Influence of personal respiratory and visual protective equipment on the development and progression of dry eye syndrome

Purpose. To study the influence of personal protective equipment (PPE) of the respiratory and visual systems on the development and progression of dry eye syndrome (DES) and its relationship with other risk factors for medical workers. Patients and methods. The data of 243 people (male - 22.2 %, female - 77.8 %) were analyzed as part of a multi-center analytical scientific one-step study. Total tear production (Schirmer I test) was studied at the beginning and the end of the working day in persons used PPE of respiratory system (disposable medical face mask, gauze masks or different types of respirators), as well as PPE of the eyes (protective half-closed/closed glasses or protective screens). Risk factors for the development and progression of DES were registered (age, smoking, systemic hormones intake, soft contact lenses), as well as the use of artificial tears. Results. A decrease in the Schirmer I test score at the end of a 7-8 hour work shift was found by an average of 3 mm (from 13 (9; 16) mm to 10 (6; 15) mm, p < 0.001). Statistically significant changes were typical mainly for medical personnel (p < 0.001) with the maximum severity in persons working in outpatient sector. The presence of at least one DES risk factor was found in 30.5 % of patients, two factors - in 3.0 %, and three or more - in 7.0 %. There was no influence of risk factors on the degree of changes in total tear production. Reduced tear production is typical for some PPE of respiratory system (disposable masks and respirators) and the eye (screens and half-closed glasses) (p < 0.001). In people who do not use PPE of the eye, significant changes were detected only in the presence of risk factors. Conclusion. The negative influence of various PPE of the respiratory system and eye on the total tear production was established. The decrease in the results of the Schirmer I test by the end of the working day was 20-25 % of the basic level, regardless of the presence of traditional risk factors for DES. The severity of changes depended on the type of PPE used. The data obtained are particularly relevant during the new COVID-19 coronavirus pandemic and justify the need to establish specific prophylactic measures. One of the possible methods is the preventive use of artificial tears. © 2020 Ophthalmology Publishing Group. All rights reserved

Comparative analysis of the efficacy and safety of fixed-dose combinations versus their individual components for open-angle glaucoma

Z.M. Nagornova1, A.V. Kuroyedov2,3, A.V. Seleznev1 1Ivanovo State Medical Academy, Ivanovo, Russian Federation 2 Central Military Clinical Hospital named after P.V. Mandryka, Moscow, Russian Federation 3Pirogov Russian National Research Medical University, Moscow, Russian Federation Currently, various glaucoma medications are available at the pharmaceutical market. Among them, fixed-dose combinations are of special importance which are considered as first-line agents for some patients (i.e., with advanced glaucoma or high intraocular pressure). Fixed-dose combinations are superior to individual components through the comfortable regimen with less instillations which improves treatment compliance. Moreover, IOP-lowering effect of fixed-dose combinations is similar or even greater than that of individual components due to the lack of washout phenomenon and less toxic effect of preservatives on the ocular surface. However, there are several disadvantages of fixed-dose combinations, e.g., dosing and regimen are inflexible and cannot easily be regulated. The paper discusses the results of clinical trials which compare the efficacy and safety of the most common fixed-dose combinations and their individual components. Thus, fixed-dose combinations of prostaglandin analogues and timolol maleate demonstrate similar IOP-lowering effect as compared with individual components and less side effects. Keywords: primary open-angle glaucoma, fixed-dose combination, glaucoma, combined therapy, treatment efficacy. For citation: Nagornova Z.M., Kuroyedov A.V., Seleznev A.V. Comparative analysis of the efficacy and safety of fixed-dose combinations versus their individual components for open-angle glaucoma. Russian Journal of Clinical Ophthalmology. 2019;19(1):13–19.<br

Prevalence of dry eye disease in Russia

O.N. Onufriichuk1, A.V. Kuroyedov2,3 1G.I. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery,&nbsp;St. Petersburg, Russian Federation 2P.V. Mandryka Military Clinical Hospital, Moscow, Russian Federation 3Pirogov Russian National Research Medical University, Moscow, Russian Federation Dry eye disease (DED) is common in the general population, and the number of patients is growing. Several risk factors including the COVID-19 pandemic and associated ubiquitous personal protective equipment (such as eye wear or face mask) wearing and distance learning and telework contribute to this process. This disease more and more affects the quality of life and labor productivity. However, the prevalence of DED in Russia is understudied while the studies vary in quantity and quality thus preventing the compilation of data and their extrapolation on the general population. This issue is further exacerbated by the lack of study coordination in a whole country and, as a result, the use of different methods and diagnostic criteria, samples of unequal age, comorbidities, region, and climatic geographical living conditions. This review paper attempts to summarize major trends and issues and to outline ways to study and solve them. Keywords: dry eye disease, DED, prevalence, epidemiology, tear, ocular surface. For citation: Onufriichuk O.N., Kuroyedov A.V. Prevalence of dry eye disease in Russia. Russian Journal of Clinical Ophthalmology. 2021;21(2):96–102. DOI: 10.32364/2311-7729-2021-21-2-96-102. </p

Diagnostics of glaucoma before clinical manifestations

Diagnostics of glaucoma before clinical manifestations N.E. Fomin1,2, A.V. Kuroyedov1,2 1P.V. Mandryka Military Clinical Hospital, Moscow, Russian Federation 2Pirogov Russian National Research Medical University, Moscow, Russian Federation The aim of current diagnostics of primary open-angle glaucoma (POAG) is to detect clinical manifestations of the disease. However, a set of preclinical diagnostic techniques to discover POAG predictors before typical signs occur are more promising. Among these methods is DNA testing, e.g., the identification of genetic mitochondrial dysfunction (mitochondria are the major producer of cellular energy). Evaluation of biochemical markers in body fluids (i.e., aqueous humor, blood, tears) may provide insight into the course of POAG but also early detection of glaucoma risk factors. Instrumental tests are of particular importance as they help assess morphological and functional changes in various ocular tissues. “General” instrumental tests are Doppler sonography of the head and neck, magnetic resonance imaging, and cerebrospinal fluid pressure measurement. “Topical” instrumental tests are retinal vascular assessment, identification of apoptotic cells, and electroretinography. Detailed evaluation of ganglion cells and verification of their changes are one the promising area. This will help reach a new level of POAG diagnostics, prevent advanced disease, and significantly improve the quality of life. Keywords: glaucoma, primary open-angle glaucoma, diagnostics of glaucoma, preclini cal diagnostics, intraocular pressure, markers, apoptosis. For citation: Fomin N.E., Kuroyedov A.V. Diagnostics of glaucoma before clinical manifestations. Russian Journal of Clinical Ophthalmology. 2020;20(3):152–158. DOI: 10.32364/2311-7729-2020-20-3-152-158. <br

Markers of vascular autoregulation in primary open-angle glaucoma

N.E. Fomin1,2, A.V. Kuroyedov1,2 1Mandryka Central Military Clinical Hospital, Moscow, Russian Federation 2Pirogov Russian National Research Medical University, Moscow, Russian Federation Vascular endothelial growth factor, or VEGF, was discovered in 1989. VEGF is a multifunctional cytokine which provides mitogenic effects on endothelial cells and monocytes/macrophages due to the presence of surface VEGF receptors on these cells. This is the key member of VEGF family involved in angiogenesis. Normal development of vascular and nervous systems of the eye is possible in the presence of various concentrations of different VEGF isoforms only. The role of this growth factor is important not only in the early stages of eye development, but also in the adults for retinal viability&nbsp; maintaining. VEGF is involved in the development of optic nerve and retinal neurons by promoting neuronal proliferation and stimulating endothelial cells. Experimental studies demonstrate that ischemia and axonotomy activate VEGF production by retinal ganglion cells. Ischemia and hypoxia of anterior and posterior eye segments as well as ischemic damage of other ocular tissues provide potential mechanism contributing to the increased VEGF expression in ocular tissues. Many studies have revealed an increase in VEGF levels in subretinal fluid, membranes, and the vitreous in patients with glaucoma. Associations of genetic polymorphisms of growth factors contributing to the development of primary open-angle glaucoma (POAG) were studied. In particular, cytokine genetic polymorphism typing was performed. It was demonstrated that VEGF (VEGFA с.—958C&gt;T) is potentially involved in POAG pathogenesis. Therefore, it is reasonable to measure VEGF levels in aqueous humor at various stages of POAG to evaluate disease activity and to predict disease course. Keywords: primary open-angle glaucoma, intraocular pressure, vascular endothelial growth factor, VEGF, hypoxia, ischemia, markers. For citation: Fomin N.E., Kuroyedov A.V. Markers of vascular autoregulation in primary open-angle glaucoma. Russian Journal of Clinical Ophthalmology. 2019;19(4):218–223. <br

Making a diagnosis of glaucoma at the present time

A.B. Movsisyan1,2, A.V. Kuroyedov1,3 1Pirogov Russian National Research Medical University, Moscow, Russian Federation 2Hospital for War Veterans No. 2, Moscow, Russian Federation 3P.V. Mandryka Military Clinical Hospital, Moscow, Russian Federation Thus far, practicing physicians perform glaucoma screening based on Graefe’s triad of symptoms. Considering the predicted increase in glaucoma incidence and the current trend in diagnosis verification at the time when patients already demonstrate significant changes in visual function, the issue on the need to revise these "markers" is raised. Summarizing the available modern diagnostic capabilities for glaucoma screening, it is fair to say that nowadays none of the diagnostic methods can "work alone". Only monitoring of glaucoma patients will help to determine accurately the presence or absence of glaucoma changes. Thus, the current standard for glaucoma detection includes several diagnostic methods. To receive reliable data on the disease prevalence, its diagnosis should be established in a timely manner. However, there are still difficulties faced in diagnosing glaucoma. This problem can be solved through the improvement of the available diagnostic tools and/or the introduction of novel methods of patient assessment. The advent of artificial intelligence (AI) technology, capable of learning and conducting in-depth analysis, has enabled the development of this approach. At the same time, the question of optimizing its application for practical medicine remains open. Keywords: primary open-angle glaucoma, glaucoma screening, glaucoma diagnosing, neural networks. For citation: Movsisyan A.B., Kuroyedov A.V. Making a diagnosis of glaucoma at the present time. Russian Journal of Clinical Ophthalmology. 2023;23(1):47–53 (in Russ.). DOI: 10.32364/2311-7729-2023-23-1-47-53. </p

Choice regularities of antihypertensive therapy regimens of primary open-angle glaucoma in conditions of real clinical practice

Z.M. Nagornova1, A.V. Seleznev1, P.Ch. Zavadsky2, A.V. Kuroyedov3,4 1 Ivanovo State Medical Academy, Russian Federation 2 High-tech Cataract Treatment Center «New Vision», Minsk, Republic of Belarus 3 Central Military Clinical Hospital named after P.V. Mandryka, Moscow, Russian Federation 4 Pirogov Russian National Research Medical University, Moscow, Russian Federation Aim: to study effectiveness of different regimens of primary open-angle glaucoma (POAG) therapy, choice and change algorithms of ophthalmic treatment components in conditions of real clinical practice. Patients and Methods: results of 398 patients (641 eyes) with different stages of POAG, diagnosed at least 6 months ago, were included in this study. At the time of enrollment in the study, a stage of the disease was verified according to current classification of glaucoma with intraocular pressure (IOP) measurement, analysis of morphometric and functional indices. Results: a mean level of IOP (all stages of the disease) at the time of glaucoma diagnosis was 28.00 (26.00; 30.00) mm Hg. It was established that a number of patients with IOP compensation is inversely proportional to a stage of the disease. All patients with the glaucoma (641 eyes) had 44 different regimens (therapy, lasers, surgery). IOP levels were analyzed in the patients with different stages of POAG who received these different regimens of therapy. Those patients in whom an advanced stage of the disease was diagnosed had significantly higher IOP at the time of diagnosis than patients with a second and first stage of the disease. An analysis of dependence of therapy regimen content on glaucoma history duration in the different stages of POAG was carried out, and the most “popular” regimens used were established. Conclusion: IOP level at the time of POAG diagnostics can determine a stage of the disease and serve as a prognostic sign of a disease course. To achieve a target IOP is possible at an early stage of the glaucoma in 95.86% of cases, at a moderate and advanced — in 74.14% and 35.95% of cases, respectively. There is a tendency to be chosen as a starting regimen for the early glaucoma of monotherapy with beta-blockers, while prostaglandin analogues are prescribed for duration of the disease for more than a year. With higher-level stages of the glaucoma, combinations of drugs and penetrating glaucoma surgery prevail. Key words: glaucoma, intraocular pressure, beta-adrenoblockers, prostaglandin analogues, combination therapy, therapy regimens. For citation: Nagornova Z.M., Seleznev A.V., Zavadsky P.Ch., Kuroyedov A.V. Choice regularities of antihypertensive therapy regimens of primary open-angle glaucoma in conditions of real clinical practice. RMJ “Clinical ophthalmology”. 2018;3:116–123.<br

Diagnosing glaucoma in optometry practice

A.V. Korneeva1, I.N. Isakov2, A.V. Kuroedov3,4, O.N. Onufriychuk5 1LLC "Ophthalmology Elite", Moscow, Russian Federation 2G.B. Kurbatov Novokuznetsk City Clinical Hospital No. 1, Novokuznetsk, Russian Federation 3Pirogov Russian National Research Medical University, Moscow, Russian Federation 4P.V. Mandryka Military Clinical Hospital, Moscow, Russian Federation 5G.I. Turner National Medical Research Center of Сhildren’s Orthopedics and Trauma Surgery, St. Petersburg, Russian Federation The article discusses the role of optometry practice in diagnosing early glaucoma in the context of the obviously increasing incidence of glaucoma and the ophthalmic staffing shortage. It elucidates the findings of domestic and international studies focused on the early glaucoma diagnosis in optometry. The evolving role of optometry personnel in the public health system is underpinned by the increasing number of patients with eye diseases and the growing demand for primary ophthalmic care due to a higher life expectancy of the population. So far, the optometry practice is not always considered as a part of the public health system, but it plays an important role in protecting the vision, as it often helps to identify patients with early stages of refractive disorders and other ophthalmic diseases. The opportunities of diagnosing of glaucoma in optometric practice usually depend on the set goals, available equipment, optometrist skills and commitments to achieving the results. Improving equipment availability in the optometrist’s office, professional development of specialists and their motivations for performing diagnostic tes ts may optimize the detection of glaucoma. It is also worth noting the importance of interaction between the optometrist and the ophthalmologist. Over the past years, a positive trend to optometry development has emerged shaping the future expansion of the scope of traditional professional interests of optometry staff. The trend is based on the improved situation with the equipment availability and the professional development of specialists. Keywords: glaucoma, optometrist, optometry practice, ophthalmologist, glaucoma diagnostics, glaucoma optic neuropathy. For citation: Korneeva A.V., Isakov I.N., Kuroedov A.V., Onufriychuk O.N. Diagnosing glaucoma in optometry practice. Russian Journal of Clinical Ophthalmology. 2022;22(4):258–264 (in Russ.). DOI: 10.32364/2311-7729-2022-22-4-258-264. </p

State-of-the-art of loading and unloading tests for glaucoma: potentialities and informative value

O.S.&nbsp; Myakonkaya1, A.S. Sarkisyan1, A.V. Seleznev2, A.V. Kuroyedov3,4, I.R. Gazizova5 1Volgograd Branch of the S.N.&nbsp;Fedorov NMRC “MNTK “Eye Microsurgery”, Volgograd,&nbsp; &nbsp;Russian Federation 2Ivanovo State Medical Academy, Ivanovo, Russian Federation 3P.V. Mandryka Military Clinical Hospital, Moscow, Russian Federation 4Pirogov Russian National Research Medical University, Moscow, Russian Federation 5N.P. Bekhtereva Institute of the Human Brain, St. Petersburg, Russian Federation Prevention of blindness and low vision resulting fr om the progression of glaucomatous optic neuropathy (GON) depends mainly on the early diagnosis of glaucoma. Loading and unloading tests which create conditions for intraocular pressure (IOP) fluctuations are important for the early diagnosis of glaucoma. Stress tests for glaucoma lead to a short-term IOP rise and help identify symptoms that are questionable under normal conditions. Stress tests include water-drinking test, position test, dark room test, dentation test, pharmacological mydriasis, corticosteroid provocative test, etc. Unloading tests are reasonable if the IOP level is the upper normal lim it or slightly higher. Unloading tests include glyceryl ascorbate test, test with acetazolamide, and instillations of IOP-lowering medications (e.g., M-cholinomimetic or prostaglandin analog). Visual changes accompanying loading and unloading tests are recorded by visual acuity measurement, IOP measurement (tono metry and tonography, visual field testing (campimetry, angioscotometry), adaptometry, retinal tomography, and electrophysiology (visually evoked potentials). Studies are currently underway to develop novel modifications of diagnostic tests using modern high-tech controlling tools. These advances increase the informative value of these tests which are relevant for both early diagnosis and stabilization of glaucoma course. This review article summarizes currently available data on the informative value of loading and unloading tests. Keywords: glaucoma, intraocular pressure, loading tests, unloading tests, early diagnosis of glaucoma. For citation:&nbsp; Myakonkaya O.S., Sarkisyan A.S., Seleznev A.V. et al. State-of-the-art of loading and unloading tests for glaucoma: potentialities and informative value. Russian Journal of Clinical Ophthalmology. 2021;21(3):153–158 (in Russ.). DOI: 10.32364/2311-7729-2021-21-3-153-158. <br

Systemic hypotension and low perfusion pressure as risk factors for primary open-angle glaucoma progression

O.S. Мyakonkaya1, A.S. Sarkisyan1, A.V. Seleznev2, A.V. Kuroyedov3,4, A.Yu. Brezhnev5 1Volgograd Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Volgograd, Russian Federation 2Ivanovo State Medical Academy, Ivanovo, Russian Federation 3Mandryka Central Military Clinical Hospital, Moscow, Russian Federation 4Pirogov Russian National Research Medical University, Moscow, Russian Federation 5Kursk State Medical University, Kursk, Russian Federation Glaucoma progression is still a relevant issue in up-to-date ophthalmology. An important prerequisite for stabilizing glaucoma is the achievement of the target intraocular pressure (IOP). However, many patients with primary open-angle glaucoma (POAG) continue to suffer vision loss despite IOP reduction. Additional factors are also important for glaucoma progression, e.g., blood pressure (BP) and ocular perfusion pressure (OPP). Multiple published data have shown a decrease in blood flow velocity in the retrobulbar vessels, choroid, retina, and optic nerve in patients with glaucoma. A decrease in OPP is a predictor of insufficient intraocular blood supply. Systemic BP has a strong effect on OPP. Intensive treatment for hypertension significantly reduces BP, decreases OPP, and prevents the progression of glaucomatous optic neuropathy. A new paradigm shift that implies a personalized approach to the choice of diagnostic and treatment strategy for glaucoma is emerging. This paper reviews current published data on the effect of systemic hypotension and low OPP on POAG progression. Keywords: glaucoma, intraocular pressure, blood pressure, hypertension, hypotension, perfusion pressure. For citation: Мyakonkaya O.S., Sarkisyan A.S., Seleznev A.V., Kuroyedov A.V., Brezhnev A.Yu. Systemic hypotension and low perfusion pressure as risk factors for primary open-angle glaucoma progression. Russian Journal of Clinical Ophthalmology. 2023;23(4):202–206 (in Russ.). DOI: 10.32364/2311-7729-2023-23-4-5. </p