Federico Saenz-Frances

Objectives: This study aimed to evaluate the diagnostic performance of peripapillary retinal nerve fiber layer (RNFL) thickness measurements corrected by artificial intelligence (AI) compared to original uncorrected values for glaucoma detection in highly myopic patients. Methods: This cross-sectional diagnostic accuracy study included 57 eyes from highly myopic patients (31 with glaucoma, 26 without glaucoma). Peripapillary RNFL parameters were obtained using Spectralis optical coherence tomography (OCT). A deep learning algorithm (MGU-Net) was employed to automatically segment retinal layers and compensate for scan tilt in elongated eyes, producing AI-corrected measurements. RNFL thickness values were extracted for six sectoral parameters (ST, SN, N, IN, T, IT) and global. Diagnostic performance was assessed using area under the ROC curve (AUC) and compared between corrected and uncorrected values. Multivariable logistic regression models were also developed using stepwise selection. Results: AI-corrected values were significantly lower than original measurements in all sectors (p < 0.001), with mean differences ranging from 15 to 35 µm. In glaucomatous eyes, significant thinning was observed in the global (p = 0.049) and inferior nasal (IN) sector (p = 0.037) among corrected values. The highest AUCs were found in IN (0.69), IT (0.67), and global (0.66) for corrected values, and in IT (0.63), T (0.59), and global (0.63) for uncorrected data. A model combining ST, T, and IT AI-corrected values achieved an AUC of 0.79. Conclusions: AI-corrected RNFL thickness measurements improve consistency and enhance diagnostic performance in highly myopic glaucoma patients. Correction algorithms may reduce false positives and help reveal glaucomatous damage otherwise obscured by myopic anatomical changes.

The evidence of the benefits of vitamins, antioxidants and neuroprotective agents in the field of glaucoma is scarce and, at best, rather controversial. To date, intra-ocular pressure reduction remains the cornerstone of glaucoma management. This interesting prospective cohort study provides evidence that, whereas isolated consumption of vitamins A, C and E has no effect in the risk of developing glaucoma, a combined supplementation of the three results in a significant protective effect against its onset.

This outstanding paper presents the results of a study designed to determine new predictors of Preserflo Microshunt surgery failure, studying the surgical-bleb geometry through a mathematical model based on anterior-segment optical coherence tomography imaging. The mathematical model allowed estimation of several new variables which depict the morphological characteristics of the surgical-bleb, and it is particularly remarkable that the results obtained suggest that those blebs with greater filtering areas and thin capsules were associated with a more successful surgical outcome.

This interesting paper presents the results of a randomised controlled trial which compares trabeculectomy versus medical treatment in terms of quality of life, clinical effectiveness, and safety when used to treat patients suffering from advanced glaucoma. Whereas both therapeutic approaches obtained similar results regarding quality of life and safety, it is worth noting that the surgical option achieved a grater intraocular pressure reduction (nearly 3mmHg of mean difference). Trial registration details: ISRCTN56878850.

The trabecular meshwork (TM) is considered to be the main site where the restriction to aqueous humor (AH) outflow, which leads to ocular hypertension, happens. This article provides an interesting perspective of the status of current research in the field of tissue-engineering fabrication techniques used to produce models that aim to mimic the TM and the physiology of AH perfusion.

The role of several molecules involved in metabolism regulation in the pathogeny and pathophysiology of glaucoma is under consideration. It has been put forward that these substances might affect the neurodegenerative processes associated with this disease. This interesting case-control study analyzed serum levels of sirtuin-1 and adiponectin in a sample of patients with primary open-angle glaucoma (POAG), pseudoexfoliative (PSX) glaucoma, and healthy volunteers. Interestingly, sirtuin-1 levels were significantly lower amongst those patients suffering from POAG when compared to healthy controls, whereas no differences existed between POAG and PSX patients or between PSX patients and healthy controls. There were not any differences in adiponectin levels between the groups studied.

There is a growing interest in the cytokine profile of the aqueous humor as a proxy of the potential role of the immune system in the pathophysiology of glaucoma. In this regard, this interesting paper highlights the fact that several proinflammatory cytokines along with TGF-β1 are elevated in the aqueous humor of patients suffering from pseudoexfoliative glaucoma.

There is a growing interest in the role of artificial devices, such as risk calculators, as ancillary tools to improve the diagnostic capacity of glaucoma. This interesting paper, which is worth reading, presents the results of a study that compares two of these calculators developed to discriminate between glaucomatous subjects, glaucoma suspects, and healthy controls. The devices were designed using, in one case, optical coherence tomography quantitative and qualitative data, and, in the other, only quantitative data. Interestingly, these tools showed a better diagnostic ability when applied to glaucomatous eyes than when dealing with glaucoma suspects, and their excellent performance in the former group suggests that instruments like these might be of great help in the field of glaucoma.