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Innovation in Glaucoma: Imaging and Visual Function
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Innovation in Glaucoma: Imaging and Visual Function

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: closed (25 March 2024) | Viewed by 4749

Special Issue Editor

Dr. Takuhei Shoji

E-Mail Website
Guest Editor
1. Department of Ophthalmology, Saitama Medical University, Saitama, Japan
2. Koedo Eye Institute, Saitama, Japan
Interests: glaucoma; imaging; myopia; optical coherence tomography; optical coherence tomography angiography; visual field; visual field testing; structure-function relationship in the visual pathway disorders in glaucoma and myopia; glaucoma surgery

Special Issue Information

Dear Colleagues,

Glaucoma, a chronic eye disease leading to progressive damage of the optic nerve and irreversible vision loss, poses a significant global health challenge. To address this growing concern, continual advancements in glaucoma diagnosis and monitoring are imperative. This summary explores innovative approaches in imaging and visual function assessment that have revolutionized the management of glaucoma.

Recent years have witnessed remarkable progress in imaging techniques, enabling clinicians to visualize and analyze ocular structures in unprecedented detail. Optical coherence tomography (OCT) has emerged as a pivotal tool in glaucoma imaging, facilitating visualization of the retinal nerve fiber layer, optic nerve head, and macula. Leveraging advanced imaging algorithms, OCT enables precise measurements of these structures, aiding in early detection, progression monitoring, and treatment response assessment in glaucoma patients.

In addition to structural imaging, functional assessment of the visual system plays a crucial role in glaucoma management. Perimetry, a long-established gold standard for evaluating glaucomatous damage, measures the visual field. Recent innovations in perimetry techniques, such as high-resolution and wide-field strategies, have enhanced the sensitivity and accuracy of detecting and tracking visual field changes.

Exciting possibilities for comprehensive glaucoma evaluation arise from emerging technologies like adaptive optics imaging and multi-modal imaging. Adaptive optics imaging enables high-resolution imaging of individual retinal cells, facilitating detailed analysis of structural abnormalities in glaucoma. Multi-modal imaging combines diverse imaging modalities, such as OCT, scanning laser ophthalmoscopy, and angiography, to provide complementary information for a more comprehensive assessment of glaucomatous damage.

These advancements in glaucoma imaging and visual function assessment have revolutionized the field by enabling earlier and more accurate detection, monitoring, and management of this sight-threatening disease. They hold promise for improving patient outcomes, developing personalized treatment approaches, and advancing our understanding of glaucoma pathophysiology. Continued research and development in this area are vital to enhance our ability to diagnose, treat, and prevent vision loss in individuals with glaucoma.

Dr. Takuhei Shoji
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • glaucoma
  • imaging
  • myopia
  • visual function
  • visual field
  • optical coherence tomography
  • optical coherence tomography angiography

Published Papers (6 papers)

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Research

9 pages, 601 KiB  
Article
Estimation of Topical Glaucoma Medication Over-Prescription and Its Associated Factors
by Eri Takao, Aona Ichitani and Masaki Tanito
J. Clin. Med. 2024, 13(1), 184; https://doi.org/10.3390/jcm13010184 - 28 Dec 2023
Viewed by 570
Abstract
This study aims to report the disparity between the ideal and actual quantities of eyedrops prescribed to individual glaucoma patients. This retrospective observational study included 676 patients receiving treatment with antiglaucoma topical medication(s) in at least one eye. These patients had follow-up appointments [...] Read more.
This study aims to report the disparity between the ideal and actual quantities of eyedrops prescribed to individual glaucoma patients. This retrospective observational study included 676 patients receiving treatment with antiglaucoma topical medication(s) in at least one eye. These patients had follow-up appointments scheduled at mean intervals of 3.4 ± 1.4 months and were actively using antiglaucoma medication. The mean age was 70.4 ± 11.9 years, with 372 (55%) being male. The over-prescription volume was 1.4 ± 1.7 bottles per month for each medication when prescribed for both eyes. Multiple regression analysis revealed that older age (p = 0.03), hyperopic refractive error (p < 0.0001), and the use of multiple medications (p = 0.03) were associated with a larger over-prescription volume, while the use of unit-dose medication only (p < 0.0001) was associated with a smaller over-prescription volume. Factors such as sex, Mini-Cog cognitive function score, best-corrected visual acuity, intraocular pressure, glaucoma type, and a history of cataract surgery were not significantly associated. This study revealed a significant over-prescription of eyedrops for glaucoma patients, with actual prescriptions often exceeding the theoretically ideal amount by 2.4 times, influenced by factors like age and the format of prescriptions, where unit-dose eyedrops show promise in reducing excess. Full article
(This article belongs to the Special Issue Innovation in Glaucoma: Imaging and Visual Function)
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12 pages, 449 KiB  
Article
Comparison of Phaco-Tanito Microhook Trabeculotomy between Propensity-Score-Matched 120-Degree and 240-Degree Incision Groups
by Kazunobu Sugihara, Ayaka Shimada, Sho Ichioka, Akiko Harano and Masaki Tanito
J. Clin. Med. 2023, 12(23), 7460; https://doi.org/10.3390/jcm12237460 - 01 Dec 2023
Viewed by 569
Abstract
This study compared the effectiveness and safety of 120-degree (nasal) and 240-degree (bilateral) incisions in Tanito Microhook Trabeculotomy (TMH) combined with cataract surgery in patients with open-angle glaucoma. From a pool of 185 eyes, 67 eyes from 67 subjects were selected for each [...] Read more.
This study compared the effectiveness and safety of 120-degree (nasal) and 240-degree (bilateral) incisions in Tanito Microhook Trabeculotomy (TMH) combined with cataract surgery in patients with open-angle glaucoma. From a pool of 185 eyes, 67 eyes from 67 subjects were selected for each incision group using propensity score matching to align age, sex, glaucoma type, and preoperative intraocular pressure (IOP). The study found that preoperative IOP, initially 18.6 mmHg in both groups, decreased to 13.2 mmHg in the nasal group and 12.8 mmHg in the bilateral group 12 months postoperatively, representing reductions of 29% and 31%, respectively. Similarly, medication scores decreased from 3.4 to 2.7 in the nasal group and from 3.1 to 2.5 in the bilateral group. Notably, the bilateral incision group exhibited a significantly higher hyphema red blood cell score compared to the nasal group (p < 0.0001). Across the study period, other parameters such as IOP, medication score, visual acuity, anterior chamber flare, corneal endothelial cell density, visual field mean deviation, and the frequency of surgical complications other than hyphema were similar between the groups. The study concluded that TMH combined with cataract surgery is equally effective and safe regardless of incision width, although narrower incisions resulted in reduced early postoperative hyphema. Full article
(This article belongs to the Special Issue Innovation in Glaucoma: Imaging and Visual Function)
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11 pages, 2535 KiB  
Article
Exploring the Pressure Characteristics of the PRESERFLO MicroShunt in In Vitro Studies and Effects of Sclera on Device Performance
by Andi Masdipa, Sachiko Kaidzu and Masaki Tanito
J. Clin. Med. 2023, 12(23), 7266; https://doi.org/10.3390/jcm12237266 - 23 Nov 2023
Viewed by 657
Abstract
This study aims to investigate the pressure characteristics of the PRESERFLO MicroShunt, a microinvasive glaucoma device, using an in vitro setup. Additionally, the study explores the impact of the scleral tissue surrounding the device on its pressure and lumen area. Ten PRESERFLO MicroShunts [...] Read more.
This study aims to investigate the pressure characteristics of the PRESERFLO MicroShunt, a microinvasive glaucoma device, using an in vitro setup. Additionally, the study explores the impact of the scleral tissue surrounding the device on its pressure and lumen area. Ten PRESERFLO MicroShunts were subjected to an in vitro experimental setup. A constant flow of physiological saline was maintained at 2 μL/min using an infusion syringe pump. The PRESERFLO was connected to a pressure transducer via a 23 G needle. Pressure characteristics were measured under three different conditions: without sclera [sclera (-)], passing through sclera at a 90° angle (sclera 90°), and passing through sclera at a 30° angle (sclera 30°). The lumen area of the device was measured using microscopic observation. We observed peak and trough pressures in this experimental setting; the peak pressure (6.76 mmHg) was significantly higher than the trough pressure of 4.74 mmHg (p = 0.0020) in the sclera (-) condition. Compared to sclera (-), the peak pressures were significantly higher in the sclera 90° (7.81 mmHg, p = 0.0020) and the sclera 30° (7.96 mmHg, p = 0.0039) conditions. Additionally, compared to sclera (-), the trough pressure was significantly higher in the sclera 90° (6.25 mmHg, p = 0.0039) and the sclera 30° (5.76 mmHg, p = 0.037) conditions. The lumen area was significantly smaller in the sclera 90° condition (3515 μm2) than the sclera (-) condition (3927 μm2, p = 0.0078). The study found that when the distal end of PRESERFLO MicroShunt was free and in air, it exhibited both peak and trough pressures. The presence of scleral tissue surrounding the PRESERFLO MicroShunt affects its lumen area and pressure characteristics. Understanding these effects can provide valuable insights into the device’s performance. Full article
(This article belongs to the Special Issue Innovation in Glaucoma: Imaging and Visual Function)
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12 pages, 1295 KiB  
Article
Roles of Cognitive Function on Visual Field Reliability Indices among Glaucoma Patients
by Aona Ichitani, Eri Takao and Masaki Tanito
J. Clin. Med. 2023, 12(22), 7119; https://doi.org/10.3390/jcm12227119 - 15 Nov 2023
Viewed by 666
Abstract
This study reports the prevalence of cognitive impairment (CI) in patients attending a glaucoma outpatient clinic at a tertiary hospital. It also comprehensively assesses possible associations between CI and visual field (VF) reliability indices among glaucoma patients. The retrospective analysis included 1464 eyes [...] Read more.
This study reports the prevalence of cognitive impairment (CI) in patients attending a glaucoma outpatient clinic at a tertiary hospital. It also comprehensively assesses possible associations between CI and visual field (VF) reliability indices among glaucoma patients. The retrospective analysis included 1464 eyes from 746 subjects (mean age, 70.6 ± 11.9; 401 males and 345 females). CI was evaluated using the Mini-Cog test, revealing a suspected prevalence of 8.0% (60 out of 746) among the patients. After adjusting for various background parameters using a mixed effects regression model, an abnormal Mini-Cog score was linked to higher false negative (FN) (p = 0.0034) and false positive (FP) (p = 0.0051) but not fixation loss (FL) (p = 0.82). Among the Mini-Cog components, a lower word recall test score was associated with higher FN (p < 0.0001), with a borderline difference in FP (p = 0.054) and no significant effect on FL (p = 0.09). Conversely, a lower clock drawing test score was associated with higher FP (p = 0.038), while FL (p = 0.49) and FN (p = 0.12) remained unaffected. These findings suggest that CI can impact the reliability of VF testing among glaucoma patients, highlighting the importance of assessing cognitive function in glaucoma care. Full article
(This article belongs to the Special Issue Innovation in Glaucoma: Imaging and Visual Function)
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12 pages, 593 KiB  
Article
Fellow-Eye Comparison between Phaco-Tanito Microhook Trabeculotomy and Phaco-iStent Inject W
by Akiko Harano, Ayaka Shimada, Sho Ichioka, Kazunobu Sugihara and Masaki Tanito
J. Clin. Med. 2023, 12(22), 7005; https://doi.org/10.3390/jcm12227005 - 09 Nov 2023
Cited by 1 | Viewed by 624
Abstract
This study aims to compare the surgical efficacy and safety of the Tanito microhook trabeculotomy (TMH-CE) and iStent inject W (Inject-CE) when performed in combination with cataract surgery on the eyes of glaucoma patients. A total of 78 glaucomatous eyes from 39 participants [...] Read more.
This study aims to compare the surgical efficacy and safety of the Tanito microhook trabeculotomy (TMH-CE) and iStent inject W (Inject-CE) when performed in combination with cataract surgery on the eyes of glaucoma patients. A total of 78 glaucomatous eyes from 39 participants were retrospectively analyzed. Intraocular pressure (IOP), the number of antiglaucoma medications, best-corrected visual acuity (BCVA), anterior chamber flare (ACF), and corneal endothelial cell density (CECD) were all evaluated preoperatively and at multiple postoperative time points. The preoperative IOP was significantly higher in the TMH-CE (19.6 ± 6.7 mmHg) than in the Inject-CE (15.7 ± 3.8 mmHg) (p < 0.0001). At the 12-month follow-up, reductions in IOP and the number of medications were more pronounced in the TMH-CE (6.6 mmHg, 27.6% and −1.1, respectively) group than Inject-CE (2.7 mmHg, 12.4% and −0.7, respectively) (p < 0.0001 and p = 0.0034), while the IOP and medication-number levels were identical between TMH-CE (13.0 ± 3.3 mmHg and 1.3 ± 0.9, respectively) and Inject-CE (12.9 ± 2.6 mmHg and 1.9 ± 0.9, respectively) (p = 0.88 and p > 0.99, respectively). The TMH-CE group exhibited a higher ACF, a higher frequency of layered hyphema, and a greater anterior chamber floating red blood cells score in the early postoperative periods. Despite these differences, the changes in BCVA, ACF, and CECD were equivalent between the two groups in later follow-up periods. TMH-CE provides a more significant IOP reduction and medication-number reduction compared to Inject-CE, while Inject-CE shows quicker BCVA recovery. This study provides valuable insights for ophthalmologists choosing the most suitable surgical approach for glaucoma and cataract patients. Full article
(This article belongs to the Special Issue Innovation in Glaucoma: Imaging and Visual Function)
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11 pages, 1208 KiB  
Article
Position of the ISTENT Inject® Trabecular Micro-Bypass System Visualized with the NIDEK GS-1 Gonioscope—A Postoperative Analysis
by Julian Alexander Zimmermann, Jens Julian Storp, Ralph-Laurent Merté, Peter Heiduschka, Nicole Eter and Viktoria Constanze Brücher
J. Clin. Med. 2023, 12(16), 5171; https://doi.org/10.3390/jcm12165171 - 08 Aug 2023
Viewed by 1310
Abstract
Glaucoma is one of the leading causes of irreversible blindness globally and is characterized by the gradual loss of retinal ganglion cells. The primary risk factor for the development and progression of glaucoma is increased intraocular pressure (IOP). Numerous surgical interventions exist to [...] Read more.
Glaucoma is one of the leading causes of irreversible blindness globally and is characterized by the gradual loss of retinal ganglion cells. The primary risk factor for the development and progression of glaucoma is increased intraocular pressure (IOP). Numerous surgical interventions exist to lower IOP should conservative therapy fail. One trend in recent years has been minimally invasive glaucoma surgery (MIGS) as an alternative to traditional methods. The ISTENT inject® is an ab interno trabecular micro-bypass implant designed to be implanted through the trabecular meshwork into the Schlemm’s canal to lower IOP. The aim of the study was the postoperative visualization and description of the positioning of the ISTENT inject® using automated circumferential goniophotography. Patients with symptomatic cataracts and mild to moderate primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX), and pigment-dispersion glaucoma were included who underwent combined cataract surgery with the ISTENT inject® and received postoperative automated gonioscopy with the NIDEK Gonioscope GS-1 to visualize the location of the implant. Twenty-four implants of 14 eyes in 11 patients could be visualized. Out of the implants, 14.3% were in the trabecular meshwork, 46.4% were at the border between the trabecular meshwork and scleral spur, 25% were below the trabecular meshwork, and 14.3% of the implants were not detectable in the gonioscopy. In the overall cohort, a statistically significant IOP reduction was found over the 12-month postoperative observation period. Even in three eyes, in each of which both stents were located below the trabecular meshwork, an IOP reduction over 12 months was observed compared to the baseline IOP. In this study, vertical two-dimensional positioning of the ISTENT inject® was performed for the first time using NIDKE GS-1 automated 360° goniophotography. The method is suitable for postoperative visualization, control, and documentation of positioning after ISTENT inject® implantation. Further studies are needed to analyze the correlation between positioning of the ISTENT inject® in the chamber angle and postoperative IOP reduction. Full article
(This article belongs to the Special Issue Innovation in Glaucoma: Imaging and Visual Function)
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