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  • AAO OTAC Glaucoma Panel, Hoskins Center for Quality Eye Care


    A report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Glaucoma Panel.

    Arthur J. Sit, SM, MD;1 Teresa C. Chen, MD;2 Hana L. Takusagawa, MD;3 Jullia A. Rosdahl, MD, PhD;4 Ambika Hoguet, MD;5 Vikas Chopra, MD;6 Grace M. Richter, MD;7 Yvonne Ou, MD;8 Stephen J. Kim, MD;9 Darrell WuDunn, MD, PhD10

    Ophthalmology, Vol. 130, 433-442, © 2023 by the American Academy of Ophthalmology. Click here for free access to the OTA.

    Purpose: To review the current published literature on the utility of corneal hysteresis (CH) to assist the clinician in the diagnosis of glaucoma or in the assessment of risk for disease progression in existing glaucoma patients.

    Methods: Searches of the peer-reviewed literature in the PubMed database were performed through July 2022. The abstracts of 423 identified articles were examined to exclude reviews and non-English articles. After inclusion and exclusion criteria were applied, 19 articles were selected, and the panel methodologist rated them for level of evidence. Eight articles were rated level I, and 5 articles were rated level II. The 6 articles rated level III were excluded.

    Results: Corneal hysteresis is lower in patients with primary open-angle glaucoma, primary angle-closure glaucoma, pseudoexfoliative glaucoma, and pseudoexfoliation syndrome compared with normal subjects. Interpretation of low CH in patients with high intraocular pressure (IOP) or on topical hypotensive medications is complicated by the influence of these parameters on CH measurements. However, CH is also lower in treatment-naïve, normal-tension glaucoma patients compared with normal subjects who have a similar IOP. In addition, lower CH is associated with an increased risk of progression of glaucoma based on visual fields or structural markers in open-angle glaucoma patients, including those with apparently well-controlled IOP.

    Conclusions: Corneal hysteresis is lower in glaucoma patients compared with normal subjects, and lower CH is associated with an increased risk of disease progression. However, a causal relationship remains to be demonstrated. Nevertheless, measurement of CH complements current structural and functional assessments in determining disease risk in glaucoma suspects and patients.

    1Mayo Clinic, Department of Ophthalmology, Rochester, Minnesota 
    2Harvard Medical School, Department of Ophthalmology, Massachusetts Eye & Ear, Glaucoma Service, Boston, Massachusetts 
    3VA Eugene Healthcare Center, Eugene, Oregon and Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon 
    4Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina 
    5Ophthalmic Consultants of Boston, Boston, Massachusetts
    6Doheny Eye Center UCLA, Pasadena, California  
    7Department of Ophthalmology, Southern California Permanente Medical Group, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California and USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, California 
    8Department of Ophthalmology, UCSF Medical Center, San Francisco, California 
    9Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, TN 
    10University of Florida College of Medicine—Jacksonville, Department of Ophthalmology, Jacksonville, Florida