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Early-stage glaucoma diagnosis is crucial for preventing permanent structural damage and irreversible vision loss. While various machine-learning approaches have been developed for glaucoma diagnosis, only a few specifically address early-stage detection. Moreover, existing early-stage detection methods rely on unimodal information and exclude subjects with high myopia, which contradicts clinical practice and overlooks the adverse effect of high myopia on prediction performance. To develop a clinically practical tool, this study proposes a deep-learning-based, end-to-end early-stage glaucoma detection framework designed for a cohort likely with high myopia. This framework uniquely integrates functional information from visual field (VF) parameters of standard automated perimetry (SAP) and Pulsar perimetry (PP) with structural information derived from optical coherence tomography (OCT) thickness maps. It comprises three key components: 3D OCT ganglion cell complex (GCC) layer segmentation, thickness map generation, and early-stage glaucoma detection. Evaluated on 394 subjects using five-time, 10-fold cross-validation, the proposed system achieved a mean area under the receiver operating characteristic (ROC) curve of 0.887 ± 0.006, outperforming the Asaoka method without transfer learning and nine models based solely on VF parameters. Results further confirmed that incorporating SAP and PP parameters was essential for mitigating the adverse effects of high myopia.

Purpose: To compare image characteristics of retinal nerve fiber layer (RNFL) between glaucoma patients and healthy controls using adaptive optics scanning laser ophthalmoscopy (AOSLO). Methods: This was a cross-sectional pilot study with two groups: a glaucoma group with patients with moderate or severe glaucoma as per the Hodapp-Parrish-Anderson classification system and a control group with healthy individuals. The optic nerve damage in moderate glaucoma was predominantly located in only one hemisphere; the other hemisphere was un- or minimally affected on optical coherence tomography and automated perimetry and is referred to as early glaucoma. The structure of RNFL bundles and gain (%) in RNFL images with mean pixel values between 15 and 35 were analyzed. Imaging was performed one degree away from the optic disc margin at two and four cardinal clock positions in the glaucoma and control groups, respectively. The field of view was 1.3° at 2.3 m resolution. We studied one eye per participant. Results: There were 11 glaucoma patients and 7 healthy controls. Imaging was successful at 88% of the locations in controls and early glaucoma; the reflectivity differed significantly (0.51 and 0.56, respectively, P < 0.001) but not the structure of RNFL bundles (Cohen's Kappa 0.11) between them. In patients with moderate and severe glaucoma, imaging was successful only at 46% of the locations; RNFL bundles were not discernible, and RNFL reflectivity did not differ from those with early glaucoma (P < 0.11). Conclusion: The recorded gain (%) of RNFL images obtained using AOSLO could be an objective indicator of early glaucoma.

To evaluate the relevance of community eye outreach programs in the early detection of glaucoma patients in southwest Nigeria. This was a retrospective, cross-sectional study that was conducted among glaucoma patients referred to the eye clinic of the University College Hospital (UCH), Ibadan, Nigeria, between January 2009 and December 2010 from different sources, including community eye outreach programs. The source of referral, stage of glaucoma, and visual field were recorded. Six hundred and fifty-three patients were studied during this period. The mean age was 56.3 years ± 16.6 years, with a median age of 60 years. Patients referred from eye outreach programs were more likely to have mild to moderate disease than patients referred from other sources, who were more likely to have severe disease according to both the optic nerve head assessment (P < 0.01, Pearson's Chi-square = 10.67, odds ratio = 1.7 [confidence interval = 1.23-2.31]) and visual field assessment (24-2) (P < 0.01, Pearson's Chi-square = 6.07, odds ratio = 1.5 [confidence interval = 1.08-2.03]). Community eye outreach programs appear highly useful in the earlier detection of glaucoma in sub-Saharan Africa.

Glaucoma is characterized by increased intraocular pressure and damage to the optic nerve, which may result in irreversible blindness. The drastic effects of this disease can be avoided if it is detected at an early stage. However, the condition is frequently detected at an advanced stage in the elderly population. Therefore, early-stage detection may save patients from irreversible vision loss. The manual assessment of glaucoma by ophthalmologists includes various skill-oriented, costly, and time-consuming methods. Several techniques are in experimental stages to detect early-stage glaucoma, but a definite diagnostic technique remains elusive. We present an automatic method based on deep learning that can detect early-stage glaucoma with very high accuracy. The detection technique involves the identification of patterns from the retinal images that are often overlooked by clinicians. The proposed approach uses the gray channels of fundus images and applies the data augmentation technique to create a large dataset of versatile fundus images to train the convolutional neural network model. Using the ResNet-50 architecture, the proposed approach achieved excellent results for detecting glaucoma on the G1020, RIM-ONE, ORIGA, and DRISHTI-GS datasets. We obtained a detection accuracy of 98.48%, a sensitivity of 99.30%, a specificity of 96.52%, an AUC of 97%, and an F1-score of 98% by using the proposed model on the G1020 dataset. The proposed model may help clinicians to diagnose early-stage glaucoma with very high accuracy for timely interventions.

The diagnosis of primary open-angle glaucoma (POAG) progression based on structural imaging such as color fundus photos (CFPs) is challenging due to the limited number of early biomarkers, as commonly determined by clinicians, and the inherent variability in optic nerve heads (ONHs) between individuals. Moreover, while visual function is the main concern for glaucoma patients, and the ability to infer future visual outcome from imaging will benefit patients by early intervention, there is currently no available tool for this. To detect glaucoma progression from ocular hypertension both structurally and functionally, and identify potential objective early biomarkers associated with progression, we developed and evaluated deep convolutional long short-term memory (CNN-LSTM) neural network models using longitudinal CFPs from the Ocular Hypertension Treatment Study (OHTS). Patients were categorized into four diagnostic groups for model input: healthy, POAG with optic disc changes, POAG with visual field (VF) changes, and POAG with both optic disc and VF changes. Gradient-weighted class activation mapping (Grad-CAM) was employed for the post hoc visualization of image features, which may be associated with the objective POAG biomarkers (rather than the biomarkers determined by clinicians). The CNN-LSTM models for the detection of POAG progression achieved promising performance results both for the structural and functional models, with an area under curve (AUC) performance of 0.894 for the disc-only group, 0.911 for the VF-only group, and 0.939 for the disc and VF group. The model demonstrated high precision (0.984) and F1-score (0.963) in the both-changes group (disc + VF). Our preliminary investigation for early POAG biomarkers with Grad-CAM feature visualization signified that retinal vasculature could serve as an early and objective biomarker for POAG progression, complementing the traditionally used optic disc features and improving clinical workflows.

Retinoblastoma represents 3% of all childhood cancers, and is the most common intraocular malignancy of childhood. It is fatal, if untreated. White eye reflex, also known as leukocoria, is the commonest sign, followed by strabismus. The pediatricians have a very important role to play in the diagnosis of this relatively rare, but easily detectable tumor. Early diagnosis yields better results. The management of retinoblastoma has gradually evolved over the past few decades, with an aim to not only preserve life and eye, but also optimize residual vision. The treatment of retinoblastoma is multimodal, with chemotherapy, focal treatment including trans-pupillary thermotherapy, cryotherapy and laser photocoagulation, radiation therapy and surgery, all playing a vital role. Intravenous chemotherapy has been the mainstay of treatment for the past two decades, and still continues to be the most extensively used eye-saving modality of treatment. Periocular and intravitreal chemotherapy have specific indications in the management of retinoblastoma. Intra-arterial chemotherapy has emerged as a promising alternative for advanced and refractory retinoblastoma, both as a primary and secondary therapy. Recent advances in genetics of retinoblastoma have also helped in improving the overall clinical management of this malignancy.

The authors indicate four key issues which, in their opinion, represent the most stimulating challenges in the field of glaucoma today, and describe the present approaches and the developments that can be expected or advised in the near future: (1) Glaucoma is often undiagnosed or diagnosed too late. Accurate detection is crucial to correctly recognize and treat affected subjects, thus reducing the disability and the social burden of the disease. Is glaucoma screening advisable and cost-effective? What strategies can be implemented to achieve an earlier diagnosis? (2) What role can genetics play in glaucoma clinics? (3) What are the fundamentals and the limits of medical hypotensive and nonhypotensive treatment of glaucoma today, and what novelties could be introduced in the next few years? (4) What are the current and future options for glaucoma surgery? Should we aim at reducing aqueous production or at enhancing aqueous outflow? What are the success figures and the pros and cons of ab externo procedures with external filtration (trabeculectomy, nonpenetrating techniques and glaucoma drainage devices) and of ab externo techniques with internal filtration (viscocanalostomy and canaloplasty)? Will microinvasive procedures ever play a role in the treatment of the disease? These questions and the possible future developments in the management of glaucoma are discussed critically, based on the current clinical state of the art, on a review of the literature, and on an everyday experience in a busy university hospital glaucoma service.

Glaucoma is the most common optic neuropathy which is characterized by progressive loss of retinal ganglion cells, the excavation of the optic nerve head, associated with defects in the visual field. It is not a disease, but the final result of united and yet completely unidentified cellular and subcellular processes and effects of many factors responsible for changes in retinal ganglion cells leading to their accelerated apoptosis. This is a prospective-retrospective, comparative, randomized clinical trial that included 150 patients, 97 were female and 53 male. The age of patients ranged from 18 to 80 years. The highest degree of myopia in category of tilted optic discs had patients with large disc (4.05 + -0.65). Values of the degree of myopia have linearly declined in relation to the size of the oblique disc. The analysis of the results revealed that the subjects who had a higher degree of myopia associated with glaucoma had frequent parapapillar atrophy of alpha and beta zones. The highest percentage of subjects with parapapillar changes were in the group of patients who had other than glaucoma and myopia (62%), then in the group of patients with glaucoma only (56%). Previous studies on the relationship between myopia and open-angle glaucoma are based on the results of observational studies. However, according to recent findings, based on the available studies, the systematic approach to estimate the association between myopia and glaucoma does not exist. Disc Damage Likelihood Scale (DDLS) is a new system for assessing glaucomatous damage of the optic disc which strongly correlates with the degree of visual field loss.

Recent advances have seen a surge of new ideas and technologies to aid in the detection, treatment and further understanding of glaucoma. These technologies and advances are discussed to provide information on risk-factors, diagnosis and treatment. Glaucoma has never before seen such an advance in research and therapies coming forward in to the clinical workplace. It is an exciting time for physicians and researchers alike and over the next decade will certainly see advances in early detection, efficacious treatments and neuroprotection.

To analyze ischemia-modified albumin (IMA) levels in aqueous humor and serum, and their correlation to RNFL thinning in primary glaucoma patients. Cross-sectional study. Patients were divided into the control and glaucoma groups. The control group was patients with senile cataracts. The glaucoma group consisted of patients diagnosed for the first time as primary open-angle glaucoma (POAG) or primary angle closure glaucoma (PACG). Exclusion criteria were secondary glaucoma and patients with systemic disease. A complete cataract examination was done for all patients, and glaucoma examinations for the glaucoma group. In both groups, the IMA aqueous humor was obtained during cataract and glaucoma procedure. Serum levels of IMA, malondialdehyde (MDA), and tumor necrosis factor alpha (TNF-α) were examined during preoperative examinations. Control group comprised 33 participants, and glaucoma group 41 patients (21 PACG and 20 POAG). Mean IMA aqueous humor (AQH) levels found in cataract group 6.039±3.16 ng/mL, glaucoma group 14.89±6.08 ng/mL, PACG group 12.69±6.25 ng/mL and POAG group 17.33±4.988 mg/mL. Mean IMA serum levels in cataract group 14.75±6.53 ng/mL, glaucoma group 13.89±6.53 ng/mL, PACG group 12.79±6.46 ng/mL± and POAG group 14.93±10.74 ng/mL. Glaucoma group had significant higher level of IMA in aqueous humor compared to control group, but opposite findings in serum IMA levels between groups. POAG patients had a higher aqueous IMA level compared to PACG group and correlated significantly with IOP. IMA AQH also negatively correlated to the RNFL thickness in both POAG and PACG group. Cut off 9.5 ng/mL was considered as a normal limit value to differentiate between control and glaucoma group. Primary glaucoma patients showed a significantly increased level of IMA AQH as a local ischemic biomarker compared to the control group. Systemic oxidative activity is not a representation of local ocular oxidative stress in both cataract and glaucoma group.