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Introduction: White-on-white standard automated perimetry (AP) uses a white round stimulus with 0.43° diameter and 4.0 mm 2 area (Goldmann size III). Patients with low vision have difficulty seeing such a small stimulus and are often tested with perimetry using the size V stimulus with 1.72° diameter and 64 mm 2 area. We undertook an observational case-control study to compare the performance of patients on AP using two differently sized stimuli., Methods: Patients with glaucoma and visual acuity worse than 20/100 underwent AP using the standard size III stimulus Swedish Interactive Threshold Algorithm (SITA) standard test and size V stimulus full threshold test. All patients were familiar with the procedure, having done the test at least twice previously. Another group of glaucoma patients with visual acuity better than 20/40 served as controls. The main outcome measures included test time, mean retinal sensitivity (MRS), foveal sensitivity (FS), fixation loss (FL), false positive (FP), false negative (FN), and the patient's subjective preference., Results: Fifty patients were included in the study. Most preferred the size V stimulus target size test. For glaucoma patients, test time was shorter with size III; MRS and FS were higher with size V; FL, FP, and FN did not differ between the tests., Conclusion: AP with stimulus size V may be a good alternative to standard size III in selected visually debilitated patients who report difficulty undergoing a standard SITA 24-2 test.

To correlate the ganglion cell complex (GCC) parameters with structural measures of the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) as evaluated by Fourier-Domain optic coherence tomography (OCT). This retrospective study included patients with glaucoma, ocular hypertensive patients and glaucoma suspects who had previously undergone OCT examination with the RTVue-100. The parameters of GCC (average, superior, inferior, focal loss volume [FLV], global loss volume [GLV]) were correlated with the values of the ONH (cup volume, cup area, horizontal cup-to-disk ratio, vertical cup-to-disk ratio, and rim area) and RNFL (average, superior, and inferior) using Pearson's correlation coefficient. The sample included 74 eyes of 37 patients. All correlations between GCC parameters and RNFL were strong (r > 0.60). The correlation between GCC parameters and ONH were good for most parameters, except that for FLV and cup volume (r = 0.13), GLV and cup volume (r = 0.09), and GLV and cup area (r = 0.21). The GCC parameters can be used as structural measures of the glaucomatous optic neuropathy.

The purpose of the study was to correlate the Fourier-domain OCT ganglion cell complex (GCC) parameters with automated perimetry (AP) functional measures of the optic nerve. This retrospective study included patients who had previously undergone examination with the RTVue-100 OCT and AP, SITA strategy. The parameters of GCC (average, superior, inferior, S-I [superior inferior difference], S-I SD [standard deviation of S-I], GLV [global loss volume] and FLV [focal loss volume]) were correlated with the mean deviation (MD) and pattern standard deviation (PSD) values of AP using linear and logarithmic regression analysis. All correlations between GCC and automated perimetry parameters were strong (r > 0.60), except that for SI and MD (r = -0.05); SI and PSD (r = 0.09); SI-DS and MD (r = -0.06); and SI-SD and PSD (r = 0.08). In summary, GCC derived structural measures showed good correlation with functional parameters from AP.

Background: The myocilin (MYOC) gene promoter polymorphism -1000C>G (MYOC mt.1) can be associated with faster progression of primary open angle glaucoma (POAG). The purpose of this study was to investigate the MYOC mt.1 in Brazilian patients with POAG and to evaluate its possible role on the phenotype and the severity of the disease., Material and Methods: One hundred sixty-seven POAG patients and 130 normal controls were enrolled. DNA samples were prepared and the MYOC mt.1 polymorphism was screened by real-time polymerase chain reaction (RT-PCR) in an Single-nucleotide polymorphism (SNP) assay. Frequencies of the MYOC mt.1 promoter polymorphism were determined for both groups and compared by Fisher's exact test and Chi-square test with Yate's correction. Intraocular pressure (IOP), cup-to-disc ratio (C/D), number of glaucoma medications, and number of glaucoma surgeries were compared between MYOC mt.1 carriers and non-carriers., Results: MYOC mt.1 genotype frequencies did not differ between POAG and controls (P  =  0.420); 14.6% of controls and 16.4% of POAG patients were MYOC mt.1 carriers (CG or GG). Frequencies of the G allele were similar between glaucomatous patients and controls (7.3% and 9.2%, respectively; P  =  0.477). Among POAG patients, there were no differences in mean C/D ratio, IOP, number of glaucoma medications, and surgical procedures for IOP control between carries and non-carriers of the MYOC mt.1 promoter polymorphism (p>0.05)., Conclusion: The G allele of the MYOC mt.1 promoter polymorphism was equally distributed among POAG patients and healthy subjects and it is possibly unrelated to the risk and severity of disease in the Brazilian population.

Purpose: To verify the frequencies of T34T, E50K, M98K, 691_692insAG, and R545Q variants in the optineurin (OPTN) gene in Brazilian subjects with primary open-angle glaucoma (POAG) and controls., Patients and Methods: Ninety-nine patients with POAG and 100 normal controls were enrolled in this study. The frequency of alterations in the OPTN gene was analyzed by direct sequencing and enzymatic digestion of PCR products., Results: None of the five alterations evaluated was significantly associated with POAG when compared to controls. However, the T34T silent change was present in greater frequency in POAG patients (37.37% vs. 23.00% in controls), while the R545Q change was more prevalent in controls (23.00% vs. 10.10% in POAG). The M98K and 691_692insAG presented with low frequencies in POAG patients (1.01% and 2.02%, respectively) and controls (2.00% and 2.00%, respectively). The E50K substitution was not observed., Conclusion: Our data show no association between the five evaluated variants and POAG in the Brazilian population.

Purpose: To compare the safety and efficacy of human preserved amniotic membrane (AM) in the trabeculectomy for treatment of primary open-angle glaucoma., Methods: A prospective, randomized clinical trial compared primary trabeculectomy with amniotic membrane (study group) and without amniotic membrane (control group) in the treatment of the glaucoma. Intraocular pressure (IOP), number of glaucoma medications and appearance of the bleb were compared between the two groups. Thirty-two patients divided into two groups of 16 patients were followed for a period of 12 months., Results: The difference of the mean postoperative intraocular pressure between groups was not statistically significant (15.19 +/- 3.33 in the control group and 12.81 +/- 2.48 in the study group p=0.297) at one year follow-up. Postoperative number of medications decreased in both groups (p<0.001 and p=0.007, study group and control respectively). At the end of a 12-month follow-up period, nine eyes (56.25%) showed thin, avascular blebs in the study group as compared to only one eye (6.25%) in the control group., Conclusions: Trabeculectomy with amniotic membrane and standard trabeculectomy promote lower postoperative intraocular pressure although results showed no statistically significant difference between groups regarding postoperative intraocular pressure after one year follow-up.

Purpose: To study the prevalence of glaucoma in employees of a public hospital in São Paulo and to analyze the role of frequency doubling perimetry along with non-contact tonometry and direct ophthalmoscopy, in the screening for glaucoma., Methods: 612 employees of the Central Hospital of the "Santa Casa de São Paulo" were evaluated from October 15 to 20, 2000; 438 were women and 174 men, with mean age of 45.05+/-7.7 years (range, 35 to 81 years); 437 were white, 104 mulatto, 43 black and 28 Asian. All examinations were done by 10 eye specialists with experience in glaucoma. All employees had both eyes examined, by means of frequency doubling perimetry (FDT), ophthalmoscopy (FO), and non-contact tonometry (TNC)., Results: 159 (25.98%) subjects presented with at least one abnormal testing; 5 (3.14%) had high IOP (TNC+); 13 (8.17%) presented suspicious disk (FO+); 110 (69.18%) presented abnormal FDT (FDP+); 8 (5.03%) TNC+ and FO+; 10 (6.28%) had TNC+ and FDT+; 9 (5.66%) presented FO+ and FDT+; 4 (2.51%) had TNC+, FO+ and FDT+; 12 (1.96%) individuals were diagnosed with glaucoma, four of whom (0.65%), with normal pressure glaucoma., Conclusions: Frequency doubling perimetry was found to be an important step in the screening for glaucoma in the study. Of the 12 individuals that had the diagnosis of glaucoma, 5 (41.6%) would not have been diagnosed if they had not undergone frequency doubling perimetry.