A busca visual é uma habilidade crítica para várias tarefas da vida diária e pode estar prejudicada em pacientes com deficiência visual. O objetivo deste estudo foi comparar a busca visual exploratória entre pacientes com glaucoma primário de ângulo aberto (GPAA) e controles saudáveis, avaliando a correlação espacial entre áreas com perdas localizadas na busca visual exploratória e os defeitos perimétricos, em pacientes com GPAA e com visão normal. Cinquenta e sete indivíduos com visão normal (acuidade visual corrigida melhor que 0.2 logMAR) diagnosticados (grupo GPAA, n = 29) ou não (grupo CONTROL, n = 28) com GPAA, realizaram um exame oftalmológico completo, incluindo perimetria visual (Humphrey -Fast 24.2) e uma tarefa exploratória de busca visual baseada em uma tela com dígitos. Um software personalizado quantificou o (s) tempo (s) gasto (s) até o encontro do número \"4\" em uma matriz aleatória de dígitos distribuídos em cinco áreas, em nove telas sequenciais do programa. Cinco áreas da tela de busca visual foram espacialmente correlacionadas com cinco setores do mapa total deviation (TD) da perimetria visual, após ajustes de ângulo e distância. A análise de covariância (ANCOVA) e testes de correlação foram utilizados para correlacionar parâmetros perimétricos e da busca visual exploratória, por meio de avaliação do tempo individual (gasto para encontrar cada dígito) e tempo total (gasto para completar a tarefa). Os pacientes com GPAA apresentaram pior sensibilidade perimétrica (MD) e de busca visual exploratória do que os controles (MD: -8,02 ± 7,88 dB vs -1,43 ± 1,50 dB; p <0,0001 e tempo total: 106,42 ± 59,64 s vs 52,75 ± 19,07 s; p < 0.0001). A sensibilidade do MD de ambos os grupos correlacionou-se significativamente com o tempo total (GPAA: r = -0.45; p = 0,01 e CONTROL: r = 0,37; p = 0,049). Os testes de ANCOVA mostraram uma correlação significativa entre a busca visual exploratória (tempo individual) e a acuidade visual (P = 0,006) e o diagnóstico de glaucoma (p = 0,005). A sensibilidade média das áreas perimétricas periféricas do grupo GPAA mostrou correlação significativa com o tempo de busca individual nas áreas espaciais correspondentes, exceto na área periférica temporal superior (r = -0,35, p = 0,06). Os controles não mostraram correlação significativa para nenhuma dessas áreas perimétricas, exceto a área periférica temporal superior (r = 0,43, p = 0,02). Com base em nossos resultados, regiões com pior desempenho na busca visual exploratória puderam ser correlacionadas às perdas periféricas localizadas dos pacientes com GPAA. Uma vez que foram estudados pacientes com acuidade visual normal, estes achados destacam a importância do uso de ferramentas de busca visual na avaliação do impacto das perdas perimétricas periféricas em atividades diárias de pacientes com glaucoma. / Visual search is a critical skill for several daily tasks and may be declined in patients with impaired vision. The objectives of this study were to compare the exploratory visual search performance (EVSP) between patients with primary open-angle glaucoma (POAG) and healthy controls, and evaluate the spatial correlation between localized decreases in the EVSP and areas of visual field (VF) loss in normally-sighted patients POAG. Fifty-seven normal vision subjects (best corrected visual acuity better than 0.2 logMAR) diagnosed (POAG group; n= 29) or not (CONTROL group; n= 28) with POAG yielded a complete comprehensive ophthalmological examination, including Humphrey VF tests (SITA-Fast 24.2), and an exploratory visual search digit-based task. A custom software quantified the time (s) spent until patients found the number \"4\" on a random array of digits distributed in five areas on nine sequential screens. Each area was spatially matched with five sectors of the total deviation map from VF, after angle and distance adjustments. Covariance (ANCOVA) and correlation tests were used for correlating VF parameters and EVSP, evaluated through individual time (spent for finding each digit) and total time (spent for completing the task). POAG patients presented worse VF mean deviation (MD) sensitivity and EVSP than controls (MD: -8.02±7.88 dB vs -1.43±1.50 dB; p<0.0001, and total time: 106.42±59.64 s vs 52.75±19.07 s; p<0.0001). MD sensitivity of both groups significantly correlated with total time (POAG: r = -0.45; p = 0.01 and CONTROL: r = 0.37; p = 0.049). ANCOVA tests showed a significant correlation between EVSP (individual time) and both visual acuity (p = 0.006) and glaucoma diagnosis (p = 0.005). The mean sensitivity of the peripheral VF areas of the POAG group showed significant correlation with the individual search time in the corresponding spatial areas, except in the peripheral temporal superior area (r = -0.35, p =0.06). Controls did not show a significant correlation for any of those VF areas, except the peripheral temporal superior area (r =0.43, p =0.02). Based on our results, worse EVSP can be attributable to localized losses in the peripheral VF areas in patients with POAG. Since only normally sighted patients were studied, these findings highlight the importance of using visual search tools to evaluate the impact of peripheral VF loss in daily activities of glaucoma patients, such as driving.

Le glaucome représente la première cause de cécité irréversible à l’échelle mondiale. C’est une maladie neuro-dégénérative caractérisée traditionnellement par une pression intraoculaire (PIO) élevée, un dommage du nerf optique et un défaut du champ visuel correspondant. En fait, la PIO élevée constitue le facteur de risque central associé au développement du glaucome. Cependant, en dépit d’un contrôle adéquat de la PIO, la maladie continue à progresser chez certains patients. Cela montre qu’il existe d’autres facteurs impliqués dans la pathogenèse du glaucome. Des études récentes indiquent qu’un dérèglement de l’oxygène est associé à son développement. En utilisant une nouvelle technologie multi-spectrale capable de mesurer la saturation en oxygène (SaO2) dans les structures capillaires de la rétine, cette étude tentera de déterminer si un état d’oxygénation anormal pourrait se retrouver à la papille optique des patients souffrant de glaucome. Une meilleure compréhension du rôle de l’oxygène pourrait aider à améliorer le pronostic du glaucome. Les résultats de l’étude indiquent que le facteur de position (supérieure, temporale et inférieure de la papille optique) n’a aucun effet sur la mesure SaO2 ainsi que sa variabilité chez les patients normaux. La comparaison de la SaO2 entre les sujets normaux et glaucomateux ne montre pas de différence statistiquement significative. En conclusion, la SaO2 «normale» mesurée dans les yeux glaucomateux n'exclut pas nécessairement que l'hypoxie ne soit pas impliquée dans la pathogenèse. Au moment de l’étude, la PIO était bien contrôlée par des médicaments topiques, ce qui pourrait influencer l’oxygénation à la papille optique. / Glaucoma is the leading cause of irreversible blindness worldwide. Traditionally, open-angle glaucoma was defined as a neurodegenerative disease characterized by high intraocular pressure (IOP), progressive retinal cell death with subsequent visual field loss. Elevated IOP has been identified as one of the major risk factors for glaucomatous optic nerve damage. However, adequate IOP control cannot prevent progression of the disease in all patients suggesting that there are other factors involved in the pathogenesis of glaucoma. Recent studies suggest that hypoxia may contribute to the development of glaucoma. Using a new multi-spectral detection system of oxygen saturation (O2Sa), this study determined whether an abnormal state of oxygenation at the optic disc could be found in glaucoma patients. Knowledge about the influence of the oxygen in glaucoma may help to improve the pronostic of the disease. The results of the study indicate that the position factor (superior, temporal and inferior of the optic nerve head) has no effect on the measurement of O2Sa and its variability in normal patients. Comparing the O2Sa between normal subjects and glaucoma subjects shows no statistically significant difference. In conclusion, the «normal» O2Sa measured in glaucomatous eyes does not necessarily exclude that hypoxia is not involved in the pathogenesis of glaucoma because glaucoma patients were under treatment with topical drops that lowered IOP. These medicines could affect the oxygenation of the optic disc.

Le glaucome représente la première cause de cécité irréversible à l’échelle mondiale. C’est une maladie neuro-dégénérative caractérisée traditionnellement par une pression intraoculaire (PIO) élevée, un dommage du nerf optique et un défaut du champ visuel correspondant. En fait, la PIO élevée constitue le facteur de risque central associé au développement du glaucome. Cependant, en dépit d’un contrôle adéquat de la PIO, la maladie continue à progresser chez certains patients. Cela montre qu’il existe d’autres facteurs impliqués dans la pathogenèse du glaucome. Des études récentes indiquent qu’un dérèglement de l’oxygène est associé à son développement. En utilisant une nouvelle technologie multi-spectrale capable de mesurer la saturation en oxygène (SaO2) dans les structures capillaires de la rétine, cette étude tentera de déterminer si un état d’oxygénation anormal pourrait se retrouver à la papille optique des patients souffrant de glaucome. Une meilleure compréhension du rôle de l’oxygène pourrait aider à améliorer le pronostic du glaucome. Les résultats de l’étude indiquent que le facteur de position (supérieure, temporale et inférieure de la papille optique) n’a aucun effet sur la mesure SaO2 ainsi que sa variabilité chez les patients normaux. La comparaison de la SaO2 entre les sujets normaux et glaucomateux ne montre pas de différence statistiquement significative. En conclusion, la SaO2 «normale» mesurée dans les yeux glaucomateux n'exclut pas nécessairement que l'hypoxie ne soit pas impliquée dans la pathogenèse. Au moment de l’étude, la PIO était bien contrôlée par des médicaments topiques, ce qui pourrait influencer l’oxygénation à la papille optique. / Glaucoma is the leading cause of irreversible blindness worldwide. Traditionally, open-angle glaucoma was defined as a neurodegenerative disease characterized by high intraocular pressure (IOP), progressive retinal cell death with subsequent visual field loss. Elevated IOP has been identified as one of the major risk factors for glaucomatous optic nerve damage. However, adequate IOP control cannot prevent progression of the disease in all patients suggesting that there are other factors involved in the pathogenesis of glaucoma. Recent studies suggest that hypoxia may contribute to the development of glaucoma. Using a new multi-spectral detection system of oxygen saturation (O2Sa), this study determined whether an abnormal state of oxygenation at the optic disc could be found in glaucoma patients. Knowledge about the influence of the oxygen in glaucoma may help to improve the pronostic of the disease. The results of the study indicate that the position factor (superior, temporal and inferior of the optic nerve head) has no effect on the measurement of O2Sa and its variability in normal patients. Comparing the O2Sa between normal subjects and glaucoma subjects shows no statistically significant difference. In conclusion, the «normal» O2Sa measured in glaucomatous eyes does not necessarily exclude that hypoxia is not involved in the pathogenesis of glaucoma because glaucoma patients were under treatment with topical drops that lowered IOP. These medicines could affect the oxygenation of the optic disc.

No description available.

Purpose To evaluate the effectiveness and safety of Selective Laser Trabeculoplasty (SLT) with the SLT mode of the VISULAS ® green laser in patients with primary open-angle glaucoma (POAG). Methods This prospective, interventional multicenter clinical investigation included patients with POAG who either needed a treatment escalation because the individual intraocular pressure (IOP) target was not met or treatment initiation and had an IOP ≥ 17 mmHg at baseline in the study eye. The study was conducted in five research centers across Germany. Approximately 100 laser applications were delivered to 360° of the trabecular meshwork. Glaucoma medications were not modified during the 3-month follow-up to allow evaluation of the sole effect of VISULAS ® green with SLT. Efficacy outcomes were postoperatively absolute and relative IOP changes at 1 and 3 months. Safety outcomes analyzed the rate of intra- and postoperative adverse events. Results Thirty-four eyes of 34 POAG patients were included. The overall mean number of preoperative glaucoma medications was 2.2 ± 1.4 in 29 treated eyes, 5 eyes were treatment naïve. Mean baseline IOP (mmHg) was 21.0 ± 2.69 and was reduced by − 3.53 ± 3.34 [95% CI − 4.61; − 2.45] and − 3.59 ± 3.41 [95% CI − 4.64; − 2.53] at the 1- and 3-month follow-up, respectively (p < 0.0001), with 48.5% of cases achieving a ≥ 20% IOP reduction at 3 months [95% CI = 30.8%; 66.5%]. The mean relative IOP reduction was − 16.4% and − 16.3% at 1 and 3 months, respectively (p < 0.0001). Potentially device- or procedure-related adverse events were mild to moderate and included 3 postoperative IOP-spikes and 6 reports regarding eye pain and discomfort. All were resolved without sequelae. Conclusions SLT performed with the VISULAS ® green laser achieved clinically significant additional IOP reductions in medically treated as well as in treatment naïve eyes with POAG and there were no relevant safety issues. The results are comparable to other reported SLT studies.