Ophthalmology. Glaucoma最新文献

{"title":"Leveraging Natural Language Processing to Assess Follow-Up Patterns in Glaucoma Care.","authors":"Andrew M Williams, Hai-Wei Liang, Chenyu Li, Yanshan Wang","doi":"10.1016/j.ogla.2026.04.009","DOIUrl":"10.1016/j.ogla.2026.04.009","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a natural language processing (NLP) algorithm that identifies follow-up recommendations from the free text of clinical glaucoma clinic notes, and to determine the proportion of patients who lapse beyond recommended follow-up intervals.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Participants: </strong>Adult glaucoma patients treated from January 2016 through December 2022 at our academic ophthalmology practice.</p><p><strong>Methods: </strong>Structured demographic and diagnosis data were extracted alongside the free text of clinical notes. An NLP algorithm was developed to identify recommended follow-up intervals from note-free text. Lapses in care were defined as absence of a return visit within 125% of the recommended follow-up interval. Generalized estimating equations with a Poisson distribution and log link were used to identify risk factors for lapsing in care. Results are reported as adjusted risk ratios (aRRs) with 95% confidence intervals (CIs).</p><p><strong>Main outcome measures: </strong>Natural language processing algorithm performance and proportion of patients with an identified lapse in care.</p><p><strong>Results: </strong>In total, 221 378 clinical notes were assessed, representing 66 228 visits by 6452 unique glaucoma patients. The NLP algorithm identified a follow-up interval for 47 084 of 66 228 (71.1%) patient visits and demonstrated high performance compared to gold standard chart review (F1 score 0.905, precision 0.948, recall 0.867). The proportion of visits that exceeded 125% of the preceding recommended follow-up interval was 20.0% (interquartile range [IQR]: 10.0-33.3). The median excess duration of the lapsed interval compared to recommended follow-up was 52.9 days (IQR: 22.0-111.5 days). The proportion of patients with any event of lapsing in follow-up was 73.7% (4754/6452). Risk factors for having at least 1 lapse in care included Black race (aRR = 1.29, 95% CI: 1.22-1.37, compared to White race) and Hispanic ethnicity (aRR = 1.53, 95% CI: 1.26-1.87), with lower risk for older age (aRR = 0.91, 95% CI: 0.86-0.97, age 71 to 80 years compared to ≤60 years). Among the 4754 patients with at least 1 lapse in care, 1183 (24.9%) never returned after lapsing.</p><p><strong>Conclusions: </strong>Natural language processing can reliably detect lapses in glaucoma care using individualized follow-up intervals. Identifying lapses in care may facilitate referrals to resources to mitigate risk of loss to follow-up.</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":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857782","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-Year Outcomes of Visco-Circumferential Suture Trabeculotomy vs. Rigid Probe Hemi-Trabeculotomy in Late-Onset Primary Congenital Glaucoma.","authors":"Ahmed S Elwehidy, Mostafa A Elwehidy, Rasha M Elzeini, Mohammed Elashry, Ghada H Allam, Mostafa Damlakhi, Abdelrahman M Elhusseiny","doi":"10.1016/j.ogla.2026.04.008","DOIUrl":"10.1016/j.ogla.2026.04.008","url":null,"abstract":"<p><strong>Objective: </strong>To compare the 2-year outcomes of visco-circumferential suture trabeculotomy (VCST) versus rigid probe hemi-trabeculotomy (RPHT) in late-onset primary congenital glaucoma (LPCG).</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Subjects: </strong>Late-onset primary congenital glaucoma patients who underwent VCST or RPHT.</p><p><strong>Methods: </strong>A retrospective chart review was conducted on LPCG patients who underwent VCST or RPHT between January 2014 and December 2023 and had a minimum of 2 years of postoperative follow-up.</p><p><strong>Main outcome measures: </strong>The primary outcome was surgical success, defined as complete success, intraocular pressure (IOP) ≤17 mmHg with ≥30% reduction from baseline, without antiglaucoma medications, and without anatomical evidence of glaucoma progression, or qualified success (meeting IOP criteria while requiring topical antiglaucoma medications [maximum of 3 agents]). The use of oral carbonic anhydrase inhibitors was considered a failure. Secondary outcomes included longitudinal changes in IOP, number of antiglaucoma medications, and incidence of complications.</p><p><strong>Results: </strong>A total of 79 eyes (79 patients) met the inclusion criteria (40 in the VCST group and 39 in the RPHT group). Baseline demographics were comparable between the 2 groups (mean age of 3.2 ± 0.3 years in the VCST vs. 3.1 ± 0.2 years in the RPHT, P = 0.42 years). At 24 months postoperatively, the overall success (complete and qualified) rate was significantly higher with VCST (95.00%) than with RPHT (84.66%; P = 0.04). Both procedures led to significant reductions in IOP from baseline, but eyes in the VCST group consistently exhibited lower mean IOP over the 24-month follow-up, with differences reaching statistical significance from the 18th month onward following Bonferroni correction (e.g., 13.7 ± 2.7 mmHg vs. 15.8 ± 3.6 mmHg at 18 months; P = 0.004). Transient hyphema was the most common complication that occurred in 66 of 79 eyes (83.5%) overall, more frequent in the VCST than in the RPHT group (relative risk: 1.24; 95% confidence interval: 1.01-1.53; P = 0.04).</p><p><strong>Conclusions: </strong>In this cohort, VCST achieved higher 2-year surgical success rates and more sustained IOP reduction compared with RPHT.</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":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846838","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":"Evaluating the Need for Anti-Inflammatory Medication Post-Laser Peripheral Iridotomy.","authors":"Ari Leshno, Eran Levanon, Reut Singer, Mordechai Goldenfeld, Hani Levkovitch-Verbin","doi":"10.1016/j.ogla.2026.04.007","DOIUrl":"10.1016/j.ogla.2026.04.007","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether the administration of topical steroids is beneficial after elective laser peripheral iridotomy (LPI).</p><p><strong>Design: </strong>A prospective, randomized, double-masked, placebo-controlled clinical trial.</p><p><strong>Participants: </strong>Twenty-eight patients (56 eyes) with anatomical narrow angles and no other ocular diseases requiring bilateral LPI.</p><p><strong>Methods: </strong>Participants underwent LPI in both eyes 1 week apart. Following the first LPI, eyes were randomized to receive either topical steroid (prednisolone acetate 1%) or placebo eye drops (artificial tears) 4 times daily for 4 days. The fellow eye received the alternative treatment after the second LPI.</p><p><strong>Main outcome measures: </strong>Intraocular pressure (IOP), iridotomy patency, anterior segment inflammation, and symptoms assessed via the Ocular Surface Disease Index (OSDI) questionnaire.</p><p><strong>Results: </strong>Baseline characteristics and laser parameters were similar between arms. At 1 week, anterior chamber inflammation was absent in all control eyes and present in 2 steroid-treated eyes (7.4%); at 1 month, no eyes had inflammation. Iridotomy was not patent in 3 control eyes (10.7%) and 4 steroid eyes (14.3%) at 1 month (P > 0.99). The OSDI scores were low and similar between arms at each visit. Mean IOP did not change significantly from baseline across visits (overall P = 0.603) and did not differ between arms (overall P = 0.243). In multivariable analyses, baseline IOP was the only variable independently associated with follow-up IOP at all time-points; treatment assignment had no effect.</p><p><strong>Conclusions: </strong>Our study suggests no clear advantage to topical steroids after high-powered pulsed LPI. These findings should be confirmed in larger, multicenter studies.</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":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846790","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":"A Staged Approach to the Number and Frequency of Visual Field Testing for Detecting Glaucoma Progression.","authors":"Jack Phu, Henrietta Wang, Michael Kalloniatis","doi":"10.1016/j.ogla.2026.04.006","DOIUrl":"10.1016/j.ogla.2026.04.006","url":null,"abstract":"<p><strong>Purpose: </strong>To assess a staged visual field review model (initially intensive, then downtitrated) for detecting cases of glaucoma progression (especially catastrophic and fast), in comparison to clinical standard, fixed review approaches.</p><p><strong>Design: </strong>A computer simulation study.</p><p><strong>Subjects: </strong>A total of 100 000 subjects.</p><p><strong>Methods: </strong>A total of 100 000 subjects were simulated to undergo 4 visual field tests in 1 \"eye\" per visit, every 3 months, over 30 years. The staged visual field model consisted of an initial intensive review (e.g., 3 tests per eye per visit, every 3 months) that was then downtitrated as 90% of progressors within a rate bin (e.g., catastrophic <-2 dB/year) were detected. The test number and review cadence were systematically downtitrated with 90% of successive progression-rate bins detected until the end of the 30-year follow-up. Comparator models were fixed reviews: 1 test every 12 months, 1 test every 6 months, 2 tests every 6 months (\"frontloading\"), and 3 tests every 24 months (\"wait-and-see\"). To reduce false positives, an immediate subsequent confirmatory progression result was required for all conditions.</p><p><strong>Main outcome measures: </strong>Number of progressors detected and number of tests/visits required per case of progression detected.</p><p><strong>Results: </strong>All staged review approaches detected 90% of catastrophic (21-36 months) and fast (36-60 months) progression bins sooner compared to all fixed methods (catastrophic: 66-108 months; fast: 84-132 months) except fixed frontloading. Detection of 50% of all progressors was also achieved sooner for the staged approaches (21-36 months) compared to all fixed methods (60-96 months), except for fixed frontloading (36 months). When using 1 test every 12 months as a reference standard, the staged approaches were 66% to 251% more likely to detect progression. The 2 tests per visit at every 3 and 6 months staged intervals were the most efficient with the lowest number of visits (10.6 and 8.6 at 5 years) and tests (15.8 and 12.9 at 5 years) per case detected over time.</p><p><strong>Conclusions: </strong>A staged visual field review model starting with intensive testing (such as 2 tests per visit at every 3 or 6 months intervals) with downtitration at 30-36 months may increase the likelihood of detecting progressors and may provide long-term efficiencies in case detection, in comparison to conventional fixed approaches.</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":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846758","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":"Association between Open-Angle Glaucoma Progression and Cardiovascular Risk Predicted by a Deep Learning-Based Fundus Imaging Model.","authors":"Jooyoung Yoon, Jaewon Seo, Dongjin Nam, Eun Hee Hong, Yong Un Shin, Min Ho Kang, Sunjin Hwang, Won June Lee","doi":"10.1016/j.ogla.2026.04.004","DOIUrl":"10.1016/j.ogla.2026.04.004","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigated the association between the RetiCAC score, a deep learning-derived estimate of systemic atherosclerotic burden from retinal photographs and glaucomatous visual field (VF) progression.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Participants: </strong>A total of 192 eyes from 192 patients diagnosed with open-angle glaucoma at Hanyang University Seoul and Guri Hospitals.</p><p><strong>Methods: </strong>RetiCAC scores were estimated from fundus photographs using a deep learning model, and patients were stratified into low-to-moderate vs. high-risk groups using a cutoff of 41 based on the RetiCAC-derived 5-year cardiovascular disease risk classification. Generalized estimating equations (GEEs) were applied to identify factors associated with VF progression. Progression-free survival was compared between risk groups using Kaplan-Meier analysis. Relationships between RetiCAC and VF change rates were examined using scatter plots with locally weighted scatterplot smoothing curves.</p><p><strong>Main outcome measures: </strong>The primary outcome was the association between the RetiCAC score and glaucomatous VF progression.</p><p><strong>Results: </strong>Higher RetiCAC scores (P = 0.023) and longer follow-up duration (P = 0.018) were independently associated with VF progression in the final multivariable GEE model. Kaplan-Meier analysis demonstrated a significantly higher probability of VF progression in the high-risk group compared to that of the low-to-moderate risk group (P = 0.030). Locally weighted scatterplot smoothing analyses identified an inflection point consistent with accelerated VF deterioration at a RetiCAC score of 51.1.</p><p><strong>Conclusions: </strong>The RetiCAC score, derived from retinal photographs, showed a significant association with glaucoma progression, independent of traditional risk factors. This noninvasive marker of systemic vascular health may be useful for predicting glaucoma progression and may reflect vascular dysfunction contributing to disease progression.</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":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790443","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":"Geographic Distribution and Drive Times to Glaucoma Specialists in the United States: A National Geospatial Access Analysis and Drive-Time Study.","authors":"Joshua Wang, Jean Adomfeh, Agnes C Owete, Shivani Kamat, Mary Qiu, Kelly W Muir","doi":"10.1016/j.ogla.2026.04.005","DOIUrl":"10.1016/j.ogla.2026.04.005","url":null,"abstract":"<p><strong>Objectives: </strong>Access to glaucoma specialists varies substantially across the United States, and geographic barriers may delay and limit care. Using publicly available spatial data, we estimated travel burden by calculating county-level drive times to the nearest practicing glaucoma specialist and summarized results at the state, US Census region, and rural-urban commuting area (RUCA) core-type levels.</p><p><strong>Design: </strong>Cross-sectional geospatial analysis SUBJECTS: County-level geographic units in the contiguous United States.</p><p><strong>Methods: </strong>This analysis was conducted in Python 3.9.6 using US Census Bureau county-level data and practice locations of glaucoma specialists obtained from the American Glaucoma Society, limited to those with provisional or active membership practicing in the United States. County geographic centroids were linked to the nearest specialist practice location across county and state boundaries. Approximate drive times from county centroids to the closest specialist were computed, and state-, census region-, and RUCA-level summaries were generated.</p><p><strong>Main outcome measures: </strong>Estimated drive time.</p><p><strong>Results: </strong>Across the contiguous 48 states, mean drive times to the nearest glaucoma specialist ranged from 0.04 hours in the District of Columbia to 3.77 hours in North Dakota, while median drive times ranged from 0.04 to 4.40 hours over the same jurisdictions. The proportion of counties with drive times below their state's mean also varied widely, from 2% in Delaware and Rhode Island to roughly 80% in Georgia, reflecting marked intrastate heterogeneity. Regional analyses showed the shortest median drive times in the Northeast (0.66 hours) and the longest in the West (1.85 hours), with the Midwest and South demonstrating intermediate medians of 1.38 hours and 1.23 hours, respectively. When stratified by RUCA core type, metro core counties had the lowest median drive time (0.23 hours), whereas small-town cores and rural counties experienced considerably longer medians (1.16 hours and 1.02, respectively).</p><p><strong>Conclusions: </strong>Access to glaucoma specialists shows striking geographic disparities. Northeastern and metropolitan counties benefit from relatively short travel times, whereas western and rural counties face substantially longer drives. These findings highlight the need for targeted outreach, teleophthalmology expansion, and workforce planning to reduce geographic barriers to glaucoma care.</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":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790389","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":"Visual Field Testing on the Envision Head-Mounted Perimeter with and without Gaming Elements.","authors":"Emmanouil Tsamis, Iván Marín-Franch, William H Swanson, Michael Chaglasian, Anne Rozwat, Brittney Brady, Donald C Hood, Nicholas Neissa, Ridwan Shabsigh, Lama A Al-Aswad","doi":"10.1016/j.ogla.2026.04.002","DOIUrl":"10.1016/j.ogla.2026.04.002","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate a new virtual reality head-mounted perimeter (Envision) with 2 test modes-a standard test (ENV) and a gaming-based test (ENVg)-by assessing their test-retest variability, comparing their results to the Humphrey Field Analyzer (HFA), and evaluating test duration and patient preferences.</p><p><strong>Design: </strong>This was a 2-part clinical trial. Part 1 involved data collection from the Envision and HFA from all participants. Part 2 was a test-retest variability study, where a subset of healthy participants (HCs) performed each Envision test twice.</p><p><strong>Participants: </strong>Thirty HCs and 30 glaucoma patients with varying disease severity.</p><p><strong>Methods: </strong>In Part 1, all 60 participants underwent visual field testing with the HFA, ENV, and ENVg tests. Patient preference surveys were also administered. In Part 2, HCs were retested with the ENV and ENVg to assess repeatability. Test-retest variability analysis was conducted on 19 HCs and 25 glaucoma participants who had reliable test results. Function-function and structure-function concordance were also evaluated in the glaucoma cohort, based on 2 approaches: (1) a clinician's evaluation and (2) a Reading Center approach.</p><p><strong>Main outcome measures: </strong>Key measures included: test-retest variability of pointwise total deviation (TD) and unweighted mean deviation (MD) values, comparison of TD/MD values between devices, test duration, concordance evaluation, and patient preference.</p><p><strong>Results: </strong>Both the ENV and ENVg tests demonstrated low test-retest variability (mean ± standard deviation TD: 0.05 ± 3.58 dB and 0.21 ± 3.70 dB, respectively, in HCs; 0.15 ± 4.81 dB, ENV only, in glaucomas), comparable to the HFA. TD and MD values were similar between ENV, ENVg, and HFA. The Envision tests had shorter and more consistent durations for patients with moderate and advanced glaucoma as compared to HFA. Function-function concordance was high, while both ENV and HFA had similar levels of structure-function agreement. Patient surveys indicated a strong preference for the ENVg test, which was perceived as more engaging and shorter in duration.</p><p><strong>Conclusions: </strong>The Envision virtual reality perimeter shows high repeatability and is comparable to the HFA. The ENVg was strongly preferred by patients, suggesting a promising avenue for improving patient engagement and compliance. The system's portability and consistent test duration make it a viable alternative for visual field testing in various clinical and nontraditional settings.</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":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719019","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":"Predicting 10-2 Swedish Interactive Thresholding Algorithm Standard from 24-2C SITA Faster: Development and Validation of Deep24-2C.","authors":"Kei Sano, Euido Nishijima, Shunsuke Sumi, Yuka Igari, Gary C Lee, Aiko Iwase, Tadashi Nakano","doi":"10.1016/j.ogla.2026.04.001","DOIUrl":"10.1016/j.ogla.2026.04.001","url":null,"abstract":"<p><strong>Purpose: </strong>To develop and validate Deep24-2C, a machine learning (ML) model that reconstructs comprehensive Humphrey Field Analyzer (HFA) 10-2 visual field (VF) thresholds from HFA 24-2C.</p><p><strong>Design: </strong>A retrospective study.</p><p><strong>Participants: </strong>A total of 3653 HFA 24-2C tests, including 181 actual tests from 136 eyes of 130 patients with glaucoma or suspected glaucoma, and 3472 synthesized tests at the Jikei University School of Medicine were included. Thirty-five actual HFA 24-2C tests from 24 eyes of 21 patients at Tajimi Iwase Eye Clinic were used for pilot external validation.</p><p><strong>Methods: </strong>The HFA 24-2C testing grid incorporates 10 additional central test points into the conventional 24-2 pattern. Deep24-2C was trained to predict all 68 threshold values of the HFA 10-2 test using subsets of 24-2C points (22-26 within the 10° region) along with age. Three ML architectures-random forest (RF), XGBoost, and multilayer perceptron (MLP)-were developed, and their ensemble combination was evaluated. Model training and internal validation were conducted using the Jikei dataset, while external validation used the Tajimi dataset. Data augmentation was applied using synthesized 24-2C tests, which combined paired HFA 24-2 and 10-2 tests. Model performance was evaluated using mean absolute error (MAE).</p><p><strong>Main outcome measures: </strong>Mean absolute error for 10-2 point-wise thresholds and mean deviation.</p><p><strong>Results: </strong>We first trained and validated Deep24-2C using the Jikei dataset. Incorporating synthesized data improved predictive accuracy from MAE 2.52 ± 0.07 dB to 2.42 ± 0.07 dB. Furthermore, models utilizing additional central test points outperformed those based on conventional 24-2 points across all ML architectures (RF, XGBoost, and MLP); the best-performing XGBoost model achieved MAE 2.30 ± 0.01 dB for predicting 10-2 thresholds. Subsequently, we performed external validation on the Tajimi dataset using an ensemble model that combined all models utilizing 10 additional central test points; the ensemble model yielded MAE 1.81 (95% confidence interval [1.69-1.93]) dB.</p><p><strong>Conclusions: </strong>Deep24-2C enables reconstruction of 10-2 VF thresholds from a 24-2C Swedish Interactive Thresholding Algorithm Faster test. Incorporating additional central points enhances predictive performance compared with conventional 24-2 grids. Deep24-2C may serve as a practical and efficient tool for evaluating central VF defects, reducing testing burden, and supporting individualized glaucoma management.</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":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678779","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":"Micropulse versus Slow Coagulation Transscleral Cyclophotocoagulation in Refractory Glaucoma: A Randomized Clinical Trial.","authors":"César R de Lima Neto, Gabriel Ayub, Samuel Goulart N E Silva, José Paulo de C Vasconcellos, Vital Paulino Costa","doi":"10.1016/j.ogla.2025.12.002","DOIUrl":"10.1016/j.ogla.2025.12.002","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare the efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) and slow coagulation transscleral cyclophotocoagulation (SC-TSCPC) in patients with refractory glaucoma followed for 12 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A parallel, double-arm, single-center, double-masked, randomized clinical trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Eighty eyes of 80 patients with refractory glaucoma.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Participants were randomly assigned (1:1) to receive either MP-TSCPC or SC-TSCPC. Micropulse transscleral cyclophotocoagulation was delivered using 2W of laser power applied in a sweeping motion over 320 seconds (31.3% duty cycle). Slow coagulation transscleral cyclophotocoagulation was performed with 1.25-1.5W continuous-wave laser applied with discrete spots for 4 seconds per spot across 3 quadrants (6 to 7 applications per quadrant). Patients and the examiner were masked for the procedure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;The primary outcome was mean intraocular pressure (IOP) reduction from baseline. Secondary outcomes included reduction in the number of antiglaucoma medications, complete and qualified success rates (defined as ≥20% IOP reduction from baseline and final IOP between 6 and 18 mmHg, without or with medications, respectively), and incidence of postoperative complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;At 12 months, MP-TSCPC reduced IOP from 31.5 ± 9.2 to 15.0 ± 8.7 mmHg (P &lt; 0.001); SC-TSCPC reduced IOP from 32.9 ± 9.0 to 12.6 ± 7.3 mmHg (P &lt; 0.001), with no statistical difference in the final mean IOPs between the 2 arms (P = 0.12). The SC-TSCPC group showed a significantly greater mean IOP reduction than the MP-TSCPC group: 20.3 ± 10.2 mmHg (61% reduction) vs. 16.5 ± 11.7 mmHg (52% reduction), respectively (P = 0.03). Complete success was achieved in 29.7% patients in MP-TSCPC group and 33.3% in SC-TSCPC group (P = 0.64), while qualified success rates were 70.3% and 66.6%, respectively (P = 0.71). Complications were more frequent in SC-TSCPC (58.9%) than MP-TSCPC (35.1%) (P = 0.02) and included hypotony (20.5% SC-TSCPC vs. 0% MP-TSCPC, P &lt; 0.005), vision loss (32.5% SC-TSCPC vs. 17.5% MP-TSCPC, P = 0.118), and phthisis bulbi (5.1% SC-TSCPC vs. 0% MP-TSCPC, P = 0.494). A multivariate analysis indicated that preoperative IOP &gt;30 mmHg (hazard ratio [HR] = 2.269; 95% confidence interval: 1.014-5.077; P = 0.046) and IOP &gt;15 mmHg at postoperative day 30 (HR = 2.477; 95% confidence interval: 1.106-5.548; P = 0.027) were independent predictors of surgical failure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Both MP-TSCPC and SC-TSCPC effectively reduced IOP. Slow coagulation transscleral cyclophotocoagulation was associated with a greater mean IOP reduction but with a higher incidence of complications. Eyes with preoperative IOP &gt;30 mmHg or IOP &gt;15 mmHg at 30 days may be at greater risk for failure after these procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Financial disclo","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727570","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":"Slow-Coagulation Continuous-Wave Cyclophotocoagulation vs. Micropulse Laser Treatment Procedure in Refractory Glaucoma: A Randomized Clinical Trial.","authors":"Luiz A F Beniz, Mariana C Ikeda, Eloisa G R M Teixeira, Carolina P B Gracitelli, Cristiano Caixeta-Umbelino, Niro Kasahara, Sergio H Teixeira, Tiago S Prata, Augusto Paranhos","doi":"10.1016/j.ogla.2025.10.004","DOIUrl":"10.1016/j.ogla.2025.10.004","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effectiveness of transscleral diode laser cyclophotocoagulation in a population of patients with refractory glaucoma, comparing the results between the slow-coagulation continuous-wave cyclophotocoagulation (SC-CPC) and micropulse laser treatment (MP-LT) techniques.</p><p><strong>Design: </strong>Prospective 2-center randomized clinical trial.</p><p><strong>Subjects: </strong>Sixty eyes from 60 patients with medically uncontrolled glaucoma under maximum therapy and no prior cyclodestructive procedures.</p><p><strong>Methods: </strong>Patients were enrolled at 2 centers and randomly assigned to laser treatment with SC-CPC or MP-LT. The technique was standardized (1250 mW, 4 s/spot, 20 spots for SC-CPC; 2000 mW, 90 s/quadrant, 31.3% duty-cycle for MP-LT; the 3- and 9-o'clock meridians were spared in both groups). Success was defined as postoperative intraocular pressure (IOP) between 6 and 18 mmHg and ≥20% reduction, without the need for additional glaucoma surgery or clinically significant visual acuity loss, including loss of light perception.</p><p><strong>Main outcome measures: </strong>Treatment success over 18 months. The secondary outcome measures included postoperative IOP, number of IOP-lowering medications, need for retreatments, postoperative complications, and visual acuity throughout follow-up.</p><p><strong>Results: </strong>Treatment success was achieved in 70.0% of SC-CPC eyes and 30.0% of MP-LT eyes (log-rank test, P = 0.001), with a lower cumulative failure probability in the SC-CPC group (33.4% vs. 70.4%). At the last visit, the mean IOP was significantly lower in the SC-CPC group compared to the MP-LT group (18.4 ± 12.9 mmHg vs. 22.5 ± 9.3 mmHg; P = 0.005), with a greater percentage reduction from baseline (23.1% vs. 11.5%; P = 0.020). The SC-CPC group required fewer IOP-lowering medications at final follow-up (2.1 ± 1.1 vs. 2.7 ± 1.1; P = 0.020). Repeated treatments and additional surgeries were more frequent in the MP-LT group.</p><p><strong>Conclusions: </strong>Slow-coagulation continuous-wave cyclophotocoagulation demonstrated superior IOP control and lower surgical failure rates compared to MP-LT. These findings support SC-CPC as a more effective option for refractory 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":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318998","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}