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Yamaguchi K, Tomita R, Koyanagi Y, Kawase K, Asaoka R, Terasaki H, Iwase T, Nishiguchi KM. Abilities of circumpapillary retinal nerve fiber layer thickness and vascular density to discriminate stages in primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2024; 262:1221-1229. [PMID: 37921882 DOI: 10.1007/s00417-023-06302-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/04/2023] [Accepted: 10/23/2023] [Indexed: 11/05/2023] Open
Abstract
PURPOSE To clarify the abilities of circumpapillary retinal nerve fiber layer thickness (cpRNFLT) obtained by optical coherence tomography (OCT) and circumpapillary vessel density (cpVD) measured by OCT-angiography to distinguish different stages in primary open-angle glaucoma determined by 24-2 or 30-2 static visual field (VF) testing. METHODS This retrospective study includes 25 healthy normal eyes of 25 subjects and 87 primary open-angle glaucoma eyes of 87 patients. Areas under the receiver operating characteristic curves (AUROC) were evaluated for determining glaucoma stages using cpRNFLT and cpVD. The absolute errors of the estimated mean total deviation (mTD) using optimal models with cpRNFLT and cpVD were also compared. RESULTS The AUROCs for discriminating glaucomatous eyes from normal eyes was significantly higher for cpRNFLT than the respective AUROCs for cpVD (0.969 [95% CI 0.939 to 0.998] vs. 0.872 [95% CI 0.806 to 0.938], p = 0.006), whereas cpVD had significantly higher AUROC for discriminating severe glaucoma eyes from moderate glaucoma eyes than cpRNFLT (0.771 [95% CI 0.655 to 0.886] vs. 0.578 [95% CI 0.420 to 0.736], p = 0.022). The mean absolute error in estimating mTD using both cpRNFLT and cpVD was significantly less than the error using cpRNFLT alone (4.56 ± 3.76 dB vs. 5.39 ± 4.00 dB, p = 0.027). CONCLUSION Our results suggest that cpVD is better for follow-ups after moderate stage. The combination of cpRNFLT and cpVD may improve VF estimation compared to cpRNFLT alone.
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Affiliation(s)
- Katsuya Yamaguchi
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Ryo Tomita
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan.
| | - Yoshito Koyanagi
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Kazuhide Kawase
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Hiroko Terasaki
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Takeshi Iwase
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
- Department of Ophthalmology, Akita University Graduate School of Medicine, 1-1-1 Hondou, Akita, 010-8543, Japan
| | - Koji M Nishiguchi
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
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Zhou W, Sabel BA. Vascular dysregulation in glaucoma: retinal vasoconstriction and normal neurovascular coupling in altitudinal visual field defects. EPMA J 2023; 14:87-99. [PMID: 36866155 PMCID: PMC9971397 DOI: 10.1007/s13167-023-00316-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/24/2023] [Indexed: 02/18/2023]
Abstract
Purpose Vision loss in glaucoma is not only associated with elevated intraocular pressure and neurodegeneration, but vascular dysregulation (VD) is a major factor. To optimize therapy, an improved understanding of concepts of predictive, preventive, and personalized medicine (3PM) is needed which is based on a more detailed understanding of VD pathology. Specifically, to learn if the root cause of glaucomatous vision loss is of neuronal (degeneration) or vascular origin, we now studied neurovascular coupling (NVC) and vessel morphology and their relationship to vision loss in glaucoma. Methods In patients with primary open angle glaucoma (POAG) (n = 30) and healthy controls (n = 22), NVC was studied using dynamic vessel analyzer to quantify retinal vessel diameter before, during, and after flicker light stimulation to evaluate the dilation response following neuronal activation. Vessel features and dilation were then related to branch level and visual field impairment. Results Retinal arterial and venous vessels had significantly smaller diameters in patients with POAG in comparison to controls. However, both arterial and venous dilation reached normal values during neuronal activation despite their smaller diameters. This was largely independent of visual field depth and varied among patients. Conclusions Because dilation/constriction is normal, VD in POAG can be explained by chronic vasoconstriction which limits energy supply to retinal (and brain) neurons with subsequent hypo-metabolism ("silent" neurons) or neuronal cell death. We propose that the root cause of POAG is primarily of vascular and not neuronal origin. This understanding can help to better personalize POAG therapy of not only targeting eye pressure but also vasoconstriction to prevent low vision, slowing its progression and supporting recovery and restoration. Trial registration ClinicalTrials.gov, # NCT04037384 on July 3, 2019.
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Affiliation(s)
- Wanshu Zhou
- grid.5807.a0000 0001 1018 4307Institute of Medical Psychology, Medical Faculty, Otto-Von-Guericke University of Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - Bernhard A. Sabel
- grid.5807.a0000 0001 1018 4307Institute of Medical Psychology, Medical Faculty, Otto-Von-Guericke University of Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
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Calzetti G, Mursch‐Edlmayr AS, Bata AM, Ungaro N, Mora P, Chua J, Schmidl D, Bolz M, Garhöfer G, Gandolfi S, Schmetterer L, Wong D. Measuring optic nerve head perfusion to monitor glaucoma: a study on structure-function relationships using laser speckle flowgraphy. Acta Ophthalmol 2022; 100:e181-e191. [PMID: 33880888 DOI: 10.1111/aos.14862] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 02/21/2021] [Accepted: 03/16/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE We aimed to describe the global and localized correlations among visual field (VF) sensitivity, optic nerve head (ONH) perfusion measured by laser speckle flowgraphy (LSFG) and neural structure measured by optical coherence tomography (OCT) in open-angle glaucoma (OAG) and to compare the floor effect for LSFG and OCT. METHODS Cross-sectional, multicenter study including one eye each from fifty OAG patients (mean age 69.3 years; average VF mean deviation, MD, -8.5 dB, range -25.17 to 0.85 dB) and fifty-one controls. Patients underwent SITA standard 24-2 automated perimetry and measurement of ONH perfusion, peripapillary retinal nerve fibre layer thickness (RNFLT) and macular ganglion cell-inner plexiform layer thickness (GCIPLT). We tested the presence of a significant change (breakpoint) in the correlation slope with VF sensitivity to assess floor effect. RESULTS The correlation between the LSFG parameter Mean All (MA) of the global disc area and MD (r = 0.56, p < 0.001) did not show a breakpoint, in contrast to the correlations between MD and OCT global parameters, which showed breakpoints at -8.53 and -4.05 dB for RNFLT and GCIPLT, respectively. Global and localized correlations with VF sensitivity were stronger for LSFG compared to OCT. In particular, LSFG outperformed OCT in the correlation with the central VF sector (r = 0.50, p < 0.001 and r = 0.06, p = 0.67 for MA and RNFLT, respectively). CONCLUSION The global and sectoral correlations with VF sensitivity and the favourable floor effect compared to OCT indicate LSFG as a promising tool to monitor progression particularly in late-stage glaucoma. Further longitudinal studies are warranted.
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Affiliation(s)
- Giacomo Calzetti
- Department of Ophthalmology University Hospital of Parma Parma Italy
- Institute of Molecular and Clinical Ophthalmology Basel Basel Switzerland
| | | | - Ahmed M. Bata
- Department of Clinical Pharmacology Medical University of Vienna Vienna Austria
- Vienna Health Association Kaiser Franz Josef (Favoriten) Hospital Vienna Austria
| | - Nicola Ungaro
- Department of Ophthalmology University Hospital of Parma Parma Italy
| | - Paolo Mora
- Department of Ophthalmology University Hospital of Parma Parma Italy
| | - Jacqueline Chua
- Singapore Eye Research Institute Singapore National Eye Centre Singapore Singapore
- Academic Clinical Program Duke‐NUS Medical School Singapore Singapore
| | - Doreen Schmidl
- Department of Clinical Pharmacology Medical University of Vienna Vienna Austria
| | - Matthias Bolz
- Department of Ophthalmology Kepler University Clinic Johannes Kepler University Linz Austria
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology Medical University of Vienna Vienna Austria
| | - Stefano Gandolfi
- Department of Ophthalmology University Hospital of Parma Parma Italy
| | - Leopold Schmetterer
- Institute of Molecular and Clinical Ophthalmology Basel Basel Switzerland
- Department of Clinical Pharmacology Medical University of Vienna Vienna Austria
- Singapore Eye Research Institute Singapore National Eye Centre Singapore Singapore
- Academic Clinical Program Duke‐NUS Medical School Singapore Singapore
- School of Chemical and Biomedical Engineering Nanyang Technological University Singapore Singapore
| | - Damon Wong
- Singapore Eye Research Institute Singapore National Eye Centre Singapore Singapore
- SERI‐NTU Advanced Ocular Engineering (STANCE) Singapore Singapore
- NTU Institute of Health Technologies Singapore Singapore
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Afarid M, Sadeghi E, Johari M, Namvar E, Sanie-Jahromi F. Evaluation of the Effect of Garlic Tablet as a Complementary Treatment for Patients with Diabetic Retinopathy. J Diabetes Res 2022; 2022:6620661. [PMID: 35875346 PMCID: PMC9303161 DOI: 10.1155/2022/6620661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the effectiveness of garlic (Allium sativum L.) tablets as a complimentary herbal medication in diabetic macular edema. METHODS A total of 91 diabetic participants (117 eyes) with central involved macular edema underwent a double-blind randomized trial. The patients used garlic tablets (500 mg) (2 tab/day) or placebo for 4 weeks and subsequently were examined by an expert ophthalmologist. Clinical manifestations including the best-corrected visual acuity (BCVA, logMAR), central macular thickness (CMT, μm), and intraocular pressure (IOP) were measured as the main outcomes. RESULTS BCVA was significantly improved by a 0.18 decrease in mean logMAR value in the garlic-treated patients in comparison with 0.06 in the control ones (P value = 0.027). CMT was decreased in both groups by a 102.99 μm decrease in the garlic group compared to 52.67 μm in the placebo group, albeit in a nonsignificant manner (P value: 0.094). IOP was decreased in the garlic group by 1.03 mmHg (P value: 0.024) and increased by 0.3 mmHg (P value: 0.468) in the placebo group. CONCLUSION Our trial suggests that garlic supplements can improve visual acuity, decrease the CMT and lower the IOP, and can be considered as an adjuvant treatment in patients with diabetic macular edema. Garlic was satisfactorily tolerated in diabetic patients, and no significant adverse effect interrupting the safety profile was observed.
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Affiliation(s)
- Mehrdad Afarid
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elham Sadeghi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadkarim Johari
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ehsan Namvar
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Sanie-Jahromi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Short-term changes in retinal and choroidal relative flow volume after anti-VEGF treatment for neovascular age-related macular degeneration. Sci Rep 2021; 11:23723. [PMID: 34887454 PMCID: PMC8660908 DOI: 10.1038/s41598-021-03179-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022] Open
Abstract
The effects of anti-vascular endothelial growth factor (anti-VEGF) agents on the native ocular vasculature are poorly understood. This pilot study aimed to assess short-term changes in retinal and choroidal perfusion after anti-VEGF treatment for neovascular exudative age-related macular degeneration (nAMD) using the relative flow volume (RFV) parameter derived from laser speckle flowgraphy. Ten treatment-naïve nAMD patients underwent measurements of mean, maximum, minimum, and differential RFV within a retinal arteriolar segment and a choroidal vessel segment outside the neovascular area. Measurement of retinal RFV (rRFV), choroidal RFV (cRFV), and subfoveal choroidal thickness (SCT) was repeated 9 and 35 days after a single anti-VEGF injection. The treatment caused a statistically significant decrease in the mean rRFV, mean cRFV, and SCT during the follow-up (p < 0.05). At the intermediate visit, the mean cRFV and SCT were − 17.6% and − 6.4% compared to baseline, respectively. However, at the final measurement, the mean cRFV was not different from the baseline value, which indicated waning of the anti-VEGF effect. In conclusion, a single anti-VEGF injection in treatment-naïve nAMD resulted in a decrease in retinal arteriolar and choroidal perfusion, according to the RFV parameter, which is a promising tool to simultaneously assess retinal and choroidal perfusion changes in response to anti-VEGF therapy.
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Kolář R, Odstrčilík J, Tornow RP. Photoplethysmographic analysis of retinal videodata based on the Fourier domain approach. BIOMEDICAL OPTICS EXPRESS 2021; 12:7405-7421. [PMID: 35003842 PMCID: PMC8713668 DOI: 10.1364/boe.441451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/22/2021] [Accepted: 10/22/2021] [Indexed: 05/23/2023]
Abstract
Assessment of retinal blood flow inside the optic nerve head (ONH) and the peripapillary area is an important task in retinal imaging. For this purpose, an experimental binocular video ophthalmoscope that acquires precisely synchronized video sequences of the optic nerve head and peripapillary area from both eyes has been previously developed. It enables to compare specific characteristics of both eyes and efficiently detect the eye asymmetry. In this paper, we describe a novel methodology for the analysis of acquired video data using a photoplethysmographic approach. We describe and calculate the pulsatile attenuation amplitude (PAA) spatial map, which quantifies the maximum relative change of blood volume during a cardiac cycle using a frequency domain approach. We also describe in detail the origin of PAA maps from the fundamental (the first) and the second harmonic component of the pulsatile signal, and we compare the results obtained by time-based and frequency-based approaches. In several cases, we show the advantages and possibilities of this device and the appropriate image analysis approach - fast measurement and comparison of blood flow characteristics of both eyes at a glance, the robustness of this approach, and the possibility of easy detection of asymmetry.
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Affiliation(s)
- Radim Kolář
- Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, 616 00 Brno, Czech Republic
| | - Jan Odstrčilík
- Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, 616 00 Brno, Czech Republic
| | - Ralf-Peter Tornow
- Department of Ophthalmology, Friedrich-Alexander-University of Erlangen-Nuremberg, 91056 Erlangen, Germany
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Gu C, Li A, Yu L. Diagnostic performance of laser speckle flowgraphy in glaucoma: a systematic review and meta-analysis. Int Ophthalmol 2021; 41:3877-3888. [PMID: 34327617 DOI: 10.1007/s10792-021-01954-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 07/09/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the diagnostic value of laser speckle flowgraphy (LSFG) in glaucoma by investigating the mean blur rate (MBR) in the optic nerve head. METHODS Systematic literature search was performed in the CENTRAL, Web of Science, PubMed, and EMBASE databases to obtain relevant studies published until December 2020 without restrictions. The Newcastle-Ottawa Scale (NOS) was used for study quality assessment. The outcome measures included the MBRs of the entire (MA), vascular (MV), and tissue (MT) areas. Subgroup analyses were performed according to glaucoma type. All data were analyzed using RevMan and Comprehensive Meta-Analysis 3.3 software. RESULTS Fifteen studies, including 692 glaucomatous and 386 healthy eyes, were included. Of these, 11 studies reported the MA, MV, and MT, three studies only reported MT, and one study only reported MV. All were classified as case-control studies and had good NOS scores. The meta-analysis showed that the MA and MT were significantly reduced in glaucomatous eyes (mean difference [MD] - 5.59, 95% confidence interval [CI] - 6.19 to - 4.99, p = 0.1; MD - 2.2, 95% CI - 2.49 to - 1.91, p = 0.07, respectively) with moderate heterogeneity (p = 0.1, I2 = 38%; p = 0.07, I2 = 39%, respectively). There was also a significant difference in the MV between glaucomatous and healthy eyes (MD - 5.92, 95% CI - 7.77 to - 4.07) with significant heterogeneity (p = 0.0003, I2 = 69%). The subgroup analyses revealed significant differences in the MBR among different glaucoma types. CONCLUSIONS Glaucoma is closely related to ocular blood flow changes. This meta-analysis suggests that LSFG is a feasible diagnostic tool for glaucoma. However, further longitudinal prospective studies are needed.
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Affiliation(s)
- Chao Gu
- Department of Ophthalmology, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Ailing Li
- Department of the School of Public Health of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Ling Yu
- Department of Ophthalmology, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China.
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Anraku A, Enomoto N, Tomita G, Iwase A, Sato T, Shoji N, Shiba T, Nakazawa T, Sugiyama K, Nitta K, Araie M. Ocular and Systemic Factors Affecting Laser Speckle Flowgraphy Measurements in the Optic Nerve Head. Transl Vis Sci Technol 2021; 10:13. [PMID: 33510952 PMCID: PMC7804520 DOI: 10.1167/tvst.10.1.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/05/2020] [Indexed: 01/12/2023] Open
Abstract
Purpose To investigate the ocular and systemic factors related to glaucoma and to be adjusted for interindividual comparison of ocular blood flow measurement results by laser speckle flowgraphy (LSFG) obtained from the optic nerve head (ONH) in normal Japanese individuals. Methods A multicenter, prospective cross-sectional study was conducted. The ONH tissue-area and vessel-area mean blur rate (MT and MV) were evaluated using LSFG and ONH structural parameters using planimetric methods. Multivariate linear mixed-effects modeled regression analysis was used to identify the contributing factors to the MT and MV. The explanatory variables were age; gender; smoking history; body mass index; mean arterial pressure (MAP); heart rate; intraocular pressure; axial length (AL); disc, rim, cup, and β-peripapillary atrophy (β-PPA) areas; and central retinal artery and vein equivalents. Results In total, 195 eyes of 126 healthy individuals with an average age of 48.1 years were included. Multivariate analysis showed that MAP and disc area had a negative (P < 0.001) correlation, whereas β-PPA area had a positive correlation with MT (P = 0.010). Age and AL had a negative correlation (P = 0.001 and P = 0.011, respectively), whereas cup area had a positive correlation (P = 0.012) with MV. Conclusions Interindividual comparison of MT or MV must be adjusted for both systemic factors (blood pressure or age) and local ocular factors (AL and disc, cup, or β-PPA area). Translational Relevance Our results provided reference data on the LSFG measurement and are important in comparing ocular blood flow between individuals using LSFG.
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Affiliation(s)
- Ayako Anraku
- Department of Ophthalmology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Nobuko Enomoto
- Department of Ophthalmology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Goji Tomita
- Department of Ophthalmology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Aiko Iwase
- Tajimi Iwase Eye Clinic, Tajimi, Gifu, Japan
| | - Takashi Sato
- Department of Ophthalmology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Tomoaki Shiba
- Department of Ophthalmology, School of Medicine, Toho University, Tokyo, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuhisa Sugiyama
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Koji Nitta
- Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Makoto Araie
- Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan
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