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Nelly N Kabedi,1 Jean-Claude Mwanza1,2 1Department of Ophthalmology, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo; 2Department of Ophthalmology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USACorrespondence: Nelly N KabediDepartment of Ophthalmology, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the CongoTel +243-971-183-249Email nelnkabedi@gmail.comAbstract: We report three cases of optic nerve toxoplasmosis, an unusual form of ocular toxoplasmosis. In one patient, the optic nerve involvement occurred in an eye with a toxoplasmic chorioretinal scar and choroidal neovascularization in the supramacular area, subretinal fibrosis, and pigment epithelium detachment. The other two patients had papilledema without healed or active chorioretinal lesions, but both had retinal hemorrhage and macular involvement. The diagnosis was based on clinical examination and elevated serum toxoplasma antibodies. Optical coherence tomography helped uncover the structural chorioretinal changes. All patients were treated with a combination of oral antitoxoplasmic drugs, oral prednisone, and intravitreal injection of bevacizumab. Visual acuity improved in all of them. Optic nerve involvement in ocular toxoplasmosis must be considered when papilledema occurs both in isolation and/or in the presence of an active or scarred chorioretinal lesion.Keywords: optic nerve toxoplasmosis, neuroretinitis, neovascularization, retinal hemorrhage

Sabrina N Mukash,1 David L Kayembe,1 Jean-Claude Mwanza1,2 1Department of Ophthalmology, School of Medicine, Kinshasa University Hospital, Kinshasa, Democratic Republic of Congo; 2Department of Ophthalmology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USACorrespondence: Sabrina N MukashDepartment of Ophthalmology, School of Medicine, Kinshasa University Hospital, Kinshasa, Democratic Republic of CongoTel +243 816917089Email mukashsaby@gmail.comObjective: To assess the agreement between retinoscopy and autorefractometry and between subjective refraction and both retinoscopy and autorefractometry in Congolese children.Patients and Methods: Fifty-four children (6– 17 years old) were enrolled consecutively in this cross-sectional study. Refraction was evaluated before and after cycloplegia (1% cyclopentolate) with retinoscopy and autorefractometry. Readings were compared (paired t-test) and agreement assessed with Bland–Altman plots. Subjective refraction was compared with the two methods to determine which one provides better reference estimates for subjective refraction.Results: Under cycloplegia, the spherical power was comparable between retinoscopy and autorefractometry (1.12 ± 1.37 D vs 1.22 ± 1.06D, P = 0.70), cylinder power was significantly more myopic on retinoscopy than autorefractometry (0.80 ± 1.10D vs − 0.62 ± 0.66, P = 0.019), and SE was greater on autorefractometry than retinoscopy (0.91 ± 1.10D vs 0.72 ± 1.00D, P = 0.014). Retinoscopy and autorefractometry overestimated the power of spherical (P = 0.022 and 0.002, respectively) and cylindrical components (all P < 0.001). There was an agreement between retinoscopy and autorefractometry in measuring spherical (bias: 0.09 ± 0.16D; limit of agreement, LoA: − 0.40 to 0.22D) and cylindrical power (bias: − 0.18 ± 0.20D; LoA: − 0.57 to 0.21D). Subjective refraction agreed with cycloplegic retinoscopy for determining SE power (bias: 0.11D; LoA: − 0.51 to 0.73D).Conclusion: Retinoscopy and autorefractometry can be used interchangeably in children for determining the power of spherical and cylindrical components. Cycloplegic retinoscopy is better than autorefractometry to obtain SE reference values for subjective refraction in children.Keywords: retinoscopy, autorefractometry, subjective refraction, agreement

Purpose: To characterize corneal and conjunctival abnormalities (CCAs) and their impact on visual acuity in a cohort of survivors from the Western African Ebola virus disease (EVD) outbreak., Design: A post hoc analysis of 121 patients, who had previously undergone screening for the Ebola Virus Persistence in Ocular Tissues and Fluids study, was performed., Methods: Patients underwent a comprehensive ophthalmic exam at the Lowell and Ruth Gess Eye Hospital in Freetown, Sierra Leone. Demographic (including age, sex, and the number of days spent in the Ebola treatment unit and examination (such as visual acuity, and ocular complications) data were collected and used for the analysis. Visual acuity was either uncorrected or corrected with spectacles. Descriptive and inferential statistical analyses were performed, and a p-value < 0.05 was considered statistically significant., Results: A total of 242 eyes (121 patients) were included in this study. The mean age was 31.5 ± 16.1 years, and 70 % were female. Of 242 eyes, 28 (11.5 %) eyes of 15 patients (12.4 %) presented with at least one or more corneal or conjunctival abnormalities. Within eyes that demonstrated CCAs, the findings included dry eye (28.6 % of eyes), band keratopathy (25 % of eyes), and corneal scar (21.4 % of eyes). Corneal edema was found in 14.3 % of eyes, while pterygium and epithelial bullae were each found in 7.1 % of affected eyes. Patients without CCAs had better visual acuity compared to patients with CCAs although the difference was not statistically significant (0.82 ± 1.17 vs 1.01 ± 1.29, p = 0.4). A subset of patients with CCAs also reported ocular symptoms including eye pain, light sensitivity, excessive tearing, and blurry vision., Conclusion: In this post hoc analysis, we observed CCAs in 12 % of EVD survivors. These findings highlight the potential for corneal and conjunctival sequelae during EVD survivorship and the need for ongoing ophthalmic care for this vulnerable population., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Steven Yeh reports financial support was provided by National Eye Institute. Steven Yeh reports financial support was provided by Macula Society Retina Research Foundation Cox Family Grant. Steven Yeh reports financial support was provided by Association for Research in Vision and Ophthalmology Mallinckrodt Foundation Young Investigator Award. Steven Yeh reports financial support was provided by Stanley M. Truhlsen Family Foundation, Inc. Jessica Shantha reports financial support was provided by National Eye Institute. Brent Hayek reports a relationship with Amgen Inc that includes: speaking and lecture fees. Ian Crozier reports financial support was provided by National Cancer Institute. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Competing Interests: The authors declare that they have no conflicts of interest to disclose.

During the last decade, global health security has been threatened by major Ebola virus disease outbreaks in Western Africa (2014 to 2016) and in eastern Democratic Republic of the Congo (2018 to 2020). Particularly in Western Africa, the outbreak initially overwhelmed health care capacity in already fragile health systems. Thousands of survivors were at risk of newly recognized postacute ocular complications, and their need for urgent ophthalmic care challenged national vision health systems with scarce eye care services. In these unprecedently large outbreaks with implications for global health security, agile eye care responses were challenging, including in regard to decision coordination and requisite logistical needs. In this report, we detail vision care initiatives implemented in response to these outbreaks and highlight the need to include vision care as a critical component of the response to infectious disease outbreaks with eye health implications., Competing Interests: The authors declare that they have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

First identified in the Democratic Republic of the Congo (DRC, formerly Zaire) in 1976, Ebola virus disease (EVD) outbreaks have afflicted thousands of Congolese over the past several decades. The nation's largest outbreak of EVD in 2018-2020 was complicated by security challenges as well as large case numbers across an expansive geographic region. These factors provided challenges for logistical considerations as well as clinical coverage. In conjunction with the EVD survivor care program spearheaded by the Ministry of Health in DRC, the DRC Intitut National de Recherche Biomédicale, (DRC Institut National de Recherche Biomedicale, DRC National Institute of Biomedical Research) and others, we launched a multidimensional effort to provide ophthalmic care to EVD survivors. During the engagement period, 237 EVD survivors were screened, 56% of which were women. The 237 EVD survivors constituted ∼75% of the total EVD survivors who were discharged at the time of the intervention. The mean time from EVD symptom onset to evaluation was 4.6 months ± 1.8 SD (range: 24 d to 8.5 mo). Ninety-seven (41%) of EVD survivors screened reported ocular symptoms during or after acute illness, such as itchy eyes (49%), eye pain (25%), and tears (24%). Ophthalmic findings, including retinal scarring, active uveitis, dry eye disease, cataracts, and glaucoma, were also identified. The need for continued monitoring and longitudinal care for EVD survivors is evident from the expanding body of literature pertaining to post-acute sequelae, including ophthalmic manifestations. Initiatives for such care should be conducted across and in conjunction with multidisciplinary stakeholders for contextualization and effectiveness., Competing Interests: The authors declare that they have no conflicts of interest to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Mpox (formerly known as monkeypox), an infectious disease caused by the monkeypox virus (MPXV), has been endemic in regions of Central and Western Africa. In 2022, the global spread of the clade IIb MPXV led to a multinational outbreak, primarily affecting sexual transmission networks among men who have sex with men. Despite interventions, new cases have continued to emerge. In Africa, the spread of a novel strain of clade I MPXV, clade Ib, has prompted a Public Health Emergency of International Concern designation by the World Health Organization in August 2024. This article provides an updated overview of the epidemiology, systemic, and ocular manifestations, highlighting the clinical features, diagnostic testing, and implications relevant to ophthalmologists and eye care providers, including infection prevention and control measures. The ocular manifestations of mpox primarily involve the ocular surface and anterior segment, with presentations ranging from conjunctivitis to severe, vision-threatening keratitis and uveitis. While the 2022 to 2024 Clade IIb outbreak has shown a lower incidence of ocular involvement compared with previous outbreaks, the potential for significant visual morbidity remains. Treatment involves both systemic and topical therapies, with tecovirimat being the primary systemic option, though its efficacy and ophthalmic bioavailability remain under investigation. Ongoing surveillance and research are essential to further understand the epidemiology and ophthalmic features of mpox and, ultimately, to optimize prevention and treatment strategies for patients., Competing Interests: The authors declare that they have no conflicts of interest to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: The initiative 2030 In Sight and the International Agency for the Prevention of Blindness have developed a plan to mitigate the global burden of preventable sight loss. One priority of this initiative is obtaining population eye health data. East Africa is a region that has historically been plagued by high rates of vision loss, and it is imperative to understand what causes are at play. Two large cross-sectional studies were previously published in 1995 and 2009, reporting the causes of childhood blindness (BL) and severe visual impairment (SVI) in East Africa. An update regarding more recent causes is warranted to better understand the trends of childhood BL/SVI in this region., Methods: A search strategy was developed a priori to identify relevant terms and align them with a standardized definition of East Africa. This strategy was then employed across PubMed, Google Scholar, and Scopus, with the yield of the overall search depicted in a Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 flow diagram. In the articles gathered by the search, causes of BL/SVI were typically categorized by anatomy and etiology., Results: Eight articles met the criteria, with data from 6 countries, consisting of 534 cases of childhood BL/SVI. Common anatomic locations identified included the cornea, lens, and whole globe. Among the most common etiologies were corneal scarring/opacity and cataract. Systemic etiologies and disease associations included measles, toxoplasmosis, and prematurity. Presumptive infectious disease and hereditary conditions were also identified as a category, but specific identification of etiologies and genetic diagnosis was largely unavailable., Conclusions: BL/SVI due to the cornea was among the common anatomic sites of disease in our study. The identification of measles as an associated systemic etiology requires further understanding in the context of increased vaccination programs. Multiple articles acknowledged that cataract has become the predominant cause of BL/SVI owing to increased measles vaccination and vitamin A supplementation. Additional research should be conducted to gain a complete understanding of childhood BL/SVI in East Africa, and responses at regional and national levels are likely necessary to address treatable causes of vision impairment., Competing Interests: The authors declare that they have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

A range of challenges exists regarding vitreoretinal (VR) surgical services in resource-limited settings, including Sierra Leone. As a result, retinal pathologies may contribute to vision loss and blindness. In the wake of the 2013 to 2016 outbreak of Ebola virus disease in West Africa, gaps in ophthalmic care were underscored as survivors were experiencing a constellation of sequelae, including uveitis and VR disease. Given the unmet needs in addressing VR disease, systems for retinal surgical care were required. To further understand long-term ocular complications in Ebola survivors and molecular and immunologic factors associated with this, research infrastructure was developed for retinal evaluation and surgery. The 5 "S'" framework was implemented and considered staff, space, stuff, systems, and social support. The ongoing development of retinal health infrastructure has helped to address challenges related to program implementation, development of surgical capacity, and alignment with local stakeholders and collaborator objectives. VR surgical services have been established in Sierra Leone through multidisciplinary partnerships and collaboration and serve patients in-country, as well as others in West Africa who have traveled for care. Continued engagement across stakeholders can aim to address challenges and promote effective care delivery., Competing Interests: The authors declare that they have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Prcis: Initial presentation of glaucoma at a major eye clinic mostly features advanced disease with a high proportion of blindness. This is likely a microcosm of a nationwide issue requiring concerted strategies to detect glaucoma early., Purpose: To characterize the severity stage of new glaucoma patients in Congolese attending a university eye clinic., Methods: New glaucoma patients (n=118) were labeled as early or late presenters based on visual field sensitivity in the worse eye., Results: Mean age was 58.9±15.7 years, 51.7% were males. Overall, the worse eye had advanced, whereas the better eye had moderate glaucoma, with an asymmetry of -7.4 dB ( P <0.001). Blindness was present in 30.5% of worse and 5.1% of better eyes. Seventy-two patients (61.0%) were late presenters. Visual acuity was lower ( P <0.001), intraocular pressure (IOP) higher ( P =0.02), cup-to-disc ratio larger ( P =0.011), and retinal nerve fiber layer thinner ( P =0.001) in late presenters' worse than better eye. The worse and better eyes of late presenters had advanced glaucoma, with a -9.6 dB interocular asymmetry ( P <0.001); 40.3% and 8.3% were blind, respectively. In early presenters, the worse and better eyes had moderate and early disease, respectively; the asymmetry was -3.2 dB ( P <0.001), and 15.2% were blind. Overall, 58.5% and 65.3% presented with advanced disease in the worse eye based on visual field and cup-to-disc ratio criteria of the Canadian Ophthalmological Society staging scale, respectively., Conclusions: Most new glaucoma patients had bilateral advanced but asymmetric disease. These findings call for the establishment of community-based measures for early detection of glaucoma and a referral network system connecting community healthcare to tertiary eye clinics., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Childhood blindness is an issue of global health impact, affecting approximately 2 million children worldwide. Vision 2020 and the United Nations Sustainable Development Goals previously identified childhood blindness as a key issue in the twentieth century, and while public health measures are underway, the precise etiologies and management require ongoing investigation and care, particularly within resource-limited settings such as sub-Saharan Africa. We systematically reviewed the literature on childhood blindness in West Africa to identify the anatomic classification and etiologies, particularly those causes of childhood blindness with systemic health implications. Treatable causes included cataract, refractive error, and corneal disease. Systemic etiologies identified included measles, rubella, vitamin A deficiency, and Ebola virus disease. While prior public health measures including vitamin A supplementation and vaccination programs have been deployed in most countries with reported data, multiple studies reported preventable or reversible etiologies of blindness and vision impairment. Ongoing research is necessary to standardize reporting for anatomies and/or etiologies of childhood blindness to determine the necessity of further development and implementation of public health measures that would ameliorate childhood blindness and vision impairment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Yeh, Huang, Huang, Hartley, Fashina, Ashby, Miller, Shantha, Justin, Chan, Mattia, Vandy, Harrison-Williams, Mustapha, Mwanza and Yeh.)

Aims and Background: Practice guidelines assert that high-risk glaucoma suspects should be treated. Yet, there is ambiguity regarding what constitutes a high enough risk for treatment. The purpose of this study was to determine which factors contribute to the decision to treat glaucoma suspects and ocular hypertensive patients in an academic ophthalmology practice., Materials and Methods: Retrospective cohort study of glaucoma suspects or ocular hypertensives at an academic ophthalmology practice from 2014 to 2020. Demographics, comorbidities, intraocular pressure (IOP), optical coherence tomography (OCT) findings, and visual field measurements were compared between treated and untreated patients. A multivariable logistic regression model assessed predictors of glaucoma suspected treatment., Results: Of the 388 patients included, 311 (80%) were untreated, and 77 (20%) were treated. There was no statistical difference in age, race/ethnicity, family history of glaucoma, central corneal thickness (CCT), or any visual field parameters between the two groups. Treated glaucoma suspects had higher IOP, thinner retinal nerve fiber layers (RNFL), more RNFL asymmetry, thinner ganglion cell-inner plexiform layers (GCIPL), and a higher prevalence of optic disc drusen, disc hemorrhage, ocular trauma, and proliferative diabetic retinopathy (PDR) ( p < 0.05 for all). In the multivariable model, elevated IOP {odds ratio [OR] 1.16 [95% confidence interval (CI) 1.04-1.30], p = 0.008}, yellow temporal [5.76 (1.80-18.40), p = 0.003] and superior [3.18 (1.01-10.0), p = 0.05] RNFL quadrants, and a history of optic disc drusen [8.77 (1.96-39.34), p = 0.005] were significant predictors of glaucoma suspect treatment., Conclusion: Higher IOP, RNFL thinning, and optic disc drusen were the strongest factors in the decision to treat a glaucoma suspect or ocular hypertensive patient. RNFL asymmetry, GCIPL thinning, and ocular comorbidities may also factor into treatment decisions., Clinical Significance: Understanding the clinical characteristics that prompt glaucoma suspect treatment helps further define glaucoma suspect disease status and inform when treatment should be initiated., How to Cite This Article: Ciociola EC, Anderson A, Jiang H, et al. Decision Factors for Glaucoma Suspects and Ocular Hypertensive Treatment at an Academic Center. J Curr Glaucoma Pract 2023;17(3):157-165., Competing Interests: Source of support: Alicia Anderson: NIH/NIA 2-T35-AG038047, UNC Chapel Hill National Training Center, Center for Aging & Health, MSTAR Program. Conflict of interest: None, (Copyright © 2023; The Author(s).)

Prcis: In both pre-perimetric and early perimetric glaucoma, the diagnostic agreements between optic disk, retinal nerve fiber layer, and ganglion cell-inner plexiform layer parameters based on Cirrus HD-OCT normative database classification were mostly fair, suggesting that abnormal classification in 1 anatomic area may suffice for the diagnosis of glaucoma in early stages., Purpose: To evaluate the agreement of normative database diagnostic classification between optic disk, retinal nerve fiber layer (RNFL), and ganglion cell-inner plexiform layer (GCIPL) in patients with early glaucoma., Methods: Retrospective cross-sectional study involving 66 eyes (66 patients) with pre-perimetric and 97 eyes (97 patients) with early perimetric glaucoma. Normative database diagnostic classifications were retrieved from Cirrus HD-OCT scans of 1 eye per participant. An eye was considered abnormal if any of the optic disk, RNFL, or GCIPL was abnormal (yellow or red color-coded classification). For combined parameters, the eye had to be flagged as abnormal by both classifications, regardless of the parameters that were abnormal (global or sectorial). The agreement was assessed with Cohen's Kappa statistics., Results: The agreement between RNFL and GCIPL was fair in both pre-perimetric (κ=0.25) and perimetric glaucoma (κ=0.21). Agreements between RNFL or GCIPL and optic nerve head parameters (rim area and vertical cup-to-disk ratio; VCDR) were inconclusive due to insufficient data ( P >0.05). Combining GCIPL and rim area agreed fairly with RNFL both in pre-perimetric (κ=0.21) and perimetric glaucoma (κ=0.33). The best classification agreement (moderate) was achieved with the comparison of RNFL-rim area versus VCDR (κ=0.48 in pre-perimetric, 0.45 in perimetric glaucoma). There were no significant differences between pre-perimetric and perimetric glaucoma coefficients of classification agreement., Conclusions: The normative database diagnostic agreements between optic disk, RNFL, and GCIPL were mostly fair in both pre-perimetric and early perimetric glaucoma. Clinicians should not wait for multiple structures to show abnormality on OCT to diagnose early glaucoma., Competing Interests: Disclosure: D.L.B. and J.C.M. hold a patent licensed to Carl Zeiss Meditec, Inc. for Cirrus HD-OCT. D.L.B. has received honoraria for speaking from Carl Zeiss Meditec, Inc. The remaining authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Prcis: The annual incidence of glaucoma progression (9.7%) and rates of visual field mean deviation (MD) change in progressors (-1.02±0.06 dB/y) are high in a small cohort of urban Ghanaians., Purpose: To report the incidence of glaucoma progression and the rate of visual field deterioration in a small cohort of Ghanaians., Methods: One hundred ten subjects (204 eyes) diagnosed with glaucoma at a baseline population-based screening examination were re-examined a mean of 8.3±0.8 years later. Eyes were classified as having progressed if the optic disc alone, visual field alone or both showed significant glaucomatous changes on follow-up. Visual field MD was used to calculate the rate of visual field progression., Results: Progression was observed in 89 (80.9%, 9.7%/year) subjects (130 eyes). Progression occurred in 32 (31.7%, 3.8%/year) subjects by optic disc alone (46 eyes), 38 (44.7%, 5.4%/year) subjects by visual field alone (58 eyes), and 19 (25.0%, 3.0%/year) subjects by both modalities (26 eyes). The average rate of change in MD differed significantly between progressors (-1.02±1.06 dB/y) and nonprogressors (+0.089±0.49 dB/y), P =0.001. The rate of visual field worsening was greater among those who were classified as having progressed by both structure and function (-1.29±0.68 dB/y) and by function alone (-1.21±1.20 dB/y) than by structure alone (-0.55±0.76 dB/y). Progression was significantly associated with older age [odds ratio (OR), 1.42; P <0.001] and higher baseline intraocular pressure (OR, 1.18; P =0.002). Factors associated with rate of MD change were baseline older age (OR, 1.66; P =0.003), higher intraocular pressure (OR, 2.81; P =0.007), better visual field MD (OR, 1.41; P =0.004), and systemic hypertension (OR, 1.15; P =0.029)., Conclusion: The incidence and rate of visual field progression are high in this longitudinal study of Ghanaian subjects with glaucoma. The findings may have important clinical and public health policy ramifications., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To investigate the performance of the Melbourne Rapid Fields (MRF) for use in clinic-based visual field testing in a low-resource setting., Design: Prospective cross-sectional study., Participants: One hundred and three participants (66 patients with glaucoma and 37 control participants) attending a clinical appointment at the Tema Eye Center, Tema, Ghana., Methods: Patients with glaucoma and control participants underwent MRF and Humphrey Field Analyzer (HFA) testing., Main Outcome Measures: Mean deviation (MD), pattern standard deviation (PSD), reliability parameters, sensitivity, specificity, and area under the receiver operating characteristic curve., Results: Mean MD was less negative and mean PSD was more positive on the MRF than the HFA in both groups (all P < 0.001). False-positive and false-negative rates were comparable between methods (P = 0.09 and P = 0.35, respectively). In patients with glaucoma, MD and PSD from the 2 devices were correlated strongly (r = 0.84; P < 0.001) and moderately (r = 0.61; P < 0.001), respectively. Agreement analysis revealed that MRF tended to generate significantly higher MD (bias, 3.3 ± 4.1 dB; P = 0.03) and PSD (bias, 1.9 ± 2.8 dB; P = 0.03) with wide limits of agreement. For detecting moderate to advanced glaucoma, the sensitivity was 60.9% for the MRF and 78.3% for the HFA (P = 0.10); respective specificities were 86.5% and 83.8% (P = 0.76)., Conclusions: The MRF underestimated MD and overestimated PSD values compared with the HFA. Agreement biases were significant, suggesting a weak agreement between the 2 devices. However, the MRF showed potential for screening in a low-resource setting, particularly for detecting moderate to advanced glaucoma., (Published by Elsevier Inc.)

Purpose: To determine the limits of normal interocular symmetry and the repeatability of central corneal thickness (CCT) and endothelial cell morphology and density., Methods: Two hundred and seventy-eight subjects (age: 10.9-80.7 years) with healthy eyes were studied. CCT as well as endothelial cell morphology and density were measured by non-contact specular microscopy. Three measurements were obtained per eye per participant. Upper and lower tolerance limits of normal interocular symmetry were defined as the 2.5th and 97.5th percentiles of the interocular differences in CCT, endothelial cell density (CECD), coefficient of variation (CoV), hexagonality, and cell size. Repeatability was determined using the intraclass coefficient correlation (ICC), the coefficient of variation (CV), and the test-retest variability standard deviation (TRTSD)., Results: The mean interocular differences were -1.05 ± 17.5 µm ( p = .32) for CCT and 0.5 ± 90.8 cells/mm 2 ( p = .76) for CECD. The 2.5th and 97.5th percentiles of the interocular differences were -13.9 and 15.4 µm for CCT and -177.4 cells/mm 2 to 182.0 cells/mm 2 for CECD. Only interocular difference in CoV correlated weakly with age ( r = -0.22, P < .001). ICCs were 0.93 (95% CI: 0.89-0.96, P < .001) for CCT and 0.95 (0.94-0.96, P < .001) for CECD. CV and TRTSD were 1.2% ± 5.3% and 4.4 ± 3.4 µm for CCT and 2.4% ± 3.9% and 17.7 ± 7.7 cells/mm 2 for CECD, respectively., Conclusions: CCT and CECD showed good repeatability and interocular symmetry in normal Congolese subjects. Absolute interocular differences in CCT and CECD exceeding 15.5 µm and 182 cells/mm 2 , respectively, should be considered suspicious and investigated. When comparing two intrasession measurements from the same eye, a difference of approximately 4.5 µm in CCT and 18 cells/mm 2 or greater may be considered statistically significant.

Purpose: To assess the vision-related quality of life (QoL) in Congolese patients with glaucoma and its associated factors., Methods: Ninety-four patients with open-angle glaucoma and 42 age-matched controls were included in the study. QoL was evaluated using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). QoL scores were compared between patients and controls. Correlation analysis was run to assess the association of QoL scores with visual function measures. Multivariate linear regression analyses were used to identify demographic and clinical factors that independently predict the overall QoL and its subdomains., Results: The QoL composite score (QoL-CS) of glaucoma patients (60.2 ± 30.5) was 31.7% lower than that of controls (87.9 ± 9.5), p < 0.001. QoL subdomain scores were also significantly lower in glaucoma patients than controls (all p < 0.001), with a reduction rate oscillating between 16.5% for color vision and 61.1% for general health. Best-corrected visual acuity (BCVA) of both better seeing eye (BSE) and worst seeing eye (WSE) correlated significantly with QoL-CS (variance: 50.4% and 42.3%, respectively). The correlations of QoL-CS with BSE (variance: 12.9%) and WSE (variance: 16.8%) visual field MD were also significant, but the strengths were weaker than those of BCVA. Every increase of BSE's BCVA by one line improved QoL-CS by 43.4., Conclusion: Vision-related quality of life in glaucoma patients is significantly impaired in Congolese patients with glaucoma, starting in the early stage of the disease. BCVA of the BSE emerged as an independent significant predictor of overall QoL and most of its components., How to Cite This Article: Kapinga IK, Kayembe DL, Mwanza JC. Vision-related Quality of Life in Congolese Patients with Glaucoma. J Curr Glaucoma Pract 2022;16(1):24-30., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2022; The Author(s).)

Objective: To evaluate the response of polypoidal choroidal vasculopathy (PCV) in eyes treated with intravitreal bevacizumab (BVZ) and untreated fellow eyes in black Africans., Methods: We studied 22 eyes (12 patients) divided into 12 treated and 10 untreated eyes from January 2017 to January 2020. Treated eyes received 1 monthly injection of BVZ 2.5mg for 3 months, with optional additional injections depending on the patient's course. Both groups of eyes were evaluated at presentation and then at 3, 6, 9, and 12 months after treatment. Outcome measures were visual acuity (VA) and ophthalmoscopic and OCT findings., Results: The mean age of the patients was 66.3±5.6 years. In treated eyes, VA remained stable from 0.10±0.12 at baseline to 0.20±0.30 at month 12, P=0.84. VA was stable in 83.3% and improved in 16.7% of eyes. On OCT, 41.7% of eyes showed decreased and another 41.7% disappearance of subretinal fluid (SRF) at 12 months. Pigment epithelial detachment (PED) height decreased in 9 eyes (75.0%) but remained unchanged in 3 eyes (25%). In untreated eyes, no difference was observed between the baseline (0.53±0.42) and 12-month VA (0.58±0.40), P=0.82. VA improved in 2 eyes, decreased in one eye, and remained unchanged in 7 eyes. OCT lesions remained stable in 6 eyes. The PED enlarged in one eye but remained stable in 3 other eyes., Conclusion: Intravitreal injection of BVZ 2.5mg led to stabilization of VA, resorption of SRF, and reduction in the size of the PED in the majority of eyes with PCV but was ineffective on the polyps. The one-year prognosis in untreated eyes with PCV was favorable and marked by functional and structural stability., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: The use of monoscopic cameras for glaucoma screening is increasing due to their portability, lower cost, and non-mydriatic capabilities. However, it is important to compare the accuracy of such devices with stereoscopic cameras that are used clinically and are considered the gold standard in optic disc assessment. The aim of this study is to compare vertical cup-to-disc ratio (VCDR) estimates obtained using images taken with a monoscopic and stereoscopic camera., Methods: Participants were selected from the Tema Eye Survey. Eligible subjects had images of at least one eye taken with two cameras. They were classified as meeting the glaucoma threshold if an eye had a VCDR estimate >97.5th percentile, corresponding to >0.725 for this population. Hence, we used 0.725 as the cutoff to group eyes into two categories: positive and negative. We calculated sensitivity, specificity, and predictive values of VCDR assessed by expert readers at a reading center for monoscopic photos using stereoscopic photos as the gold standard., Results: Three hundred and seventy-nine eyes of 206 participants were included in the study. Most participants were female (60.2%) and the most common age group was 50-59 years (36.4%). Sixteen eyes met the glaucoma threshold (VCDR > 0.725). Of these, the VCDR estimates of 14 eyes (87.5%) disagreed on the glaucoma threshold from the two cameras. The sensitivity to detect glaucoma with the monoscopic camera was 14.3% (95% CI: 4.0, 40.3)., Conclusions: The low sensitivity of monoscopic photos suggests that stereoscopic photos are more useful in the diagnosis of glaucoma., (© 2021. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Objective: To assess the quality of timolol eye drops sold in Kinshasa, Democratic Republic of Congo (DRC)., Methods: Seven samples of timolol maleate 0.5% were purchased over the counter in seven randomly selected public pharmacies in 3 neighborhoods in Kinshasa. They were submitted to a quality assessment that included visual inspection, spectrophotometry, high performance liquid chromatography (HPLC), and bacteriologic assessment., Results: The samples came from France (n=2), India (n=2) and DRC (n=3). Overall, 3 (2 from India and 1 from the DRC) of the 7 samples, or 3 out of the 5 from developing countries, showed various abnormalities consistent with substandard drugs. One sample (India) demonstrated an incorrect pH, while 3 (2 from India and one from the DRC) had lower than stated volumes as well as lower than required concentrations of the active pharmaceutical ingredient. In addition, one sample from the DRC was bacteriologically contaminated., Conclusion: These results suggest that some timolol maleate eye drops from Congolese and Indian manufacturers sold in Kinshasa are of substandard quality. This may reflect deficiencies in the manufacturers and local authorities charged with regulation of the quality control and sale of pharmaceuticals. Passing a visual inspection does not necessarily indicate that a drug is not substandard. Analytical chemistry testing and bacteriologic analysis are required to determine with certainty the quality of the drug., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Purpose: To determine the pachymetric and corneal endothelial cell morphometric features and their relationship to ocular and systemic factors in healthy Congolese subjects., Methods: Non-contact specular microscopy was used in 278 healthy eyes (278 subjects) to measure central corneal thickness (CCT), corneal endothelial cell density (CECD) along with cell size, coefficient of variation (CV) in cell size, and hexagonality (HEX). The lower and upper reference limits and average values for each parameter were determined. Correlation and association of average values with anthropo-demographic and clinical variables were assessed., Results: The mean age was 38.9 ± 17.2 years (10.9-80.7 years). Average values were 504.2 ± 30.7 μm (CCT), 2907.1 ± 290.9 cells/mm 2 (CECD), 348.5 ± 38.4 μm 2 (cell size), 32.9 ± 3.6% (CV), and 51.8 ± 7.2% (HEX). CCT was 504.9 ± 33.6 μm in men and 503.6 ± 28.3 μm in women (p = .73); values for CECD were 2917.1 ± 253.5 cells/mm 2 and 2899.2 ± 317.8 cells/mm 2 (p = 0.61), respectively. Lower and upper reference limits were 449.6 μm and 566.0 μm for CCT, and 2165.3 cells/mm 2 and 3414.4 cells/mm 2 for CECD, respectively. CCT correlated with body mass index (BMI), (r = - 0.12, P = 0.04). CECD decreased with age (r = - 0.49, P < 0.001), BMI (r = - 0.20, P = 0.001), intraocular pressure (r = - 0.13, P = 0.029) and ocular perfusion pressure (r = - 0.28, P = 0.028). CECD decayed by 8.3 cells/mm 2 or 0.30% per year of age and CCT decreased by 0.72 μm per kg/m 2 ., Conclusions: Mean central cornea was thinner, CECD higher, and references limits lower than reported in other African populations. The CCT and CECD normative values reported herein will be useful for both clinical and research purposes in this population.

Aim: To determine the frequency and types of retinal diseases and the extend of the related visual loss in adult patients attending two public eye clinics of Kinshasa, Democratic Republic of Congo., Methods: Review of medical records of patients with retinal diseases seen in the major eye clinics in Kinshasa, the University Hospital of Kinshasa (UHK) and Saint Joseph Hospital (SJH), from January 2012 to December 2014. Demographics and diagnoses were retrieved and analyzed. Outcome measures were frequency and prevalence of retinal diseases, blindness and low vision., Results: A total of 40 965 patients aged 40y or older were examined during this period in both clinics. Of these, 1208 had retinal disease, giving a 3-year and an annual prevalence of 3% and 1%, respectively. Mean age was 61.7±10.7y, and 55.8% of the patients were males. Arterial hypertension (68.1%) and diabetes (43.3%) were the most common systemic comorbidities. Hypertensive retinopathy (41.8%), diabetic retinopathy (37.9%), age-related macular degeneration (AMD; 14.6%), and chorioretinitis and retinal vein occlusion (7.3% each) were the most common retinal diseases, with 3-year prevalence rates of 1.3%, 1.0%, 0.43%, and 0.21% respectively. Bilateral low vision and blindness were present in 26.8% and 8.4% of the patients at presentation. Major causes of low vision and blindness were diabetic retinopathy (14.8%), AMD (4.9%), retinal detachment (2.8%), and retinal vein occlusion (2.5%). The prevalence was significantly higher among males than females, and at the UHK than SJH., Conclusion: Retinal diseases are common among Congolese adult patients attending eye clinics in Kinshasa. They cause a significant proportion of low vision and blindness., (International Journal of Ophthalmology Press.)

Objective: To assess the impact of polypoidal choroidal vasculopathy (PCV) on quality of life (QoL) and mental health in a cohort of Congolese patients., Methods: Fifteen PCV patients and 26 age-matched controls completed the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and the Hospital Anxiety and Depression Scale (HADS) questionnaire. Outcome measures were QoL and HADS scores, frequency of anxiety and depression, correlations between best-corrected distance visual acuity (BCDVA) and QoL and HADS scores. Risk factors for anxiety and depression were also determined., Results: The QoL composite score was (54.9 ± 24.2) in patients and (94.5 ± 4.5) in controls, p <.001. Patients scored higher on HADS-A (9.5 ± 3.4) and HADS-D (6.7 ± 4.7) than controls (3.0 ± 2.7 and 1.5 ± 2.6), all p <.001. Anxiety and depression were present in 73.3% and 46.7% of patients, respectively, versus 1% each of controls ( p <.001). Every unit improvement in best eye's BCDVA increased QoL composite score by 24.3, but decreased HADS-D by 5.9. Macular lesions decreased QoL by 34.5 while increasing HADS-A and HADS-D scores by 4.2 and 4.4, respectively. A history of stroke also increased the HADS-A score by 5.9., Conclusions: PCV impairs the QoL and induces both anxiety and depression in Congolese PCV patients. Screening for QoL, anxiety and depression in PCV patients at first presentation will help detect those in need of psychological support.

Purpose: Polypoidal choroidal vasculopathy (PCV) is a visually debilitating disease that mostly affects people of African and Asian heritage. Indocyanine green angiography (ICGA) is the recommended exploratory method for definitive diagnosis. The disease has been extensively described in Asians and Caucasians, but not in Africans. This study was conducted to document the clinical presentation and optical coherence tomography features of polypoidal choroidal vasculopathy (PCV) in Congolese patients., Methods: A prospective case series of patients with PCV was performed between January 2017 and June 2019. Routine ocular examination was performed including best corrected visual acuity measurement, slit-lamp examination, dilated direct fundoscopy, and spectral domain optical coherence tomography (OCT). The diagnosis was based on a combination of clinical and OCT signs., Results: Fourteen patients were diagnosed with PCV during this period. The average age was 64.7 ± 6.9 years. There were 8 females. Ten (71.4%) patients had systemic hypertension. Most patients ( n  = 9, 64.3%) had bilateral involvement. Blurred vision was the most common complaint (71.4%). The main clinical presentation was subretinal exudates, seen in 19 (82.6%) eyes of 11 (78.6%) patients and subretinal hemorrhage in 10 (43.5%) eyes. Macular localization was found in 16 eyes (69.5%) of 12 (85.7%) patients. Drusen were observed in 35.7% of the patients. On OCT imaging, thumb-like pigment epithelial detachment and subretinal exudation were the most frequent features, observed in 92.9% and 71.4% of the patients, respectively., Conclusions: PCV in Congolese patients showed features that are more similar to those observed in Caucasians. In this setting where indocyanine green angiography is not available, OCT facilitates the diagnosis of PCV., Competing Interests: The authors declare no conflicts of interest regarding this article., (Copyright © 2020 Nelly N. Kabedi et al.)

Purpose: Describe a new method to analyze retinal nerve fiber layer (RNFL) thickness maps., Design: Cross-sectional study., Subjects: RNFL thickness maps of healthy and glaucomatous eyes., Methods: Optical coherence tomography (OCT) RNFL raster scans from 98 healthy and 50 glaucomatous eyes were analyzed. The RNFL thickness maps were separated into superficial (SNFL) and deep (DNFL) slabs through a partial thickness plane set at the modal thickness (mode). Association between mode and OCT signal strength (SS), age, axial length, and visual field mean deviation (VFMD) was tested (Pearson coefficient, r ). Thicknesses of inferior and superior SNFL regions (i-,s-SNFL), and inferior, superior, nasal, and temporal DNFL regions (i-,s-,n-,t-DNFL) were calculated. The regions thicknesses were compared between healthy and glaucomatous eyes (t-test) and between glaucomatous eyes with early, moderate, and severe disease (ANOVA and linear regressions of thickness on VFMD). Diagnostic accuracy and correlation with VFMD of RNFL regions thicknesses were calculated as the area under the receiver operating characteristic curve (AUC) and Pearson r, respectively. P <0.05 was considered significant., Main Outcome: Thickness of regions in SNFL and DNFL slabs., Results: The mode was not associated with SS, age, axial length, or VFMD, it circumscribed the thicker RNFL around the optic disc of healthy and glaucomatous eyes, and it was used to separate the SNFL and DNFL slabs of RNFL thickness maps. The thickness of the SNFL slab was less in glaucomatous eyes than in healthy eyes ( P <0.001). S-SNFL and i-SNFL thicknesses (respectively) were 86.0±8.2μm and 87.3±9.6μm in healthy eyes vs. 66.1±9.1μm and 63.4±8.2μm in glaucomatous eyes ( P <0.001 for both). The thickness of the DNFL slab was similar between groups ( P =0.19). T-DNFL thickness was 37.0±5.3μm in healthy eyes vs. 33.9±5.0μm in glaucomatous eyes ( P <0.001); thicknesses of all other DNFL regions were similar. The SNFL regions only thinned with progressively worse glaucoma severity, had excellent AUCs (AUC≥0.95, P <0.001), and correlated strongly with VFMD ( r ≥0.60, P <0.001)., Conclusions: Glaucomatous RNFL thinning is predominantly detected within a slab with thickness greater than the mode. SNFL thickness has great AUC and correlation with VFMD in glaucomatous eyes. The usefulness for diagnosis and monitoring of glaucoma needs further study., Competing Interests: Conflict of Interest No conflicting relationship exists for any author

Glaucoma disease progression, as measured by visual field (VF) data, is often defined by periods of relative stability followed by an abrupt decrease in visual ability at some point in time. Determining the transition point of the disease trajectory to a more severe state is important clinically for disease management and for avoiding irreversible vision loss. Based on this, we present a unified statistical modeling framework that permits prediction of the timing and spatial location of future vision loss and informs clinical decisions regarding disease progression. The developed method incorporates anatomical information to create a biologically plausible data-generating model. We accomplish this by introducing a spatially varying coefficients model that includes spatially varying change points to detect structural shifts in both the mean and variance process of VF data across both space and time. The VF location-specific change point represents the underlying, and potentially censored, timing of true change in disease trajectory while a multivariate spatial boundary detection structure is introduced that accounts for the complex spatial connectivity of the VF and optic disc. We show that our method improves estimation and prediction of multiple aspects of disease management in comparison to existing methods through simulation and real data application. The R package spCP implements the new methodology.

Glaucoma is the leading cause of irreversible blindness worldwide and requires regular monitoring upon diagnosis to ascertain whether the disease is stable or progressing. However, making this determination remains a difficult clinical task. Recently, a novel spatiotemporal boundary detection predictor of glaucomatous visual field (VF) progression (STBound) was developed. In this work, we explore the ability of STBound to differentiate progressing and non-progressing glaucoma patients in comparison to existing methods. STBound, Spatial PROGgression, and traditional trend-based progression methods (global index (GI) regression, mean regression slope, point-wise linear regression, permutation of pointwise linear regression) were applied to longitudinal VF data from 191 eyes of 91 glaucoma patients. The ability of each method to identify progression was compared using Akaike information criterion (AIC), full/partial area under the receiver operating characteristic curve (AUC/pAUC), sensitivity, and specificity. STBound offered improved diagnostic ability (AIC: 197.77 vs. 204.11-217.55; AUC: 0.74 vs. 0.63-0.70) and showed no correlation (r: -0.01-0.11; p-values: 0.11-0.93) with the competing methods. STBound combined with GI (the top performing competitor) provided improved performance over all individual metrics and compared to all metrics combined with GI (all p-values < 0.05). STBound may be a valuable diagnostic tool and can be used in conjunction with existing methods.

Purpose: To determine the incidence of open-angle glaucoma (OAG) and its risk factors in the Tema Eye Survey in Ghana, West Africa., Design: Longitudinal, observational population-based study., Participants: One thousand two hundred five of 1500 participants 40 years of age or older selected randomly from 5603 participants originally drawn from the population and who had undergone a baseline examination., Methods: All participants underwent baseline and follow-up ophthalmologic examinations 8 years apart. Glaucoma diagnosis was determined based on the International Society for Geographical and Epidemiologic Ophthalmology criteria., Main Outcome Measures: Incidence and odds ratio (OR)., Results: The response rate was 80.3%. Of 1101 nonglaucomatous participants at baseline who had complete follow-up data, 4.6% (95% confidence interval [CI], 3.7%-5.2%) demonstrated OAG over the 8-year period, or 0.58% (95% CI, 0.4%-0.8%) per year. The 8-year incidence increased with age from 3.1% in those 40 to 49 years old to 7.0% in those 60 to 69 years old. Baseline risk factors for incident OAG were male gender (OR, 2.1; 95% CI, 1.1-4.0; P = 0.025), older age relative to those 40 to 49 years old (those 50-50 years old: OR, 2.6; 95% CI, 1.2-5.7; those 60-69 years old: OR, 4.3; 95% CI, 2.0-8.8; and for those 70 years of age and older: OR, 6.3; 95% CI, 2.6-15.4; all P < 0.001), higher intraocular pressure (IOP; OR, 1.4; 95% CI, 1.1-1.8; P < 0.001), larger vertical cup-to-disc ratio (OR, 5.8; 95% CI, 5.2-6.6; P < 0.001), and thinner central cornea (OR, 1.2; 95% CI, 1.03-1.5; P = 0.013). A separate analysis performed with central corneal thickness-based IOP correction did not change the outcome of the associative model of incident glaucoma., Conclusions: The incidence of OAG is higher in this population than reported in nonblack populations outside Africa. This is important not only in Ghana and probably other West African countries but also wherever people of the West African diaspora reside. These data enhance our understanding of the epidemiologic factors of OAG in this setting and may serve as reference for public health policy and planning., (Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Diagnosing glaucoma progression is critical for limiting irreversible vision loss. A common method for assessing glaucoma progression uses a longitudinal series of visual fields (VF) acquired at regular intervals. VF data are characterized by a complex spatiotemporal structure due to the data generating process and ocular anatomy. Thus, advanced statistical methods are needed to make clinical determinations regarding progression status. We introduce a spatiotemporal boundary detection model that allows the underlying anatomy of the optic disc to dictate the spatial structure of the VF data across time. We show that our new method provides novel insight into vision loss that improves diagnosis of glaucoma progression using data from the Vein Pulsation Study Trial in Glaucoma and the Lions Eye Institute trial registry. Simulations are presented, showing the proposed methodology is preferred over existing spatial methods for VF data. Supplementary materials for this article are available online and the method is implemented in the R package womblR.

Optical coherence tomography (OCT) has moved to the forefront of imaging modalities in the management of glaucoma and retinal diseases. It is modifying how glaucoma and glaucoma progression are diagnosed clinically and augmenting our understanding of the disease. OCT provides multiple parameters from various anatomic areas for glaucoma diagnosis, evaluation of treatment efficacy, and progression monitoring. While the use of multiple parameters has increased the likelihood of detecting early structural changes, diagnosing glaucoma in early stages is often challenging when the damages are subtle and not apparent on OCT scans, in addition to the fact that assessment of OCT parameters often yields conflicting findings. One promising approach is to combine multiple individual parameters into a composite parameter from the same test to improve diagnostic accuracy, sensitivity, and specificity. This review presents current evidence regarding the value of spectral domain OCT composite parameters in diagnosing early glaucoma., Competing Interests: JCM, JLW, and DLB have a patent licensed to Carl Zeiss Meditec, Inc.

Purpose: To independently validate the performance of the University of North Carolina Optical Coherence Tomography (UNC OCT) Index in diagnosing and predicting early glaucoma., Methods: Data of 118 normal subjects (118 eyes) and 96 subjects (96 eyes) with early glaucoma defined as visual field mean deviation (MD) greater than -4 decibels (dB), aged 40 to 80 years, and who were enrolled in the Full-Threshold Testing Size III, V, VI comparison study were used in this study. CIRRUS OCT average and quadrants' retinal nerve fiber layer (RNFL); optic disc vertical cup-to-disc ratio (VCDR), cup-to-disc area ratio, and rim area; and average, minimum, and six sectoral ganglion cell-inner plexiform layer (GCIPL) measurements were run through the UNC OCT Index algorithm. Area under the receiver operating characteristic curve (AUC) and sensitivities at 95% and 99% specificity were calculated and compared between single parameters and the UNC OCT Index., Results: Mean age was 60.1 ± 11.0 years for normal subjects and 66.5 ± 8.1 years for glaucoma patients ( P < 0.001). MD was 0.29 ± 1.04 dB and -1.30 ± 1.35 dB in normal and glaucomatous eyes ( P < 0.001), respectively. The AUC of the UNC OCT Index was 0.96. The best single metrics when compared to the UNC OCT Index were VCDR (0.93, P = 0.054), average RNFL (0.92, P = 0.014), and minimum GCIPL (0.91, P = 0.009). The sensitivities at 95% and 99% specificity were 85.4% and 76.0% (UNC OCT Index), 71.9% and 62.5% (VCDR, all P < 0.001), 64.6% and 53.1% (average RNFL, all P < 0.001), and 66.7% and 58.3% (minimum GCIPL, all P < 0.001), respectively., Conclusions: The findings confirm that the UNC OCT Index may provide improved diagnostic perforce over that of single OCT parameters and may be a good tool for detection of early glaucoma., Translational Relevance: The UNC OCT Index algorithm may be incorporated easily into routine clinical practice and be useful for detecting early glaucoma.

Purpose of Review: Since its introduction in ophthalmology, optical coherence tomography (OCT) has undergone significant advances in imaging protocols, algorithms, and addition of new parameters which have maximized its potential for diagnosing, evaluating the response to treatment, and assessing the progression of various ocular diseases, including glaucoma. This review provides an update on recent developments in OCT with respect to the management of glaucoma., Recent Findings: Most recent notable developments include the introduction of the minimum distance band, which is a three-dimensional optic nerve head parameter, and Swept-Source OCT with its single wide-field scanning capability. The introduction of OCT angiography provides additional structural and functional measures for glaucoma management. Adaptive optics helps visualize individual RNFL bundles and measure their widths., Summary: Continued improvements in OCT technology is both enhancing our understanding of glaucoma and improving our ability to manage the disease.

Purpose: To determine the change and rate of change in central corneal thickness (CCT) and their determinants., Design: Longitudinal observational population-based study., Methods: A total of 758 normal and 58 glaucomatous subjects underwent complete eye examination, with CCT measurements at 2 separate visits. Change and rate of change in CCT were determined. Univariate and multivariate linear regression analyses were performed to determine the factors associated with change and rate of change., Results: The mean follow-up duration was 8.4 ± 0.7 years. The overall change was -8.9 ± 16.7 μm in OD and -9.8 ± 16.2 μm in OS, both P < .0001. Changes in glaucomatous and normal subjects were -14.1 ± 2.2 μm vs -8.6 ± 0.6 μm in OD (P = .02) and -14.5 ± 2.2 μm vs -9.5 ± 0.6 μm in OS (P = .03), respectively. The overall rate of thinning was -1.1 μm/year (OD) and -1.2 μm/year (OS). Rates in glaucomatous and normal eyes were -1.7 ± 0.3 μm/year vs -1.0 ± 0.1 μm/year in OD (P = .02) and -1.7 ± 0.3 μm/year vs -1.1 ± 0.1 μm/year in OS (P = .03), respectively. Change and rate of change were associated with baseline CCT (ß = -0.1 to -0.09 and -0.011, respectively, all P < .001) and glaucoma (ß = -6.8 to -5.6, P ≤ .009, and -0.75 to -0.69, P ≤ .007, respectively)., Conclusion: CCT decreased significantly over time. The change and rate of change were greater in glaucomatous than normal eyes, and were greater than described in cross-sectional studies., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: To compare the vertical and horizontal cup-to-disc ratio (VCDR, HCDR) by an updated optical coherence tomography (OCT) Bruch membrane opening (BMO) algorithm and stereoscopic optic disc photograph readings by glaucoma specialists., Design: Reliability analysis., Methods: A total of 195 eyes (116 glaucoma and 79 glaucoma suspect) of 99 patients with stereoscopic photographs and OCT scans of the optic discs taken during the same visit were compared. Optic disc photographs were read by 2 masked glaucoma specialists for VCDR and HCDR estimation. Intraclass correlation coefficient (ICC) and Bland-Altman plots were used to assess the agreement between photograph reading and OCT in estimating CDR., Results: OCT images computed significantly larger VCDR and HCDR than photograph reading before and after stratifying eyes based on disc size (P < .001). The difference in CDR estimates between the 2 methods was equal to or greater than 0.2 in 29% and 35% of the eyes for VCDR and HCDR, respectively, with a mean difference of 0.3 in each case. The ICCs between the readers and OCT ranged between 0.50 and 0.63. The size of disagreement in VCDR correlated weakly with cup area in eyes with medium (r 2  = 0.10, P = .008) and large (r 2  = 0.09, P = .007) discs., Conclusions: OCT and photograph reading by clinicians agree poorly in CDR assessment. The difference in VCDR between the 2 methods was depended on cup area in medium and large discs. These differences should be considered when making conclusions regarding CDRs in clinical practice., (Copyright © 2017 Elsevier Inc. All rights reserved.)

PurposeTo determine if there are systematic differences in cup-to-disc ratio (CDR) grading using fundus biomicroscopy compared to stereoscopic disc photograph reading.MethodsThe vertical cup-to-disc ratio (VCDR) and horizontal cup-to-disc ratio (HCDR) of 2200 eyes (testing set) were graded by glaucoma subspecialists through fundus biomicroscopy and by a reading center using stereoscopic disc photos. For validation, the glaucoma experts also estimated VCDR and HCDR using stereoscopic disc photos in a subset of 505 eyes that they had assessed biomicroscopically. Agreement between grading methods was assessed with Bland-Altman plots.ResultsIn both sets, photo reading tended to yield small CDRs marginally larger, but read large CDRs marginally smaller than fundus biomicroscopy. The mean differences in VCDR and HCDR were 0.006±0.18 and 0.05±0.18 (testing set), and -0.053±0.23 and -0.028±0.21 (validation set), respectively. The limits of agreement were ~0.4, which is twice as large as the cutoff of clinically significant CDR difference between methods. CDR estimates differed by 0.2 or more in 33.8-48.7% between methods.ConclusionsThe differences in CDR estimates between fundus biomicroscopy and stereoscopic optic disc photo reading showed a wide variation, and reached clinically significance threshold in a large proportion of patients, suggesting a poor agreement. Thus, glaucoma should be monitored by comparing baseline and subsequent CDR estimates using the same method rather than comparing photographs to fundus biomicroscopy.

Purpose: We developed a statistical model to improve the detection of glaucomatous visual field (VF) progression as defined by the consensus of expert clinicians., Methods: We developed new methodology in the Bayesian setting to properly model the progression status of a patient (as determined by a group of expert clinicians) as a function of changes in spatially correlated sensitivities at each VF location jointly. We used a spatial probit regression model that jointly incorporates all highly correlated VF changes in a single framework while accounting for structural similarities between neighboring VF regions., Results: Our method had improved model fit and predictive ability compared to competing models as indicated by the deviance information criterion (198.15 vs. 201.29-213.38), a posterior predictive model selection metric (130.08 vs. 142.08-155.59), area under the receiver operating characteristic curve (0.80 vs. 0.59-0.72; all P values < 0.018), and optimal sensitivity (0.92 vs. 0.28-0.82). Simulation study results suggest that estimation (reduction of mean squared errors) and inference (correct coverage of 95% credible intervals) for the model parameters are improved when spatial modeling is incorporated., Conclusions: We developed a statistical model for the detection of VF progression defined by clinician expert consensus that accounts for spatially correlated changes in visual sensitivity over time, and showed that it outperformed competing models in a number of areas., Translational Relevance: This model may easily be incorporated into routine clinical practice and be useful for detecting glaucomatous VF progression defined by clinician expert consensus.

Studies of humans chronically exposed to volatile organic solvents have reported impaired visual functions, including low contrast sensitivity and reduced color discrimination. These reports, however, lacked confirmation from controlled laboratory experiments. To address this question experimentally, we examined visual function by recording visual evoked potentials (VEP) and/or electroretinograms (ERG) from four sets of rats exposed repeatedly to toluene. In addition, eyes of the rats were examined with an ophthalmoscope and some of the retinal tissues were evaluated for rod and M-cone photoreceptor immunohistochemistry. The first study examined rats following exposure to 0, 10, 100 or 1000ppm toluene by inhalation (6hr/d, 5d/wk) for 13 weeks. One week after the termination of exposure, the rats were implanted with chronically indwelling electrodes and the following week pattern-elicited VEPs were recorded. VEP amplitudes were not significantly changed by toluene exposure. Four to five weeks after completion of exposure, rats were dark-adapted overnight, anesthetized, and several sets of electroretinograms (ERG) were recorded. In dark-adapted ERGs recorded over a 5-log (cd-s/m(2)) range of flash luminance, b-wave amplitudes were significantly reduced at high stimulus luminance values in rats previously exposed to 1000ppm toluene. A second set of rats, exposed concurrently with the first set, was tested approximately one year after the termination of 13 weeks of exposure to toluene. Again, dark-adapted ERG b-wave amplitudes were reduced at high stimulus luminance values in rats previously exposed to 1000ppm toluene. A third set of rats was exposed to the same concentrations of toluene for only 4 weeks, and a fourth set of rats exposed to 0 or 1000ppm toluene for 4 weeks were tested approximately 1year after the completion of exposure. No statistically significant reductions of ERG b-wave amplitude were observed in either set of rats exposed for 4 weeks. No significant changes were observed in ERG a-wave amplitude or latency, b-wave latency, UV- or green-flicker ERGs, or in photopic flash ERGs. There were no changes in the density of rod or M-cone photoreceptors. The ERG b-wave reflects the firing patterns of on-bipolar cells. The reductions of b-wave amplitude after 13 weeks of exposure and persisting for 1year suggest that alterations may have occurred in the inner nuclear layer of the retina, where the bipolar cells reside, or the outer or inner plexiform layers where the bipolar cells make synaptic connections. These data provide experimental evidence that repeated exposure to toluene may lead to subtle persistent changes in visual function. The fact that toluene affected ERGs, but not VEPs, suggests that elements in the rat retina may be more sensitive to organic solvent exposure than the rat visual cortex., (Published by Elsevier B.V.)

Purpose of Review: Optical coherence tomography (OCT) aids in the diagnosis and long-term monitoring of various ocular diseases, including glaucoma. Initially, the retinal nerve fiber layer was the only OCT structural parameter used in glaucoma. Subsequent research has resulted in more retinal and optic nerve head parameters. In addition, OCT is being investigated for its ability to assess ocular hemodynamics. This review summarizes these spectral domain-optical coherence tomography (SDOCT) parameters in the context of glaucoma., Recent Findings: Several new SDOCT retinal nerve fiber layer, optic nerve head, and macular parameters with good glaucoma diagnostic ability have been added to existing ones recently. The combination of SDOCT and Doppler or angiography has also resulted in hemodynamic parameters that may prove to be useful in the functional assessment in glaucoma., Summary: OCT technology is advancing not only as a tool for structural assessment, but also as a multimodality tool to assess both structure and function to enhance our understanding of glaucoma, and ultimately clinical decisions.

Purpose: To compare optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness, specificity, and glaucoma discriminating ability prior and following adjustment to the fovea-disc angle axis., Design: Cross-sectional observational study., Methods: Fovea-disc angle was measured in 282 healthy subjects (normative database), 46 nonglaucomatous myopic subjects, and 86 glaucomatous subjects. The fovea-disc angle was determined using the Cirrus PanoMap feature after registering the macular ocular fundus image to the peripapillary ocular fundus image. RNFL prediction limits, specificity, and glaucoma discrimination ability were determined before and after adjustment to fovea-disc angle axis., Results: The mean fovea-disc angles were 7.4 ± 4.1 degrees (normative database), 7.1 ± 4.3 degrees (myopic subjects), and 7.6 ± 4.2 degrees (glaucomatous subjects) (all P > .05). Standard and fovea-disc angle-adjusted RNFL thicknesses showed small significant differences in quadrants and larger differences in clock-hour sectors (all P < .05), without consistent patterns in the direction of the change. The specificity remained unchanged for all parameters in normative database subjects after adjustment to fovea-disc angle. The number of sectors with improved specificity and those with worsened specificity did not differ significantly in the first (8 vs 6), second (5 vs 8), and random (6 vs 7) normative database half (all P > .05). In myopic subjects, the specificity improved and worsened in 4 sectors in each case. The glaucoma discriminating ability significantly increased in 6 sectors and decreased in 5 others., Conclusion: Correcting the RNFL profiles using the fovea-disc angle axis had no consistent effect on the thickness, specificity, and glaucoma diagnostic performance of RNFL parameters. This phenomenon may be specific to different OCT platforms., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Economic transitions in the era of globalization warrant a fresh look at the neurological risks associated with environmental change. These are driven by industrial expansion, transfer and mobility of goods, climate change and population growth. In these contexts, risk of infectious and non-infectious diseases are shared across geographical boundaries. In low- and middle-income countries, the risk of environmentally mediated brain disease is augmented several fold by lack of infrastructure, poor health and safety regulations, and limited measures for environmental protection. Neurological disorders may occur as a result of direct exposure to chemical and/or non-chemical stressors, including but not limited to, ultrafine particulate matters. Individual susceptibilities to exposure-related diseases are modified by genetic, epigenetic and metagenomic factors. The existence of several uniquely exposed populations, including those in the areas surrounding the Niger Delta or north western Amazon oil operations; those working in poorly regulated environments, such as artisanal mining industries; or those, mostly in sub-Saharan Africa, relying on cassava as a staple food, offers invaluable opportunities to advance the current understanding of brain responses to environmental challenges. Increased awareness of the brain disorders that are prevalent in low- and middle-income countries and investments in capacity for further environmental health-related research are positive steps towards improving human health.

Purpose: To determine the ability of frequency doubling technology (FDT) and scanning laser polarimetry with variable corneal compensation (GDx-VCC) to detect glaucoma when used individually and in combination., Methods: One hundred ten normal and 114 glaucomatous subjects were tested with FDT C-20-5 screening protocol and the GDx-VCC. The discriminating ability was tested for each device individually and for both devices combined using GDx-NFI, GDx-TSNIT, number of missed points of FDT, and normal or abnormal FDT. Measures of discrimination included sensitivity, specificity, area under the curve (AUC), Akaike's information criterion (AIC), and prediction confidence interval lengths., Results: For detecting glaucoma regardless of severity, the multivariable model resulting from the combination of GDx-TSNIT, number of abnormal points on FDT (NAP-FDT), and the interaction GDx-TSNIT×NAP-FDT (AIC: 88.28, AUC: 0.959, sensitivity: 94.6%, specificity: 89.5%) outperformed the best single-variable model provided by GDx-NFI (AIC: 120.88, AUC: 0.914, sensitivity: 87.8%, specificity: 84.2%). The multivariable model combining GDx-TSNIT, NAP-FDT, and interaction GDx-TSNIT×NAP-FDT consistently provided better discriminating abilities for detecting early, moderate, and severe glaucoma than the best single-variable models., Conclusions: The multivariable model including GDx-TSNIT, NAP-FDT, and the interaction GDx-TSNIT×NAP-FDT provides the best glaucoma prediction compared with all other multivariable and univariable models. Combining the FDT C-20-5 screening protocol and GDx-VCC improves glaucoma detection compared with using GDx or FDT alone.

Purpose: To estimate visual field (VF) sensitivity at which retinal nerve fiber layer (RNFL) thinning reaches the measurement floor and at which RNFL stops thinning (change points), the dynamic range of RNFL thickness, and the number of steps from normal to RNFL floor among three optical coherence tomography (OCT) devices., Methods: Glaucomatous patients (n = 58) and healthy subjects (n = 55-60) prospectively underwent VF testing and RNFL thickness measurement with Cirrus, Spectralis, and RTVue. Change points and corresponding RNFL thicknesses were estimated with simple linear regression (SLR) and Bayesian change point (BCP) analyses. The dynamic range and number of steps to RNFL floor were determined., Results: The average VF change points and corresponding residual thickness at the time RNFL stopped thinning were -22.2 dB and 57.0 μm (Cirrus), -25.3 dB and 49.2 μm (Spectralis), and -24.6 dB and 64.7 μm (RTVue). The RNFL dynamic ranges derived from SLR values were wider on Spectralis (52.6 μm) than on Cirrus (35.4 μm) and RTVue (35.5 μm); the corresponding number of steps to reach the RNFL floor were 9.0 on Cirrus, 10.6 on Spectralis, and 8.3 on RTVue., Conclusions: The relative VF sensitivity at which average RNFL thickness reaches the measurement floor, the residual layer thickness, and RNFL dynamic measurement range differ among the three devices. However, the number of steps from normal to the RNFL thickness floor is comparable.

Aim: To estimate the floor of retinal nerve fibre layer (RNFL) thickness measurements and the corresponding retinal sensitivity loss in glaucoma., Methods: Visual field (VF), Spectralis RNFL (83 patients and 37 healthy subjects) and RTVue RNFL data obtained separately (56 patients and 36 healthy subjects) were reviewed. Global and quadrant residual layer thicknesses and corresponding VF losses were estimated using two Bayesian change point models., Results: The respective residual thicknesses from change point model 1 (CPM1) on Spectralis and RTVue (respectively) were 49.9 and 70.6 µm globally, 57.1 and 83.7 µm superiorly, 55.2 and 79.0 µm inferiorly, 43.1 and 60.5 µm nasally, and 40.1 and 59.5 µm temporally. Corresponding VF losses ranged between -25.1 and -21.7 dB (Spectralis) and between -21.8 and -3.4 dB (RTVue). From CPM2, RNFL thinning reached horizontal asymptotes at VF losses between -18.0 and -10.7 dB (Spectralis) and between -12.1 and -2.5 dB (RTVue). There were no significant differences between postchange point residual layer thicknesses from CPM1 and CPM2 on Spectralis (37.0-50.8 µm vs 38.3-56.0 µm) and RTVue (60.6-80.5 µm vs 58.4-88.8 µm)., Conclusions: Global RNFL thinning reaches the floor at a smaller VF loss level with Spectralis than with RTVue. The nasal and temporal quadrants retain thinner residual layers than superior and inferior quadrant RNFL. Measuring RNFL below their minimums will not yield useful clinical information., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Purpose: To explore the association between peripapillary atrophy (PPA) area and conversion from ocular hypertension (OHT) to glaucoma., Design: Prospective, longitudinal cohort study of cases and controls., Participants: We included 279 age-matched and follow-up time-matched eyes with OHT that converted to glaucoma and 279 eyes with OHT that did not convert to glaucoma., Methods: Initial and last acceptable optic disc photos were analyzed. Disc, α-zone, and β-zone PPA were traced independently by 2 trained readers and their areas were measured with Photoshop. The α-zone and β-zone areas were expressed as a percentage of optic disc area., Main Outcome Measures: α-Zone and β-zone PPA size over time., Results: Intraclass correlation coefficients (ICCs) demonstrated that readers had good agreement on disc area (ICC = 0.97) and β-zone (ICC = 0.82), but not α-zone (ICC = 0.48). The ß-zone, as a percentage of disc area, increased in size (P < 0.001) in both eyes with incident primary open-angle glaucoma (mean, 10.6%; standard deviation, 22.6%) and matched controls (mean, 10.1%; standard deviation, 33.7) over follow-up (mean, 12.3 years). The increase in size did not differ between cases and controls (P = 0.82). Enlargement of the β-zone was not correlated with follow-up time (P = 0.39)., Conclusions: The results did not show a difference in size of the β-zone at baseline between eyes that proceed to develop glaucoma and those that do not. Moreover, the β-zone enlarges equally in case and control eyes during follow-up., (Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate and compare the diagnostic specificities of peripapillary retinal nerve fiber layer (RNFL) thickness, macular ganglion cell-inner plexiform layer (GC-IPL) thickness, and optic nerve head (ONH) measurements in nonglaucomatous myopic individuals., Methods: In a prospective, cross-sectional study, participants underwent a complete ophthalmic examination, a screening automated visual field test, and axial length measurement. The study eye then underwent optic nerve head and macular scanning using spectral-domain optical coherence tomography (OCT) instrumentation to determine RNFL thickness, GC-IPL thickness, and ONH measurements. False-positive rates for each of the OCT-derived parameters, using predefined criteria for an abnormal test, were calculated. Comparative analysis was performed using the McNemar test., Results: Data from 43 eligible subjects were analyzed. The mean age was 30±6.8 years (range, 22 to 50 y) with an average axial length of 25.26±1.21 mm (range, 23.06 to 29.07 mm) and mean spherical equivalent of -4.50±1.93 D (range, -1.00 to -9.00 D). The false-positive rate was higher when using RNFL parameters compared with both ONH (47% vs. 7%, respectively; P<0.001) and GC-IPL (47% vs. 26%, respectively; P=0.049) parameters. The false-positive rate was higher when using GC-IPL parameters, compared with ONH parameters (26% vs. 7%, respectively; P=0.039)., Conclusions: Caution should be exercised when relying on OCT-derived RNFL and GC-IPL thickness values to diagnose glaucoma in myopic individuals. OCT-derived ONH parameters perform better than RNFL and GC-IPL parameters and may increase diagnostic specificity in this population.