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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

Orathai Pitukcheewanont,1 Visanee Tantisevi,1 Sunee Chansangpetch,2 Prin Rojanapongpun1 1Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 2Department of Ophthalmology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand Background: The aim of the study was to evaluate factors related to hypertensive phase (HP) after glaucoma drainage device (GDD) implantation.Patients and methods: Retrospective charts review of glaucoma patients who underwent GDD implantation and completed 12 months of follow-up at King Chulalongkorn Memorial Hospital since 2004 was performed. Patients were divided into two groups according to the presence or absence of HP. The data were analyzed for factors associated with HP. The surgical outcomes including surgical failure, post-operative visual acuity (VA), post-operative number of medications, post-operative intraocular pressure (IOP), and post-operative complication were compared between the two groups.Results: Seventy-two patients were included. Most were diagnosed with secondary glaucoma (N=51, 70.8%), and Baerveldt was the most implanted GDD (N=49, 68.1%). Mean ± SD of IOP was significantly lower: 27.1±9.6 mmHg at pre-operation and 13.7±59 mmHg at 12-month follow-up (p

Aim: To determine prevalence, demography, mechanism, and visual morbidity of glaucoma in urban Thai people. Methods: 790 subjects aged 50 years or older from Rom Klao district, Bangkok, Thailand, were [...]

OBJECTIVE: The objective of this study was to directly compare the intraocular pressure (IOP)-lowering efficacy and safety of travoprost 0.004% eyedrops with the fixed combination of latanoprost 0.005%/timolol 0.5% eyedrops in patients with primary open-angle glaucoma or ocular hypertension. METHODS: This was a randomized, double-masked, multicenter, parallel-group, active-controlled study. Adult subjects with open-angle glaucoma (with or without pseudoexfoliation or pigment dispersion component) or ocular hypertension were eligible to participate if their IOP was inadequately controlled with > or =4 weeks of beta-blocker monotherapy, as indicated by IOP of 22 to 36 mm Hg at 9 AM at screening. Patients were randomly assigned in a 1:1 ratio to receive placebo + travoprost or latanoprost/timolol + placebo. Patients in the travoprost group administered travoprost at 9 PM and placebo at 9 AM; patients in the latanoprost/timolol group administered latanoprost/timolol at 9 AM and placebo at 9 PM. IOP measurements were performed using Goldmann applanation tonometry at 9 AM and 5 PM at the week-2 and week-6 visits. Both volunteered and elicited reports of adverse events were collected; all patients who were randomized and received > or =1 dose of study drug were included in the safety analysis. RESULTS: One hundred ten patients were randomized, of whom 106 patients were evaluable (travoprost, n = 50; latanoprost/timolol, n = 56). There were no statistically significant differences at baseline between the treatment groups, based on age group, sex, race, iris color, or diagnosis. Mean IOP values were not statistically different between groups at baseline or during treatment. In the pooled results for 9 Am assessment at weeks 2 and 6, mean (SEM) IOP reductions for travoprost and latanoprost/timolol were 7.0 (0.5) and 6.4 (0.5) mm Hg, respectively (P = NS). Adverse events related to therapy were mild in nature, and there were no statistically significant differences between the 2 treatment groups. The most frequently experienced adverse events in the travoprost group were ocular hyperemia (9.3%), foreign body sensation (5.6%), abnormal vision (1.9%), allergic reaction (1.9%), conjunctivitis (1.9%), dacryocystitis (1.9%), eye discharge (1.9%), eye pruritus (1.9%), lid edema (1.9%), lid erythema (1.9%), and tearing (1.9%). In the latanoprost/timolol group, the most frequently experienced adverse events were cataract (1.8%), dry eyes (1.8%), eye pruritus (1.8%), foreign body sensation (1.8%), and ocular hyperemia (1.8%). CONCLUSIONS: Mean IOP changes from baseline for travoprost 0.004% and latanoprost 0.005%/timolol 0.5% fixed combination were not significantly different at follow-up in these patients. Both medications were well tolerated. [ABSTRACT FROM AUTHOR]

Early detection of glaucoma, a widespread visual disease, can prevent vision loss. Unfortunately, ophthalmologists are scarce and clinical diagnosis requires much time and cost. Therefore, we developed a screening Tri-Labeling deep convolutional neural network (3-LbNets) to identify no glaucoma, glaucoma suspect, and glaucoma cases in global fundus images. 3-LbNets extracts important features from 3 different labeling modals and puts them into an artificial neural network (ANN) to find the final result. The method was effective, with an AUC of 98.66% for no glaucoma, 97.54% for glaucoma suspect, and 97.19% for glaucoma when analysing 206 fundus images evaluated with unanimous agreement from 3 well-trained ophthalmologists (3/3). When analysing 178 difficult to interpret fundus images (with majority agreement (2/3)), this method had an AUC of 80.80% for no glaucoma, 69.52% for glaucoma suspect, and 82.74% for glaucoma cases.Clinical relevance-This establishes a robust global fundus image screening network based on the ensemble method that can optimize glaucoma screening to alleviate the toll on those with glaucoma and prevent glaucoma suspects from developing the disease.

Glaucoma is the second most common cause of blindness. A glaucoma suspect has risk factors that increase the possibility of developing glaucoma. Evaluating a patient with suspected glaucoma is challenging. The "donut method" was developed in this study as an augmentation technique for obtaining high-quality fundus images for training ConvNeXt-Small model. Fundus images from GlauCUTU-DATA, labelled by randomizing at least 3 well-trained ophthalmologists (4 well-trained ophthalmologists in case of no majority agreement) with a unanimous agreement (3/3) and majority agreement (2/3), were used in the experiment. The experimental results from the proposed method showed the training model with the "donut method" increased the sensitivity of glaucoma suspects from 52.94% to 70.59% for the 3/3 data and increased the sensitivity of glaucoma suspects from 37.78% to 42.22% for the 2/3 data. This method enhanced the efficacy of classifying glaucoma suspects in both equalizing sensitivity and specificity sufficiently. Furthermore, three well-trained ophthalmologists agreed that the GradCAM++ heatmaps obtained from the training model using the proposed method highlighted the clinical criteria.Clinical relevance- The donut method for augmentation fundus images focuses on the optic nerve head region for enhancing efficacy of glaucoma suspect screening, and uses Grad-CAM++ to highlight the clinical criteria.

Background: This study aimed to assess the pain experienced during micropulse transscleral laser therapy (MPTLT) and overnight thereafter and explore the factors associated with the pain., Methods: This prospective study included 100 eyes of 81 glaucoma patients undergoing MPTLT under retrobulbar anesthesia. All patients were asked to rate both types of pain using a numerical rating scale (NRS). The risk factors were explored using multivariable mixed-effects ordinal logistic regression., Results: The mean (SD) NRS pain score during the procedure was 3.57 (3.41) (range 0-10), which included no, mild, moderate, and severe pain in 30 (30%), 33 (33%), 17 (17%), and 20 (20%) eyes, respectively. The mean (SD) NRS score of overnight pain was 2.99 (2.28) (range 0-9), which included no, mild, moderate, and severe pain in 17 (17%), 59 (59%), 17 (17%), and 7 (7%) eyes, respectively. Twenty-seven (27%) eyes reported worse pain overnight than during the procedure. Increased age, initial intraocular pressure, and pain during the procedure were significantly associated with increased overnight pain ( p < 0.05)., Conclusions: Up to a fourth of eyes had worse pain after discharge. Older age, initial intraocular pressure, and pain during the procedure were risk factors for higher levels of overnight pain.

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., (Copyright © 2021 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

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, p<0.05]. 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.

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<0.001). Moreover, most patients had an unfavourable visual acuity (49.5%) at their latest visit. 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., Competing Interests: No competing interests were disclosed., (Copyright: © 2022 Surukrattanaskul S et al.)

Purpose: The effect of statins on wound healing is controversial, and their effect on trabeculectomy outcomes remains unclear. This study aimed to examine the relationship between oral statin use and trabeculectomy outcomes., Methods: Medical records of patients who underwent primary mitomycin-C augmented trabeculectomy with 2 years of follow-up were reviewed. Pre- and postoperative intraocular pressures (IOP) and numbers of medications, subconjunctival 5-fluorouracil (5-FU) injections, and bleb-needling procedures were compared between statin users and nonusers. Failure was defined as an eye that failed to achieve a 20% lowering of IOP from baseline or had an IOP > 21 mm Hg, as well as an eye that required further surgical intervention, developed hypotony, or had no light perception visual acuity., Results: In total, 158 subjects were enrolled, with 47 eyes from statin users and 111 eyes from statin nonusers. The 24-month cumulative probability of failure was 78.7% for statin users and 60.4% for nonusers (P = .013). Cox proportional-hazards modeling showed a significantly higher hazard risk in statin users (adjusted hazard ratio 1.61, P = .026). There were no significant between-group differences in mean IOPs or number of medications (both P > .05) at 24 months. Multivariable Poisson regression analysis that statin use was associated with increased numbers of 5-FU injections (P = .014) and bleb-needling procedures (P = .031)., Conclusions: This study demonstrated that oral statin use was associated with higher rates of trabeculectomy failure and increased numbers of 5-FU injections and bleb-needling procedures., Competing Interests: The authors have declared that no competing interests exist.

Purpose: To compare corneal deformation characteristics using ultra-high-speed Scheimpflug camera (Corvis ST) in patients with nonmyopic (NM), mild-to-moderate nonaxial myopic (MM), and high axial myopic (HM) eyes., Methods: In this cross-sectional study, normal subjects aged >40 years with no history of ocular laser/surgery were classified according to axial length (AL) and spherical equivalence (SE) into three groups: (1) NM (SE > -0.50 D and AL < 26 mm), (2) MM (SE -6.00 D to -0.50 D and AL < 26 mm), and (3) HM (SE ≤ -6.00 D and AL ≥ 26 mm). Seven parameters including corneal deformation amplitude (CDA), inward/outward corneal applanation length, inward/outward corneal velocity (ICV and OCV), peak distance, and radius were measured. Pearson correlation and linear mixed-effects model were done., Results: A total of 180 eyes were recruited. 98 eyes were NM, 30 eyes were MM, and 52 eyes were HM. There were significant correlations of OCV to the degree of refractive error ( r  = 0.203, p < 0.001) and AL ( r  = -0.242, p < 0.001). After adjusting for age, sex, intraocular pressure, and corneal thickness, there was significantly higher CDA ( β  = 0.07, p < 0.001), faster OCV ( β  = -0.08, p < 0.001), and smaller radius ( β  = -0.39, p =0.01) in the HM group compared to the NM group., Conclusion: The higher CDA, faster OCV, and smaller radius found in the HM may suggest that these eyes have reduced ocular stiffness and may be less stable and more prone to stress., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Aratchaporn Tubtimthong et al.)

Glaucoma is the second leading cause of blindness worldwide. This paper proposes an automated glaucoma screening method using retinal fundus images via the ensemble technique to fuse the results of different classification networks and the result of each classification network was fed as an input to a simple artificial neural network (ANN) to obtain the final result. Three public datasets, i.e., ORIGA-650, RIM-ONE R3, and DRISHTI-GS were used for training and evaluating the performance of the proposed network. The experimental results showed that the proposed network outperformed other state-of-art glaucoma screening algorithms with AUC of 0.94. Our proposed algorithms showed promising potential as a medical support system for glaucoma screening especially in low resource countries.

Purpose: To summarize the role of anterior segment imaging (AS-imaging) in angle closure diagnosis and management, and the possible advantages over the current standard of gonioscopy., Design: Literature review and perspective., Methods: Review of the pertinent publications with interpretation and perspective in relation to the use of AS-imaging in angle closure assessment focusing on anterior segment optical coherence tomography and ultrasound biomicroscopy., Results: Several limitations have been encountered with the reference standard of gonioscopy for angle assessment. AS-imaging has been shown to have performance in angle closure detection compared to gonioscopy. Also, imaging has greater reproducibility and serves as better documentation for long-term follow-up than conventional gonioscopy. The qualitative and quantitative information obtained from AS-imaging enables better understanding of the underlying mechanisms of angle closure and provides useful parameters for risk assessment and possible prediction of the response to laser and surgical intervention. The latest technologies-including 3-dimensional imaging-have allowed for the assessment of the angle that simulates the gonioscopic view. These advantages suggest that AS-imaging has a potential to be a reference standard for the diagnosis and monitoring of angle closure disease in the future., Conclusions: Although gonioscopy remains the primary method of angle assessment, AS-imaging has an increasing role in angle closure screening and management. The test should be integrated into clinical practice as an adjunctive tool for angle assessment. It is arguable that AS-imaging should be considered first-line screening for patients at risk for angle closure., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: We evaluated the impact of myopia on corneal biomechanical properties in primary open-angle glaucoma (POAG) and nonglaucoma patients, and the effect of modification of glaucoma on myopic eyes., Methods: This cross-sectional study included 66 POAG eyes (33 myopia, 33 nonmyopia) and 66 normal eyes (33 myopia, 33 nonmyopia). Seven corneal biomechanical parameters were measured by ultra-high-speed Scheimpflug imaging, including corneal deformation amplitude (CDA), inward/outward corneal applanation length (ICA, OCA), inward/outward corneal velocity (ICV, OCV), radius, and peak distance (PD)., Results: Mean age (SD) of the 65 male (49%) and 67 female (51%) patients was 59 (9.82) years. Myopia was associated with significantly higher CDA (adjusted effect = 0.104, P = 0.001) and lower OCV (adjusted effect = -0.105, P < 0.001) in the POAG group. Within the nonglaucoma group, myopic eyes had a significantly lower OCV (adjusted effect = -0.086, P < 0.001) and higher CDA (adjusted effect = 0.079, P = 0.001). All parameters except PD suggested that glaucoma modified the effect of myopia on corneal biomechanics. Percentage differences in the adjusted myopic effect between POAG and nonglaucoma patients was 31.65, 27.27, 31.65, 50.00, 22.09, and 60.49 for CDA, ICA, OCA, ICV, OCV, and radius, respectively., Conclusions: Myopia had a significant impact on corneal biomechanical properties in the POAG and nonglaucoma groups. The differences in corneal biomechanical parameters suggest that myopia is correlated with significantly lower ocular rigidity. POAG may enhance the effects of myopia on most of these parameters.

Background: Assessment of color disc photograph (C-DP) is affected by image quality, which decreases the ability to detect glaucoma. High-dynamic-range (HDR) imaging provides a greater range of luminosity. Therefore, the objective of this study was to evaluate the capability of ophthalmology residents to detect glaucoma using HDR-concept disc photography (HDR-DP) compared to C-DP., Design: Cross-sectional study., Methods: Twenty subjects were classified by 3 glaucoma specialists as either glaucoma, glaucoma suspect, or control. All C-DPs were converted to HDR-DPs and randomly presented and assessed by 10 first-year ophthalmology residents. Sensitivity and specificity of glaucoma detection were compared., Results: The mean ± SD of averaged retinal nerve fiber layer (RNFL) thickness was 74.0 ± 6.1  μ m, 100.2 ± 9.6  μ m, and 105.8 ± 17.2  μ m for glaucoma, glaucoma suspect, and controls, respectively. The diagnostic sensitivity of HDR-DP was higher than that of C-DP (87% versus 68%, mean difference: 19.0, 95% CI: 4.91 to 33.1; p = 0.014). Regarding diagnostic specificity, HDR-DP and C-DP yielded 46% and 75% (mean difference: 29.0, 95% CI: 13.4 to 44.6; p = 0.002)., Conclusions: HDR-DP statistically increased diagnostic sensitivity but not specificity. HDR-DP may be a screening tool for nonexpert ophthalmologists.

Purpose: To describe a new syndrome of tight orbit and intractable glaucoma with a poor visual prognosis., Methods: A retrospective observational case series of six patients seen at two centres between 2001 and 2007 assessing intraocular pressure (IOP), best-corrected visual acuity and visual field., Results: Three men and three women, ranging in age at diagnosis from 14 to 53 years, demonstrated similar orbital features and progressive visual field loss despite intensive management with medication and laser and operative surgery. Highest IOPs ranged from 30 to 50 mmHg. Trabeculectomy and/or glaucoma drainage devices were attempted in five patients but all failed. One patient underwent orbital decompression with achievement of IOP control. Final IOP at last follow-up was variable; only two patients achieved IOP in the normal range, with the rest ranging from 25 to 40 mmHg. All patients had advanced visual field loss., Conclusion: Tight orbit syndrome presents a serious clinical challenge. Despite maximum medical therapy and surgical intervention IOP is difficult to control, resulting in progressive visual field loss.

Objective: To demonstrate that the intraocular pressure (IOP)-reducing effect of latanoprost once daily is at least as good as that of timolol twice daily in patients with chronic angle-closure glaucoma (CACG)., Design: Randomized, double-masked, multicenter 12-week study., Participants: In all, 137 patients with unilateral or bilateral CACG were treated with latanoprost, and 138 were treated with timolol., Methods: Patients received either latanoprost (9 pm) and a placebo (9 am) or timolol (both 9 am and 9 pm). Intraocular pressure was measured at 9 am and 5 pm at baseline and weeks 2, 6, and 12., Main Outcome Measures: The difference between groups in daily IOP (average of 9 am and 5 pm measures) reduction was the primary outcome. Secondary outcomes included differences between groups in IOP reductions at 9 am and 5 pm, and in proportions of patients reaching specified daily IOP levels., Results: Using repeated measures (analysis of covariance: intent to treat), mean changes from baseline in daily IOP levels during 12 weeks were -8.2 mmHg and -5.2 mmHg for latanoprost- and timolol-treated patients, respectively (difference: -3.0 mmHg [95% confidence interval: -4.0, -2.1], P<0.001). Greater reductions in IOP levels at both 9 am and 5 pm were found in latanoprost-treated patients (P<0.001 for both), and greater proportions of patients receiving latanoprost reached prespecified target daily IOP levels (P<0.001 for all 3 target levels tested). Both drugs were well tolerated., Conclusion: Latanoprost administered once daily provides significantly greater IOP reduction in CACG patients than does timolol instilled twice daily.