Purpose.: To investigate the association between myopia and the prevalence of glaucoma. Methods.: This cross-sectional study included 5277 participants from the 2005 to 2008 National Health and Nutrition Examination Survey, greater than or equal to 40 years old, without history of cataract or refractive surgery, who underwent auto-refraction measurement. The predictor was refractive status; emmetropia (−0.99 to +0.99 diopters [D]), mild myopia (−1.00 to −2.99 D), moderate myopia (−3.00 to −5.99 D), severe myopia (> −6.00 D), and hyperopia (> 1.00 D). The outcomes were self-reported glaucoma, vertical cup-to-disc ratio and visual field defects as found on frequency doubling technology (FDT) testing Results.: Odds of self-reported glaucoma were not significantly increased in mild (odds ratio [OR] 0.90, confidence interval [CI] 0.56–1.45), moderate (OR 1.40, CI 0.62–3.16), or severe (OR 0.26, CI 0.08–0.80) myopes compared with emmetropes. Odds of vertical cup-to-disc ratio greater than or equal to 0.7 were not significantly increased in mild (OR 0.84, CI 0.31–2.25), moderate (OR 0.37, CI 0.04–3.57), or severe (OR 0.85, CI 0.09–8.42) myopes compared with emmetropes. Odds of any visual field defects were significantly increased in mild (OR 2.02, CI 1.28–3.19), moderate (OR 3.09, CI 1.42–6.72), and severe (OR 14.43, CI 5.13–40.61) myopes compared with emmetropes. The χ² test indicated a significant difference (P = 0.001) in the distribution of subjects with each category of visual field status across subjects with each refractive status; the proportion of subjects with worse visual field defects increased with worsening myopia severity. Conclusions.: The association between myopia and visual field defects may represent an increased risk of glaucoma among myopes, and the lack of association with self-reported glaucoma may suggest a need for greater glaucoma surveillance in this population.

Cyclophotocoagulation (CPC) is traditionally used in cases of glaucoma that are refractory to medical and surgical therapy. The goal of this review is to provide an update on the methods, efficacy, complications, indications, and histopathology of transscleral and endoscopic CPC. A literature review was conducted for transscleral and endoscopic CPC. Relevant studies were included for evaluation of the procedures. For transscleral CPC (TCP), there is a wide range of success rates reported in the literature, depending on energy settings, follow-up period, and definitions of success. Repeat TCP is often required. Serious complications have included significant vision loss, hypotony, and phthisis. TCP has mostly been performed in very severe forms of glaucoma, in eyes with limited visual potential, or after filtration surgery has failed, although more recently TCP has been used as a primary surgery in eyes with good visual potential. There are more limited published results on endoscopic CPC (ECP), which have demonstrated overall good success. Complication rates are relatively low with ECP, however, large studies with long-term follow-up are lacking. ECP has also been used in difficult, refractory cases, but often used earlier when combined with cataract surgery. Both TCP and ECP are effective surgeries with potential for serious complications. Recent studies suggest they may be used increasingly as the primary surgery for various stages of glaucoma.

Research from JAMA Ophthalmology — Racial and Ethnic Disparities in Adherence to Glaucoma Follow-up Visits in a County Hospital Population

To evaluate anterior chamber biometric factors associated with the degree of angle widening and intraocular pressure (IOP) reduction after phacoemulsification. University of California, San Francisco, California, USA. Case series. Anterior chamber parameters obtained by anterior segment coherence tomography were compared preoperatively and 3 months postoperatively. Measurements included the angle opening distance 500 μm anterior to the scleral spur (AOD500), trabecular-iris space area 500 μm from the scleral spur (TISA500), iris curvature (I-Curv), anterior chamber angle (ACA), trabecular-iris space area, anterior chamber volume, anterior chamber width, and lens vault (LV). The study enrolled 73 eyes. The mean patient age was 77.45 years ± 7.84 (SD); 65.75% of patients were women. From preoperatively to 3 months postoperatively, the mean AOD500 increased significantly (0.254 ± 0.105 to 0.433 ± 0.108 mm) and the mean IOP decreased significantly (14.97 ± 3.35 to 12.62 ± 3.37 mm Hg) (P<.001). The reduction in IOP was correlated with the increase in AOD500 (r = 0.240, P=.041) and preoperative LV (r = 0.235, P=.045). After adjusting for related factors, AOD500 widening was positively correlated with LV (β = 0.458, P=.044) and I-Curv (β = 0.235, P=.043) and negatively correlated with preoperative TISA500 (β = -0.269, P=.025) and ACA (β = -0.919, P=.027). Surgically induced AOD widening was significantly correlated with anterior chamber biometric factors. Preoperative LV appears to be a significant factor in angle widening and IOP reduction after phacoemulsification.

It is well known that narrowing of the anterior chamber angle (ACA) is the fundamental mechanism for the development of acute primary angle closure and chronic primary angle-closure glaucoma.^1,2 Studies^3,4 based on advanced imaging have demonstrated that the crystalline lens has an important role in the narrowing of the angle by pushing the peripheral iris anteriorly, in particular with the cataractous lens. Lens extraction for angle-closure and associated glaucoma has increasingly become a plausible alternative and is gaining popularity, especially in Asia.^5-9