Carlos Gustavo De Moraes

Choroidal expansion during the water drinking test

PurposeTo evaluate the correlation between intraocular pressure (IOP) rise, ocular pulse amplitude (OPA), and choroidal thickness (ChT) during the water drinking test (WDT).MethodsPrimary open-angle glaucoma (POAG) patients were submitted to the WDT followed by serial IOP measurements using dynamic contour tonometry (DCT), Goldman tonometry (GAT), and ChT measurements using ultrasonographic A and B-scan (USG). A control group not submitted to the test was also evaluated using DCT, GAT, and USG. Intraclass correlation coefficient (ICC) was calculated in the control group in order to assess the reproducibility of measurements. Spearman’s coefficient (rho) was used to assess the correlation between the variables.ResultsThirty eyes were included in the study. There was a significant IOP rise during the WDT using both GAT and DCT (pu2009<u20090.001). The OPA and ChT measurements also increased significantly (pu2009<u20090.001). Spearman’s correlation between the OPA values and ChT measurements was significant and moderate (rhou2009=u20090.40, pu2009=u20090.005). The average increase of OPA and ChT measurements occurred 15xa0min before the IOP rise.ConclusionsThere was a significant increase of OPA and ChT measurements followed by an IOP rise during the WDT. Increased choroidal volume due to hemodynamic forces may be enrolled in the mechanism of IOP elevation during this stress test.

Agreement between stress intraocular pressure and long-term intraocular pressure measurements in primary open angle glaucoma.

Purpose:u2002 The aim of this paper is to study the correlation between the intraocular pressure peaks and fluctuation detected during the water drinking test and the same parameters observed during long‐term follow up.

A comparison of bimatoprost 0.03% versus the fixed-combination of latanoprost 0.005% and timolol 0.5% in adult patients with elevated intraocular pressure: an eight-week, randomized, open-label trial.

INTRODUCTION AND PURPOSEnBimatoprost and the fixed combination of latanoprost with timolol maleate are 2 medications widely used to treat glaucoma and ocular hypertension (OHT). The aim of the study is to compare the efficacy of these 2 drugs in reducing intraocular pressure (IOP) after 8 weeks of treatment in patients with primary open angle glaucoma (POAG) or OHT.nnnMETHODSnIn this randomized, open-label trial, 44 patients with POAG or OHT were allocated to receive either bimatoprost (1 drop QD) or latanoprost/timolol (1 drop QD). Primary outcome was the mean diurnal IOP measurement at the 8th week, calculated as the mean IOP measurements taken at 8:00 am, 10:00 am, and 12:00 pm Secondary outcomes included the baseline change in IOP measured 3 times a day, after the water-drinking test (performed after the last IOP measurement), and the assessment of side effects of each therapy.nnnRESULTSnThe mean IOP levels of latanoprost/timolol (13.83, SD = 2.54) was significantly lower than of bimatoprost (16.16, SD = 3.28; P < 0.0001) at week 8. Also, the change in mean IOP values was significantly higher in the latanoprost/timolol group at 10:00 am (P = 0.013) and 12:00 pm (P = 0.01), but not at 8:00 am (P = ns). During the water-drinking test, there was no significant difference in IOP increase (absolute and percentage) between groups; however, there was a significant decrease in mean heart rate in the latanoprost/timolol group. Finally, no significant changes in blood pressure and lung spirometry were observed in either groups.nnnCONCLUSIONSnThe fixed combination of latanoprost/timolol was significantly superior to bimatoprost alone in reducing IOP in patients with POAG or OHT. Further studies with large sample sizes should be taken to support the superior efficacy of latanoprost/timolol, as well as to better assess its profile of side effects.

Predictive Value of the Water Drinking Test and the Risk of Glaucomatous Visual Field Progression

Purpose: The purpose of this is to test the hypothesis the intraocular pressure (IOP) peaks during a stress test [the water drinking test (WDT)] can estimate the risk of future visual field progression in treated primary open-angle glaucoma (POAG) patients. Patients and Methods: Design: Prospective, longitudinal study. Setting: Clinical practice. Study population: Treated POAG patients whose IOP was ⩽18 mm Hg and who had no IOP-lowering interventions between the date of the WDT and the last eligible visual field. Intervention: At baseline examination, patients underwent the WDT and were then followed at regular intervals with office-based IOP measurements and visual field testing. Main outcome measure: Cox-proportional hazards survival analysis testing the predictive value of IOP peaks during the WDT versus IOP measurements during office hours on visual field progression. Results: A total of 144 eyes of 96 patients with baseline visual field damage ranging from mild to severe followed for a mean of 28 months were analyzed. In the multivariable analysis adjusting for potential confounders, higher IOP peaks during the WDT were predictive of future visual field progression (hazard ratio=1.11; 95% confidence interval, 1.02 to 1.21; P=0.013). The average and peak IOP during office hours over the same follow-up period were not significantly associated with progression (P=0.651 and 0.569, respectively). Conclusions: IOP peaks detected with the WDT were predictive of future visual field progression in a treated POAG population. This stress test could be a useful tool for risk assessment in daily practice.

Intracameral bevacizumab and mitomycin C Trabeculectomy for eyes with neovascular glaucoma: a case series.

The purpose of this study was to describe the surgical outcomes and safety of intracameral bevacizumab during trabeculectomy in eyes with neovascular glaucoma. Pilot study included four eyes (four patients) with refractory neovascular glaucoma submitted to fornix-based trabeculectomy with adjunctive use of bevacizumab in the anterior chamber during the procedure. Patients were previously treated with panretinal photocoagulation as standard therapy. Variables evaluated were intraocular pressure, bleb appearance, iris neovascularization, intraoperative/postoperative complications, and visual outcomes. No intraoperative complication was observed. The mean follow-up period was 12.75 (range, 12–15xa0months). All eyes showed significant intraocular pressure control postoperatively. Iris neovascularization reduced significantly within 1xa0month after surgery. Mild anterior chamber inflammation was observed during follow-up in all eyes. No significant postoperative complication was observed, and no patient presented visual acuity deterioration. Intracameral bevacizumab may be used as an adjunctive therapy during trabeculectomy in eyes with neovascular glaucoma.

Intraocular pressure profile during the modified diurnal tension curve using Goldman applanation tonometry and dynamic contour tonometry.

The aim of this study was to compare the intraocular pressure (IOP) profile during the modified diurnal tension curve (mDTC) using Goldman applanation tonometry (GAT) and dynamic contour tonometry (DCT) in treated glaucomatous eyes. Eligible subjects were submitted to the mDTC using GAT and DCT in this sequence. IOP measurements were performed at 8xa0a.m., 10xa0a.m., 2xa0p.m., and 4xa0p.m.. Central corneal thickness was measured using ultrasound pachymetry in the morning. Statistical analysis was performed using paired Student’s t test and Bland–Altman plot. The mean difference between DCT and GAT measurements was 0.9xa0mmHg. The meanu2009±u2009SD IOP measurements during the mDTC were 19.68u2009±u20094.68, 17.63u2009±u20094.44, 17.25u2009±u20095.41, and 17.32u2009±u20094.25xa0mmHg using GAT and 19.97u2009±u20094.75, 18.79u2009±u20094.61, 19.53u2009±u20095.30, and 19.43u2009±u20095.45xa0mmHg using DCT. IOP measurements were higher in the morning (8xa0a.m.) and decreased throughout the day using both tonometers. The difference between IOP measurements using GAT and DCT was smaller in the morning and increased throughout the day. The IOP variability using GAT was higher than using DCT. Corneal biomechanical properties might help explain our findings.

Measuring Rates of Visual Field Progression in Linear Versus Nonlinear Scales: Implications for Understanding the Relationship Between Baseline Damage and Target Rates of Glaucoma Progression

Purpose: The purpose of this study is to test the hypothesis that the relationship between baseline visual field damage and the rate of progression depends upon the use of logarithmic (dB) versus linear (1/Lambert) scale. Methods: A total of 60 eyes (60 patients) with treated, established glaucoma and at least 5 reliable 24-2 visual fields were included. Baseline visual field mean deviation (MD) in dB was transformed to 1/Lambert using standard equation. Mixed effects linear regression was used to calculate the slopes (MD rates of progression over time) with linear and nonlinear scales. We tested the relationship between baseline MD and MD slopes for each scale of measure. Results: In dB scale, worse baseline visual field loss was associated with faster MD slopes (P=0.037), whereas the opposite effect was seen in 1/Lambert (P=0.001). For a similar rate of progression in dB/y, eyes with mild visual field damage lost more linear sensitivity over a given period of time than those with more severe baseline damage. Conclusions: There is a significant relationship between baseline visual field severity and rates of MD progression, although the direction of this association depends on the scale sensitivity is measured. The definition of fast versus slow visual field progression should be revised and take into account that sensitivity in linear scales show a better correlation with structural loss than when conventionally measured in nonlinear scale.

Spatial correlation between localized decreases in exploratory visual search performance and areas of glaucomatous visual field loss

BackgroundVisual search is a critical skill for several daily tasks and may be compromised in patients with impaired vision. The objective of this study was to study the relationships between exploratory visual search performance (EVSP) visual field (VF) sensitivity in patients with glaucoma.MethodsPrimary open-angle glaucoma patients (POAG; nu2009=u200929) and healthy (Control; nu2009=u200928) individuals with best corrected visual acuity better than 0.2 logMAR underwent a comprehensive ophthalmological examination, including Humphrey VF tests (24-2 SITA-Standard), and a monocular exploratory visual search digit-based task performed using a software that quantifies the time spent to find a targert on a random array of digits distributed on nine sequential screens. The screens were divided into five areas to topographically match with five VF sectors.ResultsAs expected, POAG eyes had worse VF mean deviation (MD) sensitivity and EVSP than Controls (MD −u20098.02u2009±u20097.88xa0dB vs −u20091.43u2009±u20091.50xa0dB, pu2009<u20090.0001; and total EVSP time 106.42u2009±u200959.64xa0s vs 52.75u2009±u200919.07xa0s, pu2009<u20090.0001). MD sensitivity of both groups significantly correlated with total EVSP time (POAG ru2009=u2009−u20090.45, pu2009=u20090.01; and Control ru2009=u20090.37, pu2009=u20090.049). A significant relationship was observed between EVSP (individual time) and both visual acuity (pu2009=u20090.006) and glaucoma diagnosis (pu2009=u20090.005). The mean sensitivity of the peripheral VF areas of the POAG group showed significant correlation with the individual search time in the corresponding spatial areas, except in the peripheral superior temporal area (ru2009=u2009−u20090.35, pu2009=u20090.06).ConclusionThese data indicate that POAG patients’ EVSP is impaired in topographically-correspondent VF areas with sensitivity loss. Visual search may be considered as a measure of impairment of daily activities in glaucoma patients, if further similar tests using binocular conditions corroborate our findings.

Use of Machine Learning on Contact Lens Sensor–Derived Parameters for the Diagnosis of Primary Open-angle Glaucoma

PURPOSEnTo test the hypothesis that contact lens sensor (CLS)-based 24-hour profiles of ocular volume changes contain information complementary to intraocular pressure (IOP) to discriminate between primary open-angle glaucoma (POAG) and healthy (H) eyes.nnnDESIGNnDevelopment and evaluation of a diagnostic test with machine learning.nnnMETHODSnSubjects: From 435 subjects (193 healthy and 242 POAG), 136 POAG and 136 age-matched healthy subjects were selected. Subjects with contraindications for CLS wear were excluded.nnnPROCEDUREnThis is a pooled analysis of data from 24 prospective clinical studies and a registry. All subjects underwent 24-hour CLS recording on 1 eye. Statistical and physiological CLS parameters were derived from the signal recorded. CLS parameters frequently associated with the presence of POAG were identified using a random forest modeling approach.nnnMAIN OUTCOME MEASURESnArea under the receiver operating characteristic curve (ROC AUC) for feature sets including CLS parameters and Start IOP, as well as a feature set with CLS parameters and Start IOP combined.nnnRESULTSnThe CLS parameters feature set discriminated POAG from H eyes with mean ROC AUCs of 0.611, confidence interval (CI) 0.493-0.722. Larger values of a given CLS parameter were in general associated with a diagnosis of POAG. The Start IOP feature set discriminated between POAG and H eyes with a mean ROC AUC of 0.681, CI 0.603-0.765. The combined feature set was the best indicator of POAG with an ROC AUC of 0.759, CI 0.654-0.855. This ROC AUC was statistically higher than for CLS parameters or Start IOP feature sets alone (both P < .0001).nnnCONCLUSIONSnCLS recordings contain information complementary to IOP that enable discrimination between H and POAG. The feature set combining CLS parameters and Start IOP provide a better indication of the presence of POAG than each of the feature sets separately. As such, the CLS may be a new biomarker for POAG.

Evaluation of a Novel Visual Field Analyzer Application for Automated Classification of Glaucoma Severity

Purpose: To describe the Glaucoma Staging Application (GSA), a new application for automated classification of visual field (VF) severity that can be used in any Humphrey perimeters. We also tested and validated its performance in staging glaucomatous VFs defects and assessed its reproducibility. Materials and Methods: The GSA is based upon the modified University of São Paulo Glaucoma Visual Field Staging System, and consists of 3 sections: severity based on the visual field index; defect location based on eccentricity; and extent of topographic damage by hemifields. We analyzed 612 VFs of 32 patients. VFs were analyzed by a glaucoma expert and then compared with the output of the GSA. To evaluate the repeatability, the same search criteria were repeated 1 week later using the same GSA. The classification given by the software was considered correct if it completely agreed in all variables (severity, location, and extent of topographic damage) with the classification performed manually by the glaucoma expert. Results: One hundred seventy-eight eyes were classified as early VF damage, 148 moderate, and 156 severe. One hundred thirty-one VFs were classified as normal. When repeated, 1 week later, the GSA showed excellent repeatability. The automated classification agreed with the expert’s grading in 100% of cases. Conclusions: The GSA allows an automated, fast, reproducible, and objective classification system for multiple 24-2 VFs of Humphrey perimetry. This study is a proof-of-concept that could translate into a useful tool to analyze and stage VFs more objectively and thus help detecting progression of different types of VFs defects.