Altris AI GLAUCOMA MODULE

 

Altris AI is an artificial intelligence platform for OCT analysis, apparently capable of detecting more than 70 retinal pathologies and biomarkers, the highest among such technologies worldwide.

Altris AI has recently launched an advanced glaucoma "Optic Disc Analysis module" for OCT scans.

Traditionally, OCT results are dependent on normative databases pre-loaded in the machine. These databases can be insufficient or skewed for populations not usually seen in the region. For example, the machine can have more caucasian datasets, even though the population being evaluated is Asian or African. 

The new module evaluates optic disc parameters using OCT, providing personalized assessments by accounting for individual disc sizes and angle of rim absence. This tailored approach eliminates reliance on normative databases, making evaluations more accurate and patient-specific.

Key parameters evaluated by Altris AI’s Optic Disc Analysis include:

1. Disc area
2. Cup area
3. Cup volume
4. Minimal Cup depth
5. Maximum Cup depth
6. Cup/Disc area ratio
7. Rim Absence angle
8. Disc-Damage Likelihood Scale (DDLS)

Altris AI’s platform assigns a severity score for optic disc damage on a scale from 1 to 10, offering valuable insights into glaucomatous changes. Furthermore, it enables cross-evaluation across different OCT systems, allowing practitioners to analyze both macula and optic disc pathology, even when data originates from multiple OCT devices.

By combining GCC Asymmetry (a program developed by Altris AI previously, designed to detect early risk of glaucoma), and Advanced Optic Disc analysis for glaucoma, this technology enables eye-care practitioners to make faster evaluations and explore a wider range of treatment options. This streamlined approach empowers users with timely, actionable data, ultimately improving patient outcomes and care.

This innovation not only reduces false positive referrals but also enhances early detection and treatment planning—ensuring better outcomes for patients and optimizing healthcare resources.

REFERENCE:

https://aiineyecare.com/altris-ai-introduces-advanced-optic-disc-analysis-for-glaucoma/#

PreserFlo Microshunt occlusion

Bonatti et al have presented the successful resolution of early fibrin occlusion of PreserFlo MicroShunt with Nd:YAG laser treatment. It is regarded as the first reported case of such a nature.

The PreserFlo microshunt device is indicated in patients with moderate or advanced open-angle glaucoma who require further intraocular pressure (IOP) reduction to prevent disease progression. 

The 70-mm lumen implant redirects aqueous fluid from the anterior chamber to the subtenon space. The microshunt works immediately after its implantation, significantly reducing the IOP, typically in the single digits on the initial post-operative period.

Obstruction of the implant lumen can reduce the aqueous flow through the shunt and prevent this pressure reduction.

The authors performed a PreserFlo MicroShunt implant with phacoemulsification and acrylic intraocular lens implantation on the left eye of a 64-year-old male patient with primary open-angle glaucoma (POAG).

On the first postoperative day, he presented with an uncomfortable left eye with best corrected visual acuity (BCVA) of 6/15, mild corneal edema, and a centered intraocular lens. No filtering bleb was observed and IOP in that eye was 39 mmHg. The intracameral portion of the PreserFlo MicroShunt was in a good position in the anterior chamber, but fibrin strands were observed in the AC going toward the internal ostium of the shunt.

Apparently, the fibrin deposition was limiting drainage through the shunt. The authors used neodymium-doped yttrium aluminum garnet (Nd:YAG) laser to clear the obstructing material. 

The material was lysed under direct visualization using 10 single shots with a power of 1.1 mJ. 

Upon breaking the material, the authors immediately observed a fibrin strand being aspirated into the shunt lumen, indicating patency of the implant. However, 10 minutes after the procedure, the filtering bleb remained flat, and the IOP was 38 mmHg, without any evidence of fibrin in the anterior chamber.

It was suspected that the previously noted fibrin strand was trapped inside the shunt lumen and the patient underwent another laser procedure. 

With the aid of a Ritchie lens, the authors lasered the midsection of the shunt's lumen under the conjunctiva. Two single shots were given with a power of 1.0 mJ until gas bubbles were observed inside the lumen. After 15 minutes, the patient was symptomatically comfortable, an elevated filtering bleb was observed, and the IOP was 12 mmHg. 

At the 1-week postoperative visit, there was no evidence of fibrin in the AC, BCVA was 6/6 and IOP was 4 mmHg. 

At his last visit, 12 months after surgery, his IOP was 15 mmHg with brimonidine-timolol combination twice daily.

REFERENCE:

Bonatti R, Hodgson K, Nicolela M. Successful resolution of early fibrin occlusion of PreserFlo MicroShunt with Nd:YAG laser treatment. Can J Ophthalmol. 2025 Jun;60(3):e482-e485. doi: 10.1016/j.jcjo.2025.01.003. Epub 2025 Feb 6. PMID: 39870357.

PROSTAGLANDINS & RISK OF UVEITIS

Prostaglandin Analogues (PGAs) have often been regarded as pro-inflammatory and contraindicated in situations where there is risk of inflammation, such as neovascular glaucoma (NVG).

Chauhan et al have published a study to evaluate the risk of uveitis among patients starting on topical glaucoma therapy.

The retrospective study utilized the Sight Outcomes Research Collaborative (SOURCE) Ophthalmology Data Repository data from 10 health systems contributing to the SOURCE data repository. 

Adult glaucoma patients who were recently started on topical glaucoma therapy were included in the study. The anti-glaucoma medications included prostaglandin analogs [PGAs], beta-blockers [BBs], alpha agonists [AAs], and carbonic anhydrase inhibitors [CAIs].

Patients with pre-existing documentation of uveitis were excluded.

The main outcome measure was the incidence of uveitis within 3 months of initiating therapy with different topical glaucoma medications.

The study included 67517 patients who were newly prescribed a topical glaucoma medication. 

A total of 567 patients (0.87%) developed uveitis within 3 months of initiating the therapy. 

The incidence of uveitis was 1.95%, 1.68%, 1.63%, and 0.32% for users of BBs, CAIs, AAs, and PGAs, respectively.

After adjusting for sociodemographic factors, individuals using topical BBs, AAs, and CAIs had significantly higher odds of developing uveitis versus those using PGAs (P < 0.001 for all comparisons).

The study concluded that the use of PGAs was not associated with higher odds of developing uveitis compared with other classes of topical glaucoma medications.

REFERENCE:

Chauhan MZ, Elhusseiny AM, Marwah S, Sallam AB, Stein JD, Kishor KS; SOURCE Consortium. Incidence of Uveitis Following Initiation of Prostaglandin Analogs versus Other Glaucoma Medications: A Study from the Sight Outcomes Research Collaborative Repository. Ophthalmol Glaucoma.2025;8:126-132.

REMYELINATION BY THERAPEUTICALLY ENHANCED OLIGODENDROGENESIS

 

Myelin, made by oligodendrocytes enwrapping axons with lipid-rich membranes, is essential for proper central nervous system (CNS) function. Loss of oligodendrocytes and myelin, known as demyelination, induces severe delay and failure of action potential propagation, leaves neurons and their axons vulnerable to degeneration, and causes motor, sensory, and cognitive impairment.

Demyelination is typically followed by a period of heightened new myelin formation known as remyelination, which can restore action potential propagation and prevent neurodegeneration. Remyelination is carried out primarily by newly formed oligodendrocytes.

However, the endogenous remyelination response is often incomplete, resulting in chronic demyelination and limited functional recovery.

Myelin loss, including in visual gray matter, is a common feature of several neurodegenerative diseases and injury conditions, and is present in normal aging. In addition, myelin is malformed or present in insufficient levels in several neurodevelopmental and neuropsychiatric disorders. By promoting the formation of new oligodendrocytes and myelin, remyelination therapies may be clinically important for numerous neurological conditions.

Researchers have shown that endogenous remyelination is driven by recent oligodendrocyte loss and is highly efficacious following mild demyelination, but fails to restore the oligodendrocyte population when high rates of oligodendrocyte loss occur quickly.

Treatment with a high dose of LL-341070 substantially increased regenerative oligodendrogenesis during remyelination. Thus, incomplete remyelination via therapeutically enhanced oligodendrogenesis is sufficient to recover visual cortical function.

The authors concluded that oligodendrocyte gain rate during remyelination is driven by recent oligodendrocyte loss, rather than a drive to reestablish oligodendrocyte numbers, indicating that acute signaling around the time of the loss of myelinating oligodendrocytes induces new oligodendrocyte formation. However, the exact source of the signal is unknown, and it is unclear if it involves direct signaling from damaged oligodendrocytes or is mediated by other cell types.

REFERENCE:

Della-Flora Nunes, G., Osso, L.A., Haynes, J.A. et al. Incomplete remyelination via therapeutically enhanced oligodendrogenesis is sufficient to recover visual cortical function. Nat Commun 16, 732 (2025). https://doi.org/10.1038/s41467-025-56092-6.

 

ANTIBODY-MEDIATED TREATMENT OF GLAUCOMA

 

Early-onset familial glaucoma is attributed to nonsynonymous mutations in the gene encoding myocilin. The protein myocilin is secreted at relatively high levels in the trabecular meshwork (TM) extracellular matrix. Mutant myocilin aggregates intracellularly in the endoplasmic reticulum (ER). Subsequent ER stress causes cytotoxicity that hastens dysregulation of intraocular pressure, the primary risk factor for most forms of glaucoma.

Recombinant antibodies represent an emerging class of versatile and powerful therapeutics to treat protein conformational and misfolding associated with neurodegenerative diseases. Glaucoma management has entered a new phase with the development of antibodies targeting the aggregation-prone β-propeller olfactomedin (OLF) domain of myocilin, variants of which comprise the strongest genetic link to glaucoma.

These new antibodies target the domain of myocilin that misfolds in the ER and causes pathogenic cytotoxicity. These antibodies degrade aggregating mutant myocilin in situ by rerouting mutant myocilin for lysosomal degradation.

Clearance of OLF-resident myocilin mutants is hindered by aberrant interactions with molecular chaperones such as glucose-regulated protein 94 (Grp94), leading to the accumulation of misfolded proteins, ER stress, and subsequent TM cell death.

Multi-centric research by Ma and colleagues has discovered two recombinant antibodies: anti-OLF1 recognizes a linear epitope, while anti-OLF2 is selective for natively folded OLF and inhibits aggregation in vitro. By binding OLF, these antibodies engage autophagy/lysosomal degradation to promote degradation of two pathogenic mutant myocilins.

The interaction between Grp94 and mutant myocilin can be abrogated with selective small molecules targeting Grp94 or by downregulation of Grp94 with siRNA.

Treatment with Grp94-targeted small molecules or siRNA leads to the clearance of mutant myocilin by autophagy, similar to what is observed with anti-OLF1 and anti-OLF2.

This research shows the promise of antibodies in the treatment of familial open-angle glaucoma associated with myocilin.

REFERENCE:

Ma MT, Qerqez AN, Hill KR, Azouz LR, Youngblood HA, Hill SE, Ku Y, Peters DM, Maynard JA, Lieberman RL. Antibody-mediated clearance of an ER-resident aggregate that causes glaucoma. PNAS Nexus. 2024 Dec 10;4(1):pgae556. doi: 10.1093/pnasnexus/pgae556. PMID: 39726989; PMCID: PMC11670252.

VASCULAR DENSITY AND PERFUSION IN GLAUCOMA

 

Optical coherence tomography angiography (OCTA) is a fast, noninvasive imaging technique that offers quantitative and volumetric evaluations of both the structural and vascular features of the retina and optic nerve. The changes observed in OCTA correlate topographically with the functional alterations identified through visual field assessments and the structural modifications noted on OCT.

There have been a couple of studies to analyze the radial peripapillary capillary vessel density (RPC VD) in glaucoma.

Joseph et al. have studied the peripapillary and macular perfusion densities in 20 eyes of POAG patients, 20 of NTG, and 15 of NTG, and compared them with normal eyes by OCTA analysis.  

All POAG, PACG, and NTG patients showed a lesser peripapillary perfusion density (PD) compared to normal subjects in all quadrants, which was statistically significant (P < 0.002).

Also, all POAG, PACG, and NTG patients showed a lesser superficial perifoveal plexus PD compared to normal subjects in all zones, which was statistically significant (P < 0.004).

In NTG, the peripapillary PD of the superior quadrant showed the least PD (P < 0.001), and in PACG, the inferior, nasal, and temporal quadrants showed the least PD, which was statistically significant (P < 0.002).

The mean peripapillary flux index of the outer zone was lowest in the PACG group, which was statistically significant (P < 0.001).

All forms of glaucoma (POAG, PACG, and NTG) were associated with decreased blood supply to the ONH and the perifoveal zone.

Apart from the mechanical damage to the optic nerve head, PACG is associated with significant retinal microvascular impairment.

Significant microvascular impairment in the perifoveal area in NTG is characterized by decreased PD in the outer and full zones.

Ashour et al have shown that RPC VD is reduced in eyes with glaucomatous cupping, and not in those with physiological cupping or in normal eyes. The study included 98 eyes from 98 patients, divided into 3 groups. Group 1 included 30 eyes with primary open-angle glaucoma, group 2 included 28 normal eyes with physiological cupping (normal OCT and no evidence of glaucoma), and group 3 included 40 age-matched normal eyes (vertical cup/disc ratio ≤0.5).

The study found significantly lower RPC VD across all retinal quadrants, compared to the other groups (P<0.001) in Group 1. But no significant differences were found between Groups 2 and 3 (P=0.559). Therefore, OCTA can be used to differentiate between glaucomatous and physiological cupping.

REFERENCES:

Joseph, Rachel; Apoorva, N.; Nayak, Lakshmi D.. Comparison of vascular parameters in primary open-angle glaucoma, primary angle closure glaucoma, and normal tension glaucoma with healthy subjects using optical coherence tomography angiography. The Pan-American Journal of Ophthalmology 7(1):143, April 2025. | DOI: 10.4103/pajo.pajo_23_25

Ashour DM, Madkour NS, Ebeid WM, Mahmoud RA. Peripapillary Vascular Density Differentiates Glaucomatous Cupping From Physiological Cupping Using Optical Coherence Tomography Angiography. J Glaucoma. 2025 May 1;34(5):415-420. doi: 10.1097/IJG.0000000000002530. Epub 2024 Dec 16. PMID: 39670861.

OPTIC DISC-RNFL IN PEDIATRIC POPULATION

Optic disc and retinal nerve fiber layer (RNFL) measurements by optical coherence tomography (OCT) are important investigations in detecting glaucoma. However, the results of the OCT measurements are influenced by a normative database with which the measurements are compared. 

The results of the OCT findings in adults are reliable because of the large and stable database. However, in children below 18 years of age, the database is usually not robust, and so the OCT results are not clear.

There have been a few studies of OCT in children, and the results of those studies are being presented here.

Adem et al. reported the average peri-papillary RNFL thickness in children between 6 to 16 years of age was 106.45 9.41 μm; the average macular thickness was 326.44 14.17 μm; and the average macular volume was 0.257 0.011 mm³. The aforementioned OCT measurements were not significantly correlated with age, SE, or AL values (P > .05 for all). [Turk A, Ceylan OM, Arici C, Keskin S, Erdurman C, Durukan AH, Mutlu FM, Altinsoy HI. Evaluation of the nerve fiber layer and macula in the eyes of healthy children using spectral-domain optical coherence tomography. Am J Ophthalmol. 2012 Mar;153(3):552-559.e1.]

Patel et al. have reported the average retinal nerve fiber layer (RNFL) thickness measured with spectral-domain (SD) OCT in children between 5 and 18 years of age to be 102 to 113μm. [Patel A, Purohit R, Lee H, Sheth V, Maconachie G, Papageorgiou E, McLean RJ, Gottlob I, Proudlock FA. Optic Nerve Head Development in Healthy Infants and Children Using Handheld Spectral-Domain Optical Coherence Tomography. Ophthalmology. 2016 Oct;123(10):2147-57.] Susan et al. found the mean peripapillary RNFL thickness in children aged 5 to 15 years to be 107.6 ± 1.2 μm. [Yanni SE, Wang J, Cheng CS, Locke KI, Wen Y, Birch DG, Birch EE. Normative reference ranges for the retinal nerve fiber layer, macula, and retinal layer thicknesses in children. Am J Ophthalmol. 2013 Feb;155(2):354-360.e1.] In a study by Raffa regarding the normative OCT reference ranges in healthy Saudi children, the mean values for RNFL thickness, disc area, rim area, and cup volume were 93.9 μm, 2 mm², 1.6 mm², and 0.3 mm³, respectively. The vertical ratio of cup to disc was 0.4. [Raffa L, AlSwealh SS. Normative optical coherence tomography reference ranges of the optic nerve head, nerve fiber layer, and macula in healthy Saudi children. Saudi Med J. 2023 Nov 28;44(12):1269-1276.] An OCT study of 113 healthy children aged 6 to 17 years with no ocular abnormality except refractive error showed the mean RNFL thickness was 95.6+/-8.7 μm. [Al-Haddad C, Barikian A, Jaroudi M, Massoud V, Tamim H, Noureddin B. Spectral domain optical coherence tomography in children: normative data and biometric correlations. BMC Ophthalmol. 2014 Apr 22;14:53.] A multi-center Spanish study in normal children reported the following data: The mean global RNFL thickness was 97.40 ± 9.0 μm (range, 77-121.7 μm). [Barrio-Barrio J, Noval S, Galdós M, Ruiz-Canela M, Bonet E, Capote M, Lopez M. Multicenter Spanish study of spectral-domain optical coherence tomography in normal children. Acta Ophthalmol. 2013 Feb;91(1):e56-63.]

This study is by Hassan et al. from Iran, 9051 eyes of 4784 children were analyzed.

Vertical cup-to-disc ratio	0.45±0.15(0.45–0.46) mm
Average cup-to-disc ratio	0.43±0.14 (0.42–0.43) mm
Rim area	1.46±0.25 (1.45–1.47) mm2
Disc area	1.92±0.35 (1.91–1.93) mm2
Cup volume	0.14±0.14 (0.14–0.15) mm3

The mean±SD and 95% confidence intervals (in parentheses)

Hashemi, Hassan; Khabazkhoob, Mehdi; Heydarian, Samira; Emamian, Mohammad Hassan; Fotouhi, Akbar. Optic Disc Measurements in Children by Optical Coherence Tomography. Journal of Glaucoma 32(5):p 361-368, May 2023.

ALCOHOL AND OPEN-ANGLE GLAUCOMA

 

A study by Leo et al, based on the National Institutes of Health All of Us (AoU) Research Program, has reported a significant association between the frequency of consumption of alcoholic drinks and primary open-angle glaucoma (POAG).

The retrospective study utilized the diverse All of Us Research Program. A randomized 1:4 case/control ratio was utilized for POAG patients and randomly selected control patients. χ², bivariable, and multivariable regression were utilized to examine the associations between alcohol use and POAG.

Of the 3876 POAG patients, 2015 (52%) were female, 1943 (50%) were White, 1152 (30%) were Black, 117 (3%) were Asian, and 584 (15%) were Hispanic.

Alcohol use of 4 or more drinks per week was significantly higher in the glaucoma cohort relative to controls (15% vs. 12%, P<0.001). On bivariate analysis, diagnosed alcohol misuse was associated with higher odds of POAG [odds ratio (OR): 1.20, 95% CI: 1.17–1.23, P<0.001].

In multivariable regression, more frequent alcohol use was associated with higher odds of glaucoma; alcohol use with a frequency of 4 or more drinks per week was significantly associated with increased odds of glaucoma (OR: 1.22, 95% CI: 1.03–1.44, P=0.023).

This dose-response relationship was also observed and more pronounced for female participants, where alcohol use frequency of monthly or less was already associated with increased odds of glaucoma (OR: 1.21, 95% CI: 1.002–1.46, P=0.048).

RESULT:

According to this study, there was a dose-response relationship between alcohol consumption and POAG risk, which was more pronounced in female participants. Overall, a higher frequency of alcohol consumption was associated with an increased risk of POAG; 4 or more drinks per week was significantly associated with a higher risk of glaucoma.

REFERENCE:

Meller LLT, Saseendrakumar BR, Mahmoudinezhad G, Tavakoli K, Wu JH, Parikh A, Bhanvadia S, Moghimi S, Zangwill L, Weinreb RN, Baxter SL. Association Between Alcohol Use and Primary Open Angle Glaucoma. J Glaucoma. 2025 Feb 1;34(2):69-76. doi: 10.1097/IJG.0000000000002529. Epub 2024 Dec 16. PMID: 39670849.

 

LEOS (LASER ENDOSCOPY OPHTHALMIC SYSTEM)

 

BVI Medical, a leading global ophthalmic device company, has received 510(k) clearance from the U.S. Food and Drug Administration (FDA) for its innovative glaucoma surgical system, Leos™ (Laser Endoscopy Ophthalmic System).

Leos™ introduces a novel, more intuitive laser endoscopic cyclophotocoagulation (ECP) procedure that integrates seamlessly into the surgical workflow.

This laser system lowers intraocular pressure by addressing aqueous humor production in a minimally invasive ab interno procedure.

It incorporates unique endoscopic capabilities to provide superior visualization of the eye anatomy in a way not seen in the past, or with the latest imaging systems.

https://www.bvimedical.com/bvi-medical-announces-approval-of-breakthrough-technology-fda-510k-clearance-of-its-laser-endoscopy-ophthalmic-system-leos/

DIRECT SELECTIVE LASER TRABECULOPLASTY (DSLT)

Selective Laser Trabeculoplasty (SLT) is an effective first-line treatment option for patients with open-angle glaucoma and normal-tension glaucoma.

Alcon has improved the delivery system of SLT machines with the development of the Voyager Direct Selective Laser Trabeculoplasty (DSLT) system.

Voyager™ DSLT is designed to automatically deliver 120 laser pulses directly through the limbus to the trabecular meshwork, thereby improving aqueous outflow and reducing intraocular pressure.

The GLAUrious Study comparing DSLT and SLT did not find inferiority of the DSLT procedure at 6 and 12 months of follow-up.

The study demonstrated that DSLT with the Eagle device is effective in providing a clinically meaningful reduction in IOP at 6 months that is sustained out to 12 months.

The protocol included DSLT: 120 shots, 3 ns, 400 µm spot size, energy 1.4–1.8 mJ delivered at the limbus over 2 s. SLT: approximately 100 shots, 3 ns, 400 µm spot size administered 360 degrees at the limbus using any gonioscopy lens, energy 0.3–2.6 mJ.

According to the authors, a sample size of 164 is sufficient to detect a non- inferiority margin of 1.95 mm Hg for change from baseline IOP.

REFERENCE:

Congdon N, Azuara-Blanco A, Solberg Y, Traverso CE, Iester M, Cutolo CA, Bagnis A, Aung T, Fudemberg SJ, Lindstrom R, Samuelson T, Singh K, Blumenthal EZ, Gazzard G; GLAUrious study group. Direct selective laser trabeculoplasty in open angle glaucoma study design: a multicentre, randomised, controlled, investigator-masked trial (GLAUrious). Br J Ophthalmol. 2023 Jan;107(1):62-65. doi: 10.1136/bjophthalmol-2021-319379. Epub 2021 Aug 25. PMID: 34433548; PMCID: PMC9763163.

ESNOPER CLIP

 

Drainage implants act as flow controllers, space maintainers, and healing modulators, reducing the risk of scleral fibrosis.

The suprachoroidal implantation of drainage devices improves deep sclerectomy (DS) techniques by decreasing aqueous production by detachment of the ciliary body or by increasing the choroidal resorption of aqueous humor.

DS creates a trabeculo-descemet window by removing the deep scleral flap and the corneal stroma. This allows gradual aqueous filtration through the thin trabeculo-descemet membrane (TDM) and prevents dangerously rapid IOP decreases.

DS preserves the integrity of the anterior chamber and has the advantage of superior filtration control and reduced occurrence of perioperative and postoperative complications (e.g., hypotonia, flat anterior chamber, and choroidal detachment).

The Esnoper Clip is a nonabsorbable foldable implant made from HEMA, a nonionic polymer with a low tendency for protein deposits. The implant has a double-plate design, which facilitates both trabecular and uveoscleral drainage. It is also found to reduce fibrosis, ensuring maintenance of both the above-mentioned spaces, thus avoiding their collapse over time.

The implant has internal channels to facilitate aqueous humor flow through the device and has lateral notches for non-sutured supraciliary placement.

This implant has 2 plates, one is placed on the scleral bed and the other in the supraciliary space. The shape of the implant has been designed to preserve the patency of the intrascleral and suprachoroidal spaces and to maximize both aqueous-humor drainage pathways long after surgery.

A significant limiting factor in the long-term success of DS with uveoscleral implants is the inflammatory potential of the suprachoroidal region, characterized by significant cell infiltration and fibrosis.

A study of 39 eyes by Alina-Dana Baxant, from Charles University, Prague, showed a 87.2% success rate at one year, following DS with Esnoper Clip implantation in patients with uncontrolled glaucoma.

REFERENCE:

Baxant AD, Klimešová YM, Holubová L, Pluhovský P, Bartošová J, Veselý Ľ, Nemčoková M, Rosina J, Studený P. Efficacy and Safety of Deep Sclerectomy With the Esnoper Clip Implant for Uncontrolled Primary Open Angle Glaucoma: A 1 Year Prospective Study. J Glaucoma. 2023 Mar 1;32(3):227-235. doi: 10.1097/IJG.0000000000002137. Epub 2022 Oct 14. PMID: 36256952; PMCID: PMC9981320.

PER-001 INTRAVITREAL IMPLANT

 

Endothelin is the most potent vasoconstrictor in the human body and is upregulated in glaucoma. Endothelin is involved in inflammation and cell death through its receptors expressed in retinal vascular and neuroretinal cells. Multiple lines of evidence implicate vascular dysregulation as a driver of glaucomatous disease progression, and excess endothelin levels play a key role in reducing ocular blood flow.

PER-001 is a small molecular endothelin 1 receptor antagonist administered as a bio-erodible intravitreal implant. It is being evaluated for treating open-angle glaucoma and other ocular indications driven by ischemia, such as diabetic retinopathy, geographic atrophy, and retinal vein occlusion. It is administered into the vitreous using a single-use, 25-gauge applicator. It is designed to provide a sustained release of PER-001, allowing for a convenient every 6 months dosing frequency.

The intended treatment is pursuing both vascular benefits, such as improved autoregulation and perfusion by targeting the entire retinal vasculature and choroid, as well as non-vascular benefits, such as blocking ET-1-mediated “neurotoxicity” involving apoptotic and oxidative injury pathways in the neuroretina.

Perfuse Therapeutics, Inc. (“Perfuse Therapeutics”), a biopharmaceutical company, announced the details of PER-001. Data from three cohorts of patients with glaucoma in the completed Phase 1/2a clinical trial demonstrate that PER-001 is well tolerated and shows promise as the first disease-modifying therapy for glaucoma. A study in rabbit and monkey eyes demonstrated controllable biodegradation and sustainability of the implant without any ocular or systemic adverse findings for up to 3 and 6 months in rabbits and non-human primates, respectively.

https://perfusetherapeutics.com/perfuse-therapeutics-announces-oral-presentation-on-per-001-intravitreal-implant-for-glaucoma-at-the-association-for-research-in-vision-and-ophthalmology-arvo-meeting/

DENGUE ASSOCIATED ACUTE ANGLE CLOSURE GLAUCOMA

 

Dengue is a mosquito-borne viral disease transmitted by Aedes aegypti. It is caused by one of four dengue virus serotypes (DENV-1 to DENV-4) from the Flavivirus family.

Ophthalmic complications range from subconjunctival hemorrhage and anterior uveitis to severe optic neuritis, retinal vasculitis, maculopathy, and panophthalmitis. Other diverse ocular effects include central retinal artery occlusion, bilateral vitreous hemorrhage, and uncommonly acute angle-closure glaucoma (AACG).

From: Pierre Filho Pde T

Dengue can directly inflame ocular anatomical tissues. The ocular structures have a particularly poor tolerance for inflammatory insult and disruption of vessel regulation due to their rich choroid and ciliary body vasculature. These structures are involved in vascular leakage, which causes forward displacement of the lens-iris diaphragm and narrowing of the anterior chamber angle, potentially leading to AACG. 

Edema in the ciliary body exacerbates the mechanical crowding of the angle structures, increasing outflow resistance through the trabecular meshwork.

AACG can also be precipitated by certain drugs used to treat dengue complications, or by medications that patients may have been taking before hospitalization. For example, sulfonamide-based antibiotics and anti-epileptics, such as topiramate, have been associated with drug-induced AACG due to ciliochoroidal effusion and angle closure. Severe dengue may cause systemic capillary leak syndrome, which acts synergistically with these pharmacologic triggers to worsen anterior segment crowding and precipitate glaucoma. In addition, systemic hypovolemia and electrolyte imbalances may exacerbate vascular instability in ocular tissues, leading to fluid extravasation and segmental edema.

Dengue may have an associated autoimmune-mediated inflammation in the anterior segment. Such immune responses would further augment ciliary body edema, interfere with aqueous production and outflow, and have detrimental effects on IOP regulation. In addition, genetic predispositions associated with human leukocyte antigen (HLA) alleles could participate in the autoimmune eye inflammation induced by the dengue virus and need to be further studied.

Hypothesized Sequence of Events:

Dengue virus infection generates a systemic inflammatory response mediated by cytokines. This, in turn, leads to vascular permeability and extravasation of fluid from the ciliary body, resulting in ocular edema. The resulting anterior segment anatomical changes lead to narrowing or closure of the anterior chamber angle, ultimately leading to AACG. Additionally, the dengue pathophysiology, medications, individual anatomical predispositions, and possibly autoimmune pathways provide a multifactorial basis for AACG development in dengue-affected individuals.

REFERENCE:

Al-Essa A (April 11, 2025) Acute Angle-Closure Glaucoma as an Ocular Complication of Dengue Fever: A Comprehensive Review. Cureus 17(4): e82119. doi:10.7759/cureus.82119.

Pierre Filho Pde T, Carvalho Filho JP, Pierre ET. Bilateral acute angle closure glaucoma in a patient with dengue fever: case report. Arq Bras Oftalmol. 2008 Mar-Apr;71(2):265-8. doi: 10.1590/s0004-27492008000200025. PMID: 18516431.

SMART EYE PRESSURE MONITORING DEVICE

 

Prakhar Austin Mohan, a third-year B.Tech student at MIET Engineering Institute in Meerut, India, has designed A non-contact tonometer, called the 'Smart Eye Pressure Monitoring Device'.

In conversation with ETV Bharat, Prakhar said that traditional machines for glaucoma testing cost up to Rs 1.5 lakh, but the device he has developed will cost between Rs 20,000 and Rs 25,000 only.

According to Prakhar, the device was developed using a microcontroller.

“It provides data processing and wireless connectivity. It has a non-invasive IOP sensor, which accurately measures eye pressure without pain,” Prakhar said. He explained that he had used a cloud-connected model, which analyzes the data and monitors the pressure pattern in the eye.

The device has an OLED display and is linked to a mobile app, which provides real-time readings and alerts to patients as well as doctors. Its IOT integration enables continuous monitoring, remote access, and emergency alerts, Prakhar said.

WHEN WILL THE DEVICE HIT THE MARKET?
Prakhar informed the news portal that the device is in the final stage of development, and he has also applied for a patent to launch the device in the market. He said that the tonometer has provided accurate results during the testing phase.

https://www.etvbharat.com/en/!offbeat/eye-catching-news-for-glaucoma-patients-uttar-pradesh-engineering-student-develops-frugal-device-to-measure-eye-pressure-enn25040501950

RED-FREE (GREEN) FILTER-ENHANCED GONIOSCOPY

 

A study has shown that gonioscopy using a red-free (green) filter can enhance visibility of the iridocorneal angle.

The angles were imaged with an indirect 4-mirror goniolens with standard halogen light, red-free green filter and also warm light filter of the slit lamp. The images and videos were recorded using a smartphone adaptor to the slitlamp. The illumination was set at 1/4^th with 20x magnification.

The study found that the contrast of the gonioscopy images was enhanced objectively with a red-free filter compared to standard light photos. The built-in warm filter of the slit lamp also provided better visualization of the iridocorneal angle structures.

The evaluation of the images and videos by two glaucoma specialists revealed that the red-free (green) filter provided enhanced tissue visualization for the pigmentation of the trabecular meshwork in 90% (n = 9) of the cases, and the quality of visualization did not worsen during regular gonioscopy.

Also, the warm color provided good contrast between the angle structures, as well as being less irritating to the photosensitive patients. This filter was also found to be superior in identifying the Schlemm’s canal, as it appeared orange or red, unlike the usual halogen light appearance, where it appears white and is often difficult to identify.

This enhancement can facilitate the accurate identification of the angle structures, particularly in instances where gonioscopic interpretation is challenging and when the patient is sensitive to light.

VIEW VIDEO HERE: https://www.youtube.com/watch?v=bgRP3EmCC3Q

REFERENCE: Iqbal MI. Red-Free (Green) Filter-Enhanced Gonioscopy with Smartphone: A Pilot Study. Cureus. 2024 Jan 3;16(1):e51559. doi: 10.7759/cureus.51559. PMID: 38313936; PMCID: PMC10835508.

FOOD INSECURITY AND GLAUCOMA

 

Food insecurity is a complex social determinant of health (SDOH) that refers to the household-level economic and social conditions of limited or uncertain access to adequate food.

Food insecurity is typified by alternating periods of food adequacy and scarcity, creating a cyclical stressor that has been proposed to have complex health effects through altered feeding behaviors, nutritional status, and financial decision-making.

Food insecurity has been proposed to lead to a broad set of behaviors that increase an individual’s risk for disease and disease progression.

These feeding behaviors predispose individuals to metabolic dysregulation, reduced antioxidant intake, and chronic inflammation, which may further exacerbate the impact on individual physical and mental health. This could cause chronic eye diseases such as GLAUCOMA.

78,964 participants from The National Institutes of Health All of Us (AoU) Research Program were included in a study to assess the association of food insecurity with chronic eye diseases. Among the participants, 9732 (12.4%) had food insecurity. [1]

Of the total 78,695 participants, 2095 (2.7%) had GLAUCOMA, 1398 (1.8%) had AMD, 1127 (1.4%) had DR, and 10,135 (12.9%) had cataracts.

Participants who reported food insecurity had significantly higher odds of GLAUCOMA (adjusted odds ratio [aOR]: 1.43, 95% confidence interval [CI]: 1.18e1.72, P 0.001) compared with those without food insecurity. Participants had a 43% increased likelihood of GLAUCOMA.

No significant associations were observed between food insecurity and AMD (aOR: 0.91, 95% CI: 0.67e1.21, P ¼ 0.544), DR (aOR: 1.15, 95% CI: 0.93e1.42, P ¼0.180), or cataracts (aOR: 0.97, 95% CI: 0.87e1.08, P ¼ 0.635) in adjusted regression models.

REFERENCE:

[1] Talebi R, Yu F, Tseng VL, Coleman AL. Association between food insecurity and chronic eye disease in the National Institutes of Health’s All of US Research Program. Ophthalmology Science. 2025;5(3):100697.

VisuALL ANALYZER

 

The Olleyes VisuALL  Analyzer (vFA) is a virtual reality visual function platform designed to monitor the retinal sensitivity in patients with eye diseases. This mobile device performs Standard Automated Perimetry and other psychophysical tests, including assessment of visual acuity, color vision, contrast sensitivity, pupillometry, and extraocular motility.

The VisuALL is a portable automated perimeter that uses a virtual interface that has the potential to provide an immersive testing experience for patients. The VisuALL has two displays (one for each eye), allowing it to test both eyes simultaneously but separately with a similar test duration to other perimeters. 

The VisuALL Virtual Reality Software suite works with the seamless synergy of three elements: the WebApp, the Cloud, and Olleyes Approved VR Headset.

Annie, a Virtual Assistant, is designed to boost efficiency, monitor patients, explain the testing process to patients, and organize the test data for easy reading.

The headset runs the VisuALL Patient Testing Application (PTA), which was written in Unity (a cross-platform gaming engine). By leveraging this engine, VisuALL can create a fully immersive and self-contained environment in order to perform self-directed, interactive training tutorials for the patient and then proceed to the VF test. 

Another key component of the VisuALL PTA is the proprietary thresholding algorithms, which implement complex decision trees to determine most efficiently what the patient's threshold for light detection is at each location. 

The VisuALL uses Goldmann size III test stimuli in each VF protocol and tests both eyes simultaneously. 

The vFA has both strong short-term and long-term test-retest reliability in addition to high correlation with HFA in a standard clinical setting.

After testing is complete, the software generates a report that includes the patient's name, date of birth, gender, test ID, examination date, test time, and test strategy. It also lists the fixation losses, false positives, and false negatives. Below is a plot of the threshold values for each of the 50 points tested, and a grayscale representation of the threshold values.

COMPANY WEBSITE: https://olleyes.com/