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The purpose of this study was to investigate the association between gender and primary open-angle glaucoma (POAG) among African Americans and to assess demographic, systemic, and behavioral factors that may contribute to differences between genders. The Primary Open-Angle African American Glaucoma Genetics (POAAGG) study had a case-control design and included African Americans 35 years and older, recruited from the greater Philadelphia, Pennsylvania. Diagnosis of POAG was based on evidence of both glaucomatous optic nerve damage and characteristic visual field loss. Demographic and behavioral information, history of systemic diseases and anthropometric measurements were obtained at study enrollment. Gender differences in risk of POAG were examined using multivariate logistic regression. A total of 2,290 POAG cases and 2,538 controls were included in the study. The percentage of men among cases was higher than among controls (38.6% vs 30.3%, P<0.001). The subjects' mean age at enrollment was significantly higher for cases compared to controls (70.2±11.3 vs. 61.6±11.8 years, P<0.003). Cases had lower rates of diabetes (40% vs. 46%, P<0.001), higher rates of systemic hypertension (80% vs. 72%, P<0.001), and lower body mass index (BMI) (29.7±6.7 vs. 31.9±7.4, P<0.001) than controls. In the final multivariable model, male gender was significantly associated with POAG risk (OR, 1.64; 95% CI, 1.44-1.87; P<0.001), after adjusting for age, systemic hypertension, diabetes, and BMI. Within the POAAGG study, men were at higher risk of having POAG than women. Pending genetic results from this study will be used to better understand the underlying genetic variations that may account for these differences.

Purpose: In the ophthalmology setting, given the close proximity required for the clinical exam, appropriate mask usage and fit is essential. This study aims to assess how a simple, cost-effective 3D-printed face mask ear protectors (EP) attachment may decrease discomfort, increase compliance, and improve fit in an academic institution's Ophthalmology department. Methods: Face mask EPs were distributed to patients and providers in the Ophthalmology department. A validated questionnaire was administered before and 2 weeks after EP usage. The survey included questions on demographics and frequency of mask usage during a spectrum of activities. Descriptive statistics were performed with Fischer's t test. Results: Post-EP responses demonstrated an increased likelihood of mask usage across all activities, although not statistically significant. The greatest change was during outdoor activities, with a 14.3% increase in highest utilization. Post-EP, all subjects were very likely to wear masks while shopping and 91.7% while in the workplace. EP usage decreased the number of noncompliant individuals while spending time with friends and family by 93.3%. Almost no subjects reported mask removal of >15 times per hour post-EP. The increase in mask compliance was greatest for low mask utilizers. 91.9% reported improved comfort, 91.9% reported improved fit, and 81.6% reported increased mask usage. Conclusion: Our results suggest that simple cost-effective 3D-printed ear protectors may improve fit, comfort, and overall mask compliance. The results of this study should drive broader public health efforts to further investigate whether mask attachments can improve overall mask compliance through better comfort and fit.

Purpose of Review Loss of the ability to drive is highly associated with depressive symptoms in older persons. There are many reasons why an individual may give up driving, poor vision being an important one. Given the high prevalence of glaucoma in this population and the critical role that vision plays in the ability to drive, it is therefore important to consider how glaucomatous vision loss plays into the ability to drive safely. Recent Findings In this review article, we will summarize the literature on the topic of glaucoma and driving and the studies that have been done to evaluate this topic. Studies of both the self-perceived impact of glaucomatous visual field loss on driving as well as studies that include on-road and simulated driving experiments will be reviewed. Summary We will discuss how patients with glaucoma may be assessed for their driving safety and review how we treat and evaluate these patients in our own practices.

Latanoprostene bunod (LBN) 0.024%, a modified prostaglandin analog, was approved on November 2, 2017, for the reduction of IOP in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT). LBN works by combining the IOP-lowering effects of the prostaglandin analogs (through the uveoscleral pathway) with nitric oxide-induced relaxation of the trabecular meshwork and Schlemm's canal. Nitric oxide-induced relaxation of the trabecular meshwork and Schlemm's canal leads to increased outflow through the trabecular meshwork and thus lowering of IOP. LBN has now been shown in multiple clinical studies to be effective and safe. In this article, we summarize the clinical trials that led to LBN's approval as well as the comparative studies that have been done to evaluate the efficacy of this drug as compared to other US Food and Drug Administration (FDA)-approved therapies for OAG and OHT. We then review the side effects of treatment that were seen in each of these studies. Finally, we will attempt to discuss the place of this drug in therapy for patients with OAG.

ObjectiveTo define sloping of the retina, a novel stereoscopic feature in primary open-angle glaucoma (POAG), and to evaluate its prevalence and associated risk factors in an African ancestry population.Methods and analysisDigital stereo disc images were graded for sloping by trained non-physician graders. We defined a sloping retina as one that slanted downward towards the disc margin instead of existing on the same plane as the disc margin. A ‘sloping retina’ approached the disc margin at an angle along at least one-third of the disc’s circumference. The ocular and demographic risk factors of sloping were evaluated by univariable and multivariable logistic regression models.ResultsThe prevalence of sloping in eyes with POAG was 22.0% (95% CI 20.6% to 23.4%). In a multivariable analysis, compared with eyes without sloping, eyes with sloping were less likely to have disc haemorrhages (p=0.03) and more likely to have a tilted disc (p<0.001), larger cup-to-disc ratio ((defined as 0.7–1), p=0.002), grey crescent (p=0.02), nasalisation of the vessels (p=0.01), moderate or deep cup depth (p<0.001) and conical cup shape (p<0.001). Sloping was not associated with any demographic characteristics in the multivariable analysis.ConclusionAssociated with risk factors of advanced POAG, sloping presents as a novel feature that warrants further study to determine its mechanisms of development and prevalence in other study populations. Study limitations include: large difference in the number of eyes with and without sloping, potential morphological expressions of other phenotypes posing as sloping, impact of anatomical variability on grading, inherent biases when grading stereoscopic images and absence of a control or glaucoma suspect group. Future research into this phenotype in POAG patients might determine whether sloping retina is the result of or a precursor to glaucomatous damage, leading to a better understanding of POAG.

There are scarce data regarding the rate of the occurrence of primary open-angle glaucoma (POAG) and visible lamina cribrosa pores (LCPs) in the eyes of individuals with African ancestry; the potential impact of these features on disease burden remains unknown. We recruited subjects with POAG to the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study. Through regression models, we evaluated the association between the presence of LCPs and various phenotypic features. In a multivariable analysis of 1187 glaucomatous eyes, LCPs were found to be more likely to be present in eyes with cup-to-disc ratios (CDR) of ≥0.9 (adjusted risk ratio (aRR) 1.11, 95%CI: 1.04–1.19, p = 0.005), eyes with cylindrical-shaped (aRR 1.22, 95%CI: 1.11–1.33) and bean pot (aRR 1.24, 95%CI: 1.13–1.36) cups versus conical cups (p < 0.0001), moderate cup depth (aRR 1.24, 95%CI: 1.06–1.46) and deep cups (aRR 1.27, 95%CI: 1.07–1.50) compared to shallow cups (p = 0.01), and the nasalization of central retinal vessels (aRR 1.33, 95%CI: 1.23–1.44), p < 0.0001). Eyes with LCPs were more likely to have a higher degree of African ancestry (q0), determined by means of SNP analysis (aRR 0.96, 95%CI: 0.93–0.99, p = 0.005 for per 0.1 increase in q0). Our large cohort of POAG cases of people with African ancestry showed that LCPs may be an important risk factor in identifying severe disease, potentially warranting closer monitoring by physicians.

Background/aimsTo investigate the rates of structural and functional progression of primary open-angle glaucoma in an African ancestry cohort and identify risk factors for progression.MethodsThis retrospective study included 1424 eyes from glaucoma cases in the Primary Open-Angle African American Glaucoma Genetics cohort, with ≥2 visits for retinal nerve fibre layer (RNFL) thickness and mean deviation (MD) measurements over ≥6-month follow-up. The rates of structural progression (change in RNFL thickness/year) and functional progression (change in MD/year) were calculated from linear mixed effects models, accounting for intereye correlation and longitudinal correlation. Eyes were categorised as slow, moderate or fast progressors. Risk factors for progression rates were assessed using univariable and multivariable regression models.ResultsThe median (interquartile) rates of progression were −1.60 (−2.05 to –1.15) µm/year for RNFL thickness and −0.40 (−0.44 to –0.34) decibels/year for MD. Eyes were categorised as slow (structural: 19%, functional: 88%), moderate (structural: 54%, functional: 11%) and fast (structural: 27%, functional: 1%) progressors. In multivariable analysis, faster RNFL progression was independently associated with thicker baseline RNFL (p<0.0001), lower baseline MD (p=0.003) and beta peripapillary atrophy (p=0.03). Faster MD progression was independently associated with higher baseline MD (p<0.0001), larger cup-to-disc ratios (p=0.02) and lower body mass index (p=0.0004).ConclusionThe median rates of structural and functional progression in this African ancestry cohort were faster than the rates reported from previously published studies in other ethnic groups. Higher baseline RNFL thickness and MD values were associated with faster progression rates. Results highlight the importance of monitoring structural and functional glaucoma progression to provide timely treatment in early disease.

Background African Americans have been historically under-represented in genetic studies. More research is needed on effective recruitment strategies for this population, especially on approaches that supplement traditional clinic enrollment. This study evaluates the cost and efficacy of four supplemental recruitment methods employed by the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study. Methods After enrolling 2304 patients from University of Pennsylvania ophthalmology clinics, the POAAGG study implemented four new recruitment methods to supplement clinic enrollment. These methods included: 1) outreach in the local community, 2) in-house screening of community members (“in-reach”), 3) expansion to two external sites, and 4) sampling of the Penn Medicine Biobank. The cost per subject was calculated for each method and enrollment among cases, controls, and suspects was reported. Results The biobank offered the lowest cost ($5/subject) and highest enrollment yield ( n  = 2073) of the four methods, but provided very few glaucoma cases ( n  = 31). External sites provided 88% of cases recruited from the four methods ( n  = 388; $85/subject), but case enrollment at these sites declined over the next 9 months as the pool of eligible subjects was depleted. Outreach and in-reach screenings of community members were very high cost for low return on enrollment ($569/subject for 102 subjects and $606/subject for 45 subjects, respectively). Conclusions The biobank offered the most cost-effective method for control enrollment, while expansion to external sites was necessary to recruit richly phenotyped cases. These recruitment methods helped the POAAGG study to exceed enrollment of the discovery cohort ( n  = 5500) 6 months in advance of the predicated deadline and could be adopted by other large genetic studies seeking to supplement clinic enrollment.

AimTo investigate the prevalence and factors associated with optic disc grey crescent (GC) in African Americans with glaucoma.MethodsStereo optic disc image features from subjects with glaucoma in the Primary Open-Angle African Ancestry Glaucoma Genetics Study were evaluated independently by non-physician graders and discrepancies adjudicated by an ophthalmologist. Risk factors for GC were evaluated by logistic regression models with intereye correlation accounted for by generalised estimating equations. Adjusted ORs (aORs) were generated.ResultsGC was present in 227 (15%) of 1491 glaucoma cases, with 57 (3.82%) bilateral and 170 (11.4%) unilateral. In multivariable analysis, factors associated with GC were younger age (aOR 1.27, 95% CI 1.11 to 1.43 for every decade younger in age, p=0.001), diabetes (aOR 1.46, 95% CI 1.09 to 1.96, p=0.01), optic disc tilt (aOR 1.84, 95% CI 1.36 to 2.48, p<0.0001), a sloping retinal region adjacent to the outer disc margin (aOR 2.37, 95% CI 1.74 to 3.32, p<0.0001) and beta peripapillary atrophy (aOR 2.32, 95% CI 1.60 to 3.37, p<0.0001). Subjects with GC had a lower mean (SD) value of the ancestral component q0 than those without GC (0.22 (0.15) vs 0.27 (0.20), p=0.001), consistent with higher degrees of African ancestry.ConclusionsMore than 1 in 10 glaucoma cases with African ancestry have GC, occurring more frequently in younger subjects, higher degrees of African ancestry and diabetes. GC was associated with several ocular features, including optic disc tilt and beta peripapillary atrophy. These associations should be considered when evaluating black patients with primary open-angle glaucoma.

Men and masculinities have long been associated with narratives of dominance. Reflecting on the history of Western masculinities (a history of imperialism, expansionism and capitalist enterprise), the connections between these expressions of male power and the denigration and exploitation of the planet are plain to see. Ecomasculinity1 - a discourse concerned with how masculinities and ecologies interact - seeks to uncover and examine more positive constructions of masculinity that interact with the world from a position of care and responsibility (Slovic 2004). Discussing positive examples of being a man in the world provides a necessary and important counternarrative for contemporary Western societies experiencing a rise in the threat posed by anti-feminist and far-right ideologies supported by disenfranchised, young white men (Kimmel 2013, 2018). This counternarrative does not seek to challenge or subvert critiques of the patriarchy, or of the connections between (white) male dominance and the oppression of the natural world that ecofeminism as a discipline has exposed and described - as Greta Gaard explains, the basic premise of ecofeminism \"is that the ideology which authorizes oppressions such as those based on race, gender, class, sexuality, physical abilities, and species is the same ideology which sanctions the oppression of nature\" (1993, 1). Indeed, the work of ecofeminists has been crucial to understanding the interrelationships of systems of oppression and to building a framework for critical discussions about the relationship between gender and nature. Despite its broad focus on positive visions of masculinity, ecomasculinity as a concept does not necessarily run counter to the concerns or conclusions of ecofeminism. Scholars working in this area have been open in their agreement that \"men and masculinities have been complicit in the lion's share of our global and social environmental problems\" (Hultman and Pulé 2018, 8). Ecomasculinity, then, can be described as an expansion of the concept of masculinity within the framework of ecofeminism.