INTRODUCTION:This study aimed to investigate the changes in beta parapapillary atrophy (β-PPA) in eyes with primary angle-closure suspect (PACS) after 5 years. METHODS:This longitudinal cohort study included participants aged ≥50 years with PACS at baseline, who participated in the 5-year follow-up examinations. β-PPA was characterized using stereoscopic fundus and optical coherence tomography. Logistic and linear regression analyses were performed to identify factors correlating with the presence of β-PPA enlargement and with the enlargement of β-PPA parameters, respectively. RESULTS:A total of 83 participants with PACS (83 eyes) were included. The enlargement of β-PPA was found in 26.51% of PACS eyes during the 5-year follow-up period. The parameters of area, angular extent, and maximum radial length of β-PPA were significantly enlarged at the 5-year follow-up compared with those at baseline (P < 0.001, 0.027, and < 0.001, respectively). The presence of β-PPA enlargement was associated with a larger axial length (AL; odds ratio [OR] = 2.473, 95% confidence interval [CI]: 1.119-5.446, P = 0.025) and larger vertical cup-to-disc ratio (VCDR; OR = 1.066, 95% CI: 1.001-1.135, P = 0.048). The factor associated with the enlargement of area, angular extent, and maximum radial length of β-PPA was a longer AL (P = 0.016, 0.023, and 0.018, respectively). CONCLUSIONS:The morphology parameters of β-PPA were enlarged in eyes with PACS during the 5-year follow-up period. The presence of β-PPA enlargement was associated with a longer AL and larger VCDR at baseline.

Primary angle-closure glaucoma (PACG) is a leading cause of irreversible blindness in Asian populations. However, the topographic distribution of angle narrowing across different quadrants remains incompletely characterized in primary angle-closure suspects (PACS), and routine clinical assessments often rely solely on horizontal scans. The study aims to identify the narrowest anterior chamber angle quadrant in PACS using Anterior Segment Optical Coherence Tomography (AS-OCT). In this community-based cross-sectional study, 218 right eyes of 218 PACS subjects were recruited. All participants underwent standardized questionnaire surveys and ophthalmic examinations. AS-OCT parameters including angle opening distance (AOD), trabecular iris space area (TISA) and trabecular iris angle (TIA) were measured at 500 μm from the sclera spur (SS) in the superior, inferior, nasal and temporal quadrants. As iridotrabecular contact (ITC) in more than one quadrant precluded identification of the narrowest quadrant, only narrow-angle eyes (ITC in < 2 quadrants) were included in the analysis. Quadrant-wise comparisons and multivariate linear regression analyses were performed. Significant differences in angle width were observed across all four quadrants (P<0.001 for AOD500, TISA500, and TIA500). The superior quadrant exhibited the narrowest angle, followed by the inferior, nasal, and temporal quadrants in narrow-angle eyes. Multivariate linear regression analysis revealed that superior anterior chamber volume (ACV- superior)was positively associated (P<0.001), while superior iris thickness at 750 μm (IT750-superior) was negatively associated (P = 0.049) to superior AOD500. The superior quadrant is consistently the narrowest in PACS eyes, highlighting the necessity of including vertical cross-sectional scans in routine AS-OCT examination protocols for this population. The study was registered in the Chinese Clinical Trial Registry on September 4th, 2020 (Registration Number: ChiCTR2000037944).

Purpose:To evaluate 6-year changes in optic nerve head (ONH) perfusion using optical coherence tomography angiography (OCTA) in non-highly myopic eyes with peripapillary fundus tessellation (pFT). Methods:Adults ≥ 50 years from a rural cohort who completed 6-year follow-up and had no high myopia were included. Eyes were classified as pFT or non-pFT (npFT) by baseline fundus photographs. Baseline ocular biometry, retinal nerve fiber layer (RNFL) thickness, papillary vessel density (PVD), and peripapillary vessel density (PPVD), and their longitudinal changes were compared. Generalized estimating equation (GEE) models were used to assess factors associated with baseline pFT, adjusting for laterality and confounders. Results:Among 356 eyes of 210 participants, 182 showed pFT (51.1%): grade 1, 25.8%; grade 2, 21.3%; grade 3, 3.9%. Baseline axial length (AL) was longer in pFT than npFT eyes (23.01 mm vs. 22.69 mm; P < 0.001). In multivariable GEE logistic regression, older age (odds ratio [OR] = 1.10; 95% confidence interval [CI], 1.03-1.17; P = 0.003), higher systolic blood pressure (per 10 mm Hg; OR = 1.22; 95% CI, 1.02-1.46; P = 0.028), and longer AL (OR = 3.43; 95% CI, 1.99-5.90; P < 0.001) were independently associated with pFT. Over 6 years, reductions in PVD and PPVD were greater in pFT than npFT eyes (1.47 ± 2.74 vs. 0.94 ± 2.58 and 1.21 ± 3.12 vs. 0.52 ± 2.76). Interaction analyses showed that age-related declines in PPVD (P for interaction = 0.006) and PVD (P for interaction = 0.037) were steeper in eyes with pFT than in eyes without pFT. Conclusions:ONH microvascular density declined more markedly with age in non-highly myopic older adults with pFT than in eyes without pFT during the 6-year follow-up.

AIMS:To investigate 6-year macular microcirculation changes in participants who developed incident type 2 diabetes mellitus (T2DM) during follow-up but had no fundus photography-detectable diabetic retinopathy (DR), and to identify factors associated with early microvascular abnormalities. METHODS:This nested case-control study compared participants with incident T2DM without DR with age-matched controls without diabetes. All participants underwent ophthalmic examinations and 6 x 6 mm macular optical coherence tomography angiography at both visits. Vessel density (VD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), foveal avascular zone-related parameters, and foveal density 300 were analyzed using generalized estimating equations. RESULTS:Sixty-eight eyes from 40 participants with incident T2DM and 204 control eyes were included. Both groups showed decreases in SCP and DCP VD over 6 years. Reductions in DCP VD were greater in T2DM eyes than in controls (all P < 0.05). Microvascular abnormalities developed in 23 diabetic eyes and were independently associated with longer diabetes duration. CONCLUSION:Incident T2DM eyes showed greater decline in DCP VD than controls without fundus photography-detectable DR. These findings highlight the importance of early longitudinal monitoring of retinal perfusion in T2DM.

PURPOSE:To identify predictive factors for ciliary block (CB) following combined phacoemulsification, intraocular lens implantation, and goniosynechialysis (P+I+GSL) in patients with primary angle-closure (PAC) and primary angle-closure glaucoma (PACG). DESIGN:A multicenter retrospective study. PARTICIPANTS:This study analyzed 66 eyes from 66 patients who underwent P+I +GSL between February 2022 and December 2024. Patients were categorized into 2 groups: those who developed CB (n = 33) and those who did not (n = 33). All participants were Chinese. METHODS:Preoperative biometric parameters obtained from ultrasound biomicroscopy and IOLMaster, along with intraoperative data, were analyzed. Univariable and multivariable logistic regression analyses were conducted to identify risk factors for CB. RESULTS:Compared to the non-CB group, patients who developed CB had shorter axial length (AL), narrower anterior chamber width (ACW), and thinner lenses (lens thickness [LT]) (P < 0.05) preoperatively. Multivariable analysis identified reduced ACW (odds ratio = 0.049, P < 0.05), decreased LT (odds ratio = 0.007, P < 0.05), and lack of preoperative mannitol administration (odds ratio = 0.025, P < 0.05) as significant predictors of CB. The optimal cutoff values for predicting CB were 11.72 mm for ACW and 4.84 mm for LT, with area under the curve values of 0.861 and 0.863, respectively. CONCLUSIONS:Shorter AL, narrow ACW, thin lenses, and lack of preoperative mannitol administration are significant risk factors for CB following P+I+GSL in PAC and PACG patients. These findings highlight the importance of preoperative assessment of ACW and LT, along with the use of mannitol, which may help reduce the incidence of CB in high-risk patients. FINANCIAL DISCLOSURE(S):The authors have no proprietary or commercial interest in any materials discussed in this article.

PURPOSE:To describe non-glaucomatous age-related changes in optic nerve optical coherence tomography (OCT) and OCT angiography (OCTA). DESIGN:Prospective-cohort study. PARTICIPANTS:Daxing Eye Study participants age ≥ 50 years without glaucoma were included. METHODS:OCT, OCTA, and other systemic or ocular examinations were performed at baseline and after 5 years. MAIN OUTCOME MEASURES:Peripapillary retinal nerve fiber layer (pRNFL) thickness, macular ganglion cell complex (mGCC) thickness, superficial macular vessel density, and radial peripapillary capillary (RPC) density at baseline and after 5 years. RESULTS:This study included 1003 eyes of 579 subjects, with a follow-up of 5.8 ± 0.4 years. Over 5 years, there were significant decrease in pRNFL (mean = 1.7 µm, 95% CI: 1.5 µm to 1.9 µm, P < .01), mGCC (mean = 0.8 µm, 95% CI: 0.6 µm to 1.0 µm, P < .01), superficial macular vessel density (mean = 2.4%, 95% CI: 2.1% to 2.7%, P < .01), and RPC density (mean = 0.3%, 95% CI: 0.1% to 0.5%, P = .02). In the multivariable analysis, after adjusting for the change of signal strength index of the tests, we observed the following associations: mGCC changes were significantly associated with hyperlipidemia (linear regression coefficient B = -0.75, P = .03) and intraocular pressure (B = -0.13, P < .01). RPC changes were significantly associated with pulse (B = 0.02, P = .04), systolic blood pressure (B = 0.02, P = .02), age (B = -0.04, P = .04) and axial length (B = -0.25, P = .04). Superficial macular vessel changes were associated with axial length (B = -0.30, P < .05). CONCLUSIONS:During 5 years of normal aging, participants experienced declines in pRNFL thickness, mGCC thickness, RPC density, and superficial macular vessel density. These age-related changes should be taken into account when diagnosing and monitoring glaucoma patients.

OBJECTIVES:To investigate dome-shaped macula (DSM) in mild myopic or non-myopic eyes. METHODS:Participants aged 50 years or older were recruited from July 2023 to August 2023. Clinical features including age, sex, visual acuity (VA), spherical equivalent refraction (SER), ocular biometry parameters, SS-OCT parameters and macular complications were compared between eyes with and without DSM. Logistic analysis was performed to explore risk factors for DSM. RESULTS:923 eyes were enrolled in the final analysis. The overall prevalence of DSM was 3.03% (28/923). Among eyes with DSM, 13 eyes (46.4%) were emmetropia, 9 eyes (32.1%) were hypermetropia, and 6 eyes (21.4%) were myopia, with 4 eyes (14.3%) were mild myopia and one eye (3.6%) was moderate myopia. The mean subfoveal choroidal thickness (SFCT) in eyes with DSM was 168.00 ± 77.79μm, which was significantly thinner than their counterparts absent of DSM (289.11 ± 95.58μm, p < 0.001). Logistic regression revealed that longer AL (odds ratio (OR) = 1.716, 95%CI: 1.205-2.442, p = 0.003) and female sex (OR = 3.330, 95% CI: 1.109-10.005, p = 0.032) were associated with DSM. No vitreomacular complication including epiretinal membrane (ERM), vitreomacular traction (VMT), lamellar macular hole (LMH) and full-thickness macular hole (FTMH) was found in eyes with DSM, while the overall prevalence of those macular complications in eye without DSM was 8.8% (79/895). CONCLUSIONS:The study offered a detailed profile of DSM in mild myopic or non-myopic eyes and found a diffuse thinning of choroid in both foveal and parafoveal area in eyes with DSM. No case with vitreomacular complications was identified in DSM eyes in our study population. TRAIL REGISTRATION:The registration number of the present trial in the Chinese Clinical Trial Registry is ChiCTR2000037944.

Introduction Acute primary angle closure (APAC) is a common ophthalmic emergency for Chinese patients causing potential visual disabilities. According to current guidelines published by developed countries, a stepwise protocol (medication laser or paracentesis surgery) is recommended for emergency management of APAC. However, patients with APAC in China and developed countries differ in disease characteristics as the Chinese have longer attack duration and lower success rate in breaking the attack with solely medication or laser therapy. It has been proved that long attack duration is a risk factor for failed medical or laser therapies in subsiding APAC. Since prompt and effective treatment is pivotal in preserving visual function as well as avoiding APAC-induced blindness, direct trabeculectomy may largely benefit long-attacking patients with APAC in China.Purpose The Long-Attacking Acute Angle Closure study aims to compare long-term visual function and safety after different initial treatment strategies: direct surgery (trabeculectomy) or stepwise protocol for patients with APAC with attack duration longer than 72 hours.Methods and analysis This is a pragmatic, multicentre, randomised controlled trial targeting Chinese patients with APAC duration longer than 72 hours. Eligible participants will be identified at either emergency department or glaucoma clinics, then randomised into stepped treatment group or trabeculectomy group using a computer central randomisation service. The patients will be followed up for 1 year after initial treatment.Main outcomes and measures The primary outcome is logMAR BCVA 1 year post initial treatment. Secondary outcomes consist of complete success rate in breaking the attack, intraocular pressure value, mean deviation on Humphrey visual field testing and vision-related quality of life collected using the National Eye Institute Visual Function Questionnaire (25 items) 1 year post initial treatment.Trial registration number ChiCTR2200057289.

P URPOSE . To elucidate the genetic basis of primary angle-closure glaucoma (PACG) by identifying pathogenic tissue and critical tissue-specific variants. M ETHODS . The correlations among PACG susceptibility, axial length (AL), and anterior chamber depth (ACD) were evaluated using meta-analyses. Propensity score matching was utilized on 2161 participants from the Handan Eye Study to determine the risk factors independent of ACD and AL for PACG. Subsequently, we employed the assay for transposase-accessible chromatin with sequencing (ATAC-seq) and allele-specific self-transcribing active regulatory region sequencing (STARR-seq) to screen 202 PACG genome-wide association study (GWAS) variants for chromatin accessibility and functional roles. R ESULTS . The meta-analysis found that PACG susceptibility loci are not associated with ACD or AL. However, abnormal iris phenotypes emerged as significant independent risk factors for primary angle-closure disease (PACD), unrelated to ACD and AL. Substantial enrichment of PACG heritability was observed in the open chromatin regions of the human iris. Within the iris-relevant cellular context, 22 out of the 202 PACG GWAS variants could influence enhancer activity. Two variants in the iris open chromatin regions were implicated in the modulation of PLEKHA7 and C10orf53 expression. The downregulation of these two genes affects cytoskeletal organization. C ONCLUSIONS . Our findings underscore the importance of the iris in the pathogenesis of PACG and identified iris-specific, enhancer-modulating variants that may influence disease risk. Our approach also provides a generalizable framework for studying ocular diseases from the perspective of enhancer-modulating variants.

Objective To investigate the correlations between choroidal parameters and primary angle-closure suspect (PACS) in different age subgroups.Methods and analysis Participants aged 50 years or older in a rural area of Daxing District, Beijing, were recruited. Swept-source optical coherence tomography was used to measure the choroidal parameters. Demographic, ocular biometry parameters and choroidal parameters were compared between the PACS and non-PACS (NPACS) eyes. Logistic analysis was performed to explore the association between the choroidal parameters and PACS.Results 192 (26.89%) subjects with PACS and 509 (71.29%) with PACS were analysed. Subjects were divided into two groups: group 1 (50–60 years, n=286) and group 2 (>60 years, n=415). In group 1, the mean subfoveal choroidal thickness of PACS eyes was 341.82±88.23 µm and thicker than NPACS eyes (315.07±83.53 µm, p=0.035). The choroidal volume was greater in PACS eyes (10.61±2.78 mm3) compared with NPACS eyes (9.66±2.49 mm3, p=0.013). In group 2, no significant difference in any choroidal parameters between PACS and NPACS was found. Multivariate regression demonstrated that increased choroidal volume was associated with PACS (OR 1.298, 95% CI 1.117 to 1.510, p<0.001) in group 1.Conclusions In the age group of 50–60 years, PACS eyes had greater choroidal thickness and volume than NPACS eyes, and the increased total choroidal volume was a predisposing factor for PACS.Trial registration number ChiCTR2000037944.

Objective To compare the 24-hour intraocular pressure (IOP) fluctuation slope curve between newly diagnosed patients with ocular hypertension (OHT) and primary open-angle glaucoma (POAG).Methods and analysis Newly diagnosed and untreated OHT and POAG patients who underwent 24-hour IOP monitoring were consecutively enrolled in the study. IOP measurements were taken every 2 hours from 8:00 to 6:00 hours the following day using an iCare PRO tonometer. Patients maintained their daily routines, with IOP measured in a seated position during the day and supine at night. The 24-hour IOP fluctuation indices, including peak, trough and overall fluctuation, were calculated. Differences in the 24-hour IOP fluctuation slope curves over time between groups were analysed using a generalised additive mixed model.Results 46 patients with OHT and 41 with POAG were included. From 2:00 to 10:00 hours, mean IOP increased by 0.69 mm Hg every 2 hours in the POAG group (p<0.0001) and by 0.40 mm Hg in the OHT group (p<0.0001). After 10:00, the IOP showed a downward trend, decreasing by 0.31 mm Hg in the POAG group (p<0.0001) and by 0.17 mm Hg in the OHT group (p=0.0003) every 2 hours. The rate of slope change in the upward phase differed significantly between the groups (0.30 mm Hg per 2 hours; p=0.02), as did the rate in the downward phase (0.14 mm Hg per 2 hours; p for interaction=0.04). Multivariate models showed that each 1 mm Hg increase in circadian and diurnal IOP fluctuation was associated with a 27% and 21% higher likelihood of POAG presence, respectively.Conclusion The 24-hour IOP slope curve differed between POAG and OHT, with a steeper slope observed in the POAG group. However, the study is limited by potential confounding factors, reliance on a single 24-hour measurement period and the need for further longitudinal studies to validate these findings.

Purpose:To compare the efficacy of morning and evening latanoprost/timolol fixed-combination (LTFC) dosing in patients with primary open-angle glaucoma (POAG) and ocular hypertension. Methods:In this double-blind, randomized clinical trial, 63 untreated Chinese patients with POAG and ocular hypertension were enrolled. All patients received LTFC and were randomized (1:1) to group 1, morning (8 AM) dosing, or group 2, evening (8 PM) dosing. Vehicle drops were used in the morning or evening, accordingly, to preserve masking. Patients were treated for 4 weeks. Outcomes included mean reduction of the 24-hour intraocular pressure (IOP) and IOP fluctuation from baseline after a 4-week treatment. Results:Fifty-six patients were included in the final analysis. In both groups, the posttreatment IOP values were significantly lower than those at baseline at each 24-hour measuring time point. A significant difference between the groups in IOP reduction from baseline was observed at the 9:30 AM time point (4.01 ± 2.62 vs. 2.42 ± 3.23 mm Hg, evening dosing versus morning dosing group; P = 0.048). Both groups showed decreased IOP fluctuation after treatment. However, the morning dosing group had a significantly greater decrease in diurnal IOP fluctuation than that of the evening dosing group (2.04 ± 2.32 mm Hg vs. 0.50 ± 1.70 mm Hg, respectively; P = 0.012). Conclusions:Both morning and evening LTFC dosing can effectively reduce 24-hour IOP and IOP fluctuation. Morning dosing is more likely to effectively control diurnal IOP fluctuations. Translational Relevance:This multicenter, double-blind, randomized clinical trial generates robust evidence on the optimal LTFC dosing regimen to help clinical decision-making in the treatment of raised IOP.

To assess the interactive relationship between blood pressure status and diabetic mellitus (DM) with ganglion cell complex (GCC) thickness in elderly individuals in rural China. Participants aged 50 years and older in a rural area of Daxing District, Beijing, were recruited in this study from October 2018 to November 2018. All subjects underwent a comprehensive systemic and ocular examination. Blood pressure status was graded as normotension, controlled hypertension and uncontrolled hypertension according to blood pressure measurements and the use of any medication for hypertension treatment. GCC parameters were measured by spectral-domain optical coherence tomography (SD-OCT). Generalized linear models (GLM) adjusted for related potential confounders were used to assess the interaction between DM and blood pressure status. Among 1415 screened subjects (2830 eyes), a total of 1117 eyes were enrolled in the final analysis. GLM analysis showed a significant interactive relationship between DM with uncontrolled hypertension status (β = 3.868, p = 0.011). GCC thickness would decrease 0.255 μm per year as the age increased (β=-0.255, p < 0.001). In a subgroup of 574 subjects with uncontrolled hypertension, DM was associated with an increased average of GCC thickness (β = 1.929, p = 0.022). The present results revealed a significant interactive relationship between blood pressure status and DM. The average GCC thickness increased in individuals with DM combined with uncontrolled hypertension, which should be considered in the measurement of GCC. Further studies are warranted to explore ganglion cells changes as a non-invasive method to detect neuron alterations in individuals with DM and uncontrolled hypertension. The registration number of the present trial in the Chinese Clinical Trial Registry is ChiCTR2000037944.

Objective To investigate the characteristics of beta parapapillary atrophy (β-PPA) in patients with primary angle-closure suspect (PACS).Methods and analysis In total, 215 and 259 eyes with PACS and non-PACS (NPACS), respectively, were enrolled in this observational, cross-sectional study. Stereoscopic fundus and optical coherence tomography images were used to characterise β-PPA; the former was also used to measure the major β-PPA parameters. Univariate and multiple logistic regression analyses were used to identify the factors correlated with the presence of β-PPA and with β-PPA parameters.Results The β-PPA occurrence rates were 48.80% and 44.40% in the PACS and NPACS groups, respectively, with no significant difference between groups. Compared with that in the NPACS group, the β-PPA area was significantly larger (p=0.005) in the PACS group, but the angular extent and maximum radial length did not differ between groups (p=0.110 and 0.657, respectively) after adjusting for age and axial length. The presence of β-PPA was associated with older age (OR 1.057, 95% CI 1.028 to 1.088, p<0.001) and larger disc area (OR 1.716, 95% CI 1.170 to 2.517, p=0.006). A larger β-PPA area was associated with older age (p=0.014), greater vertical cup-to-disc ratio (p=0.028), larger disc area (p<0.001) and PACS diagnosis (p=0.035).Conclusion 48.80% of participants with PACS had β-PPA, which is slightly larger than NPACS. The area of β-PPA was larger in PACS, while the angular extent and maximum radial length did not differ between groups.

Purpose To develop and validate deep learning algorithms that can identify and classify angle-closure (AC) mechanisms using anterior segment optical coherence tomography (AS-OCT) images. Methods This cross-sectional study included participants of the Handan Eye Study aged ≥ 35 years with AC detected via gonioscopy or on the AS-OCT images. These images were classified by human experts into the following to indicate the predominant AC mechanism (ground truth): pupillary block, plateau iris configuration, or thick peripheral iris roll. A deep learning architecture, known as comprehensive mechanism decision net (CMD-Net), was developed to simulate the identification of image-level AC mechanisms by human experts. Cross-validation was performed to optimize and evaluate the model. Human-machine comparisons were conducted using a held-out and separate test sets to establish generalizability. Results In total, 11,035 AS-OCT images of 1,455 participants (2,833 eyes) were included. Among these, 8,828 and 2.207 images were included in the cross-validation and held-out test sets, respectively. A separate test was formed comprising 228 images of 35 consecutive patients with AC detected via gonioscopy at our eye center. In the classification of AC mechanisms, CMD-Net achieved a mean area under the receiver operating characteristic curve (AUC) of 0.980, 0.977, and 0.988 in the cross-validation, held-out, and separate test sets, respectively. The best-performing ophthalmologist achieved an AUC of 0.903 and 0.891 in the held-out and separate test sets, respectively. And CMD-Net outperformed glaucoma specialists, achieving an accuracy of 89.9% and 93.0% compared to 87.0% and 86.8% for the best-performing ophthalmologist in the held-out and separate test sets, respectively. Conclusions Our study suggests that CMD-Net has the potential to classify AC mechanisms using AS-OCT images, though further validation is needed.

Purpose:To investigate the anterior segment characteristics of primary angle closure disease (PACD) with long axial length (AL) compared with that of those with short and medium AL and explore the risk factors associated with AC with different AL levels. Methods:This observational cross-sectional study enrolled subjects aged 35 years or older who completed the follow-up examinations of the Handan Eye Study and dichotomized them into normal and PACD groups. Ocular data of the right eye were analyzed. AL was categorized into short (<22.0 mm), medium (22.0-24.0 mm), or long (>24.0 mm) subgroups. Demographic and anterior segment parameters of PACD subjects were compared between the three AL subgroups. Logistic regression analysis was performed to identify the risk factors for PACD in the three subgroups. Results:Data from 715 PACD and 1446 normal subjects were analyzed. Only 6.6% of the PACD eyes had long AL, with lower spherical equivalent, larger anterior chamber depth (P < 0.001), and smaller lens thickness (P < 0.001) than those with short and medium AL. No significant differences were found for angle opening distance and iris parameters on comparing the values of eyes with long AL with that of those with short and medium AL. Significant risk factors for the development of PACD with long AL were peripheral iris thickness, anterior chamber width, and lens vault. Conclusions:PACD with long AL was uncommon. A thicker peripheral iris, larger lens vault, and smaller ACW contributed to angle closure in these patients.

Tumor necrosis factor-α (TNF-α) is a multipotent pro-inflammatory cytokine that plays an important role in apoptosis, cell survival, inflammation and immunity. TNF-α is involved in the inflammatory response of the trabecular meshwork in glaucoma patients, which may lead to impaired outflow and elevated intraocular pressure. It has also been shown that TNF-α is involved in retinal ganglion cell apoptosis in glaucoma, and that TNF-α and its receptors can both promote neuroinflammation and secondary neuronal damage and may play a protective role under pathological conditions. ( Int Rev Ophthalmol, 2023, 47: 257-263)

Purpose: To assess the performance and generalizability of a convolutional neural network (CNN) model for objective and high -throughput identification of primary angle -closure disease (PACD) as well as PACD stage differentiation on anterior segment swept -source OCT (AS-OCT). Design: Cross-sectional. Participants: Patients from 3 different eye centers across China and Singapore were recruited for this study. Eight hundred forty-one eyes from the 2 Chinese centers were divided into 170 control eyes, 488 PACS, and 183 PAC + PACG eyes. An additional 300 eyes were recruited from Singapore National Eye Center as a testing data set, divided into 100 control eyes, 100 PACS, and 100 PAC + PACG eyes. Methods: Each participant underwent standardized ophthalmic examination and was classified by the presiding physician as either control, primary angle -closure suspect (PACS), primary angle closure (PAC), or primary angle -closure glaucoma (PACG). Deep Learning model was used to train 3 different CNN classifiers: classifier 1 aimed to separate control versus PACS versus PAC + PACG; classifier 2 aimed to separate control versus PACD; and classifier 3 aimed to separate PACS versus PAC + PACG. All classifiers were evaluated on independent validation sets from the same region, China and further tested using data from a different country, Singapore. Main Outcome Measures: Area under receiver operator characteristic curve (AUC), precision, and recall. Results: Classifier 1 achieved an AUC of 0.96 on validation set from the same region, but dropped to an AUC of 0.84 on test set from a different country. Classifier 2 achieved the most generalizable performance with an AUC of 0.96 on validation set and AUC of 0.95 on test set. Classifier 3 showed the poorest performance, with an AUC of 0.83 and 0.64 on test and validation data sets, respectively. Conclusions: Convolutional neural network classifiers can effectively distinguish PACD from controls on AS-OCT with good generalizability across different patient cohorts. However, their performance is moderate when trying to distinguish PACS versus PAC + PACG. Financial Disclosures: The authors have no proprietary or commercial interest in any materials discussed in this article. (c) 2023 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology

Examination of retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) have been widely used for the screening and diagnosis of early glaucoma, but the thicknesses of RNFL and GCC are affected by race, age, sex, ocular factors and systemic diseases. Optic disc size is one of the important influencing factors for measuring the thickness of RNFL and GCC in patients with different optic disc sizes using optical coherence tomography (OCT). The measurement of RNFL in the normal scanning mode of OCT is influenced by the size of optic disc, and the RNFL in large optic disc is thicker. Therefore, proportional scanning mode is more suitable for RNFL measurement of different types of optic disc. However, it is still controversial whether patients with larger optic disc have greater GCC thickness measurements than those with small optic disc, which needs further study to verify. ( Int Rev Ophthalmol, 2023, 47: 308-314)

Purpose: To investigate whether the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) change with optic nerve head (ONH) size in healthy eyes. Methods: This cross-sectional observational study recruited participants aged ≥50 years. Participants underwent optical coherence tomography–assisted measurements of the peripapillary RNFL and macular GCC and were divided into small, medium, and large ONH groups according to optic disc area (≤1.9 mm2, >1.9 mm2 and ≤2.4 mm2, and >2.4 mm2, respectively). The groups were compared for RNFL and GCC. Linear regression models were used to evaluate the correlation of RNFL and GCC with ocular and systemic factors. Results: There were 366 participants. The whole, temporal, and superior RNFLs were significantly different among the groups (P = 0.035, 0.034, and 0.013, respectively) with no significant difference in the nasal and inferior RNFL (P = 0.214, 0.267, respectively). The average, superior, and inferior GCCs were not significantly different among the groups (P = 0.583, 0.467, and 0.820, respectively). Thinner RNFL was independently associated with older age (P = 0.003), male sex (P = 0.018), smaller disc area (P < 0.001), higher vertical cup disc ratio (VCDR) (P < 0.001), and larger maximum cup depth (P = 0.007); thinner GCC was independently associated with older age (P = 0.018), larger best-corrected visual acuity (P = 0.023), and higher VCDR (P = 0.002). Conclusions: RNFL but not GCC significantly increased with ONH size in healthy eyes. GCC may be more suitable than RNFL for evaluating early glaucoma in patients with large or small ONH. Translational Relevance: GCC may be a better index than RNFL for early glaucoma evaluation in patients with large or small ONH.