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Intraocular pressure (IOP) is an important measurement that needs to be taken during ophthalmic examinations, especially in ocular hypertension subjects, glaucoma patients and in patients with risk factors for developing glaucoma. The gold standard technique in measuring IOP is still Goldmann applanation tonometry (GAT); however, this procedure requires local anesthetics, can be difficult in patients with scarce compliance, surgical patients and children, and is influenced by several corneal parameters. Numerous tonometers have been proposed in the past to address the problems related to GAT. The authors review the various devices currently in use for the measurement of intraocular pressure (IOP), highlighting the main advantages and limits of the various tools. The continuous monitoring of IOP, which is still under evaluation, will be an important step for a more complete and reliable management of patients affected by glaucoma.

Purpose: To assess ocular pathologies admitted to Italian Emergency Eye Departments (EEDs) during the COVID-19 pandemic national lockdown in 2020 in comparison with the same period in 2019. Methods: Electronic records of all patients presenting at EEDs of two tertiary-care Eye Centers during the COVID-19 national lockdown in Italy (March 10–May 3, 2020) were compared with the equivalent period in 2019. Main outcomes were patient age, gender, and diagnoses. Statistical analysis included unpaired Student t-tests, Poisson regression, and chi-square test. Results: Overall EED visits significantly decreased by 54.1% during the 2020 lockdown compared to 2019 (851 vs 1854, p Conclusions: During the 2020 lockdown, there was a significant reduction of accesses to EED, especially for non-urgent pathologies. Potentially visual function threatening conditions, such as trauma-related pathologies, retinal detachment or ruptures, and wet AMD, showed lower number of cases but higher or stable proportion relative to the total caseload, suggesting a correct and efficient access to ophthalmic health care during the pandemic period.

Glaucoma is an ocular disease caused by elevated intraocular pressure that leads to progressive optic neuropathy [...]

The aim of our study was to assess the clinical effectiveness of topical adipose derived stem cell (ADSC) treatment in laser induced corneal wounds in mice by comparing epithelial repair, inflammation, and histological analysis between treatment arms. Corneal lesions were performed on both eyes of 40 mice by laser induced photorefractive keratectomy. All eyes were treated with topical azythromycin bid for three days. Mice were divided in three treatment groups (n = 20), which included: control, stem cells and basic serum; which received topical treatment three times daily for five consecutive days. Biomicroscope assessments and digital imaging were performed by two masked graders at 30, 54, 78, 100, and 172 h to analyze extent of fluorescein positive epithelial defect, corneal inflammation, etc. Immunohistochemical techniques were used in fixed eyes to assess corneal repair markers Ki67, α Smooth Muscle Actin (α-SMA) and E-Cadherin. The fluorescein positive corneal lesion areas were significantly smaller in the stem cells group on days 1 (p < 0.05), 2 (p < 0.02) and 3. The stem cell treated group had slightly better and faster re-epithelization than the serum treated group in the initial phases. Comparative histological data showed signs of earlier and better corneal repair in epithelium and stromal layers in stem cell treated eyes, which showed more epithelial layers and enhanced wound healing performance of Ki67, E-Cadherin, and α-SMA. Our study shows the potential clinical and histological advantages in the topical ADSC treatment for corneal lesions in mice.

Adipose-derived stem cells (ADSC) are multipotent, safe, non-immunogenic and can differentiate into functional keratocytes in situ. The topical use of ADSC derived from human processed lipoaspirate was investigated for treating injured rat cornea.A total of 19 rats were used. Six animals initially underwent corneal lesion experiments with 0.5 N NaOH (right eye) and 0.2 N (left). The 0.2 NaOH protocol was then used in 13 rats. All 26 eyes of 13 rats eyes received topical azythromycin bid for 3 d and divided into five treatment groups (n = 5 eyes/group), which included: control, stem cells, serum, stem + serum and adipose (raw human lipoaspirate). The four treatment groups received topical treatment three times daily for 3 d. Stem cells were isolated and harvested from human lipoaspirate. Topical eye drops were prepared daily with 1 × 10(5) cells/treatment. Fluorescein positive defect area and light microscope assessment was performed at 20, 28, 45, 50 and 74 h. Animals were sacrificed at 74 h for histological evaluation. Data were statistically analyzed for differences amongst groups.The stem cell-treated eyes had significantly smaller epithelial defects at each time point compared to control- and adipose-treated eyes (p 0.05). This group showed slightly better epithelium healing than the serum and combined group, yet not significantly different. Histology showed that stem cell-treated corneas had complete re-epithelization, with less inflammatory cells and limited fibroblast activation structure compared with the control eyes.Our preliminary results show that topical treatment with ADSC seems to improve corneal wound healing.

PurposeTo evaluate the ability of baseline clinical, morphological, and functional factors to predict the conversion to primary open-angle glaucoma (POAG) in ocular hypertensive (OHT) patients.MethodsThis single-center prospective longitudinal observational study included 116 eyes of 116 OHT patients followed for a 10-year period. All patients had intraocular pressure (IOP) ≥24 mm Hg in one eye and >21 mm Hg in the other eye, normal visual fields (VFs) and normal optic disc (OD) appearance in both eyes at baseline. All OHT patients were untreated at baseline with subsequent treatment upon need according to clinical judgement. Only one eye per subject was randomly selected. Patient age, gender, IOP, central corneal thickness (CCT), and ibopamine test results were collected at baseline. All patients underwent standard automated perimetry, short-wavelength automated perimetry (SWAP), frequency-doubling technology, confocal scanning laser ophthalmoscopy (CSLO), and scanning laser polarimetry (SLP) at baseline and every 6 months thereafter. Main outcome measure was the conversion to POAG, defined as the development of reproducible VF and/or OD abnormalities attributable to glaucoma. Cox proportional hazards models were used to identify the baseline factors predictive of POAG conversion.ResultsDuring the 10-year follow-up, 25% of eyes converted to POAG. In multivariate Cox models, baseline factors that were significant predictors of POAG development included: older age (hazard ratio (HR) 1.0, 99% confidence intervals (CIs) 1.0-1.2, per 1 year older); SWAP Glaucoma Hemifield test 'outside normal limits' (HR 4.3, 99% CIs 1.2-17.9); greater SLP 'Inter-eye Symmetry' (HR 1.1, 99% CIs 0.4-3.0, per 1 unit lower); lower CSLO Rim Volume (HR 1.1, 99% CIs 0.3-3.2, per 0.1 mm(3) lower); and greater CSLO cup-to-disc ratio (HR 6.0, 99% CIs 3.6-16.8, per 0.1 unit greater).ConclusionsThe baseline parameters that proved to be useful in assessing the likelihood of an OHT patient to develop POAG included age, functional variables provided by SWAP, and structural variables provided by SLP and CSLO. In this cohort of patients, baseline IOP, CCT, and ibopamine provocative test results were not significant predictors of POAG conversion.

To compare central corneal thickness (CCT) and endothelial cell density (ECD) with laser scanning confocal microscope Heidelberg Retina Tomograph (HRT) II Rostock Corneal Module and noncontact specular microscope Tomey EM-3000 and to assess intra- and interobserver agreement in normal corneas.This prospective study included 48 normals (69.6 ± 7.2 years, range: 55-80 years) who underwent CCT and ECD with both Tomey and HRT 3 times by 2 independent observers. Measurement differences between instruments, agreement between devices, and test-retest variability (TRV) were determined.Mean CCTs with Tomey and HRT were 529.4 ± 35.4 and 536 ± 37.6 μm (P = 0.06), respectively; average ECDs with Tomey and HRT were 2473.5 ± 242.2 and 2539.7 ± 338.6 cells per square millimeter (P = 0.04), respectively. The mean of the differences (HRT minus Tomey) was 6.5 ± 17 μm for CCT and 65 ± 135.1 cells per square millimeter for ECD. Differences between instruments were not related to CCT (P = 0.35), whereas significantly increased with increasing ECD (P = 0.0001). Intraexaminer TRV for Tomey and HRT were 3.9 ± 3.7 and 22.2 ± 18.4 μm for CCT and 73 ± 63.4 and 152.2 ± 148.4 cells per square millimeter for ECD, respectively; interexaminer TRV was 4.6 ± 4.2 and 23.8 ± 17.3 μm for CCT and 84.9 ± 72.3 and 159.8 ± 149.8 cells per square millimeter for ECD.HRT II Rostock Corneal Module and the Tomey EM-3000 showed an overall good intermethod agreement. HRT showed a tendency to slightly overestimate CCT measurements, significantly underestimate ECD measurements in eyes with a reduced cell density (2290 cells per square millimeter), and overestimate ECD in eyes with a high cell density. Both instruments showed low intra- and interobserver TRV for both CCT and ECD measurements, which tended to be less for Tomey.

Purpose To evaluate the optic disc damage staging system (ODDSS); a new clinical method of optic disc (OD) classification based on OD size, neural rim (NR) loss severity and localization. Accuracy, reproducibility, and reliability were studied. Agreement of ODDSS with the Heidelberg-Retina-Tomograph (HRT) results was evaluated. Methods One eye of 68 consecutive open-angle glaucoma (POAG) patients and 40 controls underwent standard automated perimetry (SAP), HRT-II, and OD examination using the ODDSS classification by 3 independent graders in this prospective cross-sectional study. Sensitivity, specificity, and area under the receiver operating characteristic curve (AROC) in discriminating between normal and POAG eyes were determined for ODDSS and HRT parameters. ODDSS intraobserver and interobserver agreement and agreement with HRT-Moorfield-Regression-Analysis (MRA) were assessed. Results ODDSS sensitivity ranged from 72.0% to 89.7%; specificity ranged from 92.5% to 100%. Differences between AROCs for ODDSS (0.89 to 0.94) and for the best-performing HRT parameter (Vertical Cup/Disc Ratio 0.88) were not statistically significant. ODDSS interobserver agreement ranged from 0.33 to 0.78; intraobserver agreement ranged from 0.53 to 0.89. Agreement with HRT-MRA ranged from 0.50 to 0.87. Conclusions ODDSS is a new method for assessing, recording, and sharing information about the clinical OD appearance. Our preliminary results show that it provides good sensitivity and specificity in glaucoma detection. The interobserver and intraobserver agreement ranged from fair to good.

Purpose: To investigate short-term effect on intraocular pressure (IOP) after intravitreal injection of ranibizumab (Lucentis) (IVIL). Materials and Methods: This prospective study included 1 eye of 54 patients (64 ± 12 y) with wet age-related macular degeneration treated with IVIL. IOP measurements with TonoPen were taken: immediately before and 5 seconds, 5, 10, 15, 30, 60 minutes, and 1 day after IVIL. Axial length (with ultrasound biometry) was assessed in 24 eyes. The analysis included IOP difference at various time points and between phakic and pseudophakic eyes and the relationship between axial length and IOP increases after 5 seconds. Results: Mean IOP were 16.3 ± 3.0 mm Hg (range: 12.0 to 21.3), 44.1 ± 10.6 (22.0 to 59.3), 29.0 ± 9.6 (15.0 to 49.0), 25.8 ± 7.9 (16.0 to 45.0), 23.7 ± 6.6 (15.7 to 39.0), 21.9 ± 5.6 (14.7 to 37.0), 18.8 ± 6.1 (10.0 to 35.0), and 16.1 ± 3.0 (11.0 to 21.0), respectively, for time points immediately before, 5 seconds, 5, 10, 15, 30, 60 minutes, and 1 day after IVIL. Differences between before IVIL and after IVIL IOP were statistically significant after 5 seconds, 5, 10, 15, and 30 minutes (P = 0.0001); however, were not significant after 1 hour (P = 0.064) and 1 day (P = 0.449). Differences between phakic and pseudophakic eyes were not significant (P>0.05). The relationship between shorter axial length and IOP increase after 5 seconds was significant (linear regression analysis; R 2 = 0.28, P = 0.007). Conclusions: IVIL causes a considerable short-term transient rise in IOP. The IOP increase after IVIL can be statistically significant at 0 to 30 minutes after injection in both phakic and pseudophakic eyes, and tends to be greater in shorter eyes.

Purpose: To compare the intraocular pressure (IOP) readings taken with the new ICare tonometer and with the Goldmann applanation tonometer (GAT) and to evaluate the influence of central corneal thickness (CCT) on the IOP measurements. Patients and Methods: One eye of 178 consecutive patients with primary open-angle glaucoma underwent ultrasonic CCT measurement, followed by IOP evaluation with the GAT and with the ICare tonometer. The deviation of ICare readings from GAT values, corrected according to the Doughty and Zaman formula, was calculated and correlated to CCT by a linear regression model. The agreement between the 2 devices was assessed by use of the Bland-Altman method. Results: The average CCT was 552 ± 39mm. The mean IOP and the mean corrected IOP with GAT were 19.4 ± 5.4 mm Hg, and 18.5 ± 5.7 mm Hg, respectively. The mean ICare IOP reading was 18.4 ± 5.2 mm Hg. The deviations of ICare readings from corrected GAT values were highly correlated with CCT values (r = 0.63, P

Purpose: To determine if the N-30-F test with the new Humphrey Matrix instrument is comparable to the traditional frequency-doubling technology (FDT) N-30 test. Methods: A sample of 47 eyes from 47 patients (five normal subjects, 27 with ocular hypertension and 15 with glaucoma) underwent visual field (VF) testing with standard automated perimetry, and with FDT, using the FDT N-30 program, and the Matrix N-30-F program (using the same 19 tested points, full-threshold strategy, but with an enhanced algorithm to reduce testing time). The plots, mean deviation (MD), pattern standard deviation (PSD), defect locations and test time were compared. Results: The agreement between the two tests was shown to be good, except for subjects with large VF defects, in which greater PSD values were observed with the FDT test, whereas the Matrix test gave a higher MD and number of abnormal test locations in the total deviation plot. A lack of agreement was also found for the number of abnormal test locations on the pattern deviation plot at any VF loss severity level. The test time for the Matrix test was significantly shorter. Conclusion: The FDT N-30 and Matrix N-30-F tests proved to be comparable in cases of early to moderate VF defects.

To assess the Humphrey Matrix 30-2 test in detecting functional glaucomatous damage.One eye in each of 60 healthy individuals, 108 patients with ocular hypertension (OHT), and 150 patients with preperimetric (48) or perimetric (102) high-tension primary open-angle glaucoma (POAG) were considered. Visual fields were assessed by the standard automated perimetry (SAP) Humphrey Field Analyzer 30-2, frequency doubling technology (FDT) N-30, and Humphrey Matrix 30-2 tests. Significantly abnormal points in the pattern deviation probability plot, testing time, sensitivity, specificity, and area under the receiver operating characteristic curve of the FDT tests were evaluated.FDT revealed a significantly greater percentage of depressed points than did SAP in OHT and preperimetric POAG eyes. The FDT-N-30 test showed a significantly greater percentage of areas with P5% in the OHT, preperimetric POAG, and early POAG groups. The Matrix-30-2 test provided an area under the receiver operating characteristic curve slightly lower than the FDT-N-30 test in the preperimetric POAG group, and significantly greater in the perimetric POAG group.FDT perimetry appeared more sensitive than SAP in detecting early glaucomatous VF loss. The FDT-N-30 test showed a slightly higher ability to detect early glaucomatous damage in patients at risk for the development of glaucoma, whereas the Matrix-30-2 test provided a more detailed characterization of the glaucomatous VF loss pattern, although it required 30% more time.

PURPOSE To evaluate precision and accuracy of Corvis-ST, a new noncontact tonometer equipped with a high-speed Scheimpflug technology, which measures intraocular pressure (IOP), central corneal thickness (CCT), and corneal deformation parameters (CDPs). Relationships among IOP, CCT, and CDPs were also assessed. MATERIALS AND METHODS This prospective, randomized study included 1 eye of 164 subjects (79 controls and 85 glaucoma patients), which underwent IOP measurements taken 3 times with Goldmann applanation tonometry (GAT) and Corvis-ST in random order. Precision was evaluated using intraclass correlation coefficients. Intermethod agreement was assessed using Bland-Altman method. Relationships amongst IOP, CCT and CDPs were evaluated using linear regression analysis. RESULTS Corvis-ST intraclass correlation coefficients ranged between 0.95 and 0.99 for IOP and CCT; between 0.17 and 0.97 for CDPs. Mean (GAT-Corvis-ST) IOP was 1.4±2.7 mm Hg, which appeared related to IOP and CDPs (P

Purpose: To evaluate the repeatability and accuracy of the applanation resonance tonometer (ART) used in the automatic servo-controlled version, and to evaluate the influence of central corneal thickness (CCT) on the ART intraocular pressure (IOP) measurements. Methods: This prospective, randomized, single-centre study included one eye of 153 subjects (35 healthy volunteers and 118 patients with glaucoma). All participants underwent ultrasonic CCT measurement, followed by IOP evaluation with Goldmann applanation tonometer (GAT) and ART in random order. A single operator measured the IOP with each tonometer three times. Intra-examiner variability was evaluated using the coefficient of variation (CoV), intraclass correlation coefficient (ICC) and test–retest differences. Intermethod agreement was assessed using the Bland–Altman method. Linear regression analysis was used to evaluate the relationship between IOP measurements and CCT. Results: The mean IOP was 17.7 ± 4.4 mmHg with GAT and 20.6 ± 5.3 mmHg with ART (p

To compare higher order aberrations (HOAs) caused by the anterior and posterior corneal surfaces after conventional penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), and automated lamellar therapeutic keratoplasty (ALTK) in patients undergoing corneal transplantation for keratoconus (KC).This retrospective, observational, cross-sectional study included one eye of the following subjects: 40 patients with KC, 23 KC patients after PK, 17 KC patients after DALK, 18 KC patients after ALTK, and 38 healthy controls. All underwent imaging with a rotating Scheimpflug camera (at least 6 months after complete suture removal in grafted subjects) to assess the HOAs from the anterior and posterior corneal surfaces within the central 4-mm and 6-mm zones. The conversion of the corneal elevation profile into corneal wavefront data was performed using Zernike polynomials. Total and third- and fourth-order HOAs were considered. The root mean square of the Zernike vector magnitude, expressed in micrometers, was used. Differences among groups were assessed using the Kruskal-Wallis and Duncan multiple range tests. Statistical significance was defined as p0.05.In both 4-mm and 6-mm central zones, the total HOAs from the anterior corneal surfaces were significantly lower in DALK than in ALTK and PK groups (p0.05). The total HOAs from the posterior corneal surface were comparable amongst postoperative groups (p0.05). The aberration components that were significantly greater included coma in the KC and ALTK eyes, trefoil and coma in the DALK eyes, and trefoil in the PK eyes.The corneal anterior surface optical quality appeared significantly better after DALK than after ALTK and PK.

To assess the epithelial features of the bulbar conjunctiva using in vivo confocal microscopy in patients with glaucoma undergoing canaloplasty.Thirty consecutive patients with glaucoma were enrolled. Canaloplasty was considered successful if the preoperative intraocular pressure (IOP) was reduced by one-third. The conjunctiva was examined using confocal laser-scanning microscopy 1 week before (baseline) and 12 weeks after surgery. The mean density (MMD, cysts/mm(2)) and mean area (MMA, μm(2)) of conjunctival microcysts and IOP were measured. Anterior segment optical coherence tomography was performed to evaluate post-operative trabecular distension and scleral modifications at the surgery site.Twelve weeks after surgery, canaloplasty was successful in 23 patients (group 1) but unsuccessful in 7 (group 2). At baseline, IOP was 28.1±2.98 and 28.3±2.81 mm Hg, MMD was 10.61±4.31 and 11.35±5.6 and MMA was 2845.02±411.85 and 2700.56±518.85 in groups 1 and 2, respectively (p0.05). Twelve weeks after canaloplasty, mean IOP was 13.2±4.48 (p0.05) and 24.6±3.48 mm Hg in groups 1 and 2, respectively. In group 1, MMD and MMA were 37.86±21.4 and 11997.84±8630.35, respectively, a fourfold increase compared to baseline (p0.001); no significant differences were found in group 2. Conjunctival bleb was not documented in any case.Conjunctival microcysts were evident in all glaucomatous eyes prior to surgery, and tended to increase in density and surface area after successful canaloplasty. These findings indicated enhanced aqueous humour filtration across the sclera and conjunctiva after canaloplasty.

PURPOSE To assess Pulsar Perimetry learning effect and test-retest variability (TRV) in normal (NORM), ocular hypertension (OHT), glaucomatous optic neuropathy (GON), and primary open-angle glaucoma (POAG) eyes. METHODS This multicenter prospective study included 43 NORM, 38 OHT, 33 GON, and 36 POAG patients. All patients underwent standard automated perimetry and Pulsar Contrast Perimetry using white stimuli modulated in phase and counterphase at 30 Hz (CP-T30W test). The learning effect and TRV for Pulsar Perimetry were assessed for 3 consecutive visual fields (VFs). The learning effect were evaluated by comparing results from the first session with the other 2. TRV was assessed by calculating the mean of the differences (in absolute value) between retests for each combination of single tests. TRV was calculated for Mean Sensitivity, Mean Defect, and single Mean Sensitivity for each 66 test locations. Influence of age, VF eccentricity, and loss severity on TRV were assessed using linear regression analysis and analysis of variance. RESULTS The learning effect was not significant in any group (analysis of variance, P>0.05). TRV for Mean Sensitivity and Mean Defect was significantly lower in NORM and OHT (0.6 ± 0.5 spatial resolution contrast units) than in GON and POAG (0.9 ± 0.5 and 1.0 ± 0.8 spatial resolution contrast units, respectively) (Kruskal-Wallis test, P=0.04); however, the differences in NORM among age groups was not significant (Kruskal-Wallis test, P>0.05). Slight significant differences were found for the single Mean Sensitivity TRV among single locations (Duncan test, P

To compare intraocular pressure (IOP) measurements with Goldmann applanation tonometry (GAT) and iCare tonometry in normal and post-keratoplasty corneas and to assess the influence of central corneal thickness (CCT), corneal curvature (CC), and corneal astigmatism (CA) on IOP.This prospective cross-sectional study included one eye of 101 subjects with normal corneas (58 healthy subjects, 43 glaucoma); and 90 post-keratoplasty patients: 34 penetrating keratoplasties (PK); 20 automated-lamellar-therapeutic keratoplasties (ALTK); 19 Descemet-stripping-automated-endothelial keratoplasties (DSAEK); 17 edematous grafts. All subjects underwent GAT and iCare IOP measurements in random order, and CCT, CC, and CA evaluation. The Bland-Altman method and multivariate regression analysis were used to assess inter-tonometer agreement and the influence of CCT, CC, and CA on IOP.iCare significantly underestimated IOP in all groups compared with GAT (GAT minus iCare of 3.5±3.5 mm Hg, P0.001), but overestimated IOP in the edematous grafts (GAT minus iCare of -6.5±1.9 mm Hg, P0.001). In normal corneas, both tonometer measurements were directly related to CCT values; iCare readings appeared inversely related to CC. There was no significant relationship between IOP and CCT, CC and CA in post-keratoplasty eyes, except between CC and iCare measurements for PK eyes.The agreement between GAT and iCare was clinically acceptable in control, ALTK and DSAEK groups, and poor in PK and edematous grafts eyes. In normal corneas, GAT was significantly affected by CCT; iCare was influenced by CCT and CC. The iCare appeared less influenced by corneal edema when compared with GAT. High IOP readings taken with both tonometers in grafts should raise suspicion of true elevated IOP.

To compare the ability of frequency-doubling technology (FDT), rarebit perimetry (RBP), and pulsar perimetry (PP) in detecting early glaucomatous functional damage. This prospective observational cross-sectional case study included 52 patients with early primary open-angle glaucoma (mean deviation −2.3±1.1 dB; pattern standard deviation 3.0±1.2 dB) and 53 healthy controls. Visual field (VF) testing included standard automated perimetry (SAP) Humphrey Field Analyzer 30–2, FDT N-30, RBP (version 4.0), and PP T30W. One eye per patient was considered. Sensitivity at fixed specificities and area under the receiver operating characteristic curve (AROC) for discriminating between healthy and glaucomatous eyes were calculated and compared. The parameters associated with the largest AROC, which were not statistically different (Hanley–McNeil method, P0.42–0.71) were as follows: number of locations in the pattern deviation probability (PDP) plot with P

Purpose: To assess the use of scanning laser polarimeter with variable corneal compensation (GDx VCC) in children; to compare GDx VCC parameters between normal children and adults; and, to evaluate peripapillary retinal nerve fiber layer thickness variation with age in normals. Patients and Methods: Ninety-eight normal children (mean age 8.5 ± 2.8 y; range: 3 to 17) and 96 normal adults (mean age of 47.0 ± 20.4 y; range: 18 to 87) underwent GDx VCC testing. Eyes with small or large optic discs were excluded. The ‘‘extended parameter table’’ parameters and mean thickness values of the 4 quadrants and 64 sectors were considered. Differences between age groups, retinal thickness comparisons and age effect were assessed using unpaired t test, analysis of variance, and regression analysis. Results: GDx VCC parameters in children and adults showed wide intersubject variability. All parameters, excluding Symmetry, were significantly greater in children (P

To assess the ability of Pulsar perimetry (Pulsar) in detecting early glaucomatous visual field (VF) damage in comparison with Frequency Doubling Technology (FDT), Scanning Laser Polarimetry (SLP, GDx VCC), and Heidelberg Retina Tomography (HRT).Prospective observational cross-sectional case study.This multicenter study included: 87 ocular hypertensives (OHT); 67 glaucomatous optic neuropathy (GON) patients; 75 primary open-angle glaucoma (POAG) patients; and 90 normals. All patients underwent standard automated perimetry (SAP) HFA 30-2, Pulsar T30W, FDT N-30, HRT II, and GDx VCC. Area under Receiver Operating Characteristic Curves (AROCs) for discriminating between healthy and glaucomatous eyes and agreement among instruments were determined.The best parameters for Pulsar, FDT, HRT, and GDx were, respectively: loss variance square root; no. of areas with P5%; Cup-Shape-Measure; and Nerve Fiber Indicator (NFI). In detecting POAG eyes, Pulsar (AROC, 0.90) appeared comparable with FDT (0.89) and significantly better than HRT (0.82) and GDx (0.79). For GON, Pulsar ability (0.74) was higher than GDx (0.69) and lower than FDT (0.80) and HRT (0.83). The agreement among instruments ranged from 0.12 to 0.56. Pulsar test duration was significantly shorter than SAP and FDT (P.001).Pulsar T30W test is a rapid and easy perimetric method, showing higher sensitivity than SAP in detecting early glaucomatous VF loss. Its diagnostic ability is good for detecting early perimetric POAG eyes and fair for GON eyes. Pulsar performance was comparable with FDT, HRT, and GDx, even if the agreement between instruments was poor to fair.

Purpose To study normative ranges, learning effect (LE), test-retest variability (TRV), and influence of blur and cataract in normal subjects by using rarebit perimetry (RBP). Methods Seventy-five normal subjects underwent visual field (VF) testing with standard automated perimetry (SAP) and RBP. LE and TRV for RBP were assessed in repeated examinations conducted on four different days. LE was evaluated by comparing results from the first with those of the other three sessions. TRV was studied by calculating differences between retest for each combination of single tests. The blur effect was evaluated by repeated tests with spherical lenses added to the optimum refractive correction (+/-1.00 to +/-6.00 D). The cataract effect was studied in 23 subjects who underwent RBP 1 week before and 1 month after cataract surgery. Mean hit rate (MHR) and mean miss rate (MMR) were analyzed for single areas and test duration. Results The mean MHR was 91% +/- 5.7% (range, 78%-99%); the mean MMR ranged from 4.0% to 13.8%. MHR significantly decreased with age (mean, 0.21%/year). Mean test time was 268 +/- 34.1 seconds. No significant LE was observed. TRV was significantly higher in the central VF zone and in elderly subjects. MHR increased with refractive blur and significantly decreased after cataract surgery. Effects of blur and cataract extraction were significantly higher in the central VF zone, especially in elderly subjects. Conclusions RBP is a rapid and easily accessible VF test. RBP testing did not show a significant LE; however, inter- and intrasubject variability were consistent. Blur and media opacities may give false-positive results in RBP, especially in the central VF, and should be considered.

Purpose: To compare intraocular pressure (IOP) measurements taken with Pascal dynamic contour tonometry (DCT), the TonoPen and the Goldmann applanation tonometry (GAT). The influence of central corneal thickness (CCT) on IOP measurements taken with Pascal DCT and the TonoPen was evaluated. Methods: One eye in each of 101 consecutive patients with primary open-angle glaucoma (POAG) underwent ultrasonic CCT measurement and IOP evaluation with GAT, Pascal DCT and the TonoPen in random order. The agreement between results from Pascal DCT and the TonoPen and those of GAT was assessed using the Bland−Altman method. The deviation of Pascal DCT and TonoPen readings from GAT values, corrected for CCT, was calculated and correlated to CCT using a linear regression model. Results: The mean of the differences in IOP measurements was 3.2 ± 2.4 mmHg for Pascal DCT minus GAT readings and 0.5 ± 4.5 mmHg for TonoPen minus GAT readings. The 95% confidence interval of differences in IOP measurements was higher between TonoPen and GAT readings (− 6 to 7 mmHg) than between Pascal and GAT readings (0.1−6.8 mmHg). Pascal DCT significantly overestimated IOP compared with GAT, especially for higher IOP readings. Bland−Altman scatterplots showed reasonable inter-method agreement between Pascal DCT and GAT measurements, and poor agreement between TonoPen and GAT measurements. The deviations of Pascal DCT and TonoPen readings from the corrected GAT values were both highly correlated with CCT values (linear regression analysis, p

To compare Stratus-OCT measurements in controls, ocular hypertensive (OHT) patients with (FDT+) and without (FDT-) frequency-doubling technology (FDT) abnormalities, and in patients affected with early primary open-angle glaucoma (POAG).Thirty-two controls, 78 OHT patients (38 FDT- and 40 FDT+), and 45 early POAG patients (six FDT- and 39 FDT+) underwent the following tests within 3 months: standard automated perimetry (SAP) HFA 30-2; FDT N-30-F; and, Stratus-OCT imaging with retinal nerve fibre layer (RNFL) and optic nerve head (ONH) scans. One eye per patient was considered. Differences among groups were evaluated using the Kruskal-Wallis, analysis of variance, and Duncan's tests.There were no significant differences in all Stratus-OCT parameters between POAG and OHT FDT+ patients. Statistically significant differences were found between the control group and both the POAG and OHT FDT+ groups for 15 of the 21 Stratus-OCT parameters. Control eyes compared to OHT FDT- showed significant differences in 13 of the 21 parameters. The comparison between the OHT FDT- group, and both the POAG and OHT FDT+ group resulted in 13 of the 21 parameters to be significantly different.Stratus-OCT seems to show a higher ability in detecting significant differences between healthy, OHT, and early POAG eyes when compared to SAP and FDT. This suggests that the Stratus-OCT could show structural abnormalities before SAP or FDT visual field defects appear in patients at risk of developing glaucoma, which may be beneficial in making therapeutic decisions, especially in OHT patients.

Purpose: To compare the abilities of scanning laser polarimetry with the variable corneal compensator (GDx VCC) with those of optical coherence tomography (Stratus OCT) in discriminating between healthy and early-to-moderate perimetric glaucomatous eyes. Methods: A total of 95 glaucomatous patients (mean deviation − 3.7 ± 3.0 dB, pattern standard deviation 4.5 ± 2.7 dB) and 62 control subjects underwent imaging by the GDx VCC and Stratus OCT using both optic nerve head (ONH) and retinal nerve fibre layer (RNFL) scan protocols. One eye per patient was considered. Sensitivity at ≥ 90% specificity and area under the receiver operating characteristic curve (AROC) were calculated for each GDx VCC and Stratus OCT index. Results: The largest AROCs with Stratus OCT were associated with cup : disc area ratio (0.88) for ONH scan indices, and with average thickness (0.84) for RNFL scan indices. The nerve fibre indicator provided the greatest AROC for the GDx VCC indices (0.85). Conclusions: Both the GDx VCC and Stratus OCT instruments were shown to be useful in the detection of glaucomatous damage. The best performing indices for the GDx VCC and Stratus OCT with both ONH and RNFL scans gave similar AROCs, showing a moderate sensitivity in early-to-moderate glaucoma patients.

To determine if the N-30-F test with the new Humphrey Matrix instrument is comparable to the traditional frequency-doubling technology (FDT) N-30 test.A sample of 47 eyes from 47 patients (five normal subjects, 27 with ocular hypertension and 15 with glaucoma) underwent visual field (VF) testing with standard automated perimetry, and with FDT, using the FDT N-30 program, and the Matrix N-30-F program (using the same 19 tested points, full-threshold strategy, but with an enhanced algorithm to reduce testing time). The plots, mean deviation (MD), pattern standard deviation (PSD), defect locations and test time were compared.The agreement between the two tests was shown to be good, except for subjects with large VF defects, in which greater PSD values were observed with the FDT test, whereas the Matrix test gave a higher MD and number of abnormal test locations in the total deviation plot. A lack of agreement was also found for the number of abnormal test locations on the pattern deviation plot at any VF loss severity level. The test time for the Matrix test was significantly shorter.The FDT N-30 and Matrix N-30-F tests proved to be comparable in cases of early to moderate VF defects.

Purpose To evaluate the ability of scanning laser polarimetry (SLP) with a fixed corneal polarization compensator (GDx-FCC Nerve Fiber Analyzer) compared to one with a variable one (GDx-VCC) in the discrimination between healthy and early glaucomatous eyes. Methods Forty patients with early glaucomatous visual field defects, having a mean deviation of 3.1 ± 1.6 dB and a pattern standard deviation of 3.1 ± 0.9 dB, and 40 controls underwent both GDx-FCC and GDx-VCC. One eye per patient was considered. The cut-off point, taken as the value dividing healthy from glaucomatous eyes with highest probability, was determined for each GDx parameter. Linear discriminant functions (LDFs) were separately developed for GDx-FCC and GDx-VCC parameters. Sensitivity, specificity, and area under the receiver operating characteristic curve (AROC) for discriminating between healthy and glaucomatous eyes were calculated for each GDx parameter, both according to the GDx normative database and after the selection of new cut-off points, and for the LDFs. Results All software-provided parameters showed low sensitivity and high specificity. The selection of new cut-off points improved the performance of all GDx parameters: VCC parameters performed better than FCC parameters; the largest AROCs were associated with the superior/nasal ratio for the GDx-FCC (0.86) and with the Number for the GDx-VCC (0.87). The LDFs provided an AROC of 0.89 with both the GDx-FCC and the GDx-VCC parameters. Conclusions The GDx-VCC showed a higher ability in the early diagnosis of glaucoma when compared with the GDx-FCC. The individuation of the right cut-off point of selected parameters with both GDx settings performed better than the software-provided parameters, and comparably to the GDx parameters-based LDFs.

Aim: To compare rarebit perimetry (RBP) with standard achromatic perimetry (SAP) in detecting early glaucomatous functional damage. Methods: 43 patients with ocular hypertension (OH), 39 with early primary open angle glaucoma (POAG), and 41 controls were considered. Visual fields were assessed using the Humphrey field analyser (HFA) 30-2 and RBP tests. Differences among the groups were evaluated using Student-Newman-Keuls and χ 2 tests. Correlation between HFA and RBP parameters was assessed using the Pearson’s correlation coefficients and regression analysis. Sensitivity and specificity of RBP in detecting early glaucomatous visual damage were calculated with different algorithms. Results: RBP-mean hit rate (MHR) was respectively 88.6% (SD 4.8%) in controls; 79.1% (10.9%) in the OH group; 64.3% (13.8%) in the POAG group (differences statistically significant). Good correlation in the POAG group was found between HFA-mean deviation and RBP-MHR. Largest AROC (0.95) and optimal sensitivity (97.4%) were obtained when an abnormal RBP test was defined as having (at least 1): MHR 15 areas with a non-hit rate of >10%; ⩾2 areas with a non-hit rate of >50%; at least one area with a non-hit rate of ⩾70%. Conclusions: The RBP appeared to be a rapid, comfortable, and easily available perimetric test (requiring only a PC device), showing a high sensitivity and specificity in detecting early glaucomatous visual field defects.

PurposeTo study the relationship between pupil size and AMO-Array multifocal intraocular lens (MIOL) performance in a population of elderly patients.MethodsThis prospective trial included 62 patients (mean age 76 years; range 70 to 86) undergoing bilateral cataract phacoemulsification and MIOL (AMO-Array SA-40N, Allergan) implantation. Patients were divided into two groups based on preoperative pupil diameter: small pupil group (pupil size of 2.5–2.9 mm; 45 subjects) and large pupil group (pupil size of 3–5 mm; 17 subjects). The analysis included uncorrected (UC) and best-corrected (BC) near and distance visual acuity (VA), spectacle dependence, and photic phenomena complaints (postoperative follow-up 16.6±6.2 months; range 11–26 months).ResultsPatients in the small pupil group showed postoperatively significantly higher distance UCVA and BCVA, but lower near UCVA compared to those in the large pupil group (Mann-Whitney test, p≤0.02). Patients with small pupils also tended to: be more (not statistically significant) spectacle independent for distance (73.3% versus 47.1%) and spectacle-dependent for near vision (55.6% versus 28.4%); report significantly less photic phenomena complaints (37.8% versus 93.1%, chi-square test, pConclusionsBilateral AMO-Array MIOL implantation in elderly patients seems to be an effective and safe surgical procedure that improves distance and near UCVA, providing spectacle independence in many cases. The use of these MIOLs, however, can induce photic phenomena and cause PCO. Patients with small preoperative pupils (