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From its outbreak in early 2020, the new SARS-CoV-2 infection has deeply affected the entire eye care system for several reasons. Since the beginning of the COVID-19 pandemic, ophthalmologists were among the "high-risk category" for contracting the SARS-CoV-2 infection based on the notion that the eye was suspected to be a site of inoculation, infection, and transmission. Clinical ophthalmologists have been required to learn and promptly recognize the ocular manifestations associated with the COVID-19 disease, with its treatments and vaccinations. Restriction measures, lockdown periods, guidelines to prevent SARS-CoV-2 infection transmission, and the use of telemedicine and artificial intelligence modalities have induced profound modifications. These changes, which are most likely to be irreversible, influence routine clinical practice, education, and research, thus giving rise to a "new ophthalmology in the COVID era". This book chapter aims to provide several notions regarding COVID-19 in ophthalmology, including the SARS-CoV-2 virus infection and transmission modalities; the ocular manifestation associated with the COVID-19 disease; the drugs and vaccines used for COVID-19; the precautions adopted in the ophthalmic practice to limit the spread of the virus; the consequences of the pandemic on the ophthalmic patients, clinicians, and the entire eye care system; and, the future of ophthalmology in the era of "COVID new normal".

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This review explores the connection between the ocular surface microbiome and glaucoma, highlighting its impact on disease progression. Beginning with an overview of global glaucoma significance, it emphasizes the importance of understanding the cellular characteristics and microbiology of the ocular microbiome. A search was conducted on the PubMed and Cochrane Library databases using the phrase "ocular microbiome glaucoma". 0 records were returned from the Cochrane Library while 21 were returned from PubMed. A total of 21 results were retrieved from 2017 to 2024. This comprised one opinion paper, four original research articles, and 16 reviews. This review covered the anatomy of the ocular surface, advanced analysis methods, and the ocular microbiome. It also delved into dysbiosis in glaucoma, addressing altered microbial communities and their potential role in disease progression. The intricate interplay between the ocular microbiome and the host's immune system is explored, emphasizing crosstalk and inflammatory responses. The review concludes by discussing therapeutic implications, including modulating ocular microbiota and potential future treatment strategies. Understanding the microbiome in healthy and glaucomatous eyes can help researchers and clinicians in innovative approaches to ocular health.

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Diabetic macular edema (DME) is a common complication of diabetes mellitus and a leading cause of visual impairment worldwide. It is defined as the diabetes-related accumulation of fluid, proteins, and lipids, with retinal thickening, within the macular area. DME affects a significant proportion of individuals with diabetes, with the prevalence increasing with disease duration and severity. It is estimated that approximately 25-30% of diabetic patients will develop DME during their lifetime. Poor glycemic control, hypertension, hyperlipidemia, diabetes duration, and genetic predisposition are recognized as risk factors for the development and progression of DME. Although the exact pathophysiology is still not completely understood, it has been demonstrated that chronic hyperglycemia triggers a cascade of biochemical processes, including increased oxidative stress, inflammation, activation of vascular endothelial growth factor (VEGF), cellular dysfunction, and apoptosis, with breakdown of the blood-retinal barriers and fluid accumulation within the macular area. Early diagnosis and appropriate management of DME are crucial for improving visual outcomes. Although the control of systemic risk factors still remains the most important strategy in DME treatment, intravitreal pharmacotherapy with anti-VEGF molecules or steroids is currently considered the first-line approach in DME patients, whereas macular laser photocoagulation and pars plana vitrectomy may be useful in selected cases. Available intravitreal steroids, including triamcinolone acetonide injections and dexamethasone and fluocinolone acetonide implants, exert their therapeutic effect by reducing inflammation, inhibiting VEGF expression, stabilizing the blood-retinal barrier and thus reducing vascular permeability. They have been demonstrated to be effective in reducing macular edema and improving visual outcomes in DME patients but are associated with a high risk of intraocular pressure elevation and cataract development, so their use requires an accurate patient selection. This manuscript aims to provide a comprehensive overview of the pathology, epidemiology, risk factors, physiopathology, clinical features, treatment mechanisms of actions, treatment options, prognosis, and ongoing clinical studies related to the treatment of DME, with particular consideration of intravitreal steroids therapy.

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Non-arteritic anterior ischemic optic neuropathy (NA-AION) represents one of the most important causes of blindness or severely impaired vision in middle-aged and elderly people. Unilateral optic disc edema and abrupt, painless vision loss are its defining features. It is commonly assumed that NA-AION is caused by an ischemic infarction of the optic nerve head, and, although the exact pathogenesis is still unknown, several risk factors and comorbidities associated with its development have been found. NA-AION occurs generally in patients older than 50 years who have small optic discs and vasculopathy risk factors. Even though numerous treatment options have been proposed, no available effective medical or surgical therapy or prophylactic measure for NA-AION currently exists. The purpose of present-day therapeutic strategies is therefore to identify and possibly control any underlying modifiable risk factors, aiming to prevent the development of new NA-AION episodes in the affected and fellow eye. A thorough assessment of NAION, including its history, epidemiology, etiology, pathophysiology, risk factors, associated comorbidities, clinical findings, diagnostic tests, treatment choices, prognosis, and future research, is the goal of this work.

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Since its emergence in early 2020, the SARS-CoV-2 infection has had a significant impact on the entire eye care system. Ophthalmologists have been categorized as a high-risk group for contracting the virus due to the belief that the eye may be a site of inoculation and transmission of the SARS-CoV-2 infection. As a result, clinical ophthalmologists, optometrists, and eyecare professionals have had to familiarize themselves with the ocular manifestations of COVID-19, as well as its treatments and vaccines. The implementation of measures to prevent the transmission of the virus, such as restrictions, lockdowns, telemedicine, and artificial intelligence (AI), have led to substantial and potentially irreversible changes in routine clinical practice, education, and research. This has resulted in the emergence of a new mode of managing patients in a routine clinical setting. This brief review aims to provide an overview of various aspects of COVID-19 in ophthalmology, including the ocular manifestations related to the disease, the modes of transmission of SARS-CoV-2 infection, precautions taken in ophthalmic practice to prevent the spread of the virus, drugs, and vaccines used in the treatment of COVID-19, the impact of the pandemic on patients, clinicians, and the eye care system as a whole, and the future of ophthalmology conditioned by this global pandemic experience.

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Normal tension glaucoma (NTG) is defined as a subtype of primary open-angle glaucoma (POAG) in which the intraocular pressure (IOP) values are constantly within the statistically normal range without treatment and represents approximately the 30-40% of all glaucomatous cases. The pathophysiology of this condition is multifactorial and is still not completely well known. Several theories have been proposed to explain the onset and progression of this disease, which can be divided into IOP-dependent and IOP-independent factors, suggesting different therapeutic strategies. The current literature strongly supports the fundamental role of IOP in NTG. The gold standard treatment for NTG tends to be based on the lowering IOP even if "statistically normal". Numerous studies have shown, however, that the IOP reduction alone is not enough to slow down or stop the disease progression in all cases, suggesting that other IOP-independent risk factors may contribute to the NTG pathogenesis. In addition to IOP-lowering strategies, several different therapeutic approaches for NTG have been proposed, based on vaso-active, antioxidant, anti-inflammatory and/or neuroprotective substances. To date, unfortunately, there are no standardized or proven treatment alternatives for NTG when compared to traditional IOP reduction treatment regimes. The efficacy of the IOP-independent strategies in decreasing the risk or treating NTG still remains inconclusive. The aim of this review is to highlight strategies reported in the current literature to treat NTG. The paper also describes the challenges in finding appropriate and pertinent treatments for this potentially vision-threatening disease. Further comprehension of NTG pathophysiology can help clinicians determine when to use IOP-lowering treatments alone and when to consider additional or alternatively individualized therapies focused on particular risk factors, on a case-by-case basis.

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Glaucoma is an ocular disease caused by elevated intraocular pressure that leads to progressive optic neuropathy [...].

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The purpose of the study was to analyze the frequency of the spontaneous posterior vitreous detachment (PVD) in patients admitted to an Emergency Eye Department in Italy (EED) during the COVID-19 pandemic national lockdown in 2020 compared with the similar time period in 2019. In this retrospective observational study, patient records for ophthalmology EED patients in the month of April 2020 during the COVID-19 Italian national lockdown, were compared with those for an equivalent one-month period in 2019. Diagnoses, gender, and age were assessed. Unpaired Student t-tests were used for continuous variables. Poisson regression was used for count analysis to compare categorical variables. Chi-square test was applied to asses proportion differences. In comparison with the 2019 equivalent period, there was a significant decrease in the overall number of EED visits and in the number of patients presenting with a spontaneous PVD during the 2020 lockdown (-41.6% and -49%, respectively). During the 2020 lockdown, all diagnostic categories showed less patient admittance, however, the proportions remained stable when considering the entire cohort. The proportion of urgent visits was 90% in 2020 and 86% in 2019 (p = 0.66). The proportion of EED patients affected by spontaneous PVD was comparable between the two study periods (8.4% in 2020 vs. 9.6% in 2019, p = 0.34). Patients presenting with spontaneous PVD in both periods were significantly older when compared to patients with other pathologies (mean age of 63years in 2020 and 64years in 2019, p < 0.001). There was a significant bias in female gender (61.2% in 2019 and 60% in 2020, p < 0.05). There was a significant decrease of accesses to the EED during COVID-19 2020 lockdown. Patients affected by spontaneous PVD were about 50% less compared with the same period of 2019. Risk factors for the development of spontaneous PVD were older age and female gender. PVD represents a potentially visual function threatening condition because it can cause retinal ruptures and retinal detachment. Patients need to be educated to get urgent ophthalmic assessments in the presence of important acute signs and symptoms, like floaters and flashes, even in the presence of a lockdown.

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Intraocular pressure (IOP) is an important measurement that needs to be taken during ophthalmic examinations, especially in ocular hypertension subjects, glaucoma patients and in patients with risk factors for developing glaucoma. The gold standard technique in measuring IOP is still Goldmann applanation tonometry (GAT); however, this procedure requires local anesthetics, can be difficult in patients with scarce compliance, surgical patients and children, and is influenced by several corneal parameters. Numerous tonometers have been proposed in the past to address the problems related to GAT. The authors review the various devices currently in use for the measurement of intraocular pressure (IOP), highlighting the main advantages and limits of the various tools. The continuous monitoring of IOP, which is still under evaluation, will be an important step for a more complete and reliable management of patients affected by glaucoma.

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The aim of our study was to assess the clinical effectiveness of topical adipose derived stem cell (ADSC) treatment in laser induced corneal wounds in mice by comparing epithelial repair, inflammation, and histological analysis between treatment arms. Corneal lesions were performed on both eyes of 40 mice by laser induced photorefractive keratectomy. All eyes were treated with topical azythromycin bid for three days. Mice were divided in three treatment groups (n = 20), which included: control, stem cells and basic serum; which received topical treatment three times daily for five consecutive days. Biomicroscope assessments and digital imaging were performed by two masked graders at 30, 54, 78, 100, and 172 h to analyze extent of fluorescein positive epithelial defect, corneal inflammation, etc. Immunohistochemical techniques were used in fixed eyes to assess corneal repair markers Ki67, α Smooth Muscle Actin (α-SMA) and E-Cadherin. The fluorescein positive corneal lesion areas were significantly smaller in the stem cells group on days 1 (p < 0.05), 2 (p < 0.02) and 3. The stem cell treated group had slightly better and faster re-epithelization than the serum treated group in the initial phases. Comparative histological data showed signs of earlier and better corneal repair in epithelium and stromal layers in stem cell treated eyes, which showed more epithelial layers and enhanced wound healing performance of Ki67, E-Cadherin, and α-SMA. Our study shows the potential clinical and histological advantages in the topical ADSC treatment for corneal lesions in mice.

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PURPOSE: To compare higher order aberrations (HOAs) caused by the anterior and posterior corneal surfaces after conventional penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), and automated lamellar therapeutic keratoplasty (ALTK) in patients undergoing corneal transplantation for keratoconus (KC). METHODS: This retrospective, observational, cross-sectional study included one eye of the following subjects: 40 patients with KC, 23 KC patients after PK, 17 KC patients after DALK, 18 KC patients after ALTK, and 38 healthy controls. All underwent imaging with a rotating Scheimpflug camera (at least 6 months after complete suture removal in grafted subjects) to assess the HOAs from the anterior and posterior corneal surfaces within the central 4-mm and 6-mm zones. The conversion of the corneal elevation profile into corneal wavefront data was performed using Zernike polynomials. Total and third- and fourth-order HOAs were considered. The root mean square of the Zernike vector magnitude, expressed in micrometers, was used. Differences among groups were assessed using the Kruskal-Wallis and Duncan multiple range tests. Statistical significance was defined as p < 0.05. RESULTS: In both 4-mm and 6-mm central zones, the total HOAs from the anterior corneal surfaces were significantly lower in DALK than in ALTK and PK groups (p < 0.05). The total HOAs from the posterior corneal surface were comparable amongst postoperative groups (p > 0.05). The aberration components that were significantly greater included coma in the KC and ALTK eyes, trefoil and coma in the DALK eyes, and trefoil in the PK eyes. CONCLUSIONS: The corneal anterior surface optical quality appeared significantly better after DALK than after ALTK and PK.

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PURPOSE: Adipose-derived stem cells (ADSC) are multipotent, safe, non-immunogenic and can differentiate into functional keratocytes in situ. The topical use of ADSC derived from human processed lipoaspirate was investigated for treating injured rat cornea. METHODS: A total of 19 rats were used. Six animals initially underwent corneal lesion experiments with 0.5 N NaOH (right eye) and 0.2 N (left). The 0.2 NaOH protocol was then used in 13 rats. All 26 eyes of 13 rats eyes received topical azythromycin bid for 3 d and divided into five treatment groups (n = 5 eyes/group), which included: control, stem cells, serum, stem + serum and adipose (raw human lipoaspirate). The four treatment groups received topical treatment three times daily for 3 d. Stem cells were isolated and harvested from human lipoaspirate. Topical eye drops were prepared daily with 1 × 10(5) cells/treatment. Fluorescein positive defect area and light microscope assessment was performed at 20, 28, 45, 50 and 74 h. Animals were sacrificed at 74 h for histological evaluation. Data were statistically analyzed for differences amongst groups. RESULTS: The stem cell-treated eyes had significantly smaller epithelial defects at each time point compared to control- and adipose-treated eyes (p < 0.05). This group showed slightly better epithelium healing than the serum and combined group, yet not significantly different. Histology showed that stem cell-treated corneas had complete re-epithelization, with less inflammatory cells and limited fibroblast activation structure compared with the control eyes. CONCLUSIONS: Our preliminary results show that topical treatment with ADSC seems to improve corneal wound healing.

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PURPOSE: To assess Pulsar Perimetry learning effect and test-retest variability (TRV) in normal (NORM), ocular hypertension (OHT), glaucomatous optic neuropathy (GON), and primary open-angle glaucoma (POAG) eyes. METHODS: This multicenter prospective study included 43 NORM, 38 OHT, 33 GON, and 36 POAG patients. All patients underwent standard automated perimetry and Pulsar Contrast Perimetry using white stimuli modulated in phase and counterphase at 30 Hz (CP-T30W test). The learning effect and TRV for Pulsar Perimetry were assessed for 3 consecutive visual fields (VFs). The learning effect were evaluated by comparing results from the first session with the other 2. TRV was assessed by calculating the mean of the differences (in absolute value) between retests for each combination of single tests. TRV was calculated for Mean Sensitivity, Mean Defect, and single Mean Sensitivity for each 66 test locations. Influence of age, VF eccentricity, and loss severity on TRV were assessed using linear regression analysis and analysis of variance. RESULTS: The learning effect was not significant in any group (analysis of variance, P>0.05). TRV for Mean Sensitivity and Mean Defect was significantly lower in NORM and OHT (0.6 ± 0.5 spatial resolution contrast units) than in GON and POAG (0.9 ± 0.5 and 1.0 ± 0.8 spatial resolution contrast units, respectively) (Kruskal-Wallis test, P=0.04); however, the differences in NORM among age groups was not significant (Kruskal-Wallis test, P>0.05). Slight significant differences were found for the single Mean Sensitivity TRV among single locations (Duncan test, P<0.05). For POAG, TRV significantly increased with decreasing Mean Sensitivity and increasing Mean Defect (linear regression analysis, P<0.01). CONCLUSIONS: The Pulsar Perimetry CP-T30W test did not show significant learning effect in patients with standard automated perimetry experience. TRV for global indices was generally low, and was not related to patient age; it was only slightly affected by VF defect eccentricity, and significantly influenced by VF loss severity.

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AIM: To assess the epithelial features of the bulbar conjunctiva using in vivo confocal microscopy in patients with glaucoma undergoing canaloplasty. METHODS: Thirty consecutive patients with glaucoma were enrolled. Canaloplasty was considered successful if the preoperative intraocular pressure (IOP) was reduced by one-third. The conjunctiva was examined using confocal laser-scanning microscopy 1 week before (baseline) and 12 weeks after surgery. The mean density (MMD, cysts/mm(2)) and mean area (MMA, µm(2)) of conjunctival microcysts and IOP were measured. Anterior segment optical coherence tomography was performed to evaluate post-operative trabecular distension and scleral modifications at the surgery site. RESULTS: Twelve weeks after surgery, canaloplasty was successful in 23 patients (group 1) but unsuccessful in 7 (group 2). At baseline, IOP was 28.1±2.98 and 28.3±2.81 mm Hg, MMD was 10.61±4.31 and 11.35±5.6 and MMA was 2845.02±411.85 and 2700.56±518.85 in groups 1 and 2, respectively (p>0.05). Twelve weeks after canaloplasty, mean IOP was 13.2±4.48 (p<0.05) and 24.6±3.48 mm Hg in groups 1 and 2, respectively. In group 1, MMD and MMA were 37.86±21.4 and 11997.84±8630.35, respectively, a fourfold increase compared to baseline (p<0.001); no significant differences were found in group 2. Conjunctival bleb was not documented in any case. CONCLUSIONS: Conjunctival microcysts were evident in all glaucomatous eyes prior to surgery, and tended to increase in density and surface area after successful canaloplasty. These findings indicated enhanced aqueous humour filtration across the sclera and conjunctiva after canaloplasty.

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PURPOSE: To compare central corneal thickness (CCT) and endothelial cell density (ECD) with laser scanning confocal microscope Heidelberg Retina Tomograph (HRT) II Rostock Corneal Module and noncontact specular microscope Tomey EM-3000 and to assess intra- and interobserver agreement in normal corneas. METHODS: This prospective study included 48 normals (69.6 ± 7.2 years, range: 55-80 years) who underwent CCT and ECD with both Tomey and HRT 3 times by 2 independent observers. Measurement differences between instruments, agreement between devices, and test-retest variability (TRV) were determined. RESULTS: Mean CCTs with Tomey and HRT were 529.4 ± 35.4 and 536 ± 37.6 µm (P = 0.06), respectively; average ECDs with Tomey and HRT were 2473.5 ± 242.2 and 2539.7 ± 338.6 cells per square millimeter (P = 0.04), respectively. The mean of the differences (HRT minus Tomey) was 6.5 ± 17 µm for CCT and 65 ± 135.1 cells per square millimeter for ECD. Differences between instruments were not related to CCT (P = 0.35), whereas significantly increased with increasing ECD (P = 0.0001). Intraexaminer TRV for Tomey and HRT were 3.9 ± 3.7 and 22.2 ± 18.4 µm for CCT and 73 ± 63.4 and 152.2 ± 148.4 cells per square millimeter for ECD, respectively; interexaminer TRV was 4.6 ± 4.2 and 23.8 ± 17.3 µm for CCT and 84.9 ± 72.3 and 159.8 ± 149.8 cells per square millimeter for ECD. CONCLUSIONS: HRT II Rostock Corneal Module and the Tomey EM-3000 showed an overall good intermethod agreement. HRT showed a tendency to slightly overestimate CCT measurements, significantly underestimate ECD measurements in eyes with a reduced cell density (< 2290 cells per square millimeter), and overestimate ECD in eyes with a high cell density. Both instruments showed low intra- and interobserver TRV for both CCT and ECD measurements, which tended to be less for Tomey.

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PURPOSE: To evaluate the optic disc damage staging system (ODDSS); a new clinical method of optic disc (OD) classification based on OD size, neural rim (NR) loss severity and localization. Accuracy, reproducibility, and reliability were studied. Agreement of ODDSS with the Heidelberg-Retina-Tomograph (HRT) results was evaluated. METHODS: One eye of 68 consecutive open-angle glaucoma (POAG) patients and 40 controls underwent standard automated perimetry (SAP), HRT-II, and OD examination using the ODDSS classification by 3 independent graders in this prospective cross-sectional study. Sensitivity, specificity, and area under the receiver operating characteristic curve (AROC) in discriminating between normal and POAG eyes were determined for ODDSS and HRT parameters. ODDSS intraobserver and interobserver agreement and agreement with HRT-Moorfield-Regression-Analysis (MRA) were assessed. RESULTS: ODDSS sensitivity ranged from 72.0% to 89.7%; specificity ranged from 92.5% to 100%. Differences between AROCs for ODDSS (0.89 to 0.94) and for the best-performing HRT parameter (Vertical Cup/Disc Ratio 0.88) were not statistically significant. ODDSS interobserver agreement ranged from 0.33 to 0.78; intraobserver agreement ranged from 0.53 to 0.89. Agreement with HRT-MRA ranged from 0.50 to 0.87. CONCLUSIONS: ODDSS is a new method for assessing, recording, and sharing information about the clinical OD appearance. Our preliminary results show that it provides good sensitivity and specificity in glaucoma detection. The interobserver and intraobserver agreement ranged from fair to good.

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PURPOSE: To assess the ability of Pulsar perimetry (Pulsar) in detecting early glaucomatous visual field (VF) damage in comparison with Frequency Doubling Technology (FDT), Scanning Laser Polarimetry (SLP, GDx VCC), and Heidelberg Retina Tomography (HRT). DESIGN: Prospective observational cross-sectional case study. METHODS: This multicenter study included: 87 ocular hypertensives (OHT); 67 glaucomatous optic neuropathy (GON) patients; 75 primary open-angle glaucoma (POAG) patients; and 90 normals. All patients underwent standard automated perimetry (SAP) HFA 30-2, Pulsar T30W, FDT N-30, HRT II, and GDx VCC. Area under Receiver Operating Characteristic Curves (AROCs) for discriminating between healthy and glaucomatous eyes and agreement among instruments were determined. RESULTS: The best parameters for Pulsar, FDT, HRT, and GDx were, respectively: loss variance square root; no. of areas with P< 5%; Cup-Shape-Measure; and Nerve Fiber Indicator (NFI). In detecting POAG eyes, Pulsar (AROC, 0.90) appeared comparable with FDT (0.89) and significantly better than HRT (0.82) and GDx (0.79). For GON, Pulsar ability (0.74) was higher than GDx (0.69) and lower than FDT (0.80) and HRT (0.83). The agreement among instruments ranged from 0.12 to 0.56. Pulsar test duration was significantly shorter than SAP and FDT (P< .001). CONCLUSIONS: Pulsar T30W test is a rapid and easy perimetric method, showing higher sensitivity than SAP in detecting early glaucomatous VF loss. Its diagnostic ability is good for detecting early perimetric POAG eyes and fair for GON eyes. Pulsar performance was comparable with FDT, HRT, and GDx, even if the agreement between instruments was poor to fair.

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PURPOSE: To assess the use of scanning laser polarimeter with variable corneal compensation (GDx VCC) in children; to compare GDx VCC parameters between normal children and adults; and, to evaluate peripapillary retinal nerve fiber layer thickness variation with age in normals. PATIENTS AND METHODS: Ninety-eight normal children (mean age 8.5+/-2.8 y; range: 3 to 17) and 96 normal adults (mean age of 47.0+/-20.4 y; range: 18 to 87) underwent GDx VCC testing. Eyes with small or large optic discs were excluded. The "extended parameter table" parameters and mean thickness values of the 4 quadrants and 64 sectors were considered. Differences between age groups, retinal thickness comparisons and age effect were assessed using unpaired t test, analysis of variance, and regression analysis. RESULTS: GDx VCC parameters in children and adults showed wide intersubject variability. All parameters, excluding Symmetry, were significantly greater in children (P<0.05). TSNIT (temporal, superior, nasal, inferior, temporal) average, superior average and inferior average parameters showed a significant age-related thinning (P<0.01), at a rate of 0.043, 0.057, and 0.121 microm/y, respectively. CONCLUSIONS: A significant age-related superior and inferior retinal nerve fiber layer thinning was found using GDx VCC. Considering the significant differences between children and adults for most GDx VCC parameters, the built-in adult normative database cannot be applied in children.

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PURPOSE: To study normative ranges, learning effect (LE), test-retest variability (TRV), and influence of blur and cataract in normal subjects by using rarebit perimetry (RBP). METHODS: Seventy-five normal subjects underwent visual field (VF) testing with standard automated perimetry (SAP) and RBP. LE and TRV for RBP were assessed in repeated examinations conducted on four different days. LE was evaluated by comparing results from the first with those of the other three sessions. TRV was studied by calculating differences between retest for each combination of single tests. The blur effect was evaluated by repeated tests with spherical lenses added to the optimum refractive correction (+/-1.00 to +/-6.00 D). The cataract effect was studied in 23 subjects who underwent RBP 1 week before and 1 month after cataract surgery. Mean hit rate (MHR) and mean miss rate (MMR) were analyzed for single areas and test duration. RESULTS: The mean MHR was 91% +/- 5.7% (range, 78%-99%); the mean MMR ranged from 4.0% to 13.8%. MHR significantly decreased with age (mean, 0.21%/year). Mean test time was 268 +/- 34.1 seconds. No significant LE was observed. TRV was significantly higher in the central VF zone and in elderly subjects. MHR increased with refractive blur and significantly decreased after cataract surgery. Effects of blur and cataract extraction were significantly higher in the central VF zone, especially in elderly subjects. CONCLUSIONS: RBP is a rapid and easily accessible VF test. RBP testing did not show a significant LE; however, inter- and intrasubject variability were consistent. Blur and media opacities may give false-positive results in RBP, especially in the central VF, and should be considered.

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PURPOSE: To compare the intraocular pressure (IOP) readings taken with the new ICare tonometer and with the Goldmann applanation tonometer (GAT) and to evaluate the influence of central corneal thickness (CCT) on the IOP measurements. PATIENTS AND METHODS: One eye of 178 consecutive patients with primary open-angle glaucoma underwent ultrasonic CCT measurement, followed by IOP evaluation with the GAT and with the ICare tonometer. The deviation of ICare readings from GAT values, corrected according to the Doughty and Zaman formula, was calculated and correlated to CCT by a linear regression model. The agreement between the 2 devices was assessed by use of the Bland-Altman method. RESULTS: The average CCT was 552+/-39 mum. The mean IOP and the mean corrected IOP with GAT were 19.4+/-5.4 mm Hg, and 18.5+/-5.7 mm Hg, respectively. The mean ICare IOP reading was 18.4+/-5.2 mm Hg. The deviations of ICare readings from corrected GAT values were highly correlated with CCT values (r=0.63, P<0.01). Linear regression analysis showed that a CCT change of 10 mum resulted in an ICare reading deviation of 0.7 mm Hg. The Bland-Altman scatter-plot showed a reasonable agreement between the 2 tonometers. CONCLUSIONS: The ICare tonometer can be useful in a routine clinical setting. The IOP readings are quite in accordance with those obtained by GAT. The measurements seemed to be influenced by CCT variations, and thus pachymetry should always be taken into consideration.

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