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Purpose To develop and evaluate the performance of a 3-dimensional (3D) deep-learning–based automated digital gonioscopy system (DGS) in detecting 2 major characteristics in eyes with suspected primary angle-closure glaucoma (PACG): (1) narrow iridocorneal angles (static gonioscopy, Task I) and (2) peripheral anterior synechiae (PAS) (dynamic gonioscopy, Task II) on OCT scans. Design International, cross-sectional, multicenter study. Participants A total of 1.112 million images of 8694 volume scans (2294 patients) from 3 centers were included in this study (Task I, training/internal validation/external testing: 4515, 1101, and 2222 volume scans, respectively; Task II, training/internal validation/external testing: 378, 376, and 102 volume scans, respectively). Methods For Task I, a narrow angle was defined as an eye in which the posterior pigmented trabecular meshwork was not visible in more than 180° without indentation in the primary position captured in the dark room from the scans. For Task II, PAS was defined as the adhesion of the iris to the trabecular meshwork. The diagnostic performance of the 3D DGS was evaluated in both tasks with gonioscopic records as reference. Main Outcome Measures The area under the curve (AUC), sensitivity, and specificity of the 3D DGS were calculated. Results In Task I, 29.4% of patients had a narrow angle. The AUC, sensitivity, and specificity of 3D DGS on the external testing datasets were 0.943 (0.933–0.953), 0.867 (0.838–0.895), and 0.878 (0.859–0.896), respectively. For Task II, 13.8% of patients had PAS. The AUC, sensitivity, and specificity of 3D DGS were 0.902 (0.818–0.985), 0.900 (0.714–1.000), and 0.890 (0.841–0.938), respectively, on the external testing set at quadrant level following normal clinical practice; and 0.885 (0.836–0.933), 0.912 (0.816–1.000), and 0.700 (0.660–0.741), respectively, on the external testing set at clock-hour level. Conclusions The 3D DGS is effective in detecting eyes with suspected PACG. It has the potential to be used widely in the primary eye care community for screening of subjects at high risk of developing PACG.

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.

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, p0.05]. 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.

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

Glaucoma is a neurodegenerative disease presents with retinal nerve fiber layer (RNFL) defects. We apply machine learning classifiers on the color information of the RNFL to differentiate between intact RNFL (i-RNFL) and RNFL defect (d-RNFL) on optic disc photographs (DPs). DPs from individuals with and without glaucoma were collected. Then, a semi-circle was automatically marked on the DPs, to label i-RNFL versus d-RNFL. RGB intensities and other color spaces of two profiles were collected. Five-fold cross validation is used to compare classification efficiency of five classifiers. A total of 2,051 profiles from 89, 32 and 15 DPs from patients with glaucoma, glaucoma suspects and control subjects were collected. There were 702 and 175 points of d-RNFL and 940 and 234 of i-RNFL in the training and test sets. In the training set, the 3 best classifiers using RGB intensities were fine Gaussian support vector machine (SVM), medium k-Nearest Neighbor and ensemble RUSBoosted Trees, with accuracies of 81.8%, 79.4% and 79.2%. The performance of the fine Gaussian SVM was similar between RGB and other color spaces. In the test set, the highest sensitivity (71.4%) and specificity (88.5%) were archived using RGB and the combination of RGB and Cb and Cr.

To develop and evaluate the performance of a 3-dimensional (3D) deep-learning-based automated digital gonioscopy system (DGS) in detecting 2 major characteristics in eyes with suspected primary angle-closure glaucoma (PACG): (1) narrow iridocorneal angles (static gonioscopy, Task I) and (2) peripheral anterior synechiae (PAS) (dynamic gonioscopy, Task II) on OCT scans.International, cross-sectional, multicenter study.A total of 1.112 million images of 8694 volume scans (2294 patients) from 3 centers were included in this study (Task I, training/internal validation/external testing: 4515, 1101, and 2222 volume scans, respectively; Task II, training/internal validation/external testing: 378, 376, and 102 volume scans, respectively).For Task I, a narrow angle was defined as an eye in which the posterior pigmented trabecular meshwork was not visible in more than 180° without indentation in the primary position captured in the dark room from the scans. For Task II, PAS was defined as the adhesion of the iris to the trabecular meshwork. The diagnostic performance of the 3D DGS was evaluated in both tasks with gonioscopic records as reference.The area under the curve (AUC), sensitivity, and specificity of the 3D DGS were calculated.In Task I, 29.4% of patients had a narrow angle. The AUC, sensitivity, and specificity of 3D DGS on the external testing datasets were 0.943 (0.933-0.953), 0.867 (0.838-0.895), and 0.878 (0.859-0.896), respectively. For Task II, 13.8% of patients had PAS. The AUC, sensitivity, and specificity of 3D DGS were 0.902 (0.818-0.985), 0.900 (0.714-1.000), and 0.890 (0.841-0.938), respectively, on the external testing set at quadrant level following normal clinical practice; and 0.885 (0.836-0.933), 0.912 (0.816-1.000), and 0.700 (0.660-0.741), respectively, on the external testing set at clock-hour level.The 3D DGS is effective in detecting eyes with suspected PACG. It has the potential to be used widely in the primary eye care community for screening of subjects at high risk of developing PACG.

Angle closure glaucoma tends to have a higher magnitude and greater fluctuation of intraocular pressure (IOP), and thus leading to more blindness. Primary angle closure glaucoma (PACG) has higher IOP than other subtypes of angle closure and the normal subjects. The presence of PAS usually correlates with high IOP. The characteristic of diurnal IOP varies among the different subtypes of angle closure disease, greatest in PACG and smallest in primary angle closure suspect. However, the diurnal IOP fluctuation does not always characterize well in the different subtypes of angle closure disease. Cataract surgery, glaucoma laser procedure, and trabeculectomy in angle closure eyes potentially offer an advantage in flattening diurnal IOP curve. Some literatures suggest that greater 24-h diurnal IOP is associated with disease progression in this glaucoma entity, however, the available data are still limited and controversial. Nevertheless, diurnal IOP is worth exploring in PACG individuals who show glaucoma progression despite a favorable clinic visit IOP.

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.

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.