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Jonas JB, Panda-Jonas S, Xu J, Wei W, Wang YX. Prevalence and associations of parapapillary scleral ridges: the Beijing Eye Study. Br J Ophthalmol 2024:bjo-2024-325205. [PMID: 39326896 DOI: 10.1136/bjo-2024-325205] [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: 01/15/2024] [Accepted: 08/19/2024] [Indexed: 09/28/2024]
Abstract
PURPOSE To explore the prevalence and associated factors of parapapillary scleral ridges (PSRs). METHODS Out of the cohort of the population-based Beijing Eye Study (n=3468 participants), the study included all eyes with an axial length of ≥25 mm and a randomised sample of eyes with an axial length of <25 mm. Using optical coherence tomographic (OCT) images and fundus photographs, we examined the presence and height of PSRs, defined as a ridge-like structure located on the OCT scans in the parapapillary region. RESULTS The study cohort consisted of 366 eyes (314 individuals; mean age: 63.7±9.7 years). PSR prevalence increased from 0% in the non-myopic group to 3.8% (95% CI 0.3%, 7.3%) in moderately myopic group and 29.2% (95% CI 15.7%, 42.5%) in the highly myopic group. All PSRs were located in the temporal parapapillary gamma zone and corresponded to an ophthalmoscopically visible demarcation line running almost parallel to the optic disc border. Higher PRS prevalence correlated with longer axial length (OR 2.98; 95% CI 1.99, 4.46; p<0.001), female sex (OR 6.48; 95% CI 1.56, 27.0; p=0.01) and older age (OR 1.09; 95% CI 1.01, 1.18; p=0.02). Axial length had the strongest influence (beta: 0.48), followed by sex (beta: 0.20) and age (beta: 0.14). If age was dropped from the multivariable model, myopic maculopathy prevalence (OR 10.0; 95% CI 1.41,70.9; p=0.02) and stage (OR 3.57; 95% CI 1.21, 10.6; p=0.02) became significantly correlated with higher PSR prevalence. CONCLUSIONS With a PSR prevalence of >60% in eyes with an axial length of >28 mm, PSRs are a common morphological feature of high myopia, with age and female sex as additional associated factors. PSRs may be due to a biomechanical interplay between the optic nerve and the posterior ocular segment of markedly axially elongated eyes.
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Affiliation(s)
- Jost B Jonas
- Rothschild Foundation Hospital, Institute Francais de Myopie, Paris, France
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Privatpraxis Prof Jonas und Dr. Panda-Jonas, Heidelberg, Germany
- Beijing Visual Science and Translational Eye Research Institute (BERI), Beijing Tsinghua Changgung Hospital, Tsinghua Medicine, Tsinghua University, Beijing, China
- New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Songhomitra Panda-Jonas
- Rothschild Foundation Hospital, Institute Francais de Myopie, Paris, France
- Privatpraxis Prof Jonas und Dr. Panda-Jonas, Heidelberg, Germany
- Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jie Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Wenbin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
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Xie J, Patil NS, Popovic MM, Kertes PJ, Muni RH, Schlenker MB, Ahmed IIK, Kohly RP. Association Between Sociodemographic Factors and Self-reported Glaucoma in the National Health Interview Survey: A Population-Based Analysis. Am J Ophthalmol 2024; 263:81-92. [PMID: 38387827 DOI: 10.1016/j.ajo.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/02/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE To investigate the association between social determinants of health (SDH) in the domains of social and community context, education access, environmental context, economic stability, and healthcare access, with glaucoma prevalence. DESIGN Cross-sectional study. METHODS The study population consisted of adult participants who answered glaucoma-related questions on the 2017 National Health Interview Survey (NHIS), the most recent iteration that includes glaucoma-related questions. The main outcome measures included the relationships between SDH-related factors and self-reported glaucoma diagnosis as well as self-reported glaucomatous vision loss were examined using univariable and multivariable regression models. RESULTS In total, 26,696 of 26,742 (99.83%) NHIS respondents were included, of whom 880 (3.30%) reported a glaucoma diagnosis and 275 (1.03%) reported glaucomatous vision loss. Participants were predominantly middle-aged (50.95 ± 18.60 years), female (54.75%), and non-Hispanic White (70.49%). In age-adjusted multivariable regression (n = 25,456), non-Hispanic Black race (odds ratio [OR] = 1.87, 99% CI = [1.37, 2.55], P < .001, compared to non-Hispanic White race) and poor health status (OR = 1.54, 99% CI = [1.00, 2.37], P = .01, compared to good health status) were significant predictors of glaucoma diagnosis. For glaucomatous vision loss, having an income below the poverty threshold (OR = 2.41, 99% CI = [1.12, 5.20], P = .003, compared to income ≥5 times the poverty threshold) was the only significant predictor in univariable analyses. No SDH-related factors were significantly associated with glaucomatous vision loss in multivariable analysis (n = 848). Multicollinearity was minimal (variation inflation factor<1.6 for all independent variables). CONCLUSIONS Non-Hispanic Black race and poor health status were associated with self-reported glaucoma diagnosis. Physicians and policymakers may consider SDH when assessing clinical risk and designing public health interventions.
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Affiliation(s)
- Jim Xie
- From the Michael G. DeGroote School of Medicine (J.M., N.P.), McMaster University, Hamilton, Ontario, Canada
| | - Nikhil S Patil
- From the Michael G. DeGroote School of Medicine (J.M., N.P.), McMaster University, Hamilton, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences (M.P., P.K., R.M., M.S., I.A., R.K.), University of Toronto, Toronto, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences (M.P., P.K., R.M., M.S., I.A., R.K.), University of Toronto, Toronto, Ontario, Canada; John and Liz Tory Eye Centre (P.K, R.K.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Kensington Eye Institute (P.K., M.S.), Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences (M.P., P.K., R.M., M.S., I.A., R.K.), University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology (R.M.), St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Matthew B Schlenker
- Department of Ophthalmology and Vision Sciences (M.P., P.K., R.M., M.S., I.A., R.K.), University of Toronto, Toronto, Ontario, Canada; Kensington Eye Institute (P.K., M.S.), Toronto, Ontario, Canada; Institute for Better Health, Trillium Health Partners (M.S., I.A.), Mississauga, Ontario, Canada
| | - Iqbal Ike K Ahmed
- Department of Ophthalmology and Vision Sciences (M.P., P.K., R.M., M.S., I.A., R.K.), University of Toronto, Toronto, Ontario, Canada; Institute for Better Health, Trillium Health Partners (M.S., I.A.), Mississauga, Ontario, Canada
| | - Radha P Kohly
- Department of Ophthalmology and Vision Sciences (M.P., P.K., R.M., M.S., I.A., R.K.), University of Toronto, Toronto, Ontario, Canada; John and Liz Tory Eye Centre (P.K, R.K.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Swaminathan SS, Berchuck SI, Rao JS, Medeiros FA. Performance of Linear Mixed Models in Estimating Structural Rates of Glaucoma Progression Using Varied Random Effect Distributions. OPHTHALMOLOGY SCIENCE 2024; 4:100454. [PMID: 38317870 PMCID: PMC10838913 DOI: 10.1016/j.xops.2023.100454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/03/2023] [Accepted: 11/21/2023] [Indexed: 02/07/2024]
Abstract
Purpose To compare how linear mixed models (LMMs) using Gaussian, Student t, and log-gamma (LG) random effect distributions estimate rates of structural loss in a glaucomatous population using OCT and to compare model performance to ordinary least squares (OLS) regression. Design Retrospective cohort study. Subjects Patients in the Bascom Palmer Glaucoma Repository (BPGR). Methods Eyes with ≥ 5 reliable peripapillary retinal nerve fiber layer (RNFL) OCT tests over ≥ 2 years were identified from the BPGR. Retinal nerve fiber layer thickness values from each reliable test (signal strength ≥ 7/10) and associated time points were collected. Data were modeled using OLS regression as well as LMMs using different random effect distributions. Predictive modeling involved constructing LMMs with (n - 1) tests to predict the RNFL thickness of subsequent tests. A total of 1200 simulated eyes of different baseline RNFL thickness values and progression rates were developed to evaluate the likelihood of declared progression and predicted rates. Main Outcome Measures Model fit assessed by Watanabe-Akaike information criterion (WAIC) and mean absolute error (MAE) when predicting future RNFL thickness values; log-rank test and median time to progression with simulated eyes. Results A total of 35 862 OCT scans from 5766 eyes of 3491 subjects were included. The mean follow-up period was 7.0 ± 2.3 years, with an average of 6.2 ± 1.4 tests per eye. The Student t model produced the lowest WAIC. In predictive models, all LMMs demonstrated a significant reduction in MAE when estimating future RNFL thickness values compared with OLS (P < 0.001). Gaussian and Student t models were similar and significantly better than the LG model in estimating future RNFL thickness values (P < 0.001). Simulated eyes confirmed LMM performance in declaring progression sooner than OLS regression among moderate and fast progressors (P < 0.01). Conclusions LMMs outperformed conventional approaches for estimating rates of OCT RNFL thickness loss in a glaucomatous population. The Student t model provides the best model fit for estimating rates of change in RNFL thickness, although the use of the Gaussian or Student t distribution in models led to similar improvements in accurately estimating RNFL loss. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Swarup S. Swaminathan
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Samuel I. Berchuck
- Department of Biostatistics & Bioinformatics, Statistical Science, Duke University, Durham, North Carolina
| | - J. Sunil Rao
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Felipe A. Medeiros
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Barquet-Pizá V, Siegfried CJ. Understanding racial disparities of glaucoma. Curr Opin Ophthalmol 2024; 35:97-103. [PMID: 37922412 DOI: 10.1097/icu.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
PURPOSE OF REVIEW Increased prevalence, earlier onset, and more rapid progression to vision loss from glaucoma has demonstrated racial disparity in numerous studies over decades. Precise etiologies of these important differences among patients of African and Hispanic ancestral background have not been elucidated. This review focuses on currently available epidemiologic/population, genetic, socioeconomic and physiologic studies of racial disparities in this blinding disease. RECENT FINDINGS In depth reviews of several landmark studies of glaucoma prevalence in various racial groups have highlighted potential challenges of lack of recruitment of diverse populations in genetic studies and clinical trials, challenges of racial stratification of subjects, and the impact of socioeconomic variables. SUMMARY Through a more comprehensive analysis of racial disparities of glaucoma, both clinicians and researchers may provide more effective population screening and management with a holistic approach for individualized patient care to provide improved outcomes. Future studies of interventions in sociodemographic factors and genetic/physiologic variables that influence the prevalence, access, and consequential vision loss from glaucoma will be crucial to minimize/eliminate racial disparities and improve outcomes for all.
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Affiliation(s)
- Viviana Barquet-Pizá
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
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Khreish M, Schuman JS, Lee T, Ghassabi Z, Zambrano R, Hu J, Ishikawa H, Wollstein G, Lavinsky F. Peripapillary Atrophy Area as an Indicator of Glaucomatous Structural and Functional Progression. Transl Vis Sci Technol 2024; 13:1. [PMID: 38427349 PMCID: PMC10913935 DOI: 10.1167/tvst.13.3.1] [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: 06/02/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Abstract
Purpose To determine whether peripapillary atrophy (PPA) area is an indicator of glaucomatous structural and functional damage and progression. Methods In this retrospective longitudinal analysis from ongoing prospective study we qualified 71 eyes (50 subjects) with glaucoma. All subjects had a comprehensive ophthalmic examination, visual field (VF), and spectral-domain optical coherence tomography (OCT) testing in at least three visits. PPA was manually delineated on en face OCT optic nerve head scans, while observing the corresponding cross-sectional images, as the hyper-reflective area contiguous with the optic disc. Results The mean follow-up duration was 4.4 ± 1.4 years with an average of 6.8 ± 2.2 visits. At baseline, PPA area was significantly associated only with VF's mean deviation (MD; P = 0.041), visual field index (VFI; P = 0.041), superior ganglion cell inner plexiform layer (GCIPL; P = 0.011), and disc area (P = 0.011). Longitudinally, PPA area was negatively and significantly associated with MD (P = 0.015), VFI (P = 0.035), GCIPL (P = 0.009), superior GCIPL (P = 0.034), and disc area (P = 0.007, positive association). Conclusions Longitudinal change in PPA area is an indicator of glaucomatous structural and functional progression but PPA area at baseline cannot predict future progression. Translational Relevance Longitudinal changes in peripapillary atrophy area measured by OCT can be an indicator of structural and functional glaucoma progression.
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Affiliation(s)
- Maroun Khreish
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Joel S. Schuman
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
- Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA
- Department of Electrical and Computer Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA
- Department of Neuroscience and Physiology, NYU Langone Health, New York, NY, USA
- Center for Neural Science, NYU College of Arts and Sciences, New York, NY, USA
| | - TingFang Lee
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Zeinab Ghassabi
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Ronald Zambrano
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Jiyuan Hu
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Hiroshi Ishikawa
- Department of Ophthalmology, Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Gadi Wollstein
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
- Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA
- Center for Neural Science, NYU College of Arts and Sciences, New York, NY, USA
| | - Fabio Lavinsky
- Universidade do Vale do Rio dos Sinos Medical School, Sao Leopoldo, Brazil
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Zhang X, Jiang J, Kong K, Li F, Chen S, Wang P, Song Y, Lin F, Lin TPH, Zangwill LM, Ohno-Matsui K, Jonas JB, Weinreb RN, Lam DSC. Optic neuropathy in high myopia: Glaucoma or high myopia or both? Prog Retin Eye Res 2024; 99:101246. [PMID: 38262557 DOI: 10.1016/j.preteyeres.2024.101246] [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: 10/12/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 01/25/2024]
Abstract
Due to the increasing prevalence of high myopia around the world, structural and functional damages to the optic nerve in high myopia has recently attracted much attention. Evidence has shown that high myopia is related to the development of glaucomatous or glaucoma-like optic neuropathy, and that both have many common features. These similarities often pose a diagnostic challenge that will affect the future management of glaucoma suspects in high myopia. In this review, we summarize similarities and differences in optic neuropathy arising from non-pathologic high myopia and glaucoma by considering their respective structural and functional characteristics on fundus photography, optical coherence tomography scanning, and visual field tests. These features may also help to distinguish the underlying mechanisms of the optic neuropathies and to determine management strategies for patients with high myopia and glaucoma.
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Affiliation(s)
- Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Jingwen Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Kangjie Kong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Fei Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Shida Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Peiyuan Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Yunhe Song
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Fengbin Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Timothy P H Lin
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA.
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland.
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA.
| | - Dennis S C Lam
- The International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China; The C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China.
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Latif K, Nishida T, Moghimi S, Micheletti E, Du K, Weinreb RN. Relationship of Choroidal Microvasculature Dropout and Beta Zone Parapapillary Area With Visual Field Changes in Glaucoma. Am J Ophthalmol 2024; 257:16-24. [PMID: 37573989 DOI: 10.1016/j.ajo.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE To evaluate the association between rates of choroidal microvasculature dropout (MvD) change, beta zone parapapillary atrophy (β-PPA) area change, and visual field (VF) changes in eyes with primary open-angle glaucoma (POAG). DESIGN Retrospective, observational cohort study. METHODS In a tertiary glaucoma clinic, we included 76 eyes from 58 patients with POAG with and without localized MvD, who had ≥2 years of follow-up with a minimum of 4 visits with optical coherence tomography angiography and optical coherence tomography scans. β-PPA area was evaluated using scanning laser ophthalmoscopy-like images and compared with the area of MvD on an en face choroidal vessel density map during the follow-up period. Joint longitudinal mixed effects models were used to estimate the rates of change in β-PPA area or MvD area and VF mean deviation (MD). RESULTS Mean rates of change in β-PPA and MvD area were 0.037 mm2 (95% confidence interval [CI] 0.030-0.043 mm2) per year and 0.039 mm2 (95% CI 0.029-0.048 mm2) per year, respectively, over the mean follow-up of 4.1 years. In multivariable models, MvD area enlargement was significantly associated with faster rates of VF MD loss (0.03 mm2 [95% CI 0.02-0.04 mm2] per 1-dB worse, P < .001) but not β-PPA area enlargement (0.04 mm2 [95% CI 0.03-0.05 mm2] per 1-dB worse, P = .252). CONCLUSION MvD area rates, but not β-PPA area rates, were associated with VF MD loss changes in eyes with POAG. Assessment of MvD is useful for the detection of patients with glaucoma who are at an increased risk of faster VF loss.
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Affiliation(s)
- Kareem Latif
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Takashi Nishida
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Sasan Moghimi
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Eleonora Micheletti
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Kelvin Du
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Robert N Weinreb
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA.
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Jonas JB, Jonas RA, Jonas SB, Panda-Jonas S. Choriocapillaris, Photoreceptors, and Inner Retinal Layer in Spatial Relationship to Parapapillary Alpha, Beta, Gamma, and Delta Zones. Invest Ophthalmol Vis Sci 2023; 64:12. [PMID: 37672285 PMCID: PMC10484042 DOI: 10.1167/iovs.64.12.12] [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: 06/02/2023] [Accepted: 08/09/2023] [Indexed: 09/07/2023] Open
Abstract
Purpose To examine the spatial relationships between the retinal inner nuclear layer (INL), outer nuclear layer (ONL), retinal pigment epithelium (RPE) layer, Bruch's membrane (BM), and choriocapillaris in the parapapillary region. Methods Human eyes enucleated due to uveal melanomas or secondary angle-closure glaucoma were histomorphometrically examined. We compared the tissue dimensions between four groups of eyes categorized based on the presence/absence of high myopia and glaucoma. Results The investigation consisted of 100 globes (axial length: 25.6 ± 3.1 mm; range: 20.0-35.0 mm). In non-highly myopic nonglaucomatous eyes, the INL, ONL, RPE, BM, and choriocapillaris ended approximately at the end of the RPE layer, with no significant (all P ≥ 0.10) difference between the layers in their distance to the RPE-layer end. From non-highly myopic nonglaucomatous eyes to non-highly myopic glaucomatous eyes, highly myopic nonglaucomatous eyes, and eventually highly myopic glaucomatous eyes, the choriocapillaris, INL, and ONL increasingly extended into the beta zone, most marked for the choriocapillaris and least marked for the ONL. A larger extension of the choriocapillaris into the parapapillary beta zone correlated with longer axial length (standardized regression coefficient β, 0.24; B, 23.0; 95% confidence interval [CI], 1.6-44.5; P = 0.04) and wider parapapillary beta zone (β, 0.59; B, 0.32; 95% CI, 0.22-0.41; P < 0.001); a larger extension of the INL correlated with longer axial length (β, 0.34; B, 43.7; 95% CI, 11.6-75.7; P = 0.009), longer gamma zone (β, 0.52; B, 0.28; 95% CI, 0.15-0.41; P < 0.001), and diagnosis of non-highly myopic glaucoma (β, 0.28; B, 267; 95% CI, 80.8-454; P = 0.006); and a larger extension of the ONL into parapapillary beta zone correlated with longer axial length (β, 0.50; B, 32.2; 95% CI, 21.6-42.8; P < 0.001) and wider parapapillary beta zone (β, 0.28; B, 0.10; 95% CI, 0.04-0.16; P < 0.001). Conclusions Nonglaucomatous non-highly myopic eyes differ from highly myopic eyes and glaucomatous eyes in the spatial relationship of the parapapillary tissue layers.
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Affiliation(s)
- Jost B. Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
- Singapore Eye Research Institute, Singapore
| | - Rahul A. Jonas
- Department of Ophthalmology, University of Cologne, Cologne, Germany
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Jonas JB, Jonas RA, Bikbov MM, Wang YX, Panda-Jonas S. Myopia: Histology, clinical features, and potential implications for the etiology of axial elongation. Prog Retin Eye Res 2023; 96:101156. [PMID: 36585290 DOI: 10.1016/j.preteyeres.2022.101156] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/27/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022]
Abstract
Myopic axial elongation is associated with various non-pathological changes. These include a decrease in photoreceptor cell and retinal pigment epithelium (RPE) cell density and retinal layer thickness, mainly in the retro-equatorial to equatorial regions; choroidal and scleral thinning pronounced at the posterior pole and least marked at the ora serrata; and a shift in Bruch's membrane opening (BMO) occurring in moderately myopic eyes and typically in the temporal/inferior direction. The BMO shift leads to an overhang of Bruch's membrane (BM) into the nasal intrapapillary compartment and BM absence in the temporal region (i.e., parapapillary gamma zone), optic disc ovalization due to shortening of the ophthalmoscopically visible horizontal disc diameter, fovea-optic disc distance elongation, reduction in angle kappa, and straightening/stretching of the papillomacular retinal blood vessels and retinal nerve fibers. Highly myopic eyes additionally show an enlargement of all layers of the optic nerve canal, elongation and thinning of the lamina cribrosa, peripapillary scleral flange (i.e., parapapillary delta zone) and peripapillary choroidal border tissue, and development of circular parapapillary beta, gamma, and delta zone. Pathological features of high myopia include development of macular linear RPE defects (lacquer cracks), which widen to round RPE defects (patchy atrophies) with central BM defects, macular neovascularization, myopic macular retinoschisis, and glaucomatous/glaucoma-like and non-glaucomatous optic neuropathy. BM thickness is unrelated to axial length. Including the change in eye shape from a sphere in emmetropia to a prolate (rotational) ellipsoid in myopia, the features may be explained by a primary BM enlargement in the retro-equatorial/equatorial region leading to axial elongation.
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Affiliation(s)
- Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karis-University, Mannheim, Germany; Institute for Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany.
| | - Rahul A Jonas
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | | | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
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10
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Kurysheva NI, Nikitina AD. [Optical coherence tomography and optical coherence tomography angiography for detecting glaucoma progression. Part 1. Study methods, measurement variability and the role of age-related changes]. Vestn Oftalmol 2023; 139:122-128. [PMID: 36924524 DOI: 10.17116/oftalma2023139011122] [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: 03/18/2023]
Abstract
This paper reviews the literature on the role of optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in the diagnosis of glaucoma and considers the significance of evaluating retinal nerve fiber layer and ganglion cell complex in assessment of glaucoma progression, variability and reproducibility of the method, as well as the influence of age-related retinal changes on the results, analyzes the role of OCTA in glaucoma monitoring. Optical coherence tomography is a modern standard for glaucoma diagnosis and monitoring, and OCTA shows high potential as an auxiliary diagnostic tool.
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Affiliation(s)
- N I Kurysheva
- Medical Biological University of Innovations and Continuing Education of the Federal Biophysical Center named after A.I. Burnazyan, Moscow, Russia.,Ophthalmological Center of the Federal Medical-Biological Agency - Federal Medical Biophysical Center named after A.I. Burnazyan, Moscow, Russia
| | - A D Nikitina
- Medical Biological University of Innovations and Continuing Education of the Federal Biophysical Center named after A.I. Burnazyan, Moscow, Russia.,Ophthalmological Center of the Federal Medical-Biological Agency - Federal Medical Biophysical Center named after A.I. Burnazyan, Moscow, Russia
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11
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Stagg BC, Mariottoni EB, Berchuck SI, Jammal AA, Elam AR, Hess R, Kawamoto K, Haaland B, Medeiros FA. Longitudinal visual field variability and the ability to detect glaucoma progression in black and white individuals. Br J Ophthalmol 2022; 106:1115-1120. [PMID: 33985963 PMCID: PMC8589883 DOI: 10.1136/bjophthalmol-2020-318104] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/25/2021] [Accepted: 02/20/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To investigate racial differences in the variability of longitudinal visual field testing in a 'real-world' clinical population, evaluate how these differences are influenced by socioeconomic status, and estimate the impact of differences in variability on the time to detect visual field progression. METHODS This retrospective observational cohort study used data from 1103 eyes from 751 White individuals and 428 eyes from 317 black individuals. Linear regression was performed on the standard automated perimetry mean deviation values for each eye over time. The SD of the residuals from the trend lines was calculated and used as a measure of variability for each eye. The association of race with the SD of the residuals was evaluated using a multivariable generalised estimating equation model with an interaction between race and zip code income. Computer simulations were used to estimate the time to detect visual field progression in the two racial groups. RESULTS Black patients had larger visual field variability over time compared with white patients, even when adjusting for zip code level socioeconomic variables (SD of residuals for Black patients=1.53 dB (95% CI 1.43 to 1.64); for white patients=1.26 dB (95% CI 1.14 to 1.22); mean difference: 0.28 (95% CI 0.15 to 0.41); p<0.001). The difference in visual field variability between black and white patients was greater at lower levels of income and led to a delay in detection of glaucoma progression. CONCLUSION Black patients had larger visual field variability compared with white patients. This relationship was strongly influenced by socioeconomic status and may partially explain racial disparities in glaucoma outcomes.
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Affiliation(s)
- Brian C. Stagg
- Vision, Imaging and Performance (VIP) Laboratory, Duke Eye Center, Durham, North Carolina, USA,Moran Eye Center, University of Utah, Salt Lake City, Utah, USA,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Eduardo B. Mariottoni
- Vision, Imaging and Performance (VIP) Laboratory, Duke Eye Center, Durham, North Carolina, USA
| | - Samuel I. Berchuck
- Vision, Imaging and Performance (VIP) Laboratory, Duke Eye Center, Durham, North Carolina, USA,Department of Statistical Science and Forge, Duke University, Durham, North Carolina, USA
| | - Alessandro A. Jammal
- Vision, Imaging and Performance (VIP) Laboratory, Duke Eye Center, Durham, North Carolina, USA
| | - Angela R. Elam
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA,Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Ben Haaland
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Felipe A. Medeiros
- Vision, Imaging and Performance (VIP) Laboratory, Duke Eye Center, Durham, North Carolina, USA
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Nie F, Ouyang J, Tang W, Luo L, Cao M, Zhang L, Zhou D, Liu K, Ma D, Duan X. Posterior staphyloma is associated with the microvasculature and microstructure of myopic eyes. Graefes Arch Clin Exp Ophthalmol 2021; 259:2119-2130. [PMID: 33404680 PMCID: PMC8352845 DOI: 10.1007/s00417-020-05057-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/06/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the microvasculature and structural characteristics of the eyes of myopic patients and their association with posterior staphyloma (PS). Methods This was a retrospective, case-control study comprising of 106 eyes from 72 individuals. Using 1:1 matching of axial length (AL) of their eyes, patients were allocated into a PS group or no posterior staphyloma (NPS) group. All patients were examined using ultra-widefield fundus imaging, optical coherence tomography angiography, and ocular biometry to acquire microvasculature and microstructure parameters. Results The anterior chamber depth (ACD) of the PS group was significantly different from that of the NPS group (3.56 mm vs 3.76 mm, P < 0.001), as was 1ens thickness (3.72 mm vs 3.57 mm, P = 0.005) and spherical equivalent (SE)(-10.11D vs -8.80D, P = 0.014). The PS group had reduced choriocapillaris flow, subfoveal choroidal thickness (SFCT), and a thinner retinal layer compared with the NPS group. No difference in retinal blood flow between the two groups was observed. The PS group exhibited a smaller disc area (15082.89 vs 17,043.32, P = 0.003) and angle α between temporal retinal arterial vascular arcades (113.29°vs 128.39°, P = 0.003), a larger disc tilt ratio (1.41 vs 1.24, P < 0.001) and parapapillary atrophy (PPA) area (13840.98 vs 8753.86, P = 0.020), compared with the NPS group. Multivariate regression analysis indicated that disc tilt ratio (P = 0.031) and SFCT (P = 0.015) were significant predictors of PS. In addition, PS (P = 0.049), AL (P = 0.003), corneal refractive power (P < 0.001), ACD (P = 0.022), relative lens position (P = 0.045), and disc area (P = 0.011) were significant predictors of SE. Conclusions PS was found to be closely linked to a reduction in choriocapillaris perfusion and anatomical abnormalities including posterior and anterior segments. Furthermore, PS exacerbated the progression of myopia. Supplementary Information The online version contains supplementary material available at 10.1007/s00417-020-05057-0.
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Affiliation(s)
- Fen Nie
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Junyi Ouyang
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China.,Aier Glaucoma Research Institute, Changsha Aier Eye Hospital, Changsha, Hunan, China
| | - Wenquan Tang
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Ophthalmology, Hunan Province Children's Hospital, Changsha, Hunan, China
| | - Lijia Luo
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China.,Aier Glaucoma Research Institute, Changsha Aier Eye Hospital, Changsha, Hunan, China
| | - Mengdan Cao
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lurong Zhang
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Dengming Zhou
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ke Liu
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Daijin Ma
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China
| | - Xuanchu Duan
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China. .,Aier Glaucoma Research Institute, Changsha Aier Eye Hospital, Changsha, Hunan, China.
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13
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Wang YX, Panda-Jonas S, Jonas JB. Optic nerve head anatomy in myopia and glaucoma, including parapapillary zones alpha, beta, gamma and delta: Histology and clinical features. Prog Retin Eye Res 2020; 83:100933. [PMID: 33309588 DOI: 10.1016/j.preteyeres.2020.100933] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/22/2020] [Accepted: 11/27/2020] [Indexed: 12/13/2022]
Abstract
The optic nerve head can morphologically be differentiated into the optic disc with the lamina cribrosa as its basis, and the parapapillary region with zones alpha (irregular pigmentation due to irregularities of the retinal pigment epithelium (RPE) and peripheral location), beta zone (complete RPE loss while Bruch's membrane (BM) is present), gamma zone (absence of BM), and delta zone (elongated and thinned peripapillary scleral flange) within gamma zone and located at the peripapillary ring. Alpha zone is present in almost all eyes. Beta zone is associated with glaucoma and may develop due to a IOP rise-dependent parapapillary up-piling of RPE. Gamma zone may develop due to a shift of the non-enlarged BM opening (BMO) in moderate myopia, while in highly myopic eyes, the BMO enlarges and a circular gamma zone and delta zone develop. The ophthalmoscopic shape and size of the optic disc is markedly influenced by a myopic shift of BMO, usually into the temporal direction, leading to a BM overhanging into the intrapapillary compartment at the nasal disc border, a secondary lack of BM in the temporal parapapillary region (leading to gamma zone in non-highly myopic eyes), and an ocular optic nerve canal running obliquely from centrally posteriorly to nasally anteriorly. In highly myopic eyes (cut-off for high myopia at approximately -8 diopters or an axial length of 26.5 mm), the optic disc area enlarges, the lamina cribrosa thus enlarges in area and decreases in thickness, and the BMO increases, leading to a circular gamma zone and delta zone in highly myopic eyes.
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Affiliation(s)
- Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.
| | - Songhomitra Panda-Jonas
- Institute for Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany
| | - Jost B Jonas
- Institute for Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany; Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karis-University, Mannheim, Germany
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14
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Kim G, Lee EJ, Kim T. Parapapillary choroidal microvasculature dropout in nonglaucomatous healthy eyes. Acta Ophthalmol 2020; 98:e754-e760. [PMID: 32115892 DOI: 10.1111/aos.14385] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/05/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To determine the incidence of parapapillary choroidal microvasculature dropout (MvD) in nonglaucomatous healthy eyes using optical coherence tomography angiography (OCTA) and to characterize the MvD observed in these eyes. METHODS Seventy-six eyes (19 eyes with an MvD and 57 age-matched eyes without an MvD) from a cohort of 297 nonglaucomatous healthy eyes that underwent OCTA were included. The peripapillary choroidal microvasculature was evaluated in en-face images obtained using swept-source OCTA. An MvD was defined as a focal sectoral capillary dropout with no visible microvascular network identified in the en-face images of the choroidal layer. The incidence of MvD and clinical characteristics associated with the presence of an MvD was determined. RESULTS MvD was found in 19 of the 297 nonglaucomatous healthy eyes (6.4%). Compared with age-matched eyes without an MvD, eyes with an MvD had lower systolic blood pressure (p = 0.021), diastolic blood pressure (p = 0.048), mean arterial pressure (p = 0.025) and mean ocular perfusion pressure (p = 0.032). Logistic regression analyses showed that cold extremities (p = 0.046), lower mean arterial pressure (p = 0.021) and lower mean ocular perfusion pressure (p = 0.023) were associated with the presence of an MvD. CONCLUSIONS Parapapillary choroidal MvD can be present in nonglaucomatous healthy eyes. The presence of an MvD is associated with systemic vascular dysregulation.
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Affiliation(s)
- Gyu‐Nam Kim
- Department of Ophthalmology Institute of Health Sciences Gyeongsang National University School of Medicine Gyeongsang National University Hospital Jinju South Korea
| | - Eun Ji Lee
- Department of Ophthalmology Seoul National University College of Medicine Seoul National University Bundang Hospital Seongnam South Korea
| | - Tae‐Woo Kim
- Department of Ophthalmology Seoul National University College of Medicine Seoul National University Bundang Hospital Seongnam South Korea
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15
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Ahmad SS, Tanveer Y, Siddique M, Saleem Z. Controversies in the association of parapapillary atrophy with glaucoma. Taiwan J Ophthalmol 2019; 10:243-249. [PMID: 33437595 PMCID: PMC7787084 DOI: 10.4103/tjo.tjo_64_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/28/2019] [Indexed: 11/11/2022] Open
Abstract
Parapapillary atrophy is a condition which is seen in around 70% of normal individuals. Classically divided into zone alpha and beta, recently, it has been further categorized into zone gamma and delta. Some of these zones of parapapillary atrophy are more prevalent and larger in size in glaucoma patients. Studies have also found the rate of progression of glaucomatous change to be faster in patients with this anomaly. This condition is of clinical significance in glaucoma suspects, as it could be another pointer indicating potential risk of converting to glaucoma. On the contrary, there are other studies which question the relevance of these clinical features in glaucoma patients. In the light of these conflicting reports, it becomes an interesting exercise to explore this controversial area further. This review attempts to determine the role of parapapillary atrophy and its relevance with glaucoma. With this purpose, an online search for this term was conducted on search engines such as PubMed, Google Scholar, and others.
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Affiliation(s)
- Syed Shoeb Ahmad
- Ajmal Khan Tibbiya College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Yusra Tanveer
- Ajmal Khan Tibbiya College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Musab Siddique
- Ajmal Khan Tibbiya College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Zeba Saleem
- Ajmal Khan Tibbiya College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Author Response, "The Water-drinking Test and Glaucoma Progression: Considerations Regarding the Test Usefulness as an Independent Risk Assessment Tool". J Glaucoma 2017; 27:e26-e28. [PMID: 29088050 DOI: 10.1097/ijg.0000000000000805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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