1
|
Bak E, Kim M, Kim SH, Lee KM. Optic nerve head factors associated with initial central visual field defect in primary open-angle glaucoma. Sci Rep 2024; 14:8000. [PMID: 38580736 PMCID: PMC10997601 DOI: 10.1038/s41598-024-58749-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/02/2024] [Indexed: 04/07/2024] Open
Abstract
We investigated optic nerve head factors associated with initial parafoveal scotoma (IPFS) in primary open-angle glaucoma. Eighty (80) patients with an IPFS and 84 patients with an initial nasal step (INS) were compared. Central retinal vascular trunk (CRVT) deviation from the Bruch's membrane opening (BMO) center was measured as a surrogate of lamina cribrosa (LC)/BMO offset, and its obliqueness was defined as the absolute value of angular deviation from the fovea-BMO axis. Proximity of retinal nerve fiber layer defect (RNFLD) was defined as the angular deviation of the inner RNFLD margin from the fovea-BMO axis. Microvasculature dropout (MvD) was defined as a focal sectoral capillary dropout with no visible microvascular network identified in the choroidal layer. Factors associated with IPFS, as compared with INS, were assessed using logistic regression analyses and conditional inference tree analysis. The IPFS group had more oblique CRVT offset (P < 0.001), RNFLD closer to the fovea (P < 0.001), more MvD (P < 0.001), and more LC defects (P < 0.001) compared to the INS group. In logistic regression analyses, obliqueness of CRVT offset (P = 0.002), RNFLD proximity (P < 0.001), and MvD (P = 0.001) were significant factors influencing the presence of IPFS. Conditional inference tree analysis showed that RNFLD closer to the fovea (P < 0.001) in the upper level, more oblique CRVT offset (P = 0.013) and presence of MvD (P = 0.001) in the lower level were associated with the probability of having IPFS. IPFS was associated with closer RNFLD location to the fovea when assessed from the BMO. Oblique LC/BMO offset may not only mask RNFLD proximity to the fovea due to a deviated funduscopic disc appearance, but also potentiate IPFS via focal LC defect and MvD.
Collapse
Affiliation(s)
- Eunoo Bak
- Department of Ophthalmology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Martha Kim
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | | | - Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Ophthalmology, Seoul National University Boramae Medical Center, 39 Boramae Road, Dongjak-gu, Seoul, 07061, Korea.
| |
Collapse
|
2
|
Oh SE, Shin HJ, Park CK, Park HYL. Clinical Significance of Recurrent Disc Hemorrhage and Choroidal Microvasculature Dropout on Optical Coherence Tomography Angiography in Glaucoma. Invest Ophthalmol Vis Sci 2024; 65:5. [PMID: 38466280 PMCID: PMC10916887 DOI: 10.1167/iovs.65.3.5] [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: 09/24/2023] [Accepted: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
Purpose The purpose of this study was to investigate the clinical significance of recurrent disc hemorrhage (DH) and choroidal microvasculature dropout (MvD). Methods A retrospective cohort study was conducted of 181 eyes with open-angle glaucoma. The clinical characteristics of patients with nonrecurrent and recurrent DH with and without MvD were investigated. Results Fifty-eight patients (32.0%) had a single, nonrecurrent DH, and 63 (34.8%) had more than one DH. Sixty eyes (33.1%) with no history of DH were presented as a control group. MvD was more frequent in the recurrent DH group (44.4%) than in the nonrecurrent DH group (27.6%, P = 0.041). The recurrent DH with MvD group experienced more frequent central visual field (VF) progression (71.4%) than the recurrent DH without MvD group (17.1 %, P < 0.001). The recurrent DH without MvD group had a higher frequency of DH recurrence at different locations (42.9%) and more vascular symptoms (37.1%) than the recurrent DH with MvD group (14.3% and 7.1%, P = 0.013 and P = 0.005, respectively). Presence of DH, presence of MvD, vascular symptoms, and DH recurrence at different locations were the factors associated with central VF progression in multivariate analysis. Conclusions DH occurrence and the presence of MvDs constitute critical parameters associated with central VF progression. In the presence of MvD, recurrent DH was more likely to recur at the same location as the MvD, whereas recurrent DH without MvD was related to vascular symptoms and recurred at other locations. When eyes present with recurrent DH and MvD, closer follow-up and more aggressive treatment are required to prevent the progression of central VF.
Collapse
Affiliation(s)
- Si Eun Oh
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Hee Jong Shin
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Chan Kee Park
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Hae-Young Lopilly Park
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| |
Collapse
|
3
|
Micheletti E, El-Nimri N, Nishida T, Moghimi S, Rezapour J, Fazio MA, Suh MH, Bowd C, Belghith A, Christopher M, Jonas JB, Weinreb RN, Zangwill LM. Central visual field damage in glaucoma eyes with choroidal microvasculature dropout with and without high axial myopia. Br J Ophthalmol 2024; 108:372-379. [PMID: 36805846 DOI: 10.1136/bjo-2022-322234] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 02/09/2023] [Indexed: 02/22/2023]
Abstract
PURPOSE To characterise the relationship between a deep-layer microvasculature dropout (MvD) and central visual field (VF) damage in primary open-angle glaucoma (POAG) patients with and without high axial myopia. DESIGN Cross-sectional study. METHODS Seventy-one eyes (49 patients) with high axial myopia and POAG and 125 non-highly myopic POAG eyes (97 patients) were enrolled. Presence, area and angular circumference of juxtapapillary MvD were evaluated on optical coherence tomography angiography B-scans and en-face choroidal images. RESULTS Juxtapapillary MvD was detected more often in the highly myopic POAG eyes (43 eyes, 86%) than in the non-highly myopic eyes (73 eyes, 61.9%; p=0.002). In eyes with MvD, MvD area and angular circumference (95% CI) were significantly larger in the highly myopic eyes compared with the non-highly myopic eyes (area: (0.69 (0.40, 0.98) mm2 vs 0.31 (0.19, 0.42) mm2, p=0.011) and (angular circumference: 84.3 (62.9, 105.8) vs 74.5 (58.3, 90.9) degrees, p<0.001), respectively. 24-2 VF mean deviation (MD) was significantly worse in eyes with MvD compared with eyes without MvD in both groups (p<0.001). After adjusting for 24-2 MD VF, central VF defects were more frequently found in eyes with MvD compared with eyes without MvD (82.7% vs 60.9%, p<0.001). In multivariable analysis, higher intraocular pressure, worse 24-2 VF MD, longer axial length and greater MvD area and angular circumference were associated with worse 10-2 VF MD. CONCLUSIONS MvD was more prevalent and larger in POAG eyes with high myopia than in non-highly myopic POAG eyes. In both groups, eyes with MvD showed worse glaucoma severity and more central VF defects.
Collapse
Affiliation(s)
- Eleonora Micheletti
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
| | - Nevin El-Nimri
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
| | - Takashi Nishida
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
| | - Sasan Moghimi
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
| | - Jasmin Rezapour
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Massimo A Fazio
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Min Hee Suh
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
- Department of Ophthalmology, Inje University Busan Paik Hospital, Busan, Korea (the Republic of)
| | - Christopher Bowd
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
| | - Akram Belghith
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
| | - Mark Christopher
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
| | - Jost B Jonas
- Department of Ophthalmology, University of Heidelberg Faculty of Medicine Mannheim Institute of Public Health, Mannheim, Germany
| | - Robert N Weinreb
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
| | - Linda M Zangwill
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
| |
Collapse
|
4
|
Lee JS, Park Y, Park S, Kim M, Kim CY, Choi W, Lee SY, Bae HW. Clinical characteristics of open-angle glaucoma progression with peripapillary microvasculature dropout in different locations. Eye (Lond) 2024; 38:284-291. [PMID: 37537389 PMCID: PMC10810892 DOI: 10.1038/s41433-023-02675-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE The study attempted to identify clinical characteristics associated with structural progression in open-angle glaucoma (OAG) in the presence of MvD in different locations. METHODS A total of 181 consecutive OAG eyes (follow-up 7.3 ± 4.0 years), which demonstrated peripapillary choroidal MvD (defined as a focal capillary loss with no visible microvascular network in choroidal layer) on optical coherence tomography (OCT) angiography (OCTA), were divided based on the location of MvD. Structural progression was determined using trend-based analysis of the Guided Progression Analysis software of Cirrus OCT. RESULTS MvD was identified in the temporal quadrant in 110 eyes (temporal MvD; 60.5 ± 12.6 years), and in the inferior quadrant in 71 eyes (inferior MvD; 60.3 ± 11.1 years). After adjusting for age, average intraocular pressure (IOP) and baseline retinal nerve fibre layer (RNFL) thickness and visual field mean deviation, inferior MvD eyes showed faster rates of thinning in the inferior RNFL (mean (95% CI); -0.833 (-1.298 to -0.367)) compared to temporal MvD eyes (-0.144 (-0.496 to 0.207)) when long-term IOP fluctuation was larger than the median value (1.7 mmHg; P = 0.022). Long-term IOP fluctuations were independently associated with inferior RNFL thinning in eyes with inferior MvD (P = 0.002) but not in eyes with temporal MvD. CONCLUSIONS In OAG eyes, the rates of RNFL and GCIPL thinning were comparable regardless of MvD locations. However, inferior MvD is associated with faster RNFL and GCIPL thinning in the same quadrant when long-term IOP fluctuation is present. Structural progression in the presence of temporal MvD was less associated with IOP fluctuation.
Collapse
Affiliation(s)
- Jihei Sara Lee
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Youngmin Park
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Sungeun Park
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Mijeong Kim
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Yun Kim
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Wungrak Choi
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Yeop Lee
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Korea
| | - Hyoung Won Bae
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
5
|
Latif K, Nishida T, Moghimi S, Micheletti E, Du K, Weinreb RN. Relationship of Choroidal Microvasculature Dropout and Beta Zone Parapapillary Area With Visual Field Changes in Glaucoma. Am J Ophthalmol 2024; 257:16-24. [PMID: 37573989 DOI: 10.1016/j.ajo.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE To evaluate the association between rates of choroidal microvasculature dropout (MvD) change, beta zone parapapillary atrophy (β-PPA) area change, and visual field (VF) changes in eyes with primary open-angle glaucoma (POAG). DESIGN Retrospective, observational cohort study. METHODS In a tertiary glaucoma clinic, we included 76 eyes from 58 patients with POAG with and without localized MvD, who had ≥2 years of follow-up with a minimum of 4 visits with optical coherence tomography angiography and optical coherence tomography scans. β-PPA area was evaluated using scanning laser ophthalmoscopy-like images and compared with the area of MvD on an en face choroidal vessel density map during the follow-up period. Joint longitudinal mixed effects models were used to estimate the rates of change in β-PPA area or MvD area and VF mean deviation (MD). RESULTS Mean rates of change in β-PPA and MvD area were 0.037 mm2 (95% confidence interval [CI] 0.030-0.043 mm2) per year and 0.039 mm2 (95% CI 0.029-0.048 mm2) per year, respectively, over the mean follow-up of 4.1 years. In multivariable models, MvD area enlargement was significantly associated with faster rates of VF MD loss (0.03 mm2 [95% CI 0.02-0.04 mm2] per 1-dB worse, P < .001) but not β-PPA area enlargement (0.04 mm2 [95% CI 0.03-0.05 mm2] per 1-dB worse, P = .252). CONCLUSION MvD area rates, but not β-PPA area rates, were associated with VF MD loss changes in eyes with POAG. Assessment of MvD is useful for the detection of patients with glaucoma who are at an increased risk of faster VF loss.
Collapse
Affiliation(s)
- Kareem Latif
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Takashi Nishida
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Sasan Moghimi
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Eleonora Micheletti
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Kelvin Du
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Robert N Weinreb
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA.
| |
Collapse
|
6
|
Baek MS, Sung KR, Shin JW, Lee JY, Kim KE. Change of Choroidal Microvasculature Dropout After Trabeculectomy as Assessed by Optical Coherence Tomography Angiography. J Glaucoma 2023; 32:665-672. [PMID: 37079525 DOI: 10.1097/ijg.0000000000002230] [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: 07/20/2022] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
PRCIS Reduction in the angular circumference of choroidal microvascular dropout (CMvD AC) was found in POAG patients after trabeculectomy. Greater percentage of IOP reduction was significantly associated with decreased CMvD AC. PURPOSE The purpose of this study was to investigate the change of choroidal microvasculature dropout (CMvD) after trabeculectomy and its associated factors in primary open angle glaucoma (POAG) eyes using optical coherence tomography angiography. METHODS Fifty eyes of 50 POAG participants who had preoperative CMvD and underwent trabeculectomy were prospectively enrolled. Angular circumference (AC) of CMvD was determined from choroidal layer images by optical coherence tomography angiography preoperatively and at postoperative 1 year. The cutoff for significant AC of CMvD decrease was determined by the Bland-Altman method, and accordingly, patients were divided into 2, decreased and stable/increased CMvD AC groups. Changes in intraocular pressure (IOP) and CMvD AC were compared between the groups preoperatively and at postoperative 1 year. Factors associated with CMvD AC decrease were assessed by linear regression analysis. RESULTS The cutoff for significant CMvD AC decrease was 3.58 degrees; accordingly, 26 eyes (52.0%) were categorized as decreased CMvD AC group. No significant intergroup differences in baseline characteristics were found. However, the decreased CMvD AC group presented significantly lower IOP (10.7±3.7 vs. 12.9±2.6 mm Hg, P =0.022), lower CMvD AC (32.03±33.95% vs. 53.44±39.33%, P =0.044), and higher parapapillary choroidal vessel density ( P =0.014) compared with the increased/stable CMvD AC group at postoperative 1 year. The greater percentage of IOP reduction was significantly associated with decreased CMvD AC ( P =0.046). CONCLUSIONS CMvD AC reduction associated with IOP lowering was found after trabeculectomy. The long-term clinical relevance of postoperative CMvD reduction should be further investigated.
Collapse
Affiliation(s)
- Min Su Baek
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | | | | | | | | |
Collapse
|
7
|
Lim YJ, Bang JW, Weinreb RN, Zangwill LM, Suh MH. Temporal Optic Disc Microvasculature Dropout in Glaucoma. Invest Ophthalmol Vis Sci 2023; 64:6. [PMID: 37540177 PMCID: PMC10408767 DOI: 10.1167/iovs.64.11.6] [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: 02/13/2023] [Accepted: 07/06/2023] [Indexed: 08/05/2023] Open
Abstract
PURPOSE To assess the clinical characteristics of focal temporal optic disc microvasculature dropout (MvD-D) in primary open-angle glaucoma (POAG) patients. METHODS One hundred and eighty-seven eyes of 187 POAG patients having MvD-D on Swept-Source optical coherence tomography angiography (SS-OCTA) were enrolled. Three groups were categorized according to the presence of temporal MvD-D within the upper and lower 45° of the fovea-Bruch's membrane (BM) opening axis: focal temporal MvD-D (Group 1, isolated focal temporal MvD-D; 44 eyes), supero/inferotemporal MvD-D (Group 2, MvD-D only in superotemporal or inferotemporal sector; 78 eyes), and diffuse temporal MvD-D (Group 3, MvD-D spanning ≥ 2 consecutive sectors, at least one of which being temporal sector; 65 eyes). RESULTS Group 1 had a significantly longer axial length and β-zone parapapillary atrophy without BM. There also was a larger horizontal tilt angle and ovality index than the other two groups (P < 0.001). Group 1 had a significantly thinner retinal nerve fiber layer (RNFL) in the temporal sector than did Group 2 (P < 0.001), despite similar thicknesses in all other areas (P > 0.05). Group 3 had significantly worse visual field mean deviation and thinner RNFL than the other two groups in all areas other than the nasal, temporal, and superotemporal sectors (P < 0.05). CONCLUSIONS Focal temporal MvD-D detected by SS-OCTA was associated with a longer axial length and related subsequent morphological changes of the optic disc and parapapillary area. This suggests that stretching of the optic disc consequent on axial elongation may lead to absence of temporal optic disc microvasculature.
Collapse
Affiliation(s)
- Yeon Ju Lim
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jong Wook Bang
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Linda M. Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Min Hee Suh
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| |
Collapse
|
8
|
Lee SH, Lee EJ, Kim TW. Discrepancy between peripapillary retinal and choroidal microvasculature and the rate of localized retinal nerve fiber layer thinning in glaucoma. Sci Rep 2023; 13:6513. [PMID: 37085554 PMCID: PMC10121720 DOI: 10.1038/s41598-023-33637-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/16/2023] [Indexed: 04/23/2023] Open
Abstract
This observational case series study is conducted to compare the extent of microvasculature impairment in the peripapillary retina and choroid in eyes with primary open-angle glaucoma (POAG), and to investigate the association of the discrepancy between the microvasculature impairments of each layer with the rate of progressive retinal nerve fiber layer (RNFL) thinning. A total of 88 POAG eyes with a localized RNFL defect were enrolled, including 67 eyes with and 21 eyes without choroidal microvasculature dropout (CMvD). Circumferential widths of retinal microvascular impairment (RMvI) and CMvD were measured, and eyes were classified based on the relative width of CMvD to RMvI (CMvD/RMvI ratio). The rate of RNFL thinning was determined by linear regression based on ≥ 5 serial OCT examinations. Thinner global RNFL and worse visual field mean deviation at baseline were associated with a larger circumferential width of the RMvI, whereas the presence of cold extremities, lower mean arterial pressure and thinner juxtapapillary choroid were associated with a larger circumferential width of the CMvD. The rate of global RNFL thinning was faster in eyes with larger relative CMvD width than in eyes with equal CMvD and RMvI widths and in eyes without CMvD (P = 0.001). Lower mean arterial pressure (P = 0.041), larger CMvD width (P = 0.046), larger CMvD/RMvI ratio (P = 0.041), and detection of disc hemorrhage during the follow-up (P = 0.013) were significant factors associated with faster global RNFL thinning. Larger CMvD width relative to RMvI width may be indicative of an increased risk of faster RNFL thinning in POAG with localized RNFL defect. Comparing the microvasculature impairment in individual layers may help predict more rapid glaucoma progression.
Collapse
Affiliation(s)
- Seung Hyen Lee
- Department of Ophthalmology, Nowon Eulji University Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Eun Ji Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 13620, Gyeonggi, Korea.
| | - Tae-Woo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 13620, Gyeonggi, Korea
| |
Collapse
|
9
|
Effects of Tafluprost on Ocular Blood Flow. Ophthalmol Ther 2022; 11:1991-2003. [DOI: 10.1007/s40123-022-00566-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/26/2022] [Indexed: 10/14/2022] Open
|
10
|
Micheletti E, Moghimi S, Nishida T, El-Nimri N, Mahmoudinezhad G, Kamalipour A, Rao HL, Zangwill LM, Weinreb RN. Rates of Choroidal Microvasculature Dropout and Retinal Nerve Fiber Layer Changes in Glaucoma. Am J Ophthalmol 2022; 241:130-138. [PMID: 35551906 DOI: 10.1016/j.ajo.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/26/2022] [Accepted: 04/30/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the association between rates of choroidal microvasculature dropout (MvD) change and rates of circumpapillary retinal nerve fiber layer (cpRNFL) loss in primary open-angle glaucoma (POAG) eyes. DESIGN Cohort study from clinical trial data. METHODS A total of 91 eyes of 68 POAG patients with and without localized MvD at baseline with at least 4 visits and 2 years of follow-up with optical coherence tomography angiography (OCT-A) and OCT scans were included. Area and angular circumference of MvD were evaluated on OCT-A en face and B-scan choroidal vessel density images during the follow-up period. Joint longitudinal mixed effects models were used to estimate the rates of change in MvD area or angular circumference and RNFL thickness. Univariable and multivariable regressions were completed to identify the factors contributing to cpRNFL thinning. RESULTS MvD was identified in 53 eyes (58.2%) at baseline. Seventeen eyes (18.6%) that did not show MvD at baseline developed it over the follow-up period. Over a mean follow-up of 4.0 years, the mean rates of change in MvD area and angular circumference (95% CI) were 0.05 (0.04, 0.06) mm2 per year and 13.2° (10.7°, 15.8°) per year, respectively. In multivariable models, the rate of cpRNFL thinning was significantly associated with the rates of change in MvD area and angular circumference (P = .008 and P = .009, respectively). CONCLUSIONS Rates of MvD area and angular circumference change over time were associated with concurrent rates of cpRNFL loss in POAG eyes.
Collapse
Affiliation(s)
- Eleonora Micheletti
- From the Hamilton Glaucoma Center(E.M., S.M., T.N., N.E.N., G.M., A.K., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Sasan Moghimi
- From the Hamilton Glaucoma Center(E.M., S.M., T.N., N.E.N., G.M., A.K., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Takashi Nishida
- From the Hamilton Glaucoma Center(E.M., S.M., T.N., N.E.N., G.M., A.K., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Nevin El-Nimri
- From the Hamilton Glaucoma Center(E.M., S.M., T.N., N.E.N., G.M., A.K., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Golnoush Mahmoudinezhad
- From the Hamilton Glaucoma Center(E.M., S.M., T.N., N.E.N., G.M., A.K., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Alireza Kamalipour
- From the Hamilton Glaucoma Center(E.M., S.M., T.N., N.E.N., G.M., A.K., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Harsha L Rao
- Narayana Nethralaya (H.L.R.), Bangalore, India; University Eye Clinic Maastricht (H.L.R.), University Medical Center, Maastricht, the Netherlands
| | - Linda M Zangwill
- From the Hamilton Glaucoma Center(E.M., S.M., T.N., N.E.N., G.M., A.K., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Robert N Weinreb
- From the Hamilton Glaucoma Center(E.M., S.M., T.N., N.E.N., G.M., A.K., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA.
| |
Collapse
|
11
|
Suh MH, Jung DH, Weinreb RN, Zangwill LM. Optic Disc Microvasculature Dropout in Glaucoma Detected by Swept-Source Optical Coherence Tomography Angiography. Am J Ophthalmol 2022; 236:261-270. [PMID: 34740630 DOI: 10.1016/j.ajo.2021.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To assess the clinical utility of swept-source optical coherence tomography angiography (SS-OCTA) in detecting optic disc microvasculature dropout (MvD-D) in primary open-angle glaucoma (POAG) eyes. DESIGN Cross-sectional study. METHODS The study enrolled 197 eyes of 197 patients with POAG with acceptable-quality SS-OCTA (PLEX Elite 9000; Carl Zeiss Meditec) images. A whole-signal-mode 6.0- × 6.0-mm optic disc cube was obtained with projection artifact removal. Three groups were categorized: no MvD-D (group 1), MvD-D (group 2, complete loss of microvasculature within the optic disc), and indiscernible MvD-D (group 3, poor visualization of the anterior lamina cribrosa [LC]). RESULTS There were 82 (42.1%) and 81 (41.5%) eyes categorized as no MvD-D (group 1) and MvD-D (group 2), respectively. The remaining 32 eyes (16.4%), categorized as indiscernible MvD-D (group 3), had a significantly smaller anterior scleral canal opening (ASCO) area (P < .05). Group 2 had significantly worse visual field (VF) mean deviation (MD), thinner average retinal nerve fiber layer (RNFL), higher prevalence of focal LC defect, and parapapillary deep-layer microvasculature dropout (MvD-P) than the other 2 groups (P < .05). In the multivariable logistic regression analysis, higher prevalence of focal LC defect (odds ratio, 46.91; P < .001) and MvD-P (odds ratio, 48.94; P < .001) remained as factors associated with MvD-D. CONCLUSIONS The presence of MvD-D could be well determined by SS-OCTA in eyes with POAG. MvD-P and focal LC defects were strongly associated with MvD-D. This suggests that SS-OCTA can serve as a useful tool in detecting optic disc microvasculature damage.
Collapse
|