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Higgins BE, Yang H, Gardiner SK. The Temporal Relation Between Rates of Retinal Nerve Fiber Layer and Minimum Rim Width Changes in Glaucoma. Transl Vis Sci Technol 2024; 13:10. [PMID: 38578635 PMCID: PMC11005071 DOI: 10.1167/tvst.13.4.10] [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: 10/02/2023] [Accepted: 02/12/2024] [Indexed: 04/06/2024] Open
Abstract
Purpose This study aims to determine whether OCT-derived rates of change in minimum rim width (MRW) are associated with and can potentially predict corresponding alterations in retinal nerve fiber layer thickness (RNFLT) in people with glaucoma. Methods The rates of change between six-monthly visits were taken from 568 eyes of 278 participants in the P3 Study. Structural equation models (SEM) assessed whether one parameter was predicted by the concurrent or previous rate of the other parameter, after adjusting for its own rate in the previous time interval. Root mean square error of approximation (RMSEA, with 90% confidence intervals [CI]), Tucker Lewis index (TLI) and the comparative fit index (CFI) assessed goodness of fit. Results Models without a time lag provided a better fit for the data (RMSEA = 0.101 [CI, 0.089, 0.113]), compared to a model featuring a time lag in RNFLT (RMSEA = 0.114 [CI, 0.102, 0.126]) or MRW (RMSEA = 0.114 [CI, 0.102, 0.127]). The SEMs indicated that rates for both MRW and RNFLT were predicted by their own rate in the previous time interval and by the other measure's change in the concurrent time interval (P > 0.001 for all). No evidence of a clinically significant time lag for either parameter was determined. Conclusions MRW and RNFLT exhibit concurrent changes over time in patients with glaucoma, with no clinically significant time lag determined. Translational Relevance RNFLT may be more useful than MRW in early glaucoma assessment because of its previously reported lower variability and reduced sensitivity to intraocular pressure changes.
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Affiliation(s)
| | - Hongli Yang
- Devers Eye Institute, Legacy Health, Portland, OR, USA
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2
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Ji F, Islam MR, Wang B, Hua Y, Sigal IA. Lamina Cribrosa Insertions Into the Sclera Are Sparser, Narrower, and More Slanted in the Anterior Lamina. Invest Ophthalmol Vis Sci 2024; 65:35. [PMID: 38648038 PMCID: PMC11044832 DOI: 10.1167/iovs.65.4.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/03/2024] [Indexed: 04/25/2024] Open
Abstract
Purpose The lamina cribrosa (LC) depends on the sclera for support. The support must be provided through the LC insertions. Although a continuous insertion over the whole LC periphery is often assumed, LC insertions are actually discrete locations where LC collagenous beams meet the sclera. We hypothesized that LC insertions vary in number, size, and shape by quadrant and depth. Methods Coronal cryosections through the full LCs from six healthy monkey eyes were imaged using instant polarized light microscopy. The images were registered into a stack, on which we manually marked LC insertion outlines, nothing their position in-depth and quadrant (inferior, superior, nasal, or temporal). From the marks, we determined the insertion number, width, angle to the canal wall (90 degrees = perpendicular), and insertion ratio (fraction of LC periphery represented by insertions). Using linear mixed effect models, we determined if the insertion characteristics were associated with depth or quadrant. Results Insertions in the anterior LC were sparser, narrower, and more slanted than those in deeper LC (P values < 0.001). There were more insertions spanning a larger ratio of the canal wall in the middle LC than in the anterior and posterior (P values < 0.001). In the nasal quadrant, the insertion angles were significantly smaller (P < 0.001). Conclusions LC insertions vary substantially and significantly over the canal. The sparser, narrower, and more slanted insertions of the anterior-most LC may not provide the robust support afforded by insertions of the middle and posterior LC. These variations may contribute to the progressive deepening of the LC and regional susceptibility to glaucoma.
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Affiliation(s)
- Fengting Ji
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Mohammad R. Islam
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Department of Mechanical Engineering, University of Texas Rio Grande Valley, Edinburg, Texas, United States
| | - Bingrui Wang
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Yi Hua
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Department of Biomedical Engineering, University of Mississippi, University, Mississippi, United States
| | - Ian A. Sigal
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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3
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Girkin CA, Garner MA, Gardiner SK, Clark ME, Hubbard M, Karuppanan U, Bianco G, Bruno L, Fazio MA. Displacement of the Lamina Cribrosa With Acute Intraocular Pressure Increase in Brain-Dead Organ Donors. Invest Ophthalmol Vis Sci 2023; 64:19. [PMID: 38099735 PMCID: PMC10729839 DOI: 10.1167/iovs.64.15.19] [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: 05/30/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
Purpose To examine deformations of the optic nerve head (ONH) deep tissues in response to acute elevation of intraocular pressure (IOP). Methods Research-consented brain-dead organ donors underwent imaging by spectral domain optical coherence tomography (OCT). OCT imaging was repeated while the eye was sequentially maintained at manometric pressures of 10, 30, and 50 mm Hg. Radial scans of the ONH were automatically segmented by deep learning and quantified in three dimensions by a custom algorithm. Change in lamina cribrosa (LC) depth and choroidal thickness was correlated with IOP and age by linear mixed-effect models. LC depth was computed against commonly utilized reference planes. Results Twenty-six eyes from 20 brain-dead organ donors (age range, 22-62 years; median age, 43 years) were imaged and quantified. LC depth measured against a reference plane based on Bruch's membrane (BM), BM opening, and an anterior sclera canal opening plane showed both a reduction and an increase in LC depth with IOP elevation. LC depth universally increased in depth when measured against a sclera reference plane. Choroidal (-0.5222 µm/mm Hg, P < 0.001) and retinal nerve fiber layer thickness (-0.0717 µm/mm Hg, P < 0.001) significantly thinned with increasing IOP. The magnitude of LC depth change with IOP was significantly smaller with increasing age (P < 0.03 for all reference planes). Conclusions LC depth changes with IOP reduce with age and are significantly affected by the reference plane of choice, which highlights a need for standardizing LC metrics to properly follow progressive remodeling of the loadbearing tissues of the ONH by OCT imaging and for the definition of a reference database.
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Affiliation(s)
- Christopher A. Girkin
- Department of Ophthalmology, University of Alabama at Birmingham/Callahan Eye Hospital, Birmingham, Alabama, United States
| | - Mary A. Garner
- Department of Neuroscience, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | | | - Mark E. Clark
- Department of Ophthalmology, University of Alabama at Birmingham/Callahan Eye Hospital, Birmingham, Alabama, United States
| | | | - Udayakumar Karuppanan
- Department of Ophthalmology, University of Alabama at Birmingham/Callahan Eye Hospital, Birmingham, Alabama, United States
| | - Gianfranco Bianco
- Department of Ophthalmology, University of Alabama at Birmingham/Callahan Eye Hospital, Birmingham, Alabama, United States
| | - Luigi Bruno
- Department of Mechanical, Energy and Management Engineering, University of Calabria, Rende, Italy
| | - Massimo A. Fazio
- Department of Ophthalmology, University of Alabama at Birmingham/Callahan Eye Hospital, Birmingham, Alabama, United States
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4
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Lee S, Heisler M, Ratra D, Ratra V, Mackenzie PJ, Sarunic MV, Beg MF. Effects of Myopia and Glaucoma on the Neural Canal and Lamina Cribrosa Using Optical Coherence Tomography. J Glaucoma 2023; 32:48-56. [PMID: 36584358 PMCID: PMC10503542 DOI: 10.1097/ijg.0000000000002107] [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: 09/22/2021] [Accepted: 08/07/2022] [Indexed: 12/31/2022]
Abstract
PRCIS Glaucoma was associated with axial bowing and rotation of Bruchs membrane opening (BMO) and anterior laminar insertion (ALI), skewed neural canal, and deeper anterior lamina cribrosa surface (ALCS). Longer axial length was associated with wider, longer, and more skewed neural canal and flatter ALCS. PURPOSE Investigate the effects of myopia and glaucoma in the prelaminar neural canal and anterior lamina cribrosa using 1060-nm swept-source optical coherence tomography. PATIENTS 19 control (38 eyes) and 38 glaucomatous subjects (63 eyes). MATERIALS AND METHODS Participants were imaged with swept-source optical coherence tomography, and the images were analyzed for the BMO and ALI dimensions, prelaminar neural canal dimensions, and ALCS depth. RESULTS Glaucomatous eyes had more bowed and nasally rotated BMO and ALI, more horizontally skewed prelaminar neural canal, and deeper ALCS than the control eyes. Increased axial length was associated with a wider, longer, and more horizontally skewed neural canal and a decrease in the ALCS depth and curvature. CONCLUSION Our findings suggest that glaucomatous posterior bowing or cupping of lamina cribrosa can be significantly confounded by the myopic expansion of the neural canal. This may be related to higher glaucoma risk associated with myopia from decreased compliance and increased susceptibility to IOP-related damage of LC being pulled taut.
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Affiliation(s)
- Sieun Lee
- School of Engineering Science, Simon Fraser University
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham
| | | | | | - Vineet Ratra
- Sankara Nethralaya, College Road, Tamil Nadu, India
| | - Paul J. Mackenzie
- Department of Ophthalmology & Visual Sciences, Faculty of Medicine, University of British Columbia, BC, Canada
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Bastelica P, Labbé A, El Maftouhi A, Hamard P, Paques M, Baudouin C. Rôle de la lame criblée dans la pathogenèse du glaucome. Une revue de la littérature. J Fr Ophtalmol 2022; 45:952-966. [DOI: 10.1016/j.jfo.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 11/24/2022]
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6
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Birhanu G, Tegegne AS. Predictors for elevation of Intraocular Pressure (IOP) on glaucoma patients; a retrospective cohort study design. BMC Ophthalmol 2022; 22:254. [PMID: 35672680 PMCID: PMC9172002 DOI: 10.1186/s12886-022-02431-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Because of the increase in the number of cases, currently, glaucoma is a significant public health issue that it leads to optic nerve damage and vision loss. High Intraocular Pressure reading indicates that the treatment given to a glaucoma patient is not sufficient/ adequate. Hence, the elevation of intraocular pressure is one of the indicators that, the therapy given to glaucoma patients under treatment is inadequate. Therefore, the main objective of the current study was to investigate predictors for the variation of elevation of IOP readings on glaucoma patients. MATERIALS AND METHODS A retrospective cohort study design was conducted on 1254 glaucoma patients, whose followed-ups were from September 2015 to August 2016 at Felege Hiwot Teaching and Specialized Hospital, North West Ethiopia. Data analysis was conducted using Statistical Analysis of Systems (SAS) software version 9.2 and AMOS software. The parameter estimation was conducted using the maximum likelihood estimation technique. RESULTS Main effects like age (β = 0.01, t-value = 0.15, p-value = 0.018), patients with normal blood pressure (β = -3.35, t-value = -2.28, p-value = 0.0263), patients without diabetics (β = -3.79, t-value = -2.47, p-value = 0.014), visiting times (β = -6.00, t-value = -5.02, p-value = 0.0001), farmer glaucoma patients (β = -6.04, t-value = 3.87, p-value = 0.0001) had significant and indirect effect for the variation of elevation of IOP on glaucoma patients. Interaction effects like visiting time with existence of diabetes, visiting time with cataract surgery significantly effected on the variable of interest. Hence, both main and interaction effects had significant effects on the variable of interest. This study had identified socio-demographic characteristics, personal/individual behaviors, and clinical factors for the variation of elevation of IOP. The findings, in the current investigation, help health staff to conduct health-related education for awareness creation. Health-related education, about the progression of glaucoma, should be conducted on patients.
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7
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Girkin CA, Belghith A, Bowd C, Medeiros FA, Weinreb RN, Liebmann JM, Proudfoot JA, Zangwill LM, Fazio MA. Racial Differences in the Rate of Change in Anterior Lamina Cribrosa Surface Depth in the African Descent and Glaucoma Evaluation Study. Invest Ophthalmol Vis Sci 2021; 62:12. [PMID: 33844828 PMCID: PMC8039570 DOI: 10.1167/iovs.62.4.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to determine if the rate of change in the depth of the surface of the lamina cribrosa due to glaucomatous remodeling differs between glaucoma patients of African descent (AD) and European descent (ED). Methods There were 1122 images taken longitudinally over an average of 3 years (range = 0.9-4.1 years) from 122 patients with glaucoma followed in the African Descent and Glaucoma Evaluation Study (ADAGES) and Diagnostic Intervention and Glaucoma Study (DIGS) were automatically segmented to compute anterior lamina cribrosa surface depth (ALCSD). The rate of ALCSD change was compared across racial groups after adjusting for baseline characteristics known to be associated with ALCSD or disease progression (visual field, ALCSD, corneal thickness, optic disk size, and age). Results After adjusting for all other covariates, the ED group had significantly greater ALCSD posterior migration (deepening) than the AD group (difference = 2.57 µm/year, P = 0.035). There was a wider range of ALCSD change in the ED compared with the AD group, and more individuals had greater magnitude of both deepening and shallowing. No other covariates measured at baseline had independent effects on the longitudinal changes in ALCSD (baseline visual field severity, baseline ALCSD, corneal thickness, Bruch's membrane opening [BMO] area, or age). Conclusions Glaucomatous remodeling of the lamina cribrosa differs between AD and ED patients with glaucoma. Unlike the cross-sectional associations seen with aging, in which a deeper ALCSD was seen with age in the ED group, glaucomatous remodeling in this longitudinal study resulted in more posterior migration of ALCSD in ED compared to AD patients.
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Affiliation(s)
- Christopher A Girkin
- Department of Ophthalmology and Visual Science, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Akram Belghith
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Christopher Bowd
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Felipe A Medeiros
- Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina, United States
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York, United States
| | - James A Proudfoot
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Massimo A Fazio
- Department of Ophthalmology and Visual Science, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States.,Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States.,Department of Biomedical Engineering, School of Engineering, The University of Alabama at Birmingham, Birmingham, Alabama, United States
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8
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Sawada Y, Araie M, Shibata H, Iwase T. Nasal displacement of retinal vessels on the optic disc in glaucoma associated with a nasally angled passage through lamina cribrosa. Sci Rep 2021; 11:4176. [PMID: 33603146 PMCID: PMC7892818 DOI: 10.1038/s41598-021-83720-0] [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: 10/26/2020] [Accepted: 02/05/2021] [Indexed: 11/13/2022] Open
Abstract
To investigate nasal displacement of central retinal vessel (CRV) on the optic nerve head (ONH) in glaucoma in association with its passage through lamina cribrosa (LC). This cross-sectional study included 113 eyes with glaucoma and 60 normal eyes. Horizontal spectral-domain optical coherence tomography (SD-OCT) scans of the ONH were acquired, and point where CRV emerged on the ONH surface was defined as the position of the CRV. Next, radial scans of the ONH were acquired, and angle of the CRV passing through the LC was measured. These parameters were compared between glaucomatous and normal eyes by t-test, and their relationship with possible confounders was assessed by multiple regression analyses. In glaucoma, CRV was significantly more nasally displaced than it was in normal eyes (66.0 ± 8.6 vs. 54.3 ± 9.5, P < 0.0001), and eyes with more vessel displacement exhibited significantly worse glaucomatous visual field defects (P = 0.0004). Greater nasal displacement of the CRV was significantly associated with a more nasally angled path through the LC (rs = 0.569, P < 0.0001). By using SD-OCT, we confirmed that nasal displacement of the CRV on the ONH was associated with glaucoma and was induced by its nasally angled path through the LC.
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Affiliation(s)
- Yu Sawada
- Department of Ophthalmology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Makoto Araie
- Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan
| | - Hitomi Shibata
- Department of Ophthalmology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Takeshi Iwase
- Department of Ophthalmology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
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9
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Elucidation of the role of the lamina cribrosa in glaucoma using optical coherence tomography. Surv Ophthalmol 2021; 67:197-216. [PMID: 33548238 DOI: 10.1016/j.survophthal.2021.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 01/07/2023]
Abstract
Glaucoma is a chronic and progressive optic neuropathy characterized by the death of retinal ganglion cells and corresponding visual field loss. Despite the growing number of studies on the subject, the pathogenesis of the disease remains unclear. Notwithstanding, several studies have shown that the lamina cribrosa (LC) is considered an anatomic site of glaucomatous optic nerve injury, thus having a key role in the pathophysiology of glaucoma development and progression. Different morphological alterations of the LC have been described in vivo in glaucomatous eyes after the evolution of optical coherence tomography (OCT) devices. The most relevant findings were the reduction of laminar thickness, the presence of localized defects, and the posterior LC displacement. These new laminar parameters documented through OCT are not only promising as possible additional tools for glaucoma diagnosis and monitoring, but also as predictors of disease progression. In spite of the advance of technology, however, proper evaluation of the LC is not yet viable in all eyes. We describe OCT-identified LC changes related to the development and progression of glaucoma and provide future directions based on a critical data analysis, focusing on its clinical relevance and applicability.
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10
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Sun Y, Guo Y, Cao K, Zhang Y, Xie Y, Pang R, Shi Y, Wang H, Wang N. Relationship between corneal stiffness parameters and lamina cribrosa curvature in normal tension glaucoma. Eur J Ophthalmol 2020; 31:3049-3056. [PMID: 33334173 DOI: 10.1177/1120672120982521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the relationship between corneal biomechanical parameters and lamina cribrosa (LC) curvature in normal tension glaucoma (NTG). METHODS 95 eyes of 56 NTG patients were enrolled in this prospective, observational study. Corneal biomechanical parameters, including stiffness parameters at applanation 1 (SP-A1), deformation amplitude ratio (DA ratio), inverse concave radius and biomechanically corrected intraocular pressure estimate (bIOP), were captured using the Corneal Visualization Scheimpflug Technology instrument (Corvis-ST). LC curvature was evaluated by mean adjusted LC curvature index (maLCCI) averaged by the measurements on 12 radial B-scan images obtained using swept-source optical coherence tomography (SS-OCT). Linear mixed models were constructed to assess the relationship between corneal biomechanical parameters and LC curvature. RESULTS The mean age of participants was 51.04 ± 13.74 years (range, 24-82 years). The SP-A1 and maLCCI were 93.50 ± 13.82 mm Hg/mm and 7.57 ± 1.58, respectively. In univariate and multivariate analysis, SP-A1 (p < 0.001 and p = 0.001) and age (p = 0.010 and p = 0.024) were both significantly associated with maLCCI. The LC curvature increased with softer cornea demonstrated by lower SP-A1 and younger eyes. There was no statistical significance interaction between SP-A1 and age (p = 0.194). CONCLUSIONS The greater posterior LC curvature was associated with lower corneal stiffness parameters and younger eyes in NTG patients. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR1900021465.
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Affiliation(s)
- Yunxiao Sun
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Yiqin Guo
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Yue Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Yuan Xie
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ruiqi Pang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Yan Shi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Huaizhou Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
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11
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Clinical Assessment of Scleral Canal Area in Glaucoma Using Spectral-Domain Optical Coherence Tomography. Am J Ophthalmol 2020; 216:28-36. [PMID: 32278772 DOI: 10.1016/j.ajo.2020.03.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To investigate anterior scleral canal (ASC) area in the eyes with glaucoma using spectral-domain optical coherence tomography (SDOCT). DESIGN Cross-sectional study. METHODS This study included 206 eyes of 103 patients with glaucoma, classified as 66 eyes of 33 patients with unilateral glaucoma and 140 eyes of 70 patients with bilateral glaucoma. Radial scan enhanced depth imaging SDOCT centered on the optic disc was performed, and parameters that present ASC area such as ASC opening and the largest ASC area were obtained in each eye. The largest ASC area was the largest cross-sectional area of the ASC region identified between the ASC opening and anterior lamina cribrosa insertion. These parameters were compared between eyes with and without glaucoma in unilateral glaucoma, and eyes with worse and better visual field defect (VFD) in bilateral glaucoma. RESULTS In the patients with unilateral glaucoma, ASC opening and largest ASC area were significantly larger in the eyes with glaucoma than in those without glaucoma (both P < .001). In bilateral glaucoma, these parameters were significantly larger in the eyes with worse VFD than in those with better VFD (P = .0080 and P = .0018, respectively). Intereye differences of the ASC parameters in the glaucoma patients were significantly greater than that in the normal subjects. CONCLUSIONS Significantly larger ASC area was first observed in the living human eyes with glaucoma compared to the normal eyes. Further longitudinal studies are required to determine if the ASC area is useful in the prevention and treatment of glaucoma.
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12
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Tun TA, Wang X, Baskaran M, Nongpiur ME, Tham YC, Nguyen DQ, Strouthidis NG, Aung T, Cheng CY, Boote C, Girard MJA. Determinants of lamina cribrosa depth in healthy Asian eyes: the Singapore Epidemiology Eye Study. Br J Ophthalmol 2020; 105:367-373. [PMID: 32434775 DOI: 10.1136/bjophthalmol-2020-315840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 11/04/2022]
Abstract
AIM To investigate the determinants of lamina cribrosa depth (LCD) in healthy eyes of Chinese and Indian Singaporean adults. METHODS The optic nerve head (ONH) of the right eye of 1396 subjects (628 Chinese and 768 Indian subjects) was imaged with optical coherence tomography (OCT, Spectralis, Heidelberg, Germany). LCD was defined as the distance from the Bruch's membrane opening (LCD-BMO) or the peripapillary sclera (LCD-PPS) reference plane to the laminar surface. A linear regression model was used to evaluate the relationship between the LCD and its determinants. RESULTS Both LCDs were significantly different between the two races (LCD-BMO: 421.95 (95% CI 365.32 to 491.79) µm in Chinese vs 430.39 (367.46-509.81) µm in Indians, p=0.021; and LCD-PPS: 353.34 (300.98-421.45) µm in Chinese vs 376.76 (313.39-459.78) µm in Indians, p<0.001). In the multivariable regression analysis, the LCD-PPS of the whole cohort was independently associated with females (β=-31.93, p<0.001), Indians subjects (β=21.39, p=0.004) (Chinese as the reference), axial length (Axl) (β=-6.68, p=0.032), retinal nerve fibre layer thickness (RNFL) (β=0.71, p=0.019), choroidal thickness (ChT) (β=0.41, p<0.001), vertical cup disc ratio (VCDR) (β=24.42, p<0.001) and disc size (β=-60.75, p=0.001). For every 1 year older in age, the LCD-PPS was deeper on average by 1.95 µm in Chinese subjects (p=0.01) but there was no association in Indians subjects (p=0.851). CONCLUSIONS The LCD was influenced by age, gender, race, Axl, RNFL, ChT, VCDR and disc size. This normative LCD database may facilitate a more accurate assessment of ONH cupping using OCT in Asian populations.
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Affiliation(s)
- Tin A Tun
- Glaucoma, Singapore Eye Research Institute, Singapore.,Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Xiaofei Wang
- Department of Biomedical Engineering, National University of Singapore, Singapore.,Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Mani Baskaran
- Glaucoma, Singapore Eye Research Institute, Singapore
| | - Monisha Esther Nongpiur
- Glaucoma, Singapore Eye Research Institute, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yih Chung Tham
- Ocular Epidemiology Research Group and Data Science, Singapore Eye Research Institute, Singapore
| | - Duc Quang Nguyen
- Ocular Epidemiology Research Group and Data Science, Singapore Eye Research Institute, Singapore
| | - Nicholas G Strouthidis
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Tin Aung
- Glaucoma, Singapore Eye Research Institute, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ching-Yu Cheng
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Ocular Epidemiology Research Group and Data Science, Singapore Eye Research Institute, Singapore
| | - Craig Boote
- Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - Michael J A Girard
- Department of Biomedical Engineering, National University of Singapore, Singapore
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13
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Xu L, Yu H, Sun H, Hu B, Geng Y. Dietary Melatonin Therapy Alleviates the Lamina Cribrosa Damages in Patients with Mild Cognitive Impairments: A Double-Blinded, Randomized Controlled Study. Med Sci Monit 2020; 26:e923232. [PMID: 32376818 PMCID: PMC7233010 DOI: 10.12659/msm.923232] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/19/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) is a degenerative disease that is characterized by massive neuron devastations in the hippocampus and cortex. Mild cognitive impairment (MCI) is the transitory stage between normality and AD dementia. This study aimed to investigate the melatonin induced effects on the lamina cribrosa thickness (LCT) of patients with MCI. MATERIAL AND METHODS The LCT data of patients with MCI were compared to LCT data of healthy controls. Subsequently, all MCI patients were randomly assigned into an experimental group (with melatonin treatment) or a placebo group (without any melatonin treatment). RESULTS The LCT of MCI patients decreased significantly compared with healthy controls. The univariate analysis showed that the lower the Mini Mental State Examination (MMSE) score (P=0.038; 95% CI: 0.876, -0.209), the smaller hippocampus volume (P=0.001; 95% CI: -1.594, -2.911), and the upregulated level of cerebrospinal fluid (CSF) T-tau (P=0.036; 95% CI: 2.546, -0.271) were associated significantly with the thinner LCT in MCI patients. There were 40 patients in the experimental group and 39 patients in the placebo group. The mean age of the experimental group was not significantly different from the placebo group (66.3±8.8 versus 66.5±8.3; P>0.05). The LCT and hippocampus volume of the melatonin treated group were significantly larger compared with the placebo group (P<0.001). On the other hand, the CSF T-tau level of the melatonin treated group was significantly lower compared with the untreated group (P<0.001). CONCLUSIONS LCT assessment might allow early diagnosis of MCI. Dietary melatonin therapy could provide an effective medication for MCI patients with LCT alterations.
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Affiliation(s)
- Lei Xu
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, P.R. China
| | - Haixiang Yu
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, P.R. China
| | - Hongbin Sun
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, P.R. China
| | - Bang Hu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Yi Geng
- Department of Neurosurgery, Liaohe Oil Gem Flower Hospital, Panjin, Liaoning, P.R. China
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14
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Yang H, Luo H, Hardin C, Wang Y, Jeoung JW, Albert C, Vianna JR, Sharpe GP, Reynaud J, Demirel S, Mansberger SL, Fortune B, Nicolela M, Gardiner SK, Chauhan BC, Burgoyne CF. Optical Coherence Tomography Structural Abnormality Detection in Glaucoma Using Topographically Correspondent Rim and Retinal Nerve Fiber Layer Criteria. Am J Ophthalmol 2020; 213:203-216. [PMID: 31899204 PMCID: PMC7214190 DOI: 10.1016/j.ajo.2019.12.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/05/2019] [Accepted: 12/18/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE This study evaluated the ability of topographically correspondent (TC) minimum rim width (MRW) and peripapillary retinal nerve fiber layer thickness (pRNFLT) criteria to detect optical coherence tomography (OCT) structural abnormality in glaucoma (GL) and glaucoma suspect (GLS) eyes. DESIGN Retrospective cross-sectional study. METHODS A total of 196 GL eyes, 150 GLS eyes, and 303 heathy eyes underwent pRNFL and 24 radial optic nerve head OCT imaging and manual correction of the internal limiting membrane, Bruch's membrane opening (BMO), and outer pRNFL segmentations. MRW and pRNFLT were quantified in 6 Garway-Heath or 12 30-degree (clock-hour) sectors. OCT abnormality for each parameter was defined to be less than the 5th percentile of the healthy eye distribution. OCT abnormality for individual eyes was defined using global, sectoral, and combined parameter criteria that achieved ≥95% specificity in the healthy eyes. TC combination criteria required the sectoral location of MRW and pRNFLT abnormality to be topographically aligned and included comMR (a previously reported TC combination consisting of MRW and pRNFLT parameter: [MRW + pRNFLT × (average MRW healthy eyes/average pRNFLT healthy eyes) MRW]. RESULTS TC sectoral criteria (1 Garway-Heath MRW + corresponding Garway-Heath RNFLT), (one 30-degree MRW + any 1 corresponding or adjacent 30-degree pRNFLT), 30-degree and Garway-Heath comMR-TI and global comMR were the best performing criteria, demonstrating (96%-99% specificity), 86%-91% sensitivity for GL, 80%-84% sensitivity for early GL (MD ≥ -4.0 dB) and 93%-96% sensitivity for moderate-to-advanced GL (MD < -4.0 dB). CONCLUSIONS Clinically intuitive TC MRW and pRNFLT combination criteria identified the sectoral location of OCT abnormality in GL eyes with high diagnostic precision.
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Affiliation(s)
- Hongli Yang
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Haomin Luo
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Department of Ophthalmology, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Christy Hardin
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Yaxing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Capital Medical University, Beijing, China
| | - Jin Wook Jeoung
- Department of Ophthalmology, Medical College, the Catholic University of Korea, Seoul, South Korea
| | - Cindy Albert
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Jayme R Vianna
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Glen P Sharpe
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Juan Reynaud
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Shaban Demirel
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Steven L Mansberger
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Brad Fortune
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Marcelo Nicolela
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stuart K Gardiner
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Balwantray C Chauhan
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Claude F Burgoyne
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA.
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15
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Wong BJ, Moghimi S, Zangwill LM, Christopher M, Belghith A, Ekici E, Bowd C, Fazio MA, Girkin CA, Weinreb RN. Relationship of Corneal Hysteresis and Anterior Lamina Cribrosa Displacement in Glaucoma. Am J Ophthalmol 2020; 212:134-143. [PMID: 31770514 DOI: 10.1016/j.ajo.2019.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate the relationship between corneal hysteresis (CH) and anterior lamina cribrosa surface (ALCS) displacement over time in a cohort of patients with glaucoma. DESIGN Prospective observational case series. METHODS In this study, 147 eyes from 96 glaucoma or glaucoma suspect patients were followed for a mean of 3.5 years and 7.9 visits. Baseline CH measurements were obtained using the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments Inc, Depew, New York, USA). The mean anterior lamina cribrosa surface depth (ALCSD) and choroidal thickness were by automated segmentation of spectral-domain optical coherence tomography (SD-OCT) scans. The rate of change of ALCSD was calculated using linear mixed effects models. Relationship between baseline CH and follow-up ALCSD rate of change was adjusted for confounding factors, including age, intraocular pressure (IOP), and choroidal thickness. RESULTS The mean baseline CH was 9.4 mm Hg (95% confidence interval [CI] 9.1-9.7). Overall, the ALCS was displaced posteriorly at a rate of 0.78 μm/y (95% CI -1.82, 0.26). Seventeen eyes (11.5%) showed a significant posterior displacement of ALCS, whereas 22 eyes (15.0%) showed a significant anterior displacement of ALCS. The choroidal thickness thinned at a rate of -1.09 μm/y during the follow-up (P = .001). Multivariable mixed modeling showed that choroidal thinning, lower IOP change, and lower corneal hysteresis were significantly associated with posterior ALCS displacement over time (P = .034, P = .037, and P = .048). Each 1 mm lower CH was associated with 0.66 μm/y posterior displacement of the ALCS. CONCLUSIONS Lower corneal hysteresis was significantly associated with posterior displacement of the anterior lamina cribrosa over time. These data provide additional support for lower corneal hysteresis being a risk factor for glaucoma progression.
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16
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Girkin CA, Fazio MA, Bowd C, Medeiros FA, Weinreb RN, Liebmann JM, Proudfoot J, Zangwill LM, Belghith A. Racial Differences in the Association of Anterior Lamina Cribrosa Surface Depth and Glaucoma Severity in the African Descent and Glaucoma Evaluation Study (ADAGES). Invest Ophthalmol Vis Sci 2020; 60:4496-4502. [PMID: 31661550 PMCID: PMC6819052 DOI: 10.1167/iovs.19-26645] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose To determine if variation in anterior lamina cribrosa surface depth (ALCSD) differs between glaucoma patients of African (AD) and European descent (ED). Methods A total of 178 eyes from 123 glaucoma patients in the African Descent and Glaucoma Evaluation Study (ADAGES) and Diagnostic Innovations in Glaucoma Study (DIGS) were included. ALCSD and choroidal thickness were measured using the San Diego Automated Layer Segmentation Algorithm (SALSA). ALCSD was defined by both Bruch's membrane opening (BMO)-based (ALCSD-BMO) and scleral-based (ALCSD-Scl) reference planes. Racial differences in ALCSD were evaluated using cross-sectional univariate and multivariable models. Results A deeper ALCSD-Scl was found in males (52.4 μm, P = 0.0401), AD individuals (78.6 μm, P = 0.0004), younger individuals (−3.1 μm/year, P < 0.0213), and eyes with larger discs (81.0 μm/mm2, P = 0.024), increased visual field loss (mean defect, MD: −6.4 μm/dB [decibel], P = 0.0106), and higher intraocular pressure (IOP: 14.1 μm/mm Hg, P = 0.0256). Significant deepening of ALSCD was observed with increasing IOP and visual field severity only in the AD group. Race modified the relationship between ALCSD-Scl and age (P = 0.0145) with ALCSD-Scl in AD individuals becoming more shallow with increasing age (−3.1 μm/year, P = 0.0213), while there was no significant association in the ED group (2.1 μm/mm Hg, P < 0.2026). Conclusions This study demonstrates that a deeper ALCSD, regardless of the ALCSD reference plane used, is associated with more severe glaucoma and higher IOP in the ADAGES cohort, particularly in individuals of AD. These results suggest that characterizing ALCSD morphology and its relationships to IOP, aging, and glaucoma progression may help explain racial differences in disease susceptibility.
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Affiliation(s)
- Christopher A Girkin
- Department of Ophthalmology, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Massimo A Fazio
- Department of Ophthalmology, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States.,Department of Biomedical Engineering, School of Engineering, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Christopher Bowd
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Felipe A Medeiros
- Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina, United States
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York, United States
| | - James Proudfoot
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Akram Belghith
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
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17
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Saba A, Usmani A, Islam QU, Assad T. Unfolding the enigma of lamina cribrosa morphometry and its association with glaucoma. Pak J Med Sci 2019; 35:1730-1735. [PMID: 31777524 PMCID: PMC6861505 DOI: 10.12669/pjms.35.6.568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/11/2019] [Accepted: 08/22/2019] [Indexed: 11/28/2022] Open
Abstract
Primary open angle glaucoma (POAG) is worldwide prevalent ailment, affecting millions, and leading irreversible cause of blindness. The treatment strategies revolve around one modifiable factor, elevated intraocular pressure (IOP), despite POAG presenting with normal IOP. Emphasis is put forth in recent past detecting structural elements of glaucoma; lamina cribrosa (LC) is found to be a promising prospect. Morphological alterations of LC are implicated as early sign before onset of glaucomatous optic neuropathy (GON). In this review, the authors explored scientific works from 1976 till 2018 through Google, Google Scholar, PubMed, HEC Digital Library, Springerlink, and PakMedinet in four months' time, extracted structural features of LC, its measurable attributes, fresh innovations employed for in-vivo visualization and clinical signs aiding in establishing diagnosis of glaucoma which will assist as a prophylactic measure against GON. No such work has ever been done in South-East Asia including our country. So LC opens a new horizon for research in Pakistan.
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Affiliation(s)
- Ayesha Saba
- Dr. Ayesha Saba Naz, MBBS. Senior Lecturer, Department of Anatomy, Bahria University Medical and Dental College, Karachi, Pakistan
| | - Ambreen Usmani
- Dr. Ambreen Usmani, M. Phil, PhD, Vice Principal, Professor, Department of Anatomy. Bahria University Medical and Dental College, Karachi, Pakistan
| | - Qamar Ul Islam
- Dr. Qamar Ul Islam, FCPS. Associate Professor, Consultant PHACO and Vitreoretinal Surgeon, PNS Shifa Hospital, Karachi, Pakistan
| | - Tahira Assad
- Dr. Tahira Assad, M. Phil, PhD, Associate Professor, Department of Pharmacology, Karachi Institute of Medical Sciences, Pakistan
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18
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Tun TA, Atalay E, Baskaran M, Nongpiur ME, Htoon HM, Goh D, Cheng CY, Perera SA, Aung T, Strouthidis NG, Girard MJA. Association of Functional Loss With the Biomechanical Response of the Optic Nerve Head to Acute Transient Intraocular Pressure Elevations. JAMA Ophthalmol 2019; 136:184-192. [PMID: 29302683 DOI: 10.1001/jamaophthalmol.2017.6111] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The acute biomechanical response of the optic nerve head (ONH) to intraocular pressure (IOP) elevations may serve as a biomarker for the development and progression of glaucoma. Objective To evaluate the association between visual field loss and the biomechanical response of the ONH to acute transient IOP elevations. Design, Setting, and Participants In this observational study, 91 Chinese patients (23 with primary open-angle glaucoma [POAG], 45 with primary angle-closure glaucoma, and 23 without glaucoma) were recruited from September 3, 2014, through February 2, 2017. Optical coherence tomography scans of the ONH were acquired at baseline and at 2 sequential IOP elevations (0.64 N and then 0.90 N, by applying forces to the anterior sclera using an ophthalmodynamometer). In each optical coherence tomography volume, lamina cribrosa depth (LCD) and minimum rim width (MRW) were calculated. The mean deviation (MD) and the visual field index (VFI), as assessed by automated perimetry, were correlated with IOP-induced changes of LCD and MRW globally and sectorially. Main Outcomes and Measures The LCD, MRW, MD, and VFI. Results Among the 91 patients, 39 (42.9%) were women; the mean (SD) age was 65.48 (7.23) years. In POAG eyes, a greater change in LCD (anterior displacement) was associated with worse MD and VFI (R = -0.64; 95% CI, -0.97 to -0.31; P = .001; and R = -0.57; 95% CI, -0.94 to -0.19; P = .005, respectively) at the first IOP elevation, and a greater reduction in MRW was also associated with worse MD and VFI (first IOP elevation: R = -0.48; 95% CI, -0.86 to -0.09; P = .02; and R = -0.57; 95% CI, -0.94 to -0.20; P = .004, respectively; second IOP elevation: R = -0.56; 95% CI, -0.98 to -0.13; P = .01; and R = -0.60; 95% CI, -1.03 to -0.17; P = .008, respectively), after adjusting for age, sex, and baseline IOP. A correlation was found between the reduction in MRW in the inferior-temporal sector and the corresponding visual field cluster in POAG eyes at the second elevation (ρ = -0.55; 95% CI, -0.78 to -0.18; P = .006). Conclusions and Relevance The biomechanical response of the ONH to acute IOP elevations was associated with established visual field loss in POAG eyes, but not in primary angle-closure glaucoma eyes. This suggests that ONH biomechanics may be related to glaucoma severity in POAG and that the 2 glaucoma subgroups exhibit inherently different biomechanical properties.
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Affiliation(s)
- Tin A Tun
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Ophthalmic Engineering and Innovation Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Eray Atalay
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Mani Baskaran
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Duke-National University of Singapore Medical School, Singapore
| | - Monisha E Nongpiur
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hla M Htoon
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Duke-National University of Singapore Medical School, Singapore
| | - David Goh
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Duke-National University of Singapore Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shamira A Perera
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Duke-National University of Singapore Medical School, Singapore
| | - Tin Aung
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Duke-National University of Singapore Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas G Strouthidis
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, Australia.,National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
| | - Michaël J A Girard
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Ophthalmic Engineering and Innovation Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore
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19
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Evaluation of lamina cribrosa in angioid streaks using spectral-domain optical coherence tomography enhanced depth imaging. J Fr Ophtalmol 2019; 42:586-591. [PMID: 31101364 DOI: 10.1016/j.jfo.2018.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 12/17/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE To investigate retinal nerve fiber layer (RNFL) thickness, anterior lamina cribrosa depth (ALD) and laminar thickness (LT) in eyes with angioid streaks (AS) in comparison with healthy eyes. METHODS Patients with AS (n=32 eyes) and age-matched healthy subjects (n=42 eyes) underwent enhanced depth imaging with spectral domain optical coherence tomography of the optic nerve head. RNFL thickness was obtained automatically by using the Heidelberg software. The ALD was defined as the vertical distance between the Bruch's membrane openings as reference plane and the anterior border of the lamina cribrosa. The LT was measured as the distance between the anterior and posterior borders of the lamina cribrosa. RNFL thickness, ALD and LT were compared between the AS and healthy eyes adjusting for axial length. RESULTS The mean age was 51.7±8.0 years for AS patients and 53.8±10.2 years for control subjects (P=0.34). The mean RNFL thickness was 88.6±17.6μm in AS eyes and 102.1±8.3μm in control eyes; the difference between the groups was significantly significant. ALD was 350.9±70.8μm in AS eyes and 432.5±82.1μm in control eyes, while LT was 166.3±41.0μm in AS eyes and 241.3±43.2μm in control eyes. ALD and LT were also significantly thinner in AS eyes than control eyes (P=0.003, P<0.001; respectively). CONCLUSION Enhanced depth imaging revealed that eyes with AS demonstrate thinner RNFL, ALD and LT compared with normal eyes. Further studies with a larger sample size are needed to understand the relationship between these findings and the morphologic changes and pathogenesis of AS.
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20
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Moghimi S, Nekoozadeh S, Motamed-Gorji N, Chen R, Fard MA, Mohammadi M, Weinreb RN. Lamina Cribrosa and Choroid Features and Their Relationship to Stage of Pseudoexfoliation Glaucoma. Invest Ophthalmol Vis Sci 2019; 59:5355-5365. [PMID: 30398627 PMCID: PMC6735617 DOI: 10.1167/iovs.18-25035] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To better understand the relationship of lamina cribrosa (LC) and choroid features to the severity of pseudoexfoliation glaucoma (PXG). Methods In this cross-sectional study, 137 eyes of 122 subjects (47 eyes with moderate/advanced PXG [mean deviation (MD), -15.0 ± 7.7 dB], 34 eyes with mild PXG [MD, -2.7 ± 1.5 dB], 32 aged-matched pseudoexfoliation syndrome [PXS] eyes, and 24 aged-matched control eyes) were investigated. Optic discs, LC thickness, and anterior LC depth (ALD; midsuperior, center, and midinferior) as well as peripapillary choroidal thickness were determined. Linear mixed modeling was used to adjust for age, sex, and axial length. Results A progressive decrease in LC thickness was found when comparing controls (271.9 ± 61.3 μm), PXS (212.6 ± 51.5 μm), mild PXG (180.8 ± 24.6 μm), and moderate/advance PXG (138.9 ± 37.5 μm) (P < 0.001). ALD was greater (P < 0.001) in moderate/advance glaucoma (306.7 ± 105.3 μm) and mild PXG (209.5 ± 79.7 μm) compared with PXS (155 ± 86.7 μm) and healthy controls (149.2 ± 103 μm). Although eyes with moderate/advance PXG had the thinnest choroid (117.2 ± 36.6 μm), choroidal thickness was comparable in mild PXG, PXS, and controls (150.0 ± 46.1, 159.7 ± 65.5, and 157.5 ± 51.1 μm, respectively; P = 0.002). Worse MD was the only factor associated with thinner LC (β = 2.344, P < 0.001) and choroid (β = 1.717, P = 0.009 μm) in PXG eyes. Higher IOP (β = 4.305, P = 0.013) and worse MD (β = -6.390, P < 0.001) were associated with deeper ALD in PXG. Conclusions In pseudoexfoliation, LC thinning is an early sign, and there is progressive thinning with advancing glaucoma. Choroidal thinning is observable only with moderate/advanced glaucoma. In PXG eyes, LC thickness, depth, and peripapillary choroidal thickness are associated with glaucoma severity.
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Affiliation(s)
- Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, California, United States.,Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Rebecca Chen
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | | | | | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, California, United States
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21
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Cakmak S, Altan C, Topcu H, Arici M, Pasaoglu I, Basarir B, Solmaz B. Comparison of the Lamina Cribrosa Measurements Obtained by Spectral-Domain and Swept-Source Optical Coherence Tomography. Curr Eye Res 2019; 44:968-974. [PMID: 30963796 DOI: 10.1080/02713683.2019.1604971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose/Aim of the study: The aim of this study was to compare the lamina cribrosa (LC) measurements obtained by Spectral-Domain Optical Coherence Tomography (SD-OCT) and Swept-Source Optical Coherence Tomography (SS-OCT) in the same eye and we also investigate how the differences in measurement will change in the presence of pseudoexfoliation glaucoma (PEG). Materials and Methods: A total of 30 patients from one institution have accepted. Detailed medical case histories and clinical examination, optic nerve head imaging using the SD-OCT (Heidelberg Engineering, Heidelberg, Germany) and SS-OCT (Triton; Topcon Medical Systems, Tokyo, Japan) for patients with pseudoexfoliation glaucoma and healthy volunteer. Results: Fifty-three eyes of the 30 patients (13 female, 17 male) were included in the study. Twenty-nine of eyes were healthy and 24 of eyes had pseudoexfoliation glaucoma. The mean age was 62 ± 7.3 years (range, 50-86 years). The difference between the mean Bruch's membrane opening distance measured by SD-OCT (1504.7 ± 154.2 µm) and by SS-OCT (1568.6 ± 193.3 µm) was statistically significant (p = .009). The difference between LC depth and LC thickness measurements between two OCT devices were not statistically significant. There was a negative correlation between the difference of two devices Bruch's membrane opening distance measurements and the cup/disc ratio (p = .007). Conclusion: Generally accepted belief is that lamina cribrosa visibility would be worse in healthy subjects who have thick prelaminar tissues, and better in individuals with glaucoma who had suffered the loss of prelaminar tissue. The difference between Bruch's membrane opening distance measurements taken with two devices was greater in normal eyes, and this difference was decreasing in glaucomatous eyes in our study. The Lamina Cribrosa measurement values shall not be directly compared between SD-OCT and SS-OCT.
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Affiliation(s)
- Semih Cakmak
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital , Istanbul , Turkey
| | - Cigdem Altan
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital , Istanbul , Turkey
| | - Husna Topcu
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital , Istanbul , Turkey
| | - Murat Arici
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital , Istanbul , Turkey
| | - Isıl Pasaoglu
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital , Istanbul , Turkey
| | - Berna Basarir
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital , Istanbul , Turkey
| | - Banu Solmaz
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital , Istanbul , Turkey
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22
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Luo H, Yang H, Gardiner SK, Hardin C, Sharpe GP, Caprioli J, Demirel S, Girkin CA, Liebmann JM, Mardin CY, Quigley HA, Scheuerle AF, Fortune B, Chauhan BC, Burgoyne CF. Factors Influencing Central Lamina Cribrosa Depth: A Multicenter Study. Invest Ophthalmol Vis Sci 2019; 59:2357-2370. [PMID: 29847642 PMCID: PMC5939685 DOI: 10.1167/iovs.17-23456] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose To quantify the influence of ocular and demographic factors on central laminar depth (LD) in healthy participants. Methods A total of 362 normal subjects underwent optical coherence tomography (OCT) enhanced depth imaging of the optic nerve head (ONH) with a 24 radial B-scan pattern aligned to the fovea–to–Bruch's membrane opening (BMO) axis. BMO, anterior lamina, anterior scleral canal opening (ASCO), Bruch's membrane (BM), and the peripapillary scleral surface were manually segmented. The extent of laminar segmentation was quantified within 72 ASCO subsectors. Central LD was quantified relative to four reference planes: BMO, ASCO, BM, and scleral. The effects of age, sex, ethnicity, IOP, BMO area, ASCO area, and axial length on LD were assessed. Results Laminar visibility was most consistent within the central ASCO (median 89%, range, 69%–95%). LDBMO and LDBM were significantly shallower in eyes with greater age, BMO area, and axial length and in females. LDASCO was shallower in eyes with greater ASCO area and axial length and in European and Hispanic descent compared to African descent eyes. LDSclera behaved similarly, but was not associated with axial length. BMO and ASCO area were not different between African descent and European descent eyes. Conclusions Central LD was deeper in African descent eyes and influenced least by age, axial length, and sex, but more by ASCO area, when measured relative to the ASCO and sclera. However, the magnitude of these effects for all four reference planes was small, and their clinical importance in the detection of glaucoma and its progression remains to be determined.
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Affiliation(s)
- Haomin Luo
- Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha, Hunan Province, P.R. China.,Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States
| | - Hongli Yang
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States
| | - Stuart K Gardiner
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
| | - Christy Hardin
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States
| | - Glen P Sharpe
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joseph Caprioli
- Jules Stein Eye Institute, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, United States
| | - Shaban Demirel
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
| | - Christopher A Girkin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Jeffrey M Liebmann
- Einhorn Clinical Research Center, Moise and Chella Safra Advanced Ocular Imaging Laboratory, New York Eye and Ear Infirmary of Mount Sinai Health System, New York, New York, United States
| | | | - Harry A Quigley
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States
| | | | - Brad Fortune
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
| | - Balwantray C Chauhan
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Claude F Burgoyne
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States
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23
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Fortune B. Pulling and Tugging on the Retina: Mechanical Impact of Glaucoma Beyond the Optic Nerve Head. ACTA ACUST UNITED AC 2019; 60:26-35. [DOI: 10.1167/iovs.18-25837] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Brad Fortune
- Discoveries in Sight Research Laboratories, Devers Eye Institute and Legacy Research Institute, Legacy Health, Portland, Oregon, United States
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24
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Ha A, Kim TJ, Girard MJ, Mari JM, Kim YK, Park KH, Jeoung JW. Baseline Lamina Cribrosa Curvature and Subsequent Visual Field Progression Rate in Primary Open-Angle Glaucoma. Ophthalmology 2018; 125:1898-1906. [DOI: 10.1016/j.ophtha.2018.05.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 05/02/2018] [Accepted: 05/11/2018] [Indexed: 11/17/2022] Open
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25
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Xiao H, Xu XY, Zhong YM, Liu X. Age related changes of the central lamina cribrosa thickness, depth and prelaminar tissue in healthy Chinese subjects. Int J Ophthalmol 2018; 11:1842-1847. [PMID: 30450317 DOI: 10.18240/ijo.2018.11.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/21/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the variation in the central lamina cribrosa thickness (cLCT), and the central anterior lamina cribrosa surface depth (cALCSD), as well as the central prelaminar tissue thickness (cPLTT) related to age in healthy Chinese subjects. METHODS A total of 96 eyes from 96 Chinese healthy subjects were recruited. According to age, the 96 cases were divided into three groups: the young group (YG, 18-39y), middle-age group (MG, 40-59y) and older-age group (OG, 60y and above). Lamina cribrosa images were obtained from all participants using radial linear protocol by enhanced depth imaging spectral-domain optical coherence tomography. The cLCT, cALCSD and cPLTT were calculated from the average value of the lamina cribrosa thickness, anterior lamina cribrosa surface depth and prelaminar tissue thickness in the optic nerve head (ONH) centre point and paracentral points (150 µm from the centre point in the horizontal and vertical directions). RESULTS For the total subjects, the mean cLCT, cALCSD and cPLTT were 235.18±41.27, 358.02±93.80 and 182.02±92.11 µm, respectively. No statistically significant differences in cLCT, cALCSD or cPLTT were found between gender and different eyes (P=0.27-0.92). The cLCT of the OG was the thickest among the three groups, while the cPLTT of the YG was the thickest among the three groups (P<0.05). Age was positively correlated with cLCT (r=0.42, P<0.001), and negatively correlated with cPLTT (r=-0.24, P=0.02). No significant correlation was found between the age and cALCSD (r=-0.06, P=0.55). And no correlation has been found between axial length and cLCT, cALCSD and cPLTT (P=0.11-0.81). CONCLUSION The impact of age on the cLCT and the cPLLTT should be taken into account when analysing glaucoma and other diseases related to lamina cribrosa.
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Affiliation(s)
- Hui Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sun University, Guangzhou 510060, Guangdong Province, China
| | - Xiao-Yu Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sun University, Guangzhou 510060, Guangdong Province, China
| | - Yi-Min Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sun University, Guangzhou 510060, Guangdong Province, China
| | - Xing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sun University, Guangzhou 510060, Guangdong Province, China
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26
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Hong SW, Koenigsman H, Ren R, Yang H, Gardiner SK, Reynaud J, Kinast RM, Mansberger SL, Fortune B, Demirel S, Burgoyne CF. Glaucoma Specialist Optic Disc Margin, Rim Margin, and Rim Width Discordance in Glaucoma and Glaucoma Suspect Eyes. Am J Ophthalmol 2018; 192:65-76. [PMID: 29750947 DOI: 10.1016/j.ajo.2018.04.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/20/2018] [Accepted: 04/20/2018] [Indexed: 01/21/2023]
Abstract
PURPOSE To quantify the variability of 5 glaucoma specialists' optic disc margin (DM), rim margin (RM), and rim width (RW) estimates. DESIGN Inter-observer reliability analysis. METHODS Clinicians viewed stereo-photographs from 214 subjects with glaucoma or ocular hypertension and digitally marked the DM and RM. For each photograph, the centroid of each clinician's DM was calculated, and an averaged DMcentroid was determined. The axis between the DMcentroid and the fovea was used to establish 12 30-degree sectors. Measurements from the DMcentroid to each clinician's DM (DMradius) and RM (RMradius) were used to generate a RW (DMradius-RMradius) and cup-to-disc ratio (CDR) (RMradius/DMradius) by sector. Parameter means, standard deviations, and coefficient of variations (COVs) were calculated across all clinicians for each eye. Parameter means for each clinician, and intraclass correlation coefficients (ICC), were calculated across all eyes by sector. RESULTS Among all eyes, the median COV by sector ranged from 3% to 5% for DMradius, 20% to 25% for RMradius, and 26% to 30% for RW. Sectoral ICCs for CDR ranged from 0.566 to 0.668. Sectors suspicious for rim thinning by 1 clinician were frequently overlooked by others. Among 1724 sectors in which at least 1 clinician was suspicious for rim thinning (CDR ≥ 0.7), all 5 clinicians' CDRs were ≥ 0.7 in only 499 (29%), and 2 of the 5 clinicians failed to detect rim thinning (CDR < 0.7) in 442 (26%). CONCLUSION In this study, glaucoma specialist RM, DM, and RW discordance was frequent and substantial, even in sectors that were suspicious for rim thinning.
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Affiliation(s)
- Seung Woo Hong
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Department of Ophthalmology, Medical College, Catholic University of Korea, Seoul, South Korea
| | - Helen Koenigsman
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Ruojin Ren
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Hongli Yang
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Stuart K Gardiner
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Juan Reynaud
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Robert M Kinast
- Devers Eye Institute Glaucoma Service, Portland, Oregon, USA
| | - Steven L Mansberger
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Devers Eye Institute Glaucoma Service, Portland, Oregon, USA
| | - Brad Fortune
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Shaban Demirel
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Claude F Burgoyne
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Devers Eye Institute Glaucoma Service, Portland, Oregon, USA.
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27
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Kadziauskienė A, Jašinskienė E, Ašoklis R, Lesinskas E, Rekašius T, Chua J, Cheng CY, Mari JM, Girard MJA, Schmetterer L. Long-Term Shape, Curvature, and Depth Changes of the Lamina Cribrosa after Trabeculectomy. Ophthalmology 2018; 125:1729-1740. [PMID: 29961552 DOI: 10.1016/j.ophtha.2018.05.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 05/09/2018] [Accepted: 05/09/2018] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To evaluate changes in lamina cribrosa (LC) shape, curvature, and depth after trabeculectomy. DESIGN Prospective, observational case series. PARTICIPANTS A total of 112 patients (118 eyes) with open- or closed-angle glaucoma undergoing trabeculectomy. METHODS The optic nerve head was imaged using enhanced depth imaging spectral-domain OCT before trabeculectomy and at 6 follow-up visits throughout the first postoperative year. The anterior LC surface and Bruch's membrane opening were marked in the serial horizontal B scans for the analysis of LC parameters using Morphology 1.0 software. Postoperative morphologic LC changes were assessed. MAIN OUTCOME MEASURES The postoperative LC global shape index (GSI), nasal-temporal (N-T) and superior-inferior (S-I) curvatures, and mean and sectoral LC depth (LCD). RESULTS The mean LC GSI increased only during the early postoperative period (P = 0.02), resulting in a change toward the saddle-rut shape. There was a flattening of the LC curvature in N-T (P < 0.001) and S-I (P = 0.003) meridians 12 months after trabeculectomy. A shallowing of the mean and sectoral LCD from baseline was significant throughout the entire follow-up period (P < 0.001) and progressed up to postoperative month 6. Twenty-eight patients showed a deepening of the LC from baseline in at least 1 visit. Eyes with shallower LCD compared with baseline responded to intraocular pressure (IOP) reduction with greater movement anteriorly than eyes with deeper LCD (P = 0.002). Greater IOP reduction (P = 0.007), less retinal nerve fiber layer thinning over the year (P = 0.003), and more superiorly-inferiorly curved baseline LC (P = 0.001) were associated with an increase in GSI. Younger age and IOP reduction were related to LC shallowing (P < 0.001, P = 0.002) and N-T flattening (P < 0.001). CONCLUSIONS In most eyes, trabeculectomy resulted in long-term flattening and shallowing of the LC. However, in some eyes, LC deepened from baseline. Change in LC global shape appeared to be temporal. Reduction in IOP plays an important role in the early phase of LC change; however, in the later phase, LC remodeling may play a crucial role in view of stable IOP.
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Affiliation(s)
- Aistė Kadziauskienė
- Clinic of Ears, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
| | | | - Rimvydas Ašoklis
- Clinic of Ears, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Eugenijus Lesinskas
- Clinic of Ears, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Tomas Rekašius
- Department of Mathematical Statistics, Vilnius Gediminas Technical University, Vilnius, Lithuania
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jean Martial Mari
- GePaSud Laboratory, University of French Polynesia, Tahiti, French Polynesia
| | - Michaël J A Girard
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
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28
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The distribution of retinal nerve fiber layer thickness and associations with age, refraction, and axial length: the Gutenberg health study. Graefes Arch Clin Exp Ophthalmol 2018; 256:1685-1693. [PMID: 29777305 DOI: 10.1007/s00417-018-3991-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 04/06/2018] [Accepted: 04/16/2018] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To evaluate the distribution of peripapillary retinal nerve fiber layer thickness as measured by optical coherence tomography and its associations with ocular parameters in a population-based setting. METHODS In the population-based Gutenberg Health Study, 1974 subjects from the Mainz-Bingen region were scheduled for ophthalmologic examinations, including visual acuity, refraction, tonometry, biometry, and measurements of peripapillary retinal nerve fiber layer thickness (pRNFL) by optical coherence tomography (SD-OCT, Spectralis®, Heidelberg Engineering, Germany). The associated factors in the global and sectoral pRNFL data were analyzed using multivariable linear mixed models related to age, sex, and ocular parameters. RESULTS Advanced age and longer axial length were associated with a thinner pRNFL, whereas pRNFL thickness was independent of sex, intraocular pressure (IOP), and central corneal thickness (CCT). Spherical equivalent was positively associated with pRNFL thickness, except in the temporal pRNFL sector. CONCLUSIONS In this large, population-based study, pRNFL thickness decreased with age. Longer eyes had thinner pRNFL thickness. Sex, IOP, and CCT showed no significant association with pRNFL thickness. These data may improve the interpretation of pRNFL data.
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29
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Lavinsky F, Benfica CZ, Castoldi N, Cruz do Carmo Chaves AE, Mello PADA. Measurement of the hypotenuse of the vertical optic nerve head cup with spectral-domain optical coherence tomography for the structural diagnosis of glaucoma. Clin Ophthalmol 2018; 12:215-225. [PMID: 29416313 PMCID: PMC5789042 DOI: 10.2147/opth.s152772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose To evaluate the hypotenuse of the vertical optic nerve head cup (HVOC), measured using the length and depth of the cup obtained with enhanced depth imaging spectral-domain optic coherence tomography (SD-OCT), as a biomarker for glaucoma diagnosis. Methods This was a prospective cross-sectional study of patients with glaucoma and controls. SD-OCT was performed in all participants to assess average circumpapillary retinal nerve fiber layer (RNFL) thickness. A vertical B-scan of the optic nerve head (ONH) was obtained for HVOC measurement. The length and depth of the optic nerve cup formed the sides of a right triangle that were used to calculate the HVOC. Participants also underwent standard automated perimetry. Results One hundred and fifty-six eyes were divided into three groups: mean deviation (MD) <−7 dB (60 eyes); MD ≥−7 dB (74 eyes); and healthy subjects (22 eyes). The mean (SD) HVOC in these groups was 1,419.8 (347.2) µm, 1,234.6 (258.8) µm, and 685.79 (315.4) µm (P<0.01), respectively. In the secondary structure–function analysis, only discs with a vertical diameter of 1.51–2.00 mm were included (120 eyes). The HVOCs were divided into four percentile groups, with the following means: 940, 1,128, 1,390, and 1,662 µm. There was a significant difference in MD between percentile groups 1 and 3 (P<0.03), 1 and 4 (P<0.001), 2 and 3 (P<0.02), and 2 and 4 (P<0.001). RNFL thickness differed among all percentile groups (P<0.001). Conclusion HVOC may provide an additional morphometric biomarker for the structural evaluation of ONH remodeling in glaucoma.
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Affiliation(s)
- Fabio Lavinsky
- Department of Ophthalmology, Paulista School of Medicine, São Paulo Hospital, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Department of Ophthalmology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Camila Zanella Benfica
- Department of Ophthalmology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Nédio Castoldi
- Department of Ophthalmology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | | | - Paulo Augusto de Arruda Mello
- Department of Ophthalmology, Paulista School of Medicine, São Paulo Hospital, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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30
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Abstract
The lamina cribrosa (LC) is a multilayered, collagenous, sieve-like structure at the deep optic nerve head, and is presumed to be the primary site of axonal injury. According to biomechanical theory, intraocular pressure-induced posterior deformation of the LC causes blockage of axonal transport and alters the ocular blood flow, so that the axons of the retinal ganglion cells lead to apoptosis, which results in glaucomatous optic disc change. Although most of the research on the LC to date has been limited to experimental animal or histologic studies, the recent advances in optical coherence tomography devices and image processing techniques have made possible the visualization of the LC structure in vivo. LC deformation in glaucoma typically has been evaluated in terms of its position from a structural reference plane (LC depth), entire curvature or shape, thickness, or localized structural change (focal LC defects or LC pore change). In this review, we highlight the methods of assessing LC deformation from in vivo optical coherence tomography scans, and we discuss the clinical implications of the recent investigations of the in vivo structure of LC in glaucoma.
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31
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Yang HS, Kim JG, Cha JB, Yun YI, Park JH, Woo JE. Quantitative analysis of neural tissues around the optic disc after panretinal photocoagulation in patients with diabetic retinopathy. PLoS One 2017; 12:e0186229. [PMID: 29040280 PMCID: PMC5645105 DOI: 10.1371/journal.pone.0186229] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 09/27/2017] [Indexed: 11/25/2022] Open
Abstract
In this retrospective cross-sectional study, we quantitatively analyzed the tomographic features in the neural tissues around the optic disc in patients with diabetic retinopathy with and without panretinal photocoagulation. We analyzed 206 eyes, comprising 33 normal eyes in subjects without diabetes (group I), 30 eyes without diabetic retinopathy (group II), 66 eyes with non-proliferative diabetic retinopathy (group III), 45 eyes with panretinal photocoagulation (group IV), and 32 eyes with normal tension glaucoma (group V). Sequential images acquired using swept-source optical coherence tomography in three-dimensional mode were used to measure peripapillary retinal nerve fiber layer thickness, neuro-retinal rim thickness, anterior lamina cribrosa depth, prelaminar thickness, and thickness of the lamina cribrosa. The peripapillary retinal nerve fiber layer thickness and lamina cribrosa thickness were significantly thinner in group IV than in group III (p = 0.019 and p < 0.001). However, there was no significant difference in rim thickness, anterior lamina cribrosa depth, or prelaminar thickness between groups III and IV (p = 0.307, p = 0.877, and p = 0.212). Multivariate analysis revealed that time since panretinal photocoagulation and thickness of the lamina cribrosa had a significant effect on peripapillary retinal nerve fiber layer thickness (p < 0.001 and p = 0.014). In group IV, there was a negative correlation between time elapsed since panretinal photocoagulation and peripapillary retinal nerve fiber layer thickness, rim thickness, and thickness of the lamina cribrosa (r = -0.765, r = -0.490, and r = -0.419), but no correlation with prelaminar thickness or anterior lamina cribrosa depth (r = 0.104 and r = -0.171). Panretinal photocoagulation may be related to thinning of the peripapillary retinal nerve fiber layer, rim thickness, and lamina cribrosa, but not prelaminar thickness or anterior lamina cribrosa depth. These features are different from the peripapillary features of eyes with typical normal tension glaucoma.
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Affiliation(s)
- Hyun Seung Yang
- Department of Ophthalmology, Seoul Shinsegae Eye Center, Eui Jung Bu, Gyeonggi-do, South Korea
| | - June-Gone Kim
- Department of Ophthalmology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, South Korea
- * E-mail:
| | - Jae Bong Cha
- Department of Ophthalmology, University of Ulsan, College of Medicine, Ulsan University Hospital, Ulsan, South Korea
| | - Young In Yun
- Seoul National University, College of Medicine, Seoul, South Korea
| | - Jong Hoon Park
- Department of Ophthalmology, Seoul Shinsegae Eye Center, Eui Jung Bu, Gyeonggi-do, South Korea
| | - Jong Eun Woo
- Department of Ophthalmology, University of Ulsan, College of Medicine, Ulsan University Hospital, Ulsan, South Korea
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32
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Comparison of the Deep Optic Nerve Structures in Superior Segmental Optic Nerve Hypoplasia and Primary Open-Angle Glaucoma. J Glaucoma 2017; 25:648-56. [PMID: 26950571 DOI: 10.1097/ijg.0000000000000396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to characterize the microstructure of the deep optic nerve tissues in eyes with superior segmental optic nerve hypoplasia (SSOH) in comparison with that in primary open-angle glaucoma (POAG). METHODS Thirty-five eyes with SSOH, 37 eyes with POAG, and 54 healthy control eyes underwent enhanced depth imaging (EDI) volume scanning of the optic nerve using spectral-domain optical coherence tomography (SD-OCT). POAG patients were matched with SSOH patients in terms of the thickness of the neuroretinal rim and the retinal nerve fiber layer in the superior sector. The lamina cribrosa thickness (LCT) was determined in 3 equidistant planes, and anterior lamina cribrosa surface depth (LCD) was determined in 5 equidistant planes. The measurements were compared between groups, and the areas under the receiver operating characteristic curves (AUC) were obtained for each parameter. RESULTS Eyes with SSOH had larger LCT and smaller LCD than POAG eyes at all locations (all P<0.001). The largest LCT was observed at the superior midperiphery in the SSOH group, but at central locations in both the POAG and control groups. The best parameters for discriminating the SSOH from glaucoma and healthy eyes were the superior midperipheral LCT (AUC=0.973) and inferior and inferior midperipheral LCD (AUCs=0.906), respectively. CONCLUSIONS The LCT and LCD exhibited characteristic features in eyes with SSOH that were distinctive from those of POAG and healthy eyes. Investigation of the deep optic nerve structure using EDI SD-OCT may be beneficial for differentiating between SSOH and glaucoma, which may help to avoid both overtreatment and undertreatment.
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Abstract
PURPOSE To determine the association of vision-related quality of life (QoL) to demographic factors and visual function in glaucoma suspect or early glaucoma patients. MATERIALS AND METHODS We administered the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) on the same day as a comprehensive ocular examination to participants either with glaucoma or at high risk for developing glaucoma. Regression models were used to determine the association between VFQ-25 composite and subscale scores, visual field status, logMAR equivalent visual acuity (VA), age, and sex. In all analyses we used data from the eye with the best mean deviation (MD), best pattern SD, and best VA. RESULTS Data from 198 participants were analyzed. The mean best MD (±SD) was 0.02±1.52 dB (range, -5.11 to 2.63 dB) and the mean best pattern SD was 1.75±1.03 dB (range, 0.91 to 8.36 dB). The mean VFQ-25 composite score was 91.6±6.7 (range, 54.5 to 100.0). Composite score and the Distance Activities, Color Vision subscale scores were associated with best MD (P≤0.05). The General Vision and Driving subscale scores were associated with best VA (P≤0.03). The composite score and the Distance Activities, Driving, and Color Vision subscale scores were associated with age (P≤0.05). Finally, the Distance Activities, Driving, and Peripheral Vision subscale scores were associated with sex (P≤0.04). CONCLUSIONS Vision-related QoL is associated with visual field status even in early and suspected glaucoma. It is also associated with VA, age, and sex. Particular decreases in QoL are related to distance activities, driving, and color vision.
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Vianna JR, Lanoe VR, Quach J, Sharpe GP, Hutchison DM, Belliveau AC, Shuba LM, Nicolela MT, Chauhan BC. Serial Changes in Lamina Cribrosa Depth and Neuroretinal Parameters in Glaucoma. Ophthalmology 2017; 124:1392-1402. [DOI: 10.1016/j.ophtha.2017.03.048] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/21/2017] [Accepted: 03/24/2017] [Indexed: 02/03/2023] Open
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Kim M, Bojikian KD, Slabaugh MA, Ding L, Chen PP. Lamina depth and thickness correlate with glaucoma severity. Indian J Ophthalmol 2017; 64:358-63. [PMID: 27380974 PMCID: PMC4966372 DOI: 10.4103/0301-4738.185594] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Purpose: To evaluate the correlation between lamina cribrosa (LC) morphology and glaucoma severity in patients with primary forms of open-angle glaucoma (OAG) using enhanced depth imaging spectral-domain optical coherence tomography (SD-OCT) and Humphrey visual field test (HVF). Subjects and Methods: Patients with OAG (n = 166), divided into normal-tension glaucoma (NTG) and high-tension glaucoma (HTG) groups (n = 66 and n = 100), were imaged using SD-OCT to obtain horizontal B-scan images of the optic nerve head (ONH). Laminar depth (LD) and laminar thickness (LT) were measured at the center of ONH. Results: The mean (±standard deviation) values of LD, LT, and visual field mean deviation (MD) were 555.4 ± 142.3 μm, 179.9 ± 49.7 μm, and − 5.7 ± 6.4 dB, respectively. In the multivariate linear regression analysis, LD, LT, and intraocular pressure (IOP) were significantly correlated with MD (P = 0.007, P = 0.037, and P = 0.004, respectively). In the subgroup analyses, only LD was associated with MD in the NTG group (n = 66), whereas LT and IOP were correlated with MD in the HTG group (n = 100). Neither axial length nor central corneal thickness was associated with LD or LT. Conclusions: Glaucoma severity, as measured by HVF MD, shows significant correlations with LD and LT, with greater severity associated with increasing LD and decreasing LT. Normal- and high-tension OAG patients have different associations with LD and LT, which implies that the pathogenesis of these two entities might be different.
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Affiliation(s)
- Martha Kim
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea; Department of Ophthalmology, University of Washington, Seattle, WA, USA,
| | - Karine D Bojikian
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Mark A Slabaugh
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Leona Ding
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Philip P Chen
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
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Yang H, Reynaud J, Lockwood H, Williams G, Hardin C, Reyes L, Stowell C, Gardiner SK, Burgoyne CF. The connective tissue phenotype of glaucomatous cupping in the monkey eye - Clinical and research implications. Prog Retin Eye Res 2017; 59:1-52. [PMID: 28300644 PMCID: PMC5603293 DOI: 10.1016/j.preteyeres.2017.03.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/14/2017] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
Abstract
In a series of previous publications we have proposed a framework for conceptualizing the optic nerve head (ONH) as a biomechanical structure. That framework proposes important roles for intraocular pressure (IOP), IOP-related stress and strain, cerebrospinal fluid pressure (CSFp), systemic and ocular determinants of blood flow, inflammation, auto-immunity, genetics, and other non-IOP related risk factors in the physiology of ONH aging and the pathophysiology of glaucomatous damage to the ONH. The present report summarizes 20 years of technique development and study results pertinent to the characterization of ONH connective tissue deformation and remodeling in the unilateral monkey experimental glaucoma (EG) model. In it we propose that the defining pathophysiology of a glaucomatous optic neuropathy involves deformation, remodeling, and mechanical failure of the ONH connective tissues. We view this as an active process, driven by astrocyte, microglial, fibroblast and oligodendrocyte mechanobiology. These cells, and the connective tissue phenomena they propagate, have primary and secondary effects on retinal ganglion cell (RGC) axon, laminar beam and retrolaminar capillary homeostasis that may initially be "protective" but eventually lead to RGC axonal injury, repair and/or cell death. The primary goal of this report is to summarize our 3D histomorphometric and optical coherence tomography (OCT)-based evidence for the early onset and progression of ONH connective tissue deformation and remodeling in monkey EG. A second goal is to explain the importance of including ONH connective tissue processes in characterizing the phenotype of a glaucomatous optic neuropathy in all species. A third goal is to summarize our current efforts to move from ONH morphology to the cell biology of connective tissue remodeling and axonal insult early in the disease. A final goal is to facilitate the translation of our findings and ideas into neuroprotective interventions that target these ONH phenomena for therapeutic effect.
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Affiliation(s)
- Hongli Yang
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Juan Reynaud
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Howard Lockwood
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Galen Williams
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Christy Hardin
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Luke Reyes
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Cheri Stowell
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Stuart K Gardiner
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Claude F Burgoyne
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States.
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Ivers KM, Yang H, Gardiner SK, Qin L, Reyes L, Fortune B, Burgoyne CF. In Vivo Detection of Laminar and Peripapillary Scleral Hypercompliance in Early Monkey Experimental Glaucoma. Invest Ophthalmol Vis Sci 2017; 57:OCT388-403. [PMID: 27409498 PMCID: PMC4968772 DOI: 10.1167/iovs.15-18666] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare optical coherence tomography (OCT) detected, optic nerve head (ONH) compliance within control and experimental glaucoma (EG) eyes of 15 monkeys at EG onset. Methods Intraocular pressure (IOP) was chronically elevated in one eye of each animal using a laser. Experimental glaucoma onset was identified using confocal scanning laser tomography (CSLT). Optical coherence tomography ONH imaging (40 radial B-scans) was performed at 10 mm Hg before and after laser. At EG onset, OCT scans were obtained at IOP 10 and 30 mm Hg. Optical coherence tomography landmarks within the IOP 10/30 images were delineated to quantify IOP 10/30 differences (compliance) for anterior lamina cribrosa surface depth (ALCSD) relative to Bruch's membrane opening (BMO) (ALCSD-BMO), ALCSD relative to peripheral BM (ALCSD-BM), and BMO depth relative to peripheral BM (BMOD-BM). A linear mixed effects model assessed for acute IOP elevation effects, control versus EG eye effects, and their interaction Results Effects of IOP elevation were greater in EG versus control eyes for ALCSD-BMO (−46 ± 45 vs. −8 ± 13 μm, P = 0.0042) and ALCSD-BM (−92 ± 64 vs. −42 ± 22 μm, P = 0.0075). Experimental glaucoma eye-specific ALCSD-BMO and ALCSD-BM compliance exceeded the range of control eye compliance in 9 and 8 of the 15 EG eyes, respectively. Post-laser peak IOP (R2 = 0.798, P < 0.0001) and post-laser mean IOP (R2 = 0.634, P < 0.0004) most strongly correlated to EG versus control eye differences in ALCSD-BMO compliance. Conclusions Laminar (ALCSD-BMO) and peripapillary scleral (ALCSD-BM) hypercompliance are present in most monkey eyes at the onset of EG.
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Affiliation(s)
- Kevin M Ivers
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States 2Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Hongli Yang
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States 2Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Stuart K Gardiner
- Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Lirong Qin
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Luke Reyes
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Brad Fortune
- Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Claude F Burgoyne
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States 2Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
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Fazio MA, Johnstone JK, Smith B, Wang L, Girkin CA. Displacement of the Lamina Cribrosa in Response to Acute Intraocular Pressure Elevation in Normal Individuals of African and European Descent. Invest Ophthalmol Vis Sci 2017; 57:3331-9. [PMID: 27367500 PMCID: PMC4961061 DOI: 10.1167/iovs.15-17940] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose To assess if the in vivo mechanical displacement of the anterior laminar cribrosa surface (ALCS) as a response of an acute elevation in intraocular pressure (IOP) differs in individuals of European (ED) and African descent (AD). Methods Spectral-domain optical coherence tomography (SDOCT) scans were obtained from 24 eyes of 12 individuals of AD and 18 eyes of 9 individuals of ED at their normal baseline IOP and after 60 seconds IOP elevation using ophthalmodynamometry. Change in depth (displacement) of the LC and to the prelaminar tissue (PLT) were computed in association with the change (delta) in IOP (Δ IOP), race, age, corneal thickness, corneal rigidity (ocular response analyzer [ORA]), and axial. Results In the ED group for small IOP elevations (Δ IOP < 12 mm Hg), the ALCS initially displaced posteriorly but for larger increase of IOP an anterior displacement of the lamina followed. Inversely, in the AD group the ALCS did not show a significant posterior displacement for small Δ IOP, while for larger IOP increases the ALCS significantly displaced posteriorly. Posterior displacement of the lamina cribrosa (LC) was also significantly correlated with longer axial length, higher corneal thickness, and ORA parameters. Prelaminar tissue posteriorly displaced for any magnitude of Δ IOP, in both groups. Conclusions The African descent group demonstrated a greater acute posterior bowing of the LC after adjustment for age, axial length, Bruch's membrane opening (BMO) area, and ORA parameters. Greater PLT posterior displacement was also seen in the AD group with increasing IOP, which was tightly correlated with the displacement of the LC.
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Affiliation(s)
- Massimo A Fazio
- Department of Ophthalmology University of Alabama at Birmingham, Birmingham, Alabama, United States 2Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - John K Johnstone
- Department of Computer and Information Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Brandon Smith
- Department of Ophthalmology University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Lan Wang
- Department of Ophthalmology University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Christopher A Girkin
- Department of Ophthalmology University of Alabama at Birmingham, Birmingham, Alabama, United States
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El-Agamy A, Oteaf F, Berika M. Anterior lamina cribrosa surface depth in healthy Saudi females. Clin Ophthalmol 2017; 11:1045-1050. [PMID: 28615925 PMCID: PMC5460657 DOI: 10.2147/opth.s131612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose This study was conducted to determine normative profile of anterior lamina cribrosa surface depth (ALCSD) in healthy Saudi females using Topcon Three-Dimensional (3D) Optical Coherence Tomography (OCT) 2000 – Spectral Domain (SD-OCT). In addition, the correlation between ALCSD and other clinical factors such as age, refractive error, intraocular pressure (IOP), central corneal thickness, anterior chamber depth, axial length, retinal nerve fiber layer thickness, and disk area was also assessed. Design This study was a prospective, nonrandomized, cross-sectional, observational, and quantitative study. Methods This study included 191 eyes of 191 healthy Saudi females from the College of Applied Medical Sciences of King Saud University. Stereoscopic disk photographs were reconstructed using Topcon 3D OCT-2000 for all subjects. ALCSD was measured at three planes (superior, middle, and inferior) and defined as the distance from Bruch’s membrane opening level (reference line) to anterior lamina cribrosa surface. Average of ALCSD at all planes was defined as mean ALCSD of the eye. Correlation between ALCSD and all the clinical factors was performed by linear regression analysis. Paired t-test was performed in order to compare ALCSD at all planes. Results In this study, the average ALCSD was 371.88±114.62 μm (range, 155–647.6 μm). Paired t-test showed a significant difference between superior and middle planes (P=0.004) and middle and inferior planes (P=0.013). Using the same test, no significant difference between superior and inferior planes (P=0.820) was observed. Generally, the largest ALCSD was in the middle plane. In addition, linear regression analysis showed no significant correlation between ALCSD and associated clinical factors. Conclusion This work is the first to provide the normative profile of ALCSD in Saudi females using Topcon 3D OCT-2000. Further studies are recommended for males, different ethnic populations, high myopic eyes, and different age groups using advanced imaging techniques such as enhanced depth imaging OCT.
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Affiliation(s)
- Amira El-Agamy
- Department of Optometry and Vision Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.,Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Fayrouz Oteaf
- Department of Optometry and Vision Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed Berika
- Rehabilitation Science Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.,Anatomy Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Miri MS, Abràmoff MD, Kwon YH, Sonka M, Garvin MK. A machine-learning graph-based approach for 3D segmentation of Bruch's membrane opening from glaucomatous SD-OCT volumes. Med Image Anal 2017; 39:206-217. [PMID: 28528295 DOI: 10.1016/j.media.2017.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 04/24/2017] [Accepted: 04/26/2017] [Indexed: 01/26/2023]
Abstract
Bruch's membrane opening-minimum rim width (BMO-MRW) is a recently proposed structural parameter which estimates the remaining nerve fiber bundles in the retina and is superior to other conventional structural parameters for diagnosing glaucoma. Measuring this structural parameter requires identification of BMO locations within spectral domain-optical coherence tomography (SD-OCT) volumes. While most automated approaches for segmentation of the BMO either segment the 2D projection of BMO points or identify BMO points in individual B-scans, in this work, we propose a machine-learning graph-based approach for true 3D segmentation of BMO from glaucomatous SD-OCT volumes. The problem is formulated as an optimization problem for finding a 3D path within the SD-OCT volume. In particular, the SD-OCT volumes are transferred to the radial domain where the closed loop BMO points in the original volume form a path within the radial volume. The estimated location of BMO points in 3D are identified by finding the projected location of BMO points using a graph-theoretic approach and mapping the projected locations onto the Bruch's membrane (BM) surface. Dynamic programming is employed in order to find the 3D BMO locations as the minimum-cost path within the volume. In order to compute the cost function needed for finding the minimum-cost path, a random forest classifier is utilized to learn a BMO model, obtained by extracting intensity features from the volumes in the training set, and computing the required 3D cost function. The proposed method is tested on 44 glaucoma patients and evaluated using manual delineations. Results show that the proposed method successfully identifies the 3D BMO locations and has significantly smaller errors compared to the existing 3D BMO identification approaches.
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Affiliation(s)
- Mohammad Saleh Miri
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA, 52242, United States
| | - Michael D Abràmoff
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA, 52242, United States; Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, 52242, United States; Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA, 52242, United States; Iowa City VA Health Care System, Iowa City, IA, 52246, United States
| | - Young H Kwon
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA, 52242, United States
| | - Milan Sonka
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA, 52242, United States; Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA, 52242, United States
| | - Mona K Garvin
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA, 52242, United States; Iowa City VA Health Care System, Iowa City, IA, 52246, United States.
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Srinivas S, Dastiridou A, Durbin MK, Nittala MG, Huang AA, Tan JC, Francis BA, Sadda SR, Chopra V. Pilot Study of Lamina Cribrosa Intensity Measurements in Glaucoma Using Swept-Source Optical Coherence Tomography. J Glaucoma 2017; 26:138-143. [DOI: 10.1097/ijg.0000000000000605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lee EJ, Kim TW, Lee KM, Lee SH, Kim H. Factors Associated with the Retinal Nerve Fiber Layer Loss after Acute Primary Angle Closure: A Prospective EDI-OCT Study. PLoS One 2017; 12:e0168678. [PMID: 28141872 PMCID: PMC5283663 DOI: 10.1371/journal.pone.0168678] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 12/05/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose To determine the factors associated with retinal nerve fiber layer (RNFL) loss in eyes with acute primary angle-closure (APAC), particularly focusing on the influence of the change in the anterior lamina cribrosa surface depth (LCD). Methods After the initial presentation, 30 eyes with unilateral APAC were followed up at the following specific time points over a 12-month period: 1 week, 1~2 months, 2~3 months, 5~6 months, and 11~12 months. These follow-ups involved intraocular pressure measurements, enhanced depth-imaging spectral-domain optical coherence tomography (SD-OCT) scanning of the optic disc, and measurements of the circumpapillary RNFL thickness. The prelaminar tissue thickness (PLT) and LCD were determined in the SD-OCT images obtained at each follow-up visit. Results Repeated measures analysis of variance revealed a significant pattern of decrease in the global RNFL thickness, PLT, and LCD (all p<0.001). The global RNFL thickness decreased continuously throughout the follow-up period, while the PLT decreased until 5~6 months and did not change thereafter. The LCD reduced until 2~3 months and then also remained steady. Multivariable regression analysis revealed that symptoms with a longer duration before receiving laser peripheral iridotomy (LI) (p = 0.049) and a larger LCD reduction (p = 0.034) were significant factors associated with the conversion to an abnormal RNFL thickness defined using OCT normative data. Conclusion Early short-term decreases in the PLT and LCD and overall long-term decrease in the peripapillary RNFL were observed during a 12-month follow-up after an APAC episode. A longer duration of symptoms before receiving LI treatment and larger LCD reduction during follow-up were associated with the progressive RNFL loss. The LCD reduction may indicate a prior presence of significant pressure-induced stress that had been imposed on the optic nerve head at the time of APAC episode. Glaucomatous progression should be suspected in eyes showing LCD reduction after the APAC remission.
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Affiliation(s)
- Eun Ji Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
| | - Tae-Woo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Hyen Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyunjoong Kim
- Department of Applied Statistics, Yonsei University, Seoul, Korea
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Relationship between Intraocular Pressure and Anterior Lamina Cribrosa Depth: A Cross-Sectional Observational Study in a Healthy Portuguese Population. Eur J Ophthalmol 2016; 27:295-300. [DOI: 10.5301/ejo.5000867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 02/03/2023]
Abstract
Purpose To investigate the association between anterior lamina cribrosa depth (ALCD), determined with enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT), and intraocular pressure (IOP) in a healthy Portuguese population. Methods In this cross-sectional observational study conducted between January and July 2015, 2 optic nerve head (ONH)–centered EDI-OCT cross-scans were performed and ALCD was defined as the perpendicular distance between the line connecting both edges of Bruch's membrane opening and the anterior border of the lamina cribrosa at the maximum depth point. A multivariate regression model was performed to assess the association of IOP and ALCD. Results The studied population included 59 subjects (35 women) with a mean age of 61.7 ± 15.1 years. Mean vertical and horizontal maximum ALCD was 444.5 ± 92.2 μm and 427.6 ± 82.7 μm, respectively. When controlling for age and spherical equivalent, maximum vertical and horizontal ALCD were positively correlated with intraocular pressure (R2>0.20) by 8.58 μm (95% confidence interval [CI] 2.80-14.36 μm; p<0.01) and 8.25 μm (95% CI 2.71-13.78 μm; p<0.01) per mm Hg of IOP, respectively. Conclusions Our sample of healthy subjects presented a statistically significant positive correlation between IOP and ALCD when controlling for possible confounding factors. These results may trigger further studies to better elucidate the role of IOP in the morphologic and functional dynamics of the ONH.
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Positional and Curvature Difference of Lamina Cribrosa According to the Baseline Intraocular Pressure in Primary Open-Angle Glaucoma: A Swept-Source Optical Coherence Tomography (SS-OCT) Study. PLoS One 2016; 11:e0162182. [PMID: 27611970 PMCID: PMC5017615 DOI: 10.1371/journal.pone.0162182] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 08/18/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate the variation of lamina cribrosa (LC) structure based on the baseline intraocular pressure (IOP) in eyes with primary open-angle glaucoma (POAG) and healthy individuals using swept-source optical coherence tomography. Methods A total of 108 eyes with POAG and 61 healthy eyes were recruited. Based on the baseline IOP, the POAG eyes were divided into higher-baseline IOP (HTG; baseline IOP > 21 mmHg, n = 38 eyes) and lower-baseline IOP (NTG; baseline IOP ≤ 21 mmHg, n = 70 eyes). The anterior laminar insertion depth (ALID), mean LC depth (mLCD), and the LC curvature index (mLCD–ALID) were measured, and compared among the three groups. The regional variation of LC structure was evaluated by vertical-horizontal ALID difference. Results The mLCD and LC curvature index were greatest in HTG eyes (520.3 ± 123.0 and 80.9 ± 30.7 μm), followed by NTG (463.2 ± 110.5 and 64.5 ± 30.7 μm) and healthy eyes (382.9 ± 107.6 and 47.6 ± 25.7 μm, all P < 0.001). However, there were no significant difference in ALID between HTG and NTG eyes. The vertical-horizontal ALID difference was larger in NTG eyes (72.8 ± 56.2 μm) than in HTG (32.7 ± 61.4 μm, P = 0.004) and healthy eyes (25.5 ± 34.8 μm, P < 0.001). Conclusions Lamina cribrosa position and curvature differed in POAG eyes with low and high IOP. This would support the theory that IOP induced biomechanical effects on the optic play a role on glaucoma.
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Anterior Lamina Cribrosa Surface Depth in Open-Angle Glaucoma: Relationship with the Position of the Central Retinal Vessel Trunk. PLoS One 2016; 11:e0158443. [PMID: 27355646 PMCID: PMC4927068 DOI: 10.1371/journal.pone.0158443] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 06/16/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose To determine the factors influencing the anterior lamina cribrosa (LC) surface depth (LCD) in patients with open-angle glaucoma (OAG), focusing on the association between LCD and the position of the central retinal vessel trunk (CRVT) at the anterior LC surface. Methods Optic nerve heads of 205 OAG eyes were scanned using swept-source optical coherence tomography (SS-OCT). After processing the images using adaptive compensation, the LCD was determined from 11 horizontal B-scan images that divided the optic disc vertically into 12 equal parts. Eyes were divided into two groups (central or peripheral) according to where the CRVT exits from the anterior LC surface. The influence of CRVT position on LCD was evaluated, taking into account age, gender, untreated intraocular pressure (IOP), IOP at optic-disc scanning, retinal nerve fiber layer (RNFL) thickness, visual-field mean deviation, central corneal thickness, and axial length. Results Patients in the peripheral CRVT group were younger and more myopic, and had a larger mean LCD and thinner global RNFL than those in the central CRVT group (all P≤0.023). On multivariate analysis, the peripheral CRVT location was significantly associated with a larger LCD (P = 0.002), together with the significant association of younger age (P<0.001), higher untreated IOP (P = 0.010), and thinner RNFL (P = 0.003) on the larger LCD. Conclusion In OAG, CRVT location was an independent factor influencing the LCD, together with age, untreated IOP, and global RNFL thickness. The data indicate that the CRVT may contribute to the resistance of the LC against deformation. A longitudinal prospective observation is required to clarify this relationship.
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Yang H, Ren R, Lockwood H, Williams G, Libertiaux V, Downs C, Gardiner SK, Burgoyne CF. The Connective Tissue Components of Optic Nerve Head Cupping in Monkey Experimental Glaucoma Part 1: Global Change. Invest Ophthalmol Vis Sci 2016; 56:7661-78. [PMID: 26641545 DOI: 10.1167/iovs.15-17624] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To characterize optic nerve head (ONH) connective tissue change within 21 monkey experimental glaucoma (EG) eyes, so as to identify its principal components. METHODS Animals were imaged three to five times at baseline then every 2 weeks following chronic unilateral IOP elevation, and euthanized early through end-stage confocal scanning laser tomographic change. Optic nerve heads were serial-sectioned, three-dimensionally (3D) reconstructed, delineated, and quantified. Overall EG versus control eye differences were assessed by general estimating equations (GEE). Significant, animal-specific, EG eye change was required to exceed the maximum physiologic intereye differences in six healthy animals. RESULTS Overall EG eye change was significant (P < 0.0026) and animal-specific EG eye change most frequent, for five phenomena (number of EG eyes and range of animal-specific change): posterior laminar deformation (21, -29 to -437 μm), laminar thickening (11, 20-73 μm) and thinning (3, -23 to -31 μm), scleral canal expansion (17, 20-139 μm), outward anterior (16, -16 to -124 μm) and posterior (17, -22 to -279 μm) laminar insertion migration, and peripapillary scleral bowing (11, 21-77 μm). Experimental glaucoma versus control eye laminar thickness differences were bimodal in behavior, being thickened in most EG eyes demonstrating the least deformation and less thickened or thinned in most EG eyes demonstrating the greatest deformation. CONCLUSIONS Our postmortem studies retrospectively identify five connective tissue components of ONH "cupping" in monkey EG which serve as targets for longitudinally staging and phenotyping ONH connective tissue alteration within all forms of monkey and human optic neuropathy.
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Affiliation(s)
- Hongli Yang
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States 2Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
| | - Ruojin Ren
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States 2Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
| | - Howard Lockwood
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States 2Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
| | - Galen Williams
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States 2Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
| | - Vincent Libertiaux
- Department of Ophthalmology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - Crawford Downs
- Department of Ophthalmology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - Stuart K Gardiner
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
| | - Claude F Burgoyne
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States 2Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
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Abstract
The clinical phenomenon of cupping has 2 principal pathophysiologic components in all optic neuropathies: prelaminar thinning and laminar deformation. We define prelaminar thinning to be the portion of cup enlargement that results from thinning of the prelaminar tissues due to physical compression and/or loss of retinal ganglion cell axons. We define laminar deformation or laminar cupping to be the portion of cup enlargement that results from permanent intraocular pressure (IOP)-induced deformation of the lamina cribrosa and peripapillary scleral connective tissues after damage and/or remodeling. We propose that the defining phenomenon of glaucomatous cupping is deformation and/or remodeling of the neural and connective tissues of the optic nerve head (ONH), which is governed by the distribution of IOP-related connective tissue stress and strain, regardless of the mechanism of insult or the level of IOP at which deformation and/or remodeling occurs. In other words, "glaucomatous cupping" is the term clinicians use to describe the clinical appearance and behavior the ONH assumes as its neural and connective tissues deform, remodel, or mechanically fail: 1) in a pattern and 2) by the several pathophysiologic processes governed by IOP-related connective tissue stress and strain. ONH biomechanics explains why a given ONH will demonstrate a certain form of "cupping" and at what level of IOP that might happen. Animal models are allowing us to tease apart the important components of cupping in IOP-related and non-IOP-related forms of optic neuropathy. A paradigm change in spectral domain optical coherence tomography ONH, retinal nerve fiber layer, and macular imaging should improve our ability to phenotype the ocular manifestations of many forms of damage to the visual system including glaucoma.
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Lamina Cribrosa Depth is Associated With the Cup-to-Disc Ratio in Eyes With Large Optic Disc Cupping and Cup-to-Disc Ratio Asymmetry. J Glaucoma 2016; 25:e536-45. [DOI: 10.1097/ijg.0000000000000387] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Morgan JIW. The fundus photo has met its match: optical coherence tomography and adaptive optics ophthalmoscopy are here to stay. Ophthalmic Physiol Opt 2016; 36:218-39. [PMID: 27112222 PMCID: PMC4963017 DOI: 10.1111/opo.12289] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 01/20/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE Over the past 25 years, optical coherence tomography (OCT) and adaptive optics (AO) ophthalmoscopy have revolutionised our ability to non-invasively observe the living retina. The purpose of this review is to highlight the techniques and human clinical applications of recent advances in OCT and adaptive optics scanning laser/light ophthalmoscopy (AOSLO) ophthalmic imaging. RECENT FINDINGS Optical coherence tomography retinal and optic nerve head (ONH) imaging technology allows high resolution in the axial direction resulting in cross-sectional visualisation of retinal and ONH lamination. Complementary AO ophthalmoscopy gives high resolution in the transverse direction resulting in en face visualisation of retinal cell mosaics. Innovative detection schemes applied to OCT and AOSLO technologies (such as spectral domain OCT, OCT angiography, confocal and non-confocal AOSLO, fluorescence, and AO-OCT) have enabled high contrast between retinal and ONH structures in three dimensions and have allowed in vivo retinal imaging to approach that of histological quality. In addition, both OCT and AOSLO have shown the capability to detect retinal reflectance changes in response to visual stimuli, paving the way for future studies to investigate objective biomarkers of visual function at the cellular level. Increasingly, these imaging techniques are being applied to clinical studies of the normal and diseased visual system. SUMMARY Optical coherence tomography and AOSLO technologies are capable of elucidating the structure and function of the retina and ONH noninvasively with unprecedented resolution and contrast. The techniques have proven their worth in both basic science and clinical applications and each will continue to be utilised in future studies for many years to come.
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Affiliation(s)
- Jessica I W Morgan
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Rebolleda G, Muñoz Negrete FJ. [Enhanced Depth Imaging- optical coherence tomography technique and the lamina cribrosa in glaucoma]. ACTA ACUST UNITED AC 2016; 89:133-5. [PMID: 24731414 DOI: 10.1016/j.oftal.2014.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Affiliation(s)
- G Rebolleda
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España.
| | - F J Muñoz Negrete
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
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