Glaucoma Research Foundation

The glaucomas arising in children comprise a diverse group of developmental and secondary disorders. Until the mid-20th century, childhood glaucoma was a uniformly blinding disease. The development of surgical approaches like goniotomy ab interno (1940s) and trabeculotomy ab externo (1960s) provided the first effective treatments for this group of uncommon disorders. Since then, additional progress in the management of adult glaucoma has quickly found its way to childhood glaucoma-including the use of antimetabolites, modern glaucoma drainage devices, and techniques of circumferential ab interno and ab externo trabeculotomy using sutures or an illuminated microcatheter. Each of these techniques requires modifications to be safely used in infants and young children. The nomenclature and classification of the pediatric glaucomas were standardized in 2013 with the Childhood Glaucoma Research Network classification system which was a foundational step in developing registries and coordinated research in the field. Modern tools of molecular genetics have begun to elucidate the underlying molecular pathophysiology and inheritance of some forms of childhood glaucoma. Single-gene, Mendelian-inherited forms of childhood glaucoma may be ideal targets for clustered regularly interspaced short palindromic repeats (CRISPR) gene-editing technologies to correct the disorder locally in the anterior chamber angle. All these advances greatly improved visual outcomes in childhood glaucoma. However, with the greatly improved visual prognosis in childhood glaucoma come unique considerations in how we care for these patients over a very long lifespan. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Diabetes mellitus (DM) is a chronic metabolic non-communicable disease with the ability to cause serious microvascular and macrovascular complications throughout the body, including in the eye. Diabetic retinopathy (DR), present in one-third of patients with diabetes, is a vision-threatening complication caused by uncontrolled diabetes, which greatly affects the retinal blood vessels and the light-sensitive inner retina, eventually leading to blindness. Several epidemiological studies elucidate that DR can vary by age of onset, duration, types of diabetes, and ethnicity. Recent studies show that the pathogenesis of diabetic retinopathy has spread its roots beyond merely being the result of hyperglycemia. The complexity of its etiopathology and diagnosis makes therapeutic intervention challenging. This review throws light on the pathological processes behind DR, the cascade of events that follow it, as well as the available and emerging treatment options.

BackgroundIntraocular pressure (IOP) monitoring in glaucoma management is evolving with novel devices. We investigated the reproducibility of 24 hour profiles on two consecutive days and after 30 days of self-measurements via telemetric IOP monitoring.MethodsSeven primary patients with open-angle glaucoma previously implanted with a telemetric IOP sensor in one eye underwent automatic measurements throughout 24 hours on two consecutive days (‘day 1’ and ‘day 2’). Patients wore an antenna adjacent to the study eye connected to a reader device to record IOP every 5 min. Also, self-measurements in six of seven patients were collected for a period of 30 days. Analysis included calculation of hourly averages to correlate time-pairs of day 1 versus day 2 and the self-measurements vers day 2.ResultsThe number of IOP measurements per patient ranged between 151 and 268 on day 1, 175 and 268 on day 2 and 19 and 1236 during 30 days of self-measurements. IOP time-pairs of automatic measurements on day 1 and day 2 were significantly correlated at the group level (R=0.83, p<0.001) and in four individual patients (1, 2, 6 and 7). IOP time-pairs of self-measurements and day 2 were significantly correlated at the group level (R=0.4, p<0.001) and in four individual patients (2, 5, 6 and 7).ConclusionsTwenty-four hour automatic measurements of IOP are correlated on consecutive days and, though to a lesser degree, with self-measurements. Therefore a virtual 24-hour IOP curve might be constructed from self-measurements. Both options provide an alternative to frequent in-office IOP measurements.

Intraocular pressure (IOP) is the most important modifiable risk factor for glaucoma and fluctuates considerably within patients over short and long time periods. Our field's understanding of IOP has evolved considerably in recent years, driven by tonometric technologies with increasing accuracy, reproducibility, and temporal resolution that have refined our knowledge regarding the relationship between IOP and glaucoma risk and pathogenesis. The goal of this article is to review the published literature pertinent to the following points: 1) the factors that determine IOP in physiologic and pathologic states; 2) technologies for measuring IOP; 3) scientific and clinical rationale for measuring diverse IOP metrics in patients with glaucoma; 4) the impact and shortcomings of current standard-of-care IOP monitoring approaches; 5) recommendations for approaches to IOP monitoring that could improve patient outcomes; and 6) research questions that must be answered to improve our understanding of how IOP contributes to disease progression. Retrospective and prospective data, including that from landmark clinical trials, document greater IOP fluctuations in glaucomatous than healthy eyes, tendencies for maximal daily IOP to occur outside of office hours, and, in addition to mean and maximal IOP, an association between IOP fluctuation and glaucoma progression that is independent of mean in-office IOP. Ambulatory IOP monitoring, measuring IOP outside of office hours and at different times of day and night, provides clinicians with discrete data that could improve patient outcomes. Eye care clinicians treating glaucoma based on isolated in-office IOP measurements may make treatment decisions without fully capturing the entire IOP profile of an individual. Data linking home blood pressure monitors and home glucose sensors to dramatically improved outcomes for patients with systemic hypertension and diabetes and will be reviewed as they pertain to the question of whether ambulatory tonometry is positioned to do the same for glaucoma management. Prospective randomized controlled studies are warranted to determine whether remote tonometry-based glaucoma management might reduce vision loss and improve patient outcomes.

Ocular surface squamous neoplasia (OSSN) is a common eye surface tumour, characterized by the growth of abnormal cells on the ocular surface. OSSN includes invasive squamous cell carcinoma (SCC), in which tumour cells penetrate the basement membrane and infiltrate the stroma, as well as non-invasive conjunctival intraepithelial neoplasia, dysplasia, and SCC in-situ thereby presenting a challenge in early detection and diagnosis. Early identification and precise demarcation of the OSSN border leads to straightforward and curative treatments, such as topical medicines, whereas advanced invasive lesions may need orbital exenteration, which carries a risk of death. Artificial intelligence (AI) has emerged as a promising tool in the field of eye care and holds potential for its application in OSSN management. AI algorithms trained on large datasets can analyze ocular surface images to identify suspicious lesions associated with OSSN, aiding ophthalmologists in early detection and diagnosis. AI can also track and monitor lesion progression over time, providing objective measurements to guide treatment decisions. Furthermore, AI can assist in treatment planning by offering personalized recommendations based on patient data and predicting the treatment response. This manuscript highlights the role of AI in OSSN, specifically focusing on its contributions in early detection and diagnosis, assessment of lesion progression, treatment planning, telemedicine and remote monitoring, and research and data analysis.

Abstract Purpose: To evaluate choroidal thickness and lens thickness among various subtypes of angle closure disease and compare it with healthy controls Methods: This observational comparative study was conducted between June 2022 and February 2023 at our eye hospital, including eyes with subtypes of angle closure disease and healthy controls. Lens thickness was measured using an automated optical biometer, and choroidal thickness was measured using enhanced depth imaging spectral-domain optical coherence tomography in the subtypes of angle closure disease and healthy control subjects. Results: One hundred and twenty-four eyes were enrolled, including 93 angle closure disease eyes and 31 healthy eyes. The mean choroidal thickness was significantly higher in angle closure subtypes than healthy controls (247.19 ± 40.97 µm, 318.81 ± 24.81 µm, 383.81 ± 53.06 µm, 173.65 ± 28.19 µm in primary angle closure suspect, primary angle closure, primary angle closure glaucoma, and healthy controls, respectively (P &lt; 0.001)). The mean lens thickness was higher in angle closure disease compared to the control group (P &lt; 0.01). Conclusion: Increased choroidal thickness might be another anatomic characteristic of primary angle closure eyes along with increased lens thickness. This finding may support the hypothesis that choroidal enlargement plays a part in the development of primary angle closure disease. Trial registration number: CTRI/2022/08/044903