Gus M Gazzard

University College London | UCL · Institute of Ophthalmology

Aims To compare the baseline clinical characteristics and patterns of visual field defects between high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) in the Laser in Glaucoma and Ocular Hypertension (LiGHT) China subjects. Methods All patients (n=622) were recruited at Zhongshan Ophthalmic Center from 2015 to 2019. 1105 open-angle glauc...

Purpose: To describe the research principles and cohort characteristics of the multi-disciplinary Project HERCULES, which evaluated implementation of an innovative model of high-volume outpatient eyecare service to monitor patients with stable chronic eye diseases. The rationale was to improve capacity and efficiency of eyecare in the National Heal...

Background/aims To elicit the preferences and calculate the willingness to pay (WTP) of patients with ocular hypertension (OHT) for eye monitoring services in the UK. Methods Patients with OHT aged at least 18 years recruited from four NHS ophthalmology departments were included in the study. Patients’ preferences and WTP for an OHT monitoring ser...

Background/Aims To assess the cost-effectiveness of making treatment decisions for patients with ocular hypertension (OHT) based on a risk prediction (RP) tool in the United Kingdom. Methods A discrete event simulation model was constructed to compare the cost-effectiveness of an alternative care pathway in which the treatment decision was guided...

Importance Selective laser trabeculoplasty (SLT) is becoming the recommended first choice in the treatment of open-angle glaucoma (OAG). However, whether repeat SLT can be recommended regardless of initial response remains controversial. Objective To assess the potential of OAG and ocular hypertension (OHT) undergoing repeat laser to respond favor...

To determine whether the types and rates of post-surgical complications associated with the Port Delivery System with ranibizumab (PDS) are comparable with those reported for other ocular implants that cross the sclera. Systematic literature reviews were conducted to determine the long-term (≥ 18-month) safety of ocular implants that cross the scle...

Background To estimate global and regional trends from 2000 to 2020 of the number of persons visually impaired by cataract and their proportion of the total number of vision-impaired individuals. Methods A systematic review and meta-analysis of published population studies and gray literature from 2000 to 2020 was carried out to estimate global a...

Background We aimed to update estimates of global vision loss due to age-related macular degeneration (AMD). Methods We did a systematic review and meta-analysis of population-based surveys of eye diseases from January, 1980, to October, 2018. We fitted hierarchical models to estimate the prevalence of moderate and severe vision impairment (MSVI;...

Over the last decade, the delivery of glaucoma care in the UK has changed dramatically, with more non-medical ophthalmic practitioners involved in the care of glaucoma patients. Optometrists and other non-medical professionals are now involved in the delivery of laser treatments in the Hospital Eye Service (HES), but there is currently no standardi...

Objectives To assess whether patients from minority ethnic groups have different perceptions about the quality-of-life outcomes that matter most to them. Design Cross-sectional observational study. Setting High volume eye centres serving the most ethnically diverse region in the UK, recruiting from July 2021 to February 2022. Participants 511 pa...

Background: To estimate global and regional trends from 2000 to 2020 of the number of persons visually impaired by cataract and their proportion of the total number of vision-impaired individuals. Methods: A systematic review and meta-analysis of published population studies and gray literature from 2000 to 2020 was carried out to estimate global...

Prologue Glaucoma surgery has been, for many decades now, dominated by the universal gold standard which is trabeculectomy augmented with antimetabolites. Tubes also came into the scene to complement what we use to call conventional or traditional glaucoma surgery. More recently we experienced a changing glaucoma surgery environment with the “adve...

Selective Laser Trabeculoplasty (SLT) has been in routine clinical use for over 20 years with millions of patients successfully treated and a low rate of clinically significant complications. The procedure requires the clinician to manually position the laser beam on the trabecular meshwork (TM) using a gonioscopy lens and to titrate the SLT laser...

Background To estimate global and regional trends from 2000-2020 of the number of persons visually impaired by cataract and their proportion of the total number of vision-impaired individuals. Methods A systematic review and meta-analysis of published population studies and grey literature from 2000-2020 was carried out to estimate global and regio...

A 62-year-old woman with mild myopia presented to her local optometrist for a routine examination and was found to have intraocular pressure (IOP) of 30 mm Hg in both eyes and cupped nerves. She had a family history of glaucoma in her father. She was started on latanoprost in both eyes and was referred for a glaucoma evaluation. On initial evaluati...

Glaucoma is a common disease with an increasing prevalence [1]. Ocular surface disease (OSD) is also common, and its prevalence is increasing [2,3], due in part to the adverse effects of topical glaucoma medications [4,5]. Given this glaucoma/OSD association, David A. Sullivan, MS, PhD (Boston, MA, USA) and Amy Gallant Sullivan (Paris, France) on b...

Purpose: To examine the generalizability, discuss limitations, and critically appraise recommendations on the management of Primary Angle Closure Suspects (PACS) that emerged as a result of recent randomized clinical trials challenging the widely accepted clinical practice of offering laser peripheral iridotomy (LPI) to PACS patients. To synthetiz...

Purpose: The purpose of the study was to describe the rationale and design of Project FOREVER (Finding Ophthalmic Risk and Evaluating the Value of Eye exams and their predictive Reliability). Design: Project FOREVER will build a comprehensive database of clinical eye and vision data collected from ~280 000 adults at 100 optician stores across De...

Background/Objectives Recent clinical trials in glaucoma have used patient-reported outcome measures (PROMs) of health-related quality of life to evaluate interventions. However, existing PROMs may not be sufficiently sensitive to capture changes in health status. This study aims to determine what really matters to patients by directly exploring th...

Glaucoma is the leading cause of preventable sight loss in the United Kingdom and the provision of timely glaucoma care has been highlighted as a significant challenge in recent years. Following a recent high-profile investigation, The Healthcare Safety Investigation Branch recommended the validation of risk stratification models to safeguard the v...

Purpose: to compare visual field (VF) progression between glaucoma patients receiving cataract surgery alone (CS) or with a Hydrus microstent (CS-HMS) DESIGN: post-hoc analysis of VF data from the HORIZON multicenter randomized controlled trial METHODS: 556 patients with glaucoma and cataract were randomized 2:1 to either CS-HMS (369) or CS (187)...

Background Glaucoma staging is critical for treatment planning but has rarely been tested in severe/end-stage disease. We compared the performance of the Disc Damage Likelihood Scale (DDLS) and cup:disc ratio (CDR) using a functional glaucoma staging system (GSS) as the reference standard. Methods Post hoc analysis of a randomised controlled trial...

Background: Primary angle-closure glaucoma is a type of glaucoma associated with a physically obstructed anterior chamber angle. For example, contact between the iris and lens at the pupillary margin creates a pupillary block that increases resistance to aqueous outflow. Obstruction of the anterior chamber angle blocks drainage of fluids (aqueous...

Purpose Surgical innovations are necessary to improve patient care. After an initial exploratory phase novel surgical technique should be compared with alternative options or standard care in randomized clinical trials (RCTs). However surgical RCTs have unique methodological challenges. Our study sought to investigate key aspects of the design, con...

Purpose The LiGHT trial has shown selective laser trabeculoplasty (SLT) to be clinically and cost-effective as a primary treatment of open-angle glaucoma (OAG) and ocular hypertension (OHT) at 3 years. This paper reports health-related quality of life (HRQL) and clinical effectiveness of initial treatment with SLT compared to intra-ocular pressure...

Prcis: A literature review of SLT energy dose response found no definitive relationship between IOP reduction with respect to total or pulse energy, race, pigmentation, or application pattern. Purpose: Selective laser trabeculoplasty (SLT) is a safe and effective treatment for lowering intraocular pressure (IOP). While evidence is mounting for t...

In 2019, the Laser in Glaucoma and Ocular Hypertension (LiGHT) randomised controlled trial reported that initial treatment with selective laser trabeculoplasty (SLT) is more cost effective than initial treatment with pressure-lowering eye drops, leading to a reduced number of glaucoma surgeries and very low rates of adverse events while providing d...

Background/aims: The aim of this study was to validate the Glaucoma Risk Stratification Tool (GLAUC-STRAT-fast) currently recommended by the Royal College of Ophthalmologists for the risk stratification of patients with glaucoma in the UK National Health Service Hospital Eye Service. Methods: GLAUC-STRAT fast was applied to the LiGHT trial parti...

Purpose The purpose of this study is to establish consensus among experts on outcomes and methods to be used in clinical trials to assess adverse effects of anti-glaucomatous eye drops. Design Modified Delphi method. Methods Clinical experts from Europe, North America, South America, the Middle East, and Asia were invited to participate in two se...

Objective 5-year results of the HORIZON trial comparing cataract surgery combined with an intracanalicular microstent to cataract surgery alone. Design Prospective, multicenter, controlled randomized clinical trial. Participants Patients with cataract and POAG treated with ≥ 1 glaucoma medication, washed out diurnal intraocular pressure (DIOP) 22...

Aims To report the baseline intraocular pressure (IOP) characteristics and its diurnal fluctuation in the Laser in Glaucoma and Ocular Hypertension China cohort. Methods 622 primary open-angle glaucoma (POAG) patients and 149 ocular hypertension (OHT) patients were recruited at Zhongshan Ophthalmic Center from 2015 to 2019. Standardised ocular exa...

Purpose There are large variations in how adverse events, safety and tolerability related to intraocular pressure (IOP)-lowering eye drops are reported. Inconsistencies and discrepancies in outcomes and methods lead to missed opportunities when comparing studies and combining results in meta-analyses, making it difficult to translate the findings i...

Background Glaucoma is a major cause of sight loss worldwide, with the highest regional prevalence and incidence reported in Africa. The most common low-cost treatment used to control glaucoma is long-term timolol eye drops. However, low adherence is a major challenge. We aimed to investigate whether selective laser trabeculoplasty (SLT) was superi...

Introduction Laser trabeculoplasty is an effective and widely used treatment for glaucoma. A new laser technology, the Eagle direct selective laser trabeculoplasty (DSLT) device, may provide automated, fast, simple, safe and effective laser treatment for glaucoma in a broader range of clinical settings. This trial aims to test the hypothesis that t...

Background/objectives To explore the acceptability, training requirements, enablers and barriers of optometrist-delivered SLT. Subjects/methods Optometrists, fellowship and consultant grade ophthalmologists, hospital managers and patients were interviewed using pre-defined topic guides. Interviews were audio-recorded, transcribed, and subjected to...

The provision of timely care to the high volume of glaucoma patients stratified as “low risk” following pandemic-related appointment deferrals continues to prove challenging for glaucoma specialists. It is unknown whether stratification as “low risk” remains valid over time, raising the potential risk of harm during this period if left unmonitored....

Aims The virtual glaucoma clinic (VGC) is a well-established diagnostic pathway for delivery of glaucoma care. Current UK national guidance recommends VGCs for patients with ocular hypertension, glaucoma suspects or early glaucoma. This study evaluates whether expanded eligibility criteria, including other glaucoma phenotypes and disease stages, ca...

Importance Glaucoma affects more than 75 million people worldwide. Intraocular pressure (IOP)–lowering surgery is an important treatment for this disease. Interest in reducing surgical morbidity has led to the introduction of minimally invasive glaucoma surgeries (MIGS). Understanding the comparative effectiveness and safety of MIGS is necessary fo...

Background: Glaucoma is the leading cause of global irreversible blindness, often associated with raised intraocular pressure (IOP). Where medical or laser treatment has failed or is not tolerated, surgery is often required. Minimally-invasive surgical approaches have been developed in recent years to reduce IOP with lower surgical risks. Supracil...

Prcis: Multiple questionnaires exist to measure glaucoma's impact on quality of life. Selecting the right questionnaire for the research question is essential, as is patients' acceptability of the questionnaire to enable collection of relevant patient-reported outcomes. Purpose: Quality of life (QoL) relating to a disease and its treatment is an...

Purpose: To describe the baseline characteristics of a trial to evaluate whether selective laser trabeculoplasty (SLT), as a first-line treatment, provides superior economic and health-related quality of life outcomes to medical treatment in China. Design: LiGHT China trial is an unmasked, single-center, pragmatic, Randomized controlled trial....

Objective To compare the effectiveness and safety of the MicroShunt versus trabeculectomy in patients with primary open-angle glaucoma (POAG). Design One-year results from a 2-year, prospective, randomized, multicenter, non-inferiority study (NCT01881425) conducted in the USA and Europe. Participants Eligible patients were aged 40–85 years with i...

Selective laser trabeculoplasty (SLT) has been established as an effective treatment to lower intraocular pressure in people with glaucoma and ocular hypertension. The procedure is typically within the remit of ophthalmologists; however, there is potential to upskill optometrists and other healthcare professionals (HCPs) to deliver the treatment. W...

Summary Background Many causes of vision impairment can be prevented or treated. With an ageing global population, the demands for eye health services are increasing. We estimated the prevalence and relative contribution of avoidable causes of blindness and vision impairment globally from 1990 to 2020. We aimed to compare the results with the World...

Background: Glaucoma is the leading cause of irreversible blindness. Minimally invasive surgical techniques, such as ab interno trabecular bypass surgery, have been introduced to prevent glaucoma from progressing. OBJECTIVES: In light of the potential benefits for people with open-angle glaucoma and the widespread uptake of the technique, it is im...

The recent Laser in Glaucoma and Ocular Hypertension Trial provided the evidentiary basis for a paradigm shift away from the historical medication-first approach to glaucoma--which has numerous limitations, the most important of which is poor adherence to therapy --and toward a laser-first approach. Now 20 years after its commercialization, selecti...

Summary Background To contribute to the WHO initiative, VISION 2020: The Right to Sight, an assessment of global vision impairment in 2020 and temporal change is needed. We aimed to extensively update estimates of global vision loss burden, presenting estimates for 2020, temporal change over three decades between 1990–2020, and forecasts for 2050....

Objective: To report 3-year outcomes of the HORIZON study comparing cataract surgery with Hydrus Microstent versus cataract surgery alone. Design: Multicenter randomized clinical trial. Participants: Five hundred fifty-six eyes from 556 patients with cataract and POAG treated with ≥ 1 glaucoma medication, washed out diurnal intraocular pressur...

Introduction In the UK, the National Institute for Health and Clinical Excellence are amending guidelines to support use of selective laser trabeculoplasty (SLT) as a first-line treatment for patients with glaucoma and ocular hypertension. The procedure is quick, effective in lowering intraocular pressure, cost-effective for the National Health Ser...

Objective To compare visual field outcomes of ocular hypertensive and glaucoma patients treated with Medicine-1st against those treated with selective laser trabeculoplasty (SLT, Laser-1st). Design Secondary analysis of patients from Laser in Glaucoma and Ocular Hypertension (LiGHT), a multicentre randomised controlled trial. Participants and con...

Background/Aims This work aimed to study the effect of long-term intraocular pressure (IOP) fluctuation on visual field (VF) progression 8 years post-trabeculectomy in Asian eyes. Methods This was a retrospective analysis of 8-year post-trabeculectomy data from The Singapore 5-Fluorouracil (5-FU) Study. VFs were analysed using Progressor software...

Background: Glaucoma is a leading cause of irreversible blindness. A number of minimally-invasive surgical techniques have been introduced as a treatment to prevent glaucoma from progressing; ab interno trabecular bypass surgery with the Schlemm's canal Hydrus microstent is one of them. Objectives: To evaluate the efficacy and safety of ab inter...

Purpose To determine the test-retest reliability and diagnostic accuracy of a binocular optical coherence tomography (OCT) prototype (Envision Diagnostics, USA) for pupillometry. Design Assessment of diagnostic reliability and accuracy. Methods Fifty participants with RAPD confirmed using the swinging flashlight method (mean age 49.6 years) and 5...

Despite advances in our knowledge of the aetiology and pathophysiology of glaucoma, the sole proven, effective intervention for treating primary open-angle glaucoma (POAG) and ocular hypertension (OHT) remains lowering of intraocular pressure (IOP) to prevent further progression and visual loss. The purpose of this review is to evaluate the treatme...

Angle-closure glaucoma is an aggressive condition that causes millions to become blind worldwide. This review explores the use of prophylactic laser peripheral iridotomy (PI) in patients classified as primary angle-closure suspects (PACS), and additionally, the use of clear lens exchange as a primary treatment option in established angle-closure di...

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Purpose: To determine the efficacy of repeat selective laser trabeculoplasty (SLT) in medication-naive open-angle glaucoma (OAG) and ocular hypertensive (OHT) patients requiring repeat treatment for early to medium-term failure during the Laser in Glaucoma and Ocular Hypertension (LiGHT) trial. Design: Post hoc analysis of SLT treatment arm of a...

Background Newly diagnosed open-angle glaucoma (OAG) and ocular hypertension (OHT) are habitually treated with intraocular pressure (IOP)-lowering eyedrops. Selective laser trabeculoplasty (SLT) is a safe alternative to drops and is rarely used as first-line treatment. Objectives To compare health-related quality of life (HRQoL) in newly diagnosed...

Purpose: To report clinical efficacy, predictors of success, and safety of primary selective laser trabeculoplasty (SLT) used in treatment-naive patients with open-angle glaucoma (OAG) or ocular hypertension (OHT). Design: Post hoc analysis of a multicenter, prospective, randomized, controlled trial. Participants: Treatment-naive patients with...

BACKGROUND: Primary open angle glaucoma and ocular hypertension are habitually treated with eye drops that lower intraocular pressure. Selective laser trabeculoplasty is a safe alternative but is rarely used as first-line treatment. We compared the two. METHODS: In this observer-masked, randomised controlled trial treatment-naive patients with open...

Background: Glaucoma is a leading cause of irreversible blindness. A number of minimally invasive surgical techniques have been introduced as a treatment to prevent glaucoma progressing. Among them, endoscopic cyclophotocoagulation (ECP) is a cyclodestructive procedure developed by Martin Uram in 1992. Objectives: To evaluate the efficacy and sa...

Background: Primary angle-closure glaucoma is a type of glaucoma associated with a physically obstructed anterior chamber angle. Obstruction of the anterior chamber angle blocks drainage of fluids (aqueous humor) within the eye and may raise intraocular pressure (IOP). Elevated IOP is associated with glaucomatous optic nerve damage and visual fiel...

Background: To describe the surgical technique and refractive outcomes following clear lens extraction (CLE) in the Effectiveness, in Angle-closure Glaucoma, of Lens Extraction trial. Methods: Review of prospectively collected data from a multicentre, randomised controlled trial comparing CLE and laser peripheral iridotomy. Eligible participants...

Over the past two decades, selective laser trabeculoplasty (SLT) has increasingly become an established laser treatment used to lower intraocular pressure in open-angle glaucoma and ocular hypertensive patients. In this review we trace the origins of SLT from previous argon laser trabeculoplasty and review the current role it has in clinical practi...

Purpose: We determined whether there is relative sparing of pupil function in glaucoma patients with normal pressures compared to those with high pressures. Methods: A cross-sectional study was done of 68 patients with primary open angle glaucoma (POAG): 38 had normal IOPs on all-day phasing before treatment (never >21 mm Hg), with confirmed pro...