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A 40-year- old male factory worker presented to our eye clinic with left eye pain, redness and blurring of vision, associated with history of an injury sustained while hammering a nail into the wall three days ago. He had mild symptoms at the onset of the injury. Slit lamp examination of left eye showed a small, self-sealed laceration corneal wound at the temporal limbus and a smooth, well defined, oval mass on the iris in the anterior chamber in the lower temporal quadrant. Rest of the anterior segment and fundus were normal. X-ray orbits showed no intraocular foreign body in the left eye. In view of clinical suspicion, we proceeded with a CT scan of orbits which showed the presence of a small metallic foreign body in the anterior chamber of left eye. After giving topical antibiotic, cycloplegic, and corticosteroid eye drops along with systemic antibiotics for three days, we planned surgical removal of the mass in the anterior chamber. After the mass was removed, we noted a small metallic foreign body embedded within the fibrin mass. The same treatment was continued postoperatively. The left eye became white and quiet, and vision improved to 6/6 with above treatment. The key learning point presented is that when the history is suggestive of intraocular foreign body, even though the X-ray orbits does not show the foreign body one has to get CT scan of orbits done to rule out its presence, especially when there is inflammatory mass in the anterior chamber as seen in our case.

A 37-year-old man presented with a 1-week history of diplopia. He was under investigation by otorhinolaryngology for left sinonasal malignancy after imaging of the paranasal sinuses had revealed a large homogenous mass in the left nasal cavity. His visual acuity was 6/9 in each eye with no relative afferent pupillary defect. The left pupil, though was mid-dilated and unresponsive to light. He had a left-sided ptosis. Extraocular movements of the left eye were restricted in all directions of gaze and there was with limited abduction, dextroelevation and dextrodepression of the right eye. A trans-nasal biopsy revealed extranodal natural killer/T-cell lymphoma. Further imaging showed a large enhancing nasopharyngeal mass with intracranial extension to the cavernous sinuses and local infiltration together with intracranial abscesses. The patient was started on empirical intravenous antibiotics and supportive treatment. While awaiting institution of lymphoma chemotherapy, he died. The involvement of the cavernous sinus in sinonasal lymphoma represents an advanced stage. This case highlights that lymphoma should be considered in any patient presenting with a cavernous sinus syndrome and sinonasal disease.

Purpose: To determine the diagnostic accuracy of mean macular retinal thickness (mRT) and macular ganglion cell layer (mGCL) thickness measured by Spectralis spectral-domain optical coherence tomography (SD-OCT) posterior pole thickness map (PPTM) in differentiating between normal and glaucoma eyes of different severity.Study design: Cross-sectional study.Methods: All subjects were divided into normal and glaucoma groups according to the visual fields-based Glaucoma Staging System. They underwent slit-lamp examination, Humphrey visual field test, and SD-OCT (PPTM) imaging. mRT and mGCL thickness measurements were recorded. Analysis of variance with the least significant difference post hoc test was used for pairwise comparison. Ability to discriminate between normal eyes and those with differing severity of glaucoma was assessed using the area under the receiver operating characteristic curve (AUROC).Results: A total of 201 eyes from 201 subjects were enrolled in this study. The mean glaucoma was 290.2 ± 12.1 μm, 270.1 ± 17.0 μm, and 259.1 ± 15.0 μm, respectively. Mean mGCL thickness for the corresponding three groups was 32.3 ± 2.8 μm, 27.6 ± 3.3 μm and 22.2 ± 3.8μm, respectively. AUROC analysis showed excellent diagnostic discrimination between glaucoma and normal subjects for mRT (AUC: 0.90) and mGCL thickness (AUC: 0.92). The cut-off value of mRT was 274.9 μm (90% sensitivity, 75% specificity) and of mGCL thickness was 27.9 μm (93% sensitivity, 74% specificity). The discrimination ability performance of mRT and mGCL thickness deteriorated with increasing severity of glaucoma with mGCL thickness (AUC: 0.67–0.87) performing slightly better than mRT for all grades (AUC: 0.58–0.71).Conclusions: mRT and mGCL thickness measurement on PPTM showed great sensitivity and specificity to discern between normal and glaucomatous subjects. The discrimination ability of mRT and mGCL thickness, however, decreases with increasing grade of glaucoma. We believe SD-OCT PPTM offers an alternative imaging method to detect early glaucoma.

Background: Isolated metastasis to the optic nerve (ON) and its sheath from breast cancer (BC) without involvement of other ocular structures is extremely rare. However, it is a pivotal diagnosis to rule out as it is a both sight- and life-threatening condition. We report a case of isolated ON sheath metastasis from BC presenting with central retinal vein occlusion (CRVO). Case presentation: A 47-year-old woman with known metastatic BC presented with painless, progressive vision loss in the left eye. Visual acuity was hand movement with ipsilateral relative afferent pupillary defect. Fundal features suggested CRVO. Atypical rapid resolution of these features led to suspect ON metastasis. Magnetic resonance of the brain showed perineural enhancement of the optic nerves. Vision improved with radiotherapy. Conclusion: Isolated ON sheath metastasis from BC is rare and may present with CRVO. High degree of suspicion is warranted in patients with metastatic disease and atypical findings.

Horner syndrome (HS) classically presents with ipsilateral blepharoptosis, pupillary miosis, and facial anhidrosis and caused by a lesion along the oculosympathetic pathway from the hypothalamus to eye. The diagnosis of HS in a patient presenting with partial ptosis may be easily missed in the Asian patient. This is mainly due to the dark irides, making detection of anisocoria on direct visualization difficult. Index of suspicion must be high, especially in the absence of any extraocular motility or lid abnormalities. We present a case where a healthy asymptomatic patient presented with partial ptosis and diagnosis of HS was eventually confirmed through pharmacological tests. Non-targeted imaging with a simple chest X-ray revealed an apical lung lesion which eventually turned out to be malignant. Although it is a typical textbook description, this case highlights the importance of careful history and examination in an otherwise healthy patient presenting with mild ptosis.

Herpes zoster ophthalmicus usually manifests in elderly people as a unilateral painful skin rash in a dermatomal distribution of the ophthalmic division of the trigeminal nerve shared by the eye and ocular adnexa. It is the reactivation of varicella-zoster infection. Most common ocular manifestations of this disease include keratitis, conjunctivitis, and anterior uveitis. Severe hyphemia as a complication following herpes zoster uveitis is uncommon. We report a rare case of a 90-year-old lady with herpes zoster ophthalmicus and diabetes mellitus with unusually severe hyphemia. The disease responded well to systemic and topical steroids with improved vision outcome. Early referral to an ophthalmologist, detailed evaluation, and immediate treatment are mandatory to prevent permanent vision loss in these patients.

To determine the association between visual acuity and contrast sensitivity with frailty measures Older adults with poor contrast sensitivity are significantly more likely to be frail (OR: 5.34, p = 0.004). No association was identified between visual acuity and frailty (p = 0.241). Poor contrast sensitivity is significantly associated with frailty. Using data from the Malaysian Elders Longitudinal Research (MELoR), this study investigated the association between visual function (visual acuity and contrast sensitivity) and frailty in a group of urban-dwelling older adults. This was a cross-sectional study. 1332 participants aged ≥ 55 years were selected by random sampling from the parliamentary electoral register. Only 1274 participants completed the frailty assessment and 1278 participants completed the contrast sensitivity assessment. Impaired vision was defined as a Snellen visual acuity of worse than 6/12 in the better eye. Poor contrast sensitivity was defined as a score on the Pelli Robson chart of lower than 1.65. Frailty was defined with the Fried’s phenotype criteria. Inter-group comparisons were determined with the independent T-test for continuous variables and the Pearson’s Chi-squared test for categorical variables. The odds ratio (OR) with 95% confidence interval (CI) was used to evaluate the cross-sectional association between frailty and visual function. The mean age of participants was 68.8 ± 7.5 years, of which 58.1% (774) were women. Impaired vision and poor contrast sensitivity were present in 187 (14%) and 271 (21.2%) subjects respectively. 73 (5.8%) individuals were classified as frail, 1161 (91.0.%) pre-frail, and 40 (2.8%) non-frail. There was no significant difference in frailty phenotypes between those with good and impaired vision (p = 0.241). Fried’s component of handgrip strength, gait speed and exhaustion were significantly better in those with good visual function (p

Background Exercise may potentially provide an adjunctive measure to help control intraocular pressure in glaucoma patients. However, currently, there is still no substantial evidence that regular exercise can produce a prolonged effect of intraocular pressure reduction. We aim to determine the effects of regular exercise on intraocular pressure in healthy individuals. Methods We conducted a prospective, interventional study at the University of Malaya Medical Centre. Our subjects consist of 45 healthy participants in the intervention arm, and 38 healthy control participants who were age- and gender-matched. The intervention arm was enrolled into a supervised exercise programme for a 6-week period, where controls were asked to continue their usual daily lifestyle. The intervention consists of three sessions every week, which focused on aerobic exercise and strength training. Results Baseline intraocular pressure was measured, and then remeasured again at the end of 6 weeks of exercise conditioning. In the intervention group, there was a reduction of baseline intraocular pressure from pre-intervention mean intraocular pressure of 15.55 ± 2.63 mmHg, down to 13.36 ± 3.16 mmHg at 6 weeks, a statistically significant reduction of −2.18 ± 2.25 mmHg ( p Conclusions Our study concluded that regular exercise results in a significant intraocular pressure reduction in healthy individuals.

Introduction: Phacoemulsification surgery is known to alter anterior segment structure parameters and also intraocular pressure (IOP). We set out in this study to investigate the relationship between the two parameters by using anterior segment optical coherence tomography (AS-OCT). Purpose: To evaluate anterior segment and lens parameters associated with IOP lowering after phacoemulsification. Study design: Prospective longitudinal single centre study. Materials and methods: All consented study participants underwent uneventful phacoemulsification with foldable intraocular lens implantation. IOP measurement, gonioscopy, and AS-OCT measurements were performed pre- and postoperatively at one month. Customised software (Zhongshan Angle Assesment Programme, ZAAP) was used to measure various anterior chamber parameters. A-scan biometry was used to measure axial length (AL), lens thickness (LT), and to calculate lens position (LP) and relative lens position (RLP). Results: Eighty-six eyes from 86 patients were included in this study. The mean IOP reduced significantly after phacoemulsification (from 16.2 ± 2.4 mmHg to 14.1 ± 2.6 mmHg at one week and 14.4 ± 2.3 mmHg at one month, P < 0.001). In the multivariate regression model, preoperative IOP and AL were the only significant parameters associated with percentage change in IOP (p < 0.001). Conclusion: Change in IOP post-phacoemulsification is dependent on preoperative IOP and AL. Greater percentage change in IOP is seen in eyes with shorter axial length.

The fiscal decentralization policy has made local governments have the authority to generate income and manage regional finance independently for public services and public welfare. This study aims to: 1) Analyze the degree of fiscal decentralization in Jambi Province; 2) Analyzing community welfare proxied from the human development index in Jambi Province; 3) Analyzing the impact of fiscal decentralization on the welfare of the community in Jambi Province. This study using panel data, a combination of time series data in 2010-2016 and cross section 11 districts/cities in Jambi Province. The method of data analysis is descriptive analysis and panel data regression analysis approach, namely the fixed effect model (FEM). Hypothesis testing uses the F test statistic and the statistical t test. The results showed that: 1) The degree of fiscal decentralization, namely the ratio of district own source revenue (PAD) to total regional income (TPD) in each district/city in Jambi Province was relatively relatively low, whereas for Jambi Province it was in good category; 2) Community welfare as illustrated by the human development index in each district/city including Jambi Province is still in the moderate category, except Jambi City (76.14) and Sungai Penuh City (73.35) are categorized as high; 3) Fiscal decentralization has a positive and significant impact on improving community welfare. it means that the better the implementation of fiscal decentralization, the higher the level of community welfare.

We present a case of a 77-year-old woman who sustained blunt ocular trauma leading to a scleral rupture, superonasal subconjunctival crystalline lens dislocation, iris loss, and hyphema. Computed tomography aided in the diagnosis of traumatic phacocele. Surgical exploration revealed an 11.0 mm anterior scleral rupture that was then repaired. Secondary implantation of the uniquely designed tripodal anterior chamber intraocular lens (AC IOL) was the choice because of the presence of extensive iris loss, scleral rupture, cornea edema, and hyphema at the primary setting. This case demonstrates successful restoration of globe integrity and a good visual outcome from an appropriate AC IOL selection and timing of IOL implantation.

Precis This 5-year follow-up study on normal-tension glaucoma (NTG) patients demonstrated that those with baseline central visual field (VF) defect progress at a more increased rate compared with those with peripheral field defect. Purpose The purpose of this study was to investigate the clinical characteristics, including 24-hour ocular perfusion pressure and risk of progression in patients with baseline central VF defect, as compared with those with peripheral VF defect in NTG. Design This was a prospective, longitudinal study. Methods A total of 65 NTG patients who completed 5 years of follow-up were included in this study. All the enrolled patients underwent baseline 24-hour intraocular pressure and blood pressure monitoring via 2-hourly measurements in their habitual position and had ≥5 reliable VF tests during the 5-year follow-up. Patients were assigned to two groups on the basis of VF defect locations at baseline, the central 10 degrees, and the peripheral 10- to 24-degree area. Modified Anderson criteria were used to assess global VF progression over 5 years. Kaplan-Meier analyses were used to compare the elapsed time of confirmed VF progression in the two groups. Hazard ratios for the association between clinical risk factors and VF progression were obtained by using Cox proportional hazards models. Results There were no significant differences between the patients with baseline central and peripheral VF defects in terms of demography, clinical, ocular and systemic hemodynamic factors. Eyes with baseline defects involving the central fields progressed faster (difference: βcentral=-0.78 dB/y, 95% confidence interval=-0.22 to -1.33, P=0.007) and have 3.56 times higher hazard of progressing (95% confidence interval=1.17-10.82, P=0.025) than those with only peripheral defects. Conclusion NTG patients with baseline central VF involvement are at increased risk of progression compared with those with peripheral VF defect.

Kaposi sarcoma (KS) is an angioproliferative disease that can vary from low-grade to aggressive and lethal multicentric vascular lesions, which can involve various locations, commonly mucocutaneous, lymph nodes, and visceral organs. It can also involve unusual sites such as the eye, central or peripheral nervous system, larynx, and many other anatomical sites. We describe three cases of ocular KS, which resolved completely following different treatment modalities. All three cases were known HIV-positive individuals with low CD4 cell counts. Case 1 received pegylated doxorubicin, case 2 received local radiotherapy, and case 3 received only highly active antiretroviral therapy (HAART). All three cases responded well to their respective therapy. Ocular KS is generally responsive to treatment. Initiation of HAART can achieve a remarkable response. In large or resistant cases, other treatment modalities can be considered to achieve resolution of lesions.

Background: Acute ophthalmoparesis without ataxia was designated as ‘atypical Miller Fisher syndrome’ as it presents with progressive, relatively symmetrical ophthalmoplegia, but without ataxia nor limb weakness, in the presence of anti-GQ1b antibody. Idiopathic intracranial hypertension is characterized by signs of raised intracranial pressure occurring in the absence of cerebral pathology, with normal composition of cerebrospinal fluid and a raised opening pressure of more than 20 cmH2O during lumbar puncture. We aim to report a rare case of acute ophthalmoplegia with co-occurrence of raised intracranial pressure. Case Description: A 28-year-old gentleman with body mass index of 34.3 was referred to us for management of double vision of 2 weeks duration. His symptom started after a brief episode of upper respiratory tract infection. His best corrected visual acuity was 6/6 OU. He had bilateral sixth nerve palsy worse on the left eye and bilateral hypometric saccade. His deep tendon reflexes were found to be hyporeflexic in all four limbs. No sensory or motor power deficit was detected, and his gait was normal. Plantar reflexes were downwards bilaterally and cerebellar examination was normal. Both optic discs developed hyperaemia and swelling. Magnetic resonance imaging of brain was normal and lumbar puncture revealed an opening pressure of 50 cmH2O. Anti-GQ1b IgG and anti-GT1a IgG antibody were tested positive. Conclusion: Acute ophthalmoparesis without ataxia can present with co-occurrence of raised intracranial pressure. It is important to have a full fundoscopic assessment to look for papilloedema in patients presenting with Miller Fisher syndrome or acute ophthalmoparesis without ataxia.

OBJECTIVE: To assess the relationship between baseline intraocular pressure (IOP), blood pressure (BP) and ocular perfusion pressure (OPP), and the 5-year visual field progression in normal-tension glaucoma (NTG) patients. DESIGN: Prospective, longitudinal study. METHODS: Sixty-five NTG patients who were followed up for 5 years are included in this study. All the enrolled patients underwent baseline 24-h IOP and BP monitoring via 2-hourly measurements in their habitual position and were followed up for over 5 years with reliable VF tests. Modified Anderson criteria were used to assess VF progression. Univariable and multivariable analyses using Cox’s proportional hazards model were used to identify the systemic and clinical risk factors that predict progression. Kaplan–Meier survival analyses were used to compare the time elapsed to confirmed VF progression in the presence or absence of each potential risk factor. RESULTS: At 5-year follow-up, 35.4% of the enrolled patients demonstrated visual field progression. There were statistically significant differences in the mean diastolic blood pressure (p 43.7 mmHg (log rank = 0.018). CONCLUSION: Diastolic parameters of BP and OPP were significantly lower in the NTG patients who progressed after 5 years. Low nocturnal DOPP is an independent predictor of glaucomatous visual field progression in NTG patients.

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

Purpose. To evaluate the prevalence of ocular surface disease (OSD) in glaucoma and nonglaucoma subjects using different clinical tests and to determine the effect of number of antiglaucoma medications and preservatives on OSD. Methods. This is a cross-sectional, case-comparison study at the Eye Clinic of the University of Malaya Medical Centre, Malaysia, between June 2012 and January 2013. Glaucoma subjects (n = 105) using topical antiglaucoma medications were compared with control subjects (n = 102) who were not on any topical medications. The presence of OSD was assessed using the tear film breakup time (TBUT) test, corneal staining, Schirmer test, and Ocular Surface Disease Index (OSDI) questionnaire grading. Results. The prevalence of OSD varied from 37 to 91% in the glaucoma group, depending on the type of clinical test. More subjects in the glaucoma group had corneal staining (63% vs. 36%, p = 0.004), abnormal Schirmer tests (39% vs. 25%, p = 0.049), and moderate OSDI symptoms (17% vs. 7%, p = 0.028). The percentage with abnormal TBUT increased with higher numbers of topical medications and was high with both benzalkonium chlorideYcontaining and preservative-free eye drops (90% and 94%, respectively, both p G 0.001). Benzalkonium chloride was associated with a nearly three times higher odds ratio of showing abnormal OSDI. Conclusions. Ocular surface disease is common in those using topical antiglaucoma medications. Abnormal TBUT is associated with increasing number of eye drops and benzalkonium chlorideYcontaining eye drops, although this also occurs with the use of preservative-free eye drops. (Optom Vis Sci 2015;92:00Y00)

Purpose. To evaluate ocular biometric parameters and darkroom prone provocative test (DPPT) in family members of primary angle closure (PAC) glaucoma (PACG) patients and to establish any correlation between these biometric parameters and the DPPT response. Methods. Seventy-four family members of PACG patients underwent ultrasound ocular biometry, slit lamp biomicroscopy, Goldmann applanation tonometry, fundus examination, and gonioscopy. Lastly, DPPT was performed. Results. Of 74 family members examined, 6 (8.1%) were found to have PAC, 8 (10.8%) were PAC suspects, and 60 (81.1%) were unaffected. Of those affected, 4 (66.7%) had a positive DPPT response, whereas 87.5% of the PAC suspects had a positive or a borderline DPPT response. Affected and PAC suspects had the shallowest anterior chamber depth, thickest lens, shortest axial length, and most anteriorly positioned lens. Anterior chamber depth and lens thickness showed a significant correlation with positive DPPT. Conclusions. Anterior chamber depth and lens thickness and, to a lesser extent, axial length and lens position were significantly correlated with a positive DPPT response. The ocular biometric risk factors associated with PACG patients are also found in their respective family members who are affected and suspected of having PAC. We suggest a longitudinal study to determine the reliability of DPPT in identifying individuals who are at risk of PAC. (Optom Vis Sci 2014;91:459Y463)

To measure optic nerve (ON) volume using 3 T magnetic resonance imaging (MRI), to correlate ON volume with retinal nerve fiber layer (RNFL) thickness, and to determine the viability of MRI as an objective tool in distinguishing glaucoma severity.In this cross-sectional study, 30 severe glaucoma patients, 30 mild glaucoma patients and 30 age-matched controls were recruited. All subjects underwent standard automated perimetry, RNFL analysis and 3 T MRI examinations. Glaucoma patients were classified according to the Hodapp-Anderson-Parish classification. Pearson's correlation coefficient was used to correlate ON volume with RNFL, and receiver operating curve (ROC) analysis was performed to determine the sensitivity and specificity of ON volume in detecting glaucoma severity.Optic nerve volume was significantly lower in both the left and right eyes of the severe glaucoma group (168.70 ± 46.28 mm(3); 167.40 ± 45.36 mm(3)) than in the mild glaucoma group (264.03 ± 78.53 mm(3); 264.76 ± 78.88 mm(3)) and the control group (297.80 ± 71.45 mm(3); 296.56 ± 71.02 mm(3)). Moderate correlation was observed between: RNFL thickness and ON volume (r = 0.51, p0.001), and in mean deviation of visual field and optic nerve volume (r = 0.60, p 0.001). ON volume below 236 mm(3) was 96 % sensitive and 80 % specific for the detection of severe glaucoma.MRI measured optic nerve volume is a reliable method of assessing glaucomatous damage beyond the optic nerve head. A value of 236 mm(3) and below can be used to define severe glaucoma.

The objective of this study is to evaluate the relationship between reproductive exposures and age-related cataract among women. This was a hospital based case-control study. The study population included female patients, aged 50 years and above who attended the Eye clinic at the University of Malaya Medical Centre. The outcome measurement was based on ophthalmologic examination by an ophthalmologist. The data on exposure was obtained from face to face interview using a structured questionnaire. In order to reduce the recall bias, patients' medical records were used to substantiate the exposure status. Multiple logistic regression was used to assess the association of age-related cataract with exogenous estrogen usage (HRT and OCP) and duration of menses. Important confounders such as age, history of diabetes, cigarette smoking and steroids usage were controlled for in the analysis. Females with 29 years or less of endogenous estrogen exposure of, have almost three times the risk of developing age related cataract (adjusted OR 3.42: 95% CI: 1.28,9.16), similarly among those with exposure of 30- 32 years (adjusted OR 3.64: 95% CI: 1.08,12.26). Hormone Replacement Therapy used for more than three years was found to be a protective factor of age-related cataract. There is evidence that reproductive exposure may play a role in reducing the occurrence of age-related cataract among Malaysian women. Asia Pac J Public Health 2007; 19(2): 23-28.

Purpose: To quantify the progression of visual field loss in participants with open angle glaucoma. Methods: Cluster random samples of 3271 participants participated in this study. Each participant underwent a standardized ophthalmic examination, which included intraocular pressure measurement, Humphrey 24-2 Fastpac visual field testing and stereophotography of the optic disc. At baseline 118 participants were identified as possible, probable or definite open angle glaucoma and 74 (62.7%) of these were seen again at the follow-up examination. Progression of visual field loss was defined using three methods: the Advanced Glaucoma Intervention Study criteria, the modified Anderson criteria and the Blumenthal method. Results: In total, 49% of subjects showed progressive visual field loss with at least one method. The Blumenthal criteria yielded the highest rate of progression (37%), followed by the modified Anderson method (33%) and the Advanced Glaucoma Intervention Study method (16%). The progressive visual field loss was associated with baseline glaucoma status (P = 0.02); 65% of the definite glaucoma progressed, compared with 57% of the probable glaucoma and 25% of the possible glaucoma. Participants who had been previously diagnosed with glaucoma had a higher rate of progression (54%) when compared with those who had not been diagnosed previously (47%). In total, 50% (four of eight) of those receiving glaucoma medication at baseline had progressive visual field loss; all were in the definite glaucoma category. Conclusion: Despite use of glaucoma medications the majority of glaucoma patients managed by their regular ophthalmologist experienced progressive visual field loss over a 5-year period.