Ophthalmology. Glaucoma最新文献

{"title":"Paul vs. Baerveldt Implants in Pediatric Glaucoma: A 24-Month Retrospective Study.","authors":"Matteo Sacchi, Davide Tomaselli, Gianluca Monsellato, Davide Morante, Pierfilippo Sabella, Stefano Dore, Antonio Pinna, Paolo Nucci","doi":"10.1016/j.ogla.2026.07.005","DOIUrl":"10.1016/j.ogla.2026.07.005","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the effectiveness and safety of the Paul glaucoma implant (PGI; Advanced Ophthalmic Innovations) and the Baerveldt glaucoma implant (BGI; Abbott Medical Optics) in pediatric glaucoma over 24 months.</p><p><strong>Design: </strong>Retrospective, comparative cohort study.</p><p><strong>Participants: </strong>Thirty-three eyes from 30 pediatric patients (≤18 years) with primary or secondary glaucoma, treated with PGI (18 eyes) or BGI (15 eyes).</p><p><strong>Methods: </strong>All surgeries were performed by a single surgeon between April 2020 and October 2023. Follow-up data were analyzed up to 24 months.</p><p><strong>Main outcome measures: </strong>The primary outcome was intraocular pressure (IOP) reduction. Secondary outcomes included complete and qualified success, surgical failure, number of IOP-lowering medications, need for postoperative IOP-control procedures, best-corrected visual acuity, and complications.</p><p><strong>Results: </strong>Baseline IOP was 29.5 ± 5.0 mmHg in PGI eyes and 30.3 ± 6.7 mmHg in BGI eyes. At 24 months, IOP decreased to 13.6 ± 3.5 mmHg and 12.4 ± 4.7 mmHg, respectively, representing significant reductions from baseline in both groups (P < 0.05), with no between-group difference (P = 0.42). Medication use decreased from 2.8 ± 0.9 to 1.2 ± 1.3 in the PGI group and from 3.1 ± 0.8 to 1.5 ± 1.2 in the BGI group, with significant intragroup reductions in both cohorts (P < 0.05) and no significant difference between groups at 24 months (P = 0.76). Qualified success at 24 months was comparable (72.2% vs. 73.3%), with a nonsignificant trend toward higher complete success with PGI (38.9% vs. 13.3%). Best-corrected visual acuity remained stable in both groups. Complications occurred in 16.7% of PGI and 40.0% of BGI eyes, including a trend toward fewer hypotony-related shallow anterior chambers with PGI (0% vs. 20%, P = 0.09).</p><p><strong>Conclusions: </strong>Both implants achieved substantial and sustained IOP reduction, reduced medication burden, and comparable complete and qualified success. Paul glaucoma implant demonstrated a favorable safety profile, with few hypotony-related events, suggesting potential advantages linked to its intrinsic flow-restricting design in pediatric eyes.</p><p><strong>Financial disclosure(s): </strong>The author has no/the authors have no proprietary or commercial interest in any materials discussed in this article.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474410","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":"Prevalence and Severity of Undetected Open-Angle Glaucoma in Persons 77 to 89 Years Old.","authors":"Sigridur E Oskarsdottir, Boel Bengtsson, Anders Heijl, Johan Aspberg","doi":"10.1016/j.ogla.2026.07.003","DOIUrl":"10.1016/j.ogla.2026.07.003","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the prevalence and severity of previously undetected open-angle glaucoma (OAG) in individuals aged 77 to 89 years in Malmö, Sweden.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Subjects: </strong>All residents of Malmö, Sweden, aged 77 to 89 years were eligible for participation, except individuals with a prior glaucoma diagnosis at Skåne University Hospital. A total of 1957 individuals were invited, of whom 602 (30.8%) attended the screening.</p><p><strong>Methods: </strong>The screening procedure included intraocular pressure measurement using an iCare tonometer, visual field screening using the Frequency Doubling Technology perimeter, and fundus photography. Subjects with positive screening results were offered a postscreening visit with a full ophthalmological examination, including threshold perimetry using the Swedish Interactive Threshold Algorithm Standard 24-2 program of the Humphrey Field Analyzer. The severity of disease was evaluated based on the perimetric mean deviation index.</p><p><strong>Main outcome measures: </strong>Prevalence of previously undetected OAG in individuals aged 77 to 89 years (%) and the magnitude of visual field defects expressed as proportions (%) of patients in 5 different disease severity stages.</p><p><strong>Results: </strong>The prevalence of previously undetected OAG was 5.98% (95% confidence interval: 4.2%-8.2%), n = 35 patients. The condition was unilateral in 74% of patients. The severity of disease was early in 66% and moderate in 20%, while 14% of patients had advanced or severe disease. No patient had developed end-stage disease. The median intraocular pressure in glaucoma patients was 16 mmHg (interquartile range: 14-19 mmHg).</p><p><strong>Conclusions: </strong>The prevalence of previously undetected OAG was high in this age category, 5.98%, but most patients had early or moderate disease, and no patient had end-stage disease.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457820","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":"Two-Staged versus Single-Staged Baerveldt Implantation in Children with Glaucoma.","authors":"Brenda L Bohnsack, Adam Jacobson","doi":"10.1016/j.ogla.2026.07.002","DOIUrl":"10.1016/j.ogla.2026.07.002","url":null,"abstract":"<p><strong>Purpose: </strong>To compare 2-staged versus single-staged Baerveldt implantation in children with glaucoma.</p><p><strong>Design: </strong>Retrospective observational case series.</p><p><strong>Subjects: </strong>Children (<18 years of age) who underwent Baerveldt glaucoma drainage device (GDD) placement with at least 6 months of postoperative follow-up.</p><p><strong>Methods: </strong>Review of patients with at least 6 months of follow-up who underwent 2-stage Baerveldt placement (n = 25) between 2010 and 2025 and diagnosis and age-matched controls who had 1-stage Baerveldt placement (n = 40). Demographics, ocular diagnoses and surgeries, and examination findings (best-corrected visual acuity [BCVA], intraocular pressure [IOP], and glaucoma medications) were collected.</p><p><strong>Main outcome measures: </strong>Success and survival of Baerveldt GDD (IOP 5-21 mmHg, no additional IOP-lowering surgeries, and no visually devastating complications), BCVA, IOP, and glaucoma medications.</p><p><strong>Results: </strong>Children in the 2-stage Baerveldt and single-stage Baerveldt (control) groups showed no difference in age at surgery, type of glaucoma, prior glaucoma and intraocular surgeries, or length of follow-up. There was also no significant difference in BCVA, IOP, or number of glaucoma medications between the 2 groups before operation or at final follow-up. However, there were fewer patients whose vision worsened between the preoperative and final examinations in the staged group (P = 0.0011). In both groups, final IOP (P < 0.0001) and number of glaucoma medications (P < 0.05) were significantly decreased compared with the preoperative examination. Success at final follow-up was 64% in the 2-stage group and 60% in the controls, and there was no difference in survival curves (P = 0.6629). Greater number of prior glaucoma surgeries was associated with increased risk of failure (odds ratio, 1.7; 95% confidence interval, 1.4-2.2).</p><p><strong>Conclusions: </strong>Two-staged Baerveldt placement in children obtained IOP control on fewer medications and showed similar success and survival rates to children who underwent single-staged Baerveldt surgery.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450751","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":"Effect of Intraocular Pressure Control on Visual Field Progression in the HORIZON Trial.","authors":"Giovanni Montesano, Giovanni Ometto, Iqbal Ike K Ahmed, Gus Gazzard","doi":"10.1016/j.ogla.2026.06.010","DOIUrl":"10.1016/j.ogla.2026.06.010","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze the effect of intraocular pressure (IOP) characteristics on the 5-year rate of visual field mean deviation (MD) progression in the HORIZON trial.</p><p><strong>Design: </strong>Post-hoc analysis of data from a randomized clinical trial.</p><p><strong>Participants: </strong>Patients with glaucoma and visually significant cataract randomized to cataract surgery (CS) with or without the implant of the Hydrus Microstent (HMS).</p><p><strong>Methods: </strong>One eye of each participant with at least 3 reliable visual fields (false positive errors ≤15%) over at least 1 year was included. We used a published Bayesian hierarchical model, designed to minimize the effect of perimetric noise and learning. We compared the mean rate of MD progression between the 2 arms and measured the effect of postoperative mean intraocular pressure (MIOP), peak washed-out intraocular pressure (WO-PIOP), mean washed-out intraocular pressure (WO-MIOP), and day-1 IOP. These IOP metrics were mean-centered and standardized (divided by their standard deviation) to allow a direct comparison of their effect.</p><p><strong>Main outcome measures: </strong>Mean rate of MD progression.</p><p><strong>Results: </strong>Data from 517 eyes (352 in the CS-HMS arm) were analyzed. The MD rate was -0.55 [-0.72,-0.39] dB/year (mean [95% credible intervals]) for the CS-only arm and -0.30 [-0.38,-0.22] dB/year for the CS-HMS arm (44.6% [18.0, 64.2] reduction, P = 0.004). Increase in all IOP metrics was significantly associated with a faster MD rate. MIOP, WO-MIOP, and WO-PIOP had similar proportional effects. Day-1 IOP had a considerably smaller effect. The difference in rate between the 2 arms remained significant after adjusting for MIOP (P = 0.002) but was largely eliminated after adjusting for WO-MIOP and WO-PIOP (P = 0.396). The MD rate in the CS arm remained significantly faster than CS-HMS (P = 0.001) after removing eyes with a day-1 IOP spike (IOP > 40 mmHg or 10 mmHg above the washed-out baseline IOP).</p><p><strong>Conclusions: </strong>The MD rate was significantly slower in the CS-HMS arm in the HORIZON trial, compared to CS alone. This difference was not explained by day-1 IOP spikes or MIOP, but was largely accounted for by WO-IOP metrics.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310499","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":"Comparing National Microinvasive Glaucoma Surgery Procedure Rates in Response to Medicare and Industry Payment Changes.","authors":"Yash Gulani, Gerard F Anderson, Thomas V Johnson","doi":"10.1016/j.ogla.2026.06.009","DOIUrl":"10.1016/j.ogla.2026.06.009","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine how changes in Medicare payments and industry transfers of value (TOVs) are associated with changes in microinvasive glaucoma surgery (MIGS) procedure rates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective, observational cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Subjects: &lt;/strong&gt;Ophthalmologists who performed glaucoma surgery for Medicare beneficiaries from 2018 to 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A 20% nationally representative sample of Medicare Part B Carrier claims from 2018 to 2023 identified trabecular meshwork bypass stent implantation, goniotomy, canaloplasty, and trabeculectomy procedures using Current Procedural Terminology codes. Procedures were aggregated at the physician-year level using National Provider Identifiers. Medicare payment changes for trabecular bypass stent implantations implemented on January 1, 2022 were examined alongside contemporaneous industry stent-related TOV payments from trabecular meshwork bypass stent manufacturers (Alcon and Glaukos), obtained from the Centers for Medicare & Medicaid Services Open Payments database. Annual and quarterly procedure volumes were compared before (2018-2021) and after (2022-2023) the policy change. Trabeculectomy served as a control procedure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;Annual procedure volumes for trabecular stents, goniotomy, canaloplasty, and trabeculectomy; mean number of procedures performed per physician; association of Centers for Medicare & Medicaid Services payment rates and industry TOV payments with individual procedure rates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Following a Medicare payment reduction for trabecular stents from approximately $500 to $34 per procedure, national trabecular stent utilization stably declined by 33%. Over the same period, goniotomy utilization increased by 61% and canaloplasty utilization increased by 19%. Total MIGS volume remained relatively stable. Industry stent-related TOV payments to ophthalmologists increased substantially in 2022 but subsequently declined in 2023. Stratified analyses demonstrated that reductions in trabecular stent utilization occurred across all levels of industry TOV payment recipients, including among physicians receiving the highest payment amounts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;A large Medicare payment reduction for trabecular meshwork bypass stent implantation was associated with rapid declines in stent utilization and increased performance of alternative MIGS procedures. Concurrent increases in industry TOV payments did not offset these shifts, suggesting that Medicare payment policy exerted a stronger influence on procedural selection than industry financial incentives. These findings highlight the sensitivity of surgical practice patterns to payment policy and suggest that even substantial industry payments may have limited influence when insurer payments change dramatically.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Financial disclosure(s): &lt;/strong&gt;Proprietary or commercial disclos","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284810","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":"Standardized Classification System for Dysphotopsia Reporting.","authors":"Ryan S Huang, Natasha Verhoeff, Michael Balas, Marko M Popovic, Clara C Chan, Vital P Costa, Helena Prior Filipe, Anat Galor, Bonnie An Henderson, Edsel Ing, Alfonso Iovieno, Adam K Muzychuk, Pradeep Y Ramulu, Christopher Joseph Rudnisky, Hady Saheb, Julie M Schallhorn, Joshua C Teichman, Richard Tipperman, Paul Ursell, Kateki Vinod, George O Waring, Stephanie Louise Watson, Sonia N Yeung, Nazlee Zebardast, Cindy M L Hutnik, Irfan N Kherani, Matthew B Schlenker, David J Mathew","doi":"10.1016/j.ogla.2026.06.005","DOIUrl":"10.1016/j.ogla.2026.06.005","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To develop a consensus-based classification system and questionnaire for the standardized assessment and reporting of dysphotopsias following ophthalmic procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Systematic review and Delphi consensus process.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Twenty ophthalmic specialists with expertise in glaucoma, cataract/refractive surgery, and cornea participated in this Delphi consensus survey.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic literature search was conducted using Ovid MEDLINE and Embase to identify randomized controlled trials and observational studies reporting on dysphotopsias. Reported symptoms, assessment questionnaires, and individual question items were extracted to create a comprehensive list of potential classification items. These items were refined through iterative Delphi consensus surveys involving ophthalmic specialists, who evaluated each item for inclusion, exclusion, or rewording, and could propose the addition of new items. Consensus was defined a priori as ≥80% agreement among panelists. This iterative process allowed for progressive refinement of the classification system and continued until at least 80% of all proposed items achieved consensus.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;The proportion of ophthalmic specialists who chose to include or exclude specific dysphotopsia symptoms, and additional items of the questionnaire, including baseline characteristics, environmental modifiers, quality of life, and attempted management strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Following the screening of 5059 articles, 142 studies met inclusion criteria, identifying 34 unique dysphotopsia symptoms and 76 individual questionnaire items. Participants reached consensus on 53 of 63 items (84.1%) over 2 rounds of Delphi surveys. Items that did not meet inclusion or exclusion thresholds after the second round were excluded from the final classification system. The finalized classification system included 11 baseline clinical variables, 7 positive dysphotopsia symptoms (halos, glare/dazzle, starbursts, arcs, lines/streaks, ghosting, and flickering/shimmering), 1 negative dysphotopsia symptom (peripheral crescent/shadow), 5 environmental modifiers, 2 quality-of-life and mental health items, and 8 attempted interventions. These elements were consolidated into the DYsphotopsia Symptom Questionnaire and Outcomes intended for clinical and research applications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;A standardized classification system for the reporting of dysphotopsias following ophthalmic procedures was developed using the Delphi consensus process. The adoption of this tool in research and clinical practice may enhance the consistency, clarity, and quality of dysphotopsia reporting, enabling comparisons across interventions and enhancing evidence-based patient care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Financial disclosure(s): &lt;/strong&gt;Proprietary or commercial disclosure may be found in the F","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267129","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":"Intraocular Pressure Measurement Variability in the Ocular Hypertension Treatment Study.","authors":"Aakriti Garg Shukla, Ari Leshno, Carlos Gustavo De Moraes, Michael Kass, Mae Gordon, Emmanouil Tsamis, George A Cioffi, Jeffrey M Liebmann","doi":"10.1016/j.ogla.2026.06.004","DOIUrl":"10.1016/j.ogla.2026.06.004","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize intravisit variability of Goldmann applanation tonometry (GAT) and identify factors associated with intraocular pressure (IOP) measurement variability using longitudinal data from the Ocular Hypertension Treatment Study (OHTS).</p><p><strong>Design: </strong>A post hoc analysis of a multicenter, randomized clinical trial.</p><p><strong>Subjects, participants, controls: </strong>The OHTS trial participants.</p><p><strong>Methods: </strong>Intravisit IOP measurements obtained using a standardized GAT protocol in OHTS were analyzed over 15 years of follow-up. Two measurements (IOP₁ and IOP₂) were obtained per eye at each visit, with a third measurement (IOP₃) performed if IOP₁ and IOP₂ differed by >2 mmHg. The intravisit differences in IOP measurements were assessed. Multivariable mixed-effects logistic regression models were used to identify factors associated with the need for IOP₃ measurement during follow-up.</p><p><strong>Main outcome measures: </strong>Intravisit IOP variability and measurement variability.</p><p><strong>Results: </strong>The analysis included 1636 OHTS participants who had 35 636 patient visits (71 249 eye-visits, defined as a visit when at least 1 IOP measurement was performed for a given eye) and 145 236 IOP measurements. The first 2 measurements were within 2 mmHg in 96.2% of eye-visits. Although 44.8% of paired measurements were identical, IOP₁ was more often higher than IOP₂ (54.4%, P < 0.001). In 3.8% of eye-visits, IOP₃ was performed and lowered the final recorded IOP in 63.4%. Baseline need for IOP₃ (odds ratio (OR) 1.52; 95% confidence interval (CI), 1.14-2.03; P = 0.004), higher current visit IOP (OR 1.06 per 1 mmHg higher IOP; 95% CI, 1.04-1.09; P < 0.001), and baseline higher pattern standard deviation (OR 1.26 per 1 dB higher; 95% CI, 1.04-1.52; P = 0.02) were independently predictive of need for IOP₃ during follow-up, while randomized treatment assignment was not (OR 1.02; 95% CI, 0.88-1.19; P = 0.78).</p><p><strong>Conclusions: </strong>Goldmann applanation tonometry remains the most common procedure in ophthalmology. In the OHTS, GAT demonstrated modest measurement variability. Intraocular pressure measurement variability was associated with characteristics known to be risk factors for the development of primary open-angle glaucoma. These findings have implications for clinical decision-making, trial design, and the application of the OHTS risk calculator. Clinicians should maintain a low threshold for repeating measurements when intravisit measurements are inconsistent or when making a clinical decision based on a single IOP measurement.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260615","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":"Positive Airway Pressure and Long-Term Glaucoma Risk in Obstructive Sleep Apnea: A Cohort Study.","authors":"Takashi Nishida, Riya Mittal, Robert N Weinreb, Ghazaleh Soltani, Seyedeh Melika Hashemi, Amelia de Oliveira Pereira, Shahin Hallaj, Sally L Baxter, Maryam Maghsoudipour, Sasan Moghimi","doi":"10.1016/j.ogla.2026.05.012","DOIUrl":"10.1016/j.ogla.2026.05.012","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the association between obstructive sleep apnea (OSA), recorded positive airway pressure (PAP) device use, and incident glaucoma in a large multicenter electronic health record (EHR) cohort.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Participants: </strong>Adults in Epic Cosmos were included if they had an index encounter for OSA evaluation between January 1, 2010, and October 31, 2025, no prior glaucoma diagnosis, and at least 180 days of follow-up. Patients were categorized as sleep-tested controls without OSA, OSA without a PAP device record, or OSA with a PAP device record within 180 days.</p><p><strong>Methods: </strong>Follow-up began at a 180-day landmark after the index OSA evaluation and continued until incident glaucoma, death, or last encounter. Positive airway pressure exposure was defined using a code-based EHR proxy for PAP therapy within 180 days. Cox proportional hazards models adjusted for baseline covariates were used to estimate associations with incident glaucoma. Incidence rates were calculated per 1000 person-years from the landmark to censoring.</p><p><strong>Main outcome measures: </strong>Incident glaucoma defined as at least 2 glaucoma diagnosis codes within 365 days, with the first qualifying diagnosis occurring after the 180-day landmark.</p><p><strong>Results: </strong>The cohort included 12 516 607 patients with a mean (standard deviation) age of 60.4 (11.6) years; 43.7% were women. Over a mean (standard deviation) follow-up of 5.2 (3.7) years, 153 083 incident glaucoma events occurred. Crude incidence rates per 1000 person-years were 1.74 in controls, 2.38 in OSA without a PAP device record, and 3.39 in OSA with a PAP device record. Compared with sleep-tested controls, adjusted hazards of incident glaucoma were higher in OSA without a PAP device record (hazard ratio [HR], 1.27; 95% confidence interval [CI], 1.22-1.32) and OSA with a PAP device record (HR, 2.10; 95% CI, 1.80-2.45). At 10 years, cumulative incidence was 1.58%, 2.30%, and 3.86%, respectively.</p><p><strong>Conclusions: </strong>Obstructive sleep apnea was associated with a higher risk of incident glaucoma compared with sleep-tested controls. The observed risk gradient does not establish whether PAP itself increases or decreases glaucoma risk relative to untreated OSA because residual confounding by OSA severity and treatment indication is likely. Ophthalmic monitoring may be warranted in patients undergoing clinical evaluation or treatment for OSA.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159194","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":"Socioeconomic Differences in Glaucoma Medication Spending under Medicare Part D: Evidence on Price vs. Utilization.","authors":"Taemin Kim, Anh Vu, Chien-Hsiang Weng","doi":"10.1016/j.ogla.2026.05.013","DOIUrl":"10.1016/j.ogla.2026.05.013","url":null,"abstract":"<p><strong>Objective: </strong>To examine whether socioeconomic differences in Medicare Part D glaucoma medication spending are more strongly associated with price exposure (spending per claim) than with utilization intensity.</p><p><strong>Design: </strong>An ecologic observational study using state-year-level data.</p><p><strong>Participants: </strong>Medicare Part D beneficiaries receiving glaucoma medications across 50 states and the District of Columbia from 2019 through 2023 (255 state-years).</p><p><strong>Methods: </strong>We analyzed Centers for Medicare & Medicaid Services Medicare Part D Prescribers-by-Geography and Drug public use files. State-level socioeconomic context was measured using Area Deprivation Index (ADI) national rank and median household income (sensitivity analysis). Outcomes included inflation-adjusted spending per beneficiary and per claim, as well as utilization measures (claims and 30-day fills per beneficiary) and brand spending and claims shares. Multivariable linear regression models included year fixed effects and state-clustered standard errors.</p><p><strong>Main outcome measures: </strong>Spending per beneficiary and spending per claim.</p><p><strong>Results: </strong>Median spending per beneficiary was $403.81 (interquartile range [IQR], $359.74-$444.73), and median spending per claim was $104.22 (IQR, $89.49-$118.41). Higher median household income was associated with greater spending per beneficiary ($18.18 per $10,000; 95% confidence interval [CI], $1.30-$35.06) and per claim ($6.99; 95% CI, $1.95-$12.03). Higher ADI was associated with lower spending per claim, although estimates were imprecise (-$3.69 per 10-point increase; 95% CI, -$7.51 to $0.13). Utilization intensity varied minimally across socioeconomic strata (claims per beneficiary, 3.8-4.0), and neither ADI nor income was consistently associated with brand spending or claims share.</p><p><strong>Conclusions: </strong>State-level socioeconomic context was associated with modest differences in glaucoma medication spending per claim, with minimal differences in utilization intensity. These findings suggest that socioeconomic variation in Medicare Part D glaucoma drug spending is more consistent with differences in price exposure than with differences in volume of use.</p><p><strong>Financial disclosure(s): </strong>The authors have no proprietary or commercial interest in any materials discussed in this article.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152316","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":"Primary Open Angle Glaucoma Polygenic Risk Score is Associated with Disease Progression.","authors":"Niloufar Bineshfar, Kanza Aziz, Hetince Zhao, Yan Zhao, Uday Pratap Singh Parmar, Ha My Thi Vy, Ghislain Rocheleau, Ron Do, Jae H Kang, Ayellet V Segrè, Louis R Pasquale, Janey L Wiggs, Nazlee Zebardast","doi":"10.1016/j.ogla.2026.05.014","DOIUrl":"10.1016/j.ogla.2026.05.014","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether a polygenic risk score (PRS) for primary open-angle glaucoma (POAG) is associated with open-angle glaucoma (OAG) progression and treatment burden in a multiancestry population.</p><p><strong>Design: </strong>Longitudinal cohort study.</p><p><strong>Subjects: </strong>A total of 950 individuals with OAG and serial Humphrey visual field (VF) testing were included, comprising 713 participants from the Mass General Brigham Biobank and 237 from the Mount Sinai BioMe Biobank.</p><p><strong>Methods: </strong>A POAG PRS was generated using summary statistics from a cross-ancestry genome-wide association study. Association between PRS and VF progression, defined as a mean deviation slope worse than -0.25 dB/year, was tested with logistic regression models adjusted for age, sex, and ancestry. Associations with treatment burden, defined by a weighted score of medications, laser, and surgical interventions, were analyzed using logistic regression. Association between PRS and surgical interventions were assessed using Cox proportional hazards models.</p><p><strong>Main outcome measures: </strong>OAG progression described by mean deviation slope and treatment intensity.</p><p><strong>Results: </strong>Among 950 individuals with OAG, the mean age at baseline was 71.2 ± 10.5 years; 54.7% were female, and 65.5% were of European descent. The median follow-up duration was 6.5 years. Each standard deviation (SD) increase in PRS was associated with a faster rate of VF decline (β = -0.02 dB/year per SD higher PRS; 95% confidence interval [CI], -0.04 to -0.01; P = 0.007) and 22% higher odds of progression (odds ratio = 1.22 per SD higher PRS; 95% CI, 1.04-1.42; P = 0.014). Higher PRS was also associated with greater treatment burden (odds ratio = 1.47 per SD; 95% CI, 1.27-1.71; P < 0.001). In the Mass General Brigham cohort, higher PRS predicted shorter time to glaucoma procedures (hazard ratio = 1.34 per SD; 95% CI, 1.12-1.59; P = 0.001), and this association persisted among eyes with normal or mild baseline disease severity (hazard ratio = 1.33 per SD; 95% CI, 1.10-1.60; P = 0.003).</p><p><strong>Conclusions: </strong>In 2 independent biobank cohorts, higher POAG PRS was associated with faster VF progression and greater treatment burden in OAG. These findings support the potential utility of genetic risk profiling for prognostication of disease trajectory and management intensity in glaucoma.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152290","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}