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Pham AT, Bradley C, Hou K, Herbert P, Boland MV, Ramulu PY, Yohannan J. The Impact of Achieving Target Intraocular Pressure on Glaucomatous Retinal Nerve Fiber Layer Thinning in a Treated Clinical Population. Am J Ophthalmol 2024; 262:213-221. [PMID: 38035974 DOI: 10.1016/j.ajo.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE To estimate the effect of being below and above the clinician-set target intraocular pressure (IOP) on rates of glaucomatous retinal nerve fiber layer (RNFL) thinning in a treated real-world clinical population. DESIGN Retrospective cohort study. METHODS A total of 3256 eyes (1923 patients) with ≥5 reliable optical coherence tomography scans and 1 baseline visual field test were included. Linear mixed-effects modeling estimated the effects of the primary independent variables (mean target difference [measured IOP - target IOP] and mean IOP, mm Hg) on the primary dependent variable (RNFL slope, µm/y) while accounting for additional confounding variables (age, biological sex, race, baseline RNFL, baseline pachymetry, and disease severity). A spline term accounted for differential effects when above (target difference >0 mm Hg) and below (target difference ≤0 mm Hg) target pressure. RESULTS Eyes below and above target had significantly different mean RNFL slopes (-0.44 vs -0.71 µm/y, P < .001). Each 1 mm Hg increase above target had a 0.143 µm/y faster rate of RNFL thinning (P < .001). Separating by disease severity, suspect, mild, moderate, and advanced glaucoma had 0.135 (P = .002), 0.116 (P = .009), 0.203 (P = .02), and 0.65 (P = .22) µm/y faster rates of RNFL thinning per 1 mm Hg increase, respectively. CONCLUSIONS Being above the clinician-set target pressure is associated with more rapid RNFL thinning in suspect, mild, and moderate glaucoma. Faster rates of thinning were also present in advanced glaucoma, but statistical significance was limited by the lower sample size of eyes above target and the optical coherence tomography floor effect.
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Affiliation(s)
- Alex T Pham
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (A.T.P., C.B., P.Y.R., J.Y.), Baltimore, Maryland
| | - Chris Bradley
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (A.T.P., C.B., P.Y.R., J.Y.), Baltimore, Maryland
| | - Kaihua Hou
- Malone Center for Engineering in Healthcare, Johns Hopkins University (K.H., P.H., J.Y.), Baltimore, Maryland
| | - Patrick Herbert
- Malone Center for Engineering in Healthcare, Johns Hopkins University (K.H., P.H., J.Y.), Baltimore, Maryland
| | - Michael V Boland
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts (M. V. B.), USA
| | - Pradeep Y Ramulu
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (A.T.P., C.B., P.Y.R., J.Y.), Baltimore, Maryland
| | - Jithin Yohannan
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (A.T.P., C.B., P.Y.R., J.Y.), Baltimore, Maryland; Malone Center for Engineering in Healthcare, Johns Hopkins University (K.H., P.H., J.Y.), Baltimore, Maryland.
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Marta K, Katarzyna C, Marta K, Włodzimierz G, Maciej M, Bartłomiej K. How Does Weight Loss After Bariatric Surgery Impact the Ocular Parameters? A Review. Obes Surg 2023:10.1007/s11695-023-06607-1. [PMID: 37103665 DOI: 10.1007/s11695-023-06607-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023]
Abstract
Our review aimed to assess the effects of bariatric surgery-induced weight loss on ocular functions. We focused on retinochoroidal microcirculation, glaucomatous factors, and the condition of the eye surface pre- and postoperatively. The review covered 23 articles, including five case reports. Bariatric surgery positively impacts retinochoroidal microcirculation. The arterial perfusion and vascular density improve, venules constrict, and the arteriole-to-venule ratio increases. Weight loss positively correlates with intraocular pressure decrease. The impact of postoperative weight loss on the choroidal thickness (CT) and the retinal nerve fiber layer (RNFL) is still unclear. The correlation between ocular symptoms and hypovitaminosis A needs to be evaluated. Further research is required, especially regarding CT and RNFL, mainly focusing on long-term follow-up.
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Affiliation(s)
- Krzyżanowska Marta
- Division of Ophthalmology and Optometry, Department of Ophthalmology, Collegium Medicum, Nicolaus Copernicus University in Toruń, ul. Ujejskiego 75, 85-168, Bydgoszcz, Poland.
| | - Czarny Katarzyna
- Division of Ophthalmology and Optometry, Department of Ophthalmology, Collegium Medicum, Nicolaus Copernicus University in Toruń, ul. Ujejskiego 75, 85-168, Bydgoszcz, Poland
| | - Kroczek Marta
- Division of Ophthalmology and Optometry, Department of Ophthalmology, Collegium Medicum, Nicolaus Copernicus University in Toruń, ul. Ujejskiego 75, 85-168, Bydgoszcz, Poland
| | - Gniłka Włodzimierz
- Department of General and Minimally Invasive Surgery, Jan Biziel University Hospital Number 2, ul. Ujejskiego 75, 85-168, Bydgoszcz, Poland
| | - Michalik Maciej
- Department of General and Minimally Invasive Surgery, Jan Biziel University Hospital Number 2, ul. Ujejskiego 75, 85-168, Bydgoszcz, Poland
| | - Kałużny Bartłomiej
- Division of Ophthalmology and Optometry, Department of Ophthalmology, Collegium Medicum, Nicolaus Copernicus University in Toruń, ul. Ujejskiego 75, 85-168, Bydgoszcz, Poland
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3
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Arjmand P, Yu CW, Popovic MM, Jhaveri A, Mandelcorn ED. Prophylactic intraocular pressure lowering measures in anti-vascular endothelial growth factor therapy: A systematic review and meta-analysis. Surv Ophthalmol 2022; 68:425-445. [PMID: 36529267 DOI: 10.1016/j.survophthal.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Acute intraocular pressure (IOP) elevation following repeat intravitreal anti-vascular endothelial growth factor (VEGF) injections (IVI) may pose a risk to the integrity of the retinal nerve fiber (RNFL). This meta-analysis investigates the role of IOP-lowering interventions such as an anterior chamber paracentesis (ACP) and IOP-lowering medications on the IOP in patients undergoing IVIs. MEDLINE, EMBASE, and the Cochrane Library were searched up to February, 2021. Studies investigating IOP-lowering interventions in patients undergoing IVI versus controls were included. The primary outcome was the IOP in the short- and long-term post-IVI. Secondary outcomes were changes in the RNFL thickness and best corrected visual acuity (BCVA). ACP at time of anti-VEGF injection significantly lowered IOP immediately post anti-VEGF (WMD: -27.98 mm Hg, P < 0.001). Patients in the ACP group also had significantly thicker RNFL compared to control (WMD: 2.07 um, P < 0.00001) at median follow-up of 16.5 months. IOP-lowering medications (on the day of injection or in the long-term) significantly reduced IOP up to 30 minutes after injection (WMD: -3.31 mm Hg, P = 0.003). This effect was statistically significant between the 2 arms up to 1 month follow-up. There was no difference in BCVA in intervention versus controls. ACP reduces immediate IOP spikes post-IVI and preserves the RNFL in the short- and longterms IOP-lowering medications also reduce IOP spike, with limited data on RNFL thickness.
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Affiliation(s)
| | - Caberry W Yu
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Aaditeya Jhaveri
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Efrem D Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
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Kamalipour A, Moghimi S, Eslani M, Nishida T, Mohammadzadeh V, Micheletti E, Girkin CA, Fazio MA, Liebmann JM, Zangwill LM, Weinreb RN. A Prospective Longitudinal Study to Investigate Corneal Hysteresis as a Risk Factor of Central Visual Field Progression in Glaucoma. Am J Ophthalmol 2022; 240:159-169. [PMID: 35278360 PMCID: PMC10249485 DOI: 10.1016/j.ajo.2022.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/07/2022] [Accepted: 02/27/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the role of corneal hysteresis (CH) as a risk factor of central visual field (VF) progression in a cohort of glaucoma suspect and glaucoma patients. DESIGN Prospective cohort study. METHODS Two hundred forty-eight eyes of 143 subjects who were followed for an average of 4.8 years with a minimum of 5 visits with 10-2 and 24-2 VF tests were included. Univariable and multivariable linear mixed-effects models were used to identify characteristics associated with the rate of change over time in 10-2 and 24-2 mean deviation (MD). Mixed-effects logistic regression was used to evaluate characteristics associated with an increased likelihood of event-based 10-2 VF progression based on the clustered pointwise linear regression criterion. RESULTS CH was significantly associated with 10-2 and 24-2 VF progression in the univariable trend-based analysis. In multivariable trend-based analyses, lower CH was associated with a faster rate of decline in 10-2 MD (0.07 dB/y per 1 mm Hg, P < .001) but not with 24-2 MD (P = .490). In multivariable event-based analysis, lower CH was associated with an increased likelihood of 10-2 VF progression (odds ratio = 1.35 per 1 mm Hg lower, P = .025). Similar results were found in eyes with early glaucomatous damage at the baseline (baseline: 24-2 MD ≥ -6 dB). CONCLUSIONS Lower CH was associated with a statistically significant, but relatively small, increased risk of central VF progression on the 10-2 test grid. Given the substantial influence of central VF impairment on the quality of life, clinicians should consider using CH to assess the risk of progression in patients with primary open-angle glaucoma including those with early disease.
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Affiliation(s)
- Alireza Kamalipour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Medi Eslani
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Takashi Nishida
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Vahid Mohammadzadeh
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Eleonora Micheletti
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | | | - Massimo A Fazio
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California; Department of Ophthalmology and Visual Sciences, Heersink School of Medicine; Department of Biomedical Engineering, School of Engineering
| | - Jeffrey M Liebmann
- University of Alabama at Birmingham, Alabama, and Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California.
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Dyer KIC, Sanfilippo PG, Yazar S, Craig JE, Hewitt AW, Newnham JP, Mackey DA, Lee SSY. The Relationship Between Fetal Growth and Retinal Nerve Fiber Layer Thickness in a Cohort of Young Adults. Transl Vis Sci Technol 2022; 11:8. [PMID: 35819290 PMCID: PMC9287618 DOI: 10.1167/tvst.11.7.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Purpose To explore relationships between patterns of fetal anthropometric growth, as reflective of fetal wellbeing, and global retinal nerve fiber layer (RNFL) thickness measured in young adulthood. Methods Participants (n = 481) from within a Western Australian pregnancy cohort study underwent five serial ultrasound scans during gestation, with fetal biometry measured at each scan. Optic disc parameters were measured via spectral-domain optical coherence tomography imaging at a 20-year follow-up eye examination. Generalized estimating equations were used to evaluate differences in global RNFL thickness between groups of participants who had undergone similar growth trajectories based on fetal head circumference (FHC), abdominal circumference (FAC), femur length (FFL), and estimated fetal weight (EFW). Results Participants with consistently large FHCs throughout gestation had significantly thicker global RNFLs than those with any other pattern of FHC growth (P = 0.023), even after adjustment for potential confounders (P = 0.037). Based on model fit statistics, FHC growth trajectory was a better predictor of global RNFL thickness than birth weight or head circumference at birth. RNFL thickness did not vary significantly between groups of participants with different growth trajectories based on FAC, FFL, or EFW. Conclusions FHC growth is associated with RNFL thickness in young adulthood and, moreover, is a better predictor than either birth weight or head circumference at birth. Translational Relevance This research demonstrates an association between intrauterine growth and long-term optic nerve health, providing a basis for further exploring the extent of the influence of fetal wellbeing on clinical conditions linked to RNFL thinning.
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Affiliation(s)
- Kathleen I C Dyer
- Centre for Ophthalmology and Visual Sciences (incorporating the Lions Eye Institute), University of Western Australia, Nedlands, Australia
| | - Paul G Sanfilippo
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Seyhan Yazar
- Centre for Ophthalmology and Visual Sciences (incorporating the Lions Eye Institute), University of Western Australia, Nedlands, Australia.,Single Cell and Computational Genomics Laboratory, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - Jamie E Craig
- Eye and Vision, Flinders Health and Medical Institute, Flinders University, Adelaide, Australia
| | - Alex W Hewitt
- Centre for Ophthalmology and Visual Sciences (incorporating the Lions Eye Institute), University of Western Australia, Nedlands, Australia.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia.,School of Medicine, Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | - John P Newnham
- School of Women's and Infants' Health, The University of Western Australia, Perth, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Sciences (incorporating the Lions Eye Institute), University of Western Australia, Nedlands, Australia.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia.,School of Medicine, Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | - Samantha S Y Lee
- Centre for Ophthalmology and Visual Sciences (incorporating the Lions Eye Institute), University of Western Australia, Nedlands, Australia
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6
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Discrimination Between Healthy Eyes and Those With Mild Glaucoma Damage Using Hemoglobin Measurements of the Optic Nerve Head. J Glaucoma 2022; 31:567-573. [PMID: 35353776 DOI: 10.1097/ijg.0000000000002026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/17/2022] [Indexed: 01/31/2023]
Abstract
PRCIS The Laguna ONhE, a software that measures the hemoglobin (Hb) concentration of the optic nerve head (ONH) from fundus photographs, demonstrated good accuracy in discriminating healthy eyes from eyes with mild glaucoma. PURPOSE The aim was to evaluate Hb concentration of the optic nerve to distinguish between healthy eyes and eyes with mild glaucoma. METHODS Eyes from patients with mild primary open angle glaucoma (MD > -6 dB) (n=58) and from healthy subjects (n=64) were selected. Retinal nerve fiber layer thickness measurements of all eyes were acquired with optical coherence tomography. Optic disc photographs were also obtained, and the images were analyzed using the Laguna ONhE software, which measures the amount of Hb in 24 sectors of the ONH. The software also calculates the Glaucoma Discriminant Function (GDF), an index that expresses the chance of the ONH being compatible with glaucoma. Areas under the receiver operating characteristic curve and sensitivities at fixed specificities of 90% and 95% of each Laguna ONhE parameter were calculated. RESULTS The mean retinal nerve fiber layer thickness and vertical cup/disc ratio of the control and glaucoma groups were 90.0±10.6 μm versus 66.28±9.85 μm ( P <0.001) and 0.5±0.09 versus 0.65±0.09 ( P <0.001), respectively. Total Hb (67.9±4.45 vs. 62.89±4.89, P <0.001) and GDF (11.57±15.34 vs. -27.67±20.94, P <0.001) were significantly higher in the control group. The Hb concentration was also significantly higher in 21 of the 24 sectors in the control group compared with the glaucoma group ( P <0.05). The GDF had the largest areas under the receiver operating characteristic curve (0.93), with 79.3% sensitivity at a fixed specificity of 95%. CONCLUSION Measurements of optic nerve Hb concentration using a colorimetry photographic device demonstrated good accuracy in discriminating healthy eyes from eyes with mild glaucoma. Further studies are need to understand vascular factors implicated in the development of glaucoma.
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Seely KR, Mangalesh S, Shen LL, McGeehan B, Ying GS, Sarin N, Vajzovic L, Prakalapakorn SG, Freedman SF, Toth CA. Association Between Retinal Microanatomy in Preterm Infants and 9-Month Visual Acuity. JAMA Ophthalmol 2022; 140:699-706. [PMID: 35653144 DOI: 10.1001/jamaophthalmol.2022.1643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Preterm infants are at risk for poor visual acuity (VA) outcomes, even without retinal problems on ophthalmoscopy. Infant retinal microanatomy may provide insight as to potential causes. Objective To evaluate the association between preterm infant retinal microanatomy and VA at 9 months' corrected age. Design, Setting, and Participants This prospective observational study took place from November 2016 and December 2019 at a single academic medical center and included preterm infants enrolled in Study of Eye Imaging in Preterm Infants (BabySTEPS). Infants were eligible for enrollment in BabySTEPS if they met criteria for retinopathy of prematurity (ROP) screening, were 35 weeks' postmenstrual age or older at the time of first OCT imaging, and a parent or guardian provided written informed consent. Of 118 infants enrolled in BabySTEPS, 61 were included in this analysis. Data were analyzed from March to April 2021. Exposures Bedside optical coherence tomography (OCT) imaging at a mean (SD) 39.85 (0.79) weeks' postmenstrual age and monocular grating VA measurement at 9 months' corrected age. Main Outcomes and Measures Presence and severity of macular edema and presence of ellipsoid zone at the fovea measured by extracting semiautomated thicknesses of inner nuclear layer, inner retina, and total retina at the foveal center; choroid across foveal 1 mm; and retinal nerve fiber layer (RNFL) across the papillomacular bundle (PMB). Pearson correlation coefficients were calculated and 95% CIs were bootstrapped for the association between retinal layer thicknesses and continuous logMAR VA. Associations were analyzed between retinal microanatomy and normal (3.70 cycles/degree or greater) vs subnormal grating VA at 9 months' corrected age using logistic regression and with logMAR VA using linear regression, adjusting for birth weight, gestational age, and ROP severity at the time of OCT imaging and accounting for intereye correlation using generalized estimating equations. Results The mean (SD; range) gestational age of included infants was 27.6 (2.8; 23.0-34.6) weeks, and mean (SD; range) birth weight was 958.2 (293.7; 480-1580) g. In 122 eyes of 61 infants, the correlations between retinal layer thicknesses and logMAR VA were as follows: r, 0.01 (95% CI, -0.07 to -0.27) for inner nuclear layer; r, 0.19 (95% CI, 0.01 to 0.35) for inner retina; r, 0.15 (95% CI, -0.02 to 0.31) for total retina; r, -0.22 (95% CI, -0.38 to -0.03) for choroid; and r, -0.27 (95% CI, -0.45 to 0.10) for RNFL across the PMB. In multivariable analysis, thinner RNFL across the PMB (regression coefficient, -0.05 per 10-μm increase in RNFL thickness; 95% CI, -0.10 to -0.01; P = .046) and prior ROP treatment (regression coefficient, 0.33 for ROP treatment; 95% CI, 0.11 to 0.56; P = .003) were independently associated with poorer 9-month logMAR VA. Conclusions and Relevance In preterm infants, RNFL thinning across the PMB was associated with poorer 9-month VA, independent of birth weight, gestational age, need for ROP treatment, and macular microanatomy. Evaluation of RNFL thickness using OCT may help identify preterm infants at risk for poor vision outcomes.
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Affiliation(s)
- Kai R Seely
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Shwetha Mangalesh
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Liangbo L Shen
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina.,Department of Ophthalmology, University of California, San Francisco
| | - Brendan McGeehan
- Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia
| | - Gui-Shuang Ying
- Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia
| | - Neeru Sarin
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Lejla Vajzovic
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - S Grace Prakalapakorn
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina.,Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Sharon F Freedman
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina.,Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Cynthia A Toth
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina.,Department of Biomedical Engineering, Duke University, Durham, North Carolina
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Salehi MA, Karimi A, Mohammadi S, Arevalo JF. Spectral-domain OCT measurements in obesity: A systematic review and meta-analysis. PLoS One 2022; 17:e0267495. [PMID: 35476846 PMCID: PMC9045631 DOI: 10.1371/journal.pone.0267495] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 04/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Previous studies proposed possible applications of spectral-domain optical coherence tomography (SD-OCT) measurements in prognosticating pathologies observed in overweight/obesity, including ocular, vascular, and neurologic consequences. Therefore, we conducted a systematic review and meta-analysis to investigate the changes in the in SD-OCT measurements of the patients with higher body mass index (BMI) compared to normal weight individuals. Materials and methods We conducted a systematic search on PubMed, Scopus, and Embase. The search results underwent two-phase title/abstract and full-text screenings. We then analyzed SD-OCT measurements differences in patients with high BMI and controls, and performed meta-regression, sub-group analysis, quality assessment, and publication bias assessment. The measurements included macular thickness, cup to disc ratio, ganglion cell-inner plexiform layer (GC-IPL) and its sub-sectors, RNFL and peripapillary RNFL (pRNFL) and their sub-layers, and choroidal thickness and its sub-sectors. Results 19 studies were included in this meta-analysis accounting for 1813 individuals, 989 cases and 824 controls. There was an overall trend towards decreased thickness in high BMI patients, but only two measurements reached statistical significance: temporal retinal nerve fiber layer (RNFL) (Standardized mean difference (SMD): -0.33, 95% confidence interval (CI): -0.53 to -0.14, p<0.01) and the choroidal region 1.0 mm nasal to fovea (SMD: -0.38, 95% CI: -0.60 to -0.16, p<0.01). Conclusion Some ocular layers are thinner in patients with higher BMI than the controls. These SD-OCT measurements might correlate with adverse events related to increased body weight and have prognostic abilities. As SD-OCT is a robust, rapid and non-invasive tool, future guidelines and studies are needed to evaluate the possibility of their integration into care of the patients with obesity.
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Affiliation(s)
| | - Amirali Karimi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Mohammadi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - J. Fernando Arevalo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, United States of America
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Erichev VP, Tarasenkov AO, Andreeva YS. [Ocular hypertension after intravitreal injections]. Vestn Oftalmol 2022; 138:234-239. [PMID: 36287161 DOI: 10.17116/oftalma2022138052234] [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] [Indexed: 06/16/2023]
Abstract
Intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) for the treatment of age-related macular degeneration with choroidal neovascularization have become much more popular nowadays. Anti-VEGF therapy is generally well-tolerated; however, one of its possible side effects is ocular hypertension - elevation of intraocular pressure (IOP) above the accepted norm, but without structural and functional changes in the retina and optic nerve common for glaucoma. The average duration of IOP elevation is 30 to 60 minutes, but it can increase when the patient has primary open-angle glaucoma (POAG). There is currently no uniform understanding of the pathogenesis of elevated IOP after IVI, as well as the effect of IOP fluctuations on the functional prognosis and the condition of the ocular tunics. This review considers the main causes and mechanisms of IOP elevation after IVI, analyzes recent publications on the consequences of ocular hypertension for the neurosensory part of the retina and the optic nerve, and examines the conditions for transition of IOP fluctuations into clinically significant ocular hypertension or POAG.
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Affiliation(s)
- V P Erichev
- Research Institute of Eye Diseases, Moscow, Russia
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10
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Wu Y, Cun Q, Tao Y, Yang W, Wei J, Fan D, Zhang Y, Chen Q, Zhong H. Evaluation of Macular and Retinal Ganglion Cell Count Estimates for Detecting and Staging Glaucoma. Front Med (Lausanne) 2021; 8:740761. [PMID: 34660645 PMCID: PMC8517246 DOI: 10.3389/fmed.2021.740761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To investigate the clinical significance of macular estimated retinal ganglion cell (mRGC) and estimated retinal ganglion cell (eRGC) in the diagnosis and staging of glaucoma. Methods: This is a cross-section study. All enrolled subjects underwent standard automated perimetry (SAP) and optical coherence tomography (OCT) examination. Swedish Interactive Threshold Algorithm (SITA)-FAST detection strategy and 24-2, 10-2 detection programs were employed in SAP assessment. The visual-field parameters and OCT parameters were calculated according to three formulas to obtain the eRGC and mRGC1 or mRGC2. The efficiency of eRGC, mRGC1, and mRGC2 estimates for the staging of glaucoma was compared. The sensitivity and specificity of each parameter for diagnosis of glaucoma were analyzed using the receiver operating characteristic (ROC) curve. Results: A total of 119 eyes were included in the analysis. Compared with the healthy controls, eRGC, mRGC1, and mRGC2 estimates were significantly decreased in patients with glaucoma. As glaucoma progressed, eRGC, mRGC1, and mRGC2 estimates were gradually reduced. In preperimetric glaucoma, mRGC1, mRGC2, and eRGC were reduced by 13.2, 14.5, and 18%, respectively. In the mild stage of glaucoma, mRGC1, mRGC2, and eRGC were reduced by 28, 34, and 38%, respectively. In the advanced stage of glaucoma, mRGC1, mRGC2, and eRGC were reduced by 81, 85, and 92% respectively. The proportion of retinal ganglion cell (RGC) loss in the macula was close to that outside the macula. The specificity at 95% gave a sensitivity of 95.51, 86.52, and 87.64% for eRGC, mRGC1, and mRGC2, respectively. The sensitivity of structural parameters macular ganglion cell complex thickness and retinal nerve fiber layer (RNFL) were 98.88 and 95.51%, respectively. The sensitivity of functional parameters mean deviation (24-2) and visual field index (VFI) were 80.90 and 73.03%, respectively. The area under ROC curve of mRGC1, mRGC2, and eRGC were 0.982, 0.972, and 0.995 (P < 0.0001), respectively. Conclusion: Estimated retinal ganglion cell, mRGC1, and mRGC2 provide value to the staging of glaucoma and better diagnostic performance. Macular RGC estimatesthat integration of both structural and functional damages in macular may serve as a sensitive indicator for assessing macular damage in glaucoma and are of importance for the diagnosis and progression management of glaucoma.
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Affiliation(s)
- Yali Wu
- Department of Ophthalmology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qing Cun
- The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yijin Tao
- The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wenyan Yang
- The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jia Wei
- The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Daoqing Fan
- The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ying Zhang
- The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qin Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hua Zhong
- The First Affiliated Hospital of Kunming Medical University, Kunming, China
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11
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Zukerman R, Harris A, Oddone F, Siesky B, Verticchio Vercellin A, Ciulla TA. Glaucoma Heritability: Molecular Mechanisms of Disease. Genes (Basel) 2021; 12:genes12081135. [PMID: 34440309 PMCID: PMC8391305 DOI: 10.3390/genes12081135] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
Glaucoma is one of the world’s leading causes of irreversible blindness. A complex, multifactorial disease, the underlying pathogenesis and reasons for disease progression are not fully understood. The most common form of glaucoma, primary open-angle glaucoma (POAG), was traditionally understood to be the result of elevated intraocular pressure (IOP), leading to optic nerve damage and functional vision loss. Recently, researchers have suggested that POAG may have an underlying genetic component. In fact, studies of genetic association and heritability have yielded encouraging results showing that glaucoma may be influenced by genetic factors, and estimates for the heritability of POAG and disease-related endophenotypes show encouraging results. However, the vast majority of the underlying genetic variants and their molecular mechanisms have not been elucidated. Several genes have been suggested to have molecular mechanisms contributing to alterations in key endophenotypes such as IOP (LMX1B, MADD, NR1H3, and SEPT9), and VCDR (ABCA1, ELN, ASAP1, and ATOH7). Still, genetic studies about glaucoma and its molecular mechanisms are limited by the multifactorial nature of the disease and the large number of genes that have been identified to have an association with glaucoma. Therefore, further study into the molecular mechanisms of the disease itself are required for the future development of therapies targeted at genes leading to POAG endophenotypes and, therefore, increased risk of disease.
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Affiliation(s)
- Ryan Zukerman
- Department of Ophthalmology, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, USA; (R.Z.); (A.H.); (B.S.); (A.V.V.)
- Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, USA; (R.Z.); (A.H.); (B.S.); (A.V.V.)
| | | | - Brent Siesky
- Department of Ophthalmology, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, USA; (R.Z.); (A.H.); (B.S.); (A.V.V.)
| | - Alice Verticchio Vercellin
- Department of Ophthalmology, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, USA; (R.Z.); (A.H.); (B.S.); (A.V.V.)
| | - Thomas A. Ciulla
- Midwest Eye Institute, Indianapolis, IN 46290, USA
- Correspondence: ; Tel.: +1-(317)-506-0334 or +1-(317)-817-1822; Fax: +1-(317)-817-1898
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12
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Thompson AC, Li A, Asrani S. Agreement Between Trend-Based and Qualitative Analysis of the Retinal Nerve Fiber Layer Thickness for Glaucoma Progression on Spectral-Domain Optical Coherence Tomography. Ophthalmol Ther 2021; 10:629-642. [PMID: 34212312 PMCID: PMC8319289 DOI: 10.1007/s40123-021-00355-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/27/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION To evaluate the agreement between trend-based analysis and qualitative assessment of the retinal nerve fiber layer (RNFL) thickness for glaucomatous progression on spectral-domain optical coherence tomography (SDOCT). METHODS Retrospective review of 190 eyes from 103 patients with glaucoma or suspected glaucoma that underwent SDOCT imaging during four consecutive clinic visits. Trend-based progression was characterized by a significantly negative slope. Progression by qualitative analysis was determined by review of raw SDOCT B-scans. RESULTS The slope was significantly greater in those with progression than without progression for both trend-based and qualitative analysis (p < 0.001). However, the qualitative grading classified a significantly greater proportion of eyes as progressing compared to trend-based analysis in both the superotemporal (ST) (23.2% vs. 10.5%, p = 0.001) and inferotemporal (IT) RNFL (27.4% vs 8.4%, p < 0.001). The trend-based and qualitative classifications of progression showed poor agreement in both the ST (kappa = 0.0135) and IT RNFL (kappa = 0.1222). The agreement between trend-based and qualitative analysis was lower for eyes with artifacts (ST = 58.11%; IT = 68.7%) than those without artifacts (ST = 80.2%; IT = 74.8%). Moreover, among eyes with artifacts, there was no significant difference in slope between those qualitatively categorized as progressing versus not progressing (p > 0.05). CONCLUSIONS Poor agreement was found between a trend-based and qualitative analysis of change in RNFL on SDOCT. Careful qualitative review of SDOCT imaging may identify specific areas of glaucoma progression not captured by trend-based methods, especially in the presence of artifacts. Such an approach may also prove useful for detecting glaucoma progression in a clinical setting when there are few data points available.
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Affiliation(s)
- Atalie C Thompson
- Department of Ophthalmology, Duke University, Box 3802, Durham, NC, 27710, USA
| | - Ang Li
- Cleveland Clinic, Cleveland, OH, USA
| | - Sanjay Asrani
- Department of Ophthalmology, Duke University, Box 3802, Durham, NC, 27710, USA.
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13
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Corneal hysteresis as a risk factor for optic nerve head surface depression and retinal nerve fiber layer thinning in glaucoma patients. Sci Rep 2021; 11:11677. [PMID: 34083548 PMCID: PMC8175353 DOI: 10.1038/s41598-021-90588-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022] Open
Abstract
To evaluate the role of corneal hysteresis (CH) as a risk factor for progressive ONH surface depression and RNFL thinning measured by confocal scanning laser ophthalmoscopy (CSLO) and spectral-domain optical coherence tomography (SD-OCT), respectively in glaucoma patients. Prospective study. A total of 146 eyes of 90 patients with glaucoma were recruited consecutively. The CH measurements were acquired at baseline and 4-months interval using the Ocular Response Analyzer (Reichert Instruments, Depew, NY). Eyes were imaged by CSLO (Heidelberg Retinal Tomograph [HRT]; Heidelberg Engineering, GmbH, Dossenheim, Germany) and SD-OCT (Cirrus HD-OCT; Carl Zeiss Meditec AG, Dublin, CA) at approximately 4-month intervals for measurement of ONH surface topography and RNFL thickness, respectively. Significant ONH surface depression and RNFL thinning were defined with reference to Topographic Change Analysis (TCA) with HRT and Guided Progression Analysis (GPA) with Cirrus HD-OCT, respectively. Multivariate cox proportional hazards models were used to investigate whether CH is a risk factor for ONH surface depression and RNFL progression after adjusting potential confounding factors. All patients with glaucoma were followed for an average of 6.76 years (range, 4.56–7.61 years). Sixty-five glaucomatous eyes (44.5%) of 49 patients showed ONH surface depression, 55 eyes (37.7%) of 43 patients had progressive RNFL thinning and 20 eyes (13.7%) of 17 patients had visual field progression. In the cox proportional hazards model, after adjusting baseline diastolic IOP, CCT, age, baseline disc area and baseline MD, baseline CH was significantly associated with ONH surface depression and visual field progression (HR = 0.71, P = 0.014 and HR = 0.54, P = 0.018, respectively), but not with RNFL thinning (HR = 1.03, P = 0.836). For each 1-mmHg decrease in baseline CH, the hazards for ONH surface depression increase by 29%, and the hazards for visual field progression increase by 46%. The CH measurements were significantly associated with risk of glaucoma progression. Eyes with a lower CH were significantly associated with an increased risk of ONH surface depression and visual field progression in glaucoma patients.
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14
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Chen A, Virk A, Harris Z, Abazari A, Honkanen R, Arbab MH. Non-contact terahertz spectroscopic measurement of the intraocular pressure through corneal hydration mapping. BIOMEDICAL OPTICS EXPRESS 2021; 12:3438-3449. [PMID: 34221670 PMCID: PMC8221940 DOI: 10.1364/boe.423741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 05/03/2023]
Abstract
Elevated intraocular pressure (IOP) results in endothelial layer damage that can induce corneal hydration perturbations. We investigated the potential of terahertz spectroscopy in measuring the IOP levels through mapping corneal water content. We controlled the IOP levels in ex vivo rabbit and porcine eye samples while monitoring the change in corneal hydration using a terahertz time-domain spectroscopy (THz-TDS) scanner. Our results showed a statistically significant increase in the THz reflectivity between 0.4 and 0.6 THz corresponding to the increase in the IOP. Endothelial layer damage was confirmed using scanning electron microscopy (SEM) of the corneal biopsy samples. Our empirical results indicate that the THz-TDS can be used to track IOP levels through the changes in corneal hydration.
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Affiliation(s)
- Andrew Chen
- Department of Biomedical Engineering, Stony Brook University, 100 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Arjun Virk
- Department of Biomedical Engineering, Stony Brook University, 100 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Zachery Harris
- Department of Biomedical Engineering, Stony Brook University, 100 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Azin Abazari
- Department of Ophthalmology, Renaissance School of Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Robert Honkanen
- Department of Ophthalmology, Renaissance School of Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - M. Hassan Arbab
- Department of Biomedical Engineering, Stony Brook University, 100 Nicolls Rd, Stony Brook, NY 11794, USA
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15
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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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16
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Gracitelli CPB, Duque-Chica GL, Sanches LG, Moura AL, Nagy BV, Teixeira SH, Amaro E, Ventura DF, Paranhos A. Structural Analysis of Glaucoma Brain and its Association With Ocular Parameters. J Glaucoma 2020; 29:393-400. [PMID: 32079996 DOI: 10.1097/ijg.0000000000001470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PRECIS Glaucoma patients presented a decreased occipital pole surface area in both hemispheres. Moreover, these parameters are independently correlated with functional and structural ocular parameters. PURPOSE The purpose of this study was to evaluate structural brain abnormalities in glaucoma patients using 3-Tesla magnetic resonance imaging and assess their correlation with associated structural and functional ocular findings. PATIENTS AND METHODS This cross-sectional prospective study included 30 glaucoma patients and 18 healthy volunteers. All participants underwent standard automated perimetry, spectral-domain optical coherence tomography, and 3.0-Tesla magnetic resonance imaging. RESULTS There was a significant difference between the surface area of the occipital pole in the left hemisphere of glaucoma patients (mean: 1253.9±149.3 mm) and that of control subjects (mean: 1341.9±129.8 mm), P=0.043. There was also a significant difference between the surface area of the occipital pole in the right hemisphere of glaucoma patients (mean: 1910.5±309.4 mm) and that of control subjects (mean: 2089.1±164.2 mm), P=0.029. There was no significant difference between the lingual, calcarine, superior frontal, and inferior frontal gyri of glaucoma patients and those of the control subjects (P>0.05 for all comparisons). The surface area of the occipital pole in the left hemisphere was significantly correlated with perimetry mean deviation values, visual acuity, age, and retinal nerve fiber layer thickness (P=0.001, <0.001, 0.010, and 0.006, respectively). The surface area of the occipital pole in the right hemisphere was significantly correlated with perimetry mean deviation values, visual field indices, visual acuity, age, and retinal nerve fiber layer thickness (P<0.001, 0.007, <0.001, 0.046, and <0.001, respectively). CONCLUSION Glaucoma patients presented a decreased occipital pole surface area in both hemispheres that independently correlated with functional and structural ocular parameters.
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Affiliation(s)
- Carolina P B Gracitelli
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo
| | - Gloria L Duque-Chica
- Institute of Psychology, University of São Paulo.,Department of Psychology, University of Medellin, Medellin, Colombia
| | - Liana G Sanches
- Brain Institute-Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Ana L Moura
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo.,Institute of Psychology, University of São Paulo
| | - Balazs V Nagy
- Institute of Psychology, University of São Paulo.,Department of Mechatronics, Optics and Engineering Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Sergio H Teixeira
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo
| | - Edson Amaro
- Brain Institute-Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Dora F Ventura
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo.,Institute of Psychology, University of São Paulo
| | - Augusto Paranhos
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo.,Brain Institute-Hospital Israelita Albert Einstein, São Paulo, Brazil
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17
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Saks D, Schulz A, Craig J, Graham S. Determination of retinal nerve fibre layer and ganglion cell/inner plexiform layers progression rates using two optical coherence tomography systems: The
PROGRESSA
study. Clin Exp Ophthalmol 2020; 48:915-926. [DOI: 10.1111/ceo.13826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/19/2020] [Accepted: 06/27/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Danit Saks
- Department of Clinical Medicine Macquarie University Sydney New South Wales Australia
| | - Angela Schulz
- Department of Clinical Medicine Macquarie University Sydney New South Wales Australia
| | - Jamie Craig
- Department of Ophthalmology Flinders University Adelaide South Australia Australia
| | - Stuart Graham
- Department of Clinical Medicine Macquarie University Sydney New South Wales Australia
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Thompson AC, Jammal AA, Berchuck SI, Mariottoni EB, Wu Z, Daga FB, Ogata NG, Urata CN, Estrela T, Medeiros FA. Comparing the Rule of 5 to Trend-based Analysis for Detecting Glaucoma Progression on OCT. Ophthalmol Glaucoma 2020; 3:414-420. [PMID: 32723699 DOI: 10.1016/j.ogla.2020.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The rule of 5 is a simple rule for detecting retinal nerve fiber layer (RNFL) change on spectral-domain OCT (SD-OCT), in which a loss of 5 μm of global RNFL on a follow-up test is considered evidence of significant change when compared with the baseline. The rule is based on short-term test-retest variability of SD-OCT and is often used in clinical practice. The purpose of this study was to compare the rule of 5 with trend-based analysis of global RNFL thickness over time for detecting glaucomatous progression. DESIGN Prospective cohort. PARTICIPANTS A total of 300 eyes of 210 glaucoma subjects followed for an average of 5.4±1.5 years with a median of 11 (interquartile range, 7-14) visits. METHODS Trend-based analysis was performed by ordinary least-squares (OLS) linear regression of global RNFL thickness over time. For estimation of specificity, false-positives were obtained by assessing for progression on series of randomly permutated follow-up visits for each eye, which removes any systematic trend over time. The specificity of trend-based analysis was matched to that of the rule of 5 to allow meaningful comparison of the "hit rate," or the proportion of glaucoma eyes categorized as progressing at each time point, using the original sequence of visits. MAIN OUTCOME MEASURES Comparison between hit rates of trend-analysis versus rule of 5 at matched specificity. RESULTS After 5 years, the simple rule of 5 identified 37.5% of eyes as progressing at a specificity of 81.1%. At the same specificity, the hit rate for trend-based analysis was significantly greater than that of the rule of 5 (62.9% vs. 37.5%; P < 0.001). If the rule of 5 was required to be repeatable on a consecutive test, specificity improved to 93.4%, but hit rate decreased to 21.0%. At this higher specificity, trend-based analysis still had a significantly greater hit rate than the rule of 5 (47.4% vs. 21.0%, respectively; P < 0.001). CONCLUSIONS Trend-based analysis was superior to the simple rule of 5 for identifying progression in glaucoma eyes and should be preferred as a method for longitudinal assessment of global SD-OCT RNFL change over time.
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Affiliation(s)
- Atalie C Thompson
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina
| | - Alessandro A Jammal
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina
| | - Samuel I Berchuck
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina; Duke FORGE, Durham, North Carolina
| | - Eduardo B Mariottoni
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina
| | - Zhichao Wu
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Fabio B Daga
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina
| | - Nara G Ogata
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina
| | - Carla N Urata
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina
| | - Tais Estrela
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina
| | - Felipe A Medeiros
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina.
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Jung Y, Chun H, Moon JI. Corneal deflection amplitude and visual field progression in primary open-angle glaucoma. PLoS One 2019; 14:e0220655. [PMID: 31404083 PMCID: PMC6690643 DOI: 10.1371/journal.pone.0220655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/20/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the relationship between corneal deflection amplitude and visual field progression rate in patients with primary open-angle glaucoma (POAG). Methods This study included 113 eyes of 65 patients with POAG followed for an average of 4.81 ± 1.24 years. Evaluation of visual field progression rate was performed using mean deviation of standard automated perimetry. Corneal deflection amplitude was measured using Corvis ST (Oculus Optikgeräte GmbH, Wetzlar, Germany). Linear mixed models were performed to determine the relationship between corneal deflection amplitude, intraocular pressure (IOP), and visual field progression rate. Results Mean age was 56.36 ± 14.58 years. Baseline average mean deviation was -8.20 ± 9.12 dB and mean treated IOP was 14.38 ± 3.08 mmHg. Average deflection amplitude was 0.90 ± 0.13 mm. In both univariate and multivariate analysis, IOP (P = 0.028 and P < 0.001, respectively) and deflection amplitude (P = 0.034 and P < 0.001, respectively) significantly affected visual field progression rate. Eyes with high IOP and greater deflection amplitude showed faster progression rate. Conclusions Corneal deflection amplitude was significantly related with glaucoma progression. Eyes with greater corneal deflection amplitude showed faster visual field progression rate in patients with POAG.
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Affiliation(s)
- Younhea Jung
- Department of Ophthalmology, College of Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Heejeong Chun
- Department of Ophthalmology, College of Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Il Moon
- Department of Ophthalmology, College of Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
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20
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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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Panon N, Luangsawang K, Rugaber C, Tongchit T, Thongsepee N, Cheaha D, Kongjaidee P, Changtong A, Daradas A, Chotimol P. Correlation between body mass index and ocular parameters. Clin Ophthalmol 2019; 13:763-769. [PMID: 31118554 PMCID: PMC6503310 DOI: 10.2147/opth.s196622] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/14/2019] [Indexed: 01/17/2023] Open
Abstract
Purpose: To investigate the relationship between BMI and selected ocular parameters. Subjects and methods: Fifty-three left eyes of normal weight subjects and 67 age-sex matched overweight subjects were studied. Inclusion criteria for the normal weight and overweight groups included BMI between 18.5–22.9 and 23.0–29.9 kg/m2, respectively. Subjects with a history of systemic disease, ocular disease or surgery, or disability were excluded. All subjects underwent a medical history interview, arterial blood pressure, height, weight, waist circumference and hip circumference measurements, and BMI and waist-hip ratio calculation. The intraocular pressure (IOP) and anterior corneal curvature were measured by non-contact tonometry and corneal topography, respectively. Measurement of anterior and posterior segment parameters of the eye, including central corneal thickness, anterior chamber depth (ACD), anterior chamber angle, macular thickness (MT), ganglion cell thickness (GCT), retinal nerve fiber layer thickness, cup to disc ratio, and choroidal thickness was performed by enhanced depth-imaging optical coherence tomography. Results: There was a positive correlation between ACD and BMI (Univariate analysis; β =0.198, P=0.030, Multivariate analysis; β =0.410, P=0.005) and between BMI and IOP (Univariate analysis; β =0.269, P=0.003). The IOP of the overweight group was found to be significantly higher than of the normal weight group (12.80±3.40 and 11.86±2.12 mm Hg, respectively, P=0.002). Also, there was a significant difference found between the GCT and the MT of the two groups (P=0.036 and 0.009, respectively). Conclusion: It was found that BMI strongly correlated with ACD and IOP. Also, the degree of obesity was found to be a significant factor; therefore, the relationship between these ocular parameters and the severity of obesity should be further investigated.
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Affiliation(s)
- Nisa Panon
- Faculty of Optometry, Rangsit University, Pathumthani, Thailand
| | - Kanin Luangsawang
- Department of Ophthalmology, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | | | | | - Nattaya Thongsepee
- Department of Preclinical Sciences (Physiology), Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Dania Cheaha
- Department of Biology, Faculty of Science, Prince of Songkla University, Hat Yai, Thailand
| | - Pongnugoon Kongjaidee
- Department of Optometry, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - Akawan Changtong
- Department of Optometry, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - Adithep Daradas
- Department of Optometry, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - Phatiwat Chotimol
- Department of Cardio-Thoracic Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
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Christopher M, Belghith A, Weinreb RN, Bowd C, Goldbaum MH, Saunders LJ, Medeiros FA, Zangwill LM. Retinal Nerve Fiber Layer Features Identified by Unsupervised Machine Learning on Optical Coherence Tomography Scans Predict Glaucoma Progression. Invest Ophthalmol Vis Sci 2019; 59:2748-2756. [PMID: 29860461 PMCID: PMC5983908 DOI: 10.1167/iovs.17-23387] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To apply computational techniques to wide-angle swept-source optical coherence tomography (SS-OCT) images to identify novel, glaucoma-related structural features and improve detection of glaucoma and prediction of future glaucomatous progression. Methods Wide-angle SS-OCT, OCT circumpapillary retinal nerve fiber layer (cpRNFL) circle scans spectral-domain (SD)-OCT, standard automated perimetry (SAP), and frequency doubling technology (FDT) visual field tests were completed every 3 months for 2 years from a cohort of 28 healthy participants (56 eyes) and 93 glaucoma participants (179 eyes). RNFL thickness maps were extracted from segmented SS-OCT images and an unsupervised machine learning approach based on principal component analysis (PCA) was used to identify novel structural features. Area under the receiver operating characteristic curve (AUC) was used to assess diagnostic accuracy of RNFL PCA for detecting glaucoma and progression compared to SAP, FDT, and cpRNFL measures. Results The RNFL PCA features were significantly associated with mean deviation (MD) in both SAP (R2 = 0.49, P < 0.0001) and FDT visual field testing (R2 = 0.48, P < 0.0001), and with mean circumpapillary RNFL thickness (cpRNFLt) from SD-OCT (R2 = 0.58, P < 0.0001). The identified features outperformed each of these measures in detecting glaucoma with an AUC of 0.95 for RNFL PCA compared to an 0.90 for mean cpRNFLt (P = 0.09), 0.86 for SAP MD (P = 0.034), and 0.83 for FDT MD (P = 0.021). Accuracy in predicting progression was also significantly higher for RNFL PCA compared to SAP MD, FDT MD, and mean cpRNFLt (P = 0.046, P = 0.007, and P = 0.044, respectively). Conclusions A computational approach can identify structural features that improve glaucoma detection and progression prediction.
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Affiliation(s)
- Mark Christopher
- Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California, United States
| | - Akram Belghith
- Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California, United States
| | - Robert N Weinreb
- Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California, United States
| | - Christopher Bowd
- Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California, United States
| | - Michael H Goldbaum
- Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California, United States
| | - Luke J Saunders
- Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California, United States
| | - Felipe A Medeiros
- Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina, United States
| | - Linda M Zangwill
- Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California, United States
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YANG YJ, XIANG Y, TIAN Y, XIA F, ZHOU YS, PENG J, PENG QH. Hub Genes of Astrocyte Involved in Glaucoma with Ocular Hypertension by Integrated Bioinformatics Analysis. DIGITAL CHINESE MEDICINE 2018. [DOI: 10.1016/s2589-3777(19)30053-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Systemic Disease and Long-term Intraocular Pressure Mean, Peak, and Variability in Nonglaucomatous Eyes. Am J Ophthalmol 2018; 193:184-196. [PMID: 29981739 DOI: 10.1016/j.ajo.2018.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Elevated intraocular pressure (IOP) is a well-known risk factor in glaucoma development and progression. As most glaucoma risk factors are not modifiable, IOP remains the sole focus of medical and surgical therapy. Identifying modifiable factors and their effects on IOP, such as systemic diseases, is therefore of interest. The objective is to assess the long-term, longitudinal relationship between systemic diseases and IOP mean, peak, and variability, including diabetes, hypertension, body mass index (BMI), and smoking status. DESIGN Secondary analysis of randomized clinical trial data. METHODS Longitudinal IOP and systemic disease data from the Age-Related Eye Disease Study (AREDS), a randomized clinical trial of high-dose antioxidants, was analyzed. STUDY POPULATION A total of 3909 older participants without a reported diagnosis of glaucoma or glaucoma treatment during AREDS with up to 12 years of annual IOP and systemic disease data. MAIN OUTCOME MEASURES Independent systemic disease risk factors associated with IOP. RESULTS Univariate analysis identified numerous systemic disease factors associated with IOP mean, peak, and variability. Longitudinal adjusted models identified diabetes, obesity, and systolic hypertension as significantly associated with increased IOP, while systemic beta-blocker use was inversely associated. CONCLUSIONS Results demonstrate a relationship between multiple systemic diseases and IOP; moreover, they demonstrate that systemic diseases influence additional parameters beyond mean IOP, such as IOP peak and variability. Although only to be taken within the context of IOP, these population-level trends reveal potentially modifiable factors in IOP control, and are particularly important in the context of increasing obesity and diabetes prevalence rates in American adults.
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Susanna BN, Ogata NG, Daga FB, Susanna CN, Diniz-Filho A, Medeiros FA. Association between Rates of Visual Field Progression and Intraocular Pressure Measurements Obtained by Different Tonometers. Ophthalmology 2018; 126:49-54. [PMID: 30114419 DOI: 10.1016/j.ophtha.2018.07.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/15/2018] [Accepted: 07/31/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the associations between intraocular pressure (IOP) measurements obtained by different tonometric methods and rates of visual field loss in a cohort of patients with glaucoma followed over time. DESIGN Prospective, observational cohort study. PARTICIPANTS This study included 213 eyes of 125 glaucomatous patients who were followed for an average of 2.4±0.6 years. METHODS At each visit, IOP measurements were obtained using Goldmann applanation tonometry (GAT), the Ocular Response Analyzer (ORA) (Reichert, Inc., Depew, NY), corneal-compensated IOP (IOPcc), and the ICare Rebound Tonometer (RBT) (Tiolat, Oy, Helsinki, Finland). Rates of visual field loss were assessed by standard automated perimetry (SAP) mean deviation (MD). Linear mixed models were used to investigate the relationship between mean IOP by each tonometer and rates of visual field loss over time, while adjusting for age, race, central corneal thickness, and corneal hysteresis. MAIN OUTCOME MEASURES Strength of associations (R2) between IOP measurements from each tonometer and rates of SAP MD change over time. RESULTS Average values for mean IOP over time measured by GAT, ORA, and RBT were 14.4±3.3, 15.2±4.2, and 13.4±4.2 mmHg, respectively. Mean IOPcc had the strongest relationship with SAP MD loss over time (R2 = 24.5%) and was significantly different from the models using mean GAT IOP (R2 = 11.1%; 95% confidence interval [CI] of the difference, 6.6-19.6) and mean RBT IOP (R2= 5.8%; 95% CI of the difference, 11.1-25.0). CONCLUSIONS Mean ORA IOPcc was more predictive of rates of visual field loss than mean IOP obtained by GAT or RBT. By correcting for corneal-induced artifacts, IOPcc measurements may present significant advantages for predicting clinically relevant outcomes in patients with glaucoma.
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Affiliation(s)
- Bianca N Susanna
- Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Ophthalmology, University of California, San Diego, La Jolla, California; ABC Foundation School of Medicine, Santo André, Brazil
| | - Nara G Ogata
- Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Fábio B Daga
- Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Carolina N Susanna
- Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Ophthalmology, University of California, San Diego, La Jolla, California; ABC Foundation School of Medicine, Santo André, Brazil
| | - Alberto Diniz-Filho
- Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Felipe A Medeiros
- Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Ophthalmology, University of California, San Diego, La Jolla, California.
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Daga FB, Gracitelli CPB, Diniz-Filho A, Medeiros FA. Is vision-related quality of life impaired in patients with preperimetric glaucoma? Br J Ophthalmol 2018; 103:955-959. [PMID: 30049801 DOI: 10.1136/bjophthalmol-2018-312357] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/09/2018] [Accepted: 07/13/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To investigate whether subjects with preperimetric glaucoma exhibit decline in patient-reported vision-related quality of life (QoL) compared with healthy individuals. METHODS This cross-sectional study included 45 patients with preperimetric glaucoma, 102 patients with perimetric glaucoma and 81 healthy controls. Perimetric glaucoma was defined by the presence of repeatable abnormal standard automated perimetry tests and corresponding optic nerve damage in at least one eye. Preperimetric glaucoma was defined based on the presence of retinal nerve fibre layer (RNFL) loss as detected by spectral-domain optical coherence tomography in the absence of visual field loss. Patient-reported QoL was measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). RESULTS Patients with preperimetric glaucoma had significantly thinner average RNFL in the better eye compared with controls (79.9±9.2 µm vs 97.8±8.6 µm; p<0.001). There was no significant difference in Rasch-calibrated NEI VFQ-25 scores between the preperimetric and control groups (72.8±16.8 vs 73.7±20.2, respectively; p=0.964). The average NEI VFQ-25 score in the perimetric glaucoma group was 58.9±18.6 and was significantly different than the average score in the preperimetric glaucoma and healthy groups (p<0.001 for both comparisons). CONCLUSION Contrary to patients with perimetric damage, preperimetric glaucoma does not seem to be associated with loss in QoL. Prevention of disability from glaucoma may benefit from early diagnosis during a 'window of opportunity' given by detecting structural loss before visual field damage.
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Affiliation(s)
- Fábio B Daga
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, North Carolina, USA.,Department of Ophthalmology and Vision Science, Federal University of São Paulo, São Paulo, Brazil.,Department of Ophthalmology, University of California, San Diego, California, USA
| | - Carolina P B Gracitelli
- Department of Ophthalmology and Vision Science, Federal University of São Paulo, São Paulo, Brazil.,Department of Ophthalmology, University of California, San Diego, California, USA
| | - Alberto Diniz-Filho
- Department of Ophthalmology, University of California, San Diego, California, USA
| | - Felipe A Medeiros
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, North Carolina, USA .,Department of Ophthalmology, University of California, San Diego, California, USA
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Hou H, Shoji T, Zangwill LM, Moghimi S, Saunders LJ, Hasenstab K, Ghahari E, Manalastas PIC, Akagi T, Christopher M, Penteado RC, Weinreb RN. Progression of Primary Open-Angle Glaucoma in Diabetic and Nondiabetic Patients. Am J Ophthalmol 2018; 189:1-9. [PMID: 29447914 DOI: 10.1016/j.ajo.2018.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/31/2018] [Accepted: 02/03/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the rates of visual field (VF) loss and retinal nerve fiber layer (RNFL) thinning in primary open-angle glaucoma (POAG) patients with or without type 2 diabetes mellitus (DM). DESIGN Cohort study. METHODS A total of 197 eyes (55 eyes of 32 POAG patients with DM in POAG/DM group and 142 eyes of 111 age-matched POAG patients without DM in POAG/DM- group) were included from the Diagnostic Innovations in Glaucoma Study (DIGS). Type 2 DM participants were defined by self-report of DM history and use of antidiabetic medication. The rates of VF loss and RNFL loss were compared in POAG eyes with and without DM using univariate and multivariable mixed-effects models. RESULTS The median (interquartile range) follow-up was 5.7 years (4.0, 6.4). The mean rate of global RNFL loss in the POAG/DM group was 2-fold slower than in the POAG/DM- group overall (-0.40 μm/year vs -0.83 μm/year, respectively P = .01). Although a slower rate of VF mean deviation and pattern standard deviation loss was found in the POAG/DM group compared to the POAG/DM- group, the difference was not statistically significant. CONCLUSIONS POAG patients with treated type 2 DM, who had no detectable diabetic retinopathy, had significantly slower rates of RNFL thinning compared to those without diagnosed DM.
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Integrating Macular Ganglion Cell Inner Plexiform Layer and Parapapillary Retinal Nerve Fiber Layer Measurements to Detect Glaucoma Progression. Ophthalmology 2018; 125:822-831. [PMID: 29433852 DOI: 10.1016/j.ophtha.2017.12.027] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/02/2017] [Accepted: 12/19/2017] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To investigate the temporal relationship among progressive macular ganglion cell inner plexiform layer (GCIPL) thinning, progressive parapapillary retinal nerve fiber layer (RNFL) thinning, and visual field (VF) progression in patients with primary open-angle glaucoma (POAG). DESIGN Prospective study. PARTICIPANTS One hundred thirty-six POAG patients (231 eyes) followed up for ≥5 years. METHODS OCT imaging of the macular GCIPL and parapapillary RNFL and perimetry were performed at ∼ 4-month intervals. Progressive GCIPL and RNFL thinning were determined by Guided Progression Analysis (GPA) of serial GCIPL and RNFL thickness maps. The specificities of GPA were calculated from the proportions of eyes with progressive GCIPL or RNFL thinning in 67 eyes of 36 healthy individuals followed up for ≥5 years. Visual field progression (likely or possible) was determined by the Early Manifest Glaucoma Trial criteria. MAIN OUTCOME MEASURES Hazard ratios for VF progression, progressive RNFL thinning, and progressive GCIPL thinning, as determined by time-varying Cox models. RESULTS GPA detected 57 eyes (24.7%) with progressive GCIPL thinning and 66 eyes (28.6%) with progressive RNFL thinning at a specificity of 95.5% and 91.0%, respectively. Thirty-five eyes (15.2%) demonstrated progressive RNFL and GCIPL thinning, whereas 53 eyes (22.9%) demonstrated progressive RNFL or GCIPL thinning. Eyes with progressive GCIPL thinning had a higher risk for progressive RNFL thinning (HR, 5.27; 95% confidence interval [CI], 2.89-9.62), whereas eyes with progressive RNFL thinning were also at a higher risk for progressive GCIPL thinning (HR, 2.99; 95% CI, 1.48-6.02), after adjusting for baseline covariates. The HRs for likely and possible VF progression were 3.48 (95% CI, 1.51-8.01) and 2.74 (95% CI, 1.26-5.98), respectively, on detection of progressive GCIPL thinning and 3.66 (95% CI, 1.68-7.97) and 2.54 (95% CI, 1.23-5.21), respectively, on detection of progressive RNFL thinning after adjusting for baseline covariates. Eyes with VF progression were not at risk of progressive RNFL or GCIPL thinning (P ≥ 0.493). CONCLUSIONS Progressive macular GCIPL thinning and progressive parapapillary RNFL thinning are mutually predictive. Because progressive RNFL thinning and progressive GCIPL thinning are both indicative of VF progression, integrating macular GCIPL and parapapillary RNFL measurements is relevant to facilitate early detection of disease deterioration in glaucoma patients.
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The Estimates of Retinal Ganglion Cell Counts Performed Better than Isolated Structure and Functional Tests for Glaucoma Diagnosis. J Ophthalmol 2017; 2017:2724312. [PMID: 28811934 PMCID: PMC5546054 DOI: 10.1155/2017/2724312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/15/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the diagnostic accuracy of retinal ganglion cell (RGC) counts as estimated by combining data from standard automated perimetry (SAP) and spectral domain optical coherence tomography (SD-OCT). Methods Healthy individuals and glaucoma patients were included in this cross-sectional study. All eyes underwent 24-2 SITA SAP and structural imaging tests. RGC count estimates were obtained using a previously described algorithm, which combines estimates of RGC numbers from SAP sensitivity thresholds and SD-OCT retinal nerve fiber layer (RNFL) average thickness. Results A total of 119 eyes were evaluated, including 75 eyes of 48 healthy individuals and 44 eyes of 29 glaucoma patients. RGC count estimates performed better than data derived from SD-OCT RNFL average thickness or SAP mean deviation alone (area under ROC curves: 0.98, 0.92, and 0.79; P < 0.001) for discriminating healthy from glaucomatous eyes, even in a subgroup of eyes with mild disease (0.97, 0.88, and 0.75; P < 0.001). There was a strong and significant correlation between estimates of RGC numbers derived from SAP and SD-OCT (R2 = 0.74; P < 0.001). Conclusion RGC count estimates obtained by combined structural and functional data showed excellent diagnostic accuracy for discriminating the healthy from the glaucomatous eyes and performed better than isolated structural and functional parameters.
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Verma S, Nongpiur ME, Atalay E, Wei X, Husain R, Goh D, Perera SA, Aung T. Visual Field Progression in Patients with Primary Angle-Closure Glaucoma Using Pointwise Linear Regression Analysis. Ophthalmology 2017; 124:1065-1071. [DOI: 10.1016/j.ophtha.2017.02.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/16/2017] [Accepted: 02/22/2017] [Indexed: 10/19/2022] Open
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Abe RY, Diniz-Filho A, Zangwill LM, Gracitelli CPB, Marvasti AH, Weinreb RN, Baig S, Medeiros FA. The Relative Odds of Progressing by Structural and Functional Tests in Glaucoma. Invest Ophthalmol Vis Sci 2017; 57:OCT421-8. [PMID: 27409501 PMCID: PMC4968922 DOI: 10.1167/iovs.15-18940] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the effect of disease severity and number of tests acquired during follow-up on the relative odds of identifying progression by structural or functional tests in glaucoma. METHODS This was an observational cohort study involving 462 eyes of 305 patients with glaucoma and 62 eyes of 49 healthy subjects. Glaucoma patients and healthy subjects were followed for an average of 3.6 ± 0.9 and 3.8 ± 0.9 years, with a median (interquantile range) of 8 (6-9) and 7 (6-8) visits, respectively. At each visit, subjects underwent visual field assessment with standard automated perimetry (SAP) and retinal nerve fiber layer (RNFL) evaluation by spectral-domain optical coherence tomography (SD-OCT). Slopes of change in SAP mean sensitivity and OCT RNFL thickness over time were estimated by linear regression using progressively cumulative visits over time. Cutoff values for age-related expected rates of change for each test were obtained from the healthy group. Progression by SD-OCT and/or SAP was determined if the slope of change was statistically significant and also lower (faster) than the fifth percentile cutoff calculated from the healthy group. A generalized estimating equation logistic regression model was used to evaluate the relative odds of progressing by OCT versus SAP in glaucoma eyes. RESULTS Eyes with less severe disease at baseline had a higher chance of being detected as progressing by SD-OCT but not by SAP, whereas an increase in disease severity at baseline increased the chance that the eye would be detected as progressing by SAP but not SD-OCT. Each 1 dB higher MD was associated with a 5% increase in the odds of detecting progression by SD-OCT versus SAP (odds ratio = 1.05 per 1 dB; 95% confidence interval: 1.01-1.09; P = 0.005). CONCLUSIONS The ability to detect glaucoma progression by SAP versus SD-OCT is significantly influenced by the stage of disease. Our results may provide useful information for guiding clinicians on the relative utility of these tests for detecting change throughout the disease continuum.
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Comparing the Rates of Retinal Nerve Fiber Layer and Ganglion Cell-Inner Plexiform Layer Loss in Healthy Eyes and in Glaucoma Eyes. Am J Ophthalmol 2017; 178:38-50. [PMID: 28315655 DOI: 10.1016/j.ajo.2017.03.008] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 03/03/2017] [Accepted: 03/06/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare the rates of circumpapillary retinal nerve fiber layer (RNFL) and macular retinal ganglion cell-inner plexiform layer (GCIPL) change over time in healthy and glaucoma eyes. DESIGN Cohort study. METHODS The rates of circumpapillary RNFL and macular GCIPL loss in 28 healthy subjects and 97 glaucoma subjects from the Diagnostic Innovations in Glaucoma Study (DIGS) were compared using mixed-effects models. RESULTS The median follow-up time and number of visits were 1.7 years and 6 visits and 3.2 years and 7 visits for healthy and glaucoma eyes, respectively. Significant rates of loss of both global circumpapillary RNFL and average macular GCIPL thickness were detectable in early and moderate glaucoma eyes; in severe glaucoma eyes, rates of average macular GCIPL loss were significant, but rates of global circumpapillary RNFL loss were not. In glaucoma eyes, mean rates of global circumpapillary RNFL thickness change (-0.98 μm/year [95% confidence interval (CI), -1.20 to -0.76]) and normalized global circumpapillary RNFL change (-1.7%/year [95% CI, -2.1 to -1.3]) were significantly faster than average macular GCIPL change (-0.57 μm/year [(95% CI, -0.73 to -0.41]) and normalized macular GCIPL change (-1.3%/year [95% CI, -1.7 to -0.9]). The rates of global and inferior RNFL change were weakly correlated with global and inferior macular GCIPL change (r ranges from 0.16 to 0.23, all P < .05). CONCLUSIONS In this cohort, the rate of circumpapillary RNFL thickness change was faster than macular GCIPL change for glaucoma eyes. Global circumpapillary RNFL thickness loss was detectable in early and moderate glaucoma, and average macular GCIPL thickness loss was detectable in early, moderate, and severe glaucoma, suggesting that structural changes can be detected in severe glaucoma.
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Li BB, Cai Y, Pan YZ, Li M, Qiao RH, Fang Y, Tian T. Corneal Biomechanical Parameters and Asymmetric Visual Field Damage in Patients with Untreated Normal Tension Glaucoma. Chin Med J (Engl) 2017; 130:334-339. [PMID: 28139518 PMCID: PMC5308017 DOI: 10.4103/0366-6999.198920] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: High intraocular pressure (IOP) and low central corneal thickness (CCT) are important validated risk factors for glaucoma, and some studies also have suggested that eyes with more deformable corneas may be in higher risk of the development and worsening of glaucoma. In the present study, we aimed to evaluate the association between corneal biomechanical parameters and asymmetric visual field (VF) damage using a Corvis-ST device in patients with untreated normal tension glaucoma (NTG). Methods: In this observational, cross-sectional study, 44 newly diagnosed NTG patients were enrolled. Of these, 31 had asymmetric VF damage, which was defined as a 5-point difference between the eyes according to the Advanced Glaucoma Intervention Study scoring system. Corneal biomechanical parameters were obtained using a Corvis-ST device, such as time from start until the first and second applanation is reached (time A1 and time A2, respectively), cord length of the first and second applanation (length A1 and length A2, respectively), corneal speed during the first and second applanation (velocity A1 and velocity A2, respectively), time from start until highest concavity is reached (time HC), maximum amplitude at the apex of highest concavity (def ampl HC), distance between the two peaks at highest concavity (peak dist HC), and central concave curvature at its highest concavity (radius HC). Results: Time A1 (7.19 ± 0.28 vs. 7.37 ± 0.41 ms, P = 0.010), length A1 (1.73 [1.70–1.76] vs. 1.78 [1.76–1.79] mm, P = 0.007), length A2 (1.58 [1.46–1.70] vs. 1.84 [1.76–1.92] mm, P < 0.001), peak dist HC (3.53 [3.08–4.00] vs. 4.33 [3.92–4.74] mm, P = 0.010), and radius HC (6.20 ± 0.69 vs. 6.59 ± 1.18 mm, P = 0.032) were significantly lower in the worse eyes than in the better eyes, whereas velocity A1 and def ampl HC were significantly higher (0.156 [0.149–0.163] vs. 0.145 [0.138–0.152] m/s, P = 0.002 and 1.19 ± 0.13 vs. 1.15 ± 0.13 mm, P = 0.005, respectively). There was no significant difference in time A2, velocity A2, and time HC between the two groups. In addition, no difference was observed in IOP, CCT, and axial length. In the univariate and multivariate analyses, some of the Corvis-ST parameters, including time A1 and def ampl HC, were correlated with known risk factors for glaucoma, and there was also a significant positive correlation between def ampl HC and age. Conclusions: There were differences in dynamic corneal response parameters but not IOP or CCT between the paired eyes of NTG patients with asymmetric VF damage. We suggest that the shape of the cornea is more easily altered in the worse eyes of asymmetric NTG patients.
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Affiliation(s)
- Bai-Bing Li
- Department of Ophthalmology, Peking University First Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing 100034, China
| | - Yu Cai
- Department of Ophthalmology, Peking University First Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing 100034, China
| | - Ying-Zi Pan
- Department of Ophthalmology, Peking University First Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing 100034, China
| | - Mei Li
- Department of Ophthalmology, Peking University First Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing 100034, China
| | - Rong-Hua Qiao
- Department of Ophthalmology, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Yuan Fang
- Department of Ophthalmology, Peking University First Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing 100034, China
| | - Tian Tian
- Department of Ophthalmology, Peking University First Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing 100034, China
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Diniz-Filho A, Abe RY, Zangwill LM, Gracitelli CPB, Weinreb RN, Girkin CA, Liebmann JM, Medeiros FA. Association between Intraocular Pressure and Rates of Retinal Nerve Fiber Layer Loss Measured by Optical Coherence Tomography. Ophthalmology 2016; 123:2058-65. [PMID: 27554036 DOI: 10.1016/j.ophtha.2016.07.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 06/30/2016] [Accepted: 07/07/2016] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To evaluate the relationship between intraocular pressure (IOP) and rates of retinal nerve fiber layer (RNFL) thickness change over time measured by spectral-domain (SD) optical coherence tomography (OCT). DESIGN Observational cohort study. PARTICIPANTS The study involved 547 eyes of 339 patients followed up for an average of 3.9±0.9 years. Three hundred eight (56.3%) had a diagnosis of glaucoma and 239 (43.7%) were considered glaucoma suspects. METHODS All eyes underwent imaging using the Spectralis SD OCT (Heidelberg Engineering GmbH, Heidelberg, Germany), along with IOP measurements and standard automated perimetry (SAP). Glaucoma progression was defined as a result of "Likely Progression" from the Guided Progression Analysis software for SAP. Linear mixed models were used to investigate the relationship between average IOP during follow-up and rates of RNFL thickness change, while taking into account potential confounding factors such as age, race, corneal thickness, and baseline disease severity. MAIN OUTCOME MEASURES The association between IOP and rates of global and sectorial RNFL thickness loss measured by SD OCT. RESULTS Forty-six eyes (8.4%) showed progression on SAP during follow-up. Rates of global RNFL thickness change in eyes that progressed by SAP were faster than in those that did not progress (-1.02 vs. -0.61 μm/year, respectively; P = 0.002). For progressing eyes, each 1-mmHg higher average in IOP during follow-up was associated with an additional average loss of 0.20 μm/year (95% confidence interval [CI]: 0.08 to 0.31 μm/year; P < 0.001) of global RNFL thickness versus only 0.04 μm/year (95% CI: 0.01 to 0.07 μm/year; P = 0.015) for nonprogressing eyes. The largest associations between IOP and rates of RNFL change were seen for measurements from the temporal superior and temporal inferior sectors, whereas the smallest association was seen for measurements from the nasal sector. CONCLUSIONS Higher levels of IOP during follow-up were associated with faster rates of RNFL loss over time measured by SD OCT. These findings support the use of SD OCT RNFL thickness measurements as biomarkers for the evaluation of the efficacy of IOP-lowering therapies to slow down the rate of disease progression.
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Affiliation(s)
- Alberto Diniz-Filho
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Y Abe
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Carolina P B Gracitelli
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Christopher A Girkin
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey M Liebmann
- Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Felipe A Medeiros
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California.
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Yu M, Lin C, Weinreb RN, Lai G, Chiu V, Leung CKS. Risk of Visual Field Progression in Glaucoma Patients with Progressive Retinal Nerve Fiber Layer Thinning. Ophthalmology 2016; 123:1201-10. [DOI: 10.1016/j.ophtha.2016.02.017] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 10/22/2022] Open
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Zhang C, Tatham AJ, Abe RY, Diniz-Filho A, Zangwill LM, Weinreb RN, Medeiros FA. Corneal Hysteresis and Progressive Retinal Nerve Fiber Layer Loss in Glaucoma. Am J Ophthalmol 2016; 166:29-36. [PMID: 26949135 DOI: 10.1016/j.ajo.2016.02.034] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the relationship between corneal hysteresis (CH) and progressive retinal nerve fiber layer (RNFL) loss in a cohort of patients with glaucoma followed prospectively over time. DESIGN Prospective observational cohort study. METHODS One hundred and eighty-six eyes of 133 patients with glaucoma were followed for an average of 3.8 ± 0.8 years, with a median of 9 visits during follow-up. The CH measurements were acquired using the Ocular Response Analyzer (Reichert Instruments, Depew, New York, USA) and RNFL measurements were obtained at each follow up visit using spectral-domain optical coherence tomography (SDOCT). Random-coefficient models were used to investigate the relationship between baseline CH, central corneal thickness (CCT), average intraocular pressure (IOP), and rates of RNFL loss during follow-up, while adjusting for potentially confounding factors. RESULTS Average baseline RNFL thickness was 76.4 ± 18.1 μm and average baseline CH was 9.2 ± 1.8 mm Hg. CH had a significant effect on rates of RNFL progression. In the univariable model, including only CH as a predictive factor along with time and their interaction, each 1 mm Hg lower CH was associated with a 0.13 μm/year faster rate of RNFL decline (P = .011). A similar relationship between low CH and faster rates of RNFL loss was found using a multivariable model accounting for age, race, average IOP, and CCT (P = .015). CONCLUSIONS Lower CH was significantly associated with faster rates of RNFL loss over time. The prospective longitudinal design of this study provides further evidence that CH is an important factor to be considered in the assessment of the risk of progression in patients with glaucoma.
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Affiliation(s)
- Chunwei Zhang
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Andrew J Tatham
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Ricardo Y Abe
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Alberto Diniz-Filho
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Linda M Zangwill
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Robert N Weinreb
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Felipe A Medeiros
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California.
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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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Abstract
Purpose We aimed to assess corneal biomechanics using the ocular response analyzer in patients with normal-tension glaucoma (NTG), and to evaluate the relationship between corneal biomechanics and visual field loss. Methods This was a prospective observational case series including patients with bilateral asymmetric NTG. For all patients, corneal hysteresis (CH), corneal resistance factor (CRF), CH − CRF difference, and central corneal thickness values were matched against the mean deviation (MD) of the visual field and the cup/disc ratio. For paired-eye comparison in each patient, both eyes were categorized into a better-eyes group and a worse-eyes group according to lower and higher corneal-compensated intraocular pressure readings, respectively. Statistical analysis was carried out with the independent-samples Student’s t-test, and the level of statistical significance was set at 0.05. Correlation was assessed using Pearson’s correlation coefficient. Results The study included 240 eyes of 120 patients. CH was inversely proportional to the MD in the visual field (P=0.01). CRF in both eyes was inversely proportional to the MD of the visual field (P=0.01). CH − CRF difference was directly proportional to the MD of the visual field (P=0.01). For paired-eye comparison, lower corneal-compensated intraocular pressure was associated with higher CH, higher CRF, smaller cup/disc ratio, and less deterioration of MD of visual field. Conclusion CH, CRF, and CH − CRF are more powerful predictors of NTG progression than central corneal thickness.
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Affiliation(s)
- Hazem Helmy
- Department of Glaucoma and Optic Nerve Diseases, Research Institute of Ophthalmology, Cairo, Egypt
| | - Mahmoud Leila
- Retina Department, Research Institute of Ophthalmology, Cairo, Egypt
| | - Ahmed Atef Zaki
- Corneal Diseases Department, Research Institute of Ophthalmology, Cairo, Egypt
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Diniz-Filho A, Abe RY, Cho HJ, Baig S, Gracitelli CPB, Medeiros FA. Fast Visual Field Progression Is Associated with Depressive Symptoms in Patients with Glaucoma. Ophthalmology 2016; 123:754-9. [PMID: 26920097 DOI: 10.1016/j.ophtha.2015.12.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/26/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To evaluate the association between the rates of progressive visual field loss and the occurrence of depressive symptoms in patients with glaucoma followed over time. DESIGN Prospective observational cohort study. PARTICIPANTS The study included 204 eyes of 102 patients with glaucomatous visual field defects on standard automated perimetry (SAP). METHODS All patients had Geriatric Depression Scale (GDS) questionnaires and visual field tests obtained over a mean follow-up time of 2.2±0.6 years. Change in depressive symptoms was assessed by calculating the difference between GDS scores at the last follow-up visit from those at baseline. Rates of visual field loss were assessed by SAP. An integrated binocular visual field was estimated from the monocular SAP tests, and rates of change in mean sensitivity (MS) over time were obtained from linear mixed models. Regression models were used to investigate the association between progressive visual field loss and changes in depressive symptoms, adjusting for potentially confounding clinical and socioeconomic variables. MAIN OUTCOME MEASURES The association between rates of change in binocular SAP MS and change in GDS questionnaire scores. RESULTS There was a significant correlation between change in the GDS scores during follow-up and change in binocular SAP sensitivity. Each 1 decibel (dB)/year change in binocular SAP MS was associated with a change of 2.0 units in the GDS scores during the follow-up period (P = 0.025). In a multivariable model adjusting for baseline disease severity, change in visual acuity, age, gender, race, Montreal Cognitive Assessment score, education, income, and comorbidity index, each 1 dB/year change in binocular SAP MS was associated with a change of 3.0 units in the GDS score (P = 0.019). CONCLUSIONS Faster visual field progression was associated with the occurrence of depressive symptoms in patients with glaucoma.
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Affiliation(s)
- Alberto Diniz-Filho
- Laboratory of Performance and Visual Function, Department of Ophthalmology, University of California San Diego, La Jolla, California; Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Y Abe
- Laboratory of Performance and Visual Function, Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Hyong Jin Cho
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Saif Baig
- Laboratory of Performance and Visual Function, Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Carolina P B Gracitelli
- Laboratory of Performance and Visual Function, Department of Ophthalmology, University of California San Diego, La Jolla, California; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Felipe A Medeiros
- Laboratory of Performance and Visual Function, Department of Ophthalmology, University of California San Diego, La Jolla, California.
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Abdelkader M. Functional and anatomical assessment of retinal ganglion cells in glaucoma. DELTA JOURNAL OF OPHTHALMOLOGY 2016. [DOI: 10.4103/1110-9173.189076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rate and Pattern of Rim Area Loss in Healthy and Progressing Glaucoma Eyes. Ophthalmology 2015; 123:760-70. [PMID: 26746597 DOI: 10.1016/j.ophtha.2015.11.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 11/06/2015] [Accepted: 11/12/2015] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To characterize the rate and pattern of age-related and glaucomatous neuroretinal rim area changes in subjects of African and European descent. DESIGN Prospective longitudinal study. PARTICIPANTS Two hundred ninety-six eyes of 157 healthy subjects (88 patients of African descent and 69 of European descent) and 73 progressing glaucoma eyes of 67 subjects (24 patients of African descent and 43 of European descent) from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study were included. METHODS Global and sectoral rim areas were measured using confocal laser scanning ophthalmoscopy. Masked stereophotograph review determined progression of glaucomatous optic disc damage. The rates of absolute rim area loss and percentage rim area loss in healthy and progressing glaucomatous eyes were compared using multivariate, nested, mixed-effects models. MAIN OUTCOME MEASURES Rate of rim area loss over time. RESULTS The median follow-up time was 5.0 years (interquartile range, 2.0-7.4 years) for healthy eyes and 8.3 years (interquartile range, 7.5-9.9 years) for progressing glaucoma eyes. The mean rate of global rim area loss was significantly faster in progressing glaucomatous eyes compared with healthy eyes for both rim area loss (-10.2×10(-3) vs. -2.8×10(-3) mm(2)/year, respectively; P < 0.001) and percentage rim area loss (-1.1% vs. -0.2%/year, respectively; P < 0.001), but considerable overlap existed between the 2 groups. Sixty-three percent of progressing glaucoma eyes had a rate of change faster than the fifth quantile of healthy eyes. For both healthy and progressing eyes, the pattern of rim area loss and percentage rim area loss were similar, tending to be fastest in the superior temporal and inferior temporal sectors. The rate of change was similar in progressing eyes of patients of African or European descent. CONCLUSIONS Compared with healthy eyes, the mean rate of global rim area loss was 3.7 times faster and the mean rate of global percentage rim area loss was 5.4 times faster in progressing glaucoma eyes. A reference database of healthy eyes can be used to help clinicians distinguish age-related rim area loss from rim area loss resulting from glaucoma.
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Tian K, Shibata-Germanos S, Pahlitzsch M, Cordeiro MF. Current perspective of neuroprotection and glaucoma. Clin Ophthalmol 2015; 9:2109-18. [PMID: 26635467 PMCID: PMC4646599 DOI: 10.2147/opth.s80445] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Glaucoma is the second leading cause of blindness worldwide and is most notably characterized by progressive optic nerve atrophy and advancing loss of retinal ganglion cells (RGCs). The main concomitant factor is the elevated intraocular pressure (IOP). Existing treatments are focused generally on lowering IOP. However, both RGC loss and optic nerve atrophy can independently occur with IOP at normal levels. In recent years, there has been substantial progress in the development of neuroprotective therapies for glaucoma in order to restore vital visual function. The present review intends to offer a brief insight into conventional glaucoma treatments and discuss exciting current developments of mostly preclinical data in novel neuroprotective strategies for glaucoma that include recent advances in noninvasive diagnostics going beyond IOP maintenance for an enhanced global view. Such strategies now target RGC loss and optic nerve damage, opening a critical therapeutic window for preventative monitoring and treatment.
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Affiliation(s)
- Kailin Tian
- Glaucoma and Retinal Neurodegeneration Research Group, UCL Institute of Ophthalmology, London, UK ; Eye Centre, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Shannon Shibata-Germanos
- Glaucoma and Retinal Neurodegeneration Research Group, UCL Institute of Ophthalmology, London, UK
| | - Milena Pahlitzsch
- Glaucoma and Retinal Neurodegeneration Research Group, UCL Institute of Ophthalmology, London, UK
| | - M Francesca Cordeiro
- Glaucoma and Retinal Neurodegeneration Research Group, UCL Institute of Ophthalmology, London, UK ; Western Eye Hospital, ICORG, Imperial College NHS Trust, London, UK
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Liu T, Tatham AJ, Gracitelli CPB, Zangwill LM, Weinreb RN, Medeiros FA. Rates of Retinal Nerve Fiber Layer Loss in Contralateral Eyes of Glaucoma Patients with Unilateral Progression by Conventional Methods. Ophthalmology 2015; 122:2243-51. [PMID: 26383993 DOI: 10.1016/j.ophtha.2015.07.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/22/2015] [Accepted: 07/25/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To determine whether progressive retinal nerve fiber layer (RNFL) loss occurs in the contralateral eye of patients with glaucoma showing unilateral progression according to conventional diagnostic methods. DESIGN Prospective, longitudinal, observational cohort study. PARTICIPANTS Three hundred forty-six eyes of 173 patients (118 eyes with glaucoma and 228 eyes with suspect glaucoma at baseline) followed up for an average of 3.5±0.7 years. METHODS All subjects underwent standard automated perimetry (SAP; Humphrey Field Analyzer; Carl Zeiss Meditec, Dublin, CA) and spectral-domain (SD) optical coherence tomography (OCT; Spectralis; Heidelberg Engineering, Inc., Carlsbad, CA) in both eyes at 6-month intervals. Eyes were determined as progressing by conventional methods if there was progression on masked grading of optic disc stereophotographs or SAP Guided Progression Analysis (GPA; Carl Zeiss Meditec; "likely progression"). Rates of change in SD OCT average RNFL thickness were obtained using a linear mixed effects model. Rate of global loss was calculated using a random coefficient model and compared for nonprogressing patients, progressing eyes, and fellow eyes of unilateral progressing patients. MAIN OUTCOMES MEASURES Rate of change in global RNFL thickness. RESULTS Thirty-nine subjects showed evidence of unilateral progression by GPA, disc photographs, or both during follow-up. Mean ± standard error rate of RNFL loss in eyes progressing by conventional methods was -0.89±0.22 μm/year (P<0.001). The contralateral eyes of these subjects also showed significant loss of RNFL over time (-1.00±0.20 μm/year; P<0.001). One hundred thirty-four subjects did not show progression by conventional methods in either eye. These eyes also showed a significant decline over time in average RNFL thickness (-0.71±0.09 μm/year; P<0.001); however, the rate of change in these eyes was slower than that of the contralateral eye of patients showing unilateral progression (P<0.001). CONCLUSIONS Loss of RNFL thickness was seen in a substantial number of contralateral eyes of glaucoma patients showing unilateral progression by conventional methods. These findings indicate that assessment of RNFL thickness by SD OCT may show progressive glaucomatous damage that is not detected by visual fields or optic disc stereophotography.
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Affiliation(s)
- Ting Liu
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Ophthalmology, Daping Hospital & Research Institute of Surgery, Third Military Medical University of the People's Liberation Army, Chongqing, China
| | - Andrew J Tatham
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California; Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, Edinburgh, United Kingdom
| | - Carolina P B Gracitelli
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Linda M Zangwill
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Robert N Weinreb
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Felipe A Medeiros
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California.
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Savastano A, Savastano MC, Carlomusto L, Savastano S. Bilateral Glaucomatous Optic Neuropathy Caused by Eye Rubbing. Case Rep Ophthalmol 2015; 6:279-83. [PMID: 26483667 PMCID: PMC4608614 DOI: 10.1159/000439163] [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: 12/02/2022] Open
Abstract
In this report, we describe a particular condition of a 52-year-old man who showed advanced bilateral glaucomatous-like optic disc damage, even though the intraocular pressure resulted normal during all examinations performed. Visual field test, steady-state pattern electroretinogram, retinal nerve fiber layer and retinal tomographic evaluations were performed to evaluate the optic disc damage. Over a 4-year observational period, his visual acuity decreased to 12/20 in the right eye and counting fingers in the left eye. Visual fields were severely compromised, and intraocular pressure values were not superior to 14 mm Hg during routine examinations. An accurate anamnesis and the suspicion of this disease represent a crucial aspect to establish the correct diagnosis. In fact, our patient strongly rubbed his eyes for more than 10 h per day. Recurrent and continuous eye rubbing can induce progressive optic neuropathy, causing severe visual field damage similar to the pathology of advanced glaucoma.
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Gracitelli CPB, Abe RY, Tatham AJ, Rosen PN, Zangwill LM, Boer ER, Weinreb RN, Medeiros FA. Association between progressive retinal nerve fiber layer loss and longitudinal change in quality of life in glaucoma. JAMA Ophthalmol 2015; 133:384-90. [PMID: 25569808 DOI: 10.1001/jamaophthalmol.2014.5319] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Evaluation of structural optic nerve damage is a fundamental part of diagnosis and management of glaucoma. However, the relationship between structural measurements and disability associated with the disease is not well characterized. Quantification of this relationship may help validate structural measurements as markers directly relevant to quality of life. OBJECTIVE To evaluate the relationship between rates of retinal nerve fiber layer (RNFL) loss and longitudinal changes in quality of life in glaucoma. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study including 260 eyes of 130 patients with glaucoma followed up for a mean (SD) of 3.5 (0.7) years. All patients had repeatable visual field defects on standard automated perimetry (SAP) at baseline. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was performed annually, and spectral-domain optical coherence tomography and SAP were performed at 6-month intervals. A joint model was used to investigate the association between change in NEI VFQ-25 Rasch-calibrated scores and change in RNFL thickness, adjusting for confounding socioeconomic and clinical variables. MAIN OUTCOMES AND MEASURES Association between change in binocular RNFL thickness (RNFL thickness in the better eye at each point) and change in NEI VFQ-25 scores. RESULTS Progressive binocular RNFL thickness loss was associated with worsening of NEI VFQ-25 scores over time. In a multivariable model adjusting for baseline disease severity and the rate of change in binocular SAP sensitivity, each 1-μm-per-year loss of RNFL thickness was associated with a decrease of 1.3 units (95% CI, 1.02-1.56) per year in NEI VFQ-25 scores (P < .001). After adjusting for the contribution from SAP, 26% (95% CI, 12%-39%) of the variability of change in NEI VFQ-25 scores was associated uniquely with change in binocular RNFL thickness. The P value remained less than .001 after adjusting for potential confounding factors. CONCLUSIONS AND RELEVANCE Progressive binocular RNFL thickness loss was associated with longitudinal loss in quality of life, even after adjustment for progressive visual field loss. These findings suggest that rates of binocular RNFL change are valid markers for the degree of neural loss in glaucoma with significant relationship to glaucoma-associated disability.
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Affiliation(s)
- Carolina P B Gracitelli
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego2Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Ricardo Y Abe
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego3Department of Ophthalmology, University of Campinas, Campinas, Brazil
| | - Andrew J Tatham
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego4Princess Alexandra Eye Pavilion, Department of Ophthalmology, University of Edinburgh, Edinburgh, Scotland
| | - Peter N Rosen
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego
| | - Linda M Zangwill
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego
| | - Erwin R Boer
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego
| | - Robert N Weinreb
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego
| | - Felipe A Medeiros
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego
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Abe RY, Gracitelli CPB, Medeiros FA. The Use of Spectral-Domain Optical Coherence Tomography to Detect Glaucoma Progression. Open Ophthalmol J 2015; 9:78-88. [PMID: 26069520 PMCID: PMC4460225 DOI: 10.2174/1874364101509010078] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 03/30/2015] [Accepted: 03/30/2015] [Indexed: 11/26/2022] Open
Abstract
Detection of progression and measurement of rates of change is at the core of glaucoma management, and the use of Spectral Domain Optical Coherence Tomography (SD-OCT) has significantly improved our ability to evaluate change in the disease. In this review, we critically assess the existing literature on the use of SD-OCT for detecting glaucoma progression and estimating rates of change. We discuss aspects related to the reproducibility of measurements, their accuracy to detect longitudinal change over time, and the effect of aging on the ability to detect progression. In addition, we discuss recent studies evaluating the use of combined structure and function approaches to improve detection of glaucoma progression.
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Affiliation(s)
- Ricardo Y Abe
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA ; Department of Ophthalmology, University of Campinas, Campinas, Brazil
| | - Carolina P B Gracitelli
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA ; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Felipe A Medeiros
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
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Gracitelli CPB, Abe RY, Medeiros FA. Spectral-Domain Optical Coherence Tomography for Glaucoma Diagnosis. Open Ophthalmol J 2015; 9:68-77. [PMID: 26069519 PMCID: PMC4460228 DOI: 10.2174/1874364101509010068] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 03/30/2015] [Accepted: 03/30/2015] [Indexed: 11/26/2022] Open
Abstract
Identification of structural damage to the optic nerve and retinal nerve fiber layer (RNFL) is an essential component of diagnosis and management of glaucoma. The introduction of spectral-domain OCT (SD-OCT) has allowed objective quantification of damage to these structures with unprecedented resolution. In addition, recent attention has been directed towards imaging the macular area for quantifying loss of neural tissue caused by the disease. Many studies have evaluated and compared the diagnostic accuracies of a variety of parameters that can be obtained from imaging these areas of the ocular fundus. In this article, we critically review the existing literature evaluating the diagnostic accuracy of SD-OCT in glaucoma and we discuss issues related to how SD-OCT results should be incorporated into clinical practice.
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Affiliation(s)
- Carolina P B Gracitelli
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA ; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Ricardo Y Abe
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA ; Department of Ophthalmology, University of Campinas, Campinas, Brazil
| | - Felipe A Medeiros
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
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Yang Z, Tatham AJ, Zangwill LM, Weinreb RN, Zhang C, Medeiros FA. Diagnostic ability of retinal nerve fiber layer imaging by swept-source optical coherence tomography in glaucoma. Am J Ophthalmol 2015; 159:193-201. [PMID: 25448991 DOI: 10.1016/j.ajo.2014.10.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 10/14/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the diagnostic accuracies of swept-source optical coherence tomography (OCT) wide-angle and peripapillary retinal nerve fiber layer (RNFL) thickness measurements for glaucoma detection. DESIGN Cross-sectional case-control study. METHODS In this study we enrolled 144 glaucomatous eyes of 106 subjects and 66 eyes of 42 healthy subjects from the Diagnostic Innovations in Glaucoma Study. Glaucoma was defined by the presence of repeatable abnormal standard automated perimetry results and/or progressive glaucomatous optic disc change on masked grading of stereophotographs. Wide-angle and peripapillary RNFL thicknesses were assessed using swept-source OCT. Peripapillary RNFL thickness was also evaluated using spectral-domain OCT. Areas under the receiver operating characteristic (ROC) curves were calculated to evaluate the ability of the different swept-source OCT and spectral-domain OCT parameters to discriminate between glaucomatous and healthy eyes. RESULTS Mean (± standard deviation) average spectral-domain OCT wide-angle RNFL thicknesses were 50.5 ± 5.8 μm and 35.0 ± 9.6 μm in healthy and glaucomatous eyes, respectively (P < 0.001). Corresponding values for swept-source OCT peripapillary RNFL thicknesses were 103.5 ± 12.3 μm and 72.9 ± 16.5 μm, respectively (P < 0.001). Areas under the ROC curves of swept-source OCT wide-angle and peripapillary RNFL thickness were 0.88 and 0.89, respectively. Swept-source OCT performed similar to average peripapillary RNFL thickness obtained by spectral-domain OCT (area under the ROC curve of 0.90). CONCLUSION Swept-source OCT wide-angle and peripapillary RNFL thickness measurements performed well for detecting glaucomatous damage. The diagnostic accuracies of the swept-source OCT and spectral-domain OCT RNFL imaging protocols evaluated in this study were similar.
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Nouri-Mahdavi K, Caprioli J. Measuring rates of structural and functional change in glaucoma. Br J Ophthalmol 2014; 99:893-8. [PMID: 25287369 DOI: 10.1136/bjophthalmol-2014-305210] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 09/13/2014] [Indexed: 11/03/2022]
Abstract
Glaucoma is a progressive optic neuropathy. Hence, most glaucomatous eyes demonstrate signs of deterioration over time despite what may appear to be adequate treatment. The main goal of glaucoma treatment is to slow the rate of disease so that patients can prolong their functional vision. Therefore, it is important for clinicians caring for patients with glaucoma to be able to estimate rates of change with structural and functional outcomes in their patients. Various trend analysis models have been previously used to estimate rates of decay in glaucoma. The authors discuss the relevant issues and the inherent caveats related to estimating structural and functional rates of change in glaucoma. Patterns of deterioration, testing frequency, and combing structural and functional rates of change are also addressed.
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Affiliation(s)
- Kouros Nouri-Mahdavi
- The Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Joseph Caprioli
- The Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Deng L, Demirel S, Gardiner SK. Reducing variability in visual field assessment for glaucoma through filtering that combines structural and functional information. Invest Ophthalmol Vis Sci 2014; 55:4593-602. [PMID: 24970252 DOI: 10.1167/iovs.13-13813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To reduce variability and improve measurements of true change signal in visual field (VF) assessments through the use of filters that combine functional and structural test results. METHODS Humphrey VF data (Swedish Interactive Thresholding Algorithm [SITA] Standard, 24-2) and confocal scanning laser ophthalmoscopy (Heidelberg Retina Tomograph [HRT]) data from 1057 eyes of 637 participants were used to derive a filter. Another dataset, consisting of VF and HRT data from 112 eyes of 62 participants each with ≥5 visits, was used to test the filter. At each VF location per eye, the trend over time was modeled by a linear model (LM), and a nonlinear model (NLM), using filtered or unfiltered data, but with the last visit excluded. The SD of residuals from the trends, and prediction errors (PE) for the last visit were compared between filtered and unfiltered data. The filter was reconstructed and analyses were repeated after truncating VF data so that thresholds < 19 dB were replaced by 19 dB to reduce noise. RESULTS The SD of the residuals at all 52 VF locations for all analyses was reduced by filtering (P < 0.001). The PE was reduced by filtering at 43 and 47 VF locations (P < 0.05) for LM analyses on observed and truncated data, and all 52 VF locations (P < 0.05) for both NLM analyses. Truncating data before filtering reduced variability (P < 0.01) at 41 and 40 VF locations for LM and NLM analyses. CONCLUSIONS Filtering can reduce variability about trends in longitudinal sequences of VF data, and improves the accuracy of predicting the next test result.
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Affiliation(s)
- Lisha Deng
- Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| | - Shaban Demirel
- Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| | - Stuart K Gardiner
- Devers Eye Institute, Legacy Health, Portland, Oregon, United States
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