Zayn Al-Timimi BMed, MD , Samrat Sarkar BOptom, MAppSc , Sapna Nand BAppSc(Orth) , Simon E. Skalicky MBBS, PhD , Sartaj Sandhu MBBS , Hamish Dunn MBBS, PhD , Lisa Keay MPH, PhD
{"title":"Meaningful Patient Partnerships","authors":"Zayn Al-Timimi BMed, MD , Samrat Sarkar BOptom, MAppSc , Sapna Nand BAppSc(Orth) , Simon E. Skalicky MBBS, PhD , Sartaj Sandhu MBBS , Hamish Dunn MBBS, PhD , Lisa Keay MPH, PhD","doi":"10.1016/j.ogla.2025.04.006","DOIUrl":"10.1016/j.ogla.2025.04.006","url":null,"abstract":"<div><h3>Purpose</h3><div>Patient-centered care is key to successful clinical outcomes and meaningful clinician–patient relationships. Accordingly, a comprehensive understanding of patient perspectives is essential to aligning the clinician's focus and patient's goals. However, our understanding of patients' perceptions of glaucoma surgery<span> and involvement in surgical decision-making has not kept pace with the rapid treatment advances in the field and move toward earlier surgery with the advent of minimally invasive glaucoma surgery devices. The purpose of this study was to understand the perspectives and priorities of people with glaucoma when considering glaucoma surgery through qualitative analysis of semistructured interviews.</span></div></div><div><h3>Design</h3><div>A qualitative study.</div></div><div><h3>Participants</h3><div>Individuals diagnosed with glaucoma, above 18 years of age, and able to communicate effectively in English. Interviews were conducted with 40 participants: 23 participants who had undergone glaucoma surgery and 17 who had not.</div></div><div><h3>Methods</h3><div>Interviews were conducted over telephone, using an interview guide developed in consultation with people with glaucoma and surgeons. The cohort was purposely sampled to ensure representation across age, sex, socioeconomic status, remoteness, glaucoma severity, clinic settings, and treatment histories. Transcripts were iteratively analyzed to identify key themes pertaining to perceptions of glaucoma surgery and involvement in decision-making.</div></div><div><h3>Main Outcome Measures</h3><div>Surgical perception and involvement themes, including barriers and bridges to confidence in glaucoma surgery.</div></div><div><h3>Results</h3><div>Six key themes were identified: (1) patients feeling rushed; (2) onus on the patient to seek information; (3) undercurrents of anxiety; (4) perceptions of surgery shaped by understanding and expectations of the disease and its treatment paradigm; (5) trust in surgeon imbuing confidence in surgery; and (6) empowerment through understanding of alternatives. Key barriers to patient involvement included patient anxiety, time pressures (real or perceived), and perceived urgency of intervention.</div></div><div><h3>Conclusions</h3><div>Shared decision-making in glaucoma surgery remains aspirational. This study provides valuable insights into patient perceptions of glaucoma surgery, which can help inform patient-centered care. Readily applicable “practice points” are proposed to optimize patient involvement and empowerment.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 5","pages":"Pages 440-449"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Evolution of Visual Field Testing","authors":"Anfei Li MD, PhD , C. Gustavo De Moraes MD, PhD","doi":"10.1016/j.ogla.2025.08.001","DOIUrl":"10.1016/j.ogla.2025.08.001","url":null,"abstract":"<div><div>The assessment of the human visual field, a concept explored since ancient Greece, underwent a critical transformation in the 19th century with the advent of objective measurement techniques. Early methodologies concentrated on mapping the outer limits of vision, a practice known as perimetry. However, the focus soon shifted toward campimetry (although the name <em>perimetry</em> remained), which involves assessing defects within the central/paracentral visual field—a crucial development for diagnosing diseases such as glaucoma. Although historical methods such as Bjerrum tangent screen and Goldmann kinetic perimetry were foundational, the last 4 decades have been defined by the rise of static automated perimetry (SAP). Coinciding with the inception of the American Glaucoma Society, the 1980s marked a pivotal transition from manual techniques to computerized, automated testing. Static automated perimetry, exemplified by the Humphrey Field Analyzer (HFA), has since become the clinical standard, offering a precise and reproducible method for quantifying visual field sensitivities, which is indispensable for the detection and management of glaucoma. This review examines the evolution of modern visual field testing over the past 40 years, focusing on the technological advancements in hardware, software algorithms, and novel testing paradigms that have reshaped our approach to glaucoma care.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 5","pages":"Pages S20-S26"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"American Glaucoma Society 40th Anniversary","authors":"Carla J. Siegfried MD, Gregory L. Skuta MD","doi":"10.1016/j.ogla.2025.08.007","DOIUrl":"10.1016/j.ogla.2025.08.007","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 5","pages":"Page S1"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tianyi Wang BA , Hong Su An PhD , Jaqueline Stoutin MD , Alexander D. Valentine MD , Leah K. Depperschmidt RN , Matthew Callewaert OD , Michael Goldstein MD , Joshua D. Stein MD, MS
{"title":"Association of Eye Drop–Treated Diseases and Conditions That Can Impair Eye Drop Self-Administration","authors":"Tianyi Wang BA , Hong Su An PhD , Jaqueline Stoutin MD , Alexander D. Valentine MD , Leah K. Depperschmidt RN , Matthew Callewaert OD , Michael Goldstein MD , Joshua D. Stein MD, MS","doi":"10.1016/j.ogla.2025.04.001","DOIUrl":"10.1016/j.ogla.2025.04.001","url":null,"abstract":"<div><h3>Objective</h3><div>Eye drops are often first-line treatment for glaucoma and dry eye disease (DED). Unfortunately, proper eye drop self-administration is difficult, and this is likely magnified in persons with comorbid rheumatological, neurological, or cognitive disorders. This study investigates the association between ocular conditions often treated with eye drops (glaucoma and DED) and medical conditions that may impair proper eye drop self-administration.</div></div><div><h3>Design</h3><div>A retrospective database study.</div></div><div><h3>Participants</h3><div>From 6 health systems, 1 446 229 patients participated in the Sight Outcomes Research Collaborative between January 2012 and December 2021.</div></div><div><h3>Methods</h3><div>We determined the proportion of patients with glaucoma or DED with medical conditions that may limit proper eye drop self-administration and created multivariable logistic regression models assessing associations between glaucoma or DED and comorbid conditions.</div></div><div><h3>Main Outcome Measures</h3><div>Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of glaucoma or DED.</div></div><div><h3>Results</h3><div>Among 247 899 patients with glaucoma (mean [standard deviation] age: 60.1 [15.1] years, 56.2% female, 19.5% Black), 106 927 (43%) had ≥ 1 comorbid condition that could affect eye drop self-administration. Among 321 941 patients with DED (mean [standard deviation] age: 55.9 [16.1] years, 66.4% female, 12.6% Black), 156 811 (49%) had ≥ 1 such condition. Patients with ≥ 1 impairment affecting eye drop self-administration had 17% greater odds of glaucoma (aOR: 1.17, CI: 1.16–1.18) and 66% greater odds of DED (aOR: 1.66, CI: 1.65–1.68), compared with other patients. Persons with 2, 3, and ≥ 4 conditions that may affect eye drop administration had 27%, 39%, and 53% higher odds of glaucoma, respectively, compared with persons without such conditions (<em>P</em> < 0.0001). Persons with 2, 3, and ≥ 4 health conditions that may impair eye drop administration had 76%, 121%, and 156% higher odds of DED, respectively (<em>P</em> < 0.0001).</div></div><div><h3>Conclusions</h3><div>Nearly half of all patients with glaucoma or DED have ≥ 1 medical condition that may impair eye drop self-administration. Clinicians should assess patients' physical and mental capacity to self-administer topical ocular therapy. Some patients may benefit from alternative therapies that reduce or eliminate the need for eye drops.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 5","pages":"Pages 431-439"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James D. Brandt MD , Lauren S. Blieden MD , Alana L. Grajewski MD
{"title":"Childhood Glaucoma","authors":"James D. Brandt MD , Lauren S. Blieden MD , Alana L. Grajewski MD","doi":"10.1016/j.ogla.2025.06.011","DOIUrl":"10.1016/j.ogla.2025.06.011","url":null,"abstract":"<div><div>The glaucomas arising in children comprise a diverse group of developmental and secondary disorders. Until the mid-20th century, childhood glaucoma was a uniformly blinding disease. The development of surgical approaches like goniotomy ab interno (1940s) and trabeculotomy ab externo (1960s) provided the first effective treatments for this group of uncommon disorders. Since then, additional progress in the management of adult glaucoma has quickly found its way to childhood glaucoma—including the use of antimetabolites, modern glaucoma drainage devices, and techniques of circumferential ab interno and ab externo trabeculotomy using sutures or an illuminated microcatheter. Each of these techniques requires modifications to be safely used in infants and young children. The nomenclature and classification of the pediatric glaucomas were standardized in 2013 with the Childhood Glaucoma Research Network classification system which was a foundational step in developing registries and coordinated research in the field. Modern tools of molecular genetics have begun to elucidate the underlying molecular pathophysiology and inheritance of some forms of childhood glaucoma. Single-gene, Mendelian-inherited forms of childhood glaucoma may be ideal targets for clustered regularly interspaced short palindromic repeats (CRISPR) gene-editing technologies to correct the disorder locally in the anterior chamber angle. All these advances greatly improved visual outcomes in childhood glaucoma. However, with the greatly improved visual prognosis in childhood glaucoma come unique considerations in how we care for these patients over a very long lifespan.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 5","pages":"Pages S58-S63"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erin A. Boese MD , Wallace L.M. Alward MD , John H. Fingert MD, PhD
{"title":"Gonioscopy-Assisted Transluminal Trabeculotomy for Myocilin-Associated Juvenile Open-Angle Glaucoma","authors":"Erin A. Boese MD , Wallace L.M. Alward MD , John H. Fingert MD, PhD","doi":"10.1016/j.ogla.2025.03.011","DOIUrl":"10.1016/j.ogla.2025.03.011","url":null,"abstract":"<div><h3>Objective</h3><div><span>Mutations within the myocilin (</span><em>MYOC</em><span><span>) gene are the first known single-gene cause of both primary open-angle glaucoma and juvenile open-angle glaucoma (JOAG). Subsequent studies have shown these mutations cause trabecular meshwork dysfunction, resulting in markedly elevated </span>intraocular pressures<span> (IOPs) at young ages. Angle-based procedures, like gonioscopy-assisted transluminal trabeculotomy<span> (GATT), bypass the trabecular meshwork, and as such, are hypothesized to be particularly effective in this angle-based disease. The purpose of this case series is to evaluate the efficacy of GATT for </span></span></span><em>MYOC</em>-associated JOAG.</div></div><div><h3>Design</h3><div>A retrospective chart review was performed evaluating patients under the age of 18 years with known <em>MYOC</em>-associated JOAG who underwent GATT. A total of 8 eyes of 4 children are included.</div></div><div><h3>Participants</h3><div>All participants had a strong family history of <em>MYOC</em> glaucoma.</div></div><div><h3>Methods</h3><div><span><span>All patients underwent a thorough clinical evaluation<span>, including visual acuity, </span></span>slit lamp examination<span>, optic nerve fundoscopy, and IOP measurements by Goldmann applanation. Most patients also underwent 24-2 Swedish Interactive Thresholding algorithm (SITA) standard Humphrey visual fields and </span></span>fundus photography<span><span>, and all patients had retinal nerve fiber layer </span>OCT.</span></div></div><div><h3>Main Outcome Measures</h3><div>Main outcome measures include IOP and number of medications. Additional measures include visual acuity, optic nerve photos, visual field testing, and OCT.</div></div><div><h3>Results</h3><div>Following 360° GATT, all 8 eyes of 4 children had a mean drop in IOP of 26 mmHg (68%), and all were able to stop glaucoma medications entirely. Our patients were followed up between 2.2 and 4.1 years with no evidence of decreasing efficacy or glaucomatous progression. All patients maintain 20/20 visual acuity or better in both eyes, and glaucoma has stabilized on all available ancillary testing (OCT, Humphrey visual field, and optic nerve photos). One patient (patient 4) had a notable reversal of cupping.</div></div><div><h3>Conclusions</h3><div>In <em>MYOC-</em>associated JOAG, the pathology is concentrated at the trabecular meshwork (TM), lending itself well to angle-based surgeries, especially GATT. Gonioscopy-assisted transluminal trabeculotomy is particularly effective in children with <em>MYOC</em><span> JOAG, allowing them to avoid, or at least delay, the need for more invasive surgeries like trabeculectomy<span> and tube shunt surgeries with over 4 years of follow-up. To date, this is the first genetically directed glaucoma surgery available.</span></span></div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and ","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 5","pages":"Pages 466-473"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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