Displaying 1-10 letters out of 497 published
Comment: Evaluation of Choroidal Thickness in Retinitis Pigmentosa Using Enhanced Depth Imaging Optical Coherence Tomography
Dear Editor, We read the article entitled ''Evaluation of choroidal thickness in retinitis pigmentosa using enhanced depth imaging optical coherence tomography'' by Dilsher S. Dhoot and associates (1), and would like to offer our comments. The authors presented, in this prospective, case- control study of choroidal imaging with enhanced depth imaging spectral domain optical coherence tomography in patients with retinitis pigmentosa (RP) compared with age and refractive error-matched controls with no clinical retinal or glaucomatous disease (1). The authors established that in-vivo evidence of significantly thinner choroids in patients with RP compared to age and refraction-matched controls (1). We congratulate and applaud their interesting and important work, but we believe that some concerns must be addressed. The choroid is a highly vascular tissue, and it is known that the choroidal thickness (CT) is affected from intraocular pressure, blood pressure, smoking, and the use of certain drugs (2). The choroid is also affected from microvascular changes and dyslipidemia (3). But, it is understood from the present study that the authors did not exclude the subjects having systemic diseases such as hypercholesterolemia, hypertension, diabetes mellitus, and obstructive sleep apnea. The authors also empasized that age and refractive error were matched before comparing CT between the groups. However, we noticed that they did not define the axial length, which is known to be an important factor for the assessment of CT. Some authors reported the correlations between subfoveal CT and axial length and refractive error (4). Refractive error is associated with axial length, but it is not stable throughout life. Therefore, adjusting axial length with refractive error would be more accurate, especially in elderly patients. In conclusion, we congratulate the authors on their study, which establishes CTs of RP patients and allows comparison of CTs between healthy controls. References 1. Dhoot DS, Huo S, Yuan A, Xu D, Srivistava S, Ehlers JP, Traboulsi E, Kaiser PK. Evaluation of choroidal thickness in retinitis pigmentosa using enhanced depth imaging optical coherence tomography. Br J Ophthalmol 2013;97:66-69. 2. Mrejen S, Spaide RF. Optical coherence tomography: imaging of the choroid and beyond. Surv Ophthalmol 2013;58(5):387-429. 3. Wong IY, Wong RL, Zhao P, Lai WW. Choroidal thickness in relation to hypercholesterolemia on enhanced depth imaging optical coherence tomography. Retina 2013;33(2):423-428. 4. Li XQ, Larsen M, Munch IC. Subfoveal choroidal thickness in relation to sex and axial length in 93 Danish university students. Invest Ophthalmol Vis Sci 2011;52(11):8438-8441.
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Disagreement on Limits of Agreement
Mandal et al1 appear to have made some errors in the reporting of their Bland-Altman 95% Limits of Agreement (LoAs). Figures 1,2 and 3 all contain the following statement in their legends: "The dotted lines represent the upper and lower 95% limits of agreement."
These statements are, I believe, incorrect. The "dotted lines" are curved: an unusual feature for Bland-Altman LoAs 23. The 95% LoAs are meant to be population estimates of a range in which 95% of the values will be found. For example, for the repeatability analysis of Axial Length measurements shown in Figure 1, only 12 of the 22 points lie within the purported LoAs. If the 95% LoAs were good estimates then the chance of a sample having only 12 (or fewer) of the 22 points within it, would be 0.000000036. So, the dotted lines are not good estimates of the 95% LoAS. The dotted lines may represent something else, like the 95% confidence intervals for the population limits for the fitted regression line.
For these 22 points as plotted, the mean of differences was 0.004 mm with a 95% CI from -0.008 to 0.016mm. (Note, this is different from the values of "0.00 mm with a 95% CI of 0.05 mm" reported by Mandel et al1. They may have confused "confidence intervals" with "LoAs"). The lower LoA is -0.050 mm with a 95%CI from -0.038 to -0.074 mm and the upper LoA is 0.057 mm with a 95%CI from 0.045 to 0.082 mm.4
I think Mandal et al1 have made similar errors with reporting their LoAs in their other data sets. It may not affect their overall conclusions about the merits of Aladdin biometry, but it would be useful to have this issue clarified.
Conflict of Interest:
Non-mydriatic fundus photography in epidemiological prevalence studies
We read with interest the article by Akuffo et al reporting the prevalence of age related macular degeneration (AMD) in the Republic of Ireland and congratulate them on their findings. The authors report a recent meta-analysis demonstrating considerable heterogeneity in the prevalence of AMD across studies of European ancestry (1), with 20% variability being explained by the age-ranges used and 50% by study characteristics. The TILDA age-specific prevalence for AMD in the over 75- year age group of 2.2% seems lower than we would expect. The authors report the measured prevalence was similar to that in the National Health and Nutrition Examination Survey (2). We would like to highlight this study shared one similar methodology that we feel may contribute to the low prevalence: that of non-mydriatic 45-degree digital colour fundus photography. The use of high resolution mydriatic stereo/non-stereoscopic digital imaging has been shown to be comparable at detecting AMD lesions when compared to film-based stereoscopic photographs (3), but the use of 45-degree non-mydriatic photography has several shortcomings. It reduces colour contrast and increases the frequency of poor quality/ungradable images, especially in individuals with small pupils and media opacities (3). It has been shown to have a low sensitivity (70%) for detecting AMD when compared to 30-degeree colour photography (4). Despite this, in the TILDA study over 96% of photographs were deemed gradable which is higher than some published rates (5). We understand dilation was not possible as AMD grading was not the only aim, but we would like to emphasise that when feasible, the use of mydriatic colour fundus photography is the preferred option for detecting AMD in epidemiological studies. It makes comparison to other published prevalence rates easier to interpret which was one of the fundamental ideas behind standardising prevalence studies with the use of The International Classification System.
1. Rudnicka AR, Jarrar Z, Wormald R, Cook DG, Fletcher A, Owen CG. Age and gender variations in age-related macular degeneration prevalence in populations of European ancestry: a meta-analysis. Ophthalmology. 2012 Mar;119(3):571-80. PubMed PMID: 22176800. 2. Klein R, Chou CF, Klein BE, Zhang X, Meuer SM, Saaddine JB. Prevalence of age-related macular degeneration in the US population. Arch Ophthalmol. 2011 Jan;129(1):75-80. PubMed PMID: 21220632. 3. Klein R, Meuer SM, Moss SE, Klein BE, Neider MW, Reinke J. Detection of age-related macular degeneration using a nonmydriatic digital camera and a standard film fundus camera. Arch Ophthalmol. 2004 Nov;122(11):1642-6. PubMed PMID: 15534124. 4. Lim JI, Labree L, Nichols T, Cardenas I. Comparison of nonmydriatic digitized video fundus images with standard 35-mm slides to screen for and identify specific lesions of age-related macular degeneration. Retina. 2002 Feb;22(1):59-64. PubMed PMID: 11884880. 5. De Bats F, Vannier Nitenberg C, Fantino B, Denis P, Kodjikian L. Age- related macular degeneration screening using a nonmydriatic digital color fundus camera and telemedicine. Ophthalmologica Journal international d'ophtalmologie International journal of ophthalmology Zeitschrift fur Augenheilkunde. 2014;231(3):172-6. PubMed PMID: 24356326.
Conflict of Interest:
Significance of hyper auto fluorescent (HAF) ring in choroidal neovascularization (CNV) in Age related Macular Degeneration (AMD)
We read the article titled, "Significance of the hyperautofluorescent ring associated with choroidal neovascularization in eyes undergoing anti- VEGF therapy for wet age-related macular degeneration" with great interest. Our paper "Evaluation of fundus autofluorescence patterns in Age -related Macular Degeneration" is presently under review. After reading the above article we retrospectively analyzed our data. We studied 80 eyes of 68 patients with choroidal neovascularization (CNV) due to AMD. FAF images were classified as: Presence of hyperautofluorescent(HAF) ring around the lesion complex (Group 1) and absence of HAF ring around the lesion complex (Group 2). Horizontal extent of sub retinal fluid was measured. Out of 80 eyes, 32 eyes (40%) showed a HAF ring. In a subgroup of 36 treatment naive eyes, 14 eyes (38.88%) had HAF ring. There was no statistically significant difference between the horizontal extent of sub retinal fluid (SRF) at baseline in group 1 [2219?1387.39 micron (median- 1969.5)] and group 2 [2230.18 ? 1580.92 micron (median- 1939.5)]. Mean best corrected visual acuity was 1.16 ? 0.46 logMAR units in group 1 and 0.95 ? 0.54 in group 2 and the difference between the groups was not significant. In the study by Camacho et al, HAF ring was noted in 38.1% of cases of wet AMD the presence of which was shown to have prognostic significance. We also found similar percentage of cases with HAF ring. However, in our study presence of HAF ring did not correlate with the baseline visual acuity or the extent of SRF. This could be due to the smaller sample size in our study. We could not comment on the integrity of inner segment- outer segment junction, as we did not have post treatment SD-OCT images of the cases. Further studies on FAF patterns in AMD and their prognostic significance might give us more information.
1. Camacho N, Barteselli G, Nezgoda JT, et al. Significance of the hyperautofluorescent ring associated with choroidal neovascularisation in eyes undergoing anti-VEGF therapy for wet age-related macular degeneration. The British journal of ophthalmology 2015;99(9):1277-83 doi: 10.1136/bjophthalmol-2014-306226[published Online First: Epub Date]|.
Conflict of Interest:
Orbital lymphatic malformation may shrink with treatment of anaemia
The large single center experience of Barnacle et al does convince one of the need to use sclerotherapy and withhold surgery in such cases. But lymphatic malformations are the most varied in terms of presentations. Each malformation is different and it is not possible to club the various kinds of seemingly one type of malformations ,together, in one group ; nor would it be possible to state which modality should be first choice of therapy ,since every malformation will behave differently
Traditionally malformations were classified as lymphatic if there was no flow. (1)This can be judged by the absence of enhancement on contrast as suggested by some authors. But in one of our cases the orbital lymphatic malformation happened to have a small veinous element as well as described In some imaging studies (2) and sometimes such malformations may show low degree of enhancement if there is a significant venous component or feeder vessel. In our case of a one year old female child , there was no indication of a connection with any other tissue on MRI and CT Scan .It is known that lymphatic malformations cross anatomic planes and physiologic boundaries (3) and so the orbit brain plane crossing is a possibility one must always rule out.
Encouraged by articles like the present one, which show good results with various agents including bleomycin, doxycycline, Ethibloc, sodium tetradecyl sulfate, ethanol, and OK-432 as well as Sildenafil, with certain authors (4) preferring dual agent for macrocystic lesions and single agent for macro cystic lesions and per cutaneous drainage as a prerequisite ; we, like most others , had decided on sclerosis of our patient who was already well investigated. But insistence on doing a digital subtraction angiography revealed a connection with dural veinous sinus.
There are various reports which describe complications (5). Hematoma and thrombosis related complications are known but a dural sinus thrombosis can have catastrophic sequelae .This in our case was averted by a digital subtraction angiography which showed a low flow malformation
Further the child was discovered to be severely anaemic with haemoglobin of 6 gms/dl ( iron deficiency related) and was transfused with blood. Nutritional advice and iron supplements were given and the patient was asked to follow up after a month.Surprisingly after blood transfusion the malformation reduced in size.Hence the surgery or any other sclerotherapy intervention was deferred. The child's parents did not follow up as there was no swelling or any complaint. The child came with another episode of increase in size after 6 months. Routine blood examination for determining fitness for anaesthesia again revealed an iron deficiency anaemia with haemoglobin of 8 gms/dl . She had defaulted on iron syrup due to constipation and was malnourished.She was again given hematinics and the swelling reduced again!
This probably means flow characteristics may vary even in low flow situations and cause a variation in size of the mass in the orbit and a hyperdynamic state like anaemia should be treated first . Digital subtraction angiography may be indicated in cases which present with a history of varying size of the lesion.
This probably would mean that each case needs to be examined in close details and there would probably not be any one preferred treatment modality as first choice and solutions probably need to be tailored according to the case presenting to the surgeon , since each malformation may be different and one of its kind
1)Harris GJ. Orbital vascular malformations: a consensus statement on terminology and its clinical implications. Orbital Society. Am J Ophthalmol. 1999 Apr;127(4):453-5. . 2)Garcia DD, Heran MK, Amadi AJ, Rootman J. Low outflow distensible venous malformations of the anterior orbit: presentation, hemodynamic factors, and management. Ophthal Plast Reconstr Surg. 2011 Jan-Feb;27(1):38-43. 3) Graeb DA, Rootman J, Robertson WD, Lapointe JS, Nugent RA, Hay EJ. Orbital lymphangiomas: clinical, radiologic, and pathologic characteristics. Radiology. 1990 May;175(2):417-21. 4)Hill RH, Shiels WE, Foster JA, Czyz CN, Stacey A, Everman KR, et al. Percutaneous drainage and ablation as first line therapy for macrocystic and microcystic orbital lymphatic malformations. Ophthal Plast Reconstr Surg. 2012 Mar-Apr;28(2):119-25. 5)MacIntosh PW, Yoon MK, Fay A. Complications of intralesional bleomycin in the treatment of orbital lymphatic malformations. Semin Ophthalmol. 2014 Sep-Nov;29(5-6):450-5.
Conflict of Interest:
Re:Trephination size and success of big-bubble formation in deep anterior lamellar keratoplasty for keratoconus.
We would like to acknowledge our appreciation for Dr. Peyman for paying close attention to our article and raising important points. Now, big-bubble deep anterior lamellar keratoplasty (DALK) is a corneal transplantation technique of choice for corneal stromal pathologies not involving endothelium such as keratoconus. The principle shortcoming of this technique is that it is technically challenging. Any attempts to increase the success rate of big-bubble formation should be commended as it is a critical step and difficult for many surgeons. Our article aimed to investigate the possible influence of patient- and surgery-related variables on this rate in a homogeneous group of keratoconus patients who were operated on by a single experienced surgeon.1 The exploratory analysis revealed that among various factors, recipient sex and trephination size significantly influenced the rate of achieving a bare Descemet's membrane (DM).1 Following are points in response to the critiques posed by Dr. Peyman: 1) As mentioned in the Methods section, the influence of the independent variables on the success rate of big-bubble formation was first investigated using univariate analysis. Only the variables which had a significant association at a univariate level were entered into multiple regression analysis. In our final confirmatory analysis, there was a limited number of variables including recipient sex, vertical corneal diameter, corneal thickness, anterior chamber depth, and recipient trephination size. Therefore, it is very unlikely that multiple comparisons led to a false positive correlation between the variables. Additionally, comparisons between the bare DM group and the manual dissection group using Chi-square and Mann-Whitney tests revealed significant differences between the two groups in terms of patient sex distribution and recipient trephination size confirming the results yielded by multiple regression analyses. This indicates that the significant associations found in our study were not caused by chance. 2) Providing no evidence, Dr. Peyman anecdotally reports that when the recipient trephination size is large, it is difficult to complete the procedure as big-bubble DALK. However, Huang et al.2 used two different recipient trephination sizes (7.75 mm and 8.25 mm) and reported that big- bubble DALK was successfully completed in 89.4% of the 7.75-mm group and in 84.8% of the 8.25-mm group (P=0.60). It is possible that due to some technical problems Dr. Peyman has with large diameter trephines in DALK, he has been convinced that the larger diameter of trephination could potentially cause more failure of the procedure. 3) According to Dr. Peyman's experience, cutting the recipient cornea in a case of incomplete small bubbles is difficult and could create holes or ruptures in peripheral posterior layers. However, corneal surgeons who master different techniques of DALK such as manual dissection technique and Melle's technique can safely complete dissection using viscoelastic materials or blunt spatula once the dissection plane is reached. 4) Dr. Peyman refers to a study by Dua et al.3 to explain the reason for difficult expansion of the big bubble to the border of trephination when a large trephine is used. In the initial article, Dua et al.3 revealed that pre-Descemet posterior stromal layer (PDL) ended before the termination of DM. In the subsequent study, however, they provided evidence that PDL extends beyond the edge of the big bubble to insert into the trabecular meshwork.4 Therefore, it is possible to separate posterior stroma from the PDL far to the corneal periphery. We conducted a study comparing the rate of achieving a bare DM during big-bubble DALK using central versus peripheral air injection (the manuscript has been submitted). Using surgical calipers, we precisely measured the size of achieved bubbles which ranged from 7.0 to 10.5 mm. These data indicate the big bubble can successfully be enlarged beyond that Dr. Peyman mentioned. To summarize, DALK grafts employing a larger diameter recipient bed provide several advantages including low graft astigmatisms, stable postoperative refractive outcomes, and better graft biomechanics.2,6 Our recent study adds a new advantage to the application of a large trephine size in keratoconic eyes which increases the likelihood of successful big bubble formation during Anwar's DALK technique.1
References 1- Feizi S, Javadi MA, Daryabari SH. Factors influencing big-bubble formation during deep anterior lamellar keratoplasty in keratoconus. Br J Ophthalmol. 2015; In press. 2- Huang T, Hu Y, Gui M, et al. Large-diameter deep anterior lamellar keratoplasty for keratoconus: visual and refractive outcomes. Br J Ophthalmol. 2015; 99:1196-1200. 3- Dua HS, Faraj LA, Said DG, et al. Human corneal anatomy redefined: a novel pre-Descemet's layer (Dua's layer). Ophthalmology. 2013;120:1778- 1785. 4- Dua HS, Faraj LA, Branch MJ, et al. The collagen matrix of the human trabecular meshwork is an extension of the novel pre-Descemet's layer (Dua's layer). Br J Ophthalmol. 2014;98:691-697. 5- Feizi S, Einollahi B, Yazdani S, et al. Graft biomechanical properties after penetrating keratoplasty in keratoconus. Cornea. 2012;31:855-858. Sepehr Feizi, MD, MSc Assistant Professor of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email: email@example.com Conflict of Interest: None declared
Conflict of Interest:
Trephination size and success of big-bubble formation in deep anterior lamellar keratoplasty for keratoconus.
We enthusiastically read the article entitled: "Factors influencing big-bubble formation during deep anterior lamellar keratoplasty in keratoconus" by Feizi et al (1). Authors have included many variables to find factors influencing success in the big bubble formation and defined meaningful P value for statistical significance to less than 0.05. From statistical viewpoint multiple comparisons could increase the false discovery rate and an increase in type I error. A method of multiple testing corrections, like Bonferroni correction, or other more complex statistical adjustment is necessary to decrease the rate of apparently meaningful findings which may be due to random chance alone (2). According to our unpublished experience with big bubble deep anterior lamellar keratoplasty (DALK) in keratoconus, the bubble is difficult to spread to peripheral cornea in most cases. In larger trephinations of the recipient cornea, the surgeon needs to create a larger diameter bubble. Trying to extend the bubble sometimes will end with rupture of Dua's and Descemet's layers. On the other hand cutting the recipient cornea in a case of small bubble diameter is difficult and could create holes or ruptures in peripheral posterior layers with subsequent failure. This problem might be explained by the anatomy of the pre-Descemet's (Dua's) layer that allow expansion of type-1 bubbles up to diameter of 8.5 millimeters (3). As many of our successful DALK big bubbles are formed anterior to Dua's layer, the larger the diameter of trephination could potentially cause more failure of the procedure. In our experience trephination of recipient more than 8.25 mm could be associated with increased failure of the DALK. Revising the statistical analysis of the study by Feizi et al (1) and adjustment for the level of significance of multiple comparisons may reveal different results to this valuable article. ? References:
1. Feizi S, Javadi MA, Daryabari SH. Factors influencing big-bubble formation during deep anterior lamellar keratoplasty in keratoconus. The British journal of ophthalmology. 2015. 2. Streiner DL. Best (but oft-forgotten) practices: the multiple problems of multiplicity-whether and how to correct for many statistical tests. The American journal of clinical nutrition. 2015. 3. Dua HS, Faraj LA, Said DG, Gray T, Lowe J. Human corneal anatomy redefined: a novel pre-Descemet's layer (Dua's layer). Ophthalmology. 2013;120(9):1778-85.
Conflict of Interest:
Re:Letter to the editor: Late in-the-bag intraocular lens dislocation in patients with uveitis
We would like to thank Kucukevcilioglu et al. for their interest in our article. In patients with uveitis, strict control of pre-operative inflammation is fundamentally important for successful visual outcomes. The type of treatment required to achieve meticulous control will vary for each patient. The pre-operative preparation protocol used in our service has been published. In patients requiring surgery for dislocated intra- ocular lens effective control is equally important and may delay intervention. In cases requiring urgent surgery, peri-operative high dose oral or intravenous steroid may be necessary. As late in-the-bag dislocation results from zonular failure and dehiscence from the capsule we do not believe that anterior optic capture offers any advantage over in-the-bag optic implantation. Long-term follow up is necessary to evaluate the risk of IOL dislocation with this technique.
References 1. Steeples LR, Jones NP. Late in-the-bag intraocular lens dislocation in patients with uveitis. Br J Ophthalmol 2015;99:1206-1210. 2. Foster CS1, Rashid S. Management of coincident cataract and uveitis. Curr Opin Ophthalmol 2003;14(1):1-6. 3. Suresh PS, Jones NP. Phacoemulsification with intraocular lens implantation in patients with uveitis. Eye 2001; 15: 621-8. 4. Cataract surgery in children with uveitis: retrospective analysis of intraocular lens implantation with anterior optic capture. J Pediatr Ophthalmol Strabismus 2015;52:119-125.
Conflict of Interest:
Letter to the editor: Late in-the-bag intraocular lens dislocation in patients with uveitis
We read with interest the paper "Late in-the-bag intraocular lens dislocation in patients with uveitis" written by Steeples & Jones.1 They have reported in details the management and outcomes of 6 unique uveitis patients developed late intraocular lens (IOL) dislocation. In all cases primary surgeries for cataract extraction and secondary surgeries addressing dislocated IOL were uneventful, and interestingly there were no episodes of active uveitis at postoperative follow-up visits. We would be keen to know if the authors had taken some precautions such as pre-operative topical or systemic or intra-operative intra-cameral steroids to avoid from triggering inflammation. Another issue we would like to have authors' opinions is the in the bag IOL implantation with anterior optic capture in uveitis patients. A recent study showed safely use of this technique in pediatric uveitis patients.2 Do they think this option may help to reduce the rate of late IOL dislocation in uveitis patients?
References 1. Steeples LR, Jones NP. Late in-the-bag intraocular lens dislocation in patients with uveitis. Br J Ophthalmol. 2015;99:1206-1210. 2. Cataract surgery in children with uveitis: retrospective analysis of intraocular lens implantation with anterior optic capture. J Pediatr Ophthalmol Strabismus. 2015;52:119-125.
Conflict of Interest:
Decreasing medication use in patients with ocular hypertension
Title page: Decreasing medication use in patients with ocular hypertension
Dan C?lug?ru, PhD 1 and Mihai C?lug?ru, PhD 2
1Department of Ophthalmology, University of Medicine Cluj- Napoca/Romania
Phone number: 0745 827 552
Fax number: 0040 264 591468
2Department of Ophthalmology, University of Medicine Cluj- Napoca/Romania
Phone number: 0741 165 094
Fax number: 00 40 264 591468
E-mail: firstname.lastname@example.org Address of the Corresponding Author:
Strada Br?ncoveanu 11
E-mail: email@example.com The manuscript has been seen and approved by all authors; None of the authors has conflict of interest with the submission; The authors have never received financial support for this article;
Decreasing medication use in patients with ocular hypertension Re: Protocol-driven adjustment of ocular hypertensive medication in patients at low risk of conversion to glaucoma. Chan et al. Br J Ophthalmol 2015;99:1245-1250
In their article, Chan et al 1 evaluated the safety and potential savings of decreasing medication use in low-risk patients with ocular hypertension (OH). The authors concluded that 43.9% of low-risk OH eyes could safely reduce medications over 1 year, realizing substantial savings.
However, the study has several shortcomings, that prevent the validation of their results:
1. The authors pretended that the patients of their series had a low risk of conversion with a 5-year risk ? 15%. In fact, most patients included were at moderate risk with a 5-year risk of conversion between 5 and 15%.; 2
2. There was an increase in the intraocular pressure (IOP) from baseline (18.6 mmHg) to month 1 (20.5 mmHg) of the follow-up period; the difference (1.9 mmHg), though modest, is however, statistically significant. Of note, IOP is a major predictive factor for the development of primary open-angle glaucoma (POAG) and the risk of conversion to POAG from OH is around 10% for every 1-mmHg increase in IOP.3;
3. There were no data referring to the baseline values on medication of the mean visual field (VF) pattern standard deviation (PSD), VF mean defect, estimated 5-year risk of glaucoma conversion, and average retinal nerve fiber layer thickness;
4. Statistically significant increases occurred during the 1-year follow-up in the VF PSD and in the estimated 5-year risk of glaucoma conversion; also, one eye developed a repeatable VF defect and 13 eyes had 5-year risk > 15% at 1 year. These facts reflect a real worsening of the disease and are signs of OH progression, that bring up the issue of the opportunity to reduce medication use in these treated OH patients.
In conclusion, decreasing medication use is an act of great responsibility, requiring comprehensive and close monitoring of the OH patients. It should be made with extreme caution and only if there are no signs (even mild) of active and progressive OH.
References 1. Chan PPM, Leung CKS, Chiu V, et al. Protocol-driven adjustment of ocular hypertensive medication in patients at low risk of conversion to glaucoma. Br J Ophthalmol 2025;99:1245-50. 2. Weinberg RN, Friedman DS, Fechtner RD, et al. Risk assessment in the management of patients with ocular hypertension. Am J Ophthalmol 2004;138:458-67. 3. Gordon MO, Beiser JA, Brandt JD, et al. The Ocular Hypertension Treatment Study. Baseline factors that predict the onset of primary open- angle glaucoma. Arch Ophthalmol 2002;120:714-20.
Conflict of Interest:
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