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Wang L, Ashraf DC, Deiner M, Idowu OO, Grob SR, Winn BJ, Vagefi MR, Kersten RC. Evaluating for unrecognized deficits in perimetry associated with functional upper eyelid malposition. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2024; 4:39-44. [PMID: 38406664 PMCID: PMC10891280 DOI: 10.1016/j.aopr.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/27/2024]
Abstract
Objective To investigate whether functional upper eyelid malposition is associated with unrecognized deficits in automated perimetry among glaucoma patients by examining patients undergoing eyelid surgery who had not been identified as requiring eyelid taping during glaucoma field testing. Methods In this retrospective pre-post study, an automated database search followed by manual chart review was used to identify eligible patients from January 2012 to March 2020. Included patients had reliable visual field testing within two years before and after functional upper blepharoplasty or ptosis repair and no comorbid ocular diagnoses. As part of routine practice, glaucoma visual field technicians taped patients with pupil-obstructing eyelid malposition; taped examinations were excluded from analysis. Clinical and demographic characteristics, mean deviation, and pattern standard deviation were evaluated within a two year period before and after eyelid surgery. Results The final analysis included 60 eyes of 38 patients. Change in visual field parameters after eyelid surgery did not reach statistical significance in crude or adjusted analyses. Among patients with ptosis, the margin reflex distance-1 was not associated with change in mean deviation after surgery (Pearson R2 = 0.0061; P = 0.700). Five of 17 eyes excluded from analysis due to unreliable pre-operative visual fields demonstrated substantial improvement after surgery. Conclusions Functional upper eyelid malposition does not appear to cause spurious visual field abnormalities among glaucoma patients with reliable visual fields who were determined not to require eyelid taping at the time of their visual fields. Unreliable visual fields could be a sign of eyelid interference in this population.
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Affiliation(s)
- Linyan Wang
- Department of Ophthalmology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Ophthalmology, University of California, San Francisco, USA
| | - Davin C. Ashraf
- Department of Ophthalmology, University of California, San Francisco, USA
- Department of Ophthalmology, Oregon Health and Science University, Portland, USA
| | - Michael Deiner
- Department of Ophthalmology, University of California, San Francisco, USA
| | - Oluwatobi O. Idowu
- Department of Ophthalmology, University of California, San Francisco, USA
| | - Seanna R. Grob
- Department of Ophthalmology, University of California, San Francisco, USA
| | - Bryan J. Winn
- Department of Ophthalmology, University of California, San Francisco, USA
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, USA
- Department of Ophthalmology, Tufts Medical Center, Boston, USA
| | - Robert C. Kersten
- Department of Ophthalmology, University of California, San Francisco, USA
- Department of Ophthalmology, Tufts Medical Center, Salt Lake City, USA
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Lee JY, Shin JW, Lee A, Baek MS, Kook MS. Association of baseline optical coherence tomography angiography with the development of glaucomatous visual field defects in preperimetric glaucoma eyes. Br J Ophthalmol 2023; 107:1621-1629. [PMID: 37863500 DOI: 10.1136/bjo-2021-321025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 07/22/2022] [Indexed: 11/04/2022]
Abstract
AIMS To evaluate whether baseline vessel density (VD) parameters derived from optical coherence tomography angiography (OCT-A) is associated with the development of glaucomatous visual field (VF) defects in preperimetric glaucoma (PPG) patients. METHODS One eye from each of 200 consecutive PPG patients with a normal standard automated perimetry and OCT-A at baseline was retrospectively analysed. OCT-A was used to measure the circumpapillary VD (cpVD) and the parafoveal and perifoveal VD. The retinal nerve fibre layer (RNFL) and macular ganglion cell-inner plexiform layer thicknesses were measured as reference standards. Two patient groups were stratified based on the development of repeatable glaucomatous VF loss. A Cox proportional hazards model was constructed to determine the predictive ability of OCT-A parameters for VF defects. The correlation between these baseline OCT-A parameters and the rate of global VF sensitivity loss (dB/year) was calculated using linear regression analysis. RESULTS During a 3.1-year average follow-up period, 18 eyes (9.0%) developed glaucomatous VF defects. At baseline, the lower inferior temporal cpVD (HR (95% CI)=0.934 (0.883 to 0.988); p=0.017) and thinner inferior RNFL (HR (95% CI)=0.895 (0.839 to 0.956); p=0.001) were predictive of glaucomatous VF loss. A lower inferior temporal cpVD and thinner RNFL at baseline were associated with faster rate of global VF sensitivity loss (β=0.015; p=0.001). CONCLUSION In PPG eyes, a lower baseline inferior temporal cpVD is significantly associated with glaucomatous VF defect development and a faster rate of global VF loss.
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Affiliation(s)
- Jin Yeong Lee
- Department of Ophthalmology, Asan Medical Center, Seoul, Korea (the Republic of)
| | - Joong Won Shin
- Department of Ophthalmology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea (the Republic of)
| | - Anna Lee
- Department of Ophthalmology, Asan Medical Center, Seoul, Korea (the Republic of)
| | - Min Su Baek
- Department of Ophthalmology, Asan Medical Center, Seoul, Korea (the Republic of)
| | - Michael S Kook
- Department of Ophthalmology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea (the Republic of)
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Kiuchi Y, Inoue T, Shoji N, Nakamura M, Tanito M. The Japan Glaucoma Society guidelines for glaucoma 5th edition. Jpn J Ophthalmol 2023; 67:189-254. [PMID: 36780040 DOI: 10.1007/s10384-022-00970-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 02/14/2023]
Abstract
We are pleased to bring you the 5th edition of the Glaucoma Clinical Practice Guidelines. Clinical practice guidelines are based on evidence (scientific grounds). It is a document that presents the treatment that is the most appropriate for the patient. "Glaucoma Clinical Guidelines" was first published in 2003. This was the first guideline for glaucoma treatment in Japan. The principle of glaucoma treatment is to lower intraocular pressure. Means for lowering intraocular pressure includes drugs, lasers, and surgery; Glaucoma is a disease that should be considered as a complex syndrome rather than a single condition. Therefore, the actual medical treatment is not as simple as one word. This time we set the Clinical Questionnaire with a focus on glaucoma treatment. We hope that you will take advantage of the 5th edition.
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Affiliation(s)
- Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-31 Kasumi, Minami-ku, Hiroshima, Japan.
| | - Toshihiro Inoue
- Department of Ophthalmology, Faculty of Life Science, Kumamoto University, Kumamoto, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Makoto Nakamura
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan
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Lim WS, Ho HY, Ho HC, Chen YW, Lee CK, Chen PJ, Lai F, Jang JSR, Ko ML. Use of multimodal dataset in AI for detecting glaucoma based on fundus photographs assessed with OCT: focus group study on high prevalence of myopia. BMC Med Imaging 2022; 22:206. [PMID: 36434508 PMCID: PMC9700928 DOI: 10.1186/s12880-022-00933-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/10/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Glaucoma is one of the major causes of blindness; it is estimated that over 110 million people will be affected by glaucoma worldwide by 2040. Research on glaucoma detection using deep learning technology has been increasing, but the diagnosis of glaucoma in a large population with high incidence of myopia remains a challenge. This study aimed to provide a decision support system for the automatic detection of glaucoma using fundus images, which can be applied for general screening, especially in areas of high incidence of myopia. METHODS A total of 1,155 fundus images were acquired from 667 individuals with a mean axial length of 25.60 ± 2.0 mm at the National Taiwan University Hospital, Hsinchu Br. These images were graded based on the findings of complete ophthalmology examinations, visual field test, and optical coherence tomography into three groups: normal (N, n = 596), pre-perimetric glaucoma (PPG, n = 66), and glaucoma (G, n = 493), and divided into a training-validation (N: 476, PPG: 55, G: 373) and test (N: 120, PPG: 11, G: 120) sets. A multimodal model with the Xception model as image feature extraction and machine learning algorithms [random forest (RF), support vector machine (SVM), dense neural network (DNN), and others] was applied. RESULTS The Xception model classified the N, PPG, and G groups with 93.9% of the micro-average area under the receiver operating characteristic curve (AUROC) with tenfold cross-validation. Although normal and glaucoma sensitivity can reach 93.51% and 86.13% respectively, the PPG sensitivity was only 30.27%. The AUROC increased to 96.4% in the N + PPG and G groups. The multimodal model with the N + PPG and G groups showed that the AUROCs of RF, SVM, and DNN were 99.56%, 99.59%, and 99.10%, respectively; The N and PPG + G groups had less than 1% difference. The test set showed an overall 3%-5% less AUROC than the validation results. CONCLUSION The multimodal model had good AUROC while detecting glaucoma in a population with high incidence of myopia. The model shows the potential for general automatic screening and telemedicine, especially in Asia. TRIAL REGISTRATION The study was approved by the Institutional Review Board of the National Taiwan University Hospital, Hsinchu Branch (no. NTUHHCB 108-025-E).
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Affiliation(s)
- Wee Shin Lim
- grid.19188.390000 0004 0546 0241Department of Computer Science and Information Engineering, National Taiwan University, Taipei City 10617, Taiwan, ROC
| | - Heng-Yen Ho
- grid.19188.390000 0004 0546 0241School of Medicine, National Taiwan University, Taipei City 10617, Taiwan, ROC
| | - Heng-Chen Ho
- grid.19188.390000 0004 0546 0241School of Medicine, National Taiwan University, Taipei City 10617, Taiwan, ROC
| | - Yan-Wu Chen
- grid.412036.20000 0004 0531 9758Department of Applied Mathematics, National Sun Yat-Sen University, Kaohsiung City 804201, Taiwan, ROC
| | - Chih-Kuo Lee
- grid.412094.a0000 0004 0572 7815Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City 300, Taiwan, ROC
| | - Pao-Ju Chen
- grid.412094.a0000 0004 0572 7815Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Branch, No. 25, Lane 442, Sec.1, Jingguo Rd., Hsinchu City 300, Taiwan, ROC
| | - Feipei Lai
- grid.19188.390000 0004 0546 0241Department of Electrical Engineering, National Taiwan University, Taipei City 10617, Taiwan, ROC
| | - Jyh-Shing Roger Jang
- grid.19188.390000 0004 0546 0241Department of Computer Science and Information Engineering, National Taiwan University, Taipei City 10617, Taiwan, ROC
| | - Mei-Lan Ko
- grid.412094.a0000 0004 0572 7815Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Branch, No. 25, Lane 442, Sec.1, Jingguo Rd., Hsinchu City 300, Taiwan, ROC ,grid.38348.340000 0004 0532 0580Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Taipei City 10617, Taiwan, ROC
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Patterns of Optical Coherence Tomography Imaging in Preperimetric Open Angle Glaucoma: A Comparative Study With Young-Age-Onset and Old-Age-Onset Eyes. J Glaucoma 2022; 31:860-867. [PMID: 35980848 DOI: 10.1097/ijg.0000000000002104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/22/2022] [Indexed: 02/04/2023]
Abstract
PRCIS Optic coherence tomography imaging in preperimetric open angle glaucoma (OAG) differed between young-age-onset and old-age-onset eyes. Inferior and superior quadrants were thinner in young and old-age-onset eyes, respectively. Understanding the specific patterns of early glaucomatous damage based on age-at-onset may improve glaucoma diagnosis and monitoring. PURPOSE To investigate the patterns of retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL) thinning in preperimetric OAG by optical coherence tomography based on age at onset ("young-age onset (<40 y)" vs. "old-age onset (≥40 y)". MATERIALS AND METHODS The RNFL and GCIPL deviation images were acquired by Cirrus HD-optical coherence tomography, and overlaid, thus converted to a "deviation frequency map", respectively. The topographic thinning patterns and parameters of RNFL and GCIPL thickness measurements were compared. RESULTS A total of 194 eyes of 194 patients with preperimetric OAG and 97 eyes of 97 age-matched normal subjects were analyzed. Young-age-onset eyes of preperimetric OAG mainly had RNFL defects inferotemporally (264-296 degrees) with GCIPL defects in the inferior region (213-357 degrees). Old-age-onset preperimetric OAG eyes had RNFL defects inferotemporally (266-294°) and superotemporally (33-67 degrees), with GCIPL defects in the inferior and superior regions (206-360 degrees, 0-22 degrees). The inferior quadrant of RNFL and GCIPL thicknesses were significantly thinner in young-age-onset eyes compared with old-age-onset eyes ( P =0.012, 0.016), while the superior quadrant of those were significantly thinner in the old-age-onset eyes ( P =0.003, 0.005). CONCLUSION Young-age-onset and old-age-onset eyes of preperimetric OAG present different specific patterns of RNFL and GCIPL thinning.
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Jung Y, Park HYL, Shin H, Oh SE, Kim SA, Lee JY, Shin DY, Jeon SJ, Kim YC, Shin HY, Choi JA, Lee NY, Park CK. Microvasculature Dropout and Development of Normal Tension Glaucoma in Glaucoma Suspects: The Normal Tension Glaucoma Suspect Cohort Study: Microvasculature dropout and Normal-Tension Glaucoma. Am J Ophthalmol 2022; 243:135-148. [PMID: 35932818 DOI: 10.1016/j.ajo.2022.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To investigate the contribution of vessel parameters to identify normal tension glaucoma (NTG) suspects at risk of NTG development. DESIGN Multicenter prospective cohort study. SUBJECTS A total of 307 eyes of 307 NTG suspects having intraocular pressure within the normal range; a suspicious optic disc, but without definite localized retinal nerve fiber layer (RNFL) defects; and a normal visual field (VF). METHODS To measure laminar vessel density (VD), the VD was measured in the intradisc region from images of the deep vascular layers of optical coherence tomography angiography (OCT-A). Conversion to NTG was defined either by a new localized RNFL defect in the superotemporal or inferotemporal region, or the presence of a glaucomatous VF defect on two consecutive tests according to the pattern standard deviation plots. MAIN OUTCOME MEASURE Conversion to NTG. RESULTS In total, 73 (23.8%) of the 307 NTG suspects converted to NTG during the follow-up period of 59.84 ± 12.44 months. Detection rate of microvasculature dropout (MvD) was significantly higher in NTG suspects who progressed to NTG (50.7%) than in those who did not (6.4%; P < 0.001). The macular deep VD (P = 0.006) and laminar deep VD (P = 0.004) were significantly lower in NTG suspects who progressed to NTG. The presence of MvD (P < 0.001) and lower laminar deep VD (P = 0.006) were significantly associated with NTG conversion. CONCLUSIONS NTG suspects with baseline MvD or a lower laminar deep VD on OCT-A had a higher risk of conversion.
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Affiliation(s)
- Younhea Jung
- Department of Ophthalmology, The Catholic University of Korea, Seoul, South Korea; Yeouido St. Mary's Hospital, Seoul, South Korea
| | - Hae-Young Lopilly Park
- Department of Ophthalmology, The Catholic University of Korea, Seoul, South Korea; Seoul St. Mary's Hospital, Seoul, South Korea
| | - Heejong Shin
- Department of Ophthalmology, The Catholic University of Korea, Seoul, South Korea; Seoul St. Mary's Hospital, Seoul, South Korea
| | - Si Eun Oh
- Department of Ophthalmology, The Catholic University of Korea, Seoul, South Korea; Seoul St. Mary's Hospital, Seoul, South Korea
| | - Seong Ah Kim
- Department of Ophthalmology, The Catholic University of Korea, Seoul, South Korea; Seoul St. Mary's Hospital, Seoul, South Korea
| | - Ji-Young Lee
- Department of Ophthalmology, The Catholic University of Korea, Seoul, South Korea; Daejeon St. Mary's Hospital, Daejeon, South Korea
| | - Da Young Shin
- Department of Ophthalmology, The Catholic University of Korea, Seoul, South Korea; Eunpyeong St. Mary's Hospital, Seoul, South Korea
| | - Soo Ji Jeon
- Department of Ophthalmology, The Catholic University of Korea, Seoul, South Korea; Incheon St. Mary's Hospital, Incheon, South Korea
| | - Yong-Chan Kim
- Department of Ophthalmology, The Catholic University of Korea, Seoul, South Korea; Bucheon St. Mary's Hospital, Bucheon, South Korea
| | - Hye-Young Shin
- Department of Ophthalmology, The Catholic University of Korea, Seoul, South Korea; Uijeongbu St. Mary's Hospital, Uijeongbu, South Korea.
| | - Jin A Choi
- Department of Ophthalmology, The Catholic University of Korea, Seoul, South Korea; St. Vincent's Hospital, Suwon, South Korea
| | - Na Young Lee
- Department of Ophthalmology, The Catholic University of Korea, Seoul, South Korea; Eunpyeong St. Mary's Hospital, Seoul, South Korea
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Incidence of Glaucoma Progression and Rate of Visual Field Deterioration in a Cohort of Urban Ghanaians. J Glaucoma 2022; 31:503-510. [PMID: 35019875 DOI: 10.1097/ijg.0000000000001984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/27/2021] [Indexed: 01/31/2023]
Abstract
PRCIS The annual incidence of glaucoma progression (9.7%) and rates of visual field mean deviation (MD) change in progressors (-1.02±0.06 dB/y) are high in a small cohort of urban Ghanaians. PURPOSE To report the incidence of glaucoma progression and the rate of visual field deterioration in a small cohort of Ghanaians. METHODS One hundred ten subjects (204 eyes) diagnosed with glaucoma at a baseline population-based screening examination were re-examined a mean of 8.3±0.8 years later. Eyes were classified as having progressed if the optic disc alone, visual field alone or both showed significant glaucomatous changes on follow-up. Visual field MD was used to calculate the rate of visual field progression. RESULTS Progression was observed in 89 (80.9%, 9.7%/year) subjects (130 eyes). Progression occurred in 32 (31.7%, 3.8%/year) subjects by optic disc alone (46 eyes), 38 (44.7%, 5.4%/year) subjects by visual field alone (58 eyes), and 19 (25.0%, 3.0%/year) subjects by both modalities (26 eyes). The average rate of change in MD differed significantly between progressors (-1.02±1.06 dB/y) and nonprogressors (+0.089±0.49 dB/y), P =0.001. The rate of visual field worsening was greater among those who were classified as having progressed by both structure and function (-1.29±0.68 dB/y) and by function alone (-1.21±1.20 dB/y) than by structure alone (-0.55±0.76 dB/y). Progression was significantly associated with older age [odds ratio (OR), 1.42; P <0.001] and higher baseline intraocular pressure (OR, 1.18; P =0.002). Factors associated with rate of MD change were baseline older age (OR, 1.66; P =0.003), higher intraocular pressure (OR, 2.81; P =0.007), better visual field MD (OR, 1.41; P =0.004), and systemic hypertension (OR, 1.15; P =0.029). CONCLUSION The incidence and rate of visual field progression are high in this longitudinal study of Ghanaian subjects with glaucoma. The findings may have important clinical and public health policy ramifications.
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Cheung CY, Ling Li S, Chan N, Chan PP, Wang Y, Wong M, Lai I, Tham CC. Intraocular Pressure Control Predicts Retinal Nerve Fiber Layer Thinning in Primary Angle Closure Disease: The CUPAL Study. Am J Ophthalmol 2022; 234:205-214. [PMID: 34416183 DOI: 10.1016/j.ajo.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 08/01/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the relationship of intraocular pressure (IOP) control with subsequent retinal nerve fiber layer (RNFL) thinning in patients with primary angle closure disease (PACD). DESIGN Prospective cohort study. METHODS The study monitored 517 treated PACD eyes from 280 Chinese patients at least 24 months. IOP was measured every 3 months using Goldmann applanation tonometry, and RNFLs were measured by spectral-domain optical coherence tomography (Spectralis, Heidelberg Engineering) every 6 months. IOP mean and fluctuation were calculated as the average and the coefficient of variation of IOP measurements during the first 18 months of the study period. The relationship between IOP and subsequent RNFL changes over time were examined using multivariable linear mixed models. Intraclass correlations at the patient and eye levels were also controlled using nested random intercepts in the models. RESULTS IOP mean (β = -1.20 µm/y per 1 mm Hg, P < .001) and IOP fluctuation (β = -3.10 µm/y per 10% unit change in the coefficient of variation, P < .001) were independently negatively associated with subsequent progressive global RNFL changes, after adjustment for age, sex, and baseline RNFL thickness. In the sectoral analysis, both higher mean IOP and IOP fluctuation predicted progressive RNFL thinning in the inferotemporal, superotemporal, superonasal, and temporal sectors in the order of strength of association. In the subgroup analysis by disease category, IOP fluctuation showed greater association with global RNFL thinning in eyes with primary angle closure glaucoma (P = .010) than in eyes without glaucomatous changes (P = .07). CONCLUSIONS In treated PACD eyes, large IOP fluctuation is an independent predictor for subsequent progressive RNFL thinning in addition to high mean IOP during follow-up.
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Wan-Ezatul-Arisha WM, Diana-Toh SJ, Huwaina AS, Najib MY, Azhany Y, Norsa'adah B, Liza-Sharmini AT. Visual field progression in Malay patients with primary glaucoma: survival analysis and prognostic factors. Graefes Arch Clin Exp Ophthalmol 2021; 260:2003-2012. [PMID: 34724110 DOI: 10.1007/s00417-021-05466-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/05/2021] [Accepted: 10/15/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study aims to determine the 5-year visual field progression and identify the prognostic factors for progression in Malay patients with primary glaucoma. METHODS A retrospective cohort record review study was conducted among 222 patients (222 eyes) with primary glaucoma who were selected from a glaucoma research database of a tertiary center in Malaysia. The patients were Malays and diagnosed with primary open-angle glaucoma (POAG) or primary angle-closure glaucoma (PACG). Patients who were followed up regularly for at least 6 months between 1 January 2009 and 31 December 2014 and completed another 1-year follow-up after recruitment (between 1 January 2015 and 31 December 2015) were selected. Multiple prognostic factors that influence visual field progression were identified. Progression of visual field loss was based on the Advanced Glaucoma Intervention Study and Hodapp-Parrish-Anderson scores. Kaplan-Meier survival and Cox proportional hazard regression analyses were performed. RESULTS Sixty-three patients (28.4%) developed visual field progression after a mean (SD) follow-up of 6.9 (3.3) years. Those with POAG progressed faster (mean time, 10.6 years; 95% confidence interval [CI], 9.3, 11.9) than those with PACG (17.3 years; 95% CI, 14.8, 19.9) but not statistically significant. Disc hemorrhage and history of eye pain increased the risk of progression by 2.8-folds (95% CI, 1.6, 4.8) and 2.5-folds (1.4, 4.4), respectively. CONCLUSION The 5-year survival of the Malay primary glaucoma patients with visual field progression was similar with that of other Asian populations. However, aggressive management is required for those with disc hemorrhages and eye pain related to increased intraocular pressure.
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Affiliation(s)
- Wan Masri Wan-Ezatul-Arisha
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Shi Jin Diana-Toh
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia.,Eye Clinic, Hospital Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Abdul Satar Huwaina
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia.,Eye Clinic, Hospital Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Majdi Yaakob Najib
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Yaakub Azhany
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia.,Eye Clinic, Hospital Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Bachok Norsa'adah
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Ahmad Tajudin Liza-Sharmini
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia. .,Eye Clinic, Hospital Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia.
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Thepass G, Lemij HG, Vermeer KA, van der Steen J, Pel JJM. Slowed Saccadic Reaction Times in Seemingly Normal Parts of Glaucomatous Visual Fields. Front Med (Lausanne) 2021; 8:679297. [PMID: 34513866 PMCID: PMC8426641 DOI: 10.3389/fmed.2021.679297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: In eye movement perimetry, peripheral stimuli are confirmed by goal-directed eye movements toward the stimulus. The saccadic reaction time (SRT) is regarded as an index of visual field responsiveness, whereas in standard automated perimetry (SAP), the visual field sensitivity is tested. We investigated the relation between visual field sensitivity and responsiveness in corresponding locations of the visual field in healthy controls and in patients with mild, moderate and advanced glaucoma. Materials and Methods: Thirty-four healthy control subjects and 42 glaucoma patients underwent a 54-point protocol in eye movement perimetry (EMP) and a 24-2 SITA standard protocol in a Humphrey Field Analyzer. The visual field points were stratified by total deviation sensitivity loss in SAP into 6 strata. A generalized linear mixed model was applied to determine the influence of the various factors. Results: The generalized linear mixed model showed that the mean SRT increased with increasing glaucoma severity, from 479 ms in the control eyes to 678 ms in the eyes of patients with advanced glaucoma (p < 0.001). Mean SRTs significantly increased with increasing SAP sensitivity loss. Even at the locations where no sensitivity loss was detected by SAP (total deviation values greater or equal than 0 dB), we found lengthened SRTs in mild, moderate and advanced glaucoma compared to healthy controls (p < 0.05) and in moderate and advanced glaucoma compared to mild glaucoma (p < 0.05). At locations with total deviation values between 0 and −3 dB, −3 and −6 dB and −6 and −12 dB, we found similar differences. Conclusions: The lengthened SRT in areas with normal retinal sensitivities in glaucomatous eyes, i.e., planning and execution of saccades to specific locations, precede altered sensory perception as assessed with SAP. Better understanding of altered sensory processing in glaucoma might allow earlier diagnosis of emerging glaucoma.
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Affiliation(s)
- Gijs Thepass
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands.,Rotterdam Ophthalmic Institute, Rotterdam, Netherlands
| | - Hans G Lemij
- Glaucoma Service, Rotterdam Eye Hospital, Rotterdam, Netherlands
| | | | - Johannes van der Steen
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands.,Royal Dutch Visio, Huizen, Netherlands
| | - Johan J M Pel
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands
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11
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Abu SL, Marín-Franch I, Racette L. Detecting Progression in Patients With Different Clinical Presentations of Primary Open-angle Glaucoma. J Glaucoma 2021; 30:769-775. [PMID: 33867504 PMCID: PMC8404957 DOI: 10.1097/ijg.0000000000001843] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/07/2021] [Indexed: 11/25/2022]
Abstract
PRCIS Glaucoma progression was more frequently identified by assessing retinal fiber layer thickness than by monitoring visual field (VF) loss for different baseline classifications in primary open-angle glaucoma. PURPOSE The aim was to compare the detection of glaucoma progression by retinal nerve fiber layer thickness (RNFLT) and VF assessments for different baseline classifications of primary open-angle glaucoma. METHODS This study included 194 eyes from 194 patients with a minimum of 9 follow-up visits selected from the Diagnostic Innovation in Glaucoma Study (DIGS) and the African Descent and Glaucoma Evaluation Study (ADAGES). Each eye was classified according to baseline clinical signs: ocular hypertension (n=39), glaucomatous optic neuropathy only (n=60), glaucomatous visual field loss only (GVF, n=39) and definite glaucoma (concurrent optic disc and VF defect, n=56). We assessed progression by performing simple linear regression on global and sectorial mean deviations values generated for RNFLT (RNFLT-MD) and VF data (VF-MD). The proportion of eyes identified as progressing (positive rate) by RNFLT-MD and by VF-MD were compared within each classification. RESULTS Whereas both parameters performed similarly among glaucomatous optic neuropathy only and definite glaucoma eyes, the positive rate obtained with global RNFLT-MD was significantly greater compared with global VF-MD by 33.3% and 30.8% among ocular hypertension eyes and GVF eyes, respectively. This finding was consistent in the inferotemporal sector; however, similar positive rates were obtained for both parameters in the superotemporal sector. CONCLUSIONS While both RNFLT and VF parameters showed comparable abilities to identify progression across the different classifications, RNFLT assessment may be better suited to monitor progression, particularly among patients with elevated intraocular pressure and those who present with only GVF defect at baseline.
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Affiliation(s)
- Sampson L. Abu
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Alabama, AL
| | - Iván Marín-Franch
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Alabama, AL
- Computational Optometry, Atarfe, Spain
| | - Lyne Racette
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Alabama, AL
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12
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Predicting the development of normal tension glaucoma and related risk factors in normal tension glaucoma suspects. Sci Rep 2021; 11:16697. [PMID: 34404847 PMCID: PMC8371169 DOI: 10.1038/s41598-021-95984-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/08/2021] [Indexed: 12/29/2022] Open
Abstract
This study investigated the predicted risk factors for the development of normal-tension glaucoma (NTG) in NTG suspects. A total of 684 eyes of 379 NTG suspects who were followed-up for at least 5 years were included in the study. NTG suspects were those having (1) intraocular pressure within normal range, (2) suspicious optic disc (neuroretinal rim thinning) or enlarged cup-to-disc ratio (≥ 0.6), but without definite localized retinal nerve fiber layer (RNFL) defects on red-free disc/fundus photographs, and (3) normal visual field (VF). Demographic, systemic, and ocular characteristics were determined at the time of the first visit via detailed history-taking and examination of past medical records. Various ocular parameters were assess using spectral-domain optical coherence tomography and Heidelberg retinal tomography. Conversion to NTG was defined either by the presence of a new localized RNFL defect at the superotemporal or inferotemporal region on disc/fundus red-free photographs, or presence of a glaucomatous VF defect on pattern standard deviation plots on two consecutive tests. Hazard ratios were calculated with the Cox proportional hazard model. In total, 86 (12.6%) of the 684 NTG suspects converted to NTG during the follow-up period of 69.39 ± 7.77 months. Significant (P < 0.05, Cox regression) risk factors included medication for systemic hypertension, longer axial length, worse baseline VF parameters, thinner baseline peripapillary RNFL, greater disc torsion, and lamina cribrosa (LC) thickness < 180.5 μm (using a cut-off value obtained by regression analysis). Significant (P < 0.05, Cox regression) risk factors in the non-myopic NTG suspects included medication for systemic hypertension and a LC thinner than the cut-off value. Significant (P < 0.05, Cox regression) risk factors in the myopic NTG suspects included greater disc torsion. The results indicated that 12.6% of NTG suspects converted to NTG during the 5–6-year follow-up period. NTG suspects taking medication for systemic hypertension, disc torsion of the optic disc in the inferotemporal direction, and thinner LC of the optic nerve head at baseline were at greater risk of NTG conversion. Related baseline risk factors were different between myopic and non-myopic NTG suspects.
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13
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Risk Factors for the Structural Progression of Myopic Glaucomatous Eyes with a History of Laser Refractive Surgery. J Clin Med 2021; 10:jcm10112408. [PMID: 34072378 PMCID: PMC8198199 DOI: 10.3390/jcm10112408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/25/2022] Open
Abstract
As laser refractive surgeries (LRS) have been widely performed to correct myopia, ophthalmologists easily encounter patients with glaucoma who have a history of LRS. It is well known that intraocular pressure (IOP) in eyes with glaucoma is not accurate when measured using Goldmann applanation tonometry. However, risk factors for glaucoma progression, particularly those associated with measured IOP, have rarely been studied. We analysed data for 40 patients with a history of LRS and 50 age-matched patients without a history of LRS. Structural progression was defined as significant changes in thickness in the peripapillary retinal nerve fibre layer as identified using optical coherence tomography event-based guided progression analysis. Risk factors were determined via Cox regression analysis. Disc haemorrhage (DH) was associated with glaucoma progression in both the non-LRS group and LRS group (hazard ratio (HR): 4.650, p = 0.012 and HR: 8.666, p = 0.019, respectively). However, IOP fluctuation was associated with glaucoma progression only in the LRS group (HR: 1.452, p = 0.023). Our results show that DH was a significant sign of progression in myopic glaucoma eyes. When treating patients with myopia and glaucoma, IOP fluctuation should be monitored more carefully, even if IOP seems to be well controlled.
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14
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Bak E, Kim YW, Ha A, Kim YK, Park KH, Jeoung JW. Pre-perimetric Open Angle Glaucoma with Young Age of Onset: Natural Clinical Course and Risk Factors for Progression. Am J Ophthalmol 2020; 216:121-131. [PMID: 32222365 DOI: 10.1016/j.ajo.2020.03.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the natural clinical course of more than 5 years and the risk factors of progression in patients with pre-perimetric open angle glaucoma (OAG) of "young age of onset (under age 40)" without treatment. DESIGN Retrospective observational case series. METHODS Optic disc photography, red-free retinal nerve fiber layer (RNFL) photography, optical coherence tomography, and visual field (VF) examinations were performed every 6 months. Glaucoma progression was defined as structural or functional deterioration. A linear mixed-effects model was used to estimate the rate of structural and functional changes. Kaplan-Meier survival analysis and log-rank testing were used to compare survival experiences, and Cox proportional hazards modeling was performed to identify risk factors for glaucoma progression. RESULTS Of the 98 eyes of 98 patients (mean age, 30.6 years old), glaucoma progression was detected in 42 eyes (42.9%). The rate of average RNFL thickness thinning was -0.46 ± 0.50 μm/y, and the mean deviation (MD) change was -0.03 ± 0.13 dB/y. The glaucoma progression probability at 5 years was 39% by structural criteria and 5% by functional criteria. Older age at diagnosis (P = .004), presence of temporal raphe sign (horizontal straight line on macular ganglion cell-inner plexiform layer thickness map) (P = .011), lamina pore visibility (P = .034), and greater pattern standard deviation (P = .005) were significant factors for glaucoma progression. CONCLUSIONS In untreated pre-perimetric OAG patients with a "young age of onset" condition, the estimated MD slope for the disease course of more than 5 years was -0.03 dB/y, and the average RNFL thinning rate was -0.46 μm/y. The predictors for progression were structural parameters of temporal raphe sign, lamina pore visibility, and functional parameter of pattern standard deviation.
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15
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Abstract
PURPOSE To compare disease severity between preperimetric primary open-angle glaucoma (POAG) patients with and without deep-layer microvasculature dropout. MATERIALS AND METHODS Ninety-four eyes of 94 preperimetric POAG patients with β-zone parapapillary atrophy (βPPA) were categorized according to the presence of deep-layer microvasculature dropout defined as a complete loss of microvasculature within the choroid or scleral flange on optical coherence tomography angiography. Parameters representing disease severity, that is, visual field (VF) mean deviation (MD), global and sectoral (6-sector) retinal nerve fiber layer (RNFL) thickness, and other factors including age, focal lamina cribrosa (LC) defect, width of βPPA with and without Bruch membrane (BM) (βPPA+BM and βPPA-BM), and optic disc hemorrhage were compared between eyes with and without dropout. RESULTS Deep-layer microvasculature dropout was observed in 33 preperimetric POAG eyes (35.1%). Eyes with dropout had significantly thinner RNFL in all areas except the inferonasal sector, worse VF MD, and higher prevalence of focal LC defect, and larger βPPA-BM (P<0.05), whereas the 2 groups did not differ in age, disc hemorrhage, or βPPA+BM width (P>0.05). In the multivariable logistic regression, worse VF MD [odds ratio (OR), 1.485; P=0.045], thinner RNFL (OR, 1.141; P<0.001), and higher prevalence of focal LC defect (OR, 6.673; P<0.001) were significantly associated with dropout. CONCLUSIONS Deep-layer microvasculature dropout was observed in a considerable number of preperimetric POAG eyes, and worse disease severity was associated with dropout. Future studies elucidating the pathogenic role of deep-layer microvasculature dropout in the development and progression of glaucoma are warranted.
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Affiliation(s)
- Min Hee Suh
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jeoung Ho Na
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Linda M. Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, United States
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, United States
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16
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Progression patterns of normal-tension glaucoma groups classified by hierarchical cluster analysis. Eye (Lond) 2020; 35:536-543. [PMID: 32367001 DOI: 10.1038/s41433-020-0893-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 03/26/2020] [Accepted: 04/14/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To investigate differences in progression patterns of normal-tension glaucoma (NTG) patients in three clusters classified by hierarchical cluster analysis (HCA). MATERIALS AND METHODS In a retrospective study, 200 eyes of NTG patients classified by HCA in 2015 who were followed up to the current date were evaluated. Peripapillary retinal nerve fibre layer (RNFL) thicknesses were measured by Cirrus HD-OCT and progression rate was calculated by trend analysis (Guided Progression Analysis [GPA]). VF progression rate was evaluated by linear regression analysis of mean deviation (MD). Progression patterns of three clusters were compared by histograms. RESULTS In total, 153 eyes of 153 patients were followed up. Mean observation period was 5 years. RNFL reduction rate was -0.83 μm/year in cluster 1, which showed early glaucomatous damage in previous reports; -0.45 μm/year in cluster 2, which showed moderate glaucomatous damage; and -0.36 μm/year in cluster 3, which showed young and myopic glaucomatous damage. The progression pattern of cluster 3 showed a double-peak distribution; RNFL reduction rate was 0.11 μm/year in the non-progressive group and -1.07 μm/year in the progressive group. CONCLUSION The progression patterns were different among three NTG groups that were divided by HCA. In particular, the group of young and myopic eyes showed a mixture of two different patterns.
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17
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Lee EJ, Kim TW, Kim JA, Kim GN, Kim JM, Girard MJA, Mari JM, Kim H. Elucidation of the Strongest Factors Influencing Rapid Retinal Nerve Fiber Layer Thinning in Glaucoma. Invest Ophthalmol Vis Sci 2019; 60:3343-3351. [PMID: 31370062 DOI: 10.1167/iovs.18-26519] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine which groupings of prognostic factors best explain the rapid progressive retinal nerve fiber layer (RNFL) thinning in patients with primary open-angle glaucoma (POAG). Methods Optic nerves of 111 POAG patients who were followed for at least 2.5 years, during which the RNFL thickness was measured by serial spectral-domain optical coherence tomography (OCT) were included. Eyes were imaged using enhanced depth-imaging spectral-domain OCT and swept-source OCT angiography to determine the lamina cribrosa curvature index (LCCI), and the presence of a choroidal microvasculature dropout (cMvD), respectively. The rate of RNFL thinning was determined by linear regression of serial OCT RNFL thickness measurements. A regression tree model was used to find groupings of factors that best explain the rate of future RNFL thinning. Results Disc hemorrhage, larger LCCI, and presence of cMvD were associated with faster global RNFL thinning in the multivariate regression analysis. The regression tree analysis revealed three stratified groups based on the rate of RNFL thinning, divided by the LCCI and the presence of cMvD. Eyes with LCCI ≥11.87 had the fastest RNFL thinning (-2.4 ± 0.8 μm/year, mean ± SD). Among eyes with LCCI <11.87, the presence of cMvD was the strongest factor influencing faster RNFL thinning (-1.5 ± 0.8 μm/year). Eyes with LCCI <11.87 and without a cMvD exhibited the slowest RNFL thinning (-0.8 ± 0.9 μm/year). Conclusions Our regression tree model demonstrated that larger LCCI, and then the presence of cMvD were the first and second strongest prognostic factors for faster progressive RNFL thinning. Further studies may be needed to confirm these findings.
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Affiliation(s)
- Eun Ji Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae-Woo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji-Ah Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Gyu-Nam Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon Mo Kim
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Michaël J A Girard
- Department of Biomedical Engineering, National University of Singapore, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Jean Martial Mari
- GePaSud, Université de la Polynésie Française, Tahiti, French Polynesia
| | - Hyunjoong Kim
- Department of Applied Statistics, Yonsei University, Seoul, Korea
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18
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Mangouritsas G, Koutropoulou N, Ragkousis A, Boutouri E, Diagourtas A. Peripapillary Vessel Density In Unilateral Preperimetric Glaucoma. Clin Ophthalmol 2019; 13:2511-2519. [PMID: 31997876 PMCID: PMC6917599 DOI: 10.2147/opth.s224757] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/18/2019] [Indexed: 01/08/2023] Open
Abstract
Purpose To investigate vessel density (VD) of radial peripapillary capillaries (RPC) and structural alterations in patients with unilateral preperimetric glaucoma (PPG) using optical coherence tomography angiography (OCTA). Methods This cross-sectional observational study included 13 untreated patients with unilateral PPG. PPG eyes had larger excavation and abnormal thinning of retinal nerve fiber layer (RNFL) and/or ganglion cell complex (GCC) compared with fellow eyes (F). Both RNFL and GCC thickness in F were statistically within normal limits and/or borderline. The RPC VD on optic disc (idVD), of peripapillary (ppVD) and whole image (wiVD) scan area was measured. Twenty healthy eyes (H) served as controls. Structural and vascular parameters obtained by spectral-domain OCT/OCTA (Optovue; Fremont, CA) were compared between PPG, F and H. Results Mean RNFL and GCC average thickness in microns differed significantly (p<0.001) between PPG (82.4±7.1, 81.4±5.9), F (91.0±7.1, 88.5±3.8) and H (103.5±6.0, 99.3±5.7). PPG compared with F showed significantly (p<0.001) lower mean ppVD (43.8%±3.0% versus 47.8%±3.2%) and wiVD (45.9%±3.5% versus 50.1%±3.9%). Mean ppVD (49.7%±2.4%) and wiVD (52.6%±3.0%) in H were not significantly higher than in F. Mean idVD showed no significant differences among the 3 groups. Areas under the receiver operating characteristic curves (AUROCs) for RNFL, GCC, ppVD and wiVD between PPG and H were excellent (>0.9). AUROCs between F and H demonstrated an excellent diagnostic ability for structural parameters and a poor one (<0.7) for vascular parameters. Conclusion Affected eyes of patients with unilateral PPG demonstrated significant RPC dropout. Clinically unaffected eyes showed thinner structural parameters but no significant microvasculature differences compared with non-glaucomatous eyes. Diagnostic ability of peripapillary vascular parameters was not superior to structural measurements. Microvascular dysfunction seems to be an early but not a primary event in glaucoma continuum at the stage of undetectable visual field loss. OCTA can be useful in early glaucoma diagnosis.
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Affiliation(s)
- G Mangouritsas
- Eye Clinic, General Hospital ''Red Cross'', Athens, Greece
| | - N Koutropoulou
- Eye Clinic, General Hospital ''Red Cross'', Athens, Greece
| | - A Ragkousis
- Eye Clinic, General Hospital ''Red Cross'', Athens, Greece
| | - E Boutouri
- Eye Clinic, General Hospital ''Red Cross'', Athens, Greece
| | - A Diagourtas
- 1st University Eye Clinic, General Hospital "G. Gennimatas", Athens, Greece
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19
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Lu P, Xiao H, Liang C, Xu Y, Ye D, Huang J. Quantitative Analysis of Microvasculature in Macular and Peripapillary Regions in Early Primary Open-Angle Glaucoma. Curr Eye Res 2019; 45:629-635. [PMID: 31587582 DOI: 10.1080/02713683.2019.1676912] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Purpose: To evaluate macular and radial peripapillary capillary vessel densities (RPC VD) across normal, pre-perimetric (PPG), and early perimetric primary open-angle glaucoma (EG) using optical coherence tomography angiography (OCTA).Materials and Methods: Forty-four PPG eyes, 42 EG eyes, and 41 normal eyes were consecutively enrolled. All subjects underwent visual field, OCT, and OCTA examinations. Macular vessel densities were measured in the superficial layer. RPC VD was measured within a 750-μm-wide elliptical annulus extending outward from disc boundary. Diagnostic ability was evaluated with area under the receiver operating curve.Results: Parafoveal vessel densities (ParaVDs) in the PPG group were comparable to the normal group (p > .05), except for temporal quadrant (p = .044), while perifoveal vessel densities (PeriVD) were lower in the PPG group (p < .05). ParaVD and PeriVD were lower in the EG group compared with the normal group (p < .001). Superior-temporal and inferior-temporal retinal nerve fiber layers (RNFLs) were significantly decreased in the EG group compared with the PPG group (p < .05), while only inferior-temporal RPC VD was lower in the EG group (p < .05). RPC VD was comparable to RNFL and ganglion cell complex (GCC) in the diagnosis of PPG (p > .05). Macular whole image vessel density and PeriVD were comparable to RPC VD, RNFL, and GCC in diagnosing EG (p > .05).Conclusions: In early primary open-angle glaucoma, significant microvascular damage was present in both macular and peripapillary areas. The damage of macular microvasculature was more prominent in the peripheral area. Vessel density parameters showed promising diagnostic ability in early glaucoma.Abbreviations: POAG = primary open-angle glaucoma; RGC = retinal ganglion cell; OCTA = optical coherence tomography angiography; RNFL = retinal nerve fiber layer; PPG = pre-perimetric primary open-angle glaucoma; EG = early perimetric primary open-angle glaucoma; IOP = intraocular pressure; PSD = pattern standard deviation; MD = mean deviation; GCC = ganglion cell complex; SBP = systolic blood pressure; DBP = diastolic blood pressure; MAP = mean arterial pressure; MOPP = mean ocular perfusion pressure; wiVD = whole image vessel density; ParaVD = parafoveal vessel density; PeriVD = perifoveal vessel density; RPC VD = radial peripapillary capillary vessel density; AUC = area under the receiver operating curve.
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Affiliation(s)
- Peng Lu
- State Key Laboratory of Ophthalmology, Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Hui Xiao
- State Key Laboratory of Ophthalmology, Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chen Liang
- State Key Laboratory of Ophthalmology, Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yue Xu
- State Key Laboratory of Ophthalmology, Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Dan Ye
- State Key Laboratory of Ophthalmology, Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jingjing Huang
- State Key Laboratory of Ophthalmology, Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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20
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Hugo J, Matonti F, Beylerian M, Zanin E, Aptel F, Denis D. Safety and efficacy of high-intensity focused ultrasound in severe or refractory glaucoma. Eur J Ophthalmol 2019; 31:130-137. [PMID: 31550914 DOI: 10.1177/1120672119874594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this study was to evaluate the efficacy and safety of ultrasonic cyclocoagulation in severe or refractory glaucoma, and to analyze the procedure-related inflammation. PATIENTS AND METHODS In this retrospective study, 15 eyes of 13 patients suffering from severe or refractory glaucoma with uncontrolled intraocular pressure of ⩾21 mmHg underwent 8-s ultrasonic cyclocoagulation. A complete ophthalmic evaluation, quality of life assessment using Glau-Qol-17, endothelial cell count, and flare measurement were performed. Primary outcome was qualified surgical success (defined as intraocular pressure reduction from baseline ⩾20% and intraocular pressure >5 mmHg without hypotensive medication adjunction). Secondary outcomes were flare, endothelial cell loss, and quality of life. RESULTS Qualified success was achieved in 67% of eyes at 6 months (mean intraocular pressure reduction = 42% in these eyes). During the first month after the procedure, the mean flare reached its maximum value when the intraocular pressure was minimal; the flare slowly decreased until normalization at month 3 when the maximal intraocular pressure was noted. At month 3, there was moderate but significant endothelial cell loss (11%), and no significant alteration in quality of life was demonstrated. CONCLUSION The efficacy of ultrasonic cyclocoagulation in the present study is comparable to that reported in the literature. The kinetics of intraocular pressure and flare suggest that postoperative inflammation could be partly responsible for the early intraocular pressure decrease. The moderate endothelial cell loss, which could be caused by localized heating, and the preservation of quality of life confirm the safety of ultrasonic cyclocoagulation.
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Affiliation(s)
- Juliette Hugo
- Department of Ophthalmology, Nord Hospital, APHM, Marseille, France
| | - Frederic Matonti
- CNRS, INT, Institut Neurosciences Timone, Aix-Marseille Université, Marseille, France.,Centre Paradis Monticelli, Marseille, France
| | - Marie Beylerian
- Department of Ophthalmology, Nord Hospital, APHM, Marseille, France
| | - Emilie Zanin
- Department of Ophthalmology, Nord Hospital, APHM, Marseille, France
| | - Florent Aptel
- Department of Ophthalmology, University Hospital of Grenoble and Université Grenoble Alpes, Grenoble, France
| | - Danièle Denis
- Department of Ophthalmology, Nord Hospital, APHM, Marseille, France
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21
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Kim YC, Koo YH, Jung KI, Park CK. Impact of Posterior Sclera on Glaucoma Progression in Treated Myopic Normal-Tension Glaucoma Using Reconstructed Optical Coherence Tomographic Images. ACTA ACUST UNITED AC 2019; 60:2198-2207. [DOI: 10.1167/iovs.19-26794] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Yong Chan Kim
- Department of Ophthalmology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Yong Ho Koo
- Department of Ophthalmology, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Kyoung In Jung
- Department of Ophthalmology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Kee Park
- Department of Ophthalmology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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22
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Lee SY, Kim EW, Choi W, Park CK, Kim S, Bae HW, Seong GJ, Kim CY. Significance of dynamic contour tonometry in evaluation of progression of glaucoma in patients with a history of laser refractive surgery. Br J Ophthalmol 2019; 104:276-281. [PMID: 31088795 DOI: 10.1136/bjophthalmol-2018-313771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/22/2019] [Accepted: 04/17/2019] [Indexed: 11/04/2022]
Abstract
AIMS In this study, we tested the hypothesis that intraocular pressure (IOP) parameters measured by dynamic contour tonometry (DCT) would be more relevant in progression of glaucoma when there is a history of laser refractive surgery (LRS) than the IOP parameters measured by Goldmann applanation tonometry (GAT) or calculated by correction formulae. METHODS Ninety-eight eyes in 54 patients with open-angle glaucoma and a history of LRS were included in this retrospective study. IOP was measured by both GAT and DCT during follow-up. Baseline, mean, and peak IOP, IOP fluctuation, and IOP reduction were measured by each tonometry method. Corrected IOP parameters using central corneal thickness and mean keratometry values were also analysed. Clustered logistic regression was used to identify variables correlated with progression of glaucoma. Areas under the curve (AUCs) for correlated variables were also compared. RESULTS The mean DCT value (OR 1.36, p=0.024), peak DCT value (OR 1.19, p=0.02) and pattern SD (OR 1.10, p=0.016) were significant risk factors for progression. There was a significant difference in the predictive ability of the mean DCT and GAT values (AUC 0.63 and 0.514, respectively; p=0.01) and of the peak DCT and GAT values (0.646 and 0.503, respectively, p=0.009). The AUCs for corrected IOP did not exceed those of DCT. CONCLUSIONS IOP measurements were more associated with progression of glaucoma when measurements were obtained by DCT than by GAT or correction formulae in eyes with a history of LRS.
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Affiliation(s)
- Sang Yeop Lee
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Woo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Wungrak Choi
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Keum Park
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sangah Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyoung Won Bae
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Gong Je Seong
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Yun Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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23
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Liu Y, Chen Y, Wang Y, Zhang X, Gao K, Chen S, Zhang X. microRNA Profiling in Glaucoma Eyes With Varying Degrees of Optic Neuropathy by Using Next-Generation Sequencing. Invest Ophthalmol Vis Sci 2019; 59:2955-2966. [PMID: 30025119 DOI: 10.1167/iovs.17-23599] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To explore the microRNA (miRNA) profile and its putative role in glaucomatous optic neuropathy by using next-generation sequencing. Methods Aqueous humor (AH) samples were collected from 19 primary open-angle glaucoma (POAG) eyes and 17 cataract eyes before surgery. Next-generation sequencing was performed for RNA samples extracted from 18 AH samples, and the bioinformatics approach was applied for samples with adequate clean data output. The other 18 samples were used for quantitative PCR validation of sequencing results. Results In total, 12 (six POAG and six cataract controls) samples with sufficient clean data output after sequencing were used for further data analysis. Four hundred sixty-six and 480 mature miRNAs were detected in the POAG and cataract control groups, respectively. Among them, 164 miRNAs were detected in all POAG samples, and 96 miRNAs were detected in all cataract control samples. Furthermore, 88 miRNAs were identified as differently expressed between POAG and cataract control eyes. In addition, 16 miRNAs were differently expressed between POAG eyes with severe visual field damage and eyes with moderate visual field damage. This differential expression was predicted to regulate thiamine metabolism, purine metabolism, and transcriptional misregulation. Relative expression patterns of hsa-miR-184, hsa-miR-486-5p, and hsa-miR-93-5p were confirmed by quantitative PCR. Conclusions This study comprehensively demonstrated the miRNA expression profile in the AH of POAG eyes, especially the differential expression of miRNA in eyes with varying degrees of visual field damage, which, together with the underlying miRNA-related pathways, indicate new targets for the pathogenesis and progression of POAG.
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Affiliation(s)
- Yaoming Liu
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yang Chen
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yayi Wang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xinyu Zhang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Kai Gao
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shida Chen
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiulan Zhang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People's Republic of China
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Abstract
Autonomic dysfunction is a feature of glaucoma patients, which are reported to be related to glaucoma progression. We investigated pupil responses to a light flash using dynamic pupillometry in glaucoma patients to assess autonomic nervous system status. In total, 97 glaucoma patients, including 21 eyes of 21 glaucoma patients with cardiac autonomic dysfunction, were enrolled. Pupil reactions were assessed using 1 flash of white light after 2 minutes of dark adaptation and recorded using dynamic pupillometry. Changes in the radius of the pupil were evaluated as a function of several time-dependent and pupil/iris (P/I) diameter ratio parameters. Autonomic function was assessed using a cardiac heart-rate-variability test which performs 5 autonomic function tests and classifies patients with cardiac autonomic neuropathy (CAN). Comparison of pupil parameters between eyes with and without disc hemorrhage indicated larger P/I ratios in darkness, greater changes in the P/I ratio during examination, shorter latency to plateau, and shorter duration of constriction in eyes with disc hemorrhages. A comparison of pupil parameters between eyes with and without CAN showed larger P/I ratios in darkness, larger P/I ratios at maximum constriction, and prolonged latency to maximum constriction. The presence of CAN was significantly related to the P/I ratio in darkness and the latency of maximum constriction. Using dynamic pupillometry, we found that glaucoma patients with CAN dysfunction have larger baseline pupils in darkness and different constriction responses to light. Assessing the pupils might be a good method of identifying patients with autonomic dysfunction.
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Affiliation(s)
| | | | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal
Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic
University of Korea, Seoul, Republic of Korea
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25
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Ly A, Phu J, Katalinic P, Kalloniatis M. An evidence-based approach to the routine use of optical coherence tomography. Clin Exp Optom 2018; 102:242-259. [PMID: 30560558 PMCID: PMC6590481 DOI: 10.1111/cxo.12847] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/13/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023] Open
Abstract
Optical coherence tomography is an imaging technology that has revolutionised the detection, assessment and management of ocular disease. It is now a mainstream technology in clinical practice and is performed by non-specialised personnel in some settings. This article provides a clinical perspective on the implications of that movement and describes best practice using multimodal imaging and an evidence-based approach. Practical, illustrative guides on the interpretation of optical coherence tomography are provided for three major diseases of the ocular fundus, in which optical coherence tomography is often crucial to management: age-related macular degeneration, diabetic retinopathy and glaucoma. Topics discussed include: cross-sectional and longitudinal signs in ocular disease, so-called 'red-green' disease whereby clinicians rely on machine/statistical comparisons for diagnosis in managing treatment-naïve patients, and the utility of optical coherence tomography angiography and machine learning.
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Affiliation(s)
- Angelica Ly
- Centre for Eye Health, The University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Science, School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Jack Phu
- Centre for Eye Health, The University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Science, School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Paula Katalinic
- Centre for Eye Health, The University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Science, School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, The University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Science, School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
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Yamamoto T. The impact of disc hemorrhage studies on our understanding of glaucoma: a systematic review 50 years after the rediscovery of disc hemorrhage. Jpn J Ophthalmol 2018; 63:7-25. [PMID: 30465174 DOI: 10.1007/s10384-018-0641-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/19/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW To trace the influence of disc hemorrhage studies on our understanding of glaucoma. SOURCES Major articles published during the last 50 years since the rediscovery of disc hemorrhage were identified. A total of 196 articles were selected from 435 articles retrieved using the keywords glaucoma and disc hemorrhage as of August 9 2018 from PubMed. RECENT FINDINGS The main characteristics of disc hemorrhage, including its morphology, recurrence rate, duration, increased incidence in glaucoma, and role in the progression of normal tension glaucoma was well understood by the year 2000. Since then, studies have focused on more sophisticated and accurate methods of elucidating both structural and functional progression, with special attention to the role of the lamina cribrosa. Nevertheless, both the mechanism of disc hemorrhage development and its fuller relationship with glaucoma remain unclear. Disc hemorrhage research requires careful study of glaucomatous optic neuropathy. This has been facilitated by recent advances in optical coherence tomography (OCT) angiography and other OCT technologies. Furthermore, animal studies of disc hemorrhage promise new insights into glaucomatous optic neuropathy.
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Affiliation(s)
- Tetsuya Yamamoto
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, 501-1194, Japan.
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27
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Chen Y, Qiu C, Qian S, Chen J, Chen X, Wang L, Sun X. Lack of Association of rs1192415 in TGFBR3-CDC7 With Visual Field Progression: A Cohort Study in Chinese Open Angle Glaucoma Patients. Front Genet 2018; 9:488. [PMID: 30405695 PMCID: PMC6208000 DOI: 10.3389/fgene.2018.00488] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 10/01/2018] [Indexed: 11/13/2022] Open
Abstract
To investigate the association of known candidate genes with the visual field (VF) progression of primary open angle glaucoma (POAG) in a Han Chinese population. We included 440 POAG patients in this study. Fourteen previously reported single nucleotide polymorphisms (SNPs) at five different gene regions (TGFBR3-CDC7, TMCO1, CDKN2B-AS1, ATOH7, and SIX1/SIX6) were genotyped. Age at diagnosis, gender, intraocular pressure (IOP), mean defect (MD) of VF, vertical cup disk ratio (VCDR), best corrected visual acuity (BCVA), central corneal thickness (CCT), and axial length (AL) were recorded at baseline. Patients were followed up for 5 years to evaluate VF progression over time. Clinical information and allele frequencies of 14 SNPs were compared between patients who progressed and who did not within 5 years by multivariate logistic regression. Survival analysis was performed to evaluate the contribution of the associated SNP by cox regression. Greater MD (P < 0.0001), increased VCDR (P = 0.0001), higher IOP (P = 0.0003), worse BCVA (P = 0.002), and older age (P = 0.030) at the baseline were associated with VF progression. Both multivariate logistic regression and cox regression survival analysis showed none of the 14 SNPs statistically associated with VF progression adjusted with age at diagnosis, gender, baseline MD, follow-up IOP, CCT, and AL. There were lack of association of SNPs at TGFBR3-CDC7, TMCO1, ATOH7, CDKN2B-AS1, SIX1/SIX6 loci with VF progression in POAG patients in Han Chinese. Further studies are needed to evaluate the association of genetic variants with VF progression.
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Affiliation(s)
- Yuhong Chen
- Department of Ophthalmology and Vision Science, Eye and Ear Nose Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Chen Qiu
- Department of Ophthalmology and Vision Science, Eye and Ear Nose Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, China
| | - Shaohong Qian
- Department of Ophthalmology and Vision Science, Eye and Ear Nose Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Junyi Chen
- Department of Ophthalmology and Vision Science, Eye and Ear Nose Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xueli Chen
- Department of Ophthalmology and Vision Science, Eye and Ear Nose Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Li Wang
- Department of Ophthalmology and Vision Science, Eye and Ear Nose Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology and Vision Science, Eye and Ear Nose Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration, Shanghai, China.,State Key Laboratory of Medical Neurobiology, Institute of Brain Science, Fudan University, Shanghai, China
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28
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Phu J, Kalloniatis M, Wang H, Khuu SK. Differences in Static and Kinetic Perimetry Results are Eliminated in Retinal Disease when Psychophysical Procedures are Equated. Transl Vis Sci Technol 2018; 7:22. [PMID: 30280007 PMCID: PMC6166892 DOI: 10.1167/tvst.7.5.22] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/13/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose We tested the hypothesis that clinical statokinetic dissociation (SKD, defined as the difference in sensitivity to static and kinetic stimuli) at the scotoma border in retinal disease is due to individual criterion bias and that SKD can be eliminated by equating the psychophysical procedures for testing static and kinetic stimulus detection. Methods Six subjects with glaucoma and six with retinitis pigmentosa (RP) were tested. Clinical procedures (standard automated perimetry [SAP] and manual kinetic perimetry [MKP]) were used to determine clinical SKD and the region of interest for laboratory-based testing. Two-way Method of Limits (MoL) was used to establish the isocontrast region at the scotoma border in glaucoma and RP subjects. Method of Constant Stimuli (MoCS) and a two-interval forced choice (2IFC) procedure then were used to present static or kinetic (inward or outward) stimuli at different eccentricities within the isocontrast region. The results were fitted with psychometric functions to determine threshold eccentricities. Results Clinical SKD was found in glaucoma and RP subjects, with variable magnitude among subjects, but significantly exceeding expected typical measurement variability. The resultant psychometric functions when using MoCS and 2IFC showed equal sensitivity to static and kinetic targets, thus eliminating SKD. Conclusions Clinical SKD found using clinical techniques is due to methodologic differences and criterion bias, and is eliminated by using an equated and more objective psychophysical task, similar to normal subjects. Translational relevance Eliminating SKD using a psychophysical approach minimizing criterion bias suggests that it is not useful to distinguish between normal and diseased fields.
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Affiliation(s)
- Jack Phu
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Henrietta Wang
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
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29
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Blanch RJ, Micieli JA, Oyesiku NM, Newman NJ, Biousse V. Optical coherence tomography retinal ganglion cell complex analysis for the detection of early chiasmal compression. Pituitary 2018; 21:515-523. [PMID: 30097827 DOI: 10.1007/s11102-018-0906-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To report patients with sellar tumors and chiasmal compression with normal visual fields, who demonstrate damage to the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) on optical coherence tomography (OCT). METHODS Seven patients with sellar tumors causing mass effect on the optic chiasm without definite visual field defect, but abnormal GCC are described. GCC/RNFL analyses using Cirrus-OCT were classified into centiles based on the manufacturer's reference range. RESULTS In seven patients with radiologic compression of the chiasm by a sellar tumor, OCT-GCC thickness detected compressive chiasmopathy before visual defects became apparent on standard automated visual field testing. Without OCT, our patients would have been labelled as having normal visual function and no evidence of compressive chiasmopathy. With only OCT-RNFL analysis, 3/7 patients would still have been labelled as having no compression of the anterior visual pathways. CONCLUSIONS These patients show that OCT-GCC analysis is more sensitive than visual field testing with standard automated perimetry in the detection of compressive chiasmopathy or optic neuropathy. These cases and previous studies suggest that OCT-GCC analysis may be used in addition to visual field testing to evaluate patients with lesions compressing the chiasm.
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Affiliation(s)
- Richard J Blanch
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - Jonathan A Micieli
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Nelson M Oyesiku
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
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30
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Phu J, Khuu SK, Bui BV, Kalloniatis M. Application of Pattern Recognition Analysis to Optimize Hemifield Asymmetry Patterns for Early Detection of Glaucoma. Transl Vis Sci Technol 2018; 7:3. [PMID: 30197835 PMCID: PMC6126954 DOI: 10.1167/tvst.7.5.3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/18/2018] [Indexed: 02/01/2023] Open
Abstract
Purpose To assess the diagnostic utility of a new hemifield asymmetry analysis derived using pattern recognition contrast sensitivity isocontours (CSIs) within the Humphrey Field Analyzer (HFA) 24-2 visual field (VF) test grid. The performance of an optimal CSI-derived map was compared against a commercially available clustering method (Glaucoma Hemifield Test, GHT). Methods Five hundred VF results of 116 healthy subjects were used to determine normative distribution limits for comparisons. Pattern recognition analysis was applied to HFA 24-2 sensitivity data to determine CSI theme maps delineating clusters for hemifield comparisons. Then, 1019 VF results from 228 glaucoma patients were assessed using different clustering methods to determine the true-positive rate. We also assessed additional 354 VF results of 145 healthy subjects to determine the false-positive rate. Results The optimum clustering method was the CSI-derived seven-theme class map, which identified more glaucomatous VFs compared with the GHT map. The seven-class theme map also identified more cases compared with the five-, six-, and eight-class maps, suggesting no effect of number of clusters. Integrating information regarding the location of glaucomatous defects to the CSI clusters did not improve detection rate. Conclusions A clustering map derived using CSIs improved detection of glaucomatous VFs compared with the currently available GHT. An optimized CSI-derived map may serve as an additional means to aid earlier detection of glaucoma. Translational Relevance Pattern recognition–derived theme maps provide a means for guiding test point selection for asymmetry analysis in glaucoma assessment.
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Affiliation(s)
- Jack Phu
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Bang V Bui
- Department of Optometry and Vision Science, University of Melbourne, Parkville, VIC, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
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31
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Comparison between Lamina Cribrosa Depth and Curvature as a Predictor of Progressive Retinal Nerve Fiber Layer Thinning in Primary Open-Angle Glaucoma. Ophthalmol Glaucoma 2018; 1:44-51. [PMID: 32672632 DOI: 10.1016/j.ogla.2018.05.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/31/2018] [Accepted: 05/31/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare the ability of lamina cribrosa (LC) depth (LCD) and LC curvature to predict the rate of progressive retinal nerve fiber layer (RNFL) thinning in patients with primary open-angle glaucoma (POAG). DESIGN Observational case series. PARTICIPANTS A total of 114 eyes of 114 patients diagnosed with POAG, in which RNFL thickness had been measured by serial spectral-domain (SD) OCT for at least 2.5 years. METHODS The optic nerves of all participants underwent enhanced depth imaging volume scanning, and their circumpapillary RNFL thickness was measured using SD OCT, followed by regular serial measurements of RNFL thickness at intervals of ≥6 months. The LCD from the levels of Bruch's membrane (BM, LCD-BM) and the anterior sclera (AS, LCD-AS), and LC curvature index (LCCI) were measured by SD OCT at 3 locations: superior midperipheral, midhorizontal, and inferior midperipheral. The rate of RNFL thinning over time was determined by linear regression of serial OCT measurements of RNFL thickness. MAIN OUTCOME MEASURES Factors associated with the rate of OCT RNFL thinning. RESULTS Univariate analysis showed that larger LCD-BM (P = 0.001), LCD-AS (P < 0.001), and LCCI (P < 0.001) were all significantly associated with a faster rate of global RNFL thinning. The LCCI showed a stronger correlation with the rate of global RNFL thinning than LCD-BM (P < 0.001) or LCD-AS (P < 0.001). Of the 3 variables, only LCCI remained significant on multivariate analysis (P < 0.001). Disc hemorrhage during follow-up (P = 0.003), wider parapapillary atrophy β-zone (P = 0.017), and greater global RNFL thickness (P = 0.040) were also significantly associated with a faster rate of global RNFL thinning. CONCLUSIONS Morphology of LC was significantly associated with the rate of progressive RNFL thinning. Curvature of LC better predicted progressive RNFL thinning than did LCD measured from the BM or AS.
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Shiga Y, Aizawa N, Tsuda S, Yokoyama Y, Omodaka K, Kunikata H, Yasui T, Kato K, Kurashima H, Miyamoto E, Hashimoto M, Nakazawa T. Preperimetric Glaucoma Prospective Study (PPGPS): Predicting Visual Field Progression With Basal Optic Nerve Head Blood Flow in Normotensive PPG Eyes. Transl Vis Sci Technol 2018; 7:11. [PMID: 29372113 PMCID: PMC5782826 DOI: 10.1167/tvst.7.1.11] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/21/2017] [Indexed: 01/28/2023] Open
Abstract
Purpose To investigate the site specificity of visual field changes in eyes with normotensive preperimetric glaucoma (PPG), and to determine factors influencing visual field progression. Methods This prospective study comprised 84 eyes of 84 normotensive PPG patients followed for at least 16 months. Optic nerve head (ONH) blood flow was assessed with tissue-area mean blur rate (MBRT), derived from laser speckle flowgraphy. Total deviation (TD) was measured in each sector of the Garway-Heath map to evaluate the site specificity of visual field loss. Subjects with a TD slope in the first quartile were classified as progressive, and other subjects as nonprogressive. Linear and multiple regression analyses were performed to determine factors affecting visual field progression. Results TD in the superior sector significantly decreased in the subjects overall during the follow-up periods (−0.48 ± 1.92 dB/y, P = 0.025). Linear regression analysis showed that basal MBRT-inferior was correlated significantly with TD-superior slope (r = 0.332, P = 0.002). Furthermore, basal MBRT was significantly lower in this sector in the progressive than the nonprogressive group (P = 0.010). Multiple linear regression analysis revealed that basal MBRT-inferior was the only predictive factor for TD-superior slope (β = 0.329, P = 0.005). Conclusions These findings suggest that superior-sector visual field progression is most common in normotensive PPG eyes, and that reduced basal ONH blood flow is associated with visual field progression. Translational Relevance These findings provide new insight into the involvement of ONH blood flow impairment in glaucoma pathogenesis, and demonstrate the importance of assessing ONH blood flow to determine visual field progression in normotensive PPG.
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Affiliation(s)
- Yukihiro Shiga
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoko Aizawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoru Tsuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yu Yokoyama
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuko Omodaka
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | | | - Hiroaki Kurashima
- Japan Medical Affairs, Global R&D, Santen Pharmaceutical Co. Ltd., Osaka, Japan
| | - Etsuyo Miyamoto
- Japan Medical Affairs, Global R&D, Santen Pharmaceutical Co. Ltd., Osaka, Japan
| | - Masayo Hashimoto
- Japan Medical Affairs, Global R&D, Santen Pharmaceutical Co. Ltd., Osaka, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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33
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Relationship between corneal biomechanical properties and structural biomarkers in patients with normal-tension glaucoma: a retrospective study. BMC Ophthalmol 2018; 18:7. [PMID: 29334923 PMCID: PMC5769305 DOI: 10.1186/s12886-018-0673-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 01/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background We evaluated the relationships between corneal biomechanical properties and structural parameters in patients with newly diagnosed, untreated normal-tension glaucoma (NTG). Methods All subjects were evaluated using an Ocular Response Analyzer (ORA) measuring corneal hysteresis (CH) and the corneal resistance factor (CRF). Central corneal thickness (CCT), Goldmann applanation tonometric (GAT) data, axial length, and the spherical equivalent (SE), were also measured. Confocal scanning laser ophthalmoscopy was performed with the aid of a Heidelberg retina tomograph (HRT III). We sought correlations between HRT parameters and different variables including CCT, CH, and the CRF. Multiple linear regression analysis was performed to identify significant associations between corneal biomechanical properties and optic nerve head parameters. Results We enrolled 95 eyes of 95 NTG patients and 93 eyes of 93 normal subjects. CH and the CRF were significantly lower in more advanced glaucomatous eyes (P = 0.001, P = 0.008, respectively). The rim area, rim volume, linear cup-to-disc ratio (LCDR), and mean retinal nerve fiber layer (RNFL) thickness were significantly worse in more advanced glaucomatous eyes (P < 0.001, P < 0.001, P < 0.001, and P = 0.001). CH was directly associated with rim area, rim volume, and mean RNFL thickness (P = 0.012, P = 0.028, and P = 0.043) and inversely associated with LCDR (P = 0.015), after adjusting for age, axial length, CCT, disc area, GAT data, and SE. However, in normal subjects, there were no significant associations between corneal biomechanical properties and HRT parameters. Conclusions A lower CH is significantly associated with a smaller rim area and volume, a thinner RNFL, and a larger LCDR, independent of disc size, corneal thickness, intraocular pressure, and age.
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Lamina Cribrosa Morphology Predicts Progressive Retinal Nerve Fiber Layer Loss In Eyes with Suspected Glaucoma. Sci Rep 2018; 8:738. [PMID: 29335420 PMCID: PMC5768684 DOI: 10.1038/s41598-017-17843-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/22/2017] [Indexed: 11/22/2022] Open
Abstract
Although early diagnosis and treatment reduce the risk of blindness from glaucoma, the decision on whether or not to begin treatment in patients with suspected glaucoma is often a dilemma because the majority of patients never develop definite glaucoma. A growing body of evidences suggests that posterior bowing of the lamina cribrosa (LC) is the earliest structural change preceding the retinal nerve fiber layer (RNFL) loss in glaucomatous optic neuropathy. Based on this notion, we conducted a prospective study enrolling 87 eyes suspected of having glaucoma to investigate whether the future rate of RNFL loss is associated with the baseline LC curve evaluated by measuring the LC curve index (LCCI) using enhanced depth imaging optical coherence tomography. A faster rate of RNFL loss was significantly associated with greater LCCI (P < 0.001;standardized coefficient beta = −0.392), older age (P = 0.008;beta = −0.314), and greater vertical cup-to-disc ratio (P = 0.040;beta = −0.233). Assessment of LC morphology may help predict the disease outcome in eyes with suspected glaucoma.
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Aizawa N, Kunikata H, Shiga Y, Tsuda S, Yokoyama Y, Omodaka K, Yasui T, Kato K, Kurashima H, Miyamoto E, Hashimoto M, Nakazawa T. Preperimetric Glaucoma Prospective Observational Study (PPGPS): Design, baseline characteristics, and therapeutic effect of tafluprost in preperimetric glaucoma eye. PLoS One 2017; 12:e0188692. [PMID: 29236784 PMCID: PMC5728557 DOI: 10.1371/journal.pone.0188692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 11/10/2017] [Indexed: 11/27/2022] Open
Abstract
Purpose There is no consensus on the diagnosis or treatment policy for Preperimetric Glaucoma (PPG) because the pathogenesis of PPG is not clear at this time. Preperimetric Glaucoma Prospective Observational Study (PPGPS) is a first multicenter, prospective, observational study to clarify the pathogenesis of PPG. This article indicates study design, patient baseline characteristics, and analysis focused on optic nerve head (ONH) blood flow in PPG, as well as the intraocular pressure (IOP) -lowering effect and ONH blood flow-improving effects of Tafluprost. Method In this study, 122 eyes from 122 subjects (mean age: 53.1 ± 14.3) newly diagnosed as PPG were enrolled. The circumpapillary retinal nerve fiber layer thickness (cpRNFLT) was evaluated with optical coherence tomography (OCT). The ONH blood flow was measured with laser speckle flowgraphy. The therapeutic effect of Tafluprost was evaluated at Month 0 (ONH blood flow-improving effect) and Month 4 (IOP-lowering effect). Results The untreated IOP, cpRNFLT, and baseline Mean deviation (MD) value was 16.4 ± 2.5 mmHg, 80.4 ± 8.2 μm, and -0.48 ± 1.29 dB, respectively. In the site-specific visual field evaluation using the sector map, there was no appreciable site-specific visual field defect in the eye with PPG. The inferior region of cpRNFLT in 4-quadrant OCT sector analysis and 6 o’clock region in 12-o’clock OCT sector analysis was the highest rate of abnormality in PPG eyes. Topical administration of Tafluprost significantly reduced IOP from 16.4 ± 2.5 mmHg at baseline to 14.5 ± 2.3 mmHg at Month 4 (P < 0.001, paired t-test). In the linear regression analysis, there was a significant relationship between the increase of ONH blood flow and baseline value. Conclusion PPGPS is a first prospective study focusing on the pathology of PPG. This study is expected to elucidate the pathology of PPG, with evidence useful for determining a treatment strategy for PPG.
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Affiliation(s)
- Naoko Aizawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yukihiro Shiga
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoru Tsuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yu Yokoyama
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuko Omodaka
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | | | - Hiroaki Kurashima
- Japan Medical Affairs, Global R&D, Santen Pharmaceutical Co. Ltd., Osaka, Japan
| | - Etsuyo Miyamoto
- Japan Medical Affairs, Global R&D, Santen Pharmaceutical Co. Ltd., Osaka, Japan
| | - Masayo Hashimoto
- Japan Medical Affairs, Global R&D, Santen Pharmaceutical Co. Ltd., Osaka, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- * E-mail:
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Lee WJ, Kim YK, Park KH, Jeoung JW. Trend-based Analysis of Ganglion Cell–Inner Plexiform Layer Thickness Changes on Optical Coherence Tomography in Glaucoma Progression. Ophthalmology 2017; 124:1383-1391. [DOI: 10.1016/j.ophtha.2017.03.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 10/19/2022] Open
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Kim SB, Lee EJ, Han JC, Kee C. Comparison of peripapillary vessel density between preperimetric and perimetric glaucoma evaluated by OCT-angiography. PLoS One 2017; 12:e0184297. [PMID: 28859176 PMCID: PMC5578657 DOI: 10.1371/journal.pone.0184297] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 08/21/2017] [Indexed: 01/02/2023] Open
Abstract
Purpose To determine peripapillary vessel density in eyes with perimetric glaucoma (PG) or preperimetric glaucoma (PPG) compared to normal controls using optical coherence tomography-angiography (OCT-A). Methods We recruited 13 patients with unilateral perimetric normal-tension glaucoma (NTG) and fellow preperimetric NTG showing only inferotemporal retinal nerve fiber layer (RNFL) defect in red-free RNFL photography in both eyes. We also enrolled 9 healthy controls. Using OCT-A, radial peripapillary capillary densities at inferotemporal and superotemporal regions were evaluated. Paired comparison of peripapillary vessel density was performed for PG eye, PPG eye, and normal eye. Results A total of 26 eyes of the 13 patients with unilateral PG and fellow PPG eyes and 18 eyes of 9 normal controls were analyzed. Vessel densities at the whole peripapillary region and inferotemporal region in PG eyes were significantly lower than those in PPG eyes (P = 0.001, P<0.001, respectively). Comparison between PPG and normal eyes showed no significant difference in the whole peripapillary region or the inferotemporal region (P = 0.654, P = 0.174, respectively). There was no significant (P = 0.288) difference in vessel density at superotemporal region among the three types of eyes (PG eye, PPG eye, and normal eye). Conclusion PPG eyes and normal eyes were found to have the similar densities of peripapillary microvasculature at the area with nerve fiber layer defect, whereas in PG eye, there was a significant decrease in vessel density at the area of RNFL thinning. This provides evidence that microvascular compromise in the retina might be a secondary change to nerve fiber layer degeneration in the pathogenesis of NTG.
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Affiliation(s)
- Si Bum Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
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Phu J, Khuu SK, Yapp M, Assaad N, Hennessy MP, Kalloniatis M. The value of visual field testing in the era of advanced imaging: clinical and psychophysical perspectives. Clin Exp Optom 2017. [PMID: 28640951 PMCID: PMC5519947 DOI: 10.1111/cxo.12551] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
White‐on‐white standard automated perimetry (SAP) is widely used in clinical and research settings for assessment of contrast sensitivity using incremental light stimuli across the visual field. It is one of the main functional measures of the effect of disease upon the visual system. SAP has evolved over the last 40 years to become an indispensable tool for comprehensive assessment of visual function. In modern clinical practice, a range of objective measurements of ocular structure, such as optical coherence tomography, have also become invaluable additions to the arsenal of the ophthalmic examination. Although structure‐function correlation is a highly desirable determinant of an unambiguous clinical picture for a patient, in practice, clinicians are often faced with discordance of structural and functional results, which presents them with a challenge. The construction principles behind the development of SAP are used to discuss the interpretation of visual fields, as well as the problem of structure‐function discordance. Through illustrative clinical examples, we provide useful insights to assist clinicians in combining a range of clinical results obtained from SAP and from advanced imaging techniques into a coherent picture that can help direct clinical management.
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Affiliation(s)
- Jack Phu
- Centre for Eye Health, The University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Michael Yapp
- Centre for Eye Health, The University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Nagi Assaad
- Centre for Eye Health, The University of New South Wales, Kensington, New South Wales, Australia.,Department of Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Michael P Hennessy
- Centre for Eye Health, The University of New South Wales, Kensington, New South Wales, Australia.,Department of Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, The University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
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High-Intensity Focused Ultrasound Circular Cyclocoagulation in Glaucoma: A Step Forward for Cyclodestruction? J Ophthalmol 2017; 2017:7136275. [PMID: 28512580 PMCID: PMC5420440 DOI: 10.1155/2017/7136275] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/28/2017] [Accepted: 02/20/2017] [Indexed: 12/05/2022] Open
Abstract
The ciliary body ablation is still considered as a last resort treatment to reduce the intraocular pressure (IOP) in uncontrolled glaucoma. Several ablation techniques have been proposed over the years, all presenting a high rate of complications, nonselectivity for the target organ, and unpredictable dose-effect relationship. These drawbacks limited the application of cyclodestructive procedures almost exclusively to refractory glaucoma. High-intensity focused ultrasound (HIFU), proposed in the early 1980s and later abandoned because of the complexity and side effects of the procedure, was recently reconsidered in a new approach to destroy the ciliary body. Ultrasound circular cyclocoagulation (UC3), by using miniaturized transducers embedded in a dedicated circular-shaped device, permits to selectively treat the ciliary body in a one-step, computer-assisted, and non-operator-dependent procedure. UC3 shows a high level of safety along with a predictable and sustained IOP reduction in patients with refractory glaucoma. Because of this, the indication of UC3 was recently extended also to naïve-to-surgery patients, thus reconsidering the role and timing of ciliary body ablation in the surgical management of glaucoma. This article provides a review of the most used cycloablative techniques with particular attention to UC3, summarizing the current knowledge about this procedure and future possible developments.
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Tamçelik N, Izgi B, Temel A, Yildirim N, Okka M, Özcan A, Yüksel N, Elgin U, Altan Ç, Ozer B. Prospective, non-interventional, multicenter study of the intraocular pressure-lowering effects of prostaglandin analog/prostamide-containing therapies in previously treated patients with open-angle glaucoma or ocular hypertension. Clin Ophthalmol 2017; 11:723-731. [PMID: 28458511 PMCID: PMC5402998 DOI: 10.2147/opth.s119963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess the intraocular pressure (IOP)-lowering efficacy, tolerability, safety, and usage patterns of prostaglandin analog/prostamide (PGA/P)-containing topical ocular hypotensives in ocular hypertension (OHT) and primary open-angle glaucoma in the Turkish clinical setting. METHODS This non-interventional, multicenter study enrolled previously treated patients who failed to achieve target IOP (or experienced unacceptable adverse events [AEs]) and were prescribed a PGA/P-containing IOP-lowering agent. Treatment was initiated at baseline (V1), and patients returned at weeks 4-6 (V2) and 8-12 (V3). The primary efficacy measure was the change in IOP from baseline at V3 in each eye. The secondary measures were physician's assessment of IOP-lowering efficacy, patients (%) reaching target IOP determined at V1, hyperemia score, physician and patient assessment of study treatment tolerability at V3, and AE frequency/severity. A subgroup analysis of patients receiving the most common study treatment was conducted. All analyses were performed using the safety population (patients who received one or more doses and had any data available). RESULTS Of 358 enrolled patients, 60.6% had primary open-angle glaucoma, 29.9% had secondary open-angle glaucoma (protocol amendment), and 13.1% had OHT; 13 patients had multiple diagnoses. At V3, the mean IOP change from baseline was ≥-4.2 mmHg (≥21.1%). IOP met or was lower than the target in 81.7% of patients, 95% exhibited none to mild conjunctival hyperemia (most common AE), and tolerability was rated good/very good by >91.1% of patients and physicians. The results were similar in patients who received the most common study treatment, bimatoprost 0.03%/timolol 0.5% (bim/tim; n=310). CONCLUSION PGA/P-containing medications, including bim/tim, significantly reduced IOP in previously treated patients with open-angle glaucoma or OHT; most reached their target IOP or an IOP even lower than their target and reported good/very good tolerability. PGA/P-containing medications such as bim/tim should be considered as a safe, effective therapeutic option for Turkish patients who exhibit poor response, tolerance, or adherence to their previous therapy.
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Affiliation(s)
| | - Belgin Izgi
- Çapa School of Medicine, Istanbul University
| | - Ahmet Temel
- Pendik Research and Training Hospital, Marmara University, Istanbul
| | | | - Mehmet Okka
- Meram School of Medicine, Necmettin Erbakan University, Konya
| | - Altan Özcan
- Faculty of Medicine, Çukurova University, Adana
| | | | | | - Çiğdem Altan
- Beyoglu Eye Training and Research Hospital, Istanbul
| | - Baris Ozer
- Allergan l˙Iaçları Tic AŞ, Istanbul, Turkey
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Sawada A, Manabe Y, Yamamoto T, Nagata C. Long-term clinical course of normotensive preperimetric glaucoma. Br J Ophthalmol 2017; 101:1649-1653. [PMID: 28416494 DOI: 10.1136/bjophthalmol-2016-309401] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 11/30/2016] [Accepted: 03/24/2017] [Indexed: 11/04/2022]
Abstract
AIMS To evaluate the long-term clinical course of normotensive preperimetric glaucoma (PPG). METHODS We retrospectively analysed 130 eyes of 130 patients initially diagnosed as having preperimetric normal tension glaucoma and followed these cases for at least 5 years with reliable visual field (VF) examinations by standard automated perimetry. When the VF defect (VFD) met Anderson-Patella's criteria on three or more consecutive examinations, and consistently met the criteria on subsequent examinations, we concluded that a glaucomatous VFD was present. Predictive factors for developing a VFD were assessed. RESULTS Seventy-one eyes (54.6%) developed a glaucomatous VFD during the follow-up period. The mean deviation slope varied from -0.90 to 0.41 dB/year. A Cox proportional hazard model showed that having a greater initial pattern SD (p=0.005), the presence of optic disc haemorrhage (p=0.022) and higher mean intraocular pressure (IOP) prior to developing a VFD (p=0.039) were related to developing a VFD. CONCLUSIONS Our findings confirmed that the mean IOP, but not the IOP fluctuation, is strongly associated with the development of a VFD in cases of PPG.
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Affiliation(s)
- Akira Sawada
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yusuke Manabe
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tetsuya Yamamoto
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Chisato Nagata
- Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
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Kim HJ, Song YJ, Kim YK, Jeoung JW, Park KH. Development of visual field defect after first-detected optic disc hemorrhage in preperimetric open-angle glaucoma. Jpn J Ophthalmol 2017; 61:307-313. [DOI: 10.1007/s10384-017-0509-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 02/09/2017] [Indexed: 11/28/2022]
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Kim KE, Park KH. Optic disc hemorrhage in glaucoma: pathophysiology and prognostic significance. Curr Opin Ophthalmol 2017; 28:105-112. [PMID: 27820751 DOI: 10.1097/icu.0000000000000345] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This article reviews the recent findings with regard to the pathophysiology and clinical significance of optic disc hemorrhage in glaucoma. RECENT FINDINGS Even though the pathophysiology of disc hemorrhage has been investigated in depth, its underlying mechanism remains unclear. The key disc hemorrhage mechanisms currently under discussion are mechanical vascular disruption and associated vascular susceptibilities. Recent technical advances in spectral-domain optical coherence tomography have yielded more compelling evidence of mechanical vascular disruption behind the pathogenesis of disc hemorrhage in glaucoma. Studies show that disc hemorrhage is associated with structural and functional glaucoma progression. Furthermore, recent findings suggest that disc hemorrhage can have different significances according to its location, recurrence, and associated underlying mechanism. SUMMARY The underlying mechanism of disc hemorrhage is complex like that of glaucoma. The ongoing controversy respecting the role of disc hemorrhage as a risk factor for glaucoma progression notwithstanding, special attention entailing closer follow-up and/or treatment escalation is recommended for patients with disc hemorrhage. Further studies investigating the unrevealed pathogenesis of disc hemorrhage and its prognostic value in glaucoma are warranted.
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Affiliation(s)
- Ko Eun Kim
- aDepartment of Ophthalmology, Nowon Eulji Medical Center, Eulji University bDepartment of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea
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Phu J, Khuu SK, Zangerl B, Kalloniatis M. A comparison of Goldmann III, V and spatially equated test stimuli in visual field testing: the importance of complete and partial spatial summation. Ophthalmic Physiol Opt 2017; 37:160-176. [PMID: 28211185 PMCID: PMC5324678 DOI: 10.1111/opo.12355] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/22/2016] [Indexed: 01/10/2023]
Abstract
PURPOSE Goldmann size V (GV) test stimuli are less variable with a greater dynamic range and have been proposed for measuring contrast sensitivity instead of size III (GIII). Since GIII and GV operate within partial summation, we hypothesise that actual GV (aGV) thresholds could predict GIII (pGIII) thresholds, facilitating comparisons between actual GIII (aGIII) thresholds with pGIII thresholds derived from smaller GV variances. We test the suitability of GV for detecting visual field (VF) loss in patients with early glaucoma, and examine eccentricity-dependent effects of number and depth of defects. We also hypothesise that stimuli operating within complete spatial summation ('spatially equated stimuli') would detect more and deeper defects. METHODS Sixty normal subjects and 20 glaucoma patients underwent VF testing on the Humphrey Field Analyzer using GI-V sized stimuli on the 30-2 test grid in full threshold mode. Point-wise partial summation slope values were generated from GI-V thresholds, and we subsequently derived pGIII thresholds using aGV. Difference plots between actual GIII (aGIII) and pGIII thresholds were used to compare the amount of discordance. In glaucoma patients, the number of 'events' (points below the 95% lower limit of normal), defect depth and global indices were compared between stimuli. RESULTS 90.5% of pGIII and aGIII points were within ±3 dB of each other in normal subjects. In the glaucoma cohort, there was less concordance (63.2% within ±3 dB), decreasing with increasing eccentricity. GIII found more defects compared to GV-derived thresholds, but only at outermost test locations. Greater defect depth was found using aGIII compared to aGV and pGIII, which increased with eccentricity. Global indices revealed more severe loss when using GIII compared to GV. Spatially equated stimuli detected the greatest number of 'events' and largest defect depth. CONCLUSIONS Whilst GV may be used to reliably predict GIII values in normal subjects, there was less concordance in glaucoma patients. Similarities in 'event' detection and defect depth in the central VF were consistent with the fact that GIII and GV operate within partial summation in this region. Eccentricity-dependent effects in 'events' and defect depth were congruent with changes in spatial summation across the VF and the increase in critical area with disease. The spatially equated test stimuli showed the greatest number of defective locations and larger sensitivity loss.
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Affiliation(s)
- Jack Phu
- Centre for Eye HealthUniversity of New South WalesSydneyAustralia
- School of Optometry and Vision ScienceUniversity of New South WalesSydneyAustralia
| | - Sieu K. Khuu
- School of Optometry and Vision ScienceUniversity of New South WalesSydneyAustralia
| | - Barbara Zangerl
- Centre for Eye HealthUniversity of New South WalesSydneyAustralia
- School of Optometry and Vision ScienceUniversity of New South WalesSydneyAustralia
| | - Michael Kalloniatis
- Centre for Eye HealthUniversity of New South WalesSydneyAustralia
- School of Optometry and Vision ScienceUniversity of New South WalesSydneyAustralia
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Zhao J, Zhu TH, Chen WC, Peng SM, Huang XS, Cho KS, Chen DF, Liu GS. Optic neuropathy and increased retinal glial fibrillary acidic protein due to microbead-induced ocular hypertension in the rabbit. Int J Ophthalmol 2016; 9:1732-1739. [PMID: 28003971 DOI: 10.18240/ijo.2016.12.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/19/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To characterize whether a glaucoma model with chronic elevation of the intraocular pressure (IOP) was able to be induced by anterior chamber injection of microbeads in rabbits. METHODS In order to screen the optimal dose of microbead injection, IOP was measured every 3d for 4wk using handheld applanation tonometer after a single intracameral injection of 10 µL, 25 µL, 50 µL or 100 µL microbeads (5×106 beads/mL; n=6/group) in New Zealand White rabbits. To prolong IOP elevation, two intracameral injections of 50 µL microbeads or phosphate buffer saline (PBS) were made respectively at days 0 and 21 (n=24/group). The fellow eye was not treated. At 5wk after the second injection of microbeads or PBS, bright-field microscopy and transmission electron microscopy (TEM) were used to assess the changes in the retina. The expression of glial fibrillary acidic protein (GFAP) in the retina was evaluated by immunofluorescence, quantitative real-time polymerase chain reaction and Western blot at 5wk after the second injection of microbeads. RESULTS Following a single intracameral injection of 10 µL, 25 µL, 50 µL or 100 µL microbead, IOP levels showed a gradual increase and a later decrease over a 4wk period after a single injection of microbead into the anterior chamber of rabbits. A peak IOP was observed at day 15 after injection. No significant difference in peak value of IOP was found between 10 µL and 25 µL groups (17.13±1.25 mm Hg vs 17.63±0.74 mm Hg; P=0.346). The peak value of IOP from 50 µL group (23.25±1.16 mm Hg) was significantly higher than 10 µL and 25 µL groups (all P<0.05). Administration of 100 µL microbead solution (23.00±0.93 mm Hg) did not lead to a significant increase in IOP compared to the 50 µL group (P=0.64). A prolonged elevated IOP duration up to 8wk was achieved by administering two injections of 50 µL microbeads (20.48±1.21 mm Hg vs 13.60±0.90 mm Hg in PBS-injected group; P<0.05). The bright-field and TEM were used to assess the changes of retinal ganglion cells (RGCs). Compared with PBS-injected group, the extended IOP elevation was associated with the degeneration of optic nerve, the reduction of RGC axons (47.16%, P<0.05) and the increased GFAP expression in the retina (4.74±1.10 vs 1.00±0.46, P<0.05). CONCLUSION Two injections of microbeads into the ocular anterior chamber of rabbits lead to a prolonged IOP elevation which results in structural abnormality as well as loss in RGCs and their axons without observable ocular structural damage or inflammatory response. We have therefore established a novel and practical model of experimental glaucoma in rabbits.
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Affiliation(s)
- Jun Zhao
- School of Ophthalmology & Optometry Affiliated to Shenzhen University, Shenzhen 518040, Guangdong Province, China; Shenzhen Eye Hospital Affiliated to Jinan University, Shenzhen Key Laboratory of Ophthalmology, Shenzhen 518040, Guangdong Province, China
| | - Tian-Hui Zhu
- Shenzhen Eye Hospital Affiliated to Jinan University, Shenzhen Key Laboratory of Ophthalmology, Shenzhen 518040, Guangdong Province, China
| | - Wen-Chieh Chen
- Shenzhen Eye Hospital Affiliated to Jinan University, Shenzhen Key Laboratory of Ophthalmology, Shenzhen 518040, Guangdong Province, China
| | - Shi-Ming Peng
- Shenzhen Eye Hospital Affiliated to Jinan University, Shenzhen Key Laboratory of Ophthalmology, Shenzhen 518040, Guangdong Province, China
| | - Xiao-Sheng Huang
- Shenzhen Eye Hospital Affiliated to Jinan University, Shenzhen Key Laboratory of Ophthalmology, Shenzhen 518040, Guangdong Province, China
| | - Kin-Sang Cho
- Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston 02114, USA
| | - Dong Feng Chen
- Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston 02114, USA
| | - Guei-Sheung Liu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne 3002, Australia; Ophthalmology, Department of Surgery, University of Melbourne, East Melbourne 3002, Australia
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Sung MS, Kang YS, Heo H, Park SW. Optic Disc Rotation as a Clue for Predicting Visual Field Progression in Myopic Normal-Tension Glaucoma. Ophthalmology 2016; 123:1484-93. [DOI: 10.1016/j.ophtha.2016.03.040] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/17/2016] [Accepted: 03/22/2016] [Indexed: 10/21/2022] Open
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Saunders LJ, Medeiros FA, Weinreb RN, Zangwill LM. What rates of glaucoma progression are clinically significant? EXPERT REVIEW OF OPHTHALMOLOGY 2016; 11:227-234. [PMID: 29657575 DOI: 10.1080/17469899.2016.1180246] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Clinically important rates of glaucoma progression (worsening) are ones that put a patient at risk of future functional impairment or reduction of vision-related quality of life. Rates of progression can be evaluated through measuring structural or functional changes of the optic nerve. Most treated eyes do not progress at rates that will lead to future visual impairment, but there are a significant proportion (3-17%) of eyes, that are at risk of impairment even under clinical care. While very fast rates of progression (e.g. MD progression of -1.5 dB/year) are generally problematic, much slower rates also may be deleterious for young patients, particularly those diagnosed with late disease. As a result, it is important to consider life expectancy, disease severity and vision-related quality of life based treatment targets to estimate future prognosis when evaluating whether a rate of glaucoma progression can be clinically relevant.
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Lanza M, Iaccarino S, Bifani M. In vivo human corneal deformation analysis with a Scheimpflug camera, a critical review. JOURNAL OF BIOPHOTONICS 2016; 9:464-477. [PMID: 26871552 DOI: 10.1002/jbio.201500233] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 12/29/2015] [Accepted: 12/30/2015] [Indexed: 06/05/2023]
Abstract
Corneal morphological analysis has greatly improved in recent years, providing physicians with new and reliable parameters to study. Moreover, today corneal functional too is a routine analysis, thanks to biomechanical evaluation allowed by an ocular response analyzer (Reichert Ophthalmic Instrument, Depew, NY, USA). Corvis ST (OCULUS Optikgeräte GmbH, Wetzlar, Germany), that relies on the ultrahigh speed Scheimpflug camera, is a new device providing corneal deformation parameters measured ny scanning the cornea response to an air puff; it is an instrument able to measure intraocular pressure too. This device could open up a whole new prospective in screening, detecting and managing corneal diseases, intraocular pressure measurement and in evaluating surgical procedures involving the cornea. This paper provides a comprehensive explanation of Corvis ST measurement principles and parameters and a literature review of scientific studies.
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Affiliation(s)
- Michele Lanza
- Dipartimento Multidisciplinare di Scienze Mediche, Chirurgiche e Odontoiatriche, Seconda Università di Napoli, Napoli, Italy.
- Centro Grandi Apparecchiature, Seconda Università di Napoli, Napoli, Italy.
| | - Stefania Iaccarino
- Centro Grandi Apparecchiature, Seconda Università di Napoli, Napoli, Italy
| | - Mario Bifani
- Dipartimento Multidisciplinare di Scienze Mediche, Chirurgiche e Odontoiatriche, Seconda Università di Napoli, Napoli, Italy
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Kim KE, Park KH. Update on the Prevalence, Etiology, Diagnosis, and Monitoring of Normal-Tension Glaucoma. Asia Pac J Ophthalmol (Phila) 2016; 5:23-31. [PMID: 26886116 DOI: 10.1097/apo.0000000000000177] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Glaucoma is a leading cause of blindness worldwide. Normal-tension glaucoma (NTG) is a type of open-angle glaucoma with intraocular pressure measurements always 21 mm Hg or less. A controversy surrounding NTG is the question of whether it should be regarded as a disease within the spectrum of primary open-angle glaucoma or as a distinctive disease entity. Nonetheless, NTG does have distinctive features compared with primary open-angle glaucoma: intraocular pressure-independent risk factors for development of NTG, characteristic patterns of structural and functional damage, and a unique disease course. This review provides an overview and update on the current issues surrounding the prevalence, etiology, diagnosis, and monitoring of NTG.
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Affiliation(s)
- Ko Eun Kim
- From the Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Abstract
Open-angle glaucoma (OAG) is characterized by optic nerve fiber atrophy and deterioration of the visual field, corresponding to damage to the optic nerve head. Intraocular pressure (IOP) is currently the only evidence-based, treatable risk factor for OAG. However, normal-tension glaucoma, the most common type of OAG in Asia, is a type of glaucoma with an unclear pathogenesis. Glaucoma is suspected to be a multifactorial disease with IOP-dependent and IOP-independent risk factors, including decreased ocular blood flow (OBF), oxidative stress, decreased axoplasmic flow, and genetic background. A number of epidemiological studies have generated strong evidence that OBF may be an especially important risk factor for the progression of glaucoma. Recent innovations in laser speckle flowgraphy and optical coherence tomography-based angiography have allowed us to noninvasively monitor changes in the microcirculation of the optic nerve head with high reproducibility. Laser speckle flowgraphy-derived measurement parameters include mean blur rate and pulse wave form parameters, whereas the main optical coherence tomography angiography-derived parameter is the vessel index. Decreases in these parameters are associated with the severity of glaucomatous damage, and changes are detectible even in the earliest, preperimetric stage of glaucoma. In the future, OBF analysis may improve significantly because of continuing progress in the development of the relevant instruments. This review will summarize possible connections between systemic and OBF abnormalities and OAG, describe the scientific rationale for these connections, and discuss their potential implications. Thus, this review will summarize the role of OBF in glaucoma pathogenesis and discuss the wide range of IOP-independent risk factors.
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Affiliation(s)
- Toru Nakazawa
- From the Department of Ophthalmology, Retinal Disease Control, Ophthalmology, and Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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