Précis: Across glaucoma MCQs, GPT-5.2, Gemini 3 Pro, and Claude Opus 4.5 were highly accurate, whereas DeepSeek-V3.2 underperformed; potentially harmful wrong answers were uncommon. Purpose: To compare the accuracy and potential patient-safety risk of four large language models (LLMs) on glaucoma multiple-choice questions (MCQs). Methods: DeepSeek-V3.2, GPT-5.2 (via ChatGPT), Gemini 3 Pro, and Claude Opus 4.5 were tested on two American Academy of Ophthalmology datasets: 129 text-only AAO ONE Network glaucoma self-assessment questions and 32 text-only Basic and Clinical Science Course (BCSC) glaucoma study questions. Each item was queried once per model using a standardized prompt in a fresh session. Accuracy was compared using Cochran’s Q and pairwise exact McNemar tests with Holm adjustment. Potentially harmful wrong answers (HW2) were coded using a prespecified rubric. Results: In AAO ONE, accuracy was 69.0% for DeepSeek-V3.2, 93.0% for GPT-5.2, 92.2% for Gemini 3 Pro, and 96.1% for Claude Opus 4.5 (Q=65.17, P <0.0001). DeepSeek-V3.2 was significantly less accurate than the other three models; differences among the other models were not significant. In BCSC, accuracy was 65.6%, 93.8%, 84.4%, and 87.5%, respectively (Q=18.00, P =0.0004); GPT-5.2 outperformed DeepSeek-V3.2 after correction. A post hoc item-level screen classified 38/161 questions (23.6%) as directly HW2-eligible; four HW2 events occurred and did not differ significantly across models. Conclusions: GPT-5.2, Gemini 3 Pro and Claude Opus 4.5 achieved high accuracy on text-only glaucoma MCQs, whereas DeepSeek-V3.2 underperformed. Harmful errors were uncommon but present, underscoring the need for clinician oversight.
This retrospective observational case series evaluates the clinical outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in 6 consecutive eyes with neovascular glaucoma (NVG) treated at a tertiary referral center. NVG was defined as secondary glaucoma associated with retinal ischemia, characterized by elevated intraocular pressure (IOP) and prior presence of iris and/or angle neovascularization. All patients had previously undergone pan-retinal photocoagulation and intravitreal anti–vascular endothelial growth factor therapy and were receiving maximally tolerated medical treatment at presentation. Circumferential GATT was successfully completed in all cases. At final follow-up, IOP control was achieved in 3 eyes with topical therapy, while the remaining 3 eyes required subsequent Ahmed glaucoma valve implantation due to early surgical failure. All eyes that met failure criteria demonstrated circumferential peripheral anterior synechiae formation during early postoperative follow-up and were observed in patients with poorly controlled diabetes mellitus. Two cases required anterior chamber washout for persistent hyphema. In this small case series, our observations suggest that clinical role of GATT remains uncertain and the present data do not allow identification of patient subgroups that may benefit or support definition of clinical indications.
Precis: In this retrospective population-based cohort study, patients with open-angle glaucoma were more likely to develop obstructive sleep apnea than matched controls from the general population of Olmsted County, Minnesota. Purpose: To investigate the risk of obstructive sleep apnea (OSA) in patients with open-angle glaucoma (OAG) compared to the risk of OSA in matched controls from a general population. Patients and Methods: Retrospective population-based case-control study comparing the incidence of OSA with a diagnosis of OAG (cases) to the incidence of OSA in matched patients without OAG (controls) from Olmsted County, Minnesota between January 1, 1980 and December 31, 2018. Patients were identified using the Rochester Epidemiology Project. Medical records were reviewed to confirm OAG diagnoses. OSA diagnoses were based on sleep study data and polysomnography parameters. Cumulative probability of OSA was estimated using the Kaplan-Meier method. Results: This cohort had 7,000 patients: 3,500 case patients with OAG diagnosed at any time point, and 3,500 matched control subjects without OAG, with all OAG and OSA diagnoses manually confirmed. There was no statistically significant difference of OSA frequency prior to index date in cases versus controls ( P =0.52). There were 371 (12.5%) cases who developed OSA after glaucoma diagnosis compared to 297 (10.2%) patients who were diagnosed with OSA after the index date ( P =0.0068). The multivariate hazard ratio for diagnosis of OSA after OAG diagnosis was 1.17 ( P =0.047, 95% CI: 1.00, 1.36). The 10-year absolute risk of OSA after OAG diagnosis was 12.5%, and risk of OSA increased with time. Conclusion: In this population-based study, patients with OAG were more likely to be diagnosed with OSA compared to patients without OAG, suggesting a possible association that may justify increased clinical awareness.
Précis: Glaucoma patients appear to exhibit variable cerebrovascular differences, including reduced MCA blood velocity and heterogeneous cerebral blood flow and neurovascular coupling responses. Purpose: Glaucoma is associated with neurodegenerative and cerebrovascular diseases, such as dementia, migraine, and stroke, indicating a possible shared underlying pathophysiology of cerebrovascular dysfunction. However, no previous systematic review or meta-analysis has investigated whether people with glaucoma have poorer cerebrovascular function than those without. This study aimed to compare cerebrovascular function in glaucoma patients to healthy controls. Methods: Five electronic databases (Embase, Medline, PubMed, Scopus and Web of Science) were systematically searched until 28 October 2025 for full-text studies comparing measures of cerebrovascular function in people with glaucoma to controls. Meta-analyses were performed, where applicable, using mean differences (MD) and confidence intervals (CI) between glaucoma and control groups. Results: Qualitative analysis of sixteen observational studies revealed that glaucoma patients exhibited varying neurovascular coupling responses (both higher and lower than controls) across frontal, occipital, and parietal regions along with varying cerebral blood flow differences. Cerebral blood flow tended to be lower within the occipital and parietal lobes, and higher within the frontal lobe. Data from six observational studies were included in meta-analyses, which revealed glaucoma patients had lower systolic (MD = -16.38, 95% CI -27.96 to -4.80, P =0.006) and mean (MD = -6.50, 95% CI -11.99 to -1.02, P =0.02) blood velocities in the middle cerebral artery than controls. Sensitivity analyses indicated findings were sensitive to the inclusion of individual studies. Conclusion: Glaucoma patients show heterogeneous cerebrovascular differences compared to controls, without a consistent directional or global pattern of dysfunction. Future longitudinal studies are needed to further characterise cerebrovascular measures in glaucoma.
Precis: The Paul Glaucoma Implant demonstrated favorable short- to mid-term outcomes in patients with refractory glaucoma in the Indonesian population. Low rates of postoperative hypotony following implantation were observed with the use of intraluminal 6/0 prolene stent. Purpose: To evaluate the efficacy and safety of the Paul Glaucoma Implant in managing refractory glaucoma in the Indonesian population. Patients and methods: This retrospective study reviewed patients who underwent implantation of the Paul Glaucoma Implant at the Kedoya and Menteng branches of the Jakarta Eye Center between September 2022 and January 2025. Results: 121 implantations from 113 patients were included, with a median follow-up of 12.00 (12.00 – 24.00) months. Median intraocular pressure decreased from 35.00 (28.25 – 43.00) mmHg preoperatively to 15.00 (11.00 – 18.00) mmHg at one year and 15.00 (12.00 – 18.00) mmHg at two years. Median glaucoma medication use decreased from 3.00 (3.00 – 4.00) to 1.00 (0.00 – 1.00). Median best-corrected visual acuity improved from 0.30 (0.02 – 1.47) logarithm of the minimum angle of resolution preoperatively to 0.15 (0.00 – 1.00) at one year and 0.10 (0.00 – 0.60) at two years. Overall success rate of the Paul Glaucoma Implant was 98.08% at one year and 92.68% at two years. Four implantations (3.30%) failed, including two requiring explantation and two failing to achieve the target intraocular pressure reduction. Hypotony occurred in six eyes (4.96%), all self-resolving. An intraluminal 6/0 prolene stent was employed for implantations and removed in 81 eyes (66.94%), with a median removal time of 3.00 (2.00 – 4.00) weeks. Conclusion: The Paul Glaucoma Implant demonstrated favorable short- to mid-term outcomes, with substantial reductions in intraocular pressure and glaucoma medication use and a low rate of postoperative hypotony.
