Four articles. Four minutes. | Issue #23
Diagnostics: Inferior central defects were linked to faster 10-2 visual field loss over a decade
Epidemiology: Aerobic fitness showed no clear association with POAG severity in a cross-sectional study
Medication: Glaucoma therapy was stopped at discharge in 7% of older inpatients with recorded glaucoma
Genetics: FOXC1 duplications were found in juvenile open-angle glaucoma without overt anterior segment dysgenesis
Central visual field defect patterns and progression in glaucoma: a multicentre 10-year study
Methods
This retrospective cohort included 127 eyes of 94 adults with POAG or normal-tension glaucoma, central field defects, and baseline 24-2 mean deviation better than -6 dB at three Japanese centers. Investigators related baseline 10-2 defect patterns to progression, defined by clustered pointwise regression, over at least 10 years of follow-up.
Results
Over a mean 12.7 years, 53 eyes (41.7%) progressed. Adjusted progression hazards were higher with inferior involvement (HR 3.27 versus no inferior involvement) and defects in both hemifields (HR 3.71 versus one hemifield). Superior involvement was not significantly associated with progression. Exploratory analysis also linked inferonasal-predominant inferior loss and nasal loss in both hemifields to progression.
Conclusion
Baseline central defect location was associated with long-term 10-2 progression despite relatively preserved 24-2 mean deviation. The exploratory patterns require confirmation in independent cohorts.
Our Angle
A relatively preserved 24-2 mean deviation can be falsely reassuring when the 10-2 already shows central damage. In an eye with inferior or both-hemifield central defects, I would be more inclined to repeat 10-2 testing regularly, look for corroborating macular and optic nerve structural change, and, if progression is confirmed, reassess whether the current target IOP remains appropriate and whether medication adherence may be contributing to inadequate pressure control, especially if fixation is threatened. The value here is not a new treatment threshold, but a practical way to identify an eye with relatively mild global field loss that may deserve closer central surveillance.
The anatomical explanation is interesting but remains speculative because the study did not include longitudinal OCT to link these field patterns to structural progression. The cohort was predominantly Japanese and selected for at least 10 years of follow-up, so the reported hazard ratios may not transport directly to other populations. Most importantly, this observational study does not show that more frequent testing or a lower target IOP improves outcomes; it tells us which eyes may deserve closer attention, not how aggressively they should be treated.
Epidemiology
Cardiorespiratory fitness, cardiovascular risk, and disease-related outcomes in primary open-angle glaucoma: a cross-sectional study
Design: Cross-sectional baseline analysis
Journal: Ophthalmology Glaucoma, September 2026
Authors: Schuhmann et al.
In 110 patients with mild-to-moderate POAG, measured cardiorespiratory fitness and estimated 10-year cardiovascular risk showed no clear adjusted association with visual field loss, retinal nerve fiber layer (RNFL) thickness, glaucoma-related activity limitation, or vision-related quality of life. Exploratory adequacy analyses suggested that fitness contributed more to the visual field model and cardiovascular risk to the RNFL and quality-of-life models. The models explained little overall variation in outcomes. These baseline observations preceded an exercise trial, leaving any effect of exercise on glaucoma progression unresolved.
Medication
Glaucoma in hospitalized older adults: polypharmacy, multimorbidity, and therapy discontinuation - a REPOSI registry analysis
Design: Prospective observational registry study
Journal: Graefe's Archive for Clinical and Experimental Ophthalmology, September 2026
Authors: Quaranta et al.
Older inpatients with recorded glaucoma used more non-glaucoma medication than other patients, while overall comorbidity scores were similar. In the Italian REPOSI registry of 9,443 adults aged 65 or older, median medication counts were 7 versus 5, but the polypharmacy association was no longer statistically significant when glaucoma required both a diagnosis code and medication use. At discharge, 20 of 286 patients (7%) had all glaucoma therapy stopped. Thirty-two of 346 glaucoma cases were first recorded during hospitalization. Without ophthalmic confirmation or documented reasons for treatment changes, these records cannot establish new disease detection or whether discontinuation was appropriate.
Genetics
Association of FOXC1 Duplications With Juvenile Open-Angle Glaucoma
Design: Retrospective observational genetic cohort study
Journal: JAMA Ophthalmology, May 2026
Authors: Maxwell et al.
FOXC1 duplications were associated with early-onset glaucoma that often lacked overt anterior segment dysgenesis in a retrospective study of two glaucoma registries. The authors reported duplications in 1.5% of probands referred with juvenile open-angle glaucoma and 12.3% of those with an identified genetic cause. All 20 identified carriers from 10 families had glaucoma, including 12 with advanced disease, and systemic features were uncommon. Four members of one family with ectropion uveae were reclassified as having anterior segment dysgenesis. Selected families and incomplete testing of unaffected relatives limit estimates of penetrance and frequency.
The proposed Glaucoma Vision Act would expand eligible patients' annual screening coverage, remove applicable Medicare cost sharing, and authorize community screening and research funding.
Eligible ophthalmology practices can now review 2025 MIPS scores and request targeted review of potential errors that could affect their 2027 Medicare payments.
Sight Sciences announces US availability of OMNI Ultra, an implant-free system for single-pass canaloplasty followed by trabeculotomy in adults with primary open-angle glaucoma.
A contactless SLT platform launches at ESCRS and combines anterior chamber OCT targeting with transscleral laser delivery without a gonioscopy lens.
The first functional contact lenses, developed in the late 1880s, were fabricated from:
A. Celluloid
B. Blown glass
C. Polished quartz
D. Vulcanized rubber
See answer at bottom of newsletter
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The Open Angle is a weekly glaucoma research digest for busy eye care professionals.
Four articles worth knowing, in under four minutes.
Edited by Jella An, MD, MBA and Jason Dossantos, MD.
The Open Angle is an educational editorial product. It is not medical advice. Readers should review original sources before changing practice.
TRIVIA ANSWER EXPLANATION
The first functional contact lenses, developed in the late 1880s, were fabricated from:
B. Blown glass
The first successful glass shell served protection and cosmesis. In 1887, artificial-eye maker Friedrich Anton Müller fitted a blown-glass cover to an eye damaged by malignancy.
Corrective contact lenses followed in 1888, when Adolf Fick and Eugène Kalt independently fitted large glass scleral shells; Kalt used the cut-off ends of test tubes. August Müller then corrected his own high myopia in 1889. Protection, cosmesis, and optical correction entered the history in separate steps.