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Gardiner SK, Cull G, Fortune B. Vascular resistance indices are higher in the superior than inferior optic nerve head and retina. Exp Eye Res 2024; 248:110070. [PMID: 39243927 DOI: 10.1016/j.exer.2024.110070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 08/19/2024] [Accepted: 09/03/2024] [Indexed: 09/09/2024]
Abstract
Retinal vascular resistance is of interest in glaucoma research, as a potential link between retinal ganglion cell loss and observed phenomena including disrupted vascular autoregulation, altered biomechanical stiffness, and impaired neurovascular coupling. It can now be assessed in vivo, using laser speckle flowgraphy. However, continued progress in the field requires better understanding of its physiology. In this study, we test the hypothesis of homogeneity of vascular resistance indices between regions of the retina: specifically, between superior and inferior hemifields. The resistivity index (maximum flow minus minimum flow, as a proportion of the maximum) and pulsatility index (maximum minus minimum, as a proportion of the mean) were measured in major vessels within the optic nerve head, in the remaining tissue within the optic nerve head, and in peripapillary branch retinal arteries, separated in each case into superior and inferior quadrants. This was performed in 378 eyes of 189 participants with suspected, early or moderate glaucoma; and in 99 eyes of 50 participants without any ocular pathology. In the glaucoma cohort, the resistivity index was on average 9% higher superiorly than inferiorly in vessels within the optic nerve head; 8% higher superiorly in remaining tissue; and 8% higher superiorly in peripapillary vessels (all p < 0.001). The pulsatility index was on average 11% higher superiorly in all three locations (all p < 0.001). Average flow was slightly higher superiorly in major vessels in the nerve head, but higher inferiorly elsewhere. In the healthy control cohort, resistivity index was higher superiorly by 10% in vessels and 8% in tissue within the optic nerve head; pulsatility index was 12% and 10% higher superiorly respectively (all p < 0.001). The fact that these differences were similar between the two cohorts suggests that they are not caused by the disease process. However, it is notable that glaucomatous loss most frequently occurs first in the superior visual field, corresponding with the inferior retina. The finding that vascular resistance indices are consistently higher in the superior retina warrants further investigation, both for its causes and consequences.
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Affiliation(s)
- Stuart K Gardiner
- Devers Eye Institute, Legacy Health, 1225 NE 2nd Ave, Portland, OR, 97232, USA.
| | - Grant Cull
- Devers Eye Institute, Legacy Health, 1225 NE 2nd Ave, Portland, OR, 97232, USA
| | - Brad Fortune
- Devers Eye Institute, Legacy Health, 1225 NE 2nd Ave, Portland, OR, 97232, USA
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Tolosa-Tort C, Poza-Martin E, Garcia-Feijoo J, Mendez-Hernandez C. Study of the impact of the vascular systemic risk factors on peripapillary vascular density by optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06576-w. [PMID: 38990331 DOI: 10.1007/s00417-024-06576-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 06/17/2024] [Accepted: 07/04/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND The focus of therapeutic tools in glaucoma has been mainly to control of intraocular pressure. Recently there has been a growing interest in investigating the relationship of vascular risk factors in the development of glaucoma. The aim of this study was to assess the association between systemic arterial hypertension, diabetes mellitus and hypercholesterolemia, and peripapillary vascularization measured by Optical Coherence Tomography Angiography (OCTA) in glaucoma and healthy subjects. METHODS In this unicenter, observational, cross-sectional study, 212 subjects, 118 glaucoma patients and 94 controls were consecutively recruited. Of these, 86 participants were excluded due to poor OCTA image quality. Therefore, 146 subjects were included in the final analysis, 74 glaucoma patients and 72 controls. Using a linear regression model, with 95% confidence and 80% statistical power, the effect of vascular risk factors on OCTA parameters in the 146 subjects included in the final analysis was studied. RESULTS No significant impact of vascular risk factors on OCTA measurements was found. Diabetic patients tended to show a lower peripapillary perfusion vascular density than subjects without diabetes (β 0.016, 95%CI 0.003;0.030, p 0.016). Similarly, hypercholesterolemia patients appeared to show less peripapillary flow index than non-hypercholesterolaemic patients (β 0.029, 95%CI 0.013;0.046, p 0.001). Glaucoma patients had 0.02% lower peripapillary perfusion vascular density (β 0.020, 95% CI 0.011;0.029, p < 0.001), 0.04% lower peripapillary flow index (β 0.036, 95%CI 0.022;0.051, p < 0.001) and 9.62% thinner retinal nerve fibre layer (β 9.619, 95%CI 5.495;13.744, p < 0.001). CONCLUSIONS In conclusion glaucoma has greater effect on peripapillary vascular density parameters than any of the vascular risk factors analyzed. KEY MESSAGES What is known: • Vascular disfunction plays an important role in the development of glaucoma. • Optical coherence tomography angiography makes it possible to assess the retinal microvasculature and the role that its alterations could have in the development of glaucoma. WHAT IS NEW • Decrease of the peripapillary microcirculation seems to be more related to the increase in intraocular pressure and the glaucoma itself than to the presence of cardiovascular risk factors. • The effect of having diabetes, systemic arterial hypertension or hypercholesterolaemia on vascular parameters or nerve fibre layer thickness was low. • There was also no relevant impact of the systemic medication used for these diseases on the peripapillary vascular parameters studied or on nerve fibre layer thickness.
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Affiliation(s)
- Cristina Tolosa-Tort
- Department of Immunology, Ophthalmology and ORL. IIORC, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
| | - Emma Poza-Martin
- Department of Immunology, Ophthalmology and ORL. IIORC, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
| | - Julian Garcia-Feijoo
- Department of Immunology, Ophthalmology and ORL. IIORC, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
- Glaucoma Service, Department of Ophthalmology, Hospital Clinico San Carlos, Madrid, Spain
- Department of Immunology, Ophthalmology and ORL. IIORC, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Carmen Mendez-Hernandez
- Department of Immunology, Ophthalmology and ORL. IIORC, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain.
- Glaucoma Service, Department of Ophthalmology, Hospital Clinico San Carlos, Madrid, Spain.
- Department of Immunology, Ophthalmology and ORL. IIORC, School of Medicine, Complutense University of Madrid, Madrid, Spain.
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Valmaggia P, Cattin PC, Sandkühler R, Inglin N, Otto TP, Aumann S, Teussink MM, Spaide RF, Scholl HPN, Maloca PM. Time-Resolved Dynamic Optical Coherence Tomography for Retinal Blood Flow Analysis. Invest Ophthalmol Vis Sci 2024; 65:9. [PMID: 38837167 PMCID: PMC11160951 DOI: 10.1167/iovs.65.6.9] [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: 11/01/2023] [Accepted: 05/16/2024] [Indexed: 06/06/2024] Open
Abstract
Purpose Optical coherence tomography (OCT) representations in clinical practice are static and do not allow for a dynamic visualization and quantification of blood flow. This study aims to present a method to analyze retinal blood flow dynamics using time-resolved structural OCT. Methods We developed novel imaging protocols to acquire video-rate time-resolved OCT B-scans (1024 × 496 pixels, 10 degrees field of view) at four different sensor integration times (integration time of 44.8 µs at a nominal A-scan rate of 20 kHz, 22.4 µs at 40 kHz, 11.2 µs at 85 kHz, and 7.24 µs at 125 kHz). The vessel centers were manually annotated for each B-scan and surrounding subvolumes were extracted. We used a velocity model based on signal-to-noise ratio (SNR) drops due to fringe washout to calculate blood flow velocity profiles in vessels within five optic disc diameters of the optic disc rim. Results Time-resolved dynamic structural OCT revealed pulsatile SNR changes in the analyzed vessels and allowed the calculation of potential blood flow velocities at all integration times. Fringe washout was stronger in acquisitions with longer integration times; however, the ratio of the average SNR to the peak SNR inside the vessel was similar across all integration times. Conclusions We demonstrated the feasibility of estimating blood flow profiles based on fringe washout analysis, showing pulsatile dynamics in vessels close to the optic nerve head using structural OCT. Time-resolved dynamic OCT has the potential to uncover valuable blood flow information in clinical settings.
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Affiliation(s)
- Philippe Valmaggia
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Philippe C. Cattin
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Robin Sandkühler
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Nadja Inglin
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Basel, Switzerland
| | | | - Silke Aumann
- Heidelberg Engineering GmbH, Heidelberg, Germany
| | | | - Richard F. Spaide
- Vitreous Retina Macula Consultants of New York, New York, United States
| | - Hendrik P. N. Scholl
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Peter M. Maloca
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
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Tailor PD, Aul BJ, Sit AJ, Fautsch MP, Chen JJ. Determination of the Trans-Lamina Cribrosa Pressure Difference in a Community-Based Population and its Association with Open-Angle Glaucoma. Ophthalmol Glaucoma 2024; 7:168-176. [PMID: 37783273 PMCID: PMC10960720 DOI: 10.1016/j.ogla.2023.09.002] [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: 07/28/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To determine the trans-lamina cribrosa pressure difference (TLCPD) in a cohort of normal community-based patients and the relationship to primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG). DESIGN Retrospective cohort study of the Mayo Clinic Study of Aging. PARTICIPANTS The Mayo Clinic Study of Aging is a prospective study evaluating the normal aging population. METHODS Mayo Clinic Study of Aging patients who underwent routine lumbar puncture (LP) studies with eye examinations were reviewed. The trans-lamina cribrosa pressure difference was calculated in 2 contexts of intraocular pressure (IOP): (1) maximum IOP at eye visit closest in time to the LP (closest-in-time TLCPD); and (2) IOP before IOP-lowering treatment (pretreatment IOP and pretreatment TLCPD) in POAG and NTG patients. Glaucoma patients without POAG or NTG were excluded. Regression analyses were performed to determine the relationship with glaucoma. MAIN OUTCOME MEASURES IOP, intracranial pressure, TLCPD, POAG, normal-tension glaucoma (NTG) diagnosis, glaucoma parameters. RESULTS Five hundred forty-eight patients were analyzed. Of these, there were 38 treated glaucoma patients (14 POAG and 24 NTG) and 510 nonglaucomatous patients. Cerebral spinal fluid (CSF) opening pressure was 155.0 ± 42.2 mmH2O in nonglaucomatous patients, 144.0 ± 34.0 mmH2O in POAG (P = 0.15 vs. nonglaucomatous patients), and 136.6 ± 29.3 mmH2O in NTG (P = 0.017 vs. nonglaucomatous patients). Intraocular pressure was 15.47 ± 2.9 mmHg in nonglaucomatous patients, 26.6 ± 3.7 mmHg in POAG, and 17.4 ± 3.4 mmHg in NTG. The closest-in-time TLCPD in the nonglaucomatous cohort was 4.07 ± 4.22 mmHg, which was lower than both the POAG cohort (7.19 ± 3.6 mmHg) and the NTG cohort (5.79 ± 4.5 mmHg, P = 0.04). Pretreatment TLCPD for the overall glaucoma cohort was 10.57 ± 6.1 mmHg. The POAG cohort had a higher pretreatment TLCPD (16.05 ± 5.2 mmHg) than the NTG cohort (7.37 ± 4.1 mmHg; P < 0.0001). Closest-in-time TLCPD for the nonglaucoma cohort (4.07± 4.2 mmHg) was significantly lower than pretreatment TLCPDs for both POAG (16.05 ± 5.2 mmHg; P < 0.0001) and NTG (7.37 ± 4.1 mmHg; P < 0.0001) cohorts. CONCLUSIONS This study establishes the baseline TLCPD in a large cohort of normal, community-based patients. The differences in regression analysis between TLCPD and IOP suggests NTG pathophysiology is partially driven by TLCPD, but is also likely multifactorial. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
| | - Bryce J Aul
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Arthur J Sit
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | | | - John J Chen
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota; Department of Neurology, Mayo Clinic, Rochester, Minnesota.
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Boccaccini A, Cavaterra D, Carnevale C, Tanga L, Marini S, Bocedi A, Lacal PM, Manni G, Graziani G, Sbardella D, Tundo GR. Novel frontiers in neuroprotective therapies in glaucoma: Molecular and clinical aspects. Mol Aspects Med 2023; 94:101225. [PMID: 38000334 DOI: 10.1016/j.mam.2023.101225] [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: 07/28/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
In the last years, neuroprotective therapies have attracted the researcher interests as modern and challenging approach for the treatment of neurodegenerative diseases, aimed at protecting the nervous system from injuries. Glaucoma is a neurodegenerative disease characterized by progressive excavation of the optic nerve head, retinal axonal injury and corresponding vision loss that affects millions of people on a global scale. The molecular basis of the pathology is largely uncharacterized yet, and the therapeutic approaches available do not change the natural course of the disease. Therefore, in accordance with the therapeutic regimens proposed for other neurodegenerative diseases, a modern strategy to treat glaucoma includes prescription of drugs with neuroprotective activities. With respect to this, several preclinical and clinical investigations on a plethora of different drugs are currently ongoing. In this review, first, the conceptualization of the rationale for the adoption of neuroprotective strategies for retina is summarized. Second, the molecular aspects highlighting glaucoma as a neurodegenerative disease are reported. In conclusion, the molecular and pharmacological properties of most promising direct neuroprotective drugs used to delay glaucoma progression are examined, including: neurotrophic factors, NMDA receptor antagonists, the α2-adrenergic agonist, brimonidine, calcium channel blockers, antioxidant agents, nicotinamide and statins.
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Affiliation(s)
| | - Dario Cavaterra
- Dipartimento di Scienze e Tecnologie Chimiche, Università di Tor Vergata, Via Della Ricerca Scientifica 1, 00133, Rome, Italy
| | | | | | - Stefano Marini
- Dipartimento di Scienze Cliniche e Medicina Traslazionale, Università di Roma Tor Vergata, Via Montpellier n. 1, 00133, Roma, Italy
| | - Alessio Bocedi
- Dipartimento di Scienze e Tecnologie Chimiche, Università di Tor Vergata, Via Della Ricerca Scientifica 1, 00133, Rome, Italy
| | - Pedro M Lacal
- Laboratory of Molecular Oncology, IDI-IRCCS, Via Monti di Creta 104, 00167, Rome, Italy
| | - Gianluca Manni
- IRCCS - Fondazione Bietti, Rome, Italy; Dipartimento di Scienze Cliniche e Medicina Traslazionale, Università di Roma Tor Vergata, Via Montpellier n. 1, 00133, Roma, Italy
| | - Grazia Graziani
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy
| | | | - Grazia Raffaella Tundo
- Dipartimento di Scienze Cliniche e Medicina Traslazionale, Università di Roma Tor Vergata, Via Montpellier n. 1, 00133, Roma, Italy.
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Garrison SR, Youngson E, Perry DA, Campbell FN, Kolber MR, Korownyk C, Allan GM, Green L, Bakal J. Bedtime versus morning use of antihypertensives in frail continuing care residents (BedMed-Frail): protocol for a prospective, randomised, open-label, blinded end-point pragmatic trial. BMJ Open 2023; 13:e074777. [PMID: 37527898 PMCID: PMC10394547 DOI: 10.1136/bmjopen-2023-074777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION BedMed-Frail explores risks and benefits of switching antihypertensives from morning to bedtime in a frail population at greater risk of hypotensive adverse effects. METHODS AND ANALYSIS Design: Prospective parallel randomised, open-label, blinded end-point trial.Participants: Hypertensive continuing care residents, in either long-term care or supportive living, who are free from glaucoma, and using ≥1 once daily antihypertensive.Setting: 16 volunteer continuing care facilities in Alberta, Canada, with eligible residents identified using electronic health claims data.Intervention: All non-opted out eligible residents are randomised centrally by the provincial health data steward to bedtime versus usual care (typically morning) administration of once daily antihypertensives. Timing changes are made (maximum one change per week) by usual care facility pharmacists.Follow-up: Via linked governmental healthcare databases tracking hospital, continuing care and community medical services.Primary outcome: Composite of all-cause death, or hospitalisation for myocardial infarction/acute-coronary syndrome, stroke, or congestive heart failure.Secondary outcomes: Each primary outcome element on its own, all-cause unplanned hospitalisation or emergency department visit, non-vertebral fracture and, as assessed roughly 135 days postrandomisation, fall in the last 30 days, deteriorated cognition, urinary incontinence, decubitus skin ulceration, inappropriate or disruptive behaviour a minimum of 4 days per week, and receipt of antipsychotic medication or physical restraints in the last 7 days.Process outcome: Proportion of blood pressure medication doses taken at bedtime (broken down monthly).Primary outcome analysis: Cox-Proportional Hazards Survival Analysis.Sample size: The trial will continue until a projected 368 primary outcome events have occurred.Current status: Enrolment is ongoing with 642 randomisations to date (75% female, mean age 88 years). ETHICS AND DISSEMINATION BedMed-Frail has ethical approval from the University of Alberta Health Ethics Review Board (Pro00086129) and will publish results in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04054648.
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Affiliation(s)
- Scott R Garrison
- Family Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Pragmatic Trials Collaborative, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Erik Youngson
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Danielle A Perry
- Pragmatic Trials Collaborative, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Programs and Practice Support, College of Family Physicians of Canada, Mississauga, Alberta, Canada
| | - Farah N Campbell
- Pragmatic Trials Collaborative, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Michael R Kolber
- Family Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Pragmatic Trials Collaborative, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Christina Korownyk
- Family Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Pragmatic Trials Collaborative, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Gary Michael Allan
- Pragmatic Trials Collaborative, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Programs and Practice Support, College of Family Physicians of Canada, Mississauga, Alberta, Canada
| | - Lee Green
- Family Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Pragmatic Trials Collaborative, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Jeffrey Bakal
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
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Almeida INF, Taniguchi E, Tito CVA, Dias DT, Ushida M, Dorairaj S, Ritch R, Teixeira SH, Paranhos A, Gracitelli CPB, Kayser C, Prata TS. Vascular parameters and endothelin-1 measurements in glaucoma patients with low- and high-tension optic disc hemorrhages. Sci Rep 2023; 13:5023. [PMID: 36977700 PMCID: PMC10050085 DOI: 10.1038/s41598-023-31682-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
This prospective study aimed to compare vascular parameters (endothelin-1 [ET-1] blood levels, laser Doppler imaging [LDI] of distal phalanxes, and nailfold capillaroscopy) between open-angle glaucoma patients with low- and high-tension optic disc hemorrhages (LTDH and HTDH, respectively). The 33 enrolled patients (mean age, 62.3 ± 13 years) were classified as LTDH or HTDH if they presented at the time of DH detection an intraocular pressure (IOP) < 16 mmHg or ≥ 16 mmHg, respectively. Demographic and ophthalmological data, ET-1 concentrations, LDI (before and 1, 10, and 20 min after cold stimulation), and nailfold capillaroscopy findings were evaluated. The ET-1 blood level was 65% higher in the LTDH (2.27 ± 1.46 pg/ml) than in the HTDH (1.37 ± 0.57 pg/ml; p = 0.03) group. Moreover, there was a statistically significant negative correlation between ET-1 blood concentration and IOP at the time of DH detection (r = -0.45, p = 0.02). Blood flow measurements 10 and 20 min after cold stimulation were lower in the LTDH group than in the HTDH group (p < 0.01). Patients developing DH with lower IOPs have higher ET-1 blood levels and more peripheral vascular dysfunction as estimated by LDI than those with higher IOPs. These findings suggest that distinct underlying mechanisms may be involved in patients developing DH within different IOP ranges.
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Affiliation(s)
- Izabela N F Almeida
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil
| | - Elise Taniguchi
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil
| | | | - Diego Torres Dias
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, SP, Brazil
| | - Michele Ushida
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, SP, Brazil
| | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, USA
| | - Sérgio H Teixeira
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil
| | - Carolina P B Gracitelli
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil
- Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, Vinhedo, São Paulo, Brazil
| | - Cristiane Kayser
- Rheumatology Division, Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Tiago Santos Prata
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil.
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, SP, Brazil.
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA.
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Tufek M, Nalcacioglu P, Capraz M, Varol K, Kaya AT, Aydın N, Kara C. The impact of obesity on ocular hemodynamics and choroidal thickness. Ther Adv Ophthalmol 2023; 15:25158414231180985. [PMID: 37441618 PMCID: PMC10333989 DOI: 10.1177/25158414231180985] [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: 09/11/2022] [Accepted: 05/22/2023] [Indexed: 07/15/2023] Open
Abstract
Background Obesity affects microvascular structures. The effect of obesity on the ocular vascular system can be evaluated by changes in the choroidal thickness (CT) and retrobulbar blood flow (RBF). Objectives To evaluate the CT and RBF parameters in obese patients with various body mass index (BMI) values and compare these parameters with normal weight, healthy subjects. Design A prospective study. Methods The study included 102 eyes of 102 female patients. Patients were divided into three groups according to BMI as group 1 with a BMI of 18.5-24.99 (n = 32), normal weight group; group 2 with a BMI of 30-34.99 (n = 35), as obese class I; and group 3 with a BMI of 35-39.99 (n = 35), as obese class II. The peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index, and pulsatility index values of the central retinal artery (CRA) and ophthalmic artery (OA) were evaluated with color Doppler ultrasonography. CT was measured at the subfoveal area and at 500-µm intervals nasal and temporal to the fovea up to a distance of 1500 µm by using the enhanced depth imaging technique of optical coherence tomography. Intraocular pressure (IOP) was measured with a Goldmann applanation tonometry. Results There was a significant difference in IOP values within the groups with the highest values in group 3 (17.6 ± 2.1 mmHg) and the lowest in group 1 (12.4 ± 1.7 mmHg). The CT in groups 2 and 3 was found to be statistically significantly lower than that in group 1 at all measurement points (p < 0.001). There was a statistically significant negative correlation between CT at all measurement points and BMI (p < 0.001). The mean CRA PSV, EDV, and OA EDV values were statistically significantly lower in each obese group than those values in group 1 (p < 0.001). The OA PSV values were significantly lower in group 3 (36.5 ± 5.9 cm/s) than those in group 2 (43.8 ± 4 cm/s) and group 1 (44.6 ± 5.2 cm/s) (p < 0.001). Also, significant associations were found between BMI and CRA PSV, CRA EDV, and OA PSV values (p < 0.001). Conclusion Obesity may predispose to eye pathologies by changing the ocular vascular circulation.
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Affiliation(s)
| | - Pinar Nalcacioglu
- Department of Ophthalmology, Yildirim Beyazit
University Medical School, Ankara, Turkey
| | - Mustafa Capraz
- Department of Internal Medicine, Amasya
University, Sabuncuoglu Serafeddin Training and Research Hospital, Amasya,
Turkey
| | - Kenan Varol
- Department of Radiology, Private Rumeli
Hospital, Istanbul, Turkey
| | - Ahmet Turan Kaya
- Department of Radiology, Amasya University,
Sabuncuoglu Serafeddin Training and Research Hospital, Amasya, Turkey
| | - Nihat Aydın
- Department of Ophthalmology, Amasya University,
Sabuncuoglu Serafeddin Training and Research Hospital, Amasya, Turkey
| | - Caner Kara
- Department of Ophthalmology, Zubeyde Hanim
Women’s Education and Research Hospital, Ankara, Turkey
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9
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Ye D, Xu Y, Shi Y, Fan M, Lu P, Bai X, Feng Y, Hu C, Cui K, Tang X, Liao J, Huang W, Xu F, Liang X, Huang J. Anti-PANoptosis is involved in neuroprotective effects of melatonin in acute ocular hypertension model. J Pineal Res 2022; 73:e12828. [PMID: 36031799 DOI: 10.1111/jpi.12828] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/12/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
Acute ocular hypertension (AOH) is the most important characteristic of acute glaucoma, which can lead to retinal ganglion cell (RGC) death and permanent vision loss. So far, approved effective therapy is still lacking in acute glaucoma. PANoptosis (pyroptosis, apoptosis, and necroptosis), which consists of three key modes of programmed cell death-apoptosis, necroptosis, and pyroptosis-may contribute to AOH-induced RGC death. Previous studies have demonstrated that melatonin (N-acetyl-5-methoxytryptamine) exerts a neuroprotective effect in many retinal degenerative diseases. However, whether melatonin is anti-PANoptotic and neuroprotective in the progression of acute glaucoma remains unclear. Thus, this study aimed to explore the role of melatonin in AOH retinas and its underlying mechanisms. The results showed that melatonin treatment attenuated the loss of ganglion cell complex thickness, retinal nerve fiber layer thickness, and RGC after AOH injury, and improved the amplitudes of a-wave, b-wave, and oscillatory potentials in the electroretinogram. Additionally, the number of terminal deoxynucleotidyl transferase dUTP nick-end labeling-positive cells was decreased, and the upregulation of cleaved caspase-8, cleaved caspase-3, Bax, and Bad and downregulation of Bcl-2 and p-Bad were inhibited after melatonin administration. Meanwhile, both the expression and activation of MLKL, RIP1, and RIP3, along with the number of PI-positive cells, were reduced in melatonin-treated mice, and p-RIP3 was in both RGC and microglia/macrophage after AOH injury. Furthermore, melatonin reduced the expression of NLRP3, ASC, cleaved caspase-1, gasdermin D (GSDMD), and cleaved GSDMD, and decreased the number of Iba1/interleukin-1β-positive cells. In conclusion, melatonin ameliorated retinal structure, prevented retinal dysfunction after AOH, and exerted a neuroprotective effect via inhibition of PANoptosis in AOH retinas.
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Affiliation(s)
- Dan Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Yue Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Yuxun Shi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Matthew Fan
- Yale College, Yale University, New Haven, Connecticut, USA
| | - Peng Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xue Bai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Yanlin Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Chenyang Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Kaixuan Cui
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xiaoyu Tang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Jing Liao
- Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, China
| | - Wei Huang
- Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, China
| | - Fan Xu
- Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, China
| | - Xiaoling Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Jingjing Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
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Lotfy A, Mattout HK, Fouda SM, Hemeda S. Correlation between radial peripapillary vascular density and reduced central corneal thickness in glaucoma suspect patients. BMC Ophthalmol 2022; 22:414. [PMID: 36316681 PMCID: PMC9620628 DOI: 10.1186/s12886-022-02628-z] [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: 04/12/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 11/27/2022] Open
Abstract
Background Optical coherence tomography (OCT) angiography (OCTA) provides a quantitative assessment of the microcirculation of the retina and choroid. It may precede the retinal nerve layer (RNFL) and optic disc head defects. Retinal nerve fiber layer defects and reduced central corneal thickness (CCT) are important parameters in the assessment of a glaucoma suspect patients. The aim of this study is to investigate any possible relationship between the reduced central corneal thickness and the radial peripapillary capillary (RPC) density defect in glaucoma suspect. Methods In this cross sectional study, 92 eyes were incorporated. Peripapillary OCT angiography (4.5 mm) and Anterior segment OCT for corneal pachymetry were done. C/D Ratio, thickness of nerve fiber layer, the blood flow indices and central corneal thickness also were evaluated. Results In eyes of glaucoma suspect patients; a significant positive correlation between CCT and total RPC density was detected (r = 0.38, P < 0.001). A strong positive correlation was also found between total RPC and peripapillary RNFL thickness (r = 0.55, P < 0.001). Conclusion Reduced central corneal thickness and peripapillary capillary density are two screening parameters for glaucoma suspect patients. The radial peripapillary capillary density is a valid diagnostic tool for glaucoma. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02628-z.
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Affiliation(s)
- Ayman Lotfy
- grid.31451.320000 0001 2158 2757Zagazig University, Zagazig, Egypt
| | | | | | - Sahar Hemeda
- grid.31451.320000 0001 2158 2757Zagazig University, Zagazig, Egypt
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11
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Chen X, Zhao Y, You S, Xia Q, Mo X, Yuan F. 7,8-Dihydroxyflavone Simultaneously Provides Neuroprotection of Retinal Explants and Proangiogenesis of Human Umbilical Vein Endothelial Cells via the Tropomyosin-Related Kinase Receptor B Signaling Pathway In Vitro. J Ocul Pharmacol Ther 2022; 38:635-644. [PMID: 36260383 DOI: 10.1089/jop.2022.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: This study aimed to investigate the simultaneous neuroprotective and proangiogenic effects of 7,8-dihydroxyflavone (7,8-DHF) and explore the potential underlying molecular mechanisms. Methods: A coculture system of rat retinal explants and human umbilical vein endothelial cells (HUVECs) was established to determine the optimal concentration of 7,8-DHF, promoting neurite regeneration and HUVEC proliferation. Subsequently, the neuroprotective effect, proangiogenesis properties, and action mechanism of 7,8-DHF at an optimal concentration were investigated. Results: The cell proliferation, survival, migration, tube formation and p-tropomyosin-related kinase receptor B (TrkB)/TrkB levels in HUVECs were significantly promoted by 5 μM 7,8-DHF. The ganglion cell layer neuron survival, neurite regeneration, and p-TrkB/TrkB levels in retinal explants were also significantly promoted by 5 μM 7,8-DHF. All of these pharmacological actions of 7,8-DHF were blocked by N-[2-[(2-oxoazepan-3-yl)carbamoyl]phenyl]-1-benzothiophene-2-carboxamide. Conclusions: 7,8-DHF yields neuroprotection of retinal explants and proangiogenesis of HUVECs through the TrkB signaling pathway in vitro.
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Affiliation(s)
- Xiangwu Chen
- Department of Ophthalmology, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Yingxi Zhao
- Department of Ophthalmology, Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shuqi You
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Qing Xia
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Xiaofen Mo
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Fei Yuan
- Department of Ophthalmology, Zhongshan Hospital of Fudan University, Shanghai, China
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12
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Taurine protects R28 cells from hypoxia/re-oxygenation-induced damage via regulation of mitochondrial energy metabolism. Amino Acids 2022; 54:1585-1599. [PMID: 36056163 DOI: 10.1007/s00726-022-03199-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 08/11/2022] [Indexed: 11/26/2022]
Abstract
Oxidative-induced damage and hypoxia/re-oxygenation (H/R) injury are common causes of irreversible visual impairment. The goals of this study were to explore the effects of taurine on R28 cells under the two damage models and the underlying mechanisms. Low doses of taurine supplementation promoted cell viability, mitochondrial membrane potential (MMP), SOD levels, ATP contents and attenuated cytotoxicity and intracellular ROS generation of the R28 cells under the two kinds of damage. The expression level of GTPBP3, a mitochondrial-tRNA (mt-tRNA) modification enzyme that catalyzes the taurine involved modification, was decreased under the two damage and taurine could reverse the reduction. After knocking down GTPBP3, the R28 cells become vulnerable to damage. The viability, cytotoxicity, MMP and intracellular ROS level of knockdown cells changed more obviously under the H/R injury than those of control cell. We also found that knockdown of GTPBP3 significantly decreased mitochondrial energy metabolism by measuring the oxidative respiration rate by the Seahorse XFe24 extracellular flux analyzer. The protection of low doses of taurine disappeared on knockdown R28 cells, indicating that GTPBP3 is crucial in the protection mechanisms of taurine. However, the impacts of the reduction of GTPBP3 level can be reversed by relatively high doses of taurine, implying the protection effects of taurine were dose-dependent, and there were more complicated mechanisms remain to be explored. This study explored a new mechanism of the neuroprotective effects of taurine, which depend on the GTPBP3-mediated taurine modification of mt-tRNAs and the promotion of mitochondrial energy metabolism.
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Gonzalez de la Rosa M, de-la-Huerga-Moreno S, Alfonso-Lopez F, Cabrera-Lopez F, Pareja-Rios A, Gonzalez-Hernandez D, Gonzalez-Hernandez M. Comparison of age-related vascular changes in the optic disc of patients with diabetes, with glaucomatous and non-glaucomatous features. BMJ Open Ophthalmol 2022; 7:bmjophth-2022-001100. [PMID: 36161853 PMCID: PMC9389122 DOI: 10.1136/bmjophth-2022-001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/05/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To identify age-related vascular changes in the optic discs of patients with diabetes with and without signs of glaucoma. Methods and analysis A total of 2153 eyes of 1797 patients with diabetes without significant retinopathy were monitored with 10 Topcon-NW400 images obtained over 10.27±1.58 years. 571 non-diabetics eyes were selected as controls. Laguna ONhE uses convolutional neural networks to identify optic disc edges, vessels, cup and rim, and provides a glaucoma assessment index—Globin Distribution Function (GDF). Results In the first image, vessel pixels accounted for 33.88% of the disc area (SD=3.72) in non-glaucoma (DN) and 31.35% (SD=4.05; p<0.0001) in glaucoma cases (DG). This number of pixels was reduced by −0.55% each year (SD=0.77) in the DN and −0.76% (SD=0.86; p=0.0014) in the DG. In the first image, 76.55% of the disc pixels (SD=11.13) belonged to the rim in the DN and 62.05% (SD=11.00; p=0.0014) in the DG, decreasing annually by −0.33% (SD=0.99) in the DN and −0.68% (SD=1.08; p<0.00001) in the DG groups. All rim sectors were reduced over time in the DG group, particularly superotemporal (41°–80°) and inferotemporal (271°–310°). The reduction was smaller in DN, presenting as progressive thickening of the temporal sector (311°–40°). No changes in age were observed in healthy controls. Conclusion Patients with diabetes show progressive reduction of vessels and neuroretinal rim at the optic disc, which is more intense in association with glaucoma. In the absence of glaucoma, the temporal sector of the diabetic rim was not reduced but thickened, displacing the cup nasally.
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Affiliation(s)
| | | | | | - Francisco Cabrera-Lopez
- Ophthalmology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | | | - Marta Gonzalez-Hernandez
- Ophthalmology, Hospital Universitario de Canarias, University of La Laguna, Spain, La Laguna, Spain
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14
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Peripapillary Oxygenation and Retinal Vascular Responsiveness to Flicker Light in Primary Open Angle Glaucoma. Metabolites 2022; 12:metabo12070597. [PMID: 35888721 PMCID: PMC9318708 DOI: 10.3390/metabo12070597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of our study was to evaluate peripapillary oxygenation and its relationship to retinal vascular responsiveness to flicker light in patients with primary open angle glaucoma (POAG). Retinal vessel oxygen saturation was measured in 46 eyes of 34 Caucasian patients with POAG and in 21 eyes of 17 age-matched controls using the oximetry tool of Retinal Vessel Analyser (RVA: IMEDOS Systems UG, Jena, Germany). The mean oxygen saturation of the major arterioles (A-SO2; %) and venules (V-SO2; %), as well as the corresponding arterio−venular difference (A-V SO2; %), were calculated. We also measured retinal vascular responsiveness (RVR) to flicker light by means of RVA. Glaucoma patients were divided in two subgroups according to their median arteriolar and venular vascular responsiveness to flicker light (AFR and VFR). Glaucomatous damage was assessed by optical coherence tomography (Carl Zeiss Meditec, Dublin, CA, USA) and static automated perimetry (Octopus, program G2/standard strategy: Haag-Streit International, Köniz, Switzerland). In addition, we calculated the mean peripapillary oxygen exposure [ppO2E; %/µm] by dividing the mean A-V SO2 with the mean retinal nerve fibre layer (RNFL) thickness. In glaucoma patients, A-SO2 and V-SO2 values were significantly increased, and their difference decreased when compared to controls (p < 0.017; linear mixed-effects model). Grouped with respect to retinal vascular responsiveness to flicker light, subjects with reduced VFR (≤2.9%) had significantly higher ppO2E (0.49 ± 0.08%/µm, respectively, 0.43 ± 0.06%/µm; p = 0.027). Additionally, higher ppO2E in glaucoma patients correlated negatively with the neuroretinal rim area (p < 0.001) and the RNFL thickness (p = 0.017), and positively with the mean defect of the visual field (p = 0.012). Reduced venular vascular responsiveness in our glaucoma patients was associated with increased peripapillary oxygenation exposure. Thus, ganglion cells and their axons in glaucomatous eyes with reduced retinal vascular responsiveness are prone to be more exposed to higher oxidative stress, probably contributing to the further progression of glaucomatous damage.
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15
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Wu X, Konieczka K, Liu X, Chen M, Yao K, Wang K, Flammer J. Role of ocular blood flow in normal tension glaucoma. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2022; 2:100036. [PMID: 37846223 PMCID: PMC10577859 DOI: 10.1016/j.aopr.2022.100036] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/06/2022] [Accepted: 02/14/2022] [Indexed: 10/18/2023]
Abstract
Background Normal tension glaucoma (NTG) is a multifactorial disease in the pathogenesis of which intraocular pressure (IOP)-independent factors play a key role. Main text There is considerable evidence that impairment of the ocular blood flow (OBF) is involved both in the onset and progression of this disease. With the development of the hypothesis of OBF in NTG, various imaging techniques have been developed to evaluate the OBF and blood vessels. Moreover, vascular dysregulation, which is a main factor in Flammer syndrome, was frequently observed in NTG patients. Disturbed OBF leads to increased oxidative stress, which plays an important role in the pathogenesis of glaucomatous optic neuropathy. These results suggested that IOP-independent management may provide alternative treatment options for NTG patients. Conclusions In this review, we mainly focus on the mechanisms of the abnormal OBF in NTG.
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Affiliation(s)
- Xingdi Wu
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Katarzyna Konieczka
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, Basel, 4031, Switzerland
| | - Xin Liu
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Min Chen
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Ke Yao
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Kaijun Wang
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Josef Flammer
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, Basel, 4031, Switzerland
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16
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Salehi MA, Karimi A, Mohammadi S, Arevalo JF. Spectral-domain OCT measurements in obesity: A systematic review and meta-analysis. PLoS One 2022; 17:e0267495. [PMID: 35476846 PMCID: PMC9045631 DOI: 10.1371/journal.pone.0267495] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 04/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Previous studies proposed possible applications of spectral-domain optical coherence tomography (SD-OCT) measurements in prognosticating pathologies observed in overweight/obesity, including ocular, vascular, and neurologic consequences. Therefore, we conducted a systematic review and meta-analysis to investigate the changes in the in SD-OCT measurements of the patients with higher body mass index (BMI) compared to normal weight individuals. Materials and methods We conducted a systematic search on PubMed, Scopus, and Embase. The search results underwent two-phase title/abstract and full-text screenings. We then analyzed SD-OCT measurements differences in patients with high BMI and controls, and performed meta-regression, sub-group analysis, quality assessment, and publication bias assessment. The measurements included macular thickness, cup to disc ratio, ganglion cell-inner plexiform layer (GC-IPL) and its sub-sectors, RNFL and peripapillary RNFL (pRNFL) and their sub-layers, and choroidal thickness and its sub-sectors. Results 19 studies were included in this meta-analysis accounting for 1813 individuals, 989 cases and 824 controls. There was an overall trend towards decreased thickness in high BMI patients, but only two measurements reached statistical significance: temporal retinal nerve fiber layer (RNFL) (Standardized mean difference (SMD): -0.33, 95% confidence interval (CI): -0.53 to -0.14, p<0.01) and the choroidal region 1.0 mm nasal to fovea (SMD: -0.38, 95% CI: -0.60 to -0.16, p<0.01). Conclusion Some ocular layers are thinner in patients with higher BMI than the controls. These SD-OCT measurements might correlate with adverse events related to increased body weight and have prognostic abilities. As SD-OCT is a robust, rapid and non-invasive tool, future guidelines and studies are needed to evaluate the possibility of their integration into care of the patients with obesity.
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Affiliation(s)
| | - Amirali Karimi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Mohammadi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - J. Fernando Arevalo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, United States of America
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The Effectiveness of Laser Peripheral Iridotomy in Adolescent Eyes with Ocular Hypertension and Concave Configuration of the Peripheral Iris. J Ophthalmol 2022; 2022:4068026. [PMID: 35265367 PMCID: PMC8901309 DOI: 10.1155/2022/4068026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/07/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the efficacy of laser peripheral iridotomy (LPI) in preventing deterioration in eyes with ocular hypertension (OHT) and concave configuration of the iris. Materials and Methods This was a retrospective study, which was carried out within a period of 3–5 years. Twenty-four patients with OHT and concave irises were treated with LPI and followed up periodically. IOP, central corneal thickness (CCT), anterior chamber depth (ACD), scleral spur angle (SSA), global neuroretinal rim (NRR) thickness, and global retinal nerve fiber layer (RNFL) were examined before and after LPI. Results The average age of the 24 patients was 14.21 ± 1.41 (13–17.5) years on admission. The initial IOP of the 48 eyes was 23.21 ± 1.56 mmHg in RE and 22.96 ± 2.1 mmHg in LE before LPI. All 48 eyes had concave irises in both eyes. All eyes treated with LPI have shown iris flattening, which has persisted during follow-up (mean 1.54 ± 0.9 years). At the last follow-up visit, the average IOP was 17.58 ± 2.63 (14–21) mmHg in RE and 17.58 ± 2.86 (14–21) mmHg in LE, which was statistically lower than that of the baseline (p < 0.001). There were significant changes in SSA in both eyes and global RNFL in RE after LPI. Conclusions In the current study, LPI resulted in an IOP-lowering effect and iris flattening in adolescent eyes with a concave configuration of the peripheral iris.
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Garrison SR, Kolber MR, Allan GM, Bakal J, Green L, Singer A, Trueman DR, McAlister FA, Padwal RS, Hill MD, Manns B, McGrail K, O'Neill B, Greiver M, Froentjes LS, Manca DP, Mangin D, Wong ST, MacLean C, Kirkwood JE, McCracken R, McCormack JP, Norris C, Korownyk T. Bedtime versus morning use of antihypertensives for cardiovascular risk reduction (BedMed): protocol for a prospective, randomised, open-label, blinded end-point pragmatic trial. BMJ Open 2022; 12:e059711. [PMID: 35210352 PMCID: PMC8883279 DOI: 10.1136/bmjopen-2021-059711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Sleep-time blood pressure correlates more strongly with adverse cardiovascular events than does daytime blood pressure. The BedMed trial evaluates whether bedtime antihypertensive administration, as compared with conventional morning use, reduces major adverse cardiovascular events. METHODS AND ANALYSIS: DesignProspective randomised, open-label, blinded end-point trial.ParticipantsHypertensive primary care patients using blood pressure lowering medication and free from glaucoma.SettingCommunity primary care providers in 5 Canadian provinces (British Columbia, Alberta, Saskatchewan, Manitoba and Ontario) are mailing invitations to their eligible patients. Social media campaigns (Google, Facebook) are additionally running in the same provinces.InterventionConsenting participants are allocated via central randomisation to bedtime vs morning use of all antihypertensives.Follow-up(1) Telephone or email questionnaire at 1 week, 6 weeks, 6 months and every 6 months thereafter, and (2) accessing linked governmental healthcare databases tracking hospital and community medical services.Primary outcomeComposite of all-cause death, or hospitalisation for myocardial infarction/acute-coronary syndrome, stroke or congestive heart failure.Secondary outcomesEach primary outcome element on its own, all-cause hospitalisation or emergency department visit, long-term care admission, non-vertebral fracture, new glaucoma diagnosis, 18-month cognitive decline from baseline (via Short Blessed Test).Select other outcomesSelf-reported nocturia burden at 6 weeks and 6 months (no, minor or major burden), 1-year self-reported overall health score (EQ-5D-5L), self-reported falls, total cost of care (acute and community over study duration) and mean sleep-time systolic blood pressure after 6 months (via 24-hour monitor in a subset of 302 sequential participants).Primary outcome analysisCox proportional hazards survival analysis.Sample sizeThe trial will continue until a projected 254 primary outcome events have occurred.Current statusEnrolment ongoing (3227 randomised to date). ETHICS AND DISSEMINATION BedMed has ethics approval from six research ethics review boards and will publish results in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT02990663.
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Affiliation(s)
- Scott R Garrison
- Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Michael R Kolber
- Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - G Michael Allan
- Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey Bakal
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lee Green
- Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Alexander Singer
- Family Medicine, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
| | | | | | - Raj S Padwal
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Michael D Hill
- Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Braden Manns
- Nephrology, University of Calgary, Calgary, Alberta, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Braden O'Neill
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Greiver
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Donna P Manca
- Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Dee Mangin
- Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cathy MacLean
- Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Rita McCracken
- Family Medicine, Providence Health Care, Vancouver, British Columbia, Canada
- Family Practice, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - James P McCormack
- Faculty of Pharmaceutical Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colleen Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Tina Korownyk
- Family Medicine, University of Alberta, Edmonton, Alberta, Canada
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Giannetto C, Rajaei SM, Abdous A, Ostadhasan H, Alagha HE, Faghihi H, Piccione G, Omidi R, Fazio F. Effects of long-term oral administration of melatonin on tear production, intraocular pressure, and tear and serum melatonin concentrations in healthy dogs. J Am Vet Med Assoc 2022; 260:524-529. [PMID: 34986123 DOI: 10.2460/javma.21.03.0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effects of long-term (30-day) oral administration of melatonin on tear production, intraocular pressure (IOP), and concentration of melatonin in the tears and serum of healthy dogs. ANIMALS 20 healthy sexually intact adult male dogs. PROCEDURES 10 dogs were given melatonin (0.3 mg/kg, PO, q 24 h, administered in food at 9 am), and 10 dogs were given a placebo. Tear and serum melatonin concentrations, IOP, and tear production (determined with a Schirmer tear test) were recorded before (baseline) and 30 minutes, 3 hours, and 5 hours after administration of melatonin or the placebo on day 1 and 30 minutes after administration of melatonin or the placebo on days 8, 15, and 30. RESULTS Data collection time had significant effects on tear production, IOP, and tear melatonin concentration but not on serum melatonin concentration. Treatment (melatonin vs placebo) had a significant effect on tear melatonin concentration, but not on tear production, IOP, or serum melatonin concentration; however, tear melatonin concentration was significantly different between groups only 30 minutes after administration on day 1 and not at other times. CLINICAL RELEVANCE In healthy dogs, long-term administration of melatonin at a dosage of 0.3 mg/kg, PO, every 24 hours did not have any clinically important effects on tear production, IOP, or serum or tear melatonin concentrations.
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Affiliation(s)
- Claudia Giannetto
- 1Department of Veterinary Sciences, Polo Universitario Annunziata, University of Messina, Messina, Italy
| | - Seyed Mehdi Rajaei
- 2Ophthalmology Section, Negah Veterinary Centre, Tehran, Iran.,3Department of Clinical Sciences, College of Veterinary Medicine, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Arman Abdous
- 3Department of Clinical Sciences, College of Veterinary Medicine, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Hesam Ostadhasan
- 3Department of Clinical Sciences, College of Veterinary Medicine, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Hannah Emami Alagha
- 3Department of Clinical Sciences, College of Veterinary Medicine, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Houman Faghihi
- 2Ophthalmology Section, Negah Veterinary Centre, Tehran, Iran
| | - Giuseppe Piccione
- 1Department of Veterinary Sciences, Polo Universitario Annunziata, University of Messina, Messina, Italy
| | - Roghiyeh Omidi
- 4Stem Cell Preparation Unit, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Francesco Fazio
- 1Department of Veterinary Sciences, Polo Universitario Annunziata, University of Messina, Messina, Italy
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20
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Kortuem C, Dietter J, Bozkurt Y, Kortuem FC, Abaza A, Wahl S, Ivanov IV, Ueffing M, Voykov B. Vessel Evaluation in Patients with Primary Open-Angle Glaucoma, Normal Tension Glaucoma and Healthy Controls. Clin Ophthalmol 2021; 15:4269-4280. [PMID: 34707346 PMCID: PMC8544789 DOI: 10.2147/opth.s320505] [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: 05/20/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare changes in central retinal arterial equivalent (CRAE), central retinal vein equivalent (CRVE), arteriovenous ratio (AVR), tortuosity and fractal dimension in primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG) and in a control group (CG) on fundus photographs. Further, to provide further evidence of vascular change in glaucoma patients using a novel method of tortuosity. Patients and Methods The primary endpoint was the change in CRAE, CRVE, AVR, fractal dimension and tortuosity of the retinal vasculature from baseline, retrospectively analyzed from 2011 to 2017 at the University Eye Hospital Tuebingen. Fundus photos of POAG (N = 49), NTG (N = 38) and CG (N = 18) were computer evaluated and analyzed in the quantities mentioned above. Results CRAE in NTG and POAG and CRVE in NTG significantly decreased (P = 0.02, P = 0.01; P = 0.03) whereas CRVE in POAG increased insignificantly (P = 0.72). In NTG, AVR decreased significantly (P = 0.05), but to a lesser extent than in POAG (P < 0.001). In CG, CRAE decreased insignificantly (P = 0.10), CRVE decreased significantly (P = 0.03) and AVR increased insignificantly (P = 0.77). In POAG tortuosity calculated using standard methods as well as our novel method, increased significantly (P = 0.015-0.04), whereas it did not occur in NTG (P = 0.18-0.57) and CG (P = 0.11-0.21). Fractal dimensions in POAG decreased significantly (P = 0.001-0.002), whereas in NTG and CG changes were insignificant (P = 0.33-0.92). Conclusion Based on a retrospective analysis of fundus photographs, specific retinal vasculature features of the retinal vasculature display significant alterations associated with NTG and POAG. The assessment of tortuosity using our novel method was consistent with previously established methods for analyzing tortuosity.
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Affiliation(s)
- Constanze Kortuem
- Department of Ophthalmology, University Eye Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Johannes Dietter
- Department of Ophthalmology, Institute for Ophthalmic Research University of Tuebingen, Tuebingen, Germany
| | - Yagmur Bozkurt
- Department of Ophthalmology, Institute for Ophthalmic Research University of Tuebingen, Tuebingen, Germany
| | | | - Annegret Abaza
- Department of Ophthalmology, University Eye Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Siegfried Wahl
- Department of Ophthalmology, Institute for Ophthalmic Research University of Tuebingen, Tuebingen, Germany.,Carl Zeiss Vision International GmbH, Aalen, Germany
| | - Iliya V Ivanov
- Department of Ophthalmology, Institute for Ophthalmic Research University of Tuebingen, Tuebingen, Germany.,Carl Zeiss Vision International GmbH, Aalen, Germany
| | - Marius Ueffing
- Department of Ophthalmology, Institute for Ophthalmic Research University of Tuebingen, Tuebingen, Germany
| | - Bogomil Voykov
- Department of Ophthalmology, University Eye Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
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21
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Arrigo A, Aragona E, Saladino A, Arrigo D, Fantaguzzi F, Battaglia Parodi M, Bandello F. Cognitive Dysfunctions in Glaucoma: An Overview of Morpho-Functional Mechanisms and the Impact on Higher-Order Visual Function. Front Aging Neurosci 2021; 13:747050. [PMID: 34690746 PMCID: PMC8526892 DOI: 10.3389/fnagi.2021.747050] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/27/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Glaucoma is a chronic, vision-threatening disease, and a major cause of legal blindness. The current view is no longer limited to the progressive optic nerve injury, since growing evidence strongly support the interpretation of glaucoma as a complex neurodegenerative disease. However, the precise pathogenic mechanisms leading to the onset and progression of central nervous system (CNS) impairment, and the functional consequences of this damage, are still partially understood. The main aim of this review is to provide a complete and updated overview of the current knowledge regarding the CNS involvement in glaucoma, and the possible therapeutic perspectives. Methods: We made a careful survey of the current literature reporting all the relevant findings related to the cognitive dysfunctions occurring in glaucoma, with specific remarks dedicated on the higher-order visual function impairment and the possible employment of neuroprotective agents. Results: The current literature strongly support the interpretation of glaucoma as a multifaceted chronic neurodegenerative disease, widely affecting the CNS. The cognitive impairment may vary in terms of higher-order functions involvement and in the severity of the degeneration. Although several neuroprotective agents are currently available, the development of new molecules represents a major topic of investigation for future clinical trials. Conclusions: Glaucoma earned the right to be fully considered a neurodegenerative disease. Glaucomatous patients may experience a heterogeneous set of visual and cognitive symptoms, progressively deteriorating the quality of life. Neuroprotection is nowadays a necessary therapeutic goal and a future promising way to preserve visual and cognitive functions, thus improving patients' quality of life.
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Affiliation(s)
- Alessandro Arrigo
- Department of Ophthalmology, Scientific Institute San Raffaele Hospital, Milan, Italy
| | - Emanuela Aragona
- Department of Ophthalmology, Scientific Institute San Raffaele Hospital, Milan, Italy
| | - Andrea Saladino
- Department of Ophthalmology, Scientific Institute San Raffaele Hospital, Milan, Italy
| | - Davide Arrigo
- School of Medicine, University of Messina, Messina, Italy
| | - Federico Fantaguzzi
- Department of Ophthalmology, Scientific Institute San Raffaele Hospital, Milan, Italy
| | | | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele Hospital, Milan, Italy
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22
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Khayrallah O, Mahjoub A, Ben Abdesslam N, Mahjoub A, Ghorbel M, Mahjoub H, Knani L, Krifa F. Optical coherence tomography angiography vessel density parameters in primary open-angle glaucoma. Ann Med Surg (Lond) 2021; 69:102671. [PMID: 34408871 PMCID: PMC8361292 DOI: 10.1016/j.amsu.2021.102671] [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: 06/19/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 11/04/2022] Open
Abstract
Background Many studies suggest the existence of an alteration of the retinal hemoperfusion in primary open-angle glaucoma. The OCT-A is a novel technique that allows to provide information on retinal microcirculation in a non-invasive way, thus it represents a possible imaging target for the early diagnosis and follow-up of glaucoma. The aim of our work is to evaluate the contribution of vascular parameters provided by OCT-A and their diagnostic abilities in the different stages of primary open-angle glaucoma. Method This is a prospective cross-sectional study involving 200 eyes of control subjects and 250 eyes of glaucomatous subjects divided into early glaucoma, moderate glaucoma and advanced glaucoma subgroups. They were assessed for MD, LV by visual field, RNFL and GCC thickness by SS-OCT papillary and macular vascular densities by SS-OCT A. Results OCT-A vessel densities determined in the optic nerve head, in the peripapillary and in the macular regions were significantly lower in glaucomatous eyes. Among the vascular parameters studied the whole image vascular density showed the best diagnostic ability in the discrimination between glaucomatous eyes and healthy eyes with an AUC of 0.949. Nevertheless, the diagnostic ability of vascular parameters remains lower than of the structural parameters RNFL (AUC: 0.981). A significant correlation was found between structural, functional and vascular parameters with r < 0.05. The quadratic non-linear model defines better the relationship between structural, vascular and functional damage in glaucoma. Conclusion The OCT-A plays an important role in the early diagnosis and follow-up of PAOG. It also contributes to the understanding of some aspects of the vascular role in glaucoma. OCT-A vascular density parameters exploring the macular and papillary regions are decreased in primary open-angle glaucoma. Disc and macular vessel density parameters have excellent diagnostic abilities in diagnosing glaucomatous eyes. A correlation is shown between functional, structural, and vascular parameters. The non-linear quadratic model better describes the relationship between structural, functional, and vascular parameters.
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Affiliation(s)
- Oumayma Khayrallah
- Ophtalmology Department, Farhat Hached Hospital of Sousse, Sousse, Tunisia
| | - Ahmed Mahjoub
- Ophtalmology Department, Farhat Hached Hospital of Sousse, Sousse, Tunisia
| | | | - Anis Mahjoub
- Ophtalmology Department, Farhat Hached Hospital of Sousse, Sousse, Tunisia
| | - Mohamed Ghorbel
- Ophtalmology Department, Farhat Hached Hospital of Sousse, Sousse, Tunisia
| | - Hechmi Mahjoub
- Ophtalmology Department, Farhat Hached Hospital of Sousse, Sousse, Tunisia
| | - Leila Knani
- Ophtalmology Department, Farhat Hached Hospital of Sousse, Sousse, Tunisia
| | - Fathi Krifa
- Ophtalmology Department, Farhat Hached Hospital of Sousse, Sousse, Tunisia
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23
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Jeon SJ, Park HYL, Park CK. Vessel Density Loss of the Deep Peripapillary Area in Glaucoma Suspects and Its Association with Features of the Lamina Cribrosa. J Clin Med 2021; 10:jcm10112373. [PMID: 34071218 PMCID: PMC8197842 DOI: 10.3390/jcm10112373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose: To investigate the association of decreased vessel density (VD) in the deep peripapillary region and structural features of the lamina cribrosa (LC). Materials and Methods: 70 eyes of glaucoma suspects with enlarged cup-to-disc ratio were scanned and 51 eyes with adequate image quality were included in this study. All subjects had localized VD defects in the deep layer but intact VD in the superficial layer around the peripapillary region using optical coherence tomography angiography (OCTA). Only single-hemizone OCTA results from one eye of each subject had to fulfill the distinctive feature mentioned above to perform inter-eye and inter-hemizone comparisons. The thickness and depth of the LC, and prelaminar thickness were measured using enhanced depth imaging OCT (EDI-OCT). Paired t-tests were performed to evaluate differences in measurements of the LC and prelaminar thickness within each individual. p-values lower than 0.05 was considered to be statistically significant. Results: Eyes with deep VD defects in the peripapillary region in OCTA had thinner LC than the fellow eyes. The hemizone with the deep VD defects in the peripapillary region had a thinner LC and a deeper depth of LC than the other hemizone in the same eye. According to logistic regression analysis, a thin LC was a significant factor associated with deep VD defect in the peripapillary region. Conclusions: Glaucoma suspect eyes with deep VD defects in the peripapillary area exhibited structural differences in the LC. The structural changes of the LC was associated with the vessel density in the deep peripapillary layer at the stage of suspected glaucoma.
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Affiliation(s)
- Soo-Ji Jeon
- Apgujeong St. Mary’s Eye Center, 859 Eonju-ro, Gangnam-gu, Seoul 06023, Korea;
| | - Hae-Young Lopilly Park
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea;
| | - Chan-Kee Park
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea;
- Correspondence: ; Tel.: +82-2-2258-1188; Fax: +82-2-599-7405
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Relationship between peripheral vasospasm and visual field progression rates in patients with normal-tension glaucoma with low-teen intraocular pressure. PLoS One 2021; 16:e0250085. [PMID: 33857246 PMCID: PMC8049327 DOI: 10.1371/journal.pone.0250085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate the association between peripheral vasospasm and the visual field (VF) progression rate in patients with normal-tension glaucoma (NTG) with low-teen intraocular pressure (IOP). Methods The finger temperature of 113 NTG patients was measured before and after exposure to ice water using a Temperature gun (cold pressor test). These patients had confirmed VF progression, despite a low-teen IOP during a follow-up period of >5 years. VF progression rates were calculated as the slope of the visual field index (VFI) and mean deviation (MD) over time. Demographic, systemic, and ocular factors and VF progression rates were compared, based on the cold pressor test results. A regression analysis was used to investigate the factors affecting VF progression rates. Results Mean age, initial IOP, mean IOP during the follow-up period, and initial VF MD were 57.1 years, 15.8 mmHg, 12.0 mmHg, and -5.2 dB, respectively. When patients were divided into two groups (less vasospasm and more vasospasm) according to changes in temperature after exposure to ice water, the VF progression rate was significantly faster in the group with more vasospasm. In a multiple regression analysis, older age, worse initial VF MD, and greater decrease in finger temperature after ice water exposure were significantly associated with faster VF progression rates. Conclusion An excessive drop in finger temperature after exposure to ice water was significantly associated with faster VF progression in patients with low-teen NTG. This suggests that the blood flow in the optic nerve head may also be disturbed by peripheral vasospasm, accelerating glaucomatous damage regardless of IOP.
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25
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Lee K, Yang H, Kim JY, Seong GJ, Kim CY, Bae HW. Risk Factors Associated with Structural Progression in Normal-Tension Glaucoma: Intraocular Pressure, Systemic Blood Pressure, and Myopia. Invest Ophthalmol Vis Sci 2021; 61:35. [PMID: 32716503 PMCID: PMC7425752 DOI: 10.1167/iovs.61.8.35] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose To determine risk factors associated with structural progression in medically treated normal-tension glaucoma (NTG). Methods This retrospective cohort study included 166 NTG patients (average age, 56.5 years; average mean deviation, −4.2 dB). The structural progression endpoint was determined by optical coherence tomography; significant thickness differences in the peripapillary retinal nerve fiber layer (RNFL) or macular ganglion cell inner plexiform layer (GCIPL) that exceeded baseline test-retest variability were identified with event-based guided-progression analysis. Intraocular pressure and systemic blood pressure (BP) were measured at each visit throughout the follow-up period, and the risk for progression was evaluated with Cox regression. Myopic disc features and antihypertensives were also analyzed. Tree analysis was used to determine the cutoff values and elucidate influential risk factors. Results Structural progression, defined as progressive peripapillary RNFL or macular GCIPL thinning, was identified in 62 eyes. Occurrence of disc hemorrhages, presence of diabetes, and lower minimum systolic BP were associated with progression (hazard ratio [HR]: 2.116, P = 0.005; HR: 1.998, P = 0.031; HR: 0.968, P = 0.005; respectively). The cutoff value derived from the tree analysis of minimum systolic BP was 108 mm Hg. The tree analysis revealed systolic and diastolic BP to be the most influential risk factors for progressive peripapillary RFNL thinning and progressive macular GCIPL thinning, respectively. Conclusions Low BP measured during follow-up correlated with structural progression in medically treated NTG eyes, indicating that the evaluation of hypotension is required during the management of NTG patients. The tree analysis identified BP target values that may help prevent glaucoma progression.
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26
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Ugurlu A, Yılmaz H. Influences of Hypomagnesemia on Optic Nerve and Retinal Vascular Structure Determined Using Optical Coherence Tomography (OCT) Angiography. Curr Eye Res 2020; 46:579-584. [PMID: 33259256 DOI: 10.1080/02713683.2020.1857779] [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: 10/22/2022]
Abstract
Purpose: To evaluate the effects of low blood magnesium levels on the optic nerve, retina, and retinal vascular structure.Methods: This observational and cross-sectional study was conducted between June 2019 and May 2020 with participants aged 20-39 years, who had a visual acuity of ≥20/20, the axial length of 22-24.5 mm, refractive defect spherical equivalent of ≤±3D, and intraocular pressure of ≤21 mm Hg. All participants had a complaint of twitching in their eyes. The participants with normal serum magnesium levels constituted the control group, and patients with hypomagnesemia constituted the patient group. Updated AngioScan software (Navis ver. 1.8.0.) of Nidek's RS-3000 Advance system was used to analyze the spectral domain-optical coherence tomography (SD-OCT) and optical coherence tomography-angiography (OCT-A) images.Results: A total of 100 right eyes of 100 individuals was included in the study. The mean retinal nerve fiber layer (RNFL) thickness was 108.52 ± 12.46 μm in the control group, and 97.3 ± 9.7 μm in the hypomagnesemia group (P < .001). In the control group, the global superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel densities (VDs) were 41.92 ± 2.29, and 37.54 ± 3.83, respectively. In the patient group, the global SCP and DCP VDs were 37.66 ± 3.14, and 32.95 ± 5.57, respectively. The SCP and DCP VD percentages were significantly lower in the patient group. The mean foveal avascular zone (FAZ) area, perimeter and circularity index (CI) were 0.32 ± 0.13 mm2, 2.89 ± 0.59 mm, and 0.52 ± 0.09, respectively, for the control group and 0.38 ± 0.11 mm2, 2.99 ± 0.64 mm, and 0.38 ± 0.1, respectively, for the patient group. The FAZ area and perimeter were significantly higher (P = .013 and P = .001) and FAZ CI was significantly lower (P < .001) in the patients with hypomagnesemia.Conclusion: Our study revealed that OCT and OCT-A measurements may be used in the determination of the optic nerve and retinal vascular structure changes in hypomagnesemia.
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Affiliation(s)
- Adem Ugurlu
- Department of Ophthalmology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Hayati Yılmaz
- Department of Ophthalmology, Health Science University Umraniye Training and Research Hospital, İstanbul, Turkey
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27
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The Role of Adrenoceptors in the Retina. Cells 2020; 9:cells9122594. [PMID: 33287335 PMCID: PMC7761662 DOI: 10.3390/cells9122594] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 01/16/2023] Open
Abstract
The retina is a part of the central nervous system, a thin multilayer with neuronal lamination, responsible for detecting, preprocessing, and sending visual information to the brain. Many retinal diseases are characterized by hemodynamic perturbations and neurodegeneration leading to vision loss and reduced quality of life. Since catecholamines and respective bindings sites have been characterized in the retina, we systematically reviewed the literature with regard to retinal expression, distribution and function of alpha1 (α1)-, alpha2 (α2)-, and beta (β)-adrenoceptors (ARs). Moreover, we discuss the role of the individual adrenoceptors as targets for the treatment of retinal diseases.
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28
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Rudnicka AR, Owen CG, Welikala RA, Barman SA, Whincup PH, Strachan DP, Chan MP, Khawaja AP, Broadway DC, Luben R, Hayat SA, Khaw KT, Foster PJ. Retinal Vasculometry Associations With Glaucoma: Findings From the European Prospective Investigation of Cancer-Norfolk Eye Study. Am J Ophthalmol 2020; 220:140-151. [PMID: 32717267 PMCID: PMC7706353 DOI: 10.1016/j.ajo.2020.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 12/13/2022]
Abstract
Purpose To examine retinal vasculometry associations with different glaucomas in older British people. Design Cross-sectional study. Methods A total of 8,623 European Prospective Investigation into Cancer-Norfolk Eye study participants were examined, who underwent retinal imaging, ocular biometry assessment, and clinical ascertainment of ocular hypertensive or glaucoma status (including glaucoma suspect [GS], high-tension open-angle glaucoma [HTG], and normal-tension glaucoma [NTG]). Automated measures of arteriolar and venular tortuosity, area, and width from retinal images were obtained. MainOutcomeMeasures: Associations between glaucoma and retinal vasculometry outcomes were analyzed using multilevel linear regression, adjusted for age, sex, height, axial length, intraocular and systemic blood pressure, and within-person clustering, to provide absolute differences in width and area, and percentage differences in vessel tortuosity. Presence or absence of within-person-between-eye differences in retinal vasculometry by diagnoses were examined. Results A total of 565,593 vessel segments from 5,947 participants (mean age 67.6 years, SD 7.6 years, 57% women) were included; numbers with HTG, NTG, and GS in at least 1 eye were 87, 82, and 439, respectively. Thinner arterioles (−3.2 μm; 95% confidence interval [CI] −4.4 μm, −1.9 μm) and venules (−2.7 μm; 95% CI −4.9 μm, −0.5 μm) were associated with HTG. Reduced venular area was associated with HTG (−0.2 mm2; 95% CI −0.3 mm2, −0.1 mm2) and NTG (−0.2 mm2; 95% CI −0.3 mm2, −0.0 mm2). Less tortuous retinal arterioles and venules were associated with all glaucomas, but only significantly for GS (−3.9%; 95% CI −7.7%, −0.1% and −4.8%; 95% CI −7.4%, −2.1%, respectively). There was no evidence of within-person-between-eye differences in retinal vasculometry associations by diagnoses. Conclusions Retinal vessel width associations with glaucoma and novel associations with vessel area and tortuosity, together with no evidence of within-person-between-eye differences in retinal vasculometry, suggest a vascular cause of glaucoma. Retinal vessel measurements, including (as a first report) vessel tortuosity and area, were associated with high-tension glaucoma and other glaucoma-related outcomes. Novel analyses showing that within-person-between-eye glaucoma diagnoses, intraocular pressure, and retinal vasculometry were uncorrelated provides further evidence that systemic microvascular changes may cause glaucoma.
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Weindler H, Spitzer MS, Schultheiß M, Kromer R. OCT angiography analysis of retinal vessel density in primary open-angle glaucoma with and without Tafluprost therapy. BMC Ophthalmol 2020; 20:444. [PMID: 33183272 PMCID: PMC7663898 DOI: 10.1186/s12886-020-01707-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 10/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Primary open-angle glaucoma (POAG) is a progressive neurodegenerative disease which leads to irreversible blindness. An elevated intraocular pressure (IOP) is considered to be the main risk factor for the disease progression. It is known that retinal blood flow is altered in POAG eyes. Tafluprost, a prostaglandin analogue which lowers the IOP, has shown to also improve the retinal blood flow in animals. Methods The current study therefore evaluated the retinal vessel density in the peripapillary and macular region of POAG patients with normal IOP treated with topical Tafluprost (n = 20) compared to surgically treated patients with normal IOP (n = 22) using optical coherence tomography angiography (OCT-A). The retinal flow density was obtained after binarisation and evaluated in five sectors. Results There was a significantly higher peripapillary flow density in all sectors in Tafluprost treated eyes when compared to post-surgery eyes. The flow density in the inferior sector of the superficial plexus in the macular region was also significantly higher in the Tafluprost group. Conclusions: These results indicate that Tafluprost not only lowers IOP, but may also enhance retinal blood flow in POAG patients with a normal IOP.
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Affiliation(s)
- Hannah Weindler
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Martin S Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Maximilian Schultheiß
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Robert Kromer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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30
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Kee AR, Yip VCH, Tay ELT, Lim CW, Cheng J, Teo HY, Chua CH, Yip LWL. Comparison of two different optical coherence tomography angiography devices in detecting healthy versus glaucomatous eyes - an observational cross-sectional study. BMC Ophthalmol 2020; 20:440. [PMID: 33167902 PMCID: PMC7653880 DOI: 10.1186/s12886-020-01701-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 10/23/2020] [Indexed: 12/02/2022] Open
Abstract
Background To understand the differences between two different optical coherence tomography angiography (OCTA) devices in detecting glaucomatous from healthy eyes by comparing their vascular parameters, diagnostic accuracy and test-retest reliability. Methods A cross-sectional observational study was performed on healthy and glaucoma subjects, on whom two sets of OCTA images of optic disc and macula were acquired using both AngioVue (Optovue, USA) and Swept Source (Topcon, Japan) OCTA devices during one visit. A novel in-house software was used to calculate the vessel densities. Diagnostic accuracy of the machines in differentiating healthy versus glaucomatous eyes was determined using area under the receiver operating characteristic curve (AUROC) and test-retest repeatability of the machines was also evaluated. Results A total of 80 healthy and 38 glaucomatous eyes were evaluated. Glaucomatous eyes had reduced mean vessel density compared to healthy controls in all segmented layers of the optic disc and macula using AngioVue (p ≤ 0.001). However, glaucomatous eyes had higher mean vessel density on optic disc scans using Swept Source, with lack of statistically significant difference between healthy and glaucomatous eyes. The AUROC showed better diagnostic accuracy of AngioVue (0.761–1.000) compared to Swept Source (0.113–0.644). The test-retest reliability indices were generally better using AngioVue than Swept Source. Conclusions AngioVue showed better diagnostic capability and test-retest reliability compared to Swept Source. Further studies need to be undertaken to evaluate if there is any significant difference between the various machines in diagnosing and monitoring glaucoma.
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Affiliation(s)
- A R Kee
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - V C H Yip
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - E L T Tay
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Ophthalmology, Woodlands Health Campus, Singapore, Singapore
| | - C W Lim
- Department of Ophthalmology, Sarawak General Hospital, Kuching, Malaysia
| | - J Cheng
- Cixi Institute of Biomedical Engineering, Chinese Academy of Sciences, Ningbo, Zhejiang Province, China
| | - H Y Teo
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - C H Chua
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - L W L Yip
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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Hübnerová P, Mlčák P, Šínová I, Karhanová M, Šín M. Current use of the automatic retinal oximetry. Review. CESKÁ A SLOVENSKÁ OFTALMOLOGIE : CASOPIS CESKÉ OFTALMOLOGICKÉ SPOLECNOSTI A SLOVENSKÉ OFTALMOLOGICKÉ SPOLECNOSTI 2020; 76:3-11. [PMID: 32917089 DOI: 10.31348/2020/1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To inform about possible use of the automatic retinal oximetry for the retinal oxygen saturation measurement in the eye and systemic diseases. METHODS We performed a literature review dealing with issues of retinal oxygen saturation monitoring by dual non-invasive retinal oximetry Oxymap T1 (Oxymap ehf. Reykjavík, Iceland). RESULTS We have found two main strains writing our paper on retinal oxygen saturation eye diseases. The first section concerns diseases created by having hypoxia as its main pathological factor - for example diabetes mellitus and retinal vein occlusion. The second group deals with atrophy as the main pathological mechanism which is typical for decreasing retinal oxygen consumption - for example glaucoma or retinitis pigmentosa (the second one named is not included in our work). Oximetry in systemic diseases creates a relatively new chapter of this branch with a very big potential of interdisciplinary cooperation for the future. It is possible the cooperation will not only include diabetologists but also neurologists (for example, in diseases like sclerosis multiplex or Devics, Alzheimers and Parkinsons disease) and haematologists (retinal oxygen saturation changes in patients with different rheological attributes of blood). CONCLUSION Retinal oxygen saturation measuring by automatic retinal oximetry is a relatively new method with scientifically confirmed high reproducibility of results. Currently it is the only experimental method with vast potentials not only in the realm of the possibility of observing eye diseases (diabetic retinopathy, retinal vein occlusion or glaucoma) but also in developing interdisciplinary cooperation with diabetologists, neurologists and haematologists.
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Asefa NG, Neustaeter A, Jansonius NM, Snieder H. Autonomic Dysfunction and Blood Pressure in Glaucoma Patients: The Lifelines Cohort Study. Invest Ophthalmol Vis Sci 2020; 61:25. [PMID: 32931573 PMCID: PMC7500113 DOI: 10.1167/iovs.61.11.25] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose We investigated relationship of glaucoma with measurements related to autonomic dysfunction, including heart rate variability (HRV) and blood pressure (BP). Methods Glaucoma was defined using a questionnaire-based algorithm for 86,841 LifeLines Cohort Study participants. Baseline HRV (root mean square of successive differences [RMSSD]) was calculated from resting electrocardiograms; systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP) were oscillometric-based measurements. We used a generalized linear mixed model, adjusted for age, age square, sex, body mass index, and familial relationships to assess the relationship of baseline HRV and BP (continuous and quartiles), hypertension, and antihypertensive medication with glaucoma at follow up (median, 3.8 years). Results The odds ratio (OR) of glaucoma was 0.95 (95% confidence interval [CI], 0.92-0.99) per unit increase in log-transformed RMSSD (in ms), indicating that autonomous dysfunction (low HRV) is associated with a higher risk of glaucoma. Per 10-mm Hg increase in BP, we found ORs of 1.03 (95% CI, 1.01-1.05; P = 0.015) for SBP, 1.01 (95% CI, 0.97-1.05; P = 0.55) for DBP, 1.03 (95% CI, 1.00-1.06; P = 0.083) for MAP, and 1.04 (95% CI, 1.01-1.07; P = 0.006) for PP. The OR for the lowest versus highest RMSSD quartile was 1.15 (95% CI, 1.05-1.27; P = 0.003). The ORs for the highest versus second quartile were 1.09 (95% CI, 0.99-1.19; P = 0.091) for SBP and 1.13 (95% CI, 1.02-1.24; P = 0.015) for PP. Glaucoma was more common among hypertensives (OR, 1.25; 95% CI, 1.16-1.35; P < 0.001); among those using angiotensin-converting enzyme (ACE) inhibitors (OR, 1.35; 95% CI, 1.18-1.55; P < 0.001); and among those using calcium-channel blockers (OR, 1.19; 95% CI, 1.01-1.40; P = 0.039). Conclusions Low HRV, high SBP, high PP, and hypertension were associated with glaucoma. Longitudinal studies may elucidate if autonomic dysregulation and high BP also predict glaucoma incidence.
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Affiliation(s)
- Nigus G Asefa
- Department of Epidemiology, Graduate School of Medical Science, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anna Neustaeter
- Department of Ophthalmology, Graduate School of Medical Science, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nomdo M Jansonius
- Department of Ophthalmology, Graduate School of Medical Science, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harold Snieder
- Department of Epidemiology, Graduate School of Medical Science, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Mendez-Hernandez C, Wang S, Arribas-Pardo P, Salazar-Quiñones L, Güemes-Villahoz N, Fernandez-Perez C, Garcia-Feijoo J. Diagnostic validity of optic nerve head colorimetric assessment and optical coherence tomography angiography in patients with glaucoma. Br J Ophthalmol 2020; 105:957-963. [PMID: 32703781 PMCID: PMC8237198 DOI: 10.1136/bjophthalmol-2020-316455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/07/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022]
Abstract
Background/Aims The aim of this study was to assess the optic nerve head (ONH) and macular vessel density with optical coherence tomography angiography (OCT-A) and the ONH haemoglobin (ONH Hb) amount with Laguna ONhE program in open-angle glaucoma (OAG) patients. Methods In this prospective observational cross-sectional study, 67 OAG patients and 41 healthy age-sex frequency matched subjects were examined with OCT-A and retinal photos. The circumpapillary (wcpVD), optic nerve head (iVD) and macular (wmVD) capillary vessel density of OCT-A and ONH colorimetric assessment to determine the ONH Hb amount using the Laguna ONhE program were evaluated. Results Significant differences between normal subjects and glaucoma patients in the wcpVD (22.18±3.42 vs 16.03±2.89%; p<0.001), iVD (18.31±5.56 vs 12.52±4.67%; p<0.001), wmVD (15.60±2.34 vs 13.34±2.32%; p<0.001) and amount of ONH Hb (71.10±1.67 vs 68.86±2.46%; p<0.001) and in the papillary cup (68.14±5.25 vs 64.77±5.08%; p=0.001) were found. The Laguna ONhE glaucoma discriminant function (GDF) index had a negative value in the OAG patients and normal values in healthy subjects (−18.76±13.31 vs 7.98±14.09; p<0.001). The area under the receiver operating characteristic (ROC) curve (AUROC) for discriminating between healthy and glaucomatous eyes was highest for wcpVD (0.93; 95% CI 0.86 to 0.97, p<0.0001), followed by GDF (0.92; 95% CI 0.86 to 0.97, p<0.0001), iVD (0.79; 95% CI 0.70 to 0.86; p<0.0001) and ONH Hb (0.78; 95% CI 0.69 to 0.85, p<0.0001). Pair wise comparisons showed that the AUROC of wcpVD (0.93) was not significantly different than GDF (0.92) (p=0.855). Conclusion Laguna ONhE program and OCT-A have similar diagnostic validity in open-angle glaucoma patients.
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Affiliation(s)
- Carmen Mendez-Hernandez
- Ophthalmology, Hospital Universitario Clinico San Carlos, Madrid, Spain .,Inmunología, Oftalmología y ORL, Facultad de Medicina., Universidad Complutense, Madrid, Spain.,OFTARED, Madrid, Spain
| | - Surina Wang
- Ophthalmology, Hospital Universitario Clinico San Carlos, Madrid, Spain.,Inmunología, Oftalmología y ORL, Facultad de Medicina., Universidad Complutense, Madrid, Spain
| | | | - Liseth Salazar-Quiñones
- Ophthalmology, Hospital Universitario Clinico San Carlos, Madrid, Spain.,Inmunología, Oftalmología y ORL, Facultad de Medicina., Universidad Complutense, Madrid, Spain
| | - Noemi Güemes-Villahoz
- Ophthalmology, Hospital Universitario Clinico San Carlos, Madrid, Spain.,Inmunología, Oftalmología y ORL, Facultad de Medicina., Universidad Complutense, Madrid, Spain
| | - Cristina Fernandez-Perez
- Medicina Preventiva, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Julian Garcia-Feijoo
- Ophthalmology, Hospital Universitario Clinico San Carlos, Madrid, Spain.,Inmunología, Oftalmología y ORL, Facultad de Medicina., Universidad Complutense, Madrid, Spain.,OFTARED, Madrid, Spain
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Hommer N, Kallab M, Szegedi S, Puchner S, Stjepanek K, Bauer M, Werkmeister RM, Schmetterer L, Abensperg‐Traun M, Garhöfer G, Schmidl D. The Effect of Orally Administered Dronabinol on Optic Nerve Head Blood Flow in Healthy Subjects-A Randomized Clinical Trial. Clin Pharmacol Ther 2020; 108:155-161. [PMID: 31977076 PMCID: PMC7325313 DOI: 10.1002/cpt.1797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/04/2020] [Indexed: 02/04/2023]
Abstract
It has been hypothesized that besides its intraocular pressure (IOP) lowering potential, tetrahydrocannabinol (THC) may also improve ocular hemodynamics. The aim of the present study was to investigate whether single oral administration of dronabinol, a synthetic THC, alters optic nerve head blood flow (ONHBF) and its regulation in healthy subjects. The study was carried out in a randomized, placebo-controlled, double-masked, two-way crossover design in 24 healthy subjects. For each study participant, 2 study days were scheduled, on which they either received capsules containing 5 mg dronabinol or placebo. ONHBF was measured with laser Doppler flowmetry at rest and while the study participants performed isometric exercise for 6 minutes to increase mean arterial blood pressure (MAP). This was repeated 1 hour after drug intake. Ocular perfusion pressure (OPP) was calculated as 2/3MAP-IOP. Dronabinol was well tolerated and no cannabinoid-related psychoactive effects were reported. Neither administration of dronabinol nor placebo had an effect on IOP, MAP, or OPP. In contrast, dronabinol significantly increased ONHBF at rest by 9.5 ± 8.1%, whereas placebo did not show a change in ONHBF (0.3 ± 7.4% vs. baseline, P < 0.001 between study days). Dronabinol did not alter the autoregulatory response of ONHBF to isometric exercise. In conclusion, the present data indicate that low-dose dronabinol increases ONHBF in healthy subjects without affecting IOP, OPP, or inducing psychoactive side effects. In addition, dronabinol does not alter the autoregulatory response of ONHBF to an experimental increase in OPP. Further studies are needed to investigate whether this effect can also be observed in patients with glaucoma.
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Affiliation(s)
- Nikolaus Hommer
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - Martin Kallab
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - Stephan Szegedi
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - Stefan Puchner
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
- Center for Medical Physics and Biomedical EngineeringMedical University of ViennaViennaAustria
| | - Kristina Stjepanek
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - Martin Bauer
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - René M. Werkmeister
- Center for Medical Physics and Biomedical EngineeringMedical University of ViennaViennaAustria
| | - Leopold Schmetterer
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
- Center for Medical Physics and Biomedical EngineeringMedical University of ViennaViennaAustria
- Singapore Eye Research InstituteSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
- Ophthalmology and Visual Sciences Academic Clinical ProgramDuke‐NUS Medical SchoolSingaporeSingapore
- SERI‐NTU Advanced Ocular Engineering (STANCE)SingaporeSingapore
- Institute of OphthalmologyBaselSwitzerland
| | | | - Gerhard Garhöfer
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - Doreen Schmidl
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
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Wareham LK, Calkins DJ. The Neurovascular Unit in Glaucomatous Neurodegeneration. Front Cell Dev Biol 2020; 8:452. [PMID: 32656207 PMCID: PMC7325980 DOI: 10.3389/fcell.2020.00452] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/15/2020] [Indexed: 12/31/2022] Open
Abstract
Glaucoma is a neurodegenerative disease of the visual system and leading cause of blindness worldwide. The disease is associated with sensitivity to intraocular pressure (IOP), which over a large range of magnitudes stresses retinal ganglion cell (RGC) axons as they pass through the optic nerve head in forming the optic projection to the brain. Despite clinical efforts to lower IOP, which is the only modifiable risk factor for glaucoma, RGC degeneration and ensuing loss of vision often persist. A major contributor to failure of hypotensive regimens is the multifactorial nature of how IOP-dependent stress influences RGC physiology and structure. This stress is conveyed to the RGC axon through interactions with structural, glial, and vascular components in the nerve head and retina. These interactions promote pro-degenerative pathways involving biomechanical, metabolic, oxidative, inflammatory, immunological and vascular challenges to the microenvironment of the ganglion cell and its axon. Here, we focus on the contribution of vascular dysfunction and breakdown of neurovascular coupling in glaucoma. The vascular networks of the retina and optic nerve head have evolved complex mechanisms that help to maintain a continuous blood flow and supply of metabolites despite fluctuations in ocular perfusion pressure. In healthy tissue, autoregulation and neurovascular coupling enable blood flow to stay tightly controlled. In glaucoma patients evidence suggests these pathways are dysfunctional, thus highlighting a potential role for pathways involved in vascular dysfunction in progression and as targets for novel therapeutic intervention.
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Affiliation(s)
- Lauren K Wareham
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - David J Calkins
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
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Wang S, Mendez-Hernandez C, Arribas-Pardo P, Salazar Quiñones L, Fernandez-Perez C, Garcia-Feijoo J. Gender-related Influences on Superficial Papillary Microcirculation Measured with Optical Coherence Tomography Angiography in Patients with Glaucoma. Curr Eye Res 2020; 45:1534-1542. [PMID: 32326764 DOI: 10.1080/02713683.2020.1755698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Purpose: To evaluate the optic nerve head (ONH), macular vessel density, and retinal nerve fiber layer (RNFL) thickness differences between the genders. Material and methods: In this prospective case-control cross-sectional study 111 healthy subjects and 130 primary open-angle glaucoma (OAG) patients were examined with optical coherence tomography angiography (OCT-A (RS-3000 Advance (Nidek, Gamagori, Japan))). The vessel density in the peripapillary and macular area as well as the RNFL thickness was evaluated. Results: Men appeared to have less RNFL thickness compared with women in early glaucomatous group, being significant at the whole circumpapillary retinal nerve fiber layer (cpRNFL) thickness and inferior and nasal quadrants: (cpRNFL) (71.01 ± 9.32 vs 77.64 ± 9.95 μm; P = .001), superior quadrant (89.10 ± 16.63 vs 92.97 ± 17.53 μm; P = .284), inferior quadrant (83.03 ± 19.17 vs 95.07 ± 21.70 μm; P = .006), temporal quadrant (57.11 ± 10.36 vs 61.78 ± 11.37 μm; P = .043), nasal quadrant (54.81 ± 11.42 vs 60.73 ± 11.62 μm; P = .016). Circumpapillary (wcpVD) and macular (wmVD) vessel density values were lower in men than women in the early stage OAG group, being wmVD significantly lower: wcpVD (15.53 ± 2.45% vs 16.81 ± 3.17%, P = .032) and wmVD values (12.51 ± 2.21 vs 13.63 ± 2.28%, P = .019), but not in the moderate OAG group (wcpVD 14.46 ± 2.20% vs 16.61 ± 3.10%, P = .056 and wmVD 12.61 ± 2.40% vs 12.74 ± 2.54%, P = .870). There were no significant differences between men and women for RNFL thickness and the vessel density parameters in normal group. Conclusion: Both, the thickness of the nerve fiber layer and peripapillary and macular vessel density are lower in men than in women with glaucoma, more markedly in early stage glaucomatous patients.
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Affiliation(s)
- Surina Wang
- Department of Ophthalmology, Hospital Clinico San Carlos, Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense , Madrid, Spain
| | - Carmen Mendez-Hernandez
- Department of Ophthalmology, Hospital Clinico San Carlos, Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense , Madrid, Spain
| | | | - Liseth Salazar Quiñones
- Department of Ophthalmology, Hospital Clinico San Carlos, Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense , Madrid, Spain
| | - Cristina Fernandez-Perez
- Clinical Research and Methodology Unit, Facultad de Medicina, Hospital Clínico San Carlos Universidad Complutense de Madrid, Instituto de Investigación Sanitaria San Carlos (IdISSC) , Madrid, Spain
| | - Julian Garcia-Feijoo
- Department of Ophthalmology, Hospital Clinico San Carlos, Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense , Madrid, Spain
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El-Feky YA, Mostafa DA, Al-Sawahli MM, El-Telbany RFA, Zakaria S, Fayez AM, Ahmed KA, Alolayan EM, El-Telbany DFA. Reduction of intraocular pressure using timolol orally dissolving strips in the treatment of induced primary open-angle glaucoma in rabbits. ACTA ACUST UNITED AC 2020; 72:682-698. [PMID: 32170884 DOI: 10.1111/jphp.13239] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 12/17/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To enhance bioavailability of timolol (TML) and utilize alternatives for traditional eye drops for more patient compliance, this study was aiming to develop biodegradable orally dissolving strips (ODSs) of TML for treatment of primary open-angle glaucoma (POAG). METHODS Novel ODSs of TML were formulated and optimized using solvent casting method according to full factorial design (31 .22 ). TML ODSs were characterized with respect to many parameters. In-vivo test was carried out using four groups of 24 New Zealand albino rabbits. POAG was induced by subconjunctival treatment of betamethasone. Histopathological examination and oxidative stress markers assay were carried out. KEY FINDINGS The optimized formula (F9) exhibited a remarkably 15-s disintegration time and 96% dissolution rate after 10 min. The results revealed a potent significant inhibitory effect of the optimized TML ODS to reduce IOP in induced rabbits in comparison with control rabbits and TML eye drops-treated rabbits. The formula showed also high activity against oxidative stress and absence of histopathological changes in iridocorneal angle and cornea. CONCLUSION The ODSs could be a promising alternative delivery system for eye drops with more compliance to enhance delivery and therapeutic activity of TML in treatment of POAG.
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Affiliation(s)
- Yasmin A El-Feky
- Department of Pharmaceutics, Faculty of Pharmacy, Modern University for Technology and Information (MTI), Cairo, Egypt
| | - Dalia A Mostafa
- Department of Pharmaceutics, Faculty of Pharmacy, October University for Modern Sciences and Arts (MSA), Giza, Egypt
| | - Majid M Al-Sawahli
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Kafr Elsheikh University, Kafr Elsheikh, Egypt
| | - Rania Farag A El-Telbany
- Department of Biochemistry, Faculty of Pharmacy, Modern University for Technology and Information (MTI), Cairo, Egypt
| | - Sherin Zakaria
- Department of Pharmacology and Toxicology, Kafr Elsheikh University, Kafr Elsheikh, Egypt
| | - Ahmed M Fayez
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, October University for Modern Sciences and Arts (MSA), Giza, Egypt
| | - Kawkab A Ahmed
- Department of Pathology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Ebtesam M Alolayan
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Dalia Farag A El-Telbany
- Department of Pharmaceutics, Faculty of Pharmacy, Modern University for Technology and Information (MTI), Cairo, Egypt
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Central Corneal Thickness Variances Among Different Asian Ethnicities in Glaucoma and Nonglaucoma Patients. J Glaucoma 2020; 28:223-230. [PMID: 30624387 DOI: 10.1097/ijg.0000000000001180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the central corneal thickness (CCT) between different ethnicities and particularly Asian subethnic groups that may contribute to the different glaucoma diagnoses using the optical low-coherence reflectometry technique. METHODS A retrospective study of 6 years including 1512 eyes of 929 patients of the Beckman vision center, University of California, San Francisco from 2011 to 2017 had their biometric parameters, including CCT, measured with the Lenstar. Patients were categorized into African Americans, Caucasians, Hispanics, Pacific Islanders, and Asians. Asians were further subcategorized into Chinese, Vietnamese, Koreans, Filipinos, and Japanese. RESULTS Among 1356 patients who had their CCT measured by Lenstar from 2011 to 2017, 1512 eyes of 929 patients were included. The study population included 462 Caucasians (52.96%), 60 African Americans (6.46%), 92 Hispanics (9.9%), 32 Pacific Islanders (3.44%), 130 Chinese (13.99%), 52 Filipinos (5.6%), 37 Vietnamese (3.98%), 34 Koreans (3.66%), and 30 Japanese (3.23%). African Americans had the thinnest CCT with a mean of 518.62±40.3 followed by Asians with a mean of 539.29±34.1. Among the Asian study sample, the Chinese had the thinnest CCT with a mean of 537.66±32.5. CCT was adjusted for age, sex, glaucoma diagnosis, diabetes status, and prostaglandin analogs use for >12 months. CONCLUSIONS Optical low-coherence reflectometry is a widely used technology, which can measure CCT. Our study confirms that African Americans have the thinnest corneas followed by Asians. In the latter group, relatively thin CCT may partly explain their high rates of normal-tension glaucoma.
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Ajith TA. Possible therapeutic effect of magnesium in ocular diseases. J Basic Clin Physiol Pharmacol 2019; 31:/j/jbcpp.ahead-of-print/jbcpp-2019-0107/jbcpp-2019-0107.xml. [PMID: 31730524 DOI: 10.1515/jbcpp-2019-0107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 09/06/2019] [Indexed: 12/26/2022]
Abstract
Magnesium (Mg2+) is one of the major elements required to maintain normal metabolism and ionic balances in ocular tissues. The physiological role of Mg2+ is mediated through maintaining the Na+-K+-ATPase on membrane, favoring energy-generating reactions, replication of DNA and protein synthesis. Despite the wide availability of this element, hypomagnesemia has been associated with many human ailments. Recent studies highlighted the association of hypomagnesemia and, thereby, supplementation of Mg2+ in the management of eye diseases. Glaucoma, senile cataract and diabetic retinopathy were associated with low level of extracellular Mg2+. The neurovascular protective effects of Mg2+ mediated through activation of endothelial nitric oxide synthase and inhibition of endothelin-1 eventually result in vasodilatation of retinal vessels. Mg2+ can maintain the lens sodium pump activity and antioxidant status and block the calcium channels and release of glutamate in nerve endings. Furthermore, it can prevent the apoptosis of retinal ganglion cells. All these effects contribute to its being a pharmacological agent against ocular diseases. However, clinical trials are scant. This article discusses the role of Mg2+ as a possible therapeutic agent in the management of glaucoma, cataract and diabetic retinopathy.
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Affiliation(s)
- Thekkuttuparambil A Ajith
- Department of Biochemistry, Amala Institute of Medical Sciences, Amala Nagar, Thrissur 680 555, Kerala, India
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Lim SH, Gu WM, Cha SC. Comparison of the retinal nerve fiber layer and ganglion cell complex thickness in Korean patients with unilateral exfoliation syndrome and healthy subjects. Eye (Lond) 2019; 34:1419-1425. [PMID: 31719674 PMCID: PMC7468570 DOI: 10.1038/s41433-019-0642-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/15/2019] [Accepted: 10/02/2019] [Indexed: 11/16/2022] Open
Abstract
Purpose To compare retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness in patients with unilateral exfoliation syndrome (XFS) and age-matched controls using spectral domain-optical coherence tomography (SD-OCT). Materials and methods This prospective case–control study included 54 eyes (the XFS-affected and the fellow eyes) of 27 unilateral XFS patients and 27 eyes of 27 age-matched control subjects. The RNFL and GCC thicknesses were measured using SD-OCT (RT-Vue 100, Optovue, Fremont, CA) after pupillary dilation. RNFL and GCC thicknesses were compared between case and control groups. Results The mean age of XFS patients was 73.3 years and that of age-matched controls was 74.3 years. Both groups demonstrated a male preponderance. Superior RNFL thickness of XFS-affected eyes were significantly thinner than those of the healthy age-matched controls (P = 0.002 by ANOVA). There were no statistically significant differences in the RNFL thickness between both eyes of unilateral XFS patients. Moreover, superior GCC thickness of both eyes in unilateral XFS patients were thinner than those in controls (P = 0.002 by ANOVA). Conclusions Thinner RNFL and GCC thicknesses were observed in unilateral XFS patients without visual field defects. These findings imply that XFS itself might be a risk factor for development of glaucomatous optic disc and RNFL damage.
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Affiliation(s)
- Su-Ho Lim
- Department of Ophthalmology, Daegu Veterans Health Service Medical Center, Daegu, Republic of Korea
| | - Won Mo Gu
- Department of Ophthalmology, Daegu Premier Eye Center, Daegu, Republic of Korea
| | - Soon Cheol Cha
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Republic of Korea.
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Onishi AC, Treister AD, Nesper PL, Fawzi AA, Anchala AR. Parafoveal vessel changes in primary open-angle glaucoma and normal-tension glaucoma using optical coherence tomography angiography. Clin Ophthalmol 2019; 13:1935-1945. [PMID: 31579266 PMCID: PMC6773972 DOI: 10.2147/opth.s206288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/17/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate parafoveal and peripapillary perfusion in healthy, glaucoma suspect, normal-tension glaucoma, and primary open-angle glaucoma subjects. Patients and methods This was a retrospective cross-sectional study with optical coherence tomography angiography imaging with RTVue XR Avanti (Optovue, Inc., Fremont, CA) of 56 eyes (14 healthy, 14 glaucoma suspect, 16 normal-tension glaucoma, and 12 primary open-angle glaucoma) at a tertiary academic referral center. Parafoveal and peripapillary superficial vessel density and parafoveal superficial retinal thickness were the main parameters of interest. Area under receiver operating characteristic curves were calculated. Results There were significant decreases in parafoveal superficial vessel density in primary open-angle (40.06±4.54%, P<0.001) and normal-tension glaucoma (42.82±5.16%, P=0.010) but not suspect eyes (45.72±4.37%, P=0.916) compared to healthy eyes (48.10±2.82%). Similarly, decreases were observed in parafoveal inner retinal thickness in primary open-angle (83.19±14.29 μm, P<0.001) and normal-tension glaucoma eyes (94.97±12.44 μm, P=0.035), but not suspect eyes (99.93±9.00 μm, P=0.648), compared to healthy controls (107.00±9.55 μm). Only primary open-angle glaucoma eyes displayed significant changes in peripapillary vessel density (37.63±7.19%) compared to healthy controls (49.12±2.80%, P<0.001). Further statistical adjustment for sex and age revealed a significant decrease in parafoveal vessel density in suspects relative to controls (P=0.039). Diagnostic accuracy of parafoveal vessel density was high with an area under the curve of 0.833±0.073 for normal-tension glaucoma and 0.946±0.049 for primary open-angle glaucoma. Conclusion Parafoveal vessel density was significantly reduced in glaucomatous eyes, with good diagnostic accuracy. These findings provide further evidence that these changes may be useful in the diagnosis and monitoring of disease in glaucoma patients.
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Affiliation(s)
- Alex C Onishi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alison D Treister
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Peter L Nesper
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amani A Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Anupama R Anchala
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Onishi AC, Fawzi AA. An overview of optical coherence tomography angiography and the posterior pole. Ther Adv Ophthalmol 2019; 11:2515841419840249. [PMID: 30984909 PMCID: PMC6448101 DOI: 10.1177/2515841419840249] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Indexed: 11/30/2022] Open
Abstract
Optical coherence tomography angiography is a relatively new, noninvasive technology that has revolutionized imaging of the retinal and choroidal microvasculature. This technology is based on the detection of movement or changes that represent moving red cells in sequential optical coherence tomography scans. As with other established imaging technologies, it has unique benefits as well as certain disadvantages, which include a limited field of view and vulnerability to imaging artifacts. However, software and hardware improvements are continually evolving to mitigate these limitations. Optical coherence tomography angiography has been used to gain a better understanding of microvascular changes across a spectrum of ocular diseases including diabetic retinopathy, age-related macular degeneration, glaucoma, and retinal vein occlusions. In this article, we review algorithms and techniques commonly utilized in optical coherence tomography angiography systems and compare optical coherence tomography angiography to fluorescein angiography, the current gold standard for imaging the retinal vasculature. In addition, we provide an overview of important optical coherence tomography angiography findings in a variety of ocular diseases. Although the clinical role of this technology is still poorly defined, optical coherence tomography angiography has the potential to become an invaluable tool in the diagnosis and monitoring of vascular pathologies.
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Affiliation(s)
- Alex C Onishi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amani A Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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43
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Hasan SM, Hammer M, Meller D. Correlation of the Retinal Parapapillary Perfusion and the Retinal Vessel Oxygen Saturation in Glaucoma Patients. ACTA ACUST UNITED AC 2019; 60:1309-1315. [DOI: 10.1167/iovs.18-26099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Somar M. Hasan
- Department of Ophthalmology, Jena University Hospital, Jena, Germany
| | - Martin Hammer
- Department of Ophthalmology, Jena University Hospital, Jena, Germany
| | - Daniel Meller
- Department of Ophthalmology, Jena University Hospital, Jena, Germany
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Abstract
Autonomic dysfunction is a feature of glaucoma patients, which are reported to be related to glaucoma progression. We investigated pupil responses to a light flash using dynamic pupillometry in glaucoma patients to assess autonomic nervous system status. In total, 97 glaucoma patients, including 21 eyes of 21 glaucoma patients with cardiac autonomic dysfunction, were enrolled. Pupil reactions were assessed using 1 flash of white light after 2 minutes of dark adaptation and recorded using dynamic pupillometry. Changes in the radius of the pupil were evaluated as a function of several time-dependent and pupil/iris (P/I) diameter ratio parameters. Autonomic function was assessed using a cardiac heart-rate-variability test which performs 5 autonomic function tests and classifies patients with cardiac autonomic neuropathy (CAN). Comparison of pupil parameters between eyes with and without disc hemorrhage indicated larger P/I ratios in darkness, greater changes in the P/I ratio during examination, shorter latency to plateau, and shorter duration of constriction in eyes with disc hemorrhages. A comparison of pupil parameters between eyes with and without CAN showed larger P/I ratios in darkness, larger P/I ratios at maximum constriction, and prolonged latency to maximum constriction. The presence of CAN was significantly related to the P/I ratio in darkness and the latency of maximum constriction. Using dynamic pupillometry, we found that glaucoma patients with CAN dysfunction have larger baseline pupils in darkness and different constriction responses to light. Assessing the pupils might be a good method of identifying patients with autonomic dysfunction.
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Affiliation(s)
| | | | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal
Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic
University of Korea, Seoul, Republic of Korea
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45
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Xu J, Li Y, Song S, Cepurna W, Morrison J, Wang RK. Evaluating changes of blood flow in retina, choroid, and outer choroid in rats in response to elevated intraocular pressure by 1300 nm swept-source OCT. Microvasc Res 2019; 121:37-45. [PMID: 30267716 PMCID: PMC6286199 DOI: 10.1016/j.mvr.2018.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 01/06/2023]
Abstract
We report the development of a 1300 nm swept-source optical coherence tomography (SS-OCT) system specifically designed to perform OCT imaging and optical microangiography (OMAG) in rat eyes in vivo and its use in evaluating the effects of intraocular pressure (IOP) elevation on ocular circulation. The swept laser is operated in single longitude mode with a 90 nm bandwidth centered at 1300 nm and 200 kHz A-line rate, providing remarkable sensitivity fall-off performance along the imaging depth, a larger field of view of 2.5 × 2.5 mm2 (approximately 35°), and more time-efficient imaging acquisition. The advantage of the SS-OCT/OMAG is highlighted by an increased imaging depth of the entire posterior thickness of optic nerve head (ONH) and its surrounding vascular anatomy, to include, for the first time in vivo, the vasculature at the scleral opening, allowing visualization of the circle of Zinn-Haller and posterior ciliary arteries (PCAs). Furthermore, the capillary-level resolution angiograms achieved at the retinal and choroidal layers over a larger field of view enable a significantly improved quantification of the response of vascular area density (VAD) to elevated IOP. The results indicate that reduction in perfusion of the choroid in response to elevated IOP is delayed compared to that seen in the retina; while choroidal VAD doesn't reach 50% of baseline until ~70 mmHg, the same effect is seen for the retinal VAD at ~60 mmHg. The superior image quality offered by SS-OCT may allow more comprehensive investigation of IOP-related ocular perfusion changes and their pathological roles in glaucomatous optic nerve damage.
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Affiliation(s)
- Jingjiang Xu
- University of Washington, Department of Bioengineering, Seattle, WA 98195, USA
| | - Yuandong Li
- University of Washington, Department of Bioengineering, Seattle, WA 98195, USA
| | - Shaozhen Song
- University of Washington, Department of Bioengineering, Seattle, WA 98195, USA
| | - William Cepurna
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - John Morrison
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Ruikang K Wang
- University of Washington, Department of Bioengineering, Seattle, WA 98195, USA; University of Washington, Department of Ophthalmology, Seattle, WA 98104, USA.
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Cennamo G, Montorio D, Breve MA, Brescia Morra V, Menna F, Cennamo G. Evaluation of optic nerve subarachnoid space in primary open angle glaucoma using ultrasound examination. PLoS One 2018; 13:e0208064. [PMID: 30485355 PMCID: PMC6261615 DOI: 10.1371/journal.pone.0208064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/09/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To measure Optic Nerve Subarachnoid Space (ONSAS) in patients with primary open-angle glaucoma (POAG) and controls using A-scan ultrasound and to evaluate the measurement of the ONSAS in relation to age patient and OCT parameters. METHODS This retrospective study included 53 consecutive eyes of 27 patients with POAG and 64 normal eyes of 32 controls. Both glaucomatous and control groups were divided into 2 subgroups according to age: <60 age (glaucomatous and control group 1) and 61-90 age (glaucomatous and control group 2). RESULTS The ONSAS was significantly lower in all glaucomatous eyes (3.54 ± 0.38) versus normal eyes (3.87 ± 0.32) (p = 0.001). Significant reduction of ONSAS was showed in control group 2 (3.63 mm ± 0.37) compared to control group 1 (3.87 mm ± 0.32) (p = 0.014) and between glaucoma group 1 (3.54 mm ± 0.38) and control group 1 (p = 0.001). While no significant differences were observed between glaucomatous group 2 (3.48 mm ± 0.41) and control group 2 (p = 0.17) and between glaucoma group 1 and glaucoma group 2 (p = 0.609). Lastly, the ONSAS was not significantly associated with GCC and RNFL parameters except for Focal Loss Volume (FLV), Superior RNFL and ONSAS in glaucoma group 1 and for FLV and ONSAS in all glaucomatous group. CONCLUSION Standardized A-scan ultrasound is a non invasive imaging technique with which it is possible to monitor ONSAS changes in glaucomatous patients. The reduction of ONSAS confirm the importance of the lower orbital CSFP as further risk factor in the progression of glaucoma disease.
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Affiliation(s)
- Gilda Cennamo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Daniela Montorio
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Maria Angelica Breve
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Feliciana Menna
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Giovanni Cennamo
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
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Kurysheva NI, Maslova EV, Zolnikova IV, Fomin AV, Lagutin MB. A comparative study of structural, functional and circulatory parameters in glaucoma diagnostics. PLoS One 2018; 13:e0201599. [PMID: 30138396 PMCID: PMC6107119 DOI: 10.1371/journal.pone.0201599] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 07/18/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To compare the diagnostic accuracy of structural parameters, vessel density (VD) measured by optical coherence tomography angiography (OCTA), and electrophysiological testing in diagnosis of primary open-angle glaucoma (POAG). METHODS 35 healthy participants and 90 POAG subjects underwent the measurement of whole image en face (wi) VD in the disc/peripapillary region and macula, the retinal nerve fiber layer (RNFL), and the average thickness of ganglion cell complex (GCC), pattern electroretinograms and pattern visual evoked potentials. The area under the receiver operating characteristic curve (AUC) was assessed for each parameter to differentiate early POAG from healthy eyes and between the POAG stages. RESULTS To distinguish early POAG from healthy eyes, the parameters with the highest AUC were detected: P50 amplitude of transient pattern electroretinogram, 1° (AUC 0.93, p = 0.002), P1 component of steady-state pattern electroretinogram (AUC 0.92, p = 0.003), P100 amplitude of pattern visual evoked potential, 1° (AUC 0.84, p = 0.013), wiVD macula superficial (AUC 0.80, p = 0.001), wiVD Disc (AUC 0.74, p = 0.016), GCC (AUC 0.74, p = 0.016) and to distinguish early POAG from the moderate to severe POAG: inferotemporal peripapillary VD (AUC 0.94, p < 0.0001) and focal loss volume of GCC (AUC 0.92, p < 0, 001). CONCLUSIONS Our results demonstrate the importance of measuring the microcirculation parameters in the macular area along with PERGs and PVEPs for the early detection of glaucoma. VD in the inferotemporal sector of the peripapillary retina and focal loss volume of the GCC are important for monitoring of the disease. The inclusion of OCTA, PERGs and PVEPs in glaucoma diagnostics may improve its early detection and monitoring.
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Affiliation(s)
- Natalia Ivanovna Kurysheva
- Consultative-Diagnostic Department of Ophthalmology Center of the Federal Medical and Biological Agency of the Russian Federation, A.I. Burnazyan Federal Medical and Biophysical Center of FMBA, Ophthalmological Department of the Institute of Improvement of Professional Skill of FMBA, Moscow, Russian Federation
- * E-mail:
| | - Ekaterina Vladimirovna Maslova
- Consultative-Diagnostic Department of Ophthalmology Center of the Federal Medical and Biological Agency of the Russian Federation, A.I. Burnazyan Federal Medical and Biophysical Center of FMBA, Ophthalmological Department of the Institute of Improvement of Professional Skill of FMBA, Moscow, Russian Federation
| | | | - Alexey Valentinovich Fomin
- National Research Institute of Eye Diseases, Russian Academy of Medical Sciences, Moscow, Russian Federation
| | - Mikhail Borisovich Lagutin
- Lomonosov Moscow State University, Faculty of Mechanics and Mathematics, Department of Mathematical Statistics and Stochastic Processes, Moscow, Russian Federation
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48
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Demir MN, Ekşioğlu Ü, Altay M, Tök Ö, Yilmaz FG, Acar MA, Duranay M, Duman S. Retinal nerve fiber layer thickness in chronic renal failure without diabetes mellitus. Eur J Ophthalmol 2018; 19:1034-8. [DOI: 10.1177/112067210901900621] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- M. Necati Demir
- Department of Ophthalmology, Ankara Training and Research Hospital, Ankara
| | - Ümit Ekşioğlu
- Department of Ophthalmology, Ankara Training and Research Hospital, Ankara
| | - Mustafa Altay
- Department of Internal Medicine, Ankara Training and Research Hospital, Ankara - Turkey
| | - Özlem Tök
- Department of Ophthalmology, Ankara Training and Research Hospital, Ankara
| | - F. Gül Yilmaz
- Department of Ophthalmology, Ankara Training and Research Hospital, Ankara
| | - Mehmet A. Acar
- Department of Ophthalmology, Ankara Training and Research Hospital, Ankara
| | - Murat Duranay
- Department of Internal Medicine, Ankara Training and Research Hospital, Ankara - Turkey
| | - Sunay Duman
- Department of Ophthalmology, Ankara Training and Research Hospital, Ankara
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Yap ZL, Verma S, Lee YF, Ong C, Mohla A, Perera SA. Glaucoma related retinal oximetry: a technology update. Clin Ophthalmol 2018; 12:79-84. [PMID: 29379268 PMCID: PMC5757969 DOI: 10.2147/opth.s128459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
There are two long-standing theories about the pathogenesis of glaucoma – barotrauma and the effect of vascular hypoxia. Currently, it is still unknown whether diminished blood flow is the cause or result of glaucomatous atrophy of ganglion cells and the optic nerve. Though many other imaging techniques used to directly assess ocular blood flow have been well studied, they are limited by their inability to directly assess metabolism in the ocular tissues or measure the oxygen carrying capacity in the vessels. Retinal oximetry is a relatively novel, noninvasive imaging technique that reliably measures oxygen saturation levels in the retinal vessels, offering surrogate markers for the metabolic demands of the eye. The clinical significance of these measurements has not been well established. Thus, this review gives an overview of ocular imaging and current retinal oximetry techniques, while contextualizing the important oximetry studies that have investigated the vascular theory behind glaucoma.
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Affiliation(s)
- Zhu Li Yap
- Singapore National Eye Center.,Singapore Eye Research Institute, Singapore
| | | | - Yi Fang Lee
- Singapore National Eye Center.,Singapore Eye Research Institute, Singapore
| | - Charles Ong
- Singapore National Eye Center.,Singapore Eye Research Institute, Singapore
| | - Aditi Mohla
- Singapore National Eye Center.,Singapore Eye Research Institute, Singapore
| | - Shamira A Perera
- Singapore National Eye Center.,Singapore Eye Research Institute, Singapore
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50
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Nitta E, Hirooka K, Shimazaki T, Sato S, Ukegawa K, Nakano Y, Tsujikawa A. Retinal oxygen saturation before and after glaucoma surgery. Acta Ophthalmol 2017; 95:e350-e353. [PMID: 27775227 DOI: 10.1111/aos.13274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 08/27/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE This study compared retinal vessel oxygen saturation before and after glaucoma surgery. METHODS Retinal oxygen saturation in glaucoma patients was measured using a non-invasive spectrophotometric retinal oximeter. Adequate image quality was found in 49 of the 108 consecutive glaucoma patients recruited, with 30 undergoing trabeculectomy, 11 EX-PRESS and eight trabeculotomy. Retinal oxygen saturation measurements in the retinal arterioles and venules were performed at 1 day prior to and at approximately 10 days after surgery. Statistical analysis was performed using a Student's t-test. RESULTS After glaucoma surgery, intraocular pressure (IOP) decreased from 19.8 ± 7.7 mmHg to 9.0 ± 5.7 mmHg (p < 0.001). Although oxygen saturation in retinal arterioles remained unchanged before and after surgery (104.7 ± 10.6% before and 105.4 ± 9.3% after surgery, p = 0.58), the oxygen saturation in the venules increased from 54.9 ± 7.4% to 57.4 ± 5.7% (p = 0.01). CONCLUSION Intraocular pressure (IOP) decreases caused by glaucoma surgery had an effect on the retinal venous oxygen saturation.
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Affiliation(s)
- Eri Nitta
- Department of Ophthalmology; Kagawa University Faculty of Medicine; Kagawa Japan
| | - Kazuyuki Hirooka
- Department of Ophthalmology; Kagawa University Faculty of Medicine; Kagawa Japan
| | - Takeru Shimazaki
- Department of Ophthalmology; Kagawa University Faculty of Medicine; Kagawa Japan
| | - Shino Sato
- Department of Ophthalmology; Kagawa University Faculty of Medicine; Kagawa Japan
| | - Kaori Ukegawa
- Department of Ophthalmology; Kagawa University Faculty of Medicine; Kagawa Japan
| | - Yuki Nakano
- Department of Ophthalmology; Kagawa University Faculty of Medicine; Kagawa Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology; Kagawa University Faculty of Medicine; Kagawa Japan
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