Journal of Glaucoma

Review of Hygiene and Disinfection Recommendations for Outpatient Glaucoma Care: A COVID Era Update

Julie M. Shabto, Carlos Gustavo De Moraes, George A. Cioffi, and Jeffrey M. Liebmann,

This review focuses on best practices and recommendations for hygiene and disinfection to limit exposure and transmission of infection in outpatient glaucoma clinics during the current COVID-19 pandemic.

Deep-layer Microvasculature Dropout in Preperimetric Glaucoma Patients

Suh, Min Hee ; Na, Jeong Ho ; Zangwill, Linda M; Weinreb, Robert N.

Purpose: 

To compare disease severity between preperimetric primary open-angle glaucoma (POAG) patients with and without deep-layer microvasculature dropout.

Materials and Methods: 

Ninety-four eyes of 94 preperimetric POAG patients with β-zone parapapillary atrophy (βPPA) were categorized according to the presence of deep-layer microvasculature dropout defined as a complete loss of microvasculature within the choroid or scleral flange on optical coherence tomography angiography. Parameters representing disease severity, that is, visual field (VF) mean deviation (MD), global and sectoral (6-sector) retinal nerve fiber layer (RNFL) thickness, and other factors including age, focal lamina cribrosa (LC) defect, width of βPPA with and without Bruch membrane (BM) (βPPA+BM and βPPA−BM), and optic disc hemorrhage were compared between eyes with and without dropout.

Results: 

Deep-layer microvasculature dropout was observed in 33 preperimetric POAG eyes (35.1%). Eyes with dropout had significantly thinner RNFL in all areas except the inferonasal sector, worse VF MD, and higher prevalence of focal LC defect, and larger βPPA−BM (P<0.05), whereas the 2 groups did not differ in age, disc hemorrhage, or βPPA+BM width (P>0.05). In the multivariable logistic regression, worse VF MD [odds ratio (OR), 1.485; P=0.045], thinner RNFL (OR, 1.141; P<0.001), and higher prevalence of focal LC defect (OR, 6.673; P<0.001) were significantly associated with dropout.

Conclusions: 

Deep-layer microvasculature dropout was observed in a considerable number of preperimetric POAG eyes, and worse disease severity was associated with dropout. Future studies elucidating the pathogenic role of deep-layer microvasculature dropout in the development and progression of glaucoma are warranted.

Disc Hemorrhages Are Associated With the Presence and Progression of Glaucomatous Central Visual Field Defects

Shukla, Aakriti G; Sirinek, Portia E; De Moraes, C. Gustavo. Et all

Purpose: 

To study the relationship between disc hemorrhage (DH) and the presence and progression of glaucomatous central VF damage.

Methods: 

Cross-sectional and longitudinal analyses were performed on data from the African Descent and Glaucoma Evaluation Study (ADAGES) cohort. Two masked investigators reviewed disc photographs for the presence and location of DH. 24-2 central VF damage was based on the number of test locations within the central 10 degrees of the 24-2 field pattern deviation and their mean total deviation (MTD). 10-2 central VF damage was based on pattern deviation and MTD. Main outcome measures were the association between DH and presence of central VF damage and between DH and worsening of VF.

Results: 

DH was detected in 21 of 335 eyes (6.2%). In the cross-sectional analysis, DH was significantly associated with more severe central damage on 24-2 [incidence rate ratio=1.47; 95% confidence interval (CI)=1.02-2.12; P=0.035] and 10-2 VFs (incidence rate ratio=1.81; 95% CI=1.26-2.60; P=0.001). In the longitudinal analysis, DH eyes progressed faster than non-DH eyes based on 24-2 global MTD rates (difference in slopes, β=−۰.۰۶; ۹۵% CI=−۰.۱۱ to −۰.۰۱; P=0.009) and 10-2 MTD rates (β=−۰.۱۰; ۹۵% CI=−۰.۱۴ to −۰.۰۶; P< 0.001), but not 24-2 central MTD rates (β=−۰.۰۲; ۹۵% CI=−۰.۰۷۸ to 0.026; P=0.338).

Conclusion: 

DH was associated with the presence and progression of central VF defects. DH identification should prompt intensive central VF monitoring and surveillance with 10-2 fields to detect progression.