Utility of Central 10 Degrees Visual Field Test With Size V Stimulus in End-Stage Glaucoma

PRCIS

In end-stage glaucoma, the central 10-degree visual field test with a size V stimulus provided useful information, including the number of points with detectable retinal sensitivity threshold values and retinal sensitivity threshold values.

PURPOSE

The purpose of this study was to evaluate the clinical utility of the central 10-degree visual field test with a size V stimulus in end-stage glaucoma.

MATERIALS AND METHODS

A total of 73 eyes with end-stage glaucoma (visual field limited to a radius of <10 degrees from fixation) were included. Central 10 degrees visual field tests were performed using both size III and V stimuli. Reliability indices, test duration, number of points with detectable retinal sensitivity threshold values, and retinal sensitivity threshold values at 4 central points, 4 quadrants, and 3 clusters (papillomacular area, superior half, and inferior half) were compared between the test results using size III and V stimuli.

RESULTS

When the size V stimulus was used, the mean test duration increased from 7.8 to 13.3 minutes ( P < 0.001), the mean number of test points with detectable retinal sensitivity threshold values in total area increased from 19.0 to 37.3 ( P < 0.001), and the mean retinal sensitivity threshold values in total area increased from 3.9 to 9.3 dB ( P < 0.001) compared with the test results with the size III stimulus. Significant increase in the visual field parameters was found in all quadrants and clusters ( P < 0.001), and a greater increase was associated with better visual acuity and greater mean deviation of the visual field ( P < 0.05).

CONCLUSIONS

The central 10-degree visual field test with a size V stimulus provided more information than the test with a size III stimulus in end-stage glaucoma.

Comparison of posterior vitreous detachment-related and glaucomatous optic disc hemorrhage

This study compared the characteristics of posterior vitreous detachment (PVD)-related and glaucomatous optic disc hemorrhage (DH). Fundus photographs of eyes with PVD-related DH (PVD group) and glaucomatous DH (glaucoma group) were reviewed. The shape, type, layer, location (clock-hour sector), and DH/disc area (DH/DA) ratio of DH were investigated. In the PVD group, DH presented as a flame (60.9%), splinter (34.8%), and dot or blot (4.3%) shape. However, most of the glaucomatous DH revealed a splinter shape (92.3%), followed by a flame shape (7.7%, p < 0.001). In the PVD group, the most common type of DH was cup margin type (52.2%), whereas, in the glaucoma group it was disc rim type (53.8%, p = 0.003). Both PVD-related and glaucomatous DH were most commonly observed in the 7 o'clock sector. In the PVD group, DH was also found in the 2 and 5 o'clock sectors (p = 0.010). Mean DH/DA ratio in PVD group (0.15 ± 0.19) was greater than in glaucoma group (0.04 ± 0.04, p < 0.001). PVD-related DH showed a higher frequency of flame shape, cup margin type, nasal location, and greater area compared to the glaucomatous DH.

Correlation Between Interocular Asymmetry of Corneal Hysteresis and Visual Field Defect in Glaucoma

Purpose

To evaluate the relationship between interocular asymmetries of corneal hysteresis (CH) and visual field defects in Korean patients with glaucoma.

Methods

A total of 444 eyes of 222 participants with glaucoma in at least one eye were enrolled. CH was measured using an ocular response analyzer (Reichert Technologies Inc., Depew, NY, USA). Eyes of each participant were classified into "better eye" and "worse eye" based on the mean deviation (MD) value of visual field test. The correlation between interocular differences in intraocular pressure (IOP), axial length, central corneal thickness (CCT), CH, and MD values was evaluated using Spearman's correlation analysis. To exclude the possible effect of anti-glaucoma medication on corneal properties, additional analyses were performed on eyes without any glaucoma treatment at the time of CH measurement (treatment-naïve group).

Results

Median (interquartile range) MD value was -3.71 (-6.87, -1.30) dB in the "better eye" and -10.20 (-16.32, -5.62) dB in the "worse eye". When the correlation between the asymmetry of the MD value and asymmetry of IOP, axial length, CCT, and CH were evaluated, only interocular differences in CH were significantly associated with interocular differences in MD values (correlation coefficient = 0.214, p = 0.001). Among the 222 participants, 60 (27.0%) were treatment-naïve group. In these eyes, interocular differences in CH were also significantly associated with interocular differences in the MD values (correlation coefficient = 0.285, p = 0.029).

Conclusion

The interocular asymmetry of CH was significantly correlated with the interocular asymmetry of visual field defects in glaucoma.

Traumatic Posterior Chamber Intraocular Lens Dislocation into the Subconjunctival Space

Purpose: Here we report a case of posterior chamber intraocular lens (IOL) dislocation into the subconjunctival space (pesudophacocele) following ocular trauma.Case summary: A 66-year-old male presented with ocular pain and decreased vision in the right eye following trauma with a metallic rod. The patient had a history of trabeculectomy, glaucoma drainage device implantation, transscleral cyclophotocoagulation, and cataract surgery for uveitic glaucoma and a cataract in the right eye. On examination, vision was hand movement, the intraocular pressure was 3 mmHg, and subconjunctival hemorrhage and hyphema were observed. After the resolution of hemorrhage, uveal tissue prolapse was seen nasally behind the corneal limbus and the IOL was found to be dislocated into the nasal subconjunctival space. There were no changes in the filtering bleb and tube compared to the pre-trauma status. The IOL was removed through a conjunctival incision because the patient refused any active treatment.Conclusions: Pesudophacocele developed in a patient who had a history of glaucoma and cataract surgery in the injured eye. The IOL could not be assessed immediately after the trauma because of subconjunctival hemorrhage and hyphema. When the status of IOL is unclear or suspected to be dislocated after trauma, the possibility of pseudophacocele should be considered, in addition to the dislocation into the vitreous cavity.

COVID-19 Vaccination in Korea

Since December 2020, various coronavirus disease 2019 (COVID-19) vaccines have been developed and approved. As of February 2023, mRNA vaccines including bivalent vaccines (Pfizer/BioNTech, Moderna), recombinant protein vaccines (Novavax, SK Bioscience), and viral vector vaccines (AstraZeneca, Janssen) have been approved in Korea. COVID-19 vaccination can effectively reduce hospitalization and deaths due to symptomatic COVID-19, especially severe and critical COVID-19. The primary series vaccination against COVID-19 is recommended for all adults aged ≥18 years in Korea. Booster vaccination with the bivalent mRNA vaccine is available for those ≥12 years who have completed the primary series vaccination, regardless of the type of vaccine previously received, and is recommended for all adults. Booster vaccination can be administered since 90 days after the last dose. Localized and systemic adverse events following COVID-19 vaccination are relatively common and more frequently documented in younger age groups. Rare but potentially serious specialized adverse reactions include anaphylaxis, thrombosis with thrombocytopenia syndrome, myocarditis, and Guillain-Barré syndrome. Previous severe allergic reactions, such as anaphylaxis, to any COVID19 vaccine or vaccine component are considered a contraindication for vaccination. The indications and schedule for COVID-19 vaccination are subject to change based on further research results and the COVID-19 pandemic.

Clinical application of the Panbio™ COVID-19 Ag rapid test device and SSf-COVID19 kit for the detection of SARS-CoV-2 infection

OBJECTIVE

We evaluated the sensitivity and specificity of the Panbio™ COVID-19 Ag rapid test device using nasal swabs and those of the SSf-COVID19 kit, one of RT-PCR tests, using saliva specimens. These tests were compared with RT-PCR tests using nasopharyngeal swabs for the diagnosis of SARS-CoV-2 infection. The three diagnostic tests were simultaneously conducted for patients aged ≥ 18 years, who were about to be hospitalized or had been admitted for COVID-19 confirmed by RT-PCR in two research hospitals from August 20 to October 29, 2021. Nasal swabs were tested using the Panbio™ COVID-19 Ag rapid test device. More than 1 mL of saliva was self-collected and tested using the SSf-COVID19 kit.

RESULTS

In total, 157 patients were investigated; 124 patients who were about to be hospitalized and 33 patients already admitted for COVID-19. The overall sensitivity and specificity of the Panbio™ COVID-19 Ag rapid test device with nasal swabs were 64.7% (95% confidence interval [CI] 47.9-78.5%) and 100.0% (95% CI 97.0-100.0%), respectively. The median time to confirm a positive result was 180 s (interquartile range 60-255 s). The overall sensitivity and specificity of the SSf-COVID19 kit with saliva specimens were 94.1% (95% CI 80.9-98.4%) and 100.0% (95% CI 97.0-100.0%), respectively.

Dynamic Ranges of Retinal Nerve Fiber and Optic Nerve Head Parameters Measured Using Optical Coherence Tomography in Glaucoma: A Longitudinal Study

PURPOSE

To evaluate the dynamic range of retinal nerve fiber layer (RNFL) and optic nerve head (ONH) parameters measured using optical coherence tomography (OCT) in conditions ranging from nonglaucomatous status to advanced glaucoma by longitudinal observation.

METHODS

A total of 15 eyes from 12 participants with glaucoma progression from a nonglaucomatous status to advanced glaucoma were included. The RNFL and ONH parameters were compared between the nonglaucomatous and advanced stages within the same eye. The absolute and relative changes in OCT parameters were analyzed.

RESULTS

The median highest intraocular pressure was 42.5 mmHg (interquartile range, 37.5 to 54.5 mmHg), and the final mean deviation of the visual field test was -24.68 dB (interquartile range, -23.93 to -31.13 dB). The median relative changes in RNFL thickness were -40.6% in the overall area, and -51.9%, -21.4%, -51.1%, and -41.8% in the superior, nasal, inferior, and temporal quadrants, respectively (all p < 0.05). Relative changes in the rim area, disc area, average cup to disc ratio, vertical cup to disc ratio, and cup volume were -56.64%, 0.59%, 62.10%, 66.0%, and 337.90%, respectively (all p < 0.05, except for disc area with a p-value of 0.753).

CONCLUSIONS

The dynamic range of the RNFL thickness ranged from 40.6% to 51.9%, and the dynamic range of the ONH parameters ranged from 56.64% to 337.90%. During the course of glaucoma progression, the cup volume showed the widest dynamic range. However, the disc area did not show significant changes.

Effect of Weiss ring on peripapillary retinal nerve fiber layer thickness measurements using SD-OCT

Spectral-domain optical coherence tomography (SD-OCT) must accurately identify and measure the peripapillary retinal nerve fiber layer (pRNFL) thickness to improve the repeatability and reproducibility, and reduce measurement errors. Because Weiss ring can be located in front of the optic disc, we hypothesized that it may affect pRNFL thickness measurements obtained using SD-OCT. We retrospectively reviewed the medical records of patients with (group W) and without (group N) Weiss ring, observed on OCT fundus image and an RNFL map devised using SD-OCT. Optic disc cube scans (200 × 200) were obtained to measure pRNFL thicknesses (superior, temporal, inferior, nasal, and average) at two consecutive visits. Pearson's correlation coefficient (r), intraclass correlation coefficient (ICC), and coefficient of variation (CV) were calculated. The r and ICC values for the pRNFL thickness measurements at the two visits were lower for group W compared to group N, but statistical significance was reached only for inferior pRNFL thickness. In addition, CV values were greater for group W compared to group N, but the differences were significant only for inferior and average pRNFL thickness measurements (p < 0.001 and p = 0.004, respectively). Weiss ring located near the optic disc can affect pRNFL thickness measurements and repeatability thereof, especially the inferior quadrant and average values. Therefore, it is important to identify the presence of Weiss ring when analyzing pRNFL thickness values.

Difference between before and after Compensating for Cyclotorsion by Optical Coherence Tomography Guided Progression Analysis

Purpose: This study evaluated the difference in parameters before and after the application of optical coherence tomography (OCT) Guided Progression Analysis (GPA) to compensate for cyclotorsion during image acquisition.Methods: Among glaucomatous eyes with ≥4 OCT tests, eyes with correction for cyclotorsion in GPA printouts defined as rotated OCT fundus images were included. The degree of cyclotorsion (i.e., the degree of fundus image rotation), direction of cyclotorsion (incyclotorsion or excyclotorsion), difference in optic nerve head (ONH) parameters, and retinal nerve fiber layer (RNFL) thickness before and after correction were analyzed.Results: Correction for cyclotorsion was seen in 33 of the 401 eyes (12.2%). Incyclotorsion was observed in 16 eyes (48.5%) and excyclotorsion in 17 (51.5%). The mean degree of cyclotorsion was 5.5 ± 2.3 degrees. The ONH parameters were unchanged after correcting for cyclotorsion. The mean overall, inferior, and superior quadrant RNFL thicknesses were 73.6 ± 14.8, 79.3 ± 26.3, and 90.1 ± 24.7 μm before correction and 73.6 ± 14.9, 79.6 ± 26.6, 89.7 ± 24.8 μm afterwards (p > 0.05). The difference in RNFL thickness after correction ranged from 0 to 6 μm.Conclusions: The difference in RNFL thickness before and after cyclotorsion correction by GPA was not large. GPA did not correct the ONH parameters induced by cyclotorsion. Regarding this, GPA algorithm improvements may be needed.

Progression of Glaucoma in Highly Myopic Eyes with Paravascular Inner Retinal Defects

Purpose: To report a case of glaucoma progression in highly myopic eyes with paravascular inner retinal defects.Case summary: Retinal nerve fiber layer (RNFL) defects with cleavage-like irregular margins and internal areas were found around the retinal vessels in highly myopic eyes of a 17-year-old female. On suspicion of paravascular inner retinal defect (PIRD) instead of glaucomatous RNFL defect, observation without treatment was recommended. After 10 years of follow-up, RNFL defects and neuroretinal rim thinning were found around the pre-existing PIRD on fundus photographs. Optical coherence tomography also revealed decreased RNFL thickness.Conclusions: Glaucomatous changes progressed around the pre-existing PIRD area over the 10-year follow-up. This indicates the need for caution when assessing glaucoma in highly myopic eyes with PIRD.

Changes in circumpapillary retinal nerve fiber layer thickness after vitrectomy for rhegmatogenous retinal detachment

The study aimed to evaluate the long-term changes in circumpapillary retinal nerve fiber layer (RNFL) thickness after vitrectomy for rhegmatogenous retinal detachment (RRD) repair. A total of 33 eyes of 33 patients were enrolled. By using optical coherence tomography, the circumpapillary RNFL thickness was measured before surgery and 1, 3, 6 months and 1, 2, 3 years after surgery and compared with the preoperative value. The effect of duration, location, and extent of RRD on RNFL thickness change was evaluated. There was a significant increase of circumpapillary RNFL thickness at the 1-month, 3-month [except in the nasal superior sector (P = 0.627)], and only in the nasal inferior sector at 6-month (P = 0.010) follow-up compared with the baseline value (all Ps < 0.05). No significant differences were observed 1, 2, and 3 years after the surgery (P > 0.05). The duration, location, and extent of detachment did not reveal significant correlations with RNFL parameters (P > 0.05). Circumpapillary RNFL thickness in eyes with RRD after vitrectomy demonstrated a transient increase during the early postoperative period. This increase was not associated with duration, location, and extent of RRD. At 3 years following surgery, no RNFL thinning or thickening was observed.

Effect of Inconsistent Optical Coherence Tomography Scan Location on Glaucoma Progression Analysis

PRCIS

Circumpapillary retinal nerve fiber layer (RNFL) thickness change induced by optical coherence tomography (OCT) scan circle location displacement was not completely compensated despite the use of Guided Progression Analysis (GPA), especially when the "R1" registration method was applied.

PURPOSE

The purpose of this study was to evaluate the effect of inconsistent OCT scan location on glaucoma progression detection using GPA.

METHODS

Eighty-four glaucomatous eyes with at least 4 serial OCT tests were included. To evaluate the ability of OCT GPA to adjust the OCT scan location, an analysis was performed without manipulation (control set), and after the OCT scan of the latest test was intentionally moved inferotemporally (test set). The eyes were classified into the adjustment and nonadjustment groups based on the superior or inferior quadrant RNFL thickness agreement between the control and test sets.

RESULTS

When the OCT GPA parameters between the control and test sets were compared, the test set showed a greater superior RNFL thickness and lesser inferior RNFL thickness compared with the control set (P<0.05). The eyes in the nonadjustment group (n=21, 25%) had a lower chance of applying the eye-tracking function (P=0.003) and a higher frequency of the "R1" registration method of OCT GPA (P<0.001) than the adjustment group (n=63, 75%); all eyes with the "R1" method were in the nonadjustment group and all eyes with the "R2" method were in the adjustment group.

CONCLUSIONS

Inconsistent OCT scan location induced changes in RNFL thickness that were not completely compensated despite the use of OCT GPA, especially when the "R1" registration method was applied. These findings indicates a potential for misidentified glaucoma progression.

Clinical Outcomes of Applying Therapeutic Contact Lenses and Eye Drops after Cataract Surgery

Purpose: To investigate the safety of applying therapeutic contact lenses and eye drops after cataract surgery.Methods: Immediately after cataract surgery, 947 eyes (group 1) used therapeutic contact lenses and eye drops and 914 (group 2) applied antibiotic ointment and wore a gauze eye patch for the first postoperative day. Clinical outcomes including best corrected visual acuity (BCVA), IOP, degree of anterior chamber inflammation, wound leakage, and postoperative endophthalmitis were compared in the two groups 1 day, 1 week, and 1 month after surgery.Results: There were no significant differences in the mean pre- and postoperative BCVA and IOP at 1 day, 1 week, and 1 month between groups 1 and 2. There was no difference in anterior chamber inflammation between the two groups at 1 day (p = 0.302), 1 week (p = 0.437), or 1 month (p = 0.960) after surgery. On the first postoperative day, 10 eyes in group 1 and nine eyes in group 2 had wound leakage (p = 1.000). There was no endophthalmitis in either group.Conclusions: The risk of postoperative complications in group 1 was not higher than in group 2. Therefore, wearing therapeutic contact lenses and using eye drops is a relatively safe management method after cataract surgery.

Surgical Outcomes of the Ahmed Valve Implantation Following Trans-scleral Cyclophotocoagulation

Purpose: To determine the intraocular pressure (IOP) lowering effect and complications of Ahmed valve implantation (AGV) in patients who underwent cyclophotocoagulation (CPC).Methods: Patients who underwent AGV after CPC in group 1, those who underwent CPC after AGV in group 2, and patients who underwent repeated CPC in group 3 were included in this retrospective observational study. Changes in IOP, number of glaucoma eye drops, and best corrected visual acuity (BCVA) were analyzed before and 1 week, 1 month, 3 months, 6 months, and 12 months after surgery, and postoperative complications were analyzed.Results: Eight patients in group 1, 10 patients in group 2, and seven patients in group 3 were included in the analysis. Preoperative IOP was 45.6 ± 15.5, 29.3 ± 5.6, and 43.4 ± 14.4 mmHg in the three groups, respectively, and the number of glaucoma eye drops was 3.8 ± 0.7, 3.9 ± 0.3, and 3.7 ± 1.0 in the three groups, respectively. At 12 months postoperatively, IOP decreased significantly in all three groups compared to preoperatively (all p < 0.05), and the number of glaucoma eye drops was also significantly reduced (all p < 0.05). Among patients with preoperative BCVA of 0.02 decimal or higher, postoperative BCVA decreased in two patients in group 2 and one in group 3 (p = 0.380). Hypotony occurred in one patient in group 1 and two patients in group 3 (p = 0.383), and among them, one patient in group 1 and one patient in group 3 progressed to the phthisis (p = 0.940).Conclusions: In patients whose IOP cannot be controlled after CPC, AGV is expected to be used as a relatively safe and effective treatment method for lowering IOP.

Interocular symmetry of optical coherence tomography parameters in healthy children and adolescents

Evaluation of interocular asymmetry of optical coherence tomography (OCT) parameters is important for the glaucoma and optic neuropathies. This study was performed to evaluate the interocular asymmetry of OCT parameters in healthy children and adolescents. The circumpapillary retinal nerve fiber layer (RNFL) thickness, optic nerve head (ONH) parameters, and macular ganglion cell-inner plexiform layer (GCIPL) thickness were measured in 620 eyes of 310 healthy children and adolescents using Cirrus HD-OCT. The interocular asymmetry (right eye-left eye) in the OCT parameters was analyzed. The mean ± standard deviation age was 10.3 ± 3.7 years (range 5-17). The right eyes showed thinner superior quadrant RNFL, thicker nasal and temporal quadrant RNFL, lesser rim and disc areas, and thinner average, superior, and superonasal GCIPL than the left eyes (P < 0.05). The 2.5th and 97.5th percentile interocular difference tolerance limits were - 9.0 μm and 11.0 μm for average RNFL thickness, - 0.21 and 0.18 for average cup-to-disc ratio, and - 4.0 μm and 4.0 μm for average GCIPL thickness, respectively. Interocular differences were found in RNFL thickness, ONH parameters, and GCIPL thickness in healthy children and adolescents. These findings should be considered when comparing OCT parameters between the right and left eyes.

Can reactogenicity predict immunogenicity after COVID-19 vaccination?

BACKGROUND/AIMS

This study aimed to assess the association between local and systemic reactogenicity and humoral immunogenicity after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination.

METHODS

Adverse events were prospectively evaluated using an electronic diary in 135 healthy adults who received a SARS-CoV-2 vaccine (AZD1222, AstraZeneca/Oxford, n = 42; or BNT162b2, Pfizer/BioNTech, n = 93). We semi-quantitatively measured anti-S1 immunoglobulin G (IgG) using an enzyme-linked immunosorbent assay at baseline, 3 weeks after the first dose of AZD1222 or BNT162b2, and 2 weeks after the second dose of BNT162b2. We evaluated the association between the maximum grade of local or systemic adverse events and the anti-S1 IgG optical density using multivariate linear regression with adjustment for age, sex, and use of antipyretics.

RESULTS

The median age of the 135 vaccinees was 30 years (36 years in the AZD1222 group and 29 years in the BNT162b2 group) and 25.9% were male (9.5% in the AZD1222 group and 33.3% in the BNT162b2 group). Local and systemic adverse events were generally comparable after the first dose of AZD1222 and the second dose of BNT162b2. The grades of local and systemic adverse events were not significantly associated with anti-S1 IgG levels in the AZD1222 or BNT162b2 group.

CONCLUSION

Local and systemic reactogenicity may not be associated with humoral immunogenicity after SARS-CoV-2 vaccination.

Reproducibility of Retinal Nerve Fiber Layer and Macular Ganglion Cell Layer Thickness Measurements by Optical Coherence Tomography in Myopic Eyes

PRECIS

In myopic eyes, reproducibility of circumpapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer thickness measurement by optical coherence tomography (OCT) showed excellent reproducibility except for the temporal quadrant RNFL thickness measurement.

PURPOSE

The aim of this study was to evaluate the long-term reproducibility of circumpapillary RNFL and macular ganglion cell-inner plexiform layer (GCIPL) thickness measurements using OCT in myopic eyes.

METHODS

Sixty-five eyes with moderate-to-high myopia (spherical equivalent <-3.0 D, myopia group) and 53 eyes with low-to-no myopia (spherical equivalent ≥-3.0 D, control group) without ocular disorders, such as glaucoma or retinal diseases, were included. Three serial OCT scans recorded at 1-year intervals were analyzed. Reproducibility was evaluated using within-subject SD (Sw), coefficient of variation (CVw), and intraclass correlation coefficient (ICC).

RESULTS

Mean±SD refractive error was -0.30±0.80 and -6.26±2.45 D for control and myopia groups, respectively. The myopia group had thinner superior, inferior, and nasal quadrant RNFL, thicker temporal quadrant RNFL, and thinner GCIPL than the control group (P<0.05), except for the minimum and superotemporal GCIPL thicknesses (P>0.05). The myopia group had lower reproducibility in temporal quadrant RNFL thickness (Sw, 2.57 μm; CVw 3.27%; ICC, 0.979) than the control group (Sw, 1.80 μm; CVw 2.59%; ICC, 0.989), whereas in other sectors of RNFL and all GCIPL parameters, comparable reproducibility was observed between the 2 groups.

CONCLUSIONS

Long-term reproducibility of RNFL and GCIPL thickness measurements in moderate-to-high myopia was comparable to that of low-to-no myopia, except RNFL thickness in the temporal quadrant. These findings should be considered when detecting RNFL and GCIPL changes.

Deep Learning Ensemble Method for Classifying Glaucoma Stages Using Fundus Photographs and Convolutional Neural Networks

Purpose: This study developed and evaluated a deep learning ensemble method to automatically grade the stages of glaucoma depending on its severity.Materials and Methods: After cross-validation of three glaucoma specialists, the final dataset comprised of 3,460 fundus photographs taken from 2,204 patients were divided into three classes: unaffected controls, early-stage glaucoma, and late-stage glaucoma. The mean deviation value of standard automated perimetry was used to classify the glaucoma cases. We modeled 56 convolutional neural networks (CNN) with different characteristics and developed an ensemble system to derive the best performance by combining several modeling results.Results: The proposed method with an accuracy of 88.1% and an average area under the receiver operating characteristic of 0.975 demonstrates significantly better performance to classify glaucoma stages compared to the best single CNN model that has an accuracy of 85.2% and an average area under the receiver operating characteristic of 0.950. The false negative is the least adjacent misprediction, and it is less in the proposed method than in the best single CNN model.Conclusions: The method of averaging multiple CNN models can better classify glaucoma stages by using fundus photographs than a single CNN model. The ensemble method would be useful as a clinical decision support system in glaucoma screening for primary care because it provides high and stable performance with a relatively small amount of data.

Comparison of the Intraocular Pressure-Lowering Effect and Safety of Preservative-Free And Preservative-Containing Brimonidine/Timolol Fixed-Combination Ophthalmic Solutions in Patients with Open-Angle Glaucoma

Purpose: To compare the therapeutic efficacy and safety of newly developed preservative-free (PF) brimonidine/timolol fixed-combination (BTFC) ophthalmic solutions and a preservative-containing (PC) BTFC ophthalmic solution in patients with open-angle glaucoma.Methods: This study was conducted as a multicenter, randomized, open-label, parallel-group clinical trial to evaluate the efficacy and safety of PF BTFC as compared with PC BTFC in adult patients (aged ≥ 19 years) with open-angle glaucoma (OAG) and ocular hypertension (OHT). A total of the 106 patients were enrolled, with 53 patients each randomized to the two treatment groups and included in the analysis of the safety set (SS).After a washout period, patients with an IOP below 35 mmHg at 9 a.m. were enrolled. After a full ophthalmic and glaucoma examination, a total of 106 OAG and OHT patients were randomized to the PF group or PC group.All subjects were examined 4 and 12 weeks after first administration. At each follow-up visit, IOP was measured at 9 a.m. and 11 a.m. and the efficacy, safety, and compliance were evaluated. Throughout the study, all adverse events were recorded and monitored by the investigators.Results The mean IOP changes from baseline to 12 weeks at 11:00 a.m. were -3.45 ± 2.53 mmHg in the PF group and -3.65 ± 2.76 mmHg in the PC group (p < .0001 for both). The difference in mean IOP change between the two groups was 0.20 ± 2.65 mmHg, which was not significantly different. The proportion of patients with IOP reductions of ≥ 15% and ≥ 20% and IOP at all-time points in the PF group were not significantly different when compared with in the PC group. There were no specific differences between the two groups regarding the incidence of adverse events.Conclusions PF BTFC ophthalmic solution shows a similar efficacy and safety profile to that of PC BTFC.

Effect of baseline test selection on glaucoma progression detection by optical coherence tomography-guided progression analysis

PURPOSE

To evaluate the effect of baseline test selection on progression detection of circumpapillary retinal nerve fibre layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL) in glaucomatous eyes by optical coherence tomography (OCT)-guided progression analysis (GPA).

METHODS

A total of 53 eyes with either RNFL or GCIPL progression determined using OCT-GPA were included. Three different baseline conditions were created by dividing eight serial OCT tests from each eye into three sets. Specifically, these sets presented baseline tests at exams 1-2 (1st set), 2-3 (2nd set) and 3-4 (3rd set), respectively. Agreement on progression detection was defined as the presence of 'Possible Loss' or 'Likely Loss' in the 2nd or 3rd sets at the same location in the 1st set.

RESULTS

The proportion of eyes with agreement on progression detection was 47.1%, 20.0% and 31.0% for RNFL 'thickness map progression', 'thickness profiles progression' and 'average thickness progression', respectively. In GCIPL 'thickness map progression' and 'average thickness progression', 53.8% and 62.8% of eyes showed agreement, respectively. Eyes with disagreement showed a greater change in thickness (slope of change in the 3rd set-1st set) compared to the eyes with agreement (p<0.05), with the exception of RNFL 'thickness profiles progression' (p=0.064).

CONCLUSION

Glaucoma progression detection by OCT-GPA was affected by baseline test selection, especially in eyes with a greater reduction in progression. GCIPL thickness was less influenced by baseline test selection compared to RNFL thickness.

Transforming Growth Factor-β1-induced Human Subconjunctival Fibrosis is Mediated by MicroRNA 143/145 Expression

Purpose

To investigate the roles and pathways of microRNAs 143 and 145 in transforming growth factor (TGF)-β1-induced human subconjunctival fibrosis.

Methods

Human tenon's capsule fibroblasts (HTFs) were obtained from a healthy eye. After treating cultured HTFs with TGF-β1, the expression of microRNAs 143 and 145 was evaluated using polymerase chain reaction. To identify the pathways of TGF-β1-induced microRNA 143/145 expression, HTFs were treated with specific inhibitors of p38MAPK, PI3K/Akt, JNK, ERK, and with siRNAs for SMAD2 and SMAD4. Mutagenesis studies were performed to evaluate the role of the CArG box and SMAD-binding element (SBE). To investigate the role of microRNA 143/145 in TGF-β1-induced myofibroblast transdifferentiation, microRNA 143/145 mimics and microRNA 143/145 inhibitors were applied to the HTFs.

Results

Array analysis revealed that TGF-β1 induced the expression of microRNA 143/145 in a dose- and time-dependent manner. When inhibitors and siRNAs for p38MAPK, PI3K/Akt, ERK, and JNK were applied, the TGF-β1-induced expression of microRNA 143/145 was inhibited; however, SMAD2 and SMAD4 inhibition did not affect the TGF-β1-induced expression of these microRNAs. In the mutagenesis studies, both the CArG box and SBE were associated with TGF-β1-induced expression of microRNA 143/145. Mimics of microRNA 143/145 induced increased myofibroblast formation, whereas their inhibitors had the opposite effect.

Conclusions

TGF-β1-induced human subconjunctival fibrosis was mediated by the expression of microRNA 143/145, mainly via SMAD-independent pathways. Inhibition of TGF-β1-induced microRNA 143/145 expression in HTFs might represent a novel strategy to prevent subconjunctival fibrosis.

Fluid Dynamics of Small Diameter Tubes Used in Membrane-tube Type Glaucoma Shunt Devices

Purpose

To investigate the outflow characteristics of silicone tubes with intraluminal stents used in membrane-tube (MT) type glaucoma shunt devices.

Methods

The silicone tubes used in MicroMT (internal diameter of 100 µm with a 7-0 nylon intraluminal stent) and Finetube MT (internal diameter of 200 µm with a 5-0 nylon intraluminal stent) were connected to a syringe-pump that delivered a continuous flow of distilled water at flow rates of 2, 5, 10, and 25 µL/min. The pressures and resistances of tubes were measured at a steady flow rate with full-length, half-length, and absence of intraluminal stents.

Results

The mean outflow resistance of the two types of tubes ranged from 3.0 ± 1.9 to 3.8 ± 1.7 mmHg/µL/min with a full-length intraluminal stent, 1.8 ± 1.1 to 2.2 ± 1.1 mmHg/µL/min with a half-length intraluminal stent, and 0.1 ± 0.0 to 0.2 ± 0.0 mmHg/µL/min without an intraluminal stent. Theoretically, for a physiologic state with a flow rate of 2 µL/min and episcleral venous pressure of 6 mmHg, the mean pressures of tubes were expected to be 13.2 ± 3.0, 10.5 ± 2.4, and 6.4 ± 0.2 mmHg in MicroMT with full-length, half-length, and absence of intraluminal stents, respectively, and 12.5 ± 3.9, 9.6 ± 2.4, and 6.2 ± 0.2 mmHg in Finetube MT with full-length, half-length, and absence of intraluminal stents, respectively. The pressure variance also decreased with intraluminal stent retraction (p < 0.01).

Conclusions

The small diameter tubes of 100 and 200 µm internal diameters, with 7-0 and 5-0 nylon intraluminal stents, respectively, used in the MT-type glaucoma shunt device showed safe and effective outflow characteristics.

Surgical outcomes of membrane-tube-type glaucoma shunt device in indigenous West Africans

Purpose

The aim of this study was to report the safety and efficacy of the membrane-tube (MT)-type glaucoma shunt device (Finetube MT) in the management of refractory glaucoma in indigenous West Africans.

Methods

The Finetube MT was implanted into 25 eyes of 25 West African patients with refractory glaucoma. These patients had inadequate intraocular pressure (IOP) control despite maximum tolerable IOP-lowering medications with or without previous ocular surgeries. IOP, postoperative complications, interventions, visual acuities, and the number of IOP-lowering medications were analyzed preoperatively and postoperatively.

Results

The mean (standard deviation [SD]) age of the patients was 49.7 (20.9) years. The mean (SD) follow-up duration was 21.0 (10.6) months. Postoperatively, the mean (SD) IOP reduced from a preoperative value of 38.1 (10.3) mmHg to 14.5 (4.6), 16.1 (7.8), and 14.7 (3.0) mmHg at 1, 2, and 3 years postoperatively, respectively, representing 61.9%, 57.7%, and 61.4% reduction from baseline (P<0.01). The mean (SD) number of IOP-lowering medications reduced from 4.1 (1.0) to 0.6 (0.9) at 1 year and 0.9 (1.1) at 2 years after the operation (P<0.01). Using an IOP level between 6 and 21 mmHg and reduced by ≥20% from baseline, the cumulative survival rate (standard error) was 96.0% (3.9%) at 6 months, 89.0% (6.0%) at 18 months, and 81.3% (10.6%) at 3 years after the operation. There was no postoperative ocular hypotony, tube occlusion, or device exposure.

Conclusion

The Finetube MT may effectively control IOP with minimal risk of postoperative complications in indigenous West Africans.

Detection of progression of glaucomatous retinal nerve fibre layer defects using optical coherence tomography-guided progression analysis

PURPOSE

The aim was to investigate the agreement for detection of progression of glaucomatous retinal nerve fibre layer defects (RNFLD) between optical coherence tomography-guided progression analysis (OCT GPA) and conventional red-free fundus photography.

METHODS

Four hundred and fifteen glaucomatous eyes that underwent at least four serial red-free photographic and OCT examinations were included in the study. Based on the inspection of the red-free fundus photographs and GPA maps, RNFLD progression was defined as the development of a new defect, widening or deepening of a pre-existing RNFLD in red-free fundus photography (photographic progression) or 'Likely Loss' on a GPA map (GPA progression). The agreement of photographic and OCT GPA progression and the factors influencing it, including refractive error, severity of glaucoma (mean deviation of the visual field), type of RNFLD (localised versus diffuse), width of the baseline RNFLD, type of RNFLD progression (new defect, widening, deepening) and location of RNFLD progression (clock-hour sector) were assessed.

RESULTS

Among the 415 eyes, 82 (19.8 per cent) showed photographic or GPA progression. Among the 82 eyes with progression, progression was detected only in red-free fundus photography in nine (11.0 per cent) eyes and only in GPA in 32 (39.0 per cent) eyes. In 41 eyes (50.0 per cent), progression was detected with both methods. Detection of RNFLD progression only in GPA was associated with a higher myopia, diffuse RNFLD, deepening of the RNFLD and RNFLD progression at the 6, 9 and 12 o'clock positions (p < 0.05).

CONCLUSIONS

OCT GPA may be a useful supplement to conventional red-free fundus photography for detecting RNFLD progression.

Safety and Efficacy of a Membrane-Tube-Type Glaucoma Shunt Device: An Animal Trial

PURPOSE

To evaluate the safety and efficacy of a membrane-tube-type glaucoma shunt device (MT-device), which was developed to control intraocular pressure (IOP) with a lower chance of complications than conventional glaucoma surgery, in a rabbit model.

MATERIALS AND METHODS

The MT-device consists of an expanded polytetrafluoroethylene membrane (thickness 0.2 mm, area 2.5 × 2.5 mm²) and a tube (internal diameter 76 µm, external diameter 175.5 µm, length 7 mm) attached to the membrane. The device was implanted into the left eyes of nine New Zealand white rabbits. The tube was placed in the anterior chamber through paracentesis, and the membrane was fixated on the scleral surface; this induces aqueous drainage from the anterior chamber to the subconjunctival space. IOP, filtering bleb morphology, depth and inflammation of the anterior chamber, and possible complications were evaluated periodically for 8 weeks after surgery. Histological sections were analyzed at 2 and 8 weeks after the surgery.

RESULTS

Mean IOP decreased from a preoperative value of 8.7 ± 1.2-4.7 ± 0.6 mmHg at postoperative 8 weeks (p < 0.05). The filtering bleb was maintained during the study period. There were no major postoperative complications. Histologic assessment revealed that 2 weeks after the surgery, fibrous encapsulation, inflammatory cells, and fibroblasts were observed around the MT-device; however, 8 weeks after the surgery, minimal inflammation was observed.

CONCLUSIONS

The MT-device showed good biocompatibility and effective IOP reduction with a low risk of complications in a rabbit model.

Membrane-tube-type glaucoma shunt device for refractory glaucoma surgery

PURPOSE

To evaluate the safety and efficacy of a novel membrane-tube (MT)-type glaucoma shunt device for refractory glaucoma surgery. The device consists of an expanded polytetrafluoroethylene membranous reservoir, as well as a silicone tube (300-μm external and 200-μm internal diameter) with an intraluminal stent. We named the device "Finetube MT".

METHODS

The Finetube MT was implanted into 44 glaucomatous eyes that had insufficient intraocular pressure (IOP) control despite medical treatment or previous trabeculectomy. The membranous reservoir was placed underneath the Tenon's capsule, with each end located below the recti muscles; the tube was placed in the anterior chamber through a partial-thickness scleral track. We investigated the baseline and post-operative IOP values, the number of IOP-lowering medications used, and complications.

RESULTS

The mean age of the subjects was 51.6 ± 17.2 years, and the mean follow-up duration was 22.5 ± 12.0 months. One year after the surgery, the mean IOP had decreased from 32.8 ± 12.2 mmHg to 16.9 ± 6.4 mmHg (48.5 % reduction; p < 0.01), and the mean number of IOP-lowering medications used had decreased from 2.5 ± 0.8 to 1.1 ± 0.9 (p < 0.01). We considered the surgery as a success when the IOP was between 6 and 21 mmHg, and had been reduced by ≥ 20 % from baseline; by this standard, the success rate was 92.4 % after 1 year, and 85.0 % after 3 years. Neither postoperative ocular hypotony-related complications nor tube exposure occurred in any case.

CONCLUSIONS

The Finetube MT showed promising surgical outcomes as a treatment for refractory glaucoma, with minimal risk of postoperative ocular hypotony or tube-related complications.

High-resolution electrohydrodynamic inkjet printing of stretchable metal oxide semiconductor transistors with high performance

As demands for high pixel densities and wearable forms of displays increase, high-resolution printing technologies to achieve high performance transistors beyond current amorphous silicon levels and to allow low-temperature solution processability for plastic substrates have been explored as key processes in emerging flexible electronics. This study describes electrohydrodynamic inkjet (e-jet) technology for direct printing of oxide semiconductor thin film transistors (TFTs) with high resolution (minimum line width: 2 μm) and superb performance, including high mobility (∼230 cm² V^-1 s^-1). Logic operations of the amplifier circuits composed of these e-jet-printed metal oxide semiconductor (MOS) TFTs demonstrate their high performance. Printed In₂O TFTs with e-jet printing-assisted high-resolution S/D electrodes were prepared, and the direct printing of passivation layers on these channels enhanced their gate-bias stabilities significantly. Moreover, low process temperatures (<250 °C) enable the use of thin plastic substrates; highly flexible and stretchable TFT arrays have been demonstrated, suggesting promise for next-generation printed electronics.

Etiology and Features of Eyes with Rubeosis Iridis among Korean Patients: A Population-Based Single Center Study

Purpose

To estimate the etiology and features of the eyes with rubeosis iridis among Korean patients.

Materials and Methods

This study is a retrospective review of 533 Korean patients with rubeosis iridis who visited an eye hospital in Seoul, Korea. We defined rubeosis iridis as visible blood vessels on the iris surface detected during a slit-lamp examination. All cases were reviewed for age at the time of diagnosis, medical history, the most likely cause of rubeosis iridis, visual acuity, and intraocular pressure.

Results

The most commonly observed cause of rubeosis iridis was diabetic retinopathy (DR; n = 337, 63.2%), followed by retinal vein occlusion (RVO; n = 101, 18.9%), ocular ischemic syndrome (OIS; n = 24, 4.5%), retinal detachment (n = 17, 3.2%), and uveitis (n = 15, 2.8%). The cause was classified as miscellaneous in 18 cases (3.4%); in 21 eyes (3.9%), the cause was not clear. Age at the time of rubeosis iridis diagnosis was lower in patients with DR (56.5 years) than in those with RVO (61.0 years) and OIS (64.8 years; P < 0.01). Intraocular pressure of the eyes with DR (37.3 mmHg) and RVO (39.5 mmHg) was higher than that of the eyes with OIS (25.8 mmHg; P < 0.01).

Conclusion

In our population-based single center study, DR was the leading cause of rubeosis iridis followed by RVO and OIS among Korean patients. The clinical characteristics of the eyes with rubeosis iridis differed according to etiology. This finding may be useful when assessing eyes with rubeosis iridis.

Effect of Intracranial Atherosclerotic Disease on Endovascular Treatment for Patients with Acute Vertebrobasilar Occlusion

BACKGROUND AND PURPOSE

Although intracranial atherosclerotic disease is often encountered during endovascular treatment for acute vertebrobasilar occlusions, its clinical implication is not well-known. We aimed to evaluate whether intracranial atherosclerotic disease influences the clinical outcomes following endovascular treatment of acute vertebrobasilar occlusive stroke.

MATERIALS AND METHODS

Fifty-one patients with acute vertebrobasilar occlusive stroke were included. The onset-to-groin puncture time was ≤12 hours, and aspiration- or stent-based thrombectomy was used as the primary treatment method. Following primary endovascular treatment, intracranial atherosclerotic disease (IAD group) was angiographically diagnosed when a fixed focal stenosis was observed at the occlusion site, whereas embolism (embolic group) was diagnosed if no stenosis was observed. Clinical and treatment variables were compared in both groups, and IAD was evaluated as a prognostic factor for clinical outcomes.

RESULTS

The baseline NIHSS score tended to be lower (14 versus 22, P = .097) in the IAD group (n = 19) than in the embolic group (n = 32). The procedural time was longer in the IAD group (96 versus 61 minutes, P = .002), despite similar rates of TICI 2b-3 (89.5% versus 87.5%, P = 1.000). The NIHSS score at 7 days was higher (21 versus 8, P = .060) and poor outcomes (mRS 4-6 at 3 months) were more frequent in the IAD group (73.7% versus 43.8%, P = .038). IAD (odds ratio, 5.469; 95% CI, 1.09-27.58; P = .040) was independently associated with poor outcomes.

CONCLUSIONS

An arterial occlusion related to IAD was associated with a longer procedural time and poorer clinical outcome. Further studies are warranted to elucidate the appropriate endovascular strategy.

Novel membrane-tube type glaucoma shunt device for glaucoma surgery

BACKGROUND

The background of this study is to introduce the surgical technique and outcomes of a novel membrane-tube (MT) type glaucoma shunt device (MicroMT), which was developed to achieve safer and more predictable intraocular pressure (IOP) control compared with conventional trabeculectomy.

DESIGN

This is a retrospective, non-comparative, interventional case series study.

PARTICIPANTS

The MicroMT was implanted in 43 glaucomatous eyes with insufficient IOP control despite medical treatment.

METHODS

The MicroMT consists of an expanded polytetrafluoroethylene membrane and a silicone tube with an intraluminal stent, which allows aqueous drainage from the anterior chamber to the lamellar scleral flap. The intraluminal stent prevents excessive aqueous drainage and allows additional IOP reduction through retraction or removal of the stent.

MAIN OUTCOME MEASURES

The main outcome measures of this study are IOP changes and complications.

RESULTS

The mean (SD) IOP decreased from a preoperative value of 22.5 (6.9) mmHg to 11.1 (3.6) mmHg 3 years after the operation (50.7% reduction from baseline; P < 0.01). Intraluminal stent removal 4 weeks after the operation induced an additional 40.2% IOP reduction (P < 0.01). When success was defined as an IOP between 6 and 21 mmHg, and an IOP reduction of ≥20% from baseline, the success rate was 89.5% at 3 years after the operation. No postoperative ocular hypotony (IOP <6 mmHg) or tube-related complications occurred.

CONCLUSIONS

MicroMT implantation is a novel therapy that may reduce IOP safely and effectively, with no apparent risk of postoperative ocular hypotony. Glaucoma surgery using this device may be a good alternative to conventional glaucoma surgery.

Muscle profiling to improve the value of retail meat cuts

Nutrition and meat quality are always important to consumers, but vary by individual muscle or muscle groups in retail meat cuts. Muscle profiling of nutrient content and palatability for all retail beef cuts is necessary to suggest healthy and tasty beef cuts and to inform consumers of the benefits of beef consumption. The current paper reviews numerous studies that provide muscle profiles for nutrients and palatability attributes of muscles or muscle groups in retail beef cuts. The composition of nutrients including protein, fat, moisture, vitamins, and minerals in beef cuts is documented as well as the nutritive role as a part of a healthy diet. In addition, this review presents knowledge in relation to innovative carcass fabrication and value-added cuts to improve the value of beef carcass. Finally, the current work emphasize the palatability assessment of individual beef muscles, and concludes that all retail beef cuts should be merchandised for proper cooking according to the palatability profiles of beef muscles.

Diagnostic ability of macular ganglion cell asymmetry for glaucoma

BACKGROUND

Using spectral-domain optical coherence tomography (OCT), this study aims to investigate the glaucoma diagnostic ability of macular ganglion cell asymmetry analysis.

DESIGN

A cross-sectional study was conducted. This study was performed to investigate glaucoma diagnostic ability of macular ganglion cell asymmetry analysis in eyes with various degrees of glaucoma.

PARTICIPANTS

We enrolled 181 healthy eyes and 265 glaucomatous eyes.

METHODS

Glaucomatous eyes were subdivided into pre-perimetric, early, moderate and advanced-to-severe glaucoma based on visual field test results. For each eye, macular ganglion cell-inner plexiform layer (GCIPL) thickness was measured using OCT. Average GCIPL thickness, GCIPL thicknesses in superior and inferior hemispheres, absolute difference in GCIPL thickness between superior and inferior hemispheres and GCIPL asymmetry index calculated as the absolute value of log10 (inferior hemisphere thickness/superior hemisphere thickness) were analysed.

MAIN OUTCOME MEASURES

Areas under the receiver operating characteristics curves (AUCs) of GCIPL parameter were calculated and compared.

RESULTS

All of the GCIPL parameters showed good glaucoma diagnostic ability (AUCs ≥ 0.817, P < 0.01). AUCs of average, superior and inferior GCIPL thickness increased as the severity of glaucoma increased. GCIPL thickness difference and asymmetry index showed the highest AUCs in early and moderate glaucoma and lower AUCs in pre-perimetric and advanced-to-severe glaucoma. GCIPL thickness difference and asymmetry index showed better glaucoma diagnostic ability than other GCIPL parameters only in early stage of glaucoma (P < 0.05); in other stages, these parameters had similar to or worse glaucoma diagnostic ability than other GCIPL parameters.

CONCLUSIONS

Macular ganglion cell asymmetry analysis showed good glaucoma diagnostic ability, especially in early-stage glaucoma. However, it has limited usefulness in other stages of glaucoma.

Interocular symmetry of retinal nerve fibre layer thickness in healthy eyes: a spectral-domain optical coherence tomographic study

PURPOSE

This study was performed to investigate the interocular symmetry of peripapillary retinal nerve fibre layer (RNFL) thickness, as measured by Cirrus high-definition spectral-domain optical coherence tomography (OCT), in healthy eyes. A wide range of subject ages and refractive errors was examined.

METHODS

The retinal nerve fibre layer thickness was measured in 1,234 healthy eyes from 617 subjects using OCT. Interocular differences (right eye minus left eye) in global area and quadrant nerve fibre layer thicknesses were measured. The effect of age and refractive error on interocular nerve fibre layer thickness difference was also examined.

RESULTS

Means (and standard deviations) of subjects' ages and average subject refractive errors were 36.4 ± 19.8 years (range: five to 80 years) and -2.67 ± 2.91 D (range: -14.13 to +5.75 D), respectively. Cutoff limits for normal interocular nerve fibre layer thickness differences (2.5th and 97.5th percentiles of normative data) in the global area and in the superior, nasal, inferior and temporal quadrants were 9.5, 23.0, 15.6, 20.0 and 22.6 μm, respectively. Mean interocular retinal nerve fibre layer thickness differences in global area and in superior, nasal, inferior and temporal quadrants were 0.7 (p < 0.001), -3.9 (p < 0.001), 2.6 (p < 0.001), 1.1 (p = 0.007) and 3.0 (p < 0.001) μm, respectively. Interocular nerve fibre layer thickness differences were not significantly correlated with age or refractive error (average of right and left eyes, both p > 0.05).

CONCLUSIONS

Significant interocular differences in peripapillary retinal nerve fibre layer thickness exist in healthy eyes, particularly in the superior quadrant. This finding should be considered when comparing retinal nerve fibre layer thickness between right and left eyes.

Novel screening method for glaucomatous eyes with myopic tilted discs: the crescent moon sign

IMPORTANCE

To our knowledge, there is no reliable screening method for glaucomatous eyes with myopic tilted discs.

OBJECTIVE

To evaluate the diagnostic ability of a novel screening modality, the crescent moon (CM) sign, defined as the discontinuity between the superior or inferior optic rim margin and the temporal optic rim margin, for the detection of glaucomatous eyes with myopic tilted discs.

DESIGN, SETTING, AND PARTICIPANTS

The study was cross-sectional and conducted in a hospital setting from November 1, 2011, to November 1, 2013. Seventy eyes of 70 individuals with early open-angle glaucoma (mean deviation greater than -6 dB) and 70 eyes of 70 normal control participants who had myopic tilted discs were recruited. Another independent group consisting of 60 eyes of 60 individuals with early glaucoma and 60 eyes of 60 normal control participants was enrolled. Two masked glaucoma specialists independently assessed the optic disc on stereoscopic disc photography. The diagnostic performance of the CM sign was evaluated in comparison with violation of the ISNT rule (inferior ≥ superior ≥ nasal ≥ temporal order of configuration for disc rim thickness in normal eyes) and the modified ISNT rule (application of the ISNT rule based on the long axis of the disc).

MAIN OUTCOMES AND MEASURES

Sensitivity and specificity of the CM sign.

RESULTS

The CM sign was more frequently observed in the inferotemporal optic rim margin than in the superotemporal optic rim margin. In a comparative evaluation of the glaucoma diagnostic sensitivity and specificity, the CM sign showed higher sensitivities (90.0%-91.4%) than the ISNT rule (73.3%-75.7%) or the modified ISNT rule (68.6%-70.0%). The CM sign also showed higher specificities (82.9%-83.3%) than the ISNT rule (68.3%-71.4%) or the modified ISNT rule (76.6%-80.0%). Furthermore, the CM sign was shown to be associated with the occurrence of visual field defects in the corresponding hemifield (P < .001).

CONCLUSIONS AND RELEVANCE

The CM sign can be a useful screening tool for the detection of early glaucoma with myopic tilted discs.