eye (35.7%), and 13 (30.9%) had significant cataract. Mean intraocular pressure (IOP) was 10.5 ± 2.9 mmHg, and mean central corneal thickness (CCT) was 580.04 ± 48.61 μm. Half of the patients had significant ptosis, and 8 patients (9.75%) had undergone eyelid surgery. Macular abnormalities included retinal pigment epithelium alterations in 8 eyes of 6 patients, epiretinal membrane in 3 eyes, and lamellar hole in 2 eyes. A moderate correlation was found between IOP and ptosis with the number of triplet repeats. Conclusion: Early cataract onset, low IOP, thicker CCT, and ptosis were the most significant manifestations of DM in our sample. Correlation found between IOP and ptosis with CTG repeat could be interesting in order to improve diagnosis and medical care of these patients but should be confirmed in further studies. [ABSTRACT FROM AUTHOR]

Simple Summary: Lymphedema affecting the breast can develop after breast cancer treatment. Currently breast lymphedema isn't well recognised nor techniques to measure lymphedema affecting the breast as well studied. This paper explores the validity and reliability of measures which can be used to determine the presence of breast lymphedema. Women with and without breast lymphedema were included in this study to enable comparisons to be made. Improving the assessment of breast lymphedema will advance clinical practice and enable the outcome of treatment to be reported. Ultrasound and tissue dielectric constant were found to be able to reliably distinguish between edema and non edematous breast tissue. In addition certain patient characteristics and breast caner treatments were found to associated with the development of breast lymphedema. Lymphedema can develop after treatment for breast cancer (BCRL). Lymphedema of the breast is not well studied. Currently, the main techniques used to diagnose and monitor the effectiveness of treatment are subjective clinician assessment and patient reports. Eighty-nine women who had undergone breast cancer treatment were recruited with and without breast lymphedema. Blinded clinical assessment determined the presence or absence of breast lymphedema. Measurement of skin thickness by ultrasound scanning, local tissue water by tissue dielectric constant (TDC) and tissue indentation by tonometry was recorded. Breast cancer treatment and demographic details were documented. Descriptive statistics were undertaken to compare sample characteristics, including the Chi-squared test, Odds Ratio (OR) and Relative Risks (RR) calculated. Increased body mass index (BMI), larger bra size, increased number of positive lymph nodes, axillary surgery, chemotherapy and increased Nottingham Prognostic Index (NPI) were all associated with breast lymphedema (p < 0.05). Ultrasound and TDC measurements were significantly higher in the lymphedema group (p < 0.05). Receiver Operator Characteristic (ROC) curves demonstrated that ultrasound and TDC measurements could distinguish between edematous and non-edematous breasts. Threshold levels were produced, which demonstrated good levels of sensitivity and specificity. These findings have the potential to improve the diagnosis of breast lymphedema. [ABSTRACT FROM AUTHOR]

Background: Technology is becoming a pivotal component of day-to-day tasks, and its implementation in healthcare must be thoroughly investigated. This study aimed to compare the DigitalOptometrics tele-optometric examination experience to the traditional inperson comprehensive eye examination with post-examination satisfaction surveys. Methods: This study included 30 optometry students who were enrolled at the Illinois College of Optometry (ICO). Participants with active ocular pathology or a history of ocular surgery in the past 90 days were excluded. A teleoptometric comprehensive eye examination via the DigitalOptometrics platform was performed, and participants were provided with a postexamination survey. This was followed by an inperson comprehensive eye examination, and participants were provided with the same postexamination survey. After the completion of both examinations, participants were asked to complete a final satisfaction survey comparing the examinations. Results: Statistical analysis using Fisher analysis concluded that patient-reported satisfaction for the DigitalOptometrics tele-optometric examination was comparable to that for the gold-standard, inperson comprehensive eye examination. Conclusions: Our data suggests that the initial reported patient satisfaction was positive or comparable to that for an in-person comprehensive eye examination, supporting our hypothesis. [ABSTRACT FROM AUTHOR]

Background: The global COVID-19 pandemic has accelerated the transition from traditional care to telehealth in many facets of healthcare. Access to healthcare in otherwise remote locations, increased accessibility to appointments, and continuity of care are some of the more apparent advantages. This study aimed to compare anterior segment findings, posterior segment findings, and intraocular pressure (IOP) measurements between traditional in-person examination and tele-optometric examination. Methods: A cohort of 30 optometry students was recruited to complete two comprehensive eye examinations. A tele-optometric comprehensive eye exam was completed by an in-person technician via the DigitalOptometrics platform and video conferencing with an investigator optometrist. This was then followed by the gold standard inperson comprehensive eye exam by one of the investigator optometrists. Both eye examination methods included anterior and posterior segment evaluation, as well as IOP measurements. The teleoptometric examination used a 14-second Reichert slit lamp video recording to evaluate the anterior segment and the Eidon ultra-widefield retinal photographer to evaluate the posterior segment. DFE was completed with 90D biomicroscopy and binocular indirect ophthalmoscopy. Intraocular pressure (IOP) measurements were taken via non-contact tonometry (NCT) by an in-person technician for the telehealth exam, while the gold standard IOP measurement, Goldmann applanation tonometry (GAT) with Fluress, was taken by the investigator optometrist. Results: In chi-square statistical analysis, there was a statistically significant difference between telehealth and in-person anterior segment findings (χ2 =6.8 and p=0.009). Further analysis with Fisher’s exact test also showed a significant difference in anterior segment findings between telehealth and in-person (p=0.031). We could not perform chisquare statistical analysis on posterior segment findings because the data was not validated for chisquare analysis. In t-test statistical analysis, there was no statistically significant difference between telehealth and in-person IOP OD (p=0.166) and OS (p=0.076) measurements. The agreement in IOP between telehealth and in-person was also evaluated with Bland-Altman analysis, using the 95% limits of agreement, which corresponds to ±1.96* standard deviation of the differences between telehealth and in-person measurement. Conclusion: Based on our study design, we cannot conclusively state that telehealth is comparable to in-person exams when comparing anterior and posterior segment findings. When comparing IOP measurements, NCT in telehealth exams and GAT in in-person exams, the findings were comparable in accuracy. We are aware that there are trends in our results, but future studies should be designed specifically to address these gaps in analysis and limitations. [ABSTRACT FROM AUTHOR]

Measuring and controlling intraocular pressure (IOP) provide the foundation for glaucoma treatment. Self-tonometry has been proposed as an alternative to measure IOP throughout the entire day better. The novel EYEMATE-SC sensor (Implandata) is implanted in the suprachoroidal space to enable contactless continual IOP monitoring. The aim of the present study was to investigate the 1-year safety, performance, and accuracy of the EYEMATE-SC in patients with primary open-angle glaucoma undergoing simultaneous nonpenetrating glaucoma surgery (NPGS). Prospective, multicenter, open-label, single-arm, interventional clinical trial. Twenty-four eyes of 24 patients with primary open-angle glaucoma who were due to undergo NPGS (canaloplasty or deep sclerectomy). An EYEMATE-SC sensor was implanted during NPGS. Goldmann applanation tonometry (GAT) measurements were compared with the sensors' IOP measurements at all postoperative visits through 12 months. Device position and adverse events. Fifteen eyes underwent canaloplasty, and 9 underwent deep sclerectomy. Successful implantation of the sensor was achieved in all eyes with no reported intraoperative difficulties. Through the 12-month follow-up, no device migration, dislocation, or serious device-related complications were recorded. A total of 536 EYEMATE-SC measurements were pairwise included in the IOP agreement analysis. The overall mean difference between GAT and EYEMATE-SC measurements was 0.8 mmHg (95% confidence interval [CI] of the limits of agreement [LoA], –5.1 to 6.7 mmHg). The agreement gradually improved, and from 3 months after surgery until the end of the follow-up, the mean difference was –0.2 mmHg (95% CI of LoA, –4.6 to 4.2 mmHg) over a total of 264 EYEMATE-SC measurements, and 100% of measurements were within ±5 mmHg of GAT. The EYEMATE-SC sensor was safe and well tolerated through 12 months. Moreover, it allowed accurate, continuous IOP monitoring. Proprietary or commercial disclosure may be found after the references. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the corneal biomechanical features of eyes with granular corneal dystrophy type 2 (GCD2) by analyzing corneal biomechanical indices obtained using a Corvis ST (CST) dynamic ultra-high-speed Scheimpflug imaging device. Methods: In this retrospective case–control study, 35 CST parameters were compared in normal eyes (control) and eyes of patients with GCD2 treated at Osaka University Hospital, Osaka, Japan. The parameters included the Corvis Biomechanical Index (CBI), which is important in differentiating eyes with keratoconus from normal eyes. We measured the deposition rates of lesions in the central 7-mm region of the eye and assessed the correlation between the deposition rate and the CBI. Results: Twenty-one eyes with GCD2 and 23 control eyes were analyzed. Eyes with GCD2 showed significantly less corneal stiffness in 15 CST parameters than did control eyes. In particular, the CBI was remarkably higher in eyes with GCD2 than in control eyes (P = 0.000006). Additionally, the deposition rate and the CBI were positively correlated. Conclusions: GCD2 eyes had softer corneas than did control eyes in most biomechanical CST parameters, and one of the parameters (the CBI) was linked to the rate of deposited lesions. Since IOP may be underestimated in GCD2 eyes, management should be especially careful in GCD2 cases complicated by glaucoma. [ABSTRACT FROM AUTHOR]

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PurposeTo characterize and compare the ganglion cell complex (GCC) thickness and macula vessel density in preperimetric and early primary open-angle glaucoma (POAG) eyes.DesignCross-sectional study.MethodsFifty-seven healthy, 68 preperimetric, and 162 early POAG eyes enrolled in the Diagnostic Innovations in Glaucoma Study. Optical coherence tomography angiography (OCT-A)-based superficial macula vessel density and OCT-based GCC thickness were evaluated simultaneously. Percent loss from normal of GCC thickness and macula vessel density was compared. Area under the receiver operating characteristic curve was used to describe the diagnostic utility.ResultsBoth GCC thickness and vessel density were significantly lower in preperimetric and early POAG eyes compared to healthy eyes. Compared to the preperimetric POAG group, the early POAG group showed larger GCC thickness percent loss (whole image 4.72% vs 9.86%; all P < .01) but similar vessel density percent loss (whole image 4.97% vs 6.93%; all P > .05). In preperimetric POAG, GCC thickness and vessel density percent losses were similar (all P > .1). In contrast, in early POAG, GCC thickness percent loss was larger than that of vessel density (all P ≤ .001). To discriminate preperimetric or early glaucoma eyes from healthy eyes, GCC thickness and macula vessel density showed similar diagnostic accuracy (all P > .05).ConclusionsBoth GCC thinning and macula vessel density dropout were detectable in preperimetric and early POAG eyes. GCC loss was greater than macula vessel density loss in early perimetric POAG. However, OCT-A and OCT measurements showed similar efficiency to detect early glaucoma.

Fifty-five healthy conscious dogs were included in a prospective randomised double-blinded clinical study. The dogs allocated to one of four groups received intravenous bolus followed by infusion of fentanyl (FEN-group), or ketamine (KET-group), or lidocaine (LID-group), or saline (SAL-group). The intraocular pressure (IOP), pupil size (PS), heart rate (HR) and mean arterial pressure (MAP) were measured prior to and at 2, 5, 10, 20 and 30 min after initiation of the drug administration. The data were analysed using an analysis of variance and the Steel-Dwass test. No significant difference in the IOP within or between the groups was detected. In the FEN-group, the PS decreased significantly at all the measured times. In the KET-group, the PS increased significantly at 2, 5 and 10 minutes. The PS was significantly smaller in the FEN-group compared to the KET-group at 2, 5, 10 and 20 min, compared to the SAL-group at 5, 10, 20 and 30 minutes. In the FEN-group the HR significantly decreased compared to the baseline and was significantly lower compared to the KET-group and LID-group. Fentanyl, ketamine or lidocaine administered at the doses studied as a bolus followed by a 30-min infusion seem to cause no effect on the IOP in healthy conscious non-painful dogs without ocular abnormalities. Fentanyl decreased and ketamine transiently increased the PS.

The article discusses a multicenter analysis of intraocular pressure after the insertion of a preloaded hydrophobic acrylic monofocal intraocular lens (IOL). The EyeCee One preloaded IOLs were withdrawn from UK eye centers due to reports of high intraocular pressures. The analysis found that 1.3% of eyes had an intraocular pressure equal to or greater than 30mmHg at the first postoperative visit. The cause of the raised intraocular pressure was determined to be the inadvertent injection of a coating agent called polyvinylpyrrolidone (PVP) into the anterior chamber, obstructing the trabecular meshwork. The authors call for further information on the mechanism and biocompatibility of PVP. [Extracted from the article]

PurposeTo investigate prospectively the relationship between macular and peripapillary vessel density and progressive retinal nerve fiber layer (RNFL) loss in patients with mild to moderate primary open-angle glaucoma.DesignProspective, observational study.ParticipantsOne hundred thirty-two eyes of 83 patients with glaucoma followed up for at least 2 years (average: 27.3±3.36 months).MethodsMeasurements of macular whole image vessel density (m-wiVD) and optic nerve head whole image vessel density (onh-wiVD) were acquired at baseline using OCT angiography. RNFL, minimum rim width (MRW), and ganglion cell plus inner plexiform layer (GCIPL) thickness were obtained semiannually using spectral-domain OCT. Random-effects models were used to investigate the relationship between baseline vessel density parameters and rates of RNFL loss after adjusting for the following confounding factors: baseline visual field mean deviation, MRW, GCIPL thickness, central corneal thickness (CCT), and mean intraocular pressure during follow-up and disc hemorrhage, with or without including baseline RNFL.Main outcome measuresEffects of m-wiVD and onh-wiVD on rates of RNFL loss over time.ResultsAverage baseline RNFL thickness was 79.5±14.8 μm, which declined with a mean slope of -1.07 μm/year (95% confidence interval, -1.28 to -0.85). In the univariate model, including only a predictive factor and time and their interaction, each 1% lower m-wiVD and onh-wiVD was associated with a 0.11-μm/year (P < 0.001) and 0.06-μm/year (P = 0.031) faster rate of RNFL decline, respectively. A similar relationship between low m-wiVD and onh-wiVD and faster rates of RNFL loss was found using different multivariate models. The association between vessel density measurements and rate of RNFL loss was weak (r2 = 0.125 and r2 = 0.033 for m-wiVD and onh-wiVD, respectively). Average CCT also was a predictor for faster RNFL decline in both the univariate (0.11 μm/year; P < 0.001) and multivariate models.ConclusionsLower baseline macular and optic nerve head (ONH) vessel density are associated with a faster rate of RNFL progression in mild to moderate glaucoma. Assessment of ONH and macular vessel density may add significant information to the evaluation of the risk of glaucoma progression and prediction of rates of disease worsening.

Continuous control of intraocular pressure (IOP) is crucial to preventing long-term damage to the optic nerve in glaucoma. Recently, a novel telemetric IOP sensor (EYEMATE-IO™, Implandata Ophthalmic Products GmbH, Hannover, Germany) has been developed that continuously records IOP. The patient can read the IOP measurements wirelessly using a hand-held reading device. We present the case of a 70-year-old patient with primary open-angle glaucoma who had been implanted with an EYEMATE-IO™ and recently underwent minimally invasive bleb-filtering surgery with the PreserFlo® MicroShunt (Santen, Osaka, Japan). This case demonstrates both the benefits of continuous pressure measurement with EYEMATE-IO™ and the ability of the PreserFlo® MicroShunt to significantly reduce IOP fluctuations. [ABSTRACT FROM AUTHOR]

Given the high prevalence and poor prognosis of heart failure (HF), finding prognostic factors for patients with HF is crucial. This study investigated the prognostic value of reactive hyperemia index (RHI), a measure of endothelial function, in HF. A total of 90 HF patients (mean age, 63.7 ± 13.2 years; female, 25.6%) with a history of hospitalization for HF treatment were prospectively enrolled. RHI was measured using digital arterial tonometry in a stable condition. Clinical events, including all-cause death and HF admission, were assessed. During the median follow-up of 3.66 years (interquartile range, 0.91–4.94 years), 26 clinical events (28.9%) occurred. Although there were no significant differences in risk factors and laboratory findings according to the occurrence of clinical events, the RHI value was significantly lower in patients with clinical events than in those without (1.21 ± 0.34 vs. 1.68 ± 0.48; P < 0.001). Kaplan–Meier survival analysis showed that a lower RHI value (< 1.48) was associated with a significantly higher incidence rate of clinical events (log-rank P < 0.001). In multivariable cox regression analysis, a low RHI value (< 1.48) was associated with an increased risk of clinical events (hazard ratio, 14.09; 95% confidence interval, 3.61–54.99; P < 0.001) even after controlling for potential confounders. Our study showed that reduced RHI was associated with an increased risk of adverse clinical outcomes in HF. This suggests that endothelial dysfunction may be an important prognostic marker in patients with HF. [ABSTRACT FROM AUTHOR]

Abdominal diastasis (AD) is highly prevalent at post-partum. Although several conservative approaches have been proposed, an effective and protocolized treatment is lacking for this condition. To identify modifications of inter-rectus abdominis distance (IRAD), trunk circumferences and mechanical properties of the AD, transversus abdominis and the pelvic floor (PF) muscles, after the application of hypopressive exercises (HE) and at a two-month follow-up in postpartum AD. Twelve volunteers with post-partum AD followed a four-week (three times a week) tailored program of HE. The main outcome was the IRAD, assessed at four specific supraumbilical points (3, 6, 9, and 12 cm). Abdominal circumference and respiratory expansion were measured at three different locations (axillar, xiphoid, and umbilical), and the mechanical properties of abdomino-pelvic tissues were also assessed using tonometry (MyotonPRO). Four evaluations were performed for all outcomes: at baseline, post-intervention, at a 1-month follow-up, and at a 2-month follow-up. The IRAD of participants was reduced (p <.05), furthermore, some participants displayed no AD after the intervention period. In addition, the abdominal circumference increased, mainly at follow-up, whereas the thoracic respiratory expansion decreased a median of 2 cm. The tension and stiffness of the LA decreased, when assessed at 3 and 6 cm supraumbilical. Finally, the tension and elasticity of TA/IO and of the PF, and also the elasticity of the PF decreased after the intervention period. No complaints were identified in relation to the HE program or assessments. A program of HE showed positive results for the reduction of post-partum AD. Different study designs should be performed to better explain the effects of HE for AD. [ABSTRACT FROM AUTHOR]

Fibrous dysplasia is a benign, rare bone disease in which bone is replaced by fibro-osseous tissue to varying degrees. It can present differently depending on the amount of compression caused by the fibro-osseous tissue. Patients are usually asymptomatic, but symptoms related to cranial nerve compression may occur. In this case report, we describe a 45-year-old woman with sphenoid bone dysplasia which compressed the optic nerve and caused unilateral optic disc cupping that mimicked glaucoma. Our case highlights the importance of including compressive etiologies associated with optic disc cupping in the differential diagnosis of glaucoma. [ABSTRACT FROM AUTHOR]

Background: To investigate posture-induced changes in intraocular pressure (IOP) after ab externo XEN45 Gel-Stent implantation in patients with medically uncontrolled primary open-angle glaucoma (POAG). Methods: This prospective study included thirty-two eyes with POAG that underwent XEN45 Gel-Stent implantation as a standalone procedure using an ab externo approach at Chonnam National University Hospital. IOP was measured sequentially in the sitting position, supine position, and lateral decubitus position (LDP) before and at 1, 2, 3, and 6 months after surgery using an iCare IC200 rebound tonometer. In the LDP, the eye with XEN45 Gel-Stent implantation was in the dependent position. Results: IOP at each position was significantly reduced after XEN45 Gel-Stent implantation. Posture-induced changes in IOP were maintained during the follow-up. The range of postural IOP changes was reduced at 1 month; however, no significant change was observed after that point compared with baseline levels. Conclusions: A XEN45 Gel-Stent inserted using the ab externo approach can reduce IOP in various body positions, but seems to have limited effects on posture-induced changes in IOP in patients with POAG. [ABSTRACT FROM AUTHOR]

Purpose: Compare intraocular pressure (IOP) measured by a standard Goldmann applanation tonometer prism (IOPg) and a modified correcting applanation tonometer surface Goldmann prism (IOPc) before and after laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). Methods: Goldmann tonometry was analyzed in a retrospective, cross-sectional study, using both GAT and modified-GAT prisms pre-operatively and at the 3 month post-operative appointment on 120 eyes (64 patients) who received LASIK (n = 58) or PRK (n = 62). Demographics, central corneal thickness (CCT), manifest refraction and corneal curvature (CC) data was collected at each visit as well as surgical parameters, including maximum ablation depth. Results: Mean paired IOP following LASIK decreased by − 3.28 ± 3.2 mmHg measured by IOPg and − 1.93 ± 3.3 mmHg by IOPc (p ≤ 0.0001). Mean paired IOP following PRK reduced by − 1.92 ± 3.6 mmHg measured by IOPg and − 1.06 ± 3.6 mmHg by IOPc (p ≤ 0.0001). Increased LASIK ablation depth and post-procedural change in CCT trended toward a statistically significant reduction in IOPg (p = 0.07,p = 0.12), but not IOPc (p = 0.18,p = 0.32). PRK ablation depth was not associated with a reduction in IOPg or IOPc. Discussion: The modified Goldmann (IOPc) prism measured less of an IOP reduction following LASIK and PRK compared to the standard (IOPg) prism, and the IOP reduction with both prisms was associated with the degree of myopic correction. What is already known and the residual query: Corneal refractive surgery generally demonstrates significant postoperative Goldmann IOP reductions. Presumably, this is due to corneal biomechanical changes for which a newer method of Goldmann IOP measurement may be able to compensate. What this study adds: A modified, corneal conforming Goldmann prism demonstrates significantly less IOP reduction following myopic LASIK and PRK compared to the standard flat Goldmann prism. How this study might affect research, practice or policy: A newer, modified Goldmann prism may help detect glaucoma and OHT at an earlier stage in patients which have undergone LASIK or PRK. The findings corroborate predicted corneal biomechanical changes following the most common corneal refractive procedures. [ABSTRACT FROM AUTHOR]

Background. To preliminary explore the correlations among corneal biomechanical parameters, stiffness, and thickness in patients with ocular hypertension (OHT) before and after treatment with topical antiglaucoma medications. Methods. This was a retrospective study that included 35 eyes with newly diagnosed OHT. Axial length (AL), apical corneal thickness, and minimum corneal thickness were measured using Pentacam. The lengths, velocities, and times of the first and second corneal applanations (A1L, A1V, A1T, A2L, A2V, and A2T, respectively); the highest concavity radius; highest concavity peak distance (PDHC); highest concavity deformation amplitude (DAHC); highest concavity time (HCT); pachymetry (PACH); stress-strain index (SSI); stiffness parameter-A1 (SP-A1); deformation amplitude ratio (DA ratio); integrated radius (IR); Ambrosio's relational thickness horizontal (ARTh); corneal biomechanical index; noncorrected intraocular pressure (IOPnct); and biomechanically corrected IOP (bIOP) values were measured using the corneal visualization Scheimpflug technology (Corvis ST/CST). Results. After 5 weeks of treatment, Goldman applanation tonometer-IOP, IOPnct, bIOP, PACH, A1T, A2V, SSI, SP-A1, and ARTh decreased, but A1V, A2T, PDHC, DAHC, DA ratio, and IR increased significantly (all p < 0.05). SP-A1 and A1T were positively associated with premedication IOP and IOP changes, whereas A1V, A2T, PDHC, and IR were negatively associated (all p < 0.05). DAHC and DA ratio had significantly negative correlations with IOP variations. PDHC was found to be positively correlated with AL (p < 0.05). A positive relationship was noted between SP-A1 and HCT before medication (p < 0.05). Conclusions. SP-A1 was significantly and consistently associated with IOP. HCT might be correlated with SP-A1. SP-A1 and CST parameters could serve as potential biomarkers for evaluating OHT treatment efficacy. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and efficacy of ultrasound cycloplasty in eyes with primary or secondary open-angle glaucoma, not amenable to adequate control of intra-ocular pressure (IOP) with medical treatment.Methods: Prospective interventional cohort study of 28 eyes of 28 subjects in a tertiary eye care centre in India in patients with open-angle glaucoma. All enrolled eyes underwent ultrasound cycloplasty with the second-generation probe with six shots of 8 s each, operated by a single surgeon between November 2018 and January 2020. They were followed up for a period of 12 months. The primary treatment outcome was IOP and the secondary outcomes were vision and postoperative complications.Results: A total of 28 eyes of 28 patients were studied, and the mean age was 63.82 ± 6.46 years. Primary open-angle glaucoma (75%) was the most common etiology. There was significant reduction in IOP from the baseline (24.93 ± 4.27 mmHg) to the postoperative value (15.82 ± 3.14 mmHg) at the end of 12 months (P < 0.00001). Mean reduction in IOP was 9.14 ± 4.09 mmHg at 12 months (36.66%). Number of ocular hypotensives reduced significantly from baseline (3.32 ± 0.47) to 12-month postoperative follow-up (0.68 ± 0.74) (P < 0.00001). Qualified success was achieved in 89.28% eyes. No major complications were noted.Conclusion: Ultrasound cycloplasty is found to be effective and safe in eyes with open-angle glaucoma because of the primary or secondary etiology, being more effective in the former. [ABSTRACT FROM AUTHOR]

Summary: This study aimed to evaluate the diagnostic accuracy of home sleep apnea testing using peripheral arterial tonometry for sleep apnea as an alternative to polysomnography. We conducted a systematic review and meta‐analysis of observational studies, randomized controlled trials, and diagnostic case–control studies examining the diagnostic accuracy of peripheral arterial tonometry by searching the CENTRAL, MEDLINE, EMBASE, ICTRP and ClinicalTrials.gov databases on 5 October 2021. We assessed the risk of bias of the included studies using the Quality Assessment of Diagnostic Accuracy Studies‐2 tool. A bivariate random‐effects model was generated to derive the summary point estimates of sensitivity and specificity with 95% confidence intervals at different apnea–hypopnea index cutoffs. This meta‐analysis included 13 studies (1227 participants, median prevalence of sleep apnea with apnea–hypopnea index ≥ 5 events per hr: 85%). The risk of bias in the included studies was low to moderate. The pooled sensitivity and specificity estimates were 96% (95% confidence interval: 93%–97%) and 44% (95% confidence interval: 32%–56%) at apnea–hypopnea index ≥ 5 events per hr, 88% (85%–91%) and 74% (63%–83%) at apnea–hypopnea index ≧ 15 events per hr, and 80% (66%–89%) and 90% (83%–95%) at apnea–hypopnea index ≧ 30 events per hr, respectively. Peripheral arterial tonometry resulted in a significant number of false negatives and false positives at any apnea–hypopnea index cutoff when applied to the median prevalence setting of the included studies. The inadequate sensitivity and specificity of peripheral arterial tonometry render it an unsuitable alternative to polysomnography for detecting sleep apnea for apnea–hypopnea index ≧ 5, 15 and 30 events per hr. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study is to evaluate the effect of topical prostaglandin (PG) treatment on the corneal biomechanical properties in treatment-naïve patients with either primary open-angle glaucoma (POAG) or ocular hypertension (OHT) using the Corvis ST device. Methods: This is an observational study. We analyzed the Corvis ST dynamic corneal response parameters of our database using the newest software available. Thirty-four eyes of 34 patients were included. They were all newly diagnosed and treatment-naïve. Patients were evaluated at baseline and after 6 months of treatment with prostaglandin analogues. Ultrasound pachymetry, Optical Coherence Tomography (OCT) and a 24–2 visual field test were performed in baseline visit. Goldman Applanation Tonometry (GAT-IOP) and Corvis ST dynamic corneal response parameters were registered at baseline and at the 6-month visit. Results: After 6 months of treatment, the IOP decrease (Δ) values obtained with the different tonometers were ΔGAT -6.5 ± 3.7, ΔIOPnct -4.4 ± 5.7 and ΔbIOP -3.8 ± 5.4. The differences between ΔGAT vs ΔIOPnct, ΔGAT vs ΔbIOP, and ΔIOPnct vs ΔbIOP, were statistically significant (p < 0.05 for all comparisons). Statistically significant lower values of the stress–strain index (SSI) (1.77 ± 0.3 at baseline vs 1.54 ± 0.27 at the 6-month visit) were found (p = 0.0002). Conclusion: The SSI provided by the Corvis ST seems to decrease significantly after topical prostaglandin therapy. We believe that our results support the hypothesis that topical PG therapy does decrease the corneal stiffness and thus, that the ocular hypotensive effect of these drugs is overestimated if GAT is used for IOP measurement. [ABSTRACT FROM AUTHOR]

During Schiøtz tonometry, the eye cornea preliminarily loaded with a concave heavy stamp (footplate) is additionally loaded with a rod (plunger), by immersion depth of which the value of intraocular pressure is estimated. A mathematical modeling of this process was done on the basis of an efficient model of the eyeball, previously developed and tested by the authors. Unlike the basic (physically linear) version of this model, the elastic properties of the system are characterized here not by two but by three essential parameters, one of which is responsible for the nonlinearity of elastic behavior of the cornea. The influence of such nonlinearity on a tonometric difference (an excess of the tonometric pressure (in the eye loaded with the tonometer) over the true one (before loading)) is numerically analyzed. The possibility of a nonmonotonic dependence of the tonometric difference from true pressures (when the latter are small), which is absent in the linear model, was found. A correction to the calculation of the true pressure from the tonometric one, introduced by nonlinearity, was estimated. This correction has a different sign depending on the true pressure and is significant for sufficiently high values of this quantity: in this case, taking into account the nonlinearity reduces the tonometric difference. However, the dependence on both stiffnesses present in the model (corneal and scleral) is more significant in most cases than the effect of nonlinearity. The use of the average values of these stiffnesses instead of individual ones in the calculation of the true pressure can lead to fatal errors for the eyes, the stiffness of which deviates greatly from the average, which, particularly, occurs in glaucoma. The dependences used in the clinic during the standard processing of Schiøtz tonometry data can give the correct results with practical accuracy with some values of elastic parameters but deviate significantly from the calculated ones even at the average values of these constants, and the deviations are more noticeable when the greater is the weight of the plunger. A completely correct approach to estimating the mechanical state and mechanical characteristics of the eye should include several measurements with at least two different tonometers, followed by numerical processing of the results. [ABSTRACT FROM AUTHOR]

In order to investigate the reliability of correcting GAT formulas in comparison with dynamic contour tonometry (DCT), this study included 112 right eyes of 112 healthy subjects aged from 21 to 77 years, whose eyes underwent to a full ophthalmologic exam. IOP was measured in each eye with DCT and then with GAT. IOP values obtained with GAT were corrected with 10 equations and then compared with those provided by DCT. Participants mean age was 42.24 ± 14.08 years; mean IOP measured with DCT was 17.61 ± 2.87 and 15.50 ± 2.47 mmHg, measured with GAT. The mean discordance between DCT and GAT measurements was 2.11 ± 2.24 mmHg. All the correcting formulas, but Srodka one (p ˂ 0.001), tend to increase the difference between GAT and DCT. According to these results Śródka equation provides the best correction, reducing the difference between the two IOP measurement methods of − 0.03 ± 0.85 mmHg. Other equations do not provide a valid improvement of the agreement between the two methods or they provide a worsening of the agreement. [ABSTRACT FROM AUTHOR]

Highlights: This study is the first prospective clinical trial to evaluate the anterior corneal parameters in patients with acromegaly before and after transsphenoidal pituitary adenoma resection on the basis of several months of postoperative follow-up. An increase in CD and a decrease in AVG and CCTNSM were observed after pituitary adenoma resection. The mean CCT measured both with an ultrasonic pachymeter and with non-contact specular microscopy was significantly lower as compared to the preoperative values. IOP decreased statistically for the measured IOP air puff values. A downward trend was observed after treatment in the case of IOP GAT and IOPc, but statistical significance was not achieved. Statistically significant reduction in CH and CRF was found after the surgical treatment of acromegaly. (1) Purpose: This study aimed to investigate the changes in Reichert Ocular Response Analyzer (ORA) parameters, corneal endothelium parameters, central corneal thickness (CCT), and intraocular pressure (IOP) before and after the transsphenoidal resection of pituitary adenoma in patients with acromegaly. (2) Methods: This was a single-center, prospective, interventional study. Twenty patients with newly diagnosed acromegaly were examined before and 19 ± 9 months after transsphenoidal resection. The participants underwent a comprehensive ophthalmological examination including pneumatic IOP (IOP air puff), Goldmann applanation tonometry (IOP GAT), CCT measured using the iPac pachymeter (CCTUP), IOP value corrected for CCTUP using the Ehlers formula (IOPc) ORA measurements included corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated IOP (IOPcc), and Goldmann-correlated IOP (IOPg). CCT from non-contact specular microscopy (CCTNSM), the number of endothelial cells (CD) per mm2, and average cell size (AVG) were determined with non-contact specular microscopy. (3) Results: A statistically significant decrease was observed in CCTUP (p = 0.007), and IOP air puff (p = 0.012) after surgery. Moreover, we noted a statistically significant increase in CD (p = 0.001), and a statistically significant decrease in AVG (p = 0.009) and CCTNSM (p = 0.004) after surgery. A statistically significant decrease was also observed in IOPg (p = 0.011), CH (p = 0.016), and CRF (p = 0.001) after surgery. The mean value of IOP GAT and IOPc was lower after the surgery. However, the difference was not statistically significant. (4) Conclusions: Our study revealed significant changes in biomechanics, corneal endothelium, CCT and IOP after pituitary adenoma resection in patients with acromegaly. It proves that the eye might be sensitive to long-term overexposure to growth hormone (GH) and insulin-like growth factor-1 (IGF-1). We suggest that disease activity be taken into consideration on ophthalmological examination. [ABSTRACT FROM AUTHOR]

Objective: To determine intraocular pressure (IOP) estimates using rebound tonometry in juvenile northern bobwhite quails. Animals Studied: Eighteen, 28‐day‐old, wild caught, captive raised, northern bobwhite quails. Procedures: Birds were manually restrained in sternal recumbency with two fingers placed below the head, applying minimal pressure. Following detailed ophthalmic examination by a board‐certified veterinary ophthalmologist, IOP was obtained via rebound tonometry using the Tonovet "P" setting for undefined species in animals without obvious ocular pathology. IOPs were estimated three times on each eye. The mean result of the three estimates was recorded for further analysis. Only readings with low or no reported error were recorded. Results: No difference was detected between the eyes; therefore, a reference interval was calculated using both eyes. The overall IOP (n = 36 eyes) was 5.6 ± 1.2 mmHg (mean ± SD), the median was 6 mmHg, and the range was 2–7 mmHg. The 95% reference interval was 2.2–7.6 mmHg. All quails were ultimately released with no clinically appreciable abnormalities. Conclusions: This study provides information on normal IOP values for juvenile northern bobwhite quails, which can be used to evaluate the ocular health of this species. Future studies with a larger number of animals are needed, as well as validation of the rebound tonometry method using direct manometry. [ABSTRACT FROM AUTHOR]

Enrico Brambilla,1 Tanner J Ferguson,2 Nathan Chu,1 David Ammar,3 Paul Yoo1 1Equinox Ophthalmic, Inc., Newport Beach, CA, USA; 2Vance Thompson Vision, Sioux Falls, SD, USA; 3Lions Eye Institute for Transplant & Research, Tampa, FL, USACorrespondence: Tanner J Ferguson, Vance Thompson Vision, 3101 W. 57th St, Sioux Falls, SD, USA, Email tannerferg@gmail.comPurpose: This is a 2-part study to investigate the agreement between pneumatonometry and direct pressure transducer intraocular pressure (IOP) measurements in a perfusion organ culture (POC) model where (1) the perfusion fluid column is open to atmospheric pressure, holding IOP constant to permit evaluation of the impact of negative pressure (NP) on IOP measurements, and (2) the perfusion fluid column is a closed system, allowing IOP to vary with NP application.Methods: The first part incorporated a fluid column open to atmospheric pressure, maintaining IOP constant to permit evaluation of the effect of applied NP on IOP measurement accuracy. In the second part, the POC column was closed, allowing IOP to vary with NP application and permit evaluation of agreement between pneumatonometry and pressure transducer measurements. In each part, four perfused tissues were used in thirteen paired pre-set IOP (10, 20, 25, 30 mmHg) and NP (0, 5, 10, 15, 20 mmHg) combinations, resulting in a total of 1040 paired measurements (520 per study). The difference in IOP measurements (Δ IOP = Excursion tonometry – pressure transducer) was calculated at each paired configuration.Results: During the first part, the mean Δ IOP was − 0.7 ± 1.6 mmHg across all measurements. During the second part, the mean Δ IOP across all measurements was +0.7 ± 1.4 mmHg. At NP settings of − 5, − 10, − 15, and − 20 mmHg, across all pre-set IOPs, the mean IOP reduction via Excursion tonometry was 3.1 ± 0.3, 5.6 ± 1.3, 8.5 ± 1.7 and 11.2 ± 1.8 mmHg, respectively.Conclusion: Measurement of IOP via Excursion tonometry yields results within the accuracy range of the pneumatonometry device (per manufacturer) and is minimally impacted by NP application. The IOP-lowering results are consistent with previous studies and further support the effectiveness of the Multi-Pressure Dial in lowering IOP relative to atmospheric pressure.Keywords: tonometry, intraocular pressure, IOP, multi-pressure dial, MPD, ophthalmic techniques, diagnostics

AIM: To evaluate the agreement of biomechanically corrected intraocular pressure (b-IOP) and central corneal thickness (CCT) measurements obtained with the updated Corvis ST tonometer versus Goldmann applanation tonometry (GAT) and optical-based corneal pachymetry (OB-CCT) in controls, patients with ocular hypertension (OHT) and primary open angle glaucoma (POAG). Additionally, we examined the differences in corneal deformation parameters provided by the updated Corvis ST among the three groups. METHODS: For each participant, GAT IOP, OB-CCT and measurements with a Corvis ST with updated software were obtained. Bland-Altman analysis was used to assess the agreement between the two measurement methods. RESULTS: A consecutive series of 80 eyes from 80 participants (30 with POAG, 25 with OHT and 25 normal controls) were included in this prospective study. The mean GAT IOP of all eyes was 17.2±3.6 mm Hg, and the mean b-IOP was 15.9±3.7 mm Hg (Spearman's rho=0.767, P

Abstract Background The purpose of this study is to describe measurements using a newly developed modified Goldmann convex tonometer (CT) 1 year after myopic laser refractive surgery. Intraocular pressure (IOP) measurements were compared with IOP values obtained by Goldmann applanation tonometer (GAT), and Ocular Response Analyzer (ORA). Methods Prospective double-masked study performed on thirty eyes of thirty patients that underwent laser in situ keratomileusis (LASIK; n = 19) or photorefractive keratectomy (PRK; n = 11). IOP was measured before and 3 and 12 months after surgery. Intraclass correlation coefficient (ICC) and Bland-Altman plot were calculated to assess the agreement between GAT, CT, IOPg (Goldmann-correlated IOP) and IOPcc (corneal-compensated IOP) from ORA. Results Twelve months after LASIK, IOP measured with CT showed the best correlation with IOP measured with GAT before surgery (GATpre) (ICC = 0.886, 95% CI: 0.703–0.956) (15.60 ± 3.27 vs 15.80 ± 3.22; p

BACKGROUND: The aim of this study is to analyze and compare the intraocular pressure (IOP) values measured in three different kinds of participants such as healthy subjects (HS), keratoconus patients (KP), and those who underwent myopic photorefractive keratectomy (MPRK). The devices used in this study are the Goldmann Applanation Tonometry (GAT), the dynamic contour tonometry (DCT), the ocular response analyzer (ORA), and the Corvis ST (CST). SUBJECTS AND METHODS: This research included 92 eyes of 92 h, 63 eyes of 63 KP, and 58 eyes of 58 MPRKM. Each participant underwent a complete ophthalmic evaluation and IOP measurement with GAT, DCT, ORA, and CST. A statistical analysis was conducted to detect possible differences and correlations. RESULTS: First, according to the observed data, HS eyes displayed mean IOP values measured with GAT, DCT, ORA, and CST, respectively, 15.82 ± 2.74 mmHg, 17.63 ± 2.28 mmHg, 16.24 ± 3.14 mmHg, and 17.31 ± 3.21 mmHg. Then, KP eyes showed mean IOP values measured with GAT, DCT, ORA, and CST of, respectively, 14.89 ± 1.64 mmHg, 16.97 ± 2.08 mmHg, 13.09 ± 3.12 mmHg, and 13.78 ± 2.11 mmHg. Finally, MPRK eyes showed mean IOP values measured with GAT, DCT, ORA, and CST of, respectively, 13.92 ± 1.34 mmHg, 15.39 ± 2.86 mmHg, 16.63 ± 2.51 mmHg, and 15.06 ± 1.56 mmHg. CONCLUSION: According to the observed data, ORA and GAT might be used interchangeably in HS, whereas GAT, ORA, and CST in KP eyes. Moreover, it has been noticed that in those eyes that previously undergone a myopic PRK, GAT provided lower values of IOP in comparison with other devices.

AIM: To assess intraocular pressure (IOP) during the daily curve of intraocular pressure (DCPo) in keratoconic eyes and compare Goldmann applanation tonometer (GAT), without and with astigmatism correction (nGAT and cGAT) and Tono-Pen AVIA (TPA) assessment methods. METHODS: Thirty-nine keratoconic eyes of 24 patients were assessed. DCPo was evaluated with five IOP measurements; four were performed with a GAT (nGAT and cGAT), and a Tono-Pen AVIA (TPA) at various times throughout the day. RESULTS: Mean IOP DCPo values (mm Hg) were: nGAT, 9.9±2.6; cGAT, 11.3±2.6; TPA 12.3±3.1. Mean IOP DCPo differences (mm Hg) and Spearman's correlation coefficients were as follows: cGATc-nGAT, 1.32±1.31, rs=0.879 (PcGAT>nGAT. IOP TPA measures are predictive of cGAT values, adjusted according to anterior chamber depth and corneal astigmatism.

Glaucoma is the second leading cause of blindness in India. Despite advances in diagnosing and managing glaucoma, there is a lack of India-specific clinical guidelines on glaucoma. Ophthalmologists often refer to the European Glaucoma Society (EGS) and Asia-Pacific Glaucoma Society (APGS) guidelines. A group of glaucoma experts was convened to review the recently released EGS guideline (fifth edition) and the APGS guideline and explore their relevance to the Indian context. This review provides the salient features of EGS and APGS guidelines and their utility in Indian scenario. Glaucoma diagnosis should be based on visual acuity and refractive errors, slit-lamp examination, gonioscopy, tonometry, visual field (VF) testing, and clinical assessment of optic nerve head, retinal nerve fiber layer (RNFL), and macula. The intraocular pressure target must be individualized to the eye and revised at every visit. Prostaglandin analogues are the most effective medications and are recommended as the first choice in open-angle glaucoma (OAG). In patients with cataract and primary angle-closure glaucoma (PACG), phacoemulsification alone or combined phacoemulsification and glaucoma surgery are recommended. Trabeculectomy augmented with antifibrotic agents is recommended as the initial surgical treatment for OAG. Laser peripheral iridotomy and surgery in combination with medical treatment should be considered in high-risk individuals aged

The aim of this work is to emphasize the need to take into account several important biomechanical factors (biometrical parameters of patient, s eyes accuracy of tonometers) as well as the design of the procedure when interpreting clinical data of immediate IOP elevation after intravitreal injections

Numerous living organisms possess biophotonic nanostructures that provide colouration and other diverse functions for survival. While such structures have been actively studied and replicated in the laboratory, it remains unclear whether they can be used for biomedical applications. Here, we show a transparent photonic nanostructure inspired by the longtail glasswing butterfly (Chorinea faunus) and demonstrate its use in intraocular pressure (IOP) sensors in vivo. We exploit the phase separation between two immiscible polymers (poly(methyl methacrylate) and polystyrene) to form nanostructured features on top of a Si3N4 substrate. The membrane thus formed shows good angle-independent white-light transmission, strong hydrophilicity and anti-biofouling properties, which prevent adhesion of proteins, bacteria and eukaryotic cells. We then developed a microscale implantable IOP sensor using our photonic membrane as an optomechanical sensing element. Finally, we performed in vivo testing on New Zealand white rabbits, which showed that our device reduces the mean IOP measurement variation compared with conventional rebound tonometry without signs of inflammation.

PurposeTo evaluate the association between macula vascular density assessed by optical coherence tomography angiography (OCT-A) and central visual field (VF) threshold sensitivities in healthy, glaucoma suspect, and glaucoma patients.MethodsA total of 185 eyes from 38 healthy participants, 31 glaucoma suspects, 72 mild glaucoma patients, and 44 moderate/severe glaucoma patients from the Diagnostic Innovations in Glaucoma Study who underwent OCT-A images of the macula and 10-2 VF testing were enrolled in this observational cross-sectional study. The relationship between central VF mean sensitivity (MS) and superficial macula whole-image vessel density (wiVD), and the relationship between the MS of the 4 central points of the 10-2 VF (MS4) and parafoveal vessel density (pfVD), were assessed using linear regression models.ResultsMean wiVD (52.5%, 49.8%, 49.4% and 45.2%, respectively) and mean pfVD (54.9%, 52.1%, 51.8% and 47.7%, respectively) were found to be significantly higher in healthy eyes and glaucoma suspect eyes compared with glaucoma eyes with mild and moderate/severe disease [analysis of covariance (ANCOVA) P

Purpose:To apply computational techniques to wide-angle swept-source optical coherence tomography (SS-OCT) images to identify novel, glaucoma-related structural features and improve detection of glaucoma and prediction of future glaucomatous progression. Methods:Wide-angle SS-OCT, OCT circumpapillary retinal nerve fiber layer (cpRNFL) circle scans spectral-domain (SD)-OCT, standard automated perimetry (SAP), and frequency doubling technology (FDT) visual field tests were completed every 3 months for 2 years from a cohort of 28 healthy participants (56 eyes) and 93 glaucoma participants (179 eyes). RNFL thickness maps were extracted from segmented SS-OCT images and an unsupervised machine learning approach based on principal component analysis (PCA) was used to identify novel structural features. Area under the receiver operating characteristic curve (AUC) was used to assess diagnostic accuracy of RNFL PCA for detecting glaucoma and progression compared to SAP, FDT, and cpRNFL measures. Results:The RNFL PCA features were significantly associated with mean deviation (MD) in both SAP (R2 = 0.49, P < 0.0001) and FDT visual field testing (R2 = 0.48, P < 0.0001), and with mean circumpapillary RNFL thickness (cpRNFLt) from SD-OCT (R2 = 0.58, P < 0.0001). The identified features outperformed each of these measures in detecting glaucoma with an AUC of 0.95 for RNFL PCA compared to an 0.90 for mean cpRNFLt (P = 0.09), 0.86 for SAP MD (P = 0.034), and 0.83 for FDT MD (P = 0.021). Accuracy in predicting progression was also significantly higher for RNFL PCA compared to SAP MD, FDT MD, and mean cpRNFLt (P = 0.046, P = 0.007, and P = 0.044, respectively). Conclusions:A computational approach can identify structural features that improve glaucoma detection and progression prediction.

Purpose:To determine whether latanoprost, a prostaglandin analog proven to be very effective in reducing intraocular pressure (IOP) in humans, can also slow myopia progression in the guinea pig form deprivation (FD) model. Methods:Two-week-old pigmented guinea pigs underwent monocular FD and daily topical latanoprost (0.005%, n = 10) or artificial tears (control, n = 10) starting 1 week after the initiation of FD, with all treatments continuing for a further 9 weeks. Tonometry, retinoscopy, and high-frequency A-scan ultrasonography were used to monitor IOP, refractive error, and ocular axial dimensions, respectively. Results:Latanoprost significantly reduced IOP and slowed myopia progression. Mean interocular IOP differences (±SEM) recorded at baseline and week 10 were -0.30 ± 0.51 and 1.80 ± 1.16 mm Hg (P = 0.525) for the control group and 0.07 ± 0.35 and -5.17 ± 0.96 mm Hg (P < 0.001) for the latanoprost group. Equivalent interocular differences for optical axial length at baseline and week 10 were 0.00 ± 0.015 and 0.29 ± 0.04 mm (P < 0.001; control) and 0.02 ± 0.02 and 0.06 ± 0.02 mm (P = 0.202; latanoprost), and for refractive error were +0.025 ± 0.36 and -8.2 ± 0.71 diopter (D) (P < 0.001; control), and -0.15 ± 0.35 and -2.25 ± 0.54 D (P = 0.03; latanoprost). Conclusions:In the FD guinea pig model, latanoprost significantly reduces the development of myopia. Although further investigations into underlying mechanisms are needed, the results open the exciting possibility of a new line of myopia control therapy.

PurposeThe purpose of this study was to investigate the diurnal variation in peripapillary and macular vessel density (VD) measurements using optical coherence tomographic angiography (OCT-A) and its correlation to intraocular pressure (IOP) changes in glaucoma patients.MethodsProspective, observational cross-sectional study including 37 patients (74 eyes; age, 63.8±12.9 y) with open-angle glaucoma. OCT-A imaging and IOP measurements were performed at 08:00, 11:00, 14:00, and 16:00 timepoints on a single day. At each timepoint, 2 scan protocols were used to generate 3-dimensional en face OCT angiograms: 4.5×4.5-mm scan centered on the optic nerve head and 6×6-mm scan centered on the fovea. For each scan mode, the "radial peripapillary capillary" segment, composed of the vasculature of the retinal nerve fiber layer and ganglion cell layer, was calculated. Two trained readers reviewed OCT-A image quality. Only scans with signal strength intensity (SSI) higher than 46 and without image artifacts interfering with measurements were included. Variation in VD measurements assessed using analysis of variance (ANOVA) and the association between VD and IOP changes assessed using linear mixed modeling methods.ResultsThe optic nerve head and peripapillary VD measurements at 14:00 and 16:00 timepoints were greater than the measurements at 08:00 and 11:00 timepoints. The 14:00 and 16:00 VD measurements were statistically significantly greater (P

PURPOSE:To compare the diurnal intraocular pressure (IOP)-lowering effect of latanoprostene bunod (LBN) 0.024% with timolol maleate 0.5% in subjects with open-angle glaucoma (OAG) or ocular hypertension (OHT). PATIENTS AND METHODS:Pooled analysis of two phase 3, randomized, multicenter, double-masked, parallel-group, noninferiority trials (APOLLO and LUNAR), each with open-label safety extension phases. Adults with OAG or OHT were randomized 2:1 to double-masked treatment with LBN once daily (qd) or timolol twice daily (bid) for 3 months followed by open-label LBN treatment for 3 (LUNAR) or 9 (APOLLO) months. IOP was measured at 8 AM, 12 PM, and 4 PM at week 2, week 6, and months 3, 6, 9, and 12. RESULTS:Of the 840 subjects randomized, 774 (LBN, n=523; timolol crossover to LBN, n=251) completed the efficacy phase, and 738 completed the safety extension phase. Mean IOP was significantly lower with LBN versus timolol at all 9 evaluation timepoints during the efficacy phase (P

The leading cause of health loss and deaths worldwide are cardiovascular diseases. A predictor of cardiovascular diseases and events is the arterial stiffness. The pulse wave velocity (PWV) can be used to estimate arterial stiffness non-invasively. The tonometer is considered as the gold standard for measuring PWV. This approach requires manual probe fixation above the artery and depends on the skills of the operator. Electrical impedance plethysmography (IPG) is an interesting alternative using skin surface sensing electrodes, that is miniaturizable, cost-effective and allows measurement of deeper arteries. The aim of this pilot study was to explore if IPG can be a suitable technique to measure pulse wave velocity in legs as an alternative for the tonometer technique. The PWV was estimated by differences in the ECG-gated pulse arrival times (PAT) at the a. femoralis, a. popliteal, a. tibialis dorsalis and a. dorsalis pedis in nine healthy young adults using IPG and the SphygmoCor tonometer as a reference. The estimated PWV results from bioimpedance and the tonometer were fairly in agreement, and the beat-to-beat variability in PAT was similar. This pilot study indicates that the use of IPG may be a good alternative for estimating PWV in the legs.