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Chen J, Cao X, Chen X, Li Z, Chen X, Huang S, Xie R, Ye G, Wen Y, Zhuo Y, Wei Y, Zhu Y. Causal relationship between central corneal thickness and open-angle glaucoma: Evidence from Mendelian randomization. Exp Eye Res 2024; 246:110000. [PMID: 38992852 DOI: 10.1016/j.exer.2024.110000] [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: 01/31/2024] [Revised: 05/28/2024] [Accepted: 07/09/2024] [Indexed: 07/13/2024]
Abstract
Glaucoma is the leading cause of irreversible blindness worldwide. Previous observational studies have suggested a relationship between central corneal thickness (CCT) and glaucoma; however, the results are inconsistent. This study aimed to investigate whether CCT is associated with a risk for developing open-angle glaucoma (OAG). We employed two-sample Mendelian randomization to assess the relationship between CCT and OAG, namely, primary open-angle glaucoma (POAG) and suspected glaucoma. Genetic instruments composed of variants associated with CCT at genome-wide significance (P < 5 × 10-8) were obtained from published genome-wide association studies from Iglesias et al. for discovery and Bonnemaijer et al. for replication. Summary-level statistics for these instruments for the OAG were obtained from the FinnGen Project (Release 10). Inverse-variance-weighted regression of genetic susceptibility predicted that increased CCT was positively associated with an increased risk for POAG (odds ratio [OR], 1.005; 95% confidence interval [CI], 1.002-1.008; P = 0.001) and suspected glaucoma (OR, 1.006; 95% CI, 1.003-1.009; P < 0.001). In the replication sample of CCT, increased CCT was also positively associated with an increased risk for POAG (OR, 1.004; 95% CI, 1.000-1.008; P = 0.029) and suspected glaucoma (OR, 1.005; 95% CI, 1.001-1.008; P = 0.013). We found genetic evidence supporting a potential causal association between increased CCT and the risk of POAG and suspected glaucoma in the European population. This findings indicates the clinical significance of CCT in the diagnosis and treatment of glaucoma. Further studies are needed to elucidate the underlying mechanisms of this causal relationship.
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Affiliation(s)
- Jianqi Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Xu Cao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Xiaohong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Zhidong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Xuhao Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Shaofen Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Rui Xie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Guitong Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Yuwen Wen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Yehong Zhuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Yantao Wei
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China.
| | - Yingting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China.
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Yang Y, Xu K, Chen Z, Zhang Y, Ye Q, Ping YT, Fan Y, Liu P, Nathwani N, Jiang Y, Gazzard G, Yu M. Responsiveness to Selective Laser Trabeculoplasty in Open-Angle Glaucoma and Ocular Hypertension. JAMA Ophthalmol 2024:2822693. [PMID: 39172470 PMCID: PMC11342221 DOI: 10.1001/jamaophthalmol.2024.3133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/14/2024] [Indexed: 08/23/2024]
Abstract
Importance Selective laser trabeculoplasty (SLT) is becoming the recommended first choice in the treatment of open-angle glaucoma (OAG). However, whether repeat SLT can be recommended regardless of initial response remains controversial. Objective To assess the potential of OAG and ocular hypertension (OHT) undergoing repeat laser to respond favorably to SLT, termed responsiveness to SLT. Design, Setting, and Participants This post hoc analysis of the Laser in Glaucoma and Ocular Hypertension Trial in China (LiGHT China) was conducted from March 2015 to April 2023 in Zhongshan Ophthalmic Center. Of 1376 newly diagnosed OAG and OHT eyes of 771 adults in the original trial, 180 eyes of 105 participants were included in the present study, which underwent initial and repeat SLT as primary treatments. Exposures Standard SLT was the primary treatment. Repeat SLT was the first choice of treatment escalation regardless of initial response. IOP reduction after SLT and the duration of effect were analyzed. The maximum reduction in IOP within 2 years after initial SLT and repeat SLT was used to identify potential nonresponsiveness. Main Outcomes and Measures IOP reduction 2 months after SLT. Results A total of 180 eyes from 105 Chinese participants (mean [SD] age, 45.6 [14.5] years; 58 [55.2%] male and 47 [44.8%] female) underwent repeat SLT. Initial SLT and repeat SLT were both associated with a reduction in IOP (mean, 4.5 mm Hg; 95% CI, 3.9 to 5.1; P < .001 and mean, 3.3 mm Hg; 95% CI, 2.7 to 3.8; P < .001, respectively). The mean (SD) IOP after repeat SLT was 15.8 (3.4) mm Hg, similar to 16.0 (4.0) mm Hg after initial SLT (difference, -0.4mm Hg; 95% CI, -1.0 to 0.3; P = .24). Duration of effect after repeat SLT was longer than after initial SLT (1043 days vs 419 days; hazard ratio, 0.38; 95% CI, 0.29 to 0.50; P < .001). IOP reduction after initial SLT was uncorrelated with that after repeat SLT, and 153 eyes (85.0%) responded favorably to SLT at least once. A subset of 27 eyes (15.0%) was identified as potentially nonresponsive and found distinctive with older age (mean [SD], 54.1 [12.5] years vs 44.2 [14.2] years; difference, 10.5 years; 95% CI, 2.9 to 18.1; P = .009), higher proportion of female participants (difference, 27.5%; 95% CI, 3.6 to 51.5; P = .03), and lower baseline IOP (difference, -3.2 mm Hg; 95% CI, -5.2 to -1.3; P = .001). Conclusions and Relevance These post hoc analyses showed that most cases of OAG and OHT were highly responsive to SLT and support the consideration of repeat SLT regardless of initial response, while individuals who are nonresponsive to this treatment may have specific features.
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Affiliation(s)
- Yangfan Yang
- 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, China
| | - Kezheng Xu
- 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, China
| | - Zidong 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, China
| | - Yuning 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, China
| | - Qiaona Ye
- 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, China
| | - Yu-Tzu Ping
- 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, China
| | - Yanmei Fan
- 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, China
| | - Pingping Liu
- 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, China
| | - Neil Nathwani
- National Institute for Health and Care Research Biomedical Research Centre at Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
| | - Yuzhen Jiang
- National Institute for Health and Care Research Biomedical Research Centre at Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
| | - Gus Gazzard
- National Institute for Health and Care Research Biomedical Research Centre at Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
| | - Minbin Yu
- 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, China
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Yang Z, Tian D, Zhao X, Luo Y, Chen Y. The gut-retina axis: Uncovering the role of autoimmunity in glaucoma development. Heliyon 2024; 10:e35516. [PMID: 39170439 PMCID: PMC11336731 DOI: 10.1016/j.heliyon.2024.e35516] [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: 04/10/2024] [Revised: 07/27/2024] [Accepted: 07/30/2024] [Indexed: 08/23/2024] Open
Abstract
Glaucoma, a leading cause of irreversible blindness worldwide, is characterized by progressive loss of retinal ganglion cells (RGCs) and optic nerve damage. While elevated intraocular pressure (IOP) is the only known modifiable risk factor, normal-tension glaucoma (NTG) challenges this notion, suggesting other mechanisms beyond IOP may contribute to its development. Emerging evidence support the hypothesis that glaucoma may be an autoimmune disease. This review summarizes evidence for this hypothesis, focusing on the gut-retina axis. We discuss how antigens of gut bacterial prime peripheral T cells to breach the blood-retina barrier (BRB) and initiate cross-reactivity with ocular tissues via molecular mimicry, resulting in autoimmune RGC damage. Understanding these mechanisms may uncover new diagnostic biomarkers and therapeutic strategies targeting immune pathways alongside conventional IOP-lowering treatments.
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Affiliation(s)
- Zuyi Yang
- Eight-year Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dianzhe Tian
- Eight-year Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinyu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yunping Luo
- Department of Immunology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
- Collaborative Innovation Center for Biotherapy, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China
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Lai C, Chuang LH, Lai CC, Liu CF, Yang JW, Chen HSL. Longitudinal changes in optical coherence tomography angiography characteristics in normal-tension glaucoma with or without high myopia. Acta Ophthalmol 2024; 102:e762-e773. [PMID: 38279584 DOI: 10.1111/aos.16644] [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: 07/05/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
PURPOSE To evaluate the structural, microvascular, and functional progression of normal tension glaucoma (NTG) with or without high myopia by examining longitudinal changes in optical coherence tomography angiography (OCTA) and visual field (VF) parameters. METHODS We evaluated 61 NTG eyes and classified 25 of the eyes with axial lengths (ALs) of ≥26 mm as highly myopic. We assessed the rate of change in OCTA parameters, namely radial peripapillary capillary (RPC) vessel density (VD), parafovea VD, deep parafovea VD, retinal nerve fibre layer (RNFL) thickness, and ganglion cell complex thickness. We evaluated the correlation of the rate of change in OCTA parameters with VF loss and AL. RESULTS Among the 61 NTG eyes, rates of loss of RPC VD, parafovea VD, deep parafovea VD, and RNFL thickness were significantly different from zero despite the nonsignificant rate of change in VF mean deviation (MD). Changes in these OCTA parameters did not differ significantly in highly myopic NTG eyes. The rate of change in VF MD was significantly correlated with the rate of change in parafovea VD in highly myopic and non-highly myopic NTG eyes. In highly myopic NTG eyes, AL was negatively correlated with the rates of loss of RNFL thickness, VF MD, and VF PSD. CONCLUSION NTG eyes with a relatively stable VF exhibited loss of VD and RNFL thickness. VF progression in NTG was correlated with decreasing parafovea VD, indicating a structure-function correlation. Greater AL may indicate faster VF loss and RNFL thinning in highly myopic NTG eyes.
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Affiliation(s)
- Chin Lai
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Lan-Hsin Chuang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Fu Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ju-Wen Yang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Henry S L Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
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Terauchi R, Wada T, Fukai K, Tatemichi M, Sano K, Nishijima E, Ogawa S, Noro T, Ito K, Kato T, Kato K, Nakano T. Association Between Days of the Week and Intraocular Pressure: Japan Ningen Dock Study. J Glaucoma 2024; 33:262-269. [PMID: 37974321 DOI: 10.1097/ijg.0000000000002333] [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: 01/23/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
PRCIS The analysis of intraocular pressure (IOP) by day of the week using the mega database showed a periodic weekly pattern with the highest value on Monday. PURPOSE To evaluate IOP by the day of the week. PATIENTS AND METHODS Annual health checkup examinees between April 2014 and March 2015 were cross-sectionally evaluated. As a result, 655,818 participants [51.5±10.5 (range: 20-96) years, 40.1% women] from 103 medical centers were included. IOP was measured using a noncontact tonometer. The mean IOPs of each day of the week were compared using multiple comparison test and multiple linear regression analysis. Wednesday was set as the reference. Moreover, weekly IOP variations stratified by sex and age were also evaluated. RESULTS Mean IOPs from Monday to Sunday were 13.19±2.97, 13.06±2.92, 13.05±2.91, 13.05±2.92, 13.12±2.94, 13.10±2.96, and 13.16±2.78 mm Hg. IOP was significantly higher on Monday, Friday, and Saturday than those on Wednesday ( P <0.001, <0.001, 0.002). After adjusting for factors affecting IOP, the IOPs on Monday and Saturday were higher than those on Wednesday [β=0.097 (95% CI: 0.074-0.121), P <0.001; β=0.032 (95% CI: 0.005-0.059), P =0.019]. Men had significantly higher IOPs on Monday and Saturday than on Wednesday [β=0.142 (95% CI: 0.110-0.173), P <0.001; β=0.053 (95% CI: 0.017-0.089), P =0.004], whereas women did not have a significant trend. Participants aged below 65 years had higher IOPs on Monday ( P <0.001 in under 60 years; P =0.003 in 60-64 years), while those aged 65 years or older did not ( P =0.856). CONCLUSION IOP values may have a periodic weekly pattern. The high IOP on Monday was more pronounced in men aged less than 65 years.
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Affiliation(s)
| | - Takashi Wada
- Health Science, The Jikei University Graduate School of Medicine, Tokyo
| | - Kota Fukai
- Department of Preventive Medicine, Tokai University School of Medicine, Isehara
| | - Masayuki Tatemichi
- Department of Preventive Medicine, Tokai University School of Medicine, Isehara
| | | | | | | | | | - Kyoko Ito
- Centre for Preventive Medicine, The Jikei University School of Medicine
| | - Tomohiro Kato
- Centre for Preventive Medicine, The Jikei University School of Medicine
| | - Kiminori Kato
- Department of Prevention of Noncommunicable Diseases and promotion of Health Checkup, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Richter GM, Takusagawa HL, Sit AJ, Rosdahl JA, Chopra V, Ou Y, Kim SJ, WuDunn D. Trabecular Procedures Combined with Cataract Surgery for Open-Angle Glaucoma: A Report by the American Academy of Ophthalmology. Ophthalmology 2024; 131:370-382. [PMID: 38054909 DOI: 10.1016/j.ophtha.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 12/07/2023] Open
Abstract
PURPOSE To determine the intraocular pressure (IOP) reduction of various trabecular procedures (a form of minimally invasive glaucoma surgery [MIGS]) combined with cataract surgery compared with cataract surgery alone, to compare the safety of the various trabecular procedures, and to highlight patient characteristics that may favor one trabecular procedure over another. METHODS A search of English-language peer-reviewed literature in the PubMed database was initially conducted in February 2021 and updated in April 2023. This yielded 279 articles. Twenty studies met initial inclusion and exclusion criteria and were assessed for quality by the panel methodologist. Of these, 10 were rated level I, 3 were rated level II, and 7 were rated level III. Only the 10 level I randomized controlled trials (RCTs) were included in this assessment, and all were subject to potential industry-sponsorship bias. RESULTS The current analysis focuses on the amount of IOP reduction (in studies that involved medication washout) and on IOP reduction with concurrent medication reduction (in studies that did not involve medication washout). Based on studies that performed a medication washout, adding a trabecular procedure to cataract surgery provided an additional 1.6 to 2.3 mmHg IOP reduction in subjects with hypertensive, mild to moderate open-angle glaucoma (OAG) at 2 years over cataract surgery alone, which itself provided approximately 5.4 to 7.6 mmHg IOP reduction. In other words, adding a trabecular procedure provided an additional 3.8% to 8.9% IOP reduction over cataract surgery alone, which itself provided 21% to 28% IOP reduction. There was no clear benefit of one trabecular procedure over another. Patient-specific considerations that can guide procedure selection include uveitis predisposition, bleeding risk, metal allergy, and narrowing of Schlemm's canal. There are no level I data on the efficacy of trabecular procedures in subjects with pretreatment IOP of 21 mmHg or less. CONCLUSIONS Trabecular procedures combined with cataract surgery provide an additional mild IOP reduction over cataract surgery alone in hypertensive OAG subjects. Additional research should standardize outcome definitions, avoid industry sponsorship bias, and study the efficacy of these procedures in normotensive OAG. 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)
- Grace M Richter
- Department of Ophthalmology, Southern California Permanente Medical Group, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California; USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, California
| | - Hana L Takusagawa
- VA Eugene Healthcare Center, Eugene, Oregon and Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon
| | - Arthur J Sit
- Mayo Clinic, Department of Ophthalmology, Rochester, Minnesota
| | - Jullia A Rosdahl
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Vikas Chopra
- Doheny Eye Centers UCLA and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Yvonne Ou
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Darrell WuDunn
- University of Florida College of Medicine-Jacksonville, Department of Ophthalmology, Jacksonville, Florida
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Bikbov MM, Kazakbaeva GM, Rakhimova EM, Panda-Jonas S, Tuliakova AM, Fakhretdinova AA, Rusakova IA, Jonas JB. Intraocular pressure and its determinants in a very old population. The ural very old study. Heliyon 2024; 10:e25794. [PMID: 38375271 PMCID: PMC10875446 DOI: 10.1016/j.heliyon.2024.e25794] [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: 04/21/2023] [Revised: 12/22/2023] [Accepted: 02/02/2024] [Indexed: 02/21/2024] Open
Abstract
Purpose To explore intraocular pressure (IOP) and its associated parameters in an aged population. Methods The epidemiologic Ural Very Old Study (UVOS) conducted in Bashkortostan/Russia included 1526 participants with an age of ≥85 years. Besides a whole series of ocular and systemic examinations, IOP was determined applying non-contact tonometry. Body mass index, diastolic blood pressure and age were the factors used to estimate the cerebrospinal fluid pressure (CSFP). Results The study consisted of 904 participants (age: 88.6 ± 2.7 years) with available IOP readings and without anti-glaucomatous therapy. Mean IOP was 14.5 ± 5.1 mmHg (median: 14 mm Hg; Q1:11; Q3:16; 95%CI:8,25) and 14.8 ± 4.6 mmHg (median: 14 mm Hg; Q1:12; Q3:17; 95%CI:8,28) in the right and left eyes, respectively. Higher IOP correlated (multivariable analysis; correlation coefficient r2:0.32) with female sex (P < 0.001), more sedentary lifestyle (P = 0.006), higher estimated CSFP (P < 0.001), higher total protein serum concentration (P < 0.001), stronger hand grip force (P = 0.01), thicker central cornea (P < 0.001), longer axial length (P = 0.01), absence of previous cataract surgery (P = 0.001), higher degree of pseudoexfoliation (P = 0.02, and thinner peripapillary retinal nerve fiber layer thickness (P = 0.004). Using this that model, IOP reading enlarged by 0.22 mmHg (95% CI: 0.09, 0.35) for each increase in estimated CSFP by 1 mm Hg, by 0.03 mm Hg (95% CI: 0.02,0.05) for each thickening in central corneal thickness by 1 μm, by 0.56 mm Hg (95%CI: 0.13,1.00) for each axial elongation by 1 mm, and by 0.40 mmHg (95% CI: 0.06,0.74) for each increase in the degree of pseudoexfoliation, and it decreased by 0.40 mmHg (95% CI: 0.06,0.74) by cataract surgery. Conclusions In this study population aged 85+years, IOP readings showed similar relationships as in younger study populations, including positive associations with higher estimated CSFP and longer axial length and a negative association with cataract surgery.
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Affiliation(s)
| | | | | | - Songhomitra Panda-Jonas
- Privatpraxis Prof Jonas und Dr Panda-Jonas, Heidelberg, Germany
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | | | | | - Jost B. Jonas
- Privatpraxis Prof Jonas und Dr Panda-Jonas, Heidelberg, Germany
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Switzerland
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8
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Miki A, Fuse N, Fujimoto S, Taira M, Saito T, Okazaki T, Shiraki A, Sato S, Kawasaki R, Nakamura T, Kinoshita K, Nishida K, Yamamoto M. Prevalence, Associated Factors, and Inter-Eye Differences of Refractive Errors in a Population-Based Japanese Cohort: The Tohoku Medical Megabank Eye Study. Ophthalmic Epidemiol 2024; 31:46-54. [PMID: 37095711 DOI: 10.1080/09286586.2023.2203226] [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: 07/07/2022] [Accepted: 04/09/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE To investigate the prevalence, associated factors, and inter-eye differences of myopia and astigmatism in an adult Japanese population-based cohort. METHODS A total of 4282 participants from the Tohoku Medical Megabank Organization Eye Study (ToMMo Eye Study) underwent comprehensive ocular examinations as well as extensive physiological tests and a lifestyle questionnaire. The spherical equivalent (SE) and cylinder power were obtained as refractive parameters. The age- and gender-stratified prevalences of high myopia (SE < -5D), myopia (SE < -0.5D), hyperopia (SE > 0.5D), astigmatism (cylinder power < -0.5D), and anisometropia (SE difference >1D) were calculated. Multivariable analyses were performed to identify associated factors for refractive error (RE). Distribution and associated factors of the inter-eye difference in RE were also investigated. RESULTS The age-adjusted prevalence of high myopia, myopia, hyperopia, astigmatism, and anisometropia was 15.9%, 63.5%, 14.7%, 51.1%, and 14.7%, respectively. Both myopia and high myopia were more prevalent in the younger age group, while astigmatism was more prevalent in the older age group. Age, education, blood pressure, intraocular pressure, and corneal thickness are significantly associated with myopic refraction. Age, gender, intraocular pressure, and corneal thickness are correlated with astigmatism. Older age was associated with against-the-rule astigmatism. Older age, myopia, and longer education showed a significant correlation with large inter-eye differences in SERE. CONCLUSIONS This study demonstrated the high prevalence of myopia in young Japanese, which may be caused by a generational shift. This study also confirmed the influence of age and education on both the prevalence and inter-eye differences of RE.
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Affiliation(s)
- Atsuya Miki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Myopia Control Resaerch, Aichi Medical University, Aichi, Japan
| | - Nobuo Fuse
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Satoko Fujimoto
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
- Hawaii Macula and Retina Institute, Aiea, HI, USA
| | - Makiko Taira
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomo Saito
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Tomoyuki Okazaki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akihiko Shiraki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Sato
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
- Laboratory of Regenerative Medicine and Development, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Applied Information Science, Tohoku University Graduate School of Information Sciences, Sendai, Japan
| | - Ryo Kawasaki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Vision Informatics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomohiro Nakamura
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Kengo Kinoshita
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Department of Applied Information Science, Tohoku University Graduate School of Information Sciences, Sendai, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Osaka, Japan
| | - Masayuki Yamamoto
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Tohoku University Graduate School of Medicine, Sendai, Japan
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Jayaram H, Kolko M, Friedman DS, Gazzard G. Glaucoma: now and beyond. Lancet 2023; 402:1788-1801. [PMID: 37742700 DOI: 10.1016/s0140-6736(23)01289-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 06/11/2023] [Accepted: 06/19/2023] [Indexed: 09/26/2023]
Abstract
The glaucomas are a group of conditions leading to irreversible sight loss and characterised by progressive loss of retinal ganglion cells. Although not always elevated, intraocular pressure is the only modifiable risk factor demonstrated by large clinical trials. It remains the leading cause of irreversible blindness, but timely treatment to lower intraocular pressure is effective at slowing the rate of vision loss from glaucoma. Methods for lowering intraocular pressure include laser treatments, topical medications, and surgery. Although modern surgical innovations aim to be less invasive, many have been introduced with little supporting evidence from randomised controlled trials. Many cases remain undiagnosed until the advanced stages of disease due to the limitations of screening and poor access to opportunistic case finding. Future research aims to generate evidence for intraocular pressure-independent neuroprotective treatments, personalised treatment through genetic risk profiling, and exploration of potential advanced cellular and gene therapies.
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Affiliation(s)
- Hari Jayaram
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK; UCL Institute of Ophthalmology, London, UK; National Institute for Health and Care Research Moorfields Biomedical Research Centre, London, UK
| | - Miriam Kolko
- Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark; University of Copenhagen, Department of Drug Design and Pharmacology, Copenhagen, Denmark
| | - David S Friedman
- Massachusetts Eye and Ear Hospital, Glaucoma Center of Excellence, Boston, MA, USA; Harvard University, Boston, MA, USA
| | - Gus Gazzard
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK; UCL Institute of Ophthalmology, London, UK; National Institute for Health and Care Research Moorfields Biomedical Research Centre, London, UK.
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10
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Sharfuddin Ahmed M, Ullah AY, Barman N, Ratan ZA, Mostafa S, Khaleque A, Kabir S, Khan MH, Haque MA. Risk factors associated with elevated intraocular pressure: a population-based study in a rural community of Bangladesh. BMJ Open Ophthalmol 2023; 8:e001386. [PMID: 37844969 PMCID: PMC10582991 DOI: 10.1136/bmjophth-2023-001386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/25/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE High intraocular pressure (IOP) is one of the major modifiable risk factors for glaucoma. The objective was to examine socio-demographic and clinical factors related to IOP. METHODS AND ANALYSIS This study was conducted among 3097 adults residing in a rural area of Bangladesh, with all participants undergoing clinical and ophthalmological evaluations. The measurement of IOP was carried out using of a rebound Tonometer called Icare pro. Multiple logistic regression analysis was employed to identify variables associated to IOP levels of 21 mm Hg or above. Adjusted OR (aOR) and 95% CI were reported. RESULTS This study found that, in total, 9% of the study population had high IOP in one or both eyes. Elevated IOP was significantly associated with respondents who were service holders (aOR 2.52; 95% CI 1.48 to 4.31), had a lower education level (aOR 1.55, 95% CI 1.07 to 2.23), used biomass fuel (aOR 2.00; 95% CI 1.09 to 3.67), belonged to a higher socioeconomic position (aOR 1.55, 95% CI 1.07 to 2.23) and had obesity (aOR 2.00; 95% CI 1.07 to 3.73), hypertension (aOR 1.32; 95% CI 1.01 to 1.73) or history of diabetes (aOR 2.44; 95% CI 1.67 to 3.55), after adjusting for covariates including age, sex, marital status, light source and tobacco consumption, in a multiple regression analysis. CONCLUSION Chronic diseases, such as hypertension and diabetes, obesity and sociodemographic characteristics such as high socioeconomic status and use of biomass fuels, have all been linked to elevated IOP. Patients with chronic diseases should undergo for IOP testing regularly.
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Affiliation(s)
- Md Sharfuddin Ahmed
- Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Abm Yasin Ullah
- Department of Vitreo-Retina, National Institute of Ophthalmology and Hospital, Dhaka, Bangladesh
| | - Nilima Barman
- Department of Laboratory Medicine, Bangladesh Institute of Research and Rehabilitation of Diabetes Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Zubair Ahmed Ratan
- Department of Biomedical Engineering, Khulna University of Engineering and Technology, Khulna, Bangladesh
| | | | - Abdul Khaleque
- Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Showkat Kabir
- Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Maruf Haque Khan
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - M Atiqul Haque
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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11
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Central corneal thickness and its associations in a Russian population. The Ural eye and Medical Study. Eye (Lond) 2023; 37:705-713. [PMID: 35347290 PMCID: PMC9998395 DOI: 10.1038/s41433-022-02026-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/28/2022] [Accepted: 03/11/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To assess central corneal thickness (CCT) and its associations in a Russian population. METHODS The population-based Ural Eye and Medical Study included 5899 (80.5%) out of 7328 eligible individuals. As part of an ophthalmological and general examination, CCT was measured by Scheimflug imaging. RESULTS The study included 5792 (98.2%) participants (age:58.8 ± 10.6 years;range: 40-94 years) with available bilateral CCT measurements. Mean CCT was larger in Russians than non-Russians (549.5 ± 32.8 µm versus 539.2 ± 33.9 µm; P < 0.001). In multivariable analysis, thicker CCT was associated (regression coefficient r:0.43) with younger age (standardized regression coefficient beta:-0.09; non-standardized regression coefficient B:-0.29;95% confidence interval (CI):-0.39,-0.20; P < 0.001), male sex (beta:0.05; B:3.10; 95%CI:1.18,5.03; P = 0.002), urban region of habitation (beta:0.10; B:6.83; 95%CI:4.61, 9.05; P < 0.001), Russian ethnicity (beta:0.04; B:3.48; 95%CI:1.04, 5.91; P = 0.005), higher level of education (beta:0.04; B:0.97;95%CI:0.29,1.66; P = 0.006), higher serum bilirubin concentration (beta:0.05;B:0.15; 95%CI:0.07,0.23;P < 0.001), lower corneal refractive power (beta:-0.09;B:11.92; 95%CI:-2.50,-1.35; P < 0.001), smaller anterior chamber angle (beta:-0.07;B:-0.38;95%CI:-0.52,-0.24;P < 0.001), higher IOP readings (beta:0.38; B:3.47; 95%CI:3.21,3.73; P < 0.001), and higher rise in IOP readings by medical mydriasis (beta:0.07; B:0.88;95%CI:0.54,1.22;P < 0.001). In that model, CCT was not associated with body height (P = 0.14), previous cataract surgery (P = 0.10), axial length (P = 0.18) or prevalence of glaucoma (P = 0.11). The mean inter-eye difference in CCT was 8.52 ± 13.9 µm (median:6.0;95CI:8.16,8.88). A higher inter-eye CCT difference was associated with older age (beta:0.08; B:0.11;95%CI:0.07,0.15; P = 0.01), lower level of education (beta:-0.04;B:-0.34; 95%CI:-0.60,-0.08; P < 0.001) and status after cataract surgery (beta:0.04; B:2.92;95%CI:1.02,4.83; P = 0.003). INTRODUCTION CONCLUSIONS In this ethnically mixed population from Russia with an age of 40+ years, mean CCT (541.7 ± 33.7 µm) was associated with parameters such as younger age, male sex, Russian ethnicity, and higher educational level. These associations may be taken into account when the dependence of IOP readings on CCT are considered. Glaucoma prevalence was unrelated to CCT.
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12
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Li J, Du J, Deng A, Chen Z, Guo Y, Wang Z. Comparative Analysis of Central Corneal Thickness in Four Fish Models. Zebrafish 2022; 19:224-228. [PMID: 36459623 DOI: 10.1089/zeb.2022.0016] [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: 12/04/2022] Open
Abstract
To understand the left-right asymmetry of vertebrate eyes, this study measured the central corneal thickness (CCT) of Oryzias curvinotus, Oryzias melastigma, Oryzias latipes, and zebrafish with optical coherence tomography. The results showed that the CCTs were significant differences among different species and groups, even between the right and left eyes of each fish. The values of the CCTs (mean ± SD, μm) for the four species were 104.71 ± 14.49, 61.88 ± 8.63, 64.76 ± 10.36 and 56.96 ± 10.48, respectively. Moreover, comparing the two wild groups of O. curvinotus from Sanya on N18° and Gaoqiao on N21°, the CCT value for the low-latitude group was 104.71 ± 14.49 μm, greater than the high latitude group 76.13 ± 5.70 μm significantly (t-test, p = 0.0001). Lastly, the paired Student's t-test revealed that significant CCT differences existed between the left and right eye for all four species and groups, of which zebrafish and O. melastigma were belonging to the left thicker type in contrast to the others. This study laid a foundation for understanding the causes of the difference in CCT, and also provided possible fish models for human researches on keratomileusis, glaucoma, and other corneal diseases.
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Affiliation(s)
- Jinpeng Li
- Guangdong South China Sea Key Laboratory of Aquaculture for Aquatic Economic Animals, Fisheries College, Guangdong Ocean University, Zhanjiang, China
| | - Juan Du
- Guangdong South China Sea Key Laboratory of Aquaculture for Aquatic Economic Animals, Fisheries College, Guangdong Ocean University, Zhanjiang, China
| | - Aiping Deng
- Guangdong South China Sea Key Laboratory of Aquaculture for Aquatic Economic Animals, Fisheries College, Guangdong Ocean University, Zhanjiang, China
| | - Ziyang Chen
- Guangdong South China Sea Key Laboratory of Aquaculture for Aquatic Economic Animals, Fisheries College, Guangdong Ocean University, Zhanjiang, China
| | - Yusong Guo
- Guangdong South China Sea Key Laboratory of Aquaculture for Aquatic Economic Animals, Fisheries College, Guangdong Ocean University, Zhanjiang, China.,Guangdong Provincial Engineering Laboratory for Mariculture Organism Breeding, Fisheries College, Guangdong Ocean University, Zhanjiang, China.,Guangdong Provincial Key Laboratory of Pathogenic Biology and Epidemiology for Aquatic Economic Animals, Fisheries College, Guangdong Ocean University, Zhanjiang, China
| | - Zhongduo Wang
- Guangdong South China Sea Key Laboratory of Aquaculture for Aquatic Economic Animals, Fisheries College, Guangdong Ocean University, Zhanjiang, China.,Guangdong Provincial Engineering Laboratory for Mariculture Organism Breeding, Fisheries College, Guangdong Ocean University, Zhanjiang, China.,Guangdong Provincial Key Laboratory of Pathogenic Biology and Epidemiology for Aquatic Economic Animals, Fisheries College, Guangdong Ocean University, Zhanjiang, China
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13
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Terauchi R, Wada T, Fukai K, Tatemichi M, Ogawa S, Noro T, Ito K, Kato T, Kato K, Nakano T. Age-Related Changes in Intraocular Pressure: Japan Ningen Dock Study. J Glaucoma 2022; 31:927-934. [PMID: 36001501 DOI: 10.1097/ijg.0000000000002115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/21/2022] [Indexed: 12/29/2022]
Abstract
PRCIS The analysis of intraocular pressure by age using a mega database showed a consistent age-related intraocular pressure decrease. PURPOSE To clarify the association between age and intraocular pressure (IOP), the IOP value by age was assessed using a large IOP database. MATERIALS AND METHODS This cross-sectional study was conducted among 103 health checkup institutions registered to the Japan Society of Ningen Dock, and included participants who underwent annual health checkups between April 2014 and March 2015. The inclusion criteria were as follows: complete data for IOP in eyes, body mass index, waist circumference, blood pressure, hemoglobin A1c, and a self-administered health questionnaire. A total of 655,818 participants were enrolled. The mean age was 51.5±10.5 years (range, 20-96 y), and 40.1% were women. IOP was measured using a noncontact tonometer. Multiple linear regression analysis was conducted to explore factors associated with IOP, including age, and analyses stratified by age group: <40, 40-69, and ≥70 years. RESULTS A consistent negative association between IOP and age [β=-0.353 (95% confidence interval: -0.360--0.346)] was observed. In the age groups of <40 and ≥70 years, the age-related IOP decline was more pronounced [β=-0.502 (95% CI: -0.566 to -0.439); β=-0.674 (95% CI: -0.753 to -0.595)], with it being 14.21±2.95 and 11.18±2.52 mm Hg in the 20-24 and 90-96 year age groups, respectively. The middle-aged (aged 40-69 y) population showed gradual decline [β=-0.313 (95% CI: -0.323 to -0.303)]. CONCLUSION Age was strongly and negatively associated with IOP. The magnitude of IOP decline across lifespans was ∼3 mmHg. Age-related decreases in IOP were nonlinear and phasic.
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Affiliation(s)
- Ryo Terauchi
- Department of Ophthalmology, The Jikei University School of Medicine
| | - Takashi Wada
- Health Science, The Jikei University Graduate School of Medicine, Tokyo
| | - Kota Fukai
- Department of Preventive Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Masayuki Tatemichi
- Department of Preventive Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Shumpei Ogawa
- Department of Ophthalmology, The Jikei University School of Medicine
| | - Takahiko Noro
- Department of Ophthalmology, The Jikei University School of Medicine
| | - Kyoko Ito
- Centre for Preventive Medicine, The Jikei University School of Medicine, Tokyo Japan
| | - Tomohiro Kato
- Centre for Preventive Medicine, The Jikei University School of Medicine, Tokyo Japan
| | - Kiminori Kato
- Department of Prevention of Noncommunicable Diseases and promotion of Health Checkup, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tadashi Nakano
- Department of Ophthalmology, The Jikei University School of Medicine
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14
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Asian Race and Primary Open-Angle Glaucoma: Where Do We Stand? J Clin Med 2022; 11:jcm11092486. [PMID: 35566612 PMCID: PMC9099679 DOI: 10.3390/jcm11092486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/19/2022] [Accepted: 04/24/2022] [Indexed: 01/27/2023] Open
Abstract
Primary open-angle glaucoma (POAG) is an optic neuropathy characterized by irreversible retinal ganglion cell damage and visual field loss. The global POAG prevalence is estimated to be 3.05%, and near term is expected to significantly rise, especially within aging Asian populations. Primary angle-closure glaucoma disproportionately affects Asians, with up to four times greater prevalence of normal-tension glaucoma reported compared with high-tension glaucoma. Estimates for overall POAG prevalence in Asian populations vary, with Chinese and Indian populations representing the majority of future cases. Structural characteristics associated with glaucoma progression including the optic nerve head, retina, and cornea are distinct in Asians, serving as intermediates between African and European descent populations. Patterns in IOP suggest some similarities between races, with a significant inverse relationship between age and IOP only in Asian populations. Genetic differences have been suggested to play a role in these differences, however, a clear genetic pattern is yet to be established. POAG pathogenesis differs between Asians and other ethnicities, and it may differ within the broad classification of the Asian race. Greater awareness and further research are needed to improve treatment plans and outcomes for the increasingly high prevalence of normal tension glaucoma within aging Asian populations.
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15
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Leung DYL, Tham CC. Normal-tension glaucoma: Current concepts and approaches-A review. Clin Exp Ophthalmol 2022; 50:247-259. [PMID: 35040248 DOI: 10.1111/ceo.14043] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 12/19/2022]
Abstract
Normal tension glaucoma (NTG) has remained a challenging disease. We review, from an epidemiological perspective, why we should redefine normality, act earlier at lower pre-treatment intraocular pressure (IOP) level, and the role of ocular perfusion pressures, noting that perfusion is affected by defective vascular bed autoregulation and endothelial dysfunction. The correlation of silent cerebral infarcts (SCI) and NTG may indicate that NTG belongs to a wider spectrum of small vessel diseases (SVD), with its main pathology being also on vascular endothelium. Epidemiological studies also suggested that vascular geometry, such as fractal dimension, may affect perfusion efficiency, occurrence of SCI, SVD and glaucoma. Artificial intelligence with deep learning, may help predicting NTG progression from vascular geometry. Finally, we review latest evidence on the role of minimally-invasive glaucoma surgery, lasers, and newer drugs. We conclude that IOP is not the only modifiable risk factors as, many vascular risk factors are readily modifiable.
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Affiliation(s)
- Dexter Y L Leung
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong SAR, China
- Department of Ophthalmology, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong SAR, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China
- Lam Kin Chung . Jet King-Shing Ho Glaucoma Treatment and Research Centre, The Chinese University of Hong Kong, Hong Kong SAR, China
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16
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Yang Y, Zhang X, Chen Z, Wei Y, Ye Q, Fan Y, Nathwani N, Gazzard G, Yu M. Intraocular pressure and diurnal fluctuation of open-angle glaucoma and ocular hypertension: a baseline report from the LiGHT China trial cohort. Br J Ophthalmol 2022; 107:823-827. [PMID: 35086806 DOI: 10.1136/bjophthalmol-2021-320128] [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: 07/27/2021] [Accepted: 12/17/2021] [Indexed: 01/07/2023]
Abstract
AIMS To report the baseline intraocular pressure (IOP) characteristics and its diurnal fluctuation in the Laser in Glaucoma and Ocular Hypertension China cohort. METHODS 622 primary open-angle glaucoma (POAG) patients and 149 ocular hypertension (OHT) patients were recruited at Zhongshan Ophthalmic Center from 2015 to 2019. Standardised ocular examinations were performed including IOP measurement using the Goldmann applanation tonometer. Daytime phasing IOP was recorded at 8:00, 10:00, 11:30, 14:30, 17:00 hour. RESULTS The mean baseline IOP was 20.2 mm Hg for POAG patients and 24.4 mm Hg for OHT. Multiple regression analysis revealed that thicker central corneal thickness (CCT) was correlated with higher IOP in both POAG and OHT. Male gender and younger age were correlated with higher IOP only for POAG. As for diurnal IOP fluctuation, mean IOP fluctuation was 3.4 mm Hg in POAG eyes and 4.4 mm Hg in OHT. The peak and trough IOP occurred at 8:00 and 14:30 hour in both POAG and OHT eyes. CONCLUSIONS Younger age, male gender and thicker CCT are correlated to higher IOP in POAG patients while only thicker CCT is related to higher IOP in OHT patients. Peak IOP appears mostly at early morning or late afternoon and trough value occurs mostly at early afternoon.
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Affiliation(s)
- Yangfan Yang
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Xinyi Zhang
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Zidong Chen
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Yifan Wei
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Qiaona Ye
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Yanmei Fan
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Neil Nathwani
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Gus Gazzard
- NIHR Moorfields Biomedical Research Centre, London, UK.,University College London, London, UK
| | - Minbin Yu
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
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17
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Khan S, Kirubarajan A, Lee M, Pitha I, Buckey JC. The Correlation Between Body Weight and Intraocular Pressure. Aerosp Med Hum Perform 2021; 92:886-897. [PMID: 34819215 DOI: 10.3357/amhp.5769.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION: Preflight body weight is a strong predictor of visual changes in spaceflight. To understand the effect of body weight on the eye, we examined the effect of increased body mass index on intraocular pressure on Earth.METHODS: We conducted a systematic review to summarize the relationship between weight parameters (including body mass index (BMI) and obesity indices), and intraocular pressure (IOP). Study selection and data extraction were performed in duplicate using EMBASE, MEDLINE, and CENTRAL, from database inception to the second week of April 2020.RESULTS: A total of 66 individual studies were included for qualitative analysis from the 1364 studies eligible for title and abstract screening. A total of 39 studies were available for quantitative analysis. The average BMI was 25.9 (range, 20.148.8) and the average IOP was 14.9 mmHg (range, 11.627.8). The overall pooled RR between BMI and elevated intraocular pressure (IOP) was 1.06 (95 CI%, 1.041.07), meaning for each unit increase in BMI one is 6 more likely of having higher IOP than baseline. Two studies assessed the effects of bariatric surgery, and both showed significant decreases in IOP postoperatively.CONCLUSION: A higher BMI was associated with increased IOP in ground-based studies. IOP also decreased with weight loss. These data support the idea that alterations in body weight affect intraocular pressures. Further research is needed to understand the relationship between body weight, IOP, and microgravity-induced visual changes. This finding may also be useful clinically.Khan S, Kirubarajan A, Lee M, Pitha I, Buckey JC Jr. The correlation between body weight and intraocular pressure. Aerosp Med Hum Perform. 2021; 92(11):886-897.
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Morettin CE, Roberts DK, Newman TL, Yang Y, McMahon JM, Roberts MF, Teitelbaum BA, Winters JE. Time-of-Year Variation in Intraocular Pressure. J Glaucoma 2021; 30:952-962. [PMID: 34402464 PMCID: PMC8563404 DOI: 10.1097/ijg.0000000000001930] [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: 03/28/2021] [Accepted: 07/29/2021] [Indexed: 11/26/2022]
Abstract
PRÉCIS In this study conducted in Chicago, IL, intraocular pressure (IOP) level was found to have a subtle, but measurable, annual pattern. Reasonable evidence is presented for a time-of-year variation in IOP. Adequate numbers of subjects must be studied to detect this small variation. PURPOSE The aim was to investigate the relationship between IOP and time of year. METHODS During a separate investigation, patients from 2011 to 2018 (dataset A, N=3041) in an urban, academic facility in Chicago, IL received an examination that included Goldmann applanation tonometry. Regression analyses assessed the relationship between time of year and IOP. Two additional datasets, 1 collected in a similar manner during 1999 and 2002 (dataset B, N=3261) and another consisting of all first visits during 2012 and 2017 (dataset C, N=69,858), were used to confirm and further investigate trends. RESULTS For dataset A, peak mean IOP occurred in December/January (15.7±3.7/15.7±3.8 mm Hg) and lowest in September (14.5±3.1 mm Hg). The analysis suggested conventional quarterly analysis (January to March, etc.) can conceal time-of-year relationships because of inadequate statistical power and timing of IOP variation. Multiple linear regression analysis, with a November-to-October reordering, detected an annual, downward IOP trend (P<0.0001). Analysis of dataset B confirmed this trend (P<0.001). Fourier analysis on datasets A and B combined supported a 12-month IOP cycle for right/left eyes (P=0.01/P=0.005) and dataset C provided stronger evidence for an annual periodicity (P<0.0001). Harmonics analysis of dataset C showed a repeating pattern where IOP trended downward around April, and then back upward around October. CONCLUSIONS This analysis strongly supports a demonstrable annual, cyclical IOP pattern with a trough to peak variation of ≈1 mm Hg, which has a seasonal relationship.
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Affiliation(s)
- Christina E. Morettin
- Illinois Eye Institute, Illinois College of Optometry, Department of Clinical Education, Chicago, IL, USA
| | - Daniel K. Roberts
- Illinois Eye Institute, Illinois College of Optometry, Department of Clinical Education, Chicago, IL, USA
- University of Illinois at Chicago, School of Medicine, Department of Ophthalmology and Visual Sciences, Chicago, IL, USA
- University of Illinois at Chicago, School of Public Health, Division of Epidemiology and Biostatistics, Chicago, IL, USA
| | - Tricia L. Newman
- Illinois Eye Institute, Illinois College of Optometry, Department of Clinical Education, Chicago, IL, USA
| | - Yongyi Yang
- Illinois Institute of Technology, Department of Electrical and Computer Engineering, Chicago, IL, USA
| | - Janice M. McMahon
- Illinois Eye Institute, Illinois College of Optometry, Department of Clinical Education, Chicago, IL, USA
| | - Mary Flynn Roberts
- Illinois Eye Institute, Illinois College of Optometry, Department of Clinical Education, Chicago, IL, USA
| | - Bruce A. Teitelbaum
- Illinois Eye Institute, Illinois College of Optometry, Department of Clinical Education, Chicago, IL, USA
| | - Janis E. Winters
- Illinois Eye Institute, Illinois College of Optometry, Department of Clinical Education, Chicago, IL, USA
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Kassa MS, Gessesse GW. Ocular Biometry and Intra Ocular Lens Power among Cataract Patients in Rural Eastern Ethiopia. Ethiop J Health Sci 2021; 31:823-830. [PMID: 34703182 PMCID: PMC8512937 DOI: 10.4314/ejhs.v31i4.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background The objective of the study was to report on the main parameters of ocular biometry and Intraocular lens (IOL)power of patients attending a cataract surgical campaign in Eastern Ethiopia. Methods The study was a cross-sectional study on 765 eyes which were eligible for cataract surgery during a mass cataract surgical campaign conducted from April 04 to April 10, 2018 at Bisidimo Hospital, Eastern Ethiopia. Ocular biometric parameters were measured by automated keratorefractometer and Sonomed A-Scan (Model 300AP) using contact applanation method. Multiple linear regression analysis was done to determine association of ocular biometry components with socio demography of the study subjects. Results The mean corneal curvature and anterior chamber depth (ACD, measured from corneal epithelium to lens) were found to be 7.61 mm and 2.88mm respectively. The mean axial length was estimated to be 22.98 mm. The mean refractive power of IOL was calculated to be 19.34D. The mean axial length in females was shorter than that of males by 0.24 (P - value = 0.01). The mean ACD in males was also larger than that of females by 0.1 (P - value = 0.001). Conclusion This study provided a larger population based normative data on ocular biometry in Ethiopia. The female sex was a strong predictor of small axial length. Increasing age had no effect on axial length but was found to be a stronger predictor of shallow ACD.
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Affiliation(s)
- Mandefro Sintayehu Kassa
- Assistant Professor of Ophthalmology, Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Girum W Gessesse
- Associate Professor of Ophthalmology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Kelekele JTK, Kayembe DL, Mwanza JC. Profile of central corneal thickness and corneal endothelial cell morpho-density of in healthy Congolese eyes. BMC Ophthalmol 2021; 21:185. [PMID: 33888064 PMCID: PMC8063471 DOI: 10.1186/s12886-021-01947-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To determine the pachymetric and corneal endothelial cell morphometric features and their relationship to ocular and systemic factors in healthy Congolese subjects. Methods Non-contact specular microscopy was used in 278 healthy eyes (278 subjects) to measure central corneal thickness (CCT), corneal endothelial cell density (CECD) along with cell size, coefficient of variation (CV) in cell size, and hexagonality (HEX). The lower and upper reference limits and average values for each parameter were determined. Correlation and association of average values with anthropo-demographic and clinical variables were assessed. Results The mean age was 38.9 ± 17.2 years (10.9–80.7 years). Average values were 504.2 ± 30.7 μm (CCT), 2907.1 ± 290.9 cells/mm2 (CECD), 348.5 ± 38.4 μm2 (cell size), 32.9 ± 3.6% (CV), and 51.8 ± 7.2% (HEX). CCT was 504.9 ± 33.6 μm in men and 503.6 ± 28.3 μm in women (p = .73); values for CECD were 2917.1 ± 253.5 cells/mm2 and 2899.2 ± 317.8 cells/mm2 (p = 0.61), respectively. Lower and upper reference limits were 449.6 μm and 566.0 μm for CCT, and 2165.3 cells/mm2 and 3414.4 cells/mm2 for CECD, respectively. CCT correlated with body mass index (BMI), (r = − 0.12, P = 0.04). CECD decreased with age (r = − 0.49, P < 0.001), BMI (r = − 0.20, P = 0.001), intraocular pressure (r = − 0.13, P = 0.029) and ocular perfusion pressure (r = − 0.28, P = 0.028). CECD decayed by 8.3 cells/mm2 or 0.30% per year of age and CCT decreased by 0.72 μm per kg/m2. Conclusions Mean central cornea was thinner, CECD higher, and references limits lower than reported in other African populations. The CCT and CECD normative values reported herein will be useful for both clinical and research purposes in this population. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-01947-x.
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Affiliation(s)
| | - David L Kayembe
- Department of Ophthalmology, University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Jean-Claude Mwanza
- Department of Ophthalmology, University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo.,Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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21
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Li Z, Li S, Liu R, Scheetz J, Xiao O, Zhang J, Wang D, Guo X, Jong M, Sankaridurg P, He M. Distribution of intraocular pressure and related risk factors in a highly myopic Chinese population: an observational, cross-sectional study. Clin Exp Optom 2021; 104:767-772. [PMID: 33689617 DOI: 10.1080/08164622.2021.1878817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Clinical relevance: Those with high myopia are more likely to have glaucoma compared to those without myopia and intraocular pressure was a key factor for developing glaucoma. Thus, investigating the distribution of intraocular pressure and associated factors among those with high myopia is of high importance.Background: The aim of this work is to investigate the distribution of intraocular pressure and the correlated risk factors in a highly myopic Chinese population.Methods: A total of 884 Chinese participants with bilateral high myopia (≤ -6.00 D spherical power) were included from the Zhongshan Ophthalmic Center-Brien Holden Vision Institute High Myopia Cohort Study. All participants underwent a comprehensive ocular examination, including ocular biometry, cycloplegic refractometry, and intraocular pressure measurement with Goldmann applanation tonometry. Information on smoking and drinking status was also collected.Results: The mean spherical equivalence of left eyes was -10.02 ± 3.58 D with a mean axial length of 27.48 ± 1.55 mm. The overall mean intraocular pressure was 15.1 ± 2.4 mmHg (95% confidence interval, 15.0 to 15.3 mmHg). The intraocular pressure in the -6.00D to -7.99D spherical equivalence group, -8.00D to -9.99D spherical equivalence group, and ≤ -10.00 D group were 15.3 ± 2.4 mmHg, 15.1 ± 2.5 mmHg, and 15.0 ± 2.4 mmHg, respectively (p = 0.979). In multiple regression models, intraocular pressure in high myopes was not associated with spherical equivalence (p = 0.354) or axial length (p = 0.601), but significantly higher in those who were younger (non-standardised beta, -0.018; p = 0.007), smoked tobacco (non-standardised beta, 1.085; p = 0.001) and had greater central corneal thickness (non-standardised beta, 0.021; p < 0.001).Conclusion: Intraocular pressure was 15.1 ± 2.4 mmHg among subjects with a mean age of 22.8 years in this highly myopia Chinese population. These findings suggested that highly myopic Chinese persons of a younger age and greater central corneal thickness were more likely to have higher intraocular pressure.
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Affiliation(s)
- Zhixi Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Shuhua Li
- Guangdong Province Traditional Chinese Medical Hospital, Guangzhou, China
| | - Ran Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.,New England College of Optometry, Boston, USA
| | - Jane Scheetz
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Ou Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Jian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Decai Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Xinxing Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.,Wilmer Eye Institute, Johns Hopkins University, Baltimore, USA
| | - Monica Jong
- Brien Holden Vision Institute, Sydney, Australia
| | | | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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22
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Prud'homme C, Sala L, Szopos M. Uncertainty propagation and sensitivity analysis: results from the Ocular Mathematical Virtual Simulator. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:2010-2032. [PMID: 33892535 DOI: 10.3934/mbe.2021105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We propose an uncertainty propagation study and a sensitivity analysis with the Ocular Mathematical Virtual Simulator, a computational and mathematical model that predicts the hemodynamics and biomechanics within the human eye. In this contribution, we focus on the effect of intraocular pressure, retrolaminar tissue pressure and systemic blood pressure on the ocular posterior tissue vasculature. The combination of a physically-based model with experiments-based stochastic input allows us to gain a better understanding of the physiological system, accounting both for the driving mechanisms and the data variability.
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Affiliation(s)
| | - Lorenzo Sala
- Centre de recherche INRIA de Paris, Paris 75012, France
| | - Marcela Szopos
- MAP5 UMR CNRS 8145, Université de Paris, Paris 75006, France
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23
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Abstract
Glaucoma remains the world's leading cause of irreversible blindness and though intraocular pressure (IOP) is the most prevalent risk factor and only reliable therapeutic target, a number of systemic disease associations have been reported. Metabolic syndrome (MetS) is a constellation of findings that includes systemic hypertension, abdominal obesity, glucose intolerance, and dyslipidemia. MetS is becoming increasingly common worldwide, with prevalence up to 40% in some countries. Not only is MetS a significant cause of morbidity, but it is also associated with an increase in all-cause mortality. Reports have been conflicting regarding the association of individual components of MetS, including systemic hypertension and diabetes, with elevated IOP or glaucoma. However, though limitations in the existing literature are present, current evidence suggests that MetS is associated with IOP as well as glaucoma. Additional studies are needed to clarify this association by incorporating additional metrics including assessment of central corneal thickness as well as optic nerve structure and function. Future studies are also needed to determine whether lifestyle modification or systemic treatment of MetS could reduce the incidence or progression of glaucoma.
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24
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Moazzeni H, Khani M, Elahi E. Insights into the regulatory molecules involved in glaucoma pathogenesis. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:782-827. [PMID: 32935930 DOI: 10.1002/ajmg.c.31833] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022]
Abstract
Glaucoma is an important cause of irreversible blindness, characterized by optic nerve anomalies. Increased intraocular pressure (IOP) and aging are major risk factors. Retinal ganglion cells and trabecular meshwork cells are certainly involved in the etiology of glaucoma. Glaucoma is usually a complex disease, and various genes and functions may contribute to its etiology. Among these may be genes that encode regulatory molecules. In this review, regulatory molecules including 18 transcription factors (TFs), 195 microRNAs (miRNAs), 106 long noncoding RNAs (lncRNAs), and two circular RNAs (circRNAs) that are reasonable candidates for having roles in glaucoma pathogenesis are described. The targets of the regulators are reported. Glaucoma-related features including apoptosis, stress responses, immune functions, ECM properties, IOP, and eye development are affected by the targeted genes. The targeted genes that are frequently targeted by multiple regulators most often affect apoptosis and the related features of cell death and cell survival. BCL2, CDKN1A, and TP53 are among the frequent targets of three types of glaucoma-relevant regulators, TFs, miRNAs, and lncRNAs. TP53 was itself identified as a glaucoma-relevant TF. Several of the glaucoma-relevant TFs are themselves among frequent targets of regulatory molecules, which is consistent with existence of a complex network involved in glaucoma pathogenesis.
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Affiliation(s)
- Hamidreza Moazzeni
- School of Biology, College of Science, University of Tehran, Tehran, Iran
| | - Marzieh Khani
- School of Biology, College of Science, University of Tehran, Tehran, Iran
| | - Elahe Elahi
- School of Biology, College of Science, University of Tehran, Tehran, Iran
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25
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Lu Q, He W, Lu Y, Zhu X. Morphological features of anterior segment: factors influencing intraocular pressure after cataract surgery in nanophthalmos. EYE AND VISION 2020; 7:47. [PMID: 32974413 PMCID: PMC7495875 DOI: 10.1186/s40662-020-00212-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/19/2020] [Indexed: 11/30/2022]
Abstract
Purpose To investigate the anterior segment in nanophthalmic eyes and their association with intraocular pressure after cataract surgery. Methods Thirty-two nanophthalmic eyes (axial length [AL] < 18.5 mm) in 18 patients and 35 normal eyes (21 ≤ AL ≤ 24.5 mm) in 35 controls who had undergone uneventful cataract surgery were included. Swept-source optical coherence tomography was used to compare the anterior segment structures between the two groups. The associations between the anterior segment characteristics of nanophthalmic eyes and postoperative intraocular pressure (IOP) were also investigated. Results The IOP-lowering effect of cataract surgery was remarkably insufficient in nanophthalmic eyes. Peripheral anterior synechiae (PAS) were observed in 56% (18/32) of nanophthalmic eyes, and a characteristic boomerang-shaped iris was observed in 28% (9/32). The anterior surface of the iris seemed “smoother” in nanophthalmic eyes than in normal eyes. Schlemm’s canal (SC) diameter, SC area, trabecular meshwork (TM) thickness, TM width, and TM area were generally smaller in the nanophthalmic eyes. Younger age, higher preoperative IOP, broader PAS, and smaller SC area were main contributors to higher postoperative IOP. AL and SC diameter may also be of great importance in IOP prediction in patients without glaucoma surgery and PAS. Conclusions The morphological features of the anterior segment in nanophthalmic eyes are significantly different from those of normal eyes. Influencing factors such as age, AL, preoperative IOP, extent of PAS, SC and TM size could all be prognostic for IOP after cataract surgery in nanophthalmic eyes. Trial registration ClinicalTrails.gov, Trial registration number: NCT02182921, Registered 8 July 2014.
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Affiliation(s)
- Qiang Lu
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031 People's Republic of China.,Eye Institute, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, 200031 People's Republic of China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, 200031 People's Republic of China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031 People's Republic of China
| | - Wenwen He
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031 People's Republic of China.,Eye Institute, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, 200031 People's Republic of China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, 200031 People's Republic of China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031 People's Republic of China
| | - Yi Lu
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031 People's Republic of China.,Eye Institute, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, 200031 People's Republic of China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, 200031 People's Republic of China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031 People's Republic of China
| | - Xiangjia Zhu
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031 People's Republic of China.,Eye Institute, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, 200031 People's Republic of China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, 200031 People's Republic of China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031 People's Republic of China
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26
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Pan CW, Ke C, Chen Q, Tao YJ, Zha X, Zhang YP, Zhong H. Differential metabolic markers associated with primary open-angle glaucoma and cataract in human aqueous humor. BMC Ophthalmol 2020; 20:183. [PMID: 32375707 PMCID: PMC7203853 DOI: 10.1186/s12886-020-01452-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background We aimed to identify metabolic biomarkers and investigate the metabolic alterations in relation to primary open-angle glaucoma (POAG) and cataract in human aqueous humor. Methods Sixteen POAG patients undergoing surgical treatments and 24 patients undergoing cataract surgeries were included in this case-control study. We performed the metabolomic analysis of aqueous humor samples using a non-targeted gas chromatography coupled to time-of-flight mass spectrometer. The area under the receiver operating characteristic curve (AUC) was computed to assess the discrimination capacities of each metabolite marker. Databases including the Kyoto Encyclopedia of Genes and Genomes (KEGG) and MetaboAnalyst were utilized to search for the potential pathways of metabolites. Results Aqueous humor metabolomic profiles could well distinguish POAG from controls. Fourteen metabolic biomarkers were identified as potential aqueous humor biomarkers for POAG, yielding AUC values from 0.62 to 0.86. In pathway analysis, Biotin metabolism was highly impacted, implying that these metabolic markers play important roles in the regulation of this pathway. Conclusions This study identified valuable metabolic biomarkers and pathways that may facilitate an improved understanding of the POAG pathogenesis. The finding holds translational value in the development of new therapeutic measures for POAG.
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Affiliation(s)
- Chen-Wei Pan
- School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Suzhou, 215123, China.
| | - Chaofu Ke
- School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Suzhou, 215123, China
| | - Qin Chen
- Department of Ophthalmology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yi-Jin Tao
- Department of Ophthalmology, the First Affiliated Hospital of Kunming Medical University, No. 295 Xichang Road, Kunming, 650032, China
| | - Xu Zha
- Department of Ophthalmology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yuan-Ping Zhang
- Department of Ophthalmology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hua Zhong
- Department of Ophthalmology, the First Affiliated Hospital of Kunming Medical University, No. 295 Xichang Road, Kunming, 650032, China.
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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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Di Zazzo A, Lee SM, Sung J, Niutta M, Coassin M, Mashaghi A, Inomata T. Variable Responses to Corneal Grafts: Insights from Immunology and Systems Biology. J Clin Med 2020; 9:E586. [PMID: 32098130 PMCID: PMC7074162 DOI: 10.3390/jcm9020586] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/18/2020] [Indexed: 12/13/2022] Open
Abstract
Corneal grafts interact with their hosts via complex immunobiological processes that sometimes lead to graft failure. Prediction of graft failure is often a tedious task due to the genetic and nongenetic heterogeneity of patients. As in other areas of medicine, a reliable prediction method would impact therapeutic decision-making in corneal transplantation. Valuable insights into the clinically observed heterogeneity of host responses to corneal grafts have emerged from multidisciplinary approaches, including genomics analyses, mechanical studies, immunobiology, and theoretical modeling. Here, we review the emerging concepts, tools, and new biomarkers that may allow for the prediction of graft survival.
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Affiliation(s)
- Antonio Di Zazzo
- Ophthalmology Complex Operative Unit, Campus Bio Medico University, 00128 Rome, Italy; (A.D.Z.); (M.N.); (M.C.)
| | - Sang-Mok Lee
- Department of Ophthalmology, Catholic Kwandong University College of Medicine, Gangneung-si, Gangwon-do 25601, Korea;
- Department of Cornea, External Disease & Refractive Surgery, HanGil Eye Hospital, Incheon 21388, Korea
| | - Jaemyoung Sung
- University of South Florida, Morsani College of Medicine, Tampa, FL 33612, USA;
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo 1130033, Japan
| | - Matteo Niutta
- Ophthalmology Complex Operative Unit, Campus Bio Medico University, 00128 Rome, Italy; (A.D.Z.); (M.N.); (M.C.)
| | - Marco Coassin
- Ophthalmology Complex Operative Unit, Campus Bio Medico University, 00128 Rome, Italy; (A.D.Z.); (M.N.); (M.C.)
| | - Alireza Mashaghi
- Systems Biomedicine and Pharmacology Division, Leiden Academic Centre for Drug Research, Leiden University, 2333CC Leiden, The Netherlands
| | - Takenori Inomata
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo 1130033, Japan
- Department of Strategic Operating Room Management and Improvement, Juntendo University Faculty of Medicine, Tokyo 1130033, Japan
- Department of Hospital Administration, Juntendo University Faculty of Medicine, Tokyo 1130033, Japan
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High Myopia and Its Associated Factors in JPHC-NEXT Eye Study: A Cross-Sectional Observational Study. J Clin Med 2019; 8:jcm8111788. [PMID: 31731571 PMCID: PMC6912595 DOI: 10.3390/jcm8111788] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/22/2019] [Indexed: 11/30/2022] Open
Abstract
The increasing prevalence of high myopia has been noted. We investigated the epidemiological characteristics and the related factors of high myopia in a Japanese adult population. Japan Public Health Center-Based Prospective Study for the Next Generation (JPHC-NEXT) Eye Study was performed in Chikusei-city, a rural area in mid-east Japan, between 2013 and 2015. A cross-sectional observational analysis was conducted to investigate prevalence and related factors of high myopia. A total of 6101 participants aged ≥40 years without a history of ocular surgeries was included. High myopia was defined as a spherical equivalent refraction of ≤−6.00 diopters according to the American Academy of Ophthalmology. Potential high myopia-related factors included intraocular pressure (IOP), corneal structure, corneal endothelial cell density, age, height, body mass index, heart rate, blood pressure, biochemical profile, and current history of systemic and ocular disorders. The odds ratios of high myopia were estimated using the logistic regression models adjusted for the associated factors. The prevalence of high myopia was 3.8% in males and 5.9% in females with a significant difference. Age was inversely associated, IOP was positively associated, and none of other factors were associated with high myopia in both sexes. In conclusion, only age and IOP were associated with high myopia in this community-based sample.
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30
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Bikbov MM, Kazakbaeva GM, Zainullin RM, Salavatova VF, Gilmanshin TR, Yakupova DF, Uzianbaeva YV, Arslangareeva II, Panda-Jonas S, Mukhamadieva SR, Khikmatullin RI, Aminev SK, Nuriev IF, Zaynetdinov AF, Jonas JB. Intraocular Pressure and Its Associations in a Russian Population: The Ural Eye and Medical Study. Am J Ophthalmol 2019; 204:130-139. [PMID: 30849346 DOI: 10.1016/j.ajo.2019.02.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To assess the normal distribution of intraocular pressure (IOP) and its associations with ocular, medical, and socioeconomic factors in a Russian population. DESIGN Population-based cross-sectional study. METHODS The Ural Eye and Medical Study conducted in a rural and urban area in Ufa/Bashkortostan included 5899 (80.5%) participants out of 7328 eligible individuals aged 40+ years. IOP was measured by noncontact tonometry. RESULTS After exclusion of individuals after glaucoma surgery or with antiglaucomatous therapy, mean IOP was 13.6 ± 3.8 mm Hg (median: 13 mm Hg; range: 3-49 mm Hg; 95% confidence interval [CI]: 8-23 mm Hg). The IOP range within the mean ± 2 standard deviations was 6.0-21.2 mm Hg. In multivariable analysis higher IOP was associated (regression coefficient r: 0.40) with the systemic parameters of female sex (nonstandardized regression coefficient B: 0.44; 95%CI: 0.22, 0.66; standardized regression coefficient beta: 0.06; P < .001), urban region of habitation (B: -0.27; 95% CI: 0.51, 0.03; beta: 0.03; P = .03), Russian ethnicity (B: 0.47; 95% CI: 0.20, 0.74; beta: 0.05; P = .001), higher body mass index (B: 0.06; 95% CI: 0.04, 0.08; beta: 0.08; P < .001), lower physical activity score (B: -0.02; 95% CI: -0.03, -0.002; beta: -0.03; P = .02), higher prevalence of diabetes mellitus (B: 0.42; 95% CI: 0.08, 0.76; beta: 0.03; P = .02), higher systolic blood pressure (B: 0.01; 95% CI: 0.01, 0.02; beta: 0.08; P < .001), fewer days with intake of fruits (B: -0.07; 95% CI: -0.12, -0.01; beta: 0.03; P = .01), lower blood concentration of bilirubin (B: -0.01; 95% CI: -0.02, -0.003; beta: -0.04; P = .008) and urea (B: -0.11; 95% CI: -0.17, -0.04; beta: -0.04; P = .003), worse best-corrected visual acuity (B: 0.64; 95% CI: 0.38, 0.90; beta: 0.13; P < .001), thicker central corneal thickness (B: 0.036; 95% CI: 0.033, 0.039; beta: 0.32; P < .001), higher anterior corneal refractive power (B: 0.11; 95% CI: 0.04, 0.18; beta: 0.05; P = .003), lower anterior chamber depth (B: -0.57; 95% CI: -0.83, -0.30; beta: -0.07; P < .001) (or lower prevalence of cataract surgery [B: -0.78; 95% CI: -1.44, -0.13; beta: -0.03; P = .02]), longer axial length (B: 0.30; 95% CI: 0.18, 0.42; beta: 0.07; P < .001), and higher prevalence of pseudoexfoliation (B: 1.08; 95% CI: 0.52, 1.63; beta: 1.01; P < .001). Measured IOP decreased by 0.36 mm Hg (95% CI: 0.33, 0.39) for each increase in central corneal thickness by 10 μm. CONCLUSIONS IOP was associated with a multitude of systemic and ocular parameters, the associations of which may be considered in defining the normal range of IOP.
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Cui Y, Yang X, Zhang G, Guo H, Zhang M, Zhang L, Zeng J, Liu Q, Zhang L, Meng Q. Intraocular Pressure in General and Diabetic Populations From Southern China: the Dongguan Eye Study. Invest Ophthalmol Vis Sci 2019; 60:761-769. [PMID: 30793208 DOI: 10.1167/iovs.18-25247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the distribution and risk factors for intraocular pressure (IOP) among general and diabetic populations in Southern China. Methods The study participants aged 40 years or older were enrolled from the Dongguan Eye Study, a population-based cross-sectional study from September 2011 to February 2012. Systemic and ophthalmic examinations were performed, and diabetes status was screened based on the American Diabetes Association diagnostic criteria (2010). IOP was measured by a noncontact tonometer per standardized protocol. Regression analyses were used to assess the association between potential risk factors and IOP. Results A total of 2112 subjects were included with a median age of 55 years. IOP for general population showed a near normal distribution with an average of 15.58 ± 3.27 mm Hg. Multiple regression analyses revealed that higher IOP was significantly correlated with younger age, higher body mass index (BMI), shorter height, higher blood pressure (BP), higher fasting blood glucose (FBG), higher low-density lipoprotein cholesterol (LDL-C), lower high-density lipoprotein cholesterol (HDL-C), and thicker central corneal thickness (CCT). There was no association between diabetes status and IOP after adjusting for possible confounders. IOP for diabetic participants showed a right-skewed distribution. Risk factors for IOP elevation in diabetes included female, younger age, higher BP, higher LDL-C, lower HDL-C, and thicker CCT. Conclusions The present study identifies risk factors for elevated IOP in general and diabetic populations. Younger age and lower HDL-C, as well as higher BP, LDL-C, and CCT were significant factors contributing to higher IOP, especially in the female diabetic population.
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Affiliation(s)
- Ying Cui
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xiaohong Yang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Guanrong Zhang
- Information and Statistical Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Haike Guo
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.,Xiamen Eye Centre of Xiamen University, Xiamen, China
| | - Min Zhang
- Department of Ophthalmology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Lixin Zhang
- Department of Ophthalmology, Hengli Hospital, Dongguan, Guangdong, China
| | - Jin Zeng
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Qingyang Liu
- Department of Ophthalmology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Liang Zhang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Qianli Meng
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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Pan CW, Qian YX, Zhong H, Li J, Liu H, Chen Q. Central Corneal Thickness and Its Association with Birth Parameters in Chinese Adolescents. Ophthalmic Epidemiol 2019; 26:360-366. [PMID: 31208255 DOI: 10.1080/09286586.2019.1632903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To examine the distribution and determinants of central corneal thickness (CCT) including birth weight and gestational age in a school-based samples of Grade 7 students in rural China. Methods: 2346 (93.5%) grade 7 students with a mean age of 13.8 years participated in the study. CCT was measured for both eyes using the LenStar LS900. Information regarding birth weight and gestational age was retrieved from the participants' delivery records. A linear regression model was established to examine the relationship of birth weight, gestational age and other factors with CCT. Results: The mean CCT in this population was 534.7 µm and boys had a greater CCT compared with girls (P = .06). CCT was positively related to axial length (r = 0.056) while negatively related to anterior chamber depth (r = -0.076) and corneal power (r = -0.105) . In multivariate analyses, the cornea was 19.35µm thinner in individuals with low birth weight compared with those with normal. In addition, the cornea was 25.25µm thinner in prematurely born adolescents compared with full-term ones. The combined effect of birth weight and gestational age on CCT was not statistically significant (P for interaction = 0.12) Conclusions: Low birth weight and small gestational age are associated with thinner corneas in adolescence. This disparity across groups with different levels of birth parameters should be taken into account by future studies investigating CCT as risk factors or diagnostic tests for glaucoma.
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Affiliation(s)
- Chen-Wei Pan
- School of Public Health, Medical College of Soochow University , Suzhou , China
| | - Yu-Xi Qian
- School of Public Health, Medical College of Soochow University , Suzhou , China
| | - Hua Zhong
- Department of Ophthalmology, the First Affiliated Hospital of Kunming Medical University , Kunming , China
| | - Jun Li
- Department of Ophthalmology, the Second People's Hospital of Yunnan Province , Kunming , China
| | - Hu Liu
- Department of Ophthalmology, the First Affiliated Hospital with Nanjing Medical University , Nanjing , China
| | - Qin Chen
- Department of Ophthalmology, the First Affiliated Hospital with Nanjing Medical University , Nanjing , China
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Luo XY, Dai W, Chee ML, Tao Y, Chua J, Tan NYQ, Tham YC, Aung T, Wong TY, Cheng CY. Association of Diabetes With Central Corneal Thickness Among a Multiethnic Asian Population. JAMA Netw Open 2019; 2:e186647. [PMID: 30646192 PMCID: PMC6324536 DOI: 10.1001/jamanetworkopen.2018.6647] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
IMPORTANCE Thicker or thinner central corneas may lead to either overestimation or underestimation of intraocular pressure, which is the most important causal and treatable risk factor for glaucoma. However, the findings on the associations between diabetes, random glucose, and glycated hemoglobin A1c (HbA1c) with central corneal thickness (CCT) are conflicting. OBJECTIVE To evaluate the associations between diabetes, random glucose, and HbA1c with CCT in a multiethnic Asian population. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis of the Singapore Epidemiology of Eye Diseases (SEED) Study conducted from 2004 to 2011. A total of 10 033 Chinese, Malay, and Indian individuals 40 years or older residing in Singapore were recruited. Participants with incomplete information on diabetes status (448 participants), prior refractive or cataract surgery (1940 eyes), and corneal edema or dystrophy (29 eyes) were excluded. A meta-analysis was conducted to estimate the overall association of diabetes with CCT. EXPOSURES Standardized clinical examinations and interviewer-administered questionnaire to collect information about demographic, systemic, and ocular factors. MAIN OUTCOMES AND MEASURES Measurement of CCT using ultrasound pachymetry. RESULTS A total of 8846 adults (mean [SD] age, 57.9 [9.9] years; 4447 women [50.3%]) (17 201 eyes) were included in the final analyses. The CCT profile was similar among participants with and without diabetes (mean [SD] CCT, 545.3 [33.7] μm vs 544.8 [33.9] μm; P = .39). Following adjustments of age, sex, ethnicity, corneal curvature, axial length, and body mass index, CCT was a mean (SD) of 4.9 (0.8) μm (95% CI, 3.3-6.5 μm) thicker in patients with diabetes than those without diabetes. Multivariable analyses also showed that thicker CCT was associated with higher random glucose (per 10 mg/dL [to convert to mmol/L, multiply by 0.0555], β = 0.3; 95% CI, 0.2-0.4) and higher HbA1c (per percentage, β = 1.5; 95% CI, 1.0-2.1) (all P < .001). These associations were significant in the subgroup with diabetes but not in the subgroup without diabetes. A meta-analysis including 12 previous population- and clinical-based studies showed that CCT was 12.8 μm (95% CI, 8.2-17.5 μm) thicker in eyes of patients with diabetes. CONCLUSIONS AND RELEVANCE These findings suggest that diabetes and hyperglycemia were associated with thicker CCT. This study provides useful information on the interpretation of intraocular pressure in patients with diabetes.
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Affiliation(s)
- Xiao-Yang Luo
- Guangdong Eye Institute, Guangdong Academy of Medical Sciences, Department of Ophthalmology, Guangdong General Hospital, Guangzhou, China
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Wei Dai
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Miao-Li Chee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Yijin Tao
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke–National University of Singapore Medical School, Singapore
| | - Nicholas Y. Q. Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke–National University of Singapore Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke–National University of Singapore Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke–National University of Singapore Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Systemic Disease and Long-term Intraocular Pressure Mean, Peak, and Variability in Nonglaucomatous Eyes. Am J Ophthalmol 2018; 193:184-196. [PMID: 29981739 DOI: 10.1016/j.ajo.2018.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Elevated intraocular pressure (IOP) is a well-known risk factor in glaucoma development and progression. As most glaucoma risk factors are not modifiable, IOP remains the sole focus of medical and surgical therapy. Identifying modifiable factors and their effects on IOP, such as systemic diseases, is therefore of interest. The objective is to assess the long-term, longitudinal relationship between systemic diseases and IOP mean, peak, and variability, including diabetes, hypertension, body mass index (BMI), and smoking status. DESIGN Secondary analysis of randomized clinical trial data. METHODS Longitudinal IOP and systemic disease data from the Age-Related Eye Disease Study (AREDS), a randomized clinical trial of high-dose antioxidants, was analyzed. STUDY POPULATION A total of 3909 older participants without a reported diagnosis of glaucoma or glaucoma treatment during AREDS with up to 12 years of annual IOP and systemic disease data. MAIN OUTCOME MEASURES Independent systemic disease risk factors associated with IOP. RESULTS Univariate analysis identified numerous systemic disease factors associated with IOP mean, peak, and variability. Longitudinal adjusted models identified diabetes, obesity, and systolic hypertension as significantly associated with increased IOP, while systemic beta-blocker use was inversely associated. CONCLUSIONS Results demonstrate a relationship between multiple systemic diseases and IOP; moreover, they demonstrate that systemic diseases influence additional parameters beyond mean IOP, such as IOP peak and variability. Although only to be taken within the context of IOP, these population-level trends reveal potentially modifiable factors in IOP control, and are particularly important in the context of increasing obesity and diabetes prevalence rates in American adults.
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Han X, Zhao H, Wu C, Liu C, Yan W, Hu Y, He M. Ten-year changes of intraocular pressure in adults: the Liwan Eye Study. Clin Exp Ophthalmol 2018; 47:41-48. [PMID: 30091181 DOI: 10.1111/ceo.13372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/31/2018] [Accepted: 08/04/2018] [Indexed: 11/30/2022]
Abstract
IMPORTANCE Understanding the longitudinal intraocular pressure (IOP) changes and potential risk factors in adults is important for future glaucoma control in the aging society. BACKGROUND Limited longitudinal studies exist in Asia investigating the longitudinal IOP changes and with varying results. DESIGN Population-based cohort study. PARTICIPANTS 1405 baseline participants from the Liwan Eye Study. METHODS All baseline participants were invited for the 10-year follow-up examination in 2013. IOP (by Tonopen), central corneal thickness (CCT; by ultrasound), refractive error (by autorefractor), blood pressure, height and weight were measured per standardized protocol and the presence of hypertension or diabetes was collected by questionnaire. Follow-up examinations were conducted using the same equipment with proper calibration. Linear regression analysis was used to assess the association between IOP change and potential risk factors. MAIN OUTCOME MEASURES 10-year IOP change. RESULTS Of the 791 participants at the 10-year follow-up, IOP data were available for 602 participants with a mean age of 60.9 years (55.5% female). The average IOP change over 10 years was an increase of 1.44 mmHg (95% confidence interval, 1.12-1.75). Linear regression showed that 10-year IOP change was not associated with baseline age, gender, body mass index (BMI), CCT, spherical equivalence (SE), hypertension or diabetes. However, it was positively associated with longitudinal increase of BMI when longitudinal changes of BMI and SE were included in the model (P < 0.001). CONCLUSIONS AND RELEVANCE We observed a small increase in IOP over 10 years in this adult Chinese population, which was positively related to the longitudinal change in BMI.
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Affiliation(s)
- Xiaotong Han
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Centre for Eye Research Australia, Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Haifeng Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Department of ophthalmology, Yichun Aier Eye Hospital, Yichun, China
| | - Changfan Wu
- Department of Ophthalmology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Chi Liu
- Guangzhou Healgoo Interactive Medical Technology Co. Ltd., Guangzhou, China
| | - William Yan
- Centre for Eye Research Australia, Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Yin Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Centre for Eye Research Australia, Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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Ma R, Liu Y, Zhang L, Lei Y, Hou J, Shen Z, Yi X, Wang Y. Distribution and Trends in Corneal Thickness Parameters in a Large Population-Based Multicenter Study of Young Chinese Adults. ACTA ACUST UNITED AC 2018; 59:3366-3374. [PMID: 30025097 DOI: 10.1167/iovs.18-24332] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Ruijue Ma
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Nankai University, Tianjin, China
| | - Yuanyuan Liu
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China
| | - Lin Zhang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Nankai University, Tianjin, China
| | - Yulin Lei
- Department of Ophthalmology, Jinan Mingshui Eye Hospital, Jinan, China
| | - Jie Hou
- Department of Ophthalmology, Jinan Mingshui Eye Hospital, Jinan, China
| | - Zhengwei Shen
- Ophthalmic Department, Wuhan General Hospital of Guangzhou Military Command of PLA, Wuhan, China
| | - Xianglong Yi
- Department of Ophthalmology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Yan Wang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Nankai University, Tianjin, China
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Wang YX, Xu L, Wei WB, Jonas JB. Intraocular pressure and its normal range adjusted for ocular and systemic parameters. The Beijing Eye Study 2011. PLoS One 2018; 13:e0196926. [PMID: 29771944 PMCID: PMC5957383 DOI: 10.1371/journal.pone.0196926] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/23/2018] [Indexed: 11/23/2022] Open
Abstract
Purpose To examine the distribution of intraocular pressure (IOP) in a normal population and the associations of IOP with other ocular and systemic parameters. Methods Out of 3468 participants of the population-based cross-sectional Beijing Eye Study 2011 we selected those individuals without glaucomatous optic neuropathy. The study particpants underwent a detailed ophthalmologic and systemic examination. IOP was measured by air puff non-contact tonometry. Results The study included 3135 eyes of 3135 participants with a mean age of 64.1 ± 9.6 years (mean ± standard deviation). The mean IOP was 14.7 ± 2.8 mmHg. The 95% percentile and 97.5% percentile of the IOP distribution decreased from 20 mmHg / 21 mmHg in individuals aged 40 to 54 years to 18 mmHg / 19 mmHg in individuals aged ≥80 years. In multivariable analysis, higher IOP was associated with the systemic parameters of younger age (P<0.001), higher blood concentration of glucose (P = 0.03) and triglycerides (P<0.001), higher diastolic blood pressure (P<0.001), higher pulse rate (P = 0.003) and higher quantity of alcohol consumption (P = 0.004), and with the ocular parameters of larger central corneal thickness (P<0.001), more myopic refractive error (P = 0.01) and steeper anterior corneal curvature radius (P = 0.006). IOP decreased significantly by 0.50 mmHg and 0.76 mmHg for each increase in age by 10 years and each increase in corneal curvature radius by 1.0 mm, respectively. The range of the mean ± 2 standard deviations of the IOP adjusted for the parameters of the multivariable model was 9.0 to 18.1 mmHg versus 9.2–20.2 mmHg for the unadjusted IOP. In the age group of 50 to 55 years, the age-adjusted IOP range (mean ± 2 standard deviations) was 9 to 18 mmHg, and in the age group of ≥75 years, it was 8 to 18 mmHg. Conclusions IOP physiologically depends on a multitude of systemic and ocular factors including age and blood pressure. These physiological associations of the IOP may be taken into account in the definition of the normal range of the IOP.
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Affiliation(s)
- Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
- * E-mail: (YXW); (JBJ)
| | - Liang Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Wen Bin Wei
- Depart of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Jost B. Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
- * E-mail: (YXW); (JBJ)
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Hashemi H, Khabazkhoob M, Nabovati P, Yazdani N, Ostadimoghaddam H, Shiralivand E, Derakhshan A, Yekta A. Distribution of IOP measured with an air puff tonometer in a young population. J Curr Ophthalmol 2018; 30:35-41. [PMID: 29564406 PMCID: PMC5859631 DOI: 10.1016/j.joco.2016.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/06/2016] [Accepted: 11/06/2016] [Indexed: 11/25/2022] Open
Abstract
Purpose To determine the normal range of intraocular pressure (IOP) in the young and its association with certain corneal parameters using a non-contact device. Methods Subjects were selected from students of Mashhad University of Medical Sciences through stratified sampling. All participants had visual acuity testing, corneal imaging, a comprehensive slit-lamp examination by an ophthalmologist, and IOP measurement using a non-contact air-puff tonometer. Results Of the 1280 invitees, 1073 (83.8%) participated, and 1027 were eligible. Mean IOP was 16.38 mmHg [95% confidence interval (CI): 16.22–16.53] in the total sample, 16.14 mmHg (95% CI: 15.84–16.45) in men, and 16.48 mmHg (95% CI: 16.31–16.66) in women. There was a significant IOP difference between myopes and emmetropes (P = 0.031). Based on the multiple linear regression model, IOP associated directly with age and central corneal thickness (CCT), and inversely with corneal diameter, spherical equivalent (SE), and keratoconus. Based on standardized coefficients of the regression model, CCT and SE had the strongest association with IOP. Conclusions In the present study, we demonstrated the IOP distribution in a young population using a non-contact method. CCT and SE were strongly associated with IOP.
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Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Payam Nabovati
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Negareh Yazdani
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Ostadimoghaddam
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Shiralivand
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Akbar Derakhshan
- Khatam-al-Anbia Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - AbbasAli Yekta
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
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Belovay GW, Goldberg I. The thick and thin of the central corneal thickness in glaucoma. Eye (Lond) 2018; 32:915-923. [PMID: 29445115 DOI: 10.1038/s41433-018-0033-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 11/09/2022] Open
Abstract
Central corneal thickness (CCT) is an important parameter in the assessment of any potential glaucoma patient. While it affects prognosis in ocular hypertension, its value in patients diagnosed with glaucoma is less certain. There are several biological factors and genetic components that may influence glaucoma progression, which have been associated with thinner CCT. The CCT itself can be affected by several factors including ethnicity, age, sex, glaucoma medications, genetics, and the subtype of glaucoma. Besides, there is variability in the measurement of CCT between difference types of devices. These factors need to be considered in the evaluation of glaucoma patients' CCT and its effect on interpretation of intraocular pressure levels and risk stratification.
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Affiliation(s)
| | - Ivan Goldberg
- Glaucoma Unit, Sydney Eye Hospital, Sydney, Australia.,Discipline of Ophthalmology, University of Sydney, Sydney, Australia.,Eye Associates, Sydney, Australia
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40
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Han X, Yang T, Zhang J, Yu S, Guo X, Yan W, Hu Y, He M. Longitudinal changes in intraocular pressure and association with systemic factors and refractive error: Lingtou Eye Cohort Study. BMJ Open 2018; 8:e019416. [PMID: 29444785 PMCID: PMC5829881 DOI: 10.1136/bmjopen-2017-019416] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To investigate the longitudinal changes in intraocular pressure (IOP) and its associations with refractive error and systemic determinants in a Chinese geriatric population. DESIGN Prospective cohort study. SETTING Guangzhou Government Servant Physical Check-up Center, Guangzhou, China. PARTICIPANTS 4413 government employees aged no less than 40 years (41.9% female) attending annual physical and eye examinations were included in this study. The inclusion criterion was having attended the 2010 follow-up examination. The exclusion criteria include glaucoma or intraocular surgery history, IOP >21 mm Hg at any visit or without available IOP data at all visits from 2010 to 2014. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome measure was IOP at each follow-up visit from 2010 to 2014. Mixed-effect model was used to assess the relationship between longitudinal changes in IOP and potential risk factors. RESULTS For the 2653 participants who had available IOP data at both the 2010 and 2014 follow-up visits, the average change in IOP was an increase of 0.43 (95% CI 0.36 to 0.50) mm Hg. For the whole study population and in the optimised mixed model, there was a non-linear increase of IOP with age (P<0.001), with greater changes in younger subjects and in women (P<0.001 and P=0.002, respectively). Elevations in systolic blood pressure, diastolic blood pressure, body mass index (BMI) and fasting plasma glucose (FPG), as well as a myopic shift (all with P<0.001), during the follow-up were associated with an increasing trend of IOP, while serum lipids were found to be not significantly associated. CONCLUSIONS In this cohort of elderly Chinese adults, IOP increases non-linearly with ageing. People with increasing blood pressure, BMI, FPG and myopic progression are more likely to have IOP elevation over time.
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Affiliation(s)
- Xiaotong Han
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Tangjian Yang
- Department of Ophthalmology, Guangzhou No. 11 People’s Hospital, Guangzhou, China
| | - Jian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Sha Yu
- Department of Ophthalmology, Guangzhou No. 11 People’s Hospital, Guangzhou, China
| | - Xinxing Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - William Yan
- Ophthalmology, Department of Surgery, Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - Yin Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Ophthalmology, Department of Surgery, Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
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Guo T, Sampathkumar S, Fan S, Morris N, Wang F, Toris CB. Aqueous humour dynamics and biometrics in the ageing Chinese eye. Br J Ophthalmol 2017; 101:1290-1296. [DOI: 10.1136/bjophthalmol-2016-309883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 04/20/2017] [Accepted: 05/03/2017] [Indexed: 11/04/2022]
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Soleimanizad R, Nowroozzadeh MH, Ziaei H, Pakravan M, Yaseri M, Katibeh M. The Association of Central Corneal Thickness with Ocular and General Parameters in a Community Setting: The Yazd Eye Study. J Ophthalmic Vis Res 2017; 12:141-150. [PMID: 28540004 PMCID: PMC5423366 DOI: 10.4103/jovr.jovr_111_15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To assess central corneal thickness (CCT) and its associations in an adult Iranian population. METHODS This was a population-based cross-sectional study of adults aged 40-80 years. Eyes with corneal disorders, previous ocular surgery, or trauma were excluded. All subjects underwent complete ophthalmic examination, general health assessment, laboratory tests, and a detailed interview. CCT was measured with an ultrasonic pachymeter. Intraocular pressure (IOP) was measured with Goldmann applanation tonometry. Except for the report on interocular differences in CCT, only one eye of each subject was used for the rest of statistical analyses. RESULTS The mean age (±SD) of the 1203 participants, who had CCT measurements and met inclusion criteria, was 51.8 ± 8.5 years. The mean CCT was 544 ± 35, 564 ± 28, and 544 ± 36 μm in the eyes of the normal, ocular hypertension, and glaucoma groups, respectively (P = 0.025). In participants without glaucoma, the mean interocular difference in CCT was 9 ± 12 μm. CCT was not significantly associated with age, sex, or some select systemic factors (body mass index, diabetes, hypertension, and renal failure). While controlling for age and sex, CCT was greater in individuals with higher IOPs (P < 0.001), larger vertical or horizontal cup-to-disc ratios (P = 0.044, and P = 0.025, respectively), and hyperopia (P = 0.009). CONCLUSION In this adult Iranian population, CCT was significantly associated with IOP, cup-to-disc ratio, and the refractive status of eye. CCT outside the normal range of 475-613 μm or with interocular asymmetry greater than 33 μm (6%) should prompt evaluation for potential ocular disorders.
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Affiliation(s)
- Reza Soleimanizad
- Department of Ophthalmology, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Mohammad Hosein Nowroozzadeh
- Poostchi Ophthalmology Research Center and Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Ziaei
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Pakravan
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Katibeh
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Center for Global Health, Department of Public Health, Aarhus University, Denmark
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the role of central corneal thickness (CCT) in the clinical management of a glaucoma patient. RECENT FINDINGS The prognostic value of CCT is well recognized in patients with ocular hypertension. However, its predictive value in other glaucoma suspects and patients with established glaucoma is less certain. Tonometry artefacts can result from variations in CCT. However, an adequately validated correction algorithm for Goldmann applanation tonometry measurements does not exist. Newer methods of tonometry are potentially less influenced by CCT but are limited in their clinical use. There may also be biological and genetic associations between corneal thickness and glaucoma. Demographics, environmental factors, glaucoma treatment and the measurement device used have a significant influence on CCT, and should be considered when interpreting the effect of cornea thickness in patients with glaucoma. New measurements of the biomechanical properties of the cornea are likely to be better approximations of the globe biomechanics than CCT, but these require further evaluation. SUMMARY The clinical significance of CCT is well recognized in the context of glaucoma diagnosis and management, though the extent of its importance remains debatable. Corneal biomechanical properties may be more significantly associated with glaucoma than CCT.
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Pakravan M, Javadi MA, Yazdani S, Ghahari E, Behroozi Z, Soleimanizad R, Moghimi S, Nilforoushan N, Zarei R, Eslami Y, Ghassami M, Ziaei H, Katibeh M, Tabesh H, Yaseri M. Distribution of intraocular pressure, central corneal thickness and vertical cup-to-disc ratio in a healthy Iranian population: the Yazd Eye Study. Acta Ophthalmol 2017; 95:e144-e151. [PMID: 27778447 DOI: 10.1111/aos.13231] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 07/10/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the distribution of intraocular pressure (IOP), central corneal thickness (CCT) and vertical cup-to-disc ratio (VCDR) in the healthy Iranian population. METHODS This population-based, epidemiologic study evaluated Iranian aged 40-80 years, residing in Yazd, Iran, in 2010-2011. Eligible subjects were selected by cluster random sampling. Each participant underwent an interview and ophthalmologic examination including slit lamp examination, Goldmann applanation tonometry, binocular optic disc evaluation, stereoscopic fundus photography, ultrasonic pachymetry and visual field testing. RESULTS Of 2320 eligible individuals, 2098 subjects (response rate of 90.4%) participated in the study. One eye from 1159 subjects (total of 2262 normal eyes) were randomly selected for the purpose of the study. Mean age was 53.1 ± 9.6 years. Mean IOP, CCT and VCDR were 14.2 ± 2.5 mmHg, 543 ± 37 μm and 0.32 ± 0.14, respectively. Multiple regression analysis showed a significant correlation between IOP and age (regression coefficient = 0.02 per year, p = 0.015), CCT (regression coefficient = 0.02 per micron, p < 0.001), Spherical equivalent (regression coefficient = -0.15 per dioptre, p = 0.0.024) and smoking (regression coefficient = 0.89 higher for smokers, p = 0.009); it also showed a significant correlation between CCT with spherical equivalent (regression coefficient = 3.6 per dioptre, p = 0.002) and IOP (regression coefficient = 3.6 per mmHG, p < 0.001). There was no significant correlation with VCDR. CONCLUSIONS Mean IOP, CCT and VCDR were 14.2 ± 2.5 mmHg, 543 ± 35 μm and 0.32 ± 0.14, respectively, in healthy Iranians that is different from other ethnicities. It seems advisable to pay attention to ethnicity for interpretation of each person's variables.
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Affiliation(s)
- Mohammad Pakravan
- Ophthalmic Epidemiology and Prevention of Blindness Center; Shahid Beheshti University of Medical Science; Tehran Iran
| | - Mohammad Ali Javadi
- Ophthalmic Epidemiology and Prevention of Blindness Center; Shahid Beheshti University of Medical Science; Tehran Iran
| | - Shahin Yazdani
- Ophthalmic Epidemiology and Prevention of Blindness Center; Shahid Beheshti University of Medical Science; Tehran Iran
| | - Elham Ghahari
- Ophthalmic Epidemiology and Prevention of Blindness Center; Shahid Beheshti University of Medical Science; Tehran Iran
| | - Zohreh Behroozi
- Ophthalmic Epidemiology and Prevention of Blindness Center; Shahid Beheshti University of Medical Science; Tehran Iran
| | | | - Sasan Moghimi
- Department of Ophthalmology and Eye Research Center; Tehran University of Medical Sciences; Tehran Iran
| | - Naveed Nilforoushan
- Department of Ophthalmology and Eye Research Center; Tehran University of Medical Sciences; Tehran Iran
| | - Reza Zarei
- Department of Ophthalmology and Eye Research Center; Tehran University of Medical Sciences; Tehran Iran
| | - Yadollah Eslami
- Department of Ophthalmology and Eye Research Center; Tehran University of Medical Sciences; Tehran Iran
| | - Mahmood Ghassami
- Ophthalmic Epidemiology and Prevention of Blindness Center; Shahid Beheshti University of Medical Science; Tehran Iran
| | - Hossein Ziaei
- Ophthalmic Epidemiology and Prevention of Blindness Center; Shahid Beheshti University of Medical Science; Tehran Iran
| | - Marzieh Katibeh
- Ophthalmic Epidemiology and Prevention of Blindness Center; Shahid Beheshti University of Medical Science; Tehran Iran
| | - Hanif Tabesh
- Ophthalmic Epidemiology and Prevention of Blindness Center; Shahid Beheshti University of Medical Science; Tehran Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics; School of Public Health; Tehran University of Medical Sciences; Tehran Iran
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Associations with intraocular pressure across Europe: The European Eye Epidemiology (E 3) Consortium. Eur J Epidemiol 2016; 31:1101-1111. [PMID: 27613171 PMCID: PMC5206267 DOI: 10.1007/s10654-016-0191-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 08/07/2016] [Indexed: 11/22/2022]
Abstract
Raised intraocular pressure (IOP) is the most important risk factor for developing glaucoma, the second commonest cause of blindness globally. Understanding associations with IOP and variations in IOP between countries may teach us about mechanisms underlying glaucoma. We examined cross-sectional associations with IOP in 43,500 European adults from 12 cohort studies belonging to the European Eye Epidemiology (E3) consortium. Each study conducted multivariable linear regression with IOP as the outcome variable and results were pooled using random effects meta-analysis. The association of standardized study IOP with latitude was tested using meta-regression. Higher IOP was observed in men (0.18 mmHg; 95 % CI 0.06, 0.31; P = 0.004) and with higher body mass index (0.21 mmHg per 5 kg/m2; 95 % CI 0.14, 0.28; P < 0.001), shorter height (−0.17 mmHg per 10 cm; 95 % CI –0.25, −0.08; P < 0.001), higher systolic blood pressure (0.17 mmHg per 10 mmHg; 95 % CI 0.12, 0.22; P < 0.001) and more myopic refraction (0.06 mmHg per Dioptre; 95 % CI 0.03, 0.09; P < 0.001). An inverted U-shaped trend was observed between age and IOP, with IOP increasing up to the age of 60 and decreasing in participants older than 70 years. We found no significant association between standardized IOP and study location latitude (P = 0.76). Novel findings of our study include the association of lower IOP in taller people and an inverted-U shaped association of IOP with age. We found no evidence of significant variation in IOP across Europe. Despite the limited range of latitude amongst included studies, this finding is in favour of collaborative pooling of data from studies examining environmental and genetic determinants of IOP in Europeans.
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Hashemi H, Khabazkhoob M, Emamian MH, Shariati M, Yekta A, Fotouhi A. Distribution of intraocular pressure and its determinants in an Iranian adult population. Int J Ophthalmol 2016; 9:1207-14. [PMID: 27588277 DOI: 10.18240/ijo.2016.08.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 04/14/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To determine the distribution of intraocular pressure (IOP) and its determinants in an Iranian population. METHODS In a cross-sectional survey, random cluster sampling was conducted from the 40-64 years old population of Shahroud, in the north of Iran. All participants had optometry and ophthalmic exams. IOP was determined using the Goldmann tonometry method and biometric components were measured. RESULTS Of the 6311 people selected for the study, 5190 (82.2%) participated. The mean age of the participants was 50.9±6.2y and 58.7% of them were female. Mean IOP was 12.87±2.27 mm Hg. In this study 0.3% of the participants had an IOP higher than 21 mm Hg. The multiple linear regression model revealed that sex (Coef=-0.30; 95% CI: -0.43 to -0.17), diabetes (Coef=0.43; 95% CI: 0.19 to 0.67), high systolic blood pressure (Coef=0.02; 95% CI: 0.01 to 0.02), high body mass index (BMI) (Coef=0.03; 95% CI: 0.01 to 0.04), higher education (Coef=0.02, 95% CI: 0.01 to 0.04), thicker central corneal thickness (Coef=0.01; 95% CI: 0.01 to 0.02), and myopic shift in spherical equivalent (Coef=-0.14; 95% CI: -0.18 to -0.10) significantly correlated with high IOP. CONCLUSION The IOP in this 40-64 years old population is low overall. In the north of Iran, average IOP is statistically significantly correlated with female sex, diabetes, higher BMI, systolic blood pressure, higher education, thicker cornea, and myopic refractive error.
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Affiliation(s)
- Hassan Hashemi
- Ophthalmic Epidemiology, Noor Research Center, Noor Eye Hospital, Tehran 1968653163, Iran; Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran 1968653163, Iran
| | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran 1634858433, Iran
| | - Mohammad Hassan Emamian
- Health Related Social and Behavioral Sciences Research Center, Shahroud University of Medical Sciences, Shahroud 3614773947, Iran
| | - Mohammad Shariati
- Department of Community Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran 1417613181, Iran
| | - Abbasali Yekta
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad 9183896858, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran 1417613181, Iran
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Central Corneal Thickness and its Associations With Ocular and Systemic Factors in an Urban West African Population. Am J Ophthalmol 2016; 169:268-275. [PMID: 27423792 DOI: 10.1016/j.ajo.2016.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 11/21/2022]
Abstract
PURPOSE To assess the associations of central corneal thickness (CCT) with ocular and systemic factors in a West African population. DESIGN Population-based cross-sectional study. METHODS Participants aged ≥40 years in the Tema Eye Survey who had clinically normal corneas were included in this study. CCT was determined bilaterally using handheld ultrasound pachymetry. The association between CCT and ocular or systemic factors was analyzed with univariable linear regression. Multivariable linear regression analysis was performed for variables significantly associated with CCT in the univariable analysis. Main outcome measures were CCT (μm) and its associations with age, sex, IOP, cup-to-disc ratio (CDR), glaucoma, hypertension, and diabetes. RESULTS A total of 6806 eligible subjects were identified, of whom 5603 (82.3%) participated in the Tema Eye Survey. A total of 4737 participants (84.5% of participants) of West African descent and clinically normal corneas were included. The mean age ± standard deviation (SD) of participants was 51.2 ± 9.7 years and 38.7% were male. The mean ± SD CCT in the population was 533.9 ± 34.0 μm. In the multivariable linear regression analysis, increased CCT was significantly associated with younger age, male sex, and higher IOP (all P < .001). There were no significant associations between CCT and CDR, glaucoma, hypertension, and diabetes. CONCLUSIONS This population-based cross-sectional survey of West African adults found a significant association between increased CCT and younger age, male sex, and higher IOP but not glaucoma or CDR. Variations in corneal thickness may influence the accuracy of IOP measurements in African persons.
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Central Corneal Thickness in Spectral-Domain OCT and Associations with Ocular and Systemic Parameters. J Ophthalmol 2016; 2016:2596956. [PMID: 27340561 PMCID: PMC4909915 DOI: 10.1155/2016/2596956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/22/2016] [Accepted: 05/16/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Optical coherence tomography (OCT) allows quantitative analysis of the anterior segment of the eye with a noncontact examination. The aim of this study is to analyze associations of central corneal thickness (CCT) as measured by OCT with ocular and systemic cardiovascular parameters. Methods. A cross-sectional study of 734 persons was performed in a working age population. Only healthy eyes were included. A comprehensive ophthalmological examination including refraction, noncontact tonometry, and imaging of the anterior segment by SD-OCT was performed. In parallel, a broad range of systemic cardiovascular parameters were measured. Associations were analyzed using a generalized estimating equations' model. Results. CCT measurements showed a significant association with corneal curvature and intraocular pressure: a thinner CCT was associated with a flatter cornea and with lower intraocular pressure (p < 0.001). Age was positively associated with CCT (p < 0.001); all other cardiovascular parameters were not associated. Conclusion. A thinner cornea is associated with a flatter surface and with lower intraocular pressure readings, while there are no independent associations with refraction and systemic cardiovascular parameters. Our findings highlight the value of SD-OCT CCT measurements as a standard tool in anterior segment analysis.
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Han X, Niu Y, Guo X, Hu Y, Yan W, He M. Age-Related Changes of Intraocular Pressure in Elderly People in Southern China: Lingtou Eye Cohort Study. PLoS One 2016; 11:e0151766. [PMID: 26986222 PMCID: PMC4795753 DOI: 10.1371/journal.pone.0151766] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/03/2016] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To study age-related changes of intraocular pressure (IOP) and assess the cohort effect in both cross-sectional and longitudinal settings among elderly Chinese adults. METHODS Participants were enrolled from the Lingtou Eye Cohort Study with Chinese government officials aged 40 years and older at baseline and received physical check-up and ocular examinations from 2010 to 2012. IOP was measured using a non-contact tonometer according to standardized protocols, as well as systolic blood pressure (SBP), diastolic blood pressure (DBP) and body mass index (BMI). Participants who had attended IOP measurements in both 2010 and 2012 were included in this study. Cross-sectional association of IOP with age was assessed using multivariate liner regression analyses and based on the data of 2010. Longitudinal changes in IOP were assessed by paired t-test. RESULTS A total of 3372 subjects were enrolled in the current analysis (2010 mean [SD] age, 61.9 [7.1] years; 60.2% men). The mean IOP in 2010 was 15.4 ± 2.3 mmHg for women and 15.2 ± 2.3 mmHg for men with an intersex difference (P = 0.029). Cross-sectional analysis showed that IOP was negatively associated with age (P = 0.003, β = -0.033 for women and P<0.001, β = -0.061 for men) adjusted for baseline SBP, DBP and BMI. Paired t-test suggested that IOP was higher in the year 2012 than 2010 in women (P = 0.006) but did not change significantly in men within 2 years (P = 0.345). In addition, the 2-year changes of IOP were not associated with age adjusted for baseline IOP in 2010 (P = 0.249). CONCLUSION Cross-sectional data suggests that IOP is lower in people with older age. Longitudinal data does not support such findings and thus the identified decreasing pattern with age in cross-sectional analysis is likely caused by cohort effects.
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Affiliation(s)
- Xiaotong Han
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yong Niu
- Guangzhou No.11 People’s Hospital, Guangzhou, China
| | - Xinxing Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yin Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - William Yan
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
- * E-mail:
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Clement CI, Parker DGA, Goldberg I. Intra-Ocular Pressure Measurement in a Patient with a Thin, Thick or Abnormal Cornea. Open Ophthalmol J 2016; 10:35-43. [PMID: 27014386 PMCID: PMC4780515 DOI: 10.2174/1874364101610010035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 11/23/2022] Open
Abstract
Accurate measurement of intra-ocular pressure is a fundamental component of the ocular examination. The most common method of measuring IOP is by Goldmann applanation tonometry, the accuracy of which is influenced by the thickness and biomechanical properties of the cornea. Algorithms devised to correct for corneal thickness to estimate IOP oversimplify the effects of corneal biomechanics. The viscous and elastic properties of the cornea influence IOP measurements in unpredictable ways, a finding borne out in studies of patients with inherently abnormal and surgically altered corneal biomechanics. Dynamic contour tonometry, rebound tonometry and the ocular response analyzer provide useful alternatives to GAT in patients with abnormal corneas, such as those who have undergone laser vision correction or keratoplasty. This article reviews the various methods of intra-ocular pressure measurement available to the clinician and the ways in which their utility is influenced by variations in corneal thickness and biomechanics.
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Affiliation(s)
- Colin I Clement
- Eye Associates, 4/187 Macquarie Street Sydney NSW 2000, Australia; Glaucoma Unit, Sydney Eye Hospital, Australia; Discipline of Ophthalmology, The University of Sydney, Australia; Gosford and Wyong Eye Surgery, Australia
| | - Douglas G A Parker
- Eye Associates, 4/187 Macquarie Street Sydney NSW 2000, Australia; Gosford and Wyong Eye Surgery, Australia
| | - Ivan Goldberg
- Eye Associates, 4/187 Macquarie Street Sydney NSW 2000, Australia; Glaucoma Unit, Sydney Eye Hospital, Australia; Discipline of Ophthalmology, The University of Sydney, Australia
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