To uncover the mechanism of subconjunctival outflow in humans. Cross-sectional study. Fifteen patients receiving subconjunctival anesthesia before intravitreal injection for routine clinical care. Anterior segment (AS) OCT was performed in patients with various instances of conjunctival edema or subconjunctival fluid. Other patients received a subconjunctival mixture of 0.005% indocyanine green and 2% lidocaine. After subconjunctival injection of the tracer and anesthetic mixture, blebs and associated outflow pathways were imaged angiographically and the time for appearance was recorded. The pattern and structure of outflow pathways were studied using AS OCT. Angiographic and AS OCT results were compared with trabecular and conventional outflow imaging, which demonstrates veins. Ocular surface lymphangiography and AS OCT images. Anterior segment OCT of the conjunctiva in a normal eye demonstrated thin nonedematous conjunctiva with absent intraconjunctival lumens or subconjunctival fluid. Patients with a history of trabeculectomy, subconjunctival drug injection, or chemosis demonstrated thickened conjunctiva and intraconjunctival luminal pathways that contained valve-like structures. Tracer-based studies in patients demonstrated blebs with irregular subconjunctival bleb-related outflow patterns that arose in a time-dependent fashion. These angiographic pathways were luminal on OCT, sausage shaped, and contained intraluminal valve-like structures. This was in contrast to trabecular and conventional outflow imaging, where pathways were classically Y-shaped, of even caliber, and lacked valve-like structures. Outflow pathways were seen in patients with conjunctival edema and after subconjunctival tracer injection. These pathways were lymphatic based on pattern and structural study. Better understanding of bleb-related lymphatic outflow may lead to improved bleb-requiring glaucoma surgeries and subconjunctival drug delivery.

Background/Objectives: This study aimed to evaluate the clinical interchangeability of intraocular pressure (IOP) measurements between a non-contact tonometer (NCT), the TRK-3 OMNIA, and Goldmann applanation tonometry (GAT) and to assess the repeatability of TRK-3 measurements. Methods: This prospective, multicenter study included 120 subjects stratified into three IOP groups based on GAT measurements: low IOP (7–16 mmHg), intermediate IOP (>16 to <23 mmHg), and high IOP (≥23 mmHg). The study eye was randomly selected from each subject. IOP was measured using both TRK-3 OMNIA and GAT following a standardized protocol. Agreement between the two methods was evaluated using Bland–Altman analysis, 95% limits of agreement (LoA), and equivalence testing via the two one-sided test (TOST) approach with a predefined ±5 mmHg margin. Linear regression analysis was performed to characterize the relationship between TRK-3 and GAT measurements. The repeatability of TRK-3 measurements was assessed using the intraclass correlation coefficient (ICC), repeatability limit, and coefficient of variation (CV). Results: Across all subjects, the mean difference between TRK-3 OMNIA and GAT IOP measurements was −0.2 mmHg. TRK-3 OMNIA overestimated IOP in the low IOP group (mean difference: 2.1 mmHg, LoA: −1.2 to 5.4 mmHg) and underestimated in the high IOP group (mean difference: −2.4 mmHg, LoA: −5.9 to 1.1 mmHg), while agreement was highest in the intermediate IOP group (−0.2 mmHg, LoA: −2.9 to 2.5 mmHg). Despite the systematic trend, equivalence testing confirmed statistical equivalence across all groups, with 90% confidence intervals (CI) of 1.7 to 2.5 mmHg (low IOP group), −0.6 to 0.2 mmHg (intermediate IOP group), and −2.9 to −2.0 mmHg (high IOP group). Linear regression analysis found a strong correlation (r = 0.92) between TRK-3 and GAT. The TRK-3 OMNIA demonstrated good repeatability, with an ICC of 0.94, a repeatability limit of 3.12 mmHg, and a CV of 5.65%. The repeatability limits were 2.22 mmHg, 2.60 mmHg, and 4.19 mmHg in the low, intermediate, and high IOP groups, respectively. Conclusions: TRK-3 OMNIA and GAT measurements showed strong agreement, statistical equivalence, and a high correlation, supporting their clinical interchangeability. TRK-3 also demonstrated high repeatability. These findings indicate that this automated non-contact tonometer provides reliable and repeatable IOP measurements, supporting its integration into routine clinical workflows.

Oxidative stress accumulates early in the central nervous system (CNS) and is one major driver of age-related neurodegeneration. Here we compare major oxidative-stress models, highlighting their distinct mechanisms and disease relevance. We summarize therapeutic strategies ranging from radical scavengers and endogenous antioxidant enhancers to mitochondrial-targeted agents and rejuvenation approaches that restore intrinsic cytoprotective programs. We further discuss emerging oxidative-stress profiling strategies to define individual redox vulnerabilities. Together, mechanistically informed modeling, multidimensional profiling, and targeted restoration of oxidative resilience may enable more precise interventions for age-related CNS degeneration.