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Lee EJ, Han DK, Roh YJ, Kim TW. Underlying Microstructure of the Lamina Cribrosa at the Site of Microvasculature Dropout. Invest Ophthalmol Vis Sci 2024; 65:47. [PMID: 39078730 PMCID: PMC11290565 DOI: 10.1167/iovs.65.8.47] [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: 05/15/2024] [Accepted: 07/11/2024] [Indexed: 08/02/2024] Open
Abstract
Purpose To determine the microstructure of the lamina cribrosa (LC) associated with microvasculature dropout (MvD) of the deep optic nerve head (ONH) in primary open-angle glaucoma (POAG) and to identify factors related to the presence of MvD. Methods POAG eyes that exhibited MvD in the LC (MvD-LC) or MvD in the peripapillary choroid (MvD-PC) underwent optical coherence tomography and optical coherence tomography angiography (OCTA) to evaluate the structure and microvasculature of the deep ONH, respectively. The presence of MvD-LC or MvD-PC was determined using en face OCTA images of the deep ONH. The sectoral LC thickness (LCT) and LC curvature index (LCCI) (at MvD-LC site, when applicable), the mean LCT and LCCI of the global ONH, and other clinical characteristics were measured and compared between eyes with and without MvD-LC. Results The study included 93 eyes with and 51 without MvD-LC. The presence of MvD-LC was associated with lower sectoral LCT (odds ratio [OR] = 0.96, P < 0.001) and mean LCT (OR = 0.97, P = 0.032), larger visual field pattern standard deviation (PSD; OR = 1.20, P = 0.038), and higher pretreatment intraocular pressure (IOP; OR = 1.22, P = 0.012). Fifteen percent of the eyes with MvD-LC (14/93) did not present MvD-PC. Those eyes had younger age (P = 0.043), thicker juxtapapillary choroid (P = 0.018), larger sectoral LCCI (P = 0.040), thicker retinal nerve fiber layer (P = 0.024), smaller PSD (P = 0.008), and higher pretreatment IOP (P = 0.006) than those with both MvD-LC and MvD-PC. Conclusions MvD-LC was associated with a localized morphologic alteration of the LC, and eyes with MvD-LC tended to have a higher pretreatment IOP. The clinical implications of MvD-LC should differ from those of MvD-PC in eyes with POAG.
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Affiliation(s)
- Eun Ji Lee
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Dong Kyun Han
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yu Jin Roh
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Tae-Woo Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Han Y, Wang X, Xue CC, Jonas JB, Wang YX. Lamina Cribrosa Configurations in Highly Myopic and Non-Highly Myopic Eyes: The Beijing Eye Study. Invest Ophthalmol Vis Sci 2024; 65:28. [PMID: 39023442 PMCID: PMC11262544 DOI: 10.1167/iovs.65.8.28] [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: 04/08/2024] [Accepted: 07/01/2024] [Indexed: 07/20/2024] Open
Abstract
Purpose The purpose of this study was to examine characteristics of lamina cribrosa (LC) configuration in highly myopic (HM) eyes. Methods Participants from the Beijing Eye Study 2011, free of optic nerve or retinal diseases, were randomly selected to examine LC depth (LCD) and LC tilt (LCT) using three-dimensional optical coherent tomography images of the optic nerve head (ONH). LCD and LCT were measured as the distance and angle between the LC plane with two reference planes, including the Bruch's membrane opening (BMO) plane and the peripapillary sclera (PPS) plane, respectively. Each parameter was measured in both horizontal and vertical B-scans. Results The study included 685 individuals (685 eyes) aged 59.6 ± 7.7 years, including 72 HM eyes and 613 non-HM eyes. LCD measurements showed no significant differences between HM eyes and non-HM eyes in both horizontal (LCD-BMO = 421.83 ± 107.86 µm for HM eyes vs. 447.24 ± 104.94 µm for non-HM eyes, P = 0.18; and LCD-PPS = 406.39 ± 127.69 µm vs. 394.00 ± 101.64 µm, P = 1.00) and vertical directions (LCD-BMO = 435.78 ± 101.29 µm vs. 450.97 ± 106.54 µm, P = 0.70; and LCD-PPS = 401.62 ± 109.9 µm vs. 379.85 ± 110.35 µm, P = 0.35). However, the LCT was significantly more negative (tilted) in HM eyes than in non-HM eyes horizontally (LCT-BMO = -4.38 ± 5.94 degrees vs. -0.04 ± 5.86 degrees, P < 0.001; and LCT-PPS = -3.16 ± 5.23 degrees vs. -0.94 ± 4.71 degrees, P = 0.003), but not vertically (P = 1.00). Conclusions Although LCD did not differ significantly between HM and non-HM eyes, LCT was more negative in HM eyes, suggesting that the temporal or inferior side of the LC was closer to the reference plane. These findings provide insights into morphological and structural changes in the LC and ONH between HM and non-HM eyes.
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Affiliation(s)
- Yingxiang Han
- Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xiaofei Wang
- Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Can Can Xue
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Jost B. Jonas
- Rothschild Foundation Hospital, Institut Français de Myopie, Paris, France
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
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Canleblebici M, Celiker U, Yıldırım H, Balbaba M. Evaluation of lamina cribrosa curvature index in different types of glaucoma. Int Ophthalmol 2024; 44:284. [PMID: 38926206 DOI: 10.1007/s10792-024-03190-x] [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: 01/24/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the lamina cribrosa curvature index in different types of glaucoma in comparison with clinical findings and conventional measurement methods. MATERIAL AND METHOD Patients older than 18 years who were followed up in Glaucoma Unit of Department of Ophthalmology at Fırat University Faculty of Medicine, whose disease had been under control at least for 1 year, who had at least three reliable visual fields, whose refractive error was between - 6 and + 5 diopter and who did not have any disease other than glaucoma that would affect the visual field, were included in the study. Clinical and demographic characteristics, visual field, optical coherence tomography and lamina cribrosa curvature index (LCCI) results were evaluated. The study patients were divided into six groups: early-stage primary open-angle glaucoma (POAG) as group 1 and intermediate-advanced stage POAG as group 2, pseudo-exfoliation glaucoma (PEXG) as group 3, normal tension glaucoma (NTG) as group 4, ocular hypertension patients whom subsequently developed POAG as group 5 and healthy control as group 6. RESULTS A total of 189 eyes of 101 patients were included in our study. Forty-seven patients were male (46.5%) and 54 were female (53.5%). The mean age was 62.43 ± 1.49 years. LCCI, mean deviation (MD), visual field index (VFI), pattern standard deviation (PSD) and retinal nerve fiber layer thickness (RNFL) values were analyzed in all groups and Pearson correlation analysis showed statistically significant correlation between PSD and RNFL measurements with LCCI values in all groups. MD value was correlated with LCCI in groups 2, 3 and 4, while VFI value was correlated with LCCI in all groups except group 5. When the groups were compared with each other according to the Post-Hoc Tamhane test, LCCI measurement showed statistically significant results in accordance with MD, VFI, PSD and RNFL values. CONCLUSION The LCCI assessment is mostly consistent with conventional tests. In this study, in which different types of glaucoma and healthy subjects were examined simultaneously, LCCI shows promise as a detailed and reliable assessment method.
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Affiliation(s)
| | - Ulku Celiker
- Faculty of Medicine, Department of Ophthalmology, Fırat University, Elazığ, Turkey
| | - Hakan Yıldırım
- Faculty of Medicine, Department of Ophthalmology, Fırat University, Elazığ, Turkey
| | - Mehmet Balbaba
- Faculty of Medicine, Department of Ophthalmology, Fırat University, Elazığ, Turkey
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Akagi T, Kato-Takano Y, Miyamoto D, Sakaue Y, Igarashi R, Iikawa R, Arimatsu M, Miyajima M, Togano T, Fukuchi T. Relationship between Inter-Eye Asymmetries in Corneal Hysteresis and Visual Field Severity in Patients with Primary Open-Angle Glaucoma. J Clin Med 2023; 12:4514. [PMID: 37445554 DOI: 10.3390/jcm12134514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
This study investigated the influence of asymmetric corneal hysteresis (CH) on asymmetric visual field impairment between right and left eyes in patients with primary open-angle glaucoma (POAG) without a history of intraocular surgery. CH, corneal resistance factor (CRF), and corneal compensated intraocular pressure (IOPcc) were measured using the Ocular Response Analyzer. Differences between the eyes (right eye-left eye: DIFRL) and CH-based and in target parameters (higher CH eye-lower CH eye: DIFCH) were calculated in the same patient. In 242 phakic eyes of 121 patients, older age (p < 0.001), lower CH (p = 0.001), and lower CRF (p = 0.007) were significantly associated with worse standard automated perimetry (SAP) 24-2 mean deviation (MD). The DIFsRL in axial length (p = 0.003), IOPcc (p = 0.028), and CH (p = 0.001) were significantly associated with the DIFRL in SAP24-2 MD, but not in central corneal thickness (CCT), Goldmann applanation tonometry (GAT) measurement, and CRF. When dividing the patients into two groups based on the median of the CH DIFsCH (0.46), the DIFsCH in CRF (p < 0.001), IOPcc (p < 0.001), CCT (p = 0.004), SAP24-2 MD (p < 0.001), and SAP10-2 MD (p = 0.010) were significantly different between the groups. Large inter-eye asymmetry in CH is an important explanatory factor for disease worsening in patients with POAG.
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Affiliation(s)
- Tadamichi Akagi
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Yukiho Kato-Takano
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Daiki Miyamoto
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Yuta Sakaue
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Ryoko Igarashi
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Ryu Iikawa
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Mao Arimatsu
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Makoto Miyajima
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Tetsuya Togano
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Takeo Fukuchi
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
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Lee EJ, Song JE, Hwang HS, Kim JA, Lee SH, Kim TW. Choroidal Microvasculature Dropout in the Absence of Parapapillary Atrophy in POAG. Invest Ophthalmol Vis Sci 2023; 64:21. [PMID: 36897150 PMCID: PMC10010446 DOI: 10.1167/iovs.64.3.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Purpose To describe the parapapillary choroidal microvasculature dropout (CMvD) in glaucomatous eyes without β-zone parapapillary atrophy (β-PPA) and compare its characteristics with that of CMvD with β-PPA. Methods Peripapillary choroidal microvasculature was evaluated on en face images obtained using optical coherence tomography angiography. CMvD was defined as a focal sectoral capillary dropout with no visible microvascular network identified in the choroidal layer. Peripapillary and optic nerve head structures, including the presence of β-PPA, peripapillary choroidal thickness and lamina cribrosa curvature index were evaluated using the images obtained by enhanced depth-imaging optical coherence tomography. Results The study included 100 glaucomatous eyes with CMvD (25 without and 75 with β-PPA) and 97 eyes without CMvD (57 without and 40 with β-PPA). Regardless of the presence of β-PPA, eyes with CMvD tended to have a worse visual field at a given RNFL thickness than eyes without CMvD, with patients having eyes with CMvD having lower diastolic blood pressure and more frequent cold extremities than patients with eyes lacking CMvD. Peripapillary choroidal thickness was significantly smaller in eyes with than without CMvD, but was not affected by the presence of β-PPA. β-PPA without CMvD was not associated with vascular variables. Conclusions CMvD were found in the absence of β-PPA in glaucomatous eyes. CMvDs had similar characteristics in the presence and absence of β-PPA. Clinical and optic nerve head structural characteristics potentially relevant to compromised optic nerve head perfusion were dependent on the presence of CMvD, rather than the presence of β-PPA.
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Affiliation(s)
- Eun Ji Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Eun Song
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Seong Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Ah Kim
- Department of Ophthalmology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seung Hyen Lee
- Department of Ophthalmology, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
| | - Tae-Woo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Lee EJ, Kim TW, Kim JA, Lee SH, Kim H. Predictive Modeling of Long-Term Glaucoma Progression Based on Initial Ophthalmic Data and Optic Nerve Head Characteristics. Transl Vis Sci Technol 2022; 11:24. [PMID: 36251319 PMCID: PMC9586140 DOI: 10.1167/tvst.11.10.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to develop a model, based on initial optic nerve head (ONH) characteristics, predictive of long-term rapid retinal nerve fiber layer (RNFL) thinning in patients with open-angle glaucoma (OAG). Methods This study evaluated 712 eyes with OAG that had been followed up for >5 years with annual evaluation of RNFL thickness. Baseline ophthalmic features were incorporated into the machine learning models for prediction of faster RNFL thinning. The model was trained and tested using a random forest (RF) method, and was interpreted using Shapley additive explanations. Factors associated with faster rate of RNFL thinning were statistically evaluated using a decision tree. Results The RF model showed that greater lamina cribrosa (LC) curvature, higher intraocular pressure (IOP), visual field mean deviation converging towards −5 dB, and thinner peripapillary choroid at baseline were the four most significant features predicting faster RNFL thinning. Partial interaction between the features showed that larger LC curvature was a strong factor for faster RNFL thinning when it exceeded approximately 12.0. When the LC curvature was ≤12, higher initial IOP and thinner peripapillary choroid played a role in the rapid RNFL thinning. Based on the decision tree, higher IOP (>26.5 mm Hg), greater laminar curvature (>13.95), and thinner peripapillary choroid (≤117.5 µm) were the 3 most important determinants affecting the rate of RNFL thinning. Conclusions Baseline ophthalmic data and ONH characteristics of patients with OAG were predictive of eyes at risk of faster progression. Combinations of important characteristics, such as IOP, LC curvature, and choroidal thickness, could stratify eyes into groups with different rates of RNFL thinning. Translational Relevance This work lays the foundations for developing prediction models to estimate glaucoma prognosis based on initial ONH characteristics.
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Affiliation(s)
- Eun Ji Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae-Woo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Ah Kim
- Department of Ophthalmology, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Seung Hyen Lee
- Department of Ophthalmology, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
| | - Hyunjoong Kim
- Department of Applied Statistics, Yonsei University, Seoul, Korea
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Bastelica P, Labbé A, El Maftouhi A, Hamard P, Paques M, Baudouin C. Rôle de la lame criblée dans la pathogenèse du glaucome. Une revue de la littérature. J Fr Ophtalmol 2022; 45:952-966. [DOI: 10.1016/j.jfo.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 11/24/2022]
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Kim JA, Lee EJ, Kim TW, Woo SJ. Difference in topographic morphology of optic nerve head and neuroretinal rim between normal tension glaucoma and central retinal artery occlusion. Sci Rep 2022; 12:10895. [PMID: 35764667 PMCID: PMC9240046 DOI: 10.1038/s41598-022-14943-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/15/2022] [Indexed: 11/09/2022] Open
Abstract
Although central retinal artery occlusion (CRAO) has its own defining pathomechanism and clinical characteristics, morphologic feature of the optic nerve head (ONH) during its later stage is not diagnostic, which makes it difficult to differentiate CRAO from other optic neuropathies. This cross-sectional study was performed to investigate the differences in the topographic morphology of the ONH in eyes with normal-tension glaucoma (NTG) and CRAO. Thirty-one eyes with NTG; 31 eyes with CRAO; and 31 healthy fellow eyes of the subjects with CRAO were included. ONH morphology was evaluated by measuring horizontal rim width (HRW), minimal rim width in the selected horizontal image (MRW), and lamina cribrosa curvature index (LCCI) in horizontal B-scan images obtained using enhanced depth-imaging optical coherence tomography. HRW was smaller and LCCI was larger in NTG eyes than in both CRAO and healthy fellow eyes (both P < 0.001), while both were comparable between CRAO and healthy fellow eyes. MRW differed significantly among the three groups, being smallest in NTG eyes followed by CRAO and healthy fellow eyes (P < 0.001). NTG and CRAO eyes with a similar degree of RNFL loss differed in ONH morphology, indicating that mechanisms of ONH damage differ between these two conditions.
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Affiliation(s)
- Ji-Ah Kim
- Department of Ophthalmology, Ewha Womans University College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Eun Ji Lee
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 463-707, Gyeonggi-do, Korea.
| | - Tae-Woo Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 463-707, Gyeonggi-do, Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 463-707, Gyeonggi-do, Korea
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Comparison between frequency-doubling technology perimetry and standard automated perimetry in early glaucoma. Sci Rep 2022; 12:10173. [PMID: 35715424 PMCID: PMC9205973 DOI: 10.1038/s41598-022-13781-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/27/2022] [Indexed: 11/18/2022] Open
Abstract
This study aimed to find out the significance of the difference between frequency-doubling technology perimetry (FDT) and standard automated perimetry (SAP) in terms of the detected visual field (VF) damage, and evaluate associated factors to SAP–FDT difference in early glaucoma. Glaucoma patients in early stage (MD better than − 6.0 decibel, 96 eyes) were included in this cross-sectional study. We subtracted mean deviation (MD) and pattern standard deviation (PSD) of FDT from those of SAP, respectively. Additionally, we counted significantly depressed points of P < 5% and P < 1% on the pattern deviation probability plot of both FDT and SAP and defined eyes with significant SAP–FDT difference when the number of abnormal points were greater than 4 points on FDT. We measured lamina cribrosa depth (LCD) and lamina cribrosa curvature index (LCCI) for structural parameters of the optic nerve head from images using enhanced depth imaging of the optical coherence tomography (OCT). Peripapillary vessel density (VD) and presence of microvasculature dropout (MvD), the complete loss of choriocapillaris in localized regions of parapapillary atrophy, was evaluated using deep layer map of OCT angiography (OCT-A) for vascular parameters. Peripheral nasal step (PNS) group had an isolated glaucomatous VF defect within nasal periphery outside 10° of fixation. Parafoveal scotoma (PFS) group had an isolated glaucomatous VF defect within 12 points of a central 10˚ radius. Eyes with significant SAP–FDT difference showed higher detection of MvD on deep layer map of OCT-A, greater LCD, and greater LCCI (all P < 0.05, respectively). In logistic regression analysis, frequent presence of MvD, less presence of disc hemorrhage, and greater LCD were significantly associated with significant SAP–FDT difference. Sub-analysis was performed in eyes with PNS (50 eyes) and PFS (46 eyes). SAP–FDT difference of MD value showed positive association with peripapillary VD on deep layer of OCT-A, which was significant in eyes with PFS compared to eyes with PNS. SAP–FDT difference of PSD value showed negative association with LCCI and LCD, which was significant in eyes with PNS compared to eyes with PFS. Glaucomatous eyes classified by the difference of the detected VF damage on FDT versus SAP showed different clinical features. Greater SAP–FDT difference was significantly associated with structural parameters such as LCD and LCCI. Less SAP–FDT difference was associated with presence of disc hemorrhage and lower deep layer peripepillary VD. There is possibility to use the difference of SAP and FDT to identify associated risk factors in glaucoma patients.
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BARMAN KAKİL Ş, ERDEM E, HARBİYELİ İİ, YAĞMUR M. Predictive values of lamina cribrosa depth and ganglion cell complex thickness in early diagnosis of glaucoma. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1029547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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11
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Hepokur M, Elgin CY, Gunes M, Sali F, Oguz H. A comprehensive enhanced depth imaging spectral-domain optical coherence tomography analysis of pseudoexfoliation spectrum from non-glaucomatous to advanced stage glaucoma in the aspect of Bruch's membrane opening-minimum rim width. Int Ophthalmol 2022; 42:1835-1847. [PMID: 34984628 DOI: 10.1007/s10792-021-02181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the correlations between lamina cribrosa (LC) and related structures with Bruch's membrane opening-minimum rim width (BMO-MRW) and retinal nerve fiber layer (RNFL) thickness in pseudoexfoliation syndrome (PXS) and different stages of pseudoexfoliation glaucoma (PXG). METHODS This prospective cross-sectional study included 32 PXS eyes of 24 patients and 94 PXG eyes (early-stage (n: 55) and advanced-stage glaucoma (n: 39) of 78 patients. Global and six sectors of RNFL thicknesses and BMO-MRW parameters were measured with enhanced depth imaging (EDI) mode of SD-OCT. Structural parameters; lamina cribrosa thickness (LCT), lamina cribrosa depth (LCD), prelaminar tissue thickness (PLTT), four quadrants of peripapillary choroidal thicknesses (PPCT), and subfoveal choroidal thickness (SFCT) were measured and statistical relationships between the structural parameters have been laid out. We apply the generalized estimating equations method to take into account dependency of right and left eyes. RESULTS From PXS to mild and advanced PXG groups LCT and PLTT decrease from 147.29 ± 33.10, 145.62 ± 30.64, 126.30 ± 29.14 and 260.93 ± 185.07, 247.27 ± 142.58, 159.89 ± 86.84, respectively, and LCD varies as 159.89 ± 86.84, 420.88 ± 117.80, and 505.64 ± 183.25. The correlations between LCD, LCT, and PLTT and the stage of the disease are significant. BMO-MRW shows slightly stronger correlations than the RNFL with LC related parameters. SFCT does not exhibit any significant relationship with the stage of the disease. However, PPCT in only the interior quadrant does. The significant correlations between LCD and all quadrants of PPCT is the sign of important anatomic relationship. CONCLUSION These findings show that the BMO-MRW parameter may be more sensitive than RNFL and can safely be used in the diagnosis and follow-up in PXS and PXG, but this result should be supported with longer and larger series.
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Affiliation(s)
- Mustafa Hepokur
- Department of Ophthalmology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Cansu Yuksel Elgin
- Department of Ophthalmology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey.
| | - Medine Gunes
- Department of Ophthalmology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey.,Department of Ophthalmology, Istanbul Medeniyet University Medical Faculty, Istanbul, Turkey
| | - Fatma Sali
- Department of Ophthalmology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey.,Department of Ophthalmology, Istanbul Medeniyet University Medical Faculty, Istanbul, Turkey
| | - Halit Oguz
- Department of Ophthalmology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey.,Department of Ophthalmology, Istanbul Medeniyet University Medical Faculty, Istanbul, Turkey
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Vertical Position of the Central Retinal Vessel in the Optic Disc and Its Association With the Site of Visual Field Defects in Glaucoma. Am J Ophthalmol 2021; 229:253-265. [PMID: 34048804 DOI: 10.1016/j.ajo.2021.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/03/2021] [Accepted: 05/12/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of this study was to investigate the association between the vertical position of the central retinal vessel (CRV) within the optic nerve head (ONH) and the site of visual field defects (VFDs) in glaucoma. DESIGN Cross-sectional study. METHODS The vertical position of the CRV was identified in 134 glaucoma eyes and 61 normal eyes at the point at which CRV exited the lamina cribrosa (LC) onto the ONH surface, by using spectral-domain optical coherence tomography (exit position). The position was also identified at the entry point into the LC from the retrolaminar ONH region (entry position), which was little influenced by glaucomatous LC deformation, therefore close to the original position before the glaucoma development. Positions were compared among glaucoma eyes with different sites of VFDs, and between glaucoma and normal eyes. RESULTS In glaucoma eyes, the entry position of the CRV was in the superior ONH region in 63.0% of eyes with superior VFDs and in the inferior ONH region in 97.8% of eyes with inferior VFDs (P < .0001). The exit position exhibited a similar percentage. The vertical CRV positions were not significantly different between glaucoma and normal eyes, both at the entry and exit positions. CONCLUSIONS Eyes with CRVs in the superior ONH region were significantly more likely to form VFDs in the superior hemifields and vice versa. The vertical position of the CRV was little altered by the development of glaucoma. The original position of the CRV before the development of glaucoma may influence regional susceptibility to glaucomatous stress and may be useful in predicting initial sites of VFDs.
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Predicting the development of normal tension glaucoma and related risk factors in normal tension glaucoma suspects. Sci Rep 2021; 11:16697. [PMID: 34404847 PMCID: PMC8371169 DOI: 10.1038/s41598-021-95984-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/08/2021] [Indexed: 12/29/2022] Open
Abstract
This study investigated the predicted risk factors for the development of normal-tension glaucoma (NTG) in NTG suspects. A total of 684 eyes of 379 NTG suspects who were followed-up for at least 5 years were included in the study. NTG suspects were those having (1) intraocular pressure within normal range, (2) suspicious optic disc (neuroretinal rim thinning) or enlarged cup-to-disc ratio (≥ 0.6), but without definite localized retinal nerve fiber layer (RNFL) defects on red-free disc/fundus photographs, and (3) normal visual field (VF). Demographic, systemic, and ocular characteristics were determined at the time of the first visit via detailed history-taking and examination of past medical records. Various ocular parameters were assess using spectral-domain optical coherence tomography and Heidelberg retinal tomography. Conversion to NTG was defined either by the presence of a new localized RNFL defect at the superotemporal or inferotemporal region on disc/fundus red-free photographs, or presence of a glaucomatous VF defect on pattern standard deviation plots on two consecutive tests. Hazard ratios were calculated with the Cox proportional hazard model. In total, 86 (12.6%) of the 684 NTG suspects converted to NTG during the follow-up period of 69.39 ± 7.77 months. Significant (P < 0.05, Cox regression) risk factors included medication for systemic hypertension, longer axial length, worse baseline VF parameters, thinner baseline peripapillary RNFL, greater disc torsion, and lamina cribrosa (LC) thickness < 180.5 μm (using a cut-off value obtained by regression analysis). Significant (P < 0.05, Cox regression) risk factors in the non-myopic NTG suspects included medication for systemic hypertension and a LC thinner than the cut-off value. Significant (P < 0.05, Cox regression) risk factors in the myopic NTG suspects included greater disc torsion. The results indicated that 12.6% of NTG suspects converted to NTG during the 5–6-year follow-up period. NTG suspects taking medication for systemic hypertension, disc torsion of the optic disc in the inferotemporal direction, and thinner LC of the optic nerve head at baseline were at greater risk of NTG conversion. Related baseline risk factors were different between myopic and non-myopic NTG suspects.
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Rahman MH, Jeong HW, Kim NR, Kim DY. Automatic Quantification of Anterior Lamina Cribrosa Structures in Optical Coherence Tomography Using a Two-Stage CNN Framework. SENSORS (BASEL, SWITZERLAND) 2021; 21:5383. [PMID: 34450823 PMCID: PMC8400634 DOI: 10.3390/s21165383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/17/2022]
Abstract
In this study, we propose a new intelligent system to automatically quantify the morphological parameters of the lamina cribrosa (LC) of the optical coherence tomography (OCT), including depth, curve depth, and curve index from OCT images. The proposed system consisted of a two-stage deep learning (DL) model, which was composed of the detection and the segmentation models as well as a quantification process with a post-processing scheme. The models were used to solve the class imbalance problem and obtain Bruch's membrane opening (BMO) as well as anterior LC information. The detection model was implemented by using YOLOv3 to acquire the BMO and LC position information. The Attention U-Net segmentation model is used to compute accurate locations of the BMO and LC curve information. In addition, post-processing is applied using polynomial regression to attain the anterior LC curve boundary information. Finally, the numerical values of morphological parameters are quantified from BMO and LC curve information using an image processing algorithm. The average precision values in the detection performances of BMO and LC information were 99.92% and 99.18%, respectively, which is very accurate. A highly correlated performance of R2 = 0.96 between the predicted and ground-truth values was obtained, which was very close to 1 and satisfied the quantification results. The proposed system was performed accurately by fully automatic quantification of BMO and LC morphological parameters using a DL model.
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Affiliation(s)
- Md Habibur Rahman
- Department of Electrical and Computer Engineering, Inha University, Incheon 22212, Korea; (M.H.R.); (H.W.J.)
| | - Hyeon Woo Jeong
- Department of Electrical and Computer Engineering, Inha University, Incheon 22212, Korea; (M.H.R.); (H.W.J.)
| | - Na Rae Kim
- Department of Ophthalmology, Inha University, Incheon 22212, Korea
| | - Dae Yu Kim
- Department of Electrical and Computer Engineering, Inha University, Incheon 22212, Korea; (M.H.R.); (H.W.J.)
- Inha Research Institute for Aerospace Medicine, Inha University, Incheon 22212, Korea
- Center for Sensor Systems, Inha University, Incheon 22212, Korea
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The influence of different intraocular pressure on lamina cribrosa parameters in glaucoma and the relation clinical implication. Sci Rep 2021; 11:9755. [PMID: 33963202 PMCID: PMC8105377 DOI: 10.1038/s41598-021-87844-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 03/30/2021] [Indexed: 12/04/2022] Open
Abstract
Elevated intraocular pressure (IOP) is one of the main risk factors for glaucoma, and pathological changes in the lamina cribrosa (LC) may play a leading role. This study aimed to explore the influence of different IOP on LC parameters and the correlation between parameters and glaucoma severity. A total of 91 eyes were examined by swept-source OCT and divided into IOP ≥ 30 mmHg (group A), 21 mmHg ≤ IOP < 30 mmHg (group B), and normal IOP (control, group C). Clinical parameters and all LC parameters such as cup depth (CD), lamina cribrosa depth (LCD), prelaminar tissue thickness (PTT) and LC curvature index (LCCI) were used for statistical analysis. The bulk of parameters were greater in group A than in the other groups (group B, P < 0.05; group C, P < 0.001). PTT and Bruch’s membrane opening minimum rim width (BMO-MRW) were thinner in group A than in group C (P < 0.01). In univariate and multivariable linear regression analysis, visual field (VF), mean retinal nerve fiber layer (RNFL) thickness, CD, LCD, PLCSD, PTT, LCCI, aLCCI, and BMO-MRW were significantly correlated with IOP changes (P < 0.05). Pearson test showed that LCD and LCCI were correlated with mean retinal nerve fiber layer (RNFL) thickness (LCD, r = − 0.420, P = 0.002; LCCI, r = − 0.449, P < 0.001) and BMO-MRW (LCD, r = − 0.245, P = 0.019; LCCI, r = − 0.345, P < 0.001). Therefore, different levels of IOP have a remarkable effect on clinical symptoms (VF, BCVA) and LC parameters, between which there may be a linear relationship. LCCI may exhibit a more significant correlation with RNFL thickness and BMO-MRW, which may further suggest that LCCI shows a better correlation with clinical symptoms under the influence of long-term high IOP.
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Gupta S, Singh A, Mahalingam K, Selvan H, Gupta P, Pandey S, Somarajan BI, Gupta V. Myopia and glaucoma progression among patients with juvenile onset open angle glaucoma: A retrospective follow up study. Ophthalmic Physiol Opt 2021; 41:475-485. [DOI: 10.1111/opo.12805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/01/2021] [Indexed: 01/09/2023]
Affiliation(s)
- Shikha Gupta
- Glaucoma Services Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi India
| | - Abhishek Singh
- Glaucoma Services Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi India
| | - Karthikeyan Mahalingam
- Glaucoma Services Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi India
| | - Harathy Selvan
- Glaucoma Services Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi India
| | - Prasad Gupta
- Glaucoma Services Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi India
| | - Shivam Pandey
- Department of Biostatistics All India Institute of Medical Sciences New Delhi India
| | - Bindu I Somarajan
- Glaucoma Services Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi India
| | - Viney Gupta
- Glaucoma Services Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi India
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Sawada Y, Araie M, Shibata H, Iwase T. Nasal displacement of retinal vessels on the optic disc in glaucoma associated with a nasally angled passage through lamina cribrosa. Sci Rep 2021; 11:4176. [PMID: 33603146 PMCID: PMC7892818 DOI: 10.1038/s41598-021-83720-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/05/2021] [Indexed: 11/13/2022] Open
Abstract
To investigate nasal displacement of central retinal vessel (CRV) on the optic nerve head (ONH) in glaucoma in association with its passage through lamina cribrosa (LC). This cross-sectional study included 113 eyes with glaucoma and 60 normal eyes. Horizontal spectral-domain optical coherence tomography (SD-OCT) scans of the ONH were acquired, and point where CRV emerged on the ONH surface was defined as the position of the CRV. Next, radial scans of the ONH were acquired, and angle of the CRV passing through the LC was measured. These parameters were compared between glaucomatous and normal eyes by t-test, and their relationship with possible confounders was assessed by multiple regression analyses. In glaucoma, CRV was significantly more nasally displaced than it was in normal eyes (66.0 ± 8.6 vs. 54.3 ± 9.5, P < 0.0001), and eyes with more vessel displacement exhibited significantly worse glaucomatous visual field defects (P = 0.0004). Greater nasal displacement of the CRV was significantly associated with a more nasally angled path through the LC (rs = 0.569, P < 0.0001). By using SD-OCT, we confirmed that nasal displacement of the CRV on the ONH was associated with glaucoma and was induced by its nasally angled path through the LC.
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Affiliation(s)
- Yu Sawada
- Department of Ophthalmology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Makoto Araie
- Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan
| | - Hitomi Shibata
- Department of Ophthalmology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Takeshi Iwase
- Department of Ophthalmology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
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Elucidation of the role of the lamina cribrosa in glaucoma using optical coherence tomography. Surv Ophthalmol 2021; 67:197-216. [PMID: 33548238 DOI: 10.1016/j.survophthal.2021.01.015] [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] [Received: 09/16/2020] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 01/07/2023]
Abstract
Glaucoma is a chronic and progressive optic neuropathy characterized by the death of retinal ganglion cells and corresponding visual field loss. Despite the growing number of studies on the subject, the pathogenesis of the disease remains unclear. Notwithstanding, several studies have shown that the lamina cribrosa (LC) is considered an anatomic site of glaucomatous optic nerve injury, thus having a key role in the pathophysiology of glaucoma development and progression. Different morphological alterations of the LC have been described in vivo in glaucomatous eyes after the evolution of optical coherence tomography (OCT) devices. The most relevant findings were the reduction of laminar thickness, the presence of localized defects, and the posterior LC displacement. These new laminar parameters documented through OCT are not only promising as possible additional tools for glaucoma diagnosis and monitoring, but also as predictors of disease progression. In spite of the advance of technology, however, proper evaluation of the LC is not yet viable in all eyes. We describe OCT-identified LC changes related to the development and progression of glaucoma and provide future directions based on a critical data analysis, focusing on its clinical relevance and applicability.
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LIU YUSHU, MA LIPING, GAO WEI, LIU ZHICHENG, WANG SHOUXIN, LIU LIU, GUO XUEQIAN, QIAN XIUQING, LI LIN. THE INFERENCE OF THE CHANGES OF AXONAL TRANSPORT OF OPTIC NERVE BY DEFORMATIONS OF LAMINA CRIBROSA. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519420400278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Understanding the relationship between the changes in the axonal transport of the optic nerve (ON) and lamina cribrosa (LC) deformation will be helpful to estimate the degree of axonal transport block by measuring the LC deformation in vivo. First, the changes in the axonal transport of the ON were studied using an acute high intraocular pressure (IOP) model, which was established by perfusing saline water into the anterior chamber of cats. The IOP of cat was unilaterally elevated to and maintained at 30, 40, and 50[Formula: see text]mmHg. The axonal transport of the ON was examined by confocal laser scanning microscope. Then the deformations and stress distributions of the LC and ON were calculated using a three-dimensional finite element model of the LC microstructure including ON. The results showed axonal transport changes of ON increased with elevation of the IOPs. While Young’s modulus of the LC and ON were assumed as 0.1[Formula: see text]MPa and 0.03[Formula: see text]MPa, the numerical simulation results showed that LC had displacements of 0.02, 0.03, and 0.04[Formula: see text]mm backward at the IOPs of 30, 40, and 50[Formula: see text]mmHg, respectively. The calculated compressive strain applied to the ON were 0.0425, 0.0567, and 0.0709 under 30, 40, and 50[Formula: see text]mmHg IOP, respectively. The results of strain and stress analysis of LC and ON showed that the deformation of LC would compress the ON. The axonal transport abnormalities could be inferred by measuring the LC deformation in vivo.
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Affiliation(s)
- YUSHU LIU
- Beijing Key Laboratory of Fundamental, Research on Biomechanics in Clinical Application, Capital Medical University, Beijing 100069, P. R. China
- School of Biomedical Engineering, Capital Medical University, Beijing 100069, P. R. China
| | - LIPING MA
- School of Biomedical Engineering, Capital Medical University, Beijing 100069, P. R. China
| | - WEI GAO
- Handan Central Hospital, Handan, Hebei 056001, P. R. China
| | - ZHICHENG LIU
- School of Biomedical Engineering, Capital Medical University, Beijing 100069, P. R. China
| | - SHOUXIN WANG
- School of Biomedical Engineering, Capital Medical University, Beijing 100069, P. R. China
| | - LIU LIU
- School of Biomedical Engineering, Capital Medical University, Beijing 100069, P. R. China
| | - XUEQIAN GUO
- School of Biomedical Engineering, Capital Medical University, Beijing 100069, P. R. China
| | - XIUQING QIAN
- Beijing Key Laboratory of Fundamental, Research on Biomechanics in Clinical Application, Capital Medical University, Beijing 100069, P. R. China
- School of Biomedical Engineering, Capital Medical University, Beijing 100069, P. R. China
| | - LIN LI
- Beijing Key Laboratory of Fundamental, Research on Biomechanics in Clinical Application, Capital Medical University, Beijing 100069, P. R. China
- School of Biomedical Engineering, Capital Medical University, Beijing 100069, P. R. China
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20
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Yazdani S, Naderi Beni A, Pakravan M. Laminar and Prelaminar Tissue Characteristics of Glaucomatous Eyes Using Enhanced Depth Imaging OCT. Ophthalmol Glaucoma 2020; 4:95-101. [PMID: 32827800 DOI: 10.1016/j.ogla.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate characteristics of the lamina cribrosa (LC) and prelaminar tissue (PLT) in eyes of patients with primary open-angle glaucoma (POAG), primary angle-closure glaucoma (PACG), and pseudoexfoliation glaucoma (PXG) using enhanced depth imaging (EDI) OCT. DESIGN Observational case-control study. PARTICIPANTS A total of 116 eyes from 116 participants with POAG (n = 30 eyes), PACG (n = 29 eyes), or PXG (n = 29 eyes) and 28 healthy eyes. METHODS Participants underwent a complete ophthalmologic examination in addition to corneal pachymetry, standard achromatic perimetry, peripapillary retinal nerve fiber layer (RNFL) OCT, and EDI OCT, as well as measurement of LC, PLT thickness, and LC depth. MAIN OUTCOME MEASURES Lamina cribrosa measurement, PLT thickness, and LC thickness. RESULTS Average LC thickness was significantly different among the 4 groups with the thinnest values in the PXG group. Prelaminar tissue also was significantly thinner in PXG eyes. The POAG eyes demonstrated the largest LC depths (P < 0.05), whereas PACG and healthy eyes demonstrated the smallest LC depths (P < 0.05). Mean deviation on standard achromatic perimetry and average thickness on peripapillary RNFL OCT were associated significantly with LC and PLT thickness. CONCLUSIONS Pseudoexfoliation glaucoma eyes demonstrate reduced LC and PLT thickness compared with POAG, PACG, and healthy eyes. Lamina cribrosa depth was larger in POAG eyes as compared with PXG, PACG, and healthy eyes. These findings may account for the peculiar appearance of the optic nerve head in PXG eyes.
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Affiliation(s)
- Shahin Yazdani
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afsaneh Naderi Beni
- Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Ophthalmology, Feiz Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mohammad Pakravan
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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21
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Yoon JY, Sung KR, Yun SC, Shin JW. Progressive Optic Disc Tilt in Young Myopic Glaucomatous Eyes. KOREAN JOURNAL OF OPHTHALMOLOGY 2020; 33:520-527. [PMID: 31833249 PMCID: PMC6911789 DOI: 10.3341/kjo.2019.0069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/14/2019] [Accepted: 09/01/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose To explore the progressive change and associated factors of optic disc tilt in young myopic glaucomatous eyes by analyzing long-term follow-up data. Methods Optic disc images were obtained from spectral-domain optical coherence tomography enhanced depth imaging from at least five different visits. At each visit, the disc tilt angle (DTA), defined as the angle between the Bruch's membrane opening plane and the optic canal plane, was estimated at the central frame that passes through the optic disc. Glaucoma progression was assessed on the basis of changes noted on serial optic disc and retinal nerve fiber layer photographs or changes in the visual field (VF). A linear mixed effect model was used to assess the influence of parameters (age, sex, baseline and follow-up intraocular pressure, retinal nerve fiber layer thickness, VF mean deviation, axial length, central corneal thickness), and presence of glaucomatous progression upon DTA change. Results A total of 26 eyes of 26 young myopic primary open-angle glaucoma patients (axial length >24.0 mm; mean age, 25.1 ± 4.0 years; mean follow-up, 3.3 ± 0.9 years) were included. DTA was 7.0 ± 3.4 degrees at baseline and 8.3 ± 3.8 degrees at last visit, which represents a significant difference (p < 0.001). Worse VF mean deviation (p < 0.001) and longer axial length (p = 0.006) were significantly associated with DTA increase. Conclusions Young myopic glaucomatous eyes showed progressive optic disc tilting. Progressive optic disc tilting in young myopic glaucomatous eyes may be related to either continuous axial myopic shift or glaucomatous structural change.
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Affiliation(s)
- Joo Young Yoon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Rim Sung
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Sung Cheol Yun
- Division of Biostatistics, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joong Won Shin
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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22
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Bak E, Lee WJ, Kim JS, Lee J, Ha A, Kim YW, Girard MJA, Mari JM, Jeoung JW, Kim YK, Park KH. Deep optic nerve head morphology and glaucoma progression in eyes with and without laminar dot sign: a longitudinal comparative study. Eye (Lond) 2020; 35:936-944. [PMID: 32499586 DOI: 10.1038/s41433-020-1001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 04/15/2020] [Accepted: 05/21/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate the association between the laminar dot sign (LDS) and the deep optic nerve head (ONH) structure in eyes with primary-open-angle glaucoma (POAG). METHODS Eighty-four eyes of 84 patients with POAG were prospectively included. All of the patients underwent stereo optic disc photography (SDP), red-free retinal nerve fibre layer (RNFL) photography, SS-OCT, and standard automated perimetry. By evaluating the SDP, patients were classified into laminar dot sign (LDS) and non-LDS groups. The deep structure of the ONH including the anterior prelaminar depth (APLD) and prelaminar tissue thickness (PTT) were quantitated using SS-OCT. Progression was assessed by structural or functional deterioration during the average 4.3 ± 1.2 years of follow-up. RESULTS The LDS group had deeper APLD (405.47 ± 107.55 vs. 302.45 ± 149.51, P < 0.001) and thinner PTT (74.34 ± 24.46 vs. 137.29 ± 40.07, P = 0.001) relative to the non-LDS group. By multivariate analysis, thin PTT was significantly associated with the presence of LDS (odds ratio = 0.939, P < 0.001). Structural progression was detected in 45 eyes (84.9%) in the LDS group and 8 eyes (25.8%) in the non-LDS group. Functional progression was demonstrated in 29 eyes (34.5%) in the LDS group and 6 eyes (19.4%) in the non-LDS group. The eyes with LDS had a significantly higher risk of glaucoma progression (χ2 = 5.00, degree of freedom = 1, P = 0.033). CONCLUSIONS In eyes with POAG, the presence of LDS was associated with thinner prelaminar tissue and faster disease progression.
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Affiliation(s)
- Eunoo Bak
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Won June Lee
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jin-Soo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jinho Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ahnul Ha
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong Woo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Michael J A Girard
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | | | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea.
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23
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Lee SH, Lee EJ, Kim JM, Girard MJA, Mari JM, Kim TW. Lamina Cribrosa Moves Anteriorly After Trabeculectomy in Myopic Eyes. Invest Ophthalmol Vis Sci 2020; 61:36. [PMID: 32543664 PMCID: PMC7415314 DOI: 10.1167/iovs.61.6.36] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to investigate changes in lamina cribrosa (LC) depth after trabeculectomy in myopic eyes using enhanced depth imaging (EDI) spectral-domain optical coherence tomography (SD-OCT). Methods Serial horizontal B-scans of the optic nerve head of 41 myopic eyes with primary open-angle glaucoma (POAG) were obtained before and 3 months after trabeculectomy using EDI SD-OCT. LC depth, defined as the distance from the opening plane of Bruch's membrane to the level of the anterior LC surface, was measured before and 3 months after trabeculectomy at 7 locations spaced equidistantly across the vertical optic disc diameter on B-scan images. The mean of the measurements at these seven planes was defined as the average LC depth. Factors associated with changes in LC depth were identified by linear regression. Results Intraocular pressure (IOP) decreased from 26.3 ± 9.3 millimeters of mercury (mm Hg) preoperatively to 10.6 ± 3.5 mm Hg 3 months after trabeculectomy. LC depth was significantly lower 3 months after trabeculectomy than preoperatively (P < 0.001, all planes). The magnitude of LC depth reduction was significantly associated with younger age, higher preoperative LC depth, and greater magnitude of IOP reduction (all P ≤ 0.016). Conclusions LC depth reduction was observed after trabeculectomy in myopic eyes. The degree of LC depth reduction was not related to the degree of myopia.
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Topcu H, Altan C, Cakmak S, Alagoz N, Pasaoglu IB, Solmaz B, Basarir B, Yasar T. Comparison of the lamina cribrosa parameters in eyes with exfoliation syndrome, exfoliation glaucoma and healthy subjects. Photodiagnosis Photodyn Ther 2020; 31:101832. [PMID: 32454088 DOI: 10.1016/j.pdpdt.2020.101832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study aimed to compare lamina cribrosa (LC) parameters obtained by spectral-domain optical coherence tomography (SD-OCT) of eyes with exfoliation syndrome (PXS), exfoliation glaucoma (PXG) and healthy subjects. METHODS In this cross-sectional comparative study, 206 eyes of 206 subjects were included. The Bruch's membrane opening distance (BMOd), the anterior and posterior borders of the LC (LC thickness) and the anterior laminar depth (ALD) were imaged using the enhanced depth imaging (EDI) mode of SD-OCT. RESULTS There were 96 eyes in the PXG group, 55 eyes in the PXS group, and 55 eyes in the control group. The LC thickness was the thinnest in the PXG group (151.10 ± 51.18 μm), followed in the PXS group (158.76 ± 49.62 μm), and the thickest in the control group (181.00 ± 39.10 μm) (p = 0.002). In PXG cases where LC was observed in the deepest location, the ALD value was highest (423.92 ± 111.75 μm) in the PXG group, followed by the control group (403.08 ± 63.56 μm), and PXS group (357.43 ± 80.87 μm) (p < 0.001). The BMOd values were largest in the PXG group (1542.43 ± 152.99 μm), followed by the control group (1506.52 ± 169.09 μm) and PXS group (1435.74 ± 141.06 μm) (p < 0.001). In the PXG group, peripapillary retinal nerve fiber layer (pRNFL) thickness, BCVA, and cup to disc (C/D) ratio were also statistically different from the other groups (p < 0.001). CONCLUSION We found thinner LC thickness in PXG and PXS cases relative to the control group. Although its severity is associated with the diagnosis and severity of glaucoma, LC thinning can be encountered as an isolated condition in the presence of exfoliation.
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Affiliation(s)
- Husna Topcu
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - Cigdem Altan
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - Semih Cakmak
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - Nese Alagoz
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - Isil Basgil Pasaoglu
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - Banu Solmaz
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - Berna Basarir
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - Tekin Yasar
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
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Wong BJ, Moghimi S, Zangwill LM, Christopher M, Belghith A, Ekici E, Bowd C, Fazio MA, Girkin CA, Weinreb RN. Relationship of Corneal Hysteresis and Anterior Lamina Cribrosa Displacement in Glaucoma. Am J Ophthalmol 2020; 212:134-143. [PMID: 31770514 DOI: 10.1016/j.ajo.2019.11.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate the relationship between corneal hysteresis (CH) and anterior lamina cribrosa surface (ALCS) displacement over time in a cohort of patients with glaucoma. DESIGN Prospective observational case series. METHODS In this study, 147 eyes from 96 glaucoma or glaucoma suspect patients were followed for a mean of 3.5 years and 7.9 visits. Baseline CH measurements were obtained using the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments Inc, Depew, New York, USA). The mean anterior lamina cribrosa surface depth (ALCSD) and choroidal thickness were by automated segmentation of spectral-domain optical coherence tomography (SD-OCT) scans. The rate of change of ALCSD was calculated using linear mixed effects models. Relationship between baseline CH and follow-up ALCSD rate of change was adjusted for confounding factors, including age, intraocular pressure (IOP), and choroidal thickness. RESULTS The mean baseline CH was 9.4 mm Hg (95% confidence interval [CI] 9.1-9.7). Overall, the ALCS was displaced posteriorly at a rate of 0.78 μm/y (95% CI -1.82, 0.26). Seventeen eyes (11.5%) showed a significant posterior displacement of ALCS, whereas 22 eyes (15.0%) showed a significant anterior displacement of ALCS. The choroidal thickness thinned at a rate of -1.09 μm/y during the follow-up (P = .001). Multivariable mixed modeling showed that choroidal thinning, lower IOP change, and lower corneal hysteresis were significantly associated with posterior ALCS displacement over time (P = .034, P = .037, and P = .048). Each 1 mm lower CH was associated with 0.66 μm/y posterior displacement of the ALCS. CONCLUSIONS Lower corneal hysteresis was significantly associated with posterior displacement of the anterior lamina cribrosa over time. These data provide additional support for lower corneal hysteresis being a risk factor for glaucoma progression.
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Kim JA, Lee EJ, Kim TW. Evaluation of Parapapillary Choroidal Microvasculature Dropout and Progressive Retinal Nerve Fiber Layer Thinning in Patients With Glaucoma. JAMA Ophthalmol 2020; 137:810-816. [PMID: 31120486 DOI: 10.1001/jamaophthalmol.2019.1212] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Importance Parapapillary choroidal microvasculature dropout (MvD) is considered one of pathophysiological manifestations of glaucomatous damage. Objective To evaluate the longitudinal change in the parapapillary choroidal MvD in patients with primary open-angle glaucoma (POAG), and to determine whether this change is associated with progressive retinal nerve fiber layer (RNFL) thinning. Design, Setting, and Participants This prospective observational case series was conducted at a tertiary referral center in Korea and included 68 patients with POAG who exhibited parapapillary choroidal MvD in en face optical coherence tomography (OCT) angiography (OCTA) images who were enrolled from the ongoing Investigating Glaucoma Progression Study from January 1, 2016, through July 31, 2018. The mean (SD) follow-up period was 2.5 (0.2) years and observers were masked to the clinical characteristics of the participants for measurements. The OCTA images were obtained twice at an interval of at least 2 years, during which the RNFL thickness was measured at least 4 times in serial OCT examinations. Microvasculature dropout was defined as a focal sectoral capillary dropout with no visible microvascular network identified in the choroidal layer. The MvD area was measured in the OCTA images obtained at the baseline and the final follow-up. The significance of changes in the MvD area was defined using the 95% Bland-Altman limits of agreement. The rate of RNFL thinning was determined by linear regression of the serial OCT RNFL thickness measurements. Main Outcomes and Measures The association between the change in the MvD area and the rate of RNFL thinning. Results Of 68 Korean participants, 37 (54.5%) were women, and the mean (SD) age was 54.3 (13.1) years. Among 68 eyes, 22 (32.4%) showed increases in the MvD area during the follow-up. Faster global RNFL thinning was associated with a larger baseline parapapillary atrophy β-zone (β = -0.55; 95% CI, -0.96 to -0.14; P = .01), disc hemorrhage detection during the follow-up period (β = -0.75; 95% CI, -1.67 to -0.34; P = .001), and a larger increase in the MvD area (β = -4.74; 95% CI, -7.72 to -1.75; P = .002). The MvD area was not associated with the rate of RNFL thinning at baseline or the final follow-up. Conclusions and Relevance Microvasculature dropout enlargement was associated with progressive RNFL thinning in POAG.
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Affiliation(s)
- Ji-Ah Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Ji Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae-Woo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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27
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Moghimi S, Zangwill LM, Manalastas PIC, Suh MH, Penteado RC, Hou H, Hasenstab K, Ghahari E, Bowd C, Weinreb RN. Association Between Lamina Cribrosa Defects and Progressive Retinal Nerve Fiber Layer Loss in Glaucoma. JAMA Ophthalmol 2020; 137:425-433. [PMID: 30730530 DOI: 10.1001/jamaophthalmol.2018.6941] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Certain features of the lamina cribrosa may be associated with increased risk of glaucoma progression. Objectives To compare the rates of retinal nerve fiber layer (RNFL) thinning in patients with open-angle glaucoma with or without lamina cribrosa (LC) defects and to evaluate factors associated with the rate of glaucoma progression in eyes with LC defects. Design, Setting, and Participants This longitudinal cohort study designed in September 2017 and conducted at a tertiary glaucoma center in California included 51 eyes of 43 patients with LC defects and 83 eyes of 68 patients without LC defects followed up for a mean (SD) of 3.5 (0.8) years from April 2012 to May 2017. Main Outcomes and Measures Focal LC defects were detected using swept-source optical coherence tomographic images. All participants underwent visual field testing and spectral-domain optical coherence tomography for RNFL thickness measurements every 6 months. Univariate and multivariable random-effects models were used to compare the rate of local and global RNFL loss. Results The mean (95% CI) age at baseline for individuals with LC defects was 69.5 (65.4 to 73.6) years, and for those without LC defects, it was 69.6 (67.2-72.0) years; 18 individuals (41%) with LC defects and 35 individuals (51%) without LC defects were men; 6 individuals (14%) with LC defects and 17 individuals (25%) without were African American. The mean (95% CI) rate of global RNFL loss in eyes with LC defects was 2-fold faster than that in eyes without LC defects (-0.91 [-1.20 to -0.62] vs -0.48 [-0.65 to -0.31] μm/y; difference, -0.43 [-0.76 to -0.09] μm/y; P = .01). The rate of RNFL thinning was faster in the LC defect sectors than that in the unaffected sectors (difference, -0.90 [95% CI, -1.68 to -0.12] μm/y, P = .02). Thinner corneal thickness was the only factor that was associated with a faster rate of RNFL loss in eyes with LC defects (β2 = -0.09 [95% CI, -0.14 to -0.04], P = .001). No association was found between mean intraocular pressure during follow-up and the mean rate of RNFL thinning in eyes with LC defects (β2, -0.05 [95% CI, -0.17 to 0.06], P = .36). Conclusions and Relevance These data suggest that LC defects are an independent risk factor for RNFL thinning and that glaucoma progression may correspond topographically to the LC defect location. Thinner corneal thickness in eyes with LC defects was associated with faster further glaucoma progression. In the management of open-angle glaucoma, LC findings may inform the likelihood and rate of glaucoma progression.
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Affiliation(s)
- Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego.,Tehran University of Medical Sciences, Tehran, Iran
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego
| | - Patricia Isabel C Manalastas
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego
| | - Min Hee Suh
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego
| | - Rafaella C Penteado
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego
| | - Huiyuan Hou
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego
| | - Kyle Hasenstab
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego
| | - Elham Ghahari
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego
| | - Christopher Bowd
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego
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Harris A, Guidoboni G, Siesky B, Mathew S, Verticchio Vercellin AC, Rowe L, Arciero J. Ocular blood flow as a clinical observation: Value, limitations and data analysis. Prog Retin Eye Res 2020; 78:100841. [PMID: 31987983 PMCID: PMC8908549 DOI: 10.1016/j.preteyeres.2020.100841] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 12/24/2022]
Abstract
Alterations in ocular blood flow have been identified as important risk factors for the onset and progression of numerous diseases of the eye. In particular, several population-based and longitudinal-based studies have provided compelling evidence of hemodynamic biomarkers as independent risk factors for ocular disease throughout several different geographic regions. Despite this evidence, the relative contribution of blood flow to ocular physiology and pathology in synergy with other risk factors and comorbidities (e.g., age, gender, race, diabetes and hypertension) remains uncertain. There is currently no gold standard for assessing all relevant vascular beds in the eye, and the heterogeneous vascular biomarkers derived from multiple ocular imaging technologies are non-interchangeable and difficult to interpret as a whole. As a result of these disease complexities and imaging limitations, standard statistical methods often yield inconsistent results across studies and are unable to quantify or explain a patient's overall risk for ocular disease. Combining mathematical modeling with artificial intelligence holds great promise for advancing data analysis in ophthalmology and enabling individualized risk assessment from diverse, multi-input clinical and demographic biomarkers. Mechanism-driven mathematical modeling makes virtual laboratories available to investigate pathogenic mechanisms, advance diagnostic ability and improve disease management. Artificial intelligence provides a novel method for utilizing a vast amount of data from a wide range of patient types to diagnose and monitor ocular disease. This article reviews the state of the art and major unanswered questions related to ocular vascular anatomy and physiology, ocular imaging techniques, clinical findings in glaucoma and other eye diseases, and mechanistic modeling predictions, while laying a path for integrating clinical observations with mathematical models and artificial intelligence. Viable alternatives for integrated data analysis are proposed that aim to overcome the limitations of standard statistical approaches and enable individually tailored precision medicine in ophthalmology.
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Affiliation(s)
- Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | | | - Brent Siesky
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Sunu Mathew
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alice C Verticchio Vercellin
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA; University of Pavia, Pavia, Italy; IRCCS - Fondazione Bietti, Rome, Italy
| | - Lucas Rowe
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Julia Arciero
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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29
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Seo Y, Shin WB, Bae HW, Yoon JS. Effects of Orbital Decompression on Lamina Cribrosa Depth in Patients with Graves' Orbitopathy. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:436-445. [PMID: 31612654 PMCID: PMC6791952 DOI: 10.3341/kjo.2019.0036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose We sought to investigate the effects of Graves' orbitopathy (GO) and orbital decompression on lamina cribrosa depth (LCD) using spectral-domain optical coherence tomography. Methods Forty eyes that underwent orbital decompression to relieve compressive optic neuropathy or correct disfiguring exophthalmos in the context of GO were included. Subjects were imaged with spectral-domain optical coherence tomography before surgery and at 1 and 3 months after surgery, at which the examiner measured the LCD (distance from the anterior surface of the lamina cribrosa to the Bruch membrane opening line) and peripapillary retinal nerve fiber layer thickness. Subjects were divided into two groups—a muscle-dominant group composed of patients who had extraocular muscle enlargement on preoperative orbital computed tomography scan and a fat-dominant group composed of patients who did not show extraocular muscle enlargement on preoperative orbital computed tomography scan—and subgroup analysis was performed. Preoperative and postoperative intraocular pressure, exophthalmos, LCD, and retinal nerve fiber layer thickness were evaluated. Results At baseline, LCD was remarkably shallower in the muscle-dominant group than in the fat-dominant group (95% confidence interval, p = 0.007). In the muscle-dominant group, LCD showed no definite change after surgery. However, the fat-dominant group showed temporary posterior displacement of the lamina cribrosa at 1-month postoperation that was reversed to baseline at 3 months postoperation (95% confidence interval, p < 0.01). Conclusions The lamina cribrosa was anteriorly displaced preoperatively, and its position was nearly unchanged after the surgery, especially in association with extraocular muscle enlargement. An enlarged extraocular muscle could reduce the pressure-relieving effect of orbital decompression around the scleral canal in patients with GO.
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Affiliation(s)
- Yuri Seo
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Beom Shin
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyoung Won Bae
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sook Yoon
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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30
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Lee EJ, Kim TW, Kim JA, Kim GN, Kim JM, Girard MJA, Mari JM, Kim H. Elucidation of the Strongest Factors Influencing Rapid Retinal Nerve Fiber Layer Thinning in Glaucoma. Invest Ophthalmol Vis Sci 2019; 60:3343-3351. [PMID: 31370062 DOI: 10.1167/iovs.18-26519] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine which groupings of prognostic factors best explain the rapid progressive retinal nerve fiber layer (RNFL) thinning in patients with primary open-angle glaucoma (POAG). Methods Optic nerves of 111 POAG patients who were followed for at least 2.5 years, during which the RNFL thickness was measured by serial spectral-domain optical coherence tomography (OCT) were included. Eyes were imaged using enhanced depth-imaging spectral-domain OCT and swept-source OCT angiography to determine the lamina cribrosa curvature index (LCCI), and the presence of a choroidal microvasculature dropout (cMvD), respectively. The rate of RNFL thinning was determined by linear regression of serial OCT RNFL thickness measurements. A regression tree model was used to find groupings of factors that best explain the rate of future RNFL thinning. Results Disc hemorrhage, larger LCCI, and presence of cMvD were associated with faster global RNFL thinning in the multivariate regression analysis. The regression tree analysis revealed three stratified groups based on the rate of RNFL thinning, divided by the LCCI and the presence of cMvD. Eyes with LCCI ≥11.87 had the fastest RNFL thinning (-2.4 ± 0.8 μm/year, mean ± SD). Among eyes with LCCI <11.87, the presence of cMvD was the strongest factor influencing faster RNFL thinning (-1.5 ± 0.8 μm/year). Eyes with LCCI <11.87 and without a cMvD exhibited the slowest RNFL thinning (-0.8 ± 0.9 μm/year). Conclusions Our regression tree model demonstrated that larger LCCI, and then the presence of cMvD were the first and second strongest prognostic factors for faster progressive RNFL thinning. Further studies may be needed to confirm these findings.
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Affiliation(s)
- Eun Ji Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae-Woo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji-Ah Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Gyu-Nam Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon Mo Kim
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Michaël J A Girard
- Department of Biomedical Engineering, National University of Singapore, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Jean Martial Mari
- GePaSud, Université de la Polynésie Française, Tahiti, French Polynesia
| | - Hyunjoong Kim
- Department of Applied Statistics, Yonsei University, Seoul, Korea
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31
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The Influence of Translaminar Pressure Gradient and Intracranial Pressure in Glaucoma: A Review. J Glaucoma 2019; 29:141-146. [DOI: 10.1097/ijg.0000000000001421] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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32
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Pulse Waveform Analysis of the Ocular Blood Flow Using Laser Speckle Flowgraphy before and after Glaucoma Treatment. J Ophthalmol 2019; 2019:1980493. [PMID: 31687195 PMCID: PMC6794986 DOI: 10.1155/2019/1980493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/04/2019] [Accepted: 09/17/2019] [Indexed: 11/17/2022] Open
Abstract
Although reduction in intraocular pressure (IOP) is the principle of glaucoma treatment, impaired ocular blood flow is believed to play a role in the progression of glaucoma. This study evaluated the effect of glaucoma treatment on pulse waveforms for optic nerve head (ONH) microcirculation in patients with glaucoma. Fifty-one subjects were included on the basis of the glaucoma treatment administered, which involved instillation of prostaglandin (PG) analogs (PG group; n = 28) or trabeculectomy (trabeculectomy group; n = 23). ONH blood flow, represented by the mean blur rate (MBRT) and pulse waveforms, was measured using laser speckle flowgraphy before and 1 and 3 months after treatment. Three months after treatment, IOP exhibited a significant decrease (p < 0.05). Although there was no significant change in MBRT after treatment, the acceleration time index (ATI) significantly decreased (p=0.034) in the PG group. In the trabeculectomy group, there was no significant change in the MBRT after treatment, while fluctuation (p=0.019) and blowout score (BOS) (p=0.036) exhibited significant decrease and increase, respectively. Multiple regression analysis showed that mean deviation was significantly associated with the rate of change in the BOS (p=0.013), age was a significant contributing factor for the rate of change in fluctuation in the trabeculectomy group, reflection was significantly associated with the ATI (p=0.037) in the in the PG group. Both glaucoma treatments can change the pulse waveforms, with MBRT remaining unchanged, and IOP reduction owing to the treatment may contribute to stable blood flow in the tissue area of the ONH. As impaired ocular blood flow plays a role in the progression of glaucomatous damage, it would be beneficial if glaucoma treatment could improve the stability of ONH microcirculation.
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Mao Z, Miki A, Mei S, Dong Y, Maruyama K, Kawasaki R, Usui S, Matsushita K, Nishida K, Chan K. Deep learning based noise reduction method for automatic 3D segmentation of the anterior of lamina cribrosa in optical coherence tomography volumetric scans. BIOMEDICAL OPTICS EXPRESS 2019; 10:5832-5851. [PMID: 31799050 PMCID: PMC6865099 DOI: 10.1364/boe.10.005832] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 06/07/2023]
Abstract
A deep-learning (DL) based noise reduction algorithm, in combination with a vessel shadow compensation method and a three-dimensional (3D) segmentation technique, has been developed to achieve, to the authors best knowledge, the first automatic segmentation of the anterior surface of the lamina cribrosa (LC) in volumetric ophthalmic optical coherence tomography (OCT) scans. The present DL-based OCT noise reduction algorithm was trained without the need of noise-free ground truth images by utilizing the latest development in deep learning of de-noising from single noisy images, and was demonstrated to be able to cover more locations in the retina and disease cases of different types to achieve high robustness. Compared with the original single OCT images, a 6.6 dB improvement in peak signal-to-noise ratio and a 0.65 improvement in the structural similarity index were achieved. The vessel shadow compensation method analyzes the energy profile in each A-line and automatically compensates the pixel intensity of locations underneath the detected blood vessel. Combining the noise reduction algorithm and the shadow compensation and contrast enhancement technique, medical experts were able to identify the anterior surface of the LC in 98.3% of the OCT images. The 3D segmentation algorithm employs a two-round procedure based on gradients information and information from neighboring images. An accuracy of 90.6% was achieved in a validation study involving 180 individual B-scans from 36 subjects, compared to 64.4% in raw images. This imaging and analysis strategy enables the first automatic complete view of the anterior LC surface, to the authors best knowledge, which may have the potentials in new LC parameters development for glaucoma diagnosis and management.
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Affiliation(s)
- Zaixing Mao
- Topcon Advanced Biomedical Imaging
Laboratory, Oakland, NJ 07436, USA
| | - Atsuya Miki
- Department of Ophthalmology, Osaka
University Graduate School of Medicine, Osaka, Japan
| | - Song Mei
- Topcon Advanced Biomedical Imaging
Laboratory, Oakland, NJ 07436, USA
| | - Ying Dong
- Topcon Advanced Biomedical Imaging
Laboratory, Oakland, NJ 07436, USA
| | - Kazuichi Maruyama
- Department of Ophthalmology, Osaka
University Graduate School of Medicine, Osaka, Japan
| | - Ryo Kawasaki
- Department of Ophthalmology, Osaka
University Graduate School of Medicine, Osaka, Japan
| | - Shinichi Usui
- Department of Ophthalmology, Osaka
University Graduate School of Medicine, Osaka, Japan
| | - Kenji Matsushita
- Department of Ophthalmology, Osaka
University Graduate School of Medicine, Osaka, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka
University Graduate School of Medicine, Osaka, Japan
| | - Kinpui Chan
- Topcon Advanced Biomedical Imaging
Laboratory, Oakland, NJ 07436, USA
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Jung Y, Park HYL, Park CK. Relationship between corneal deformation amplitude and optic nerve head structure in primary open-angle glaucoma. Medicine (Baltimore) 2019; 98:e17223. [PMID: 31567980 PMCID: PMC6756713 DOI: 10.1097/md.0000000000017223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The purpose of the study was to investigate the relationship between corneal deformation amplitude (DA), which is the amount of corneal displacement at highest degree of concavity measured by Corvis Scheimpflug Technology (ST), and various optic nerve head parameters in patients with primary open-angle glaucoma (POAG).Fifty-eight POAG patients were included in this observational study. For each patient, DA with Corvis ST, color optic disc photography, and optic nerve head imaging by enhanced depth imaging with a Heidelberg spectralis optical coherence tomography (OCT), Cirrus OCT, and Heidelberg retina tomograph (HRT) were obtained. Pearson correlation was used to analyze the relationship between DA and optic nerve head parameters before and after adjusting for age, intraocular pressure, central corneal thickness, and axial length.Corneal DA was negatively associated with lamina cribrosa (LC) depth (r = -0.390, P = .003) after adjusting for confounders. It showed positive relationship with parapapillary atrophy (PPA) area (r = 0.321, P = .046). In addition, the corneal DA was negatively correlated with cup volume (r = -0.351, P = .017) and mean cup depth (r = -0.409, P = .005) measured by HRT.Corneal DA is related with optic nerve head parameters in patients with POAG. Patients with lower corneal DA showed greater LC depth, greater cup area, deeper cup, and smaller PPA than those with higher corneal DA.
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Affiliation(s)
- Younhea Jung
- Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine
| | - Hae-Young Lopilly Park
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Kee Park
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Moghimi S, Nekoozadeh S, Motamed-Gorji N, Chen R, Fard MA, Mohammadi M, Weinreb RN. Lamina Cribrosa and Choroid Features and Their Relationship to Stage of Pseudoexfoliation Glaucoma. Invest Ophthalmol Vis Sci 2019; 59:5355-5365. [PMID: 30398627 PMCID: PMC6735617 DOI: 10.1167/iovs.18-25035] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To better understand the relationship of lamina cribrosa (LC) and choroid features to the severity of pseudoexfoliation glaucoma (PXG). Methods In this cross-sectional study, 137 eyes of 122 subjects (47 eyes with moderate/advanced PXG [mean deviation (MD), -15.0 ± 7.7 dB], 34 eyes with mild PXG [MD, -2.7 ± 1.5 dB], 32 aged-matched pseudoexfoliation syndrome [PXS] eyes, and 24 aged-matched control eyes) were investigated. Optic discs, LC thickness, and anterior LC depth (ALD; midsuperior, center, and midinferior) as well as peripapillary choroidal thickness were determined. Linear mixed modeling was used to adjust for age, sex, and axial length. Results A progressive decrease in LC thickness was found when comparing controls (271.9 ± 61.3 μm), PXS (212.6 ± 51.5 μm), mild PXG (180.8 ± 24.6 μm), and moderate/advance PXG (138.9 ± 37.5 μm) (P < 0.001). ALD was greater (P < 0.001) in moderate/advance glaucoma (306.7 ± 105.3 μm) and mild PXG (209.5 ± 79.7 μm) compared with PXS (155 ± 86.7 μm) and healthy controls (149.2 ± 103 μm). Although eyes with moderate/advance PXG had the thinnest choroid (117.2 ± 36.6 μm), choroidal thickness was comparable in mild PXG, PXS, and controls (150.0 ± 46.1, 159.7 ± 65.5, and 157.5 ± 51.1 μm, respectively; P = 0.002). Worse MD was the only factor associated with thinner LC (β = 2.344, P < 0.001) and choroid (β = 1.717, P = 0.009 μm) in PXG eyes. Higher IOP (β = 4.305, P = 0.013) and worse MD (β = -6.390, P < 0.001) were associated with deeper ALD in PXG. Conclusions In pseudoexfoliation, LC thinning is an early sign, and there is progressive thinning with advancing glaucoma. Choroidal thinning is observable only with moderate/advanced glaucoma. In PXG eyes, LC thickness, depth, and peripapillary choroidal thickness are associated with glaucoma severity.
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Affiliation(s)
- Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, California, United States.,Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Rebecca Chen
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | | | | | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, California, United States
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Tan NYQ, Tham YC, Thakku SG, Wang X, Baskaran M, Tan MCL, Mari JM, Strouthidis NG, Aung T, Girard MJA, Cheng CY. Changes in the Anterior Lamina Cribrosa Morphology with Glaucoma Severity. Sci Rep 2019; 9:6612. [PMID: 31036869 PMCID: PMC6488637 DOI: 10.1038/s41598-019-42649-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/27/2019] [Indexed: 01/05/2023] Open
Abstract
This study was designed to evaluate if primary open angle glaucoma (POAG) and its severity are associated with the shape of the lamina cribrosa (LC) as measured by a global shape index (LC-GSI), or other indices of LC curvature or depth. Optical coherence tomography (OCT) scans of the optic nerve head (OHN) were obtained from subjects with POAG (n = 99) and non-glaucomatous controls (n = 76). ONH structures were delineated, the anterior LC morphology reconstructed in 3D, and the LC-GSI calculated (more negative values denote greater posterior concavity). Anterior LC depth and 2D-curvature were also measured. Severity of glaucoma was defined by the extent of visual field loss, based on the Hodapp-Parrish-Anderson grading. Linear regression analyses compared LC characteristics between controls, mild-moderate, and advanced POAG groups. After adjusting for age, gender, ethnicity, intraocular pressure, axial length and corneal curvature, the LC-GSI was most negative in the advanced POAG group (mean [standard error] = −0.34 [0.05]), followed by the mild-moderate POAG group (−0.31 [0.02]) and then controls (−0.23 [0.02], PTrend = 0.01). There was also a significant trend of increasing LC depth and greater LC horizontal curvature with increasing severity of glaucoma (PTrend = 0.04 and 0.02, respectively). Therefore, with more severe glaucoma, the LC-GSI was increasingly more negative, and the anterior LC depth and curvature greater. These observations collectively correspond to greater cupping of the ONH at the level of the LC. As the LC-GSI describes the 3D anterior LC morphology, its potential usage may be complementary to existing ONH parameters measured on OCT.
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Affiliation(s)
- Nicholas Y Q Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Sri Gowtham Thakku
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Xiaofei Wang
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Mani Baskaran
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Marcus C L Tan
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Vision Performance Centre, Singapore Armed Forces, Singapore, Singapore
| | - Jean-Martial Mari
- GePaSud, Université de la Polynésie Française, Tahiti, French Polynesia
| | - Nicholas G Strouthidis
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Michaël J A Girard
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore. .,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore. .,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Relative Contributions of Intracranial Pressure and Intraocular Pressure on Lamina Cribrosa Behavior. J Ophthalmol 2019; 2019:3064949. [PMID: 31007950 PMCID: PMC6441528 DOI: 10.1155/2019/3064949] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/13/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose To characterize the relative contributions of intraocular pressure (IOP) and intracranial pressure (ICP) on lamina cribrosa (LC) behavior, specifically LC depth (LCD) and LC peak strain. Methods An axially symmetric finite element model of the posterior eye was constructed with an elongated optic nerve and retro-orbital subarachnoid space ensheathed by pia and dura mater. The mechanical environment in LC was evaluated with ICP ranging from 5 to 15 mmHg and IOP from 10 to 45 mmHg. LCD and LC peak strains at various ICP and IOP levels were estimated using full factorial experiments. Multiple linear regression analyses were then applied to estimate LCD and LC peak strain using ICP and IOP as independent variables. Results Both increased ICP and decreased IOP led to a smaller LCD and LC peak strain. The regression correlation coefficient for LCD was -1.047 for ICP and 1.049 for IOP, and the ratio of the two regression coefficients was -1.0. The regression correlation coefficient for LC peak strain was -0.025 for ICP and 0.106 for IOP, and the ratio of the two regression coefficients was -0.24. A stiffer sclera increased LCD but decreased LC peak strain; besides, it increased the relative contribution of ICP on the LCD but decreased that on the LC peak strain. Conclusions ICP and IOP have opposing effects on LCD and LC peak strain. While their effects on LCD are equivalent, the effect of IOP on LC peak strain is 3 times larger than that of ICP. The influences of these pressure are dependent on sclera material properties, which might explain the pathogenesis of ocular hypertension and normal-tension glaucoma.
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Hao L, Xiao H, Gao X, Xu X, Liu X. Measurement of Structural Parameters of the Lamina Cribrosa in Primary Open-Angle Glaucoma and Chronic Primary Angle-Closure Glaucoma by Optical Coherence Tomography and Its Correlations with Ocular Parameters. Ophthalmic Res 2019; 62:36-45. [DOI: 10.1159/000496558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/28/2018] [Indexed: 11/19/2022]
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Lopes FS, Matsubara I, Almeida I, Dorairaj SK, Vessani RM, Paranhos A, Prata TS. Structure-function relationships in glaucoma using enhanced depth imaging optical coherence tomography-derived parameters: a cross-sectional observational study. BMC Ophthalmol 2019; 19:52. [PMID: 30770751 PMCID: PMC6377769 DOI: 10.1186/s12886-019-1054-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 01/29/2019] [Indexed: 12/14/2022] Open
Abstract
Background To investigate structural and functional correlations in glaucoma patients using enhanced depth imaging spectral-domain optical coherence tomography (EDI OCT)-derived parameters. Methods We prospectively enrolled healthy participants and glaucomatous patients with a wide range of disease stages. All participants underwent visual field (VF) testing (SITA - Standard 24–2; Carl Zeiss Meditec, Dublin, CA) and EDI OCT imaging (Spectralis; Heidelberg Engineering Co., Heidelberg, Germany). The following optic nerve head parameters were measured on serial vertical EDI OCT B-scans by two experienced examiners masked to patients clinical data: lamina cribrosa (LC) thickness and area, prelaminar neural tissue thickness and area, anterior LC depth, Bruch’s membrane opening (BMO) and average, superior, and inferior BMO-minimum rim width (BMO-MRW). Only good quality images were considered, and whenever both eyes were eligible, one was randomly selected for analysis. Scatter plots were constructed to investigate correlations between each anatomic parameter and patient’s VF status (based on VF index [VFI] values). Results A total of 73 eyes of 73 patients were included. All EDI OCT parameters evaluated differed significantly between glaucomatous and control eyes (P ≤ 0.045). A secondary analysis, in which glaucomatous patients were divided according to VF mean deviation index values into 3 groups (mild [G1; > − 6 dB], moderate [G2; − 6 to − 12 dB] and advanced [G3; <− 12 dB] glaucoma), revealed that average BMO-MRW was the EDI OCT parameter that presented more significant differences between the different stages of glaucoma. Significant structure-function correlations were found between VFI values and prelaminar neural tissue area (R2 = 0.20, P = 0.017), average BMO-MRW (R2 = 0.35, P ≤ 0.001), superior BMO-MRW (R2 = 0.21, P = 0.012), and inferior BMO-MRW (R2 = 0.27, P = 0.002). No significant correlations were found for LC area and anterior LC depth (P ≥ 0.452). Conclusions Evaluating the distribution pattern and structure-function correlations of different laminar and prelaminar EDI OCT-derived parameters in glaucomatous patients, we found better results for neural tissue-based indexes (compared to LC-derived parameters). The diagnostic utility of each parameter deserves further investigations. Electronic supplementary material The online version of this article (10.1186/s12886-019-1054-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Flavio S Lopes
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, 04021-001, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, R. Salém Bechara, 281, Centro, Osasco, 06018-180, Brazil
| | - Igor Matsubara
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, 04021-001, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, R. Salém Bechara, 281, Centro, Osasco, 06018-180, Brazil
| | - Izabela Almeida
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, 04021-001, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, R. Salém Bechara, 281, Centro, Osasco, 06018-180, Brazil
| | - Syril K Dorairaj
- Department of Ophthalmology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
| | - Roberto M Vessani
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, 04021-001, Brazil
| | - Augusto Paranhos
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, 04021-001, Brazil
| | - Tiago S Prata
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, 04021-001, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, R. Salém Bechara, 281, Centro, Osasco, 06018-180, Brazil.,Department of Ophthalmology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
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Increased prelaminar tissue thickness in patients with open-angle glaucoma and type 2 diabetes. PLoS One 2019; 14:e0211641. [PMID: 30730917 PMCID: PMC6366732 DOI: 10.1371/journal.pone.0211641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/17/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The characteristics of the optic nerve head (ONH) in open angle glaucoma (OAG) patients with diabetes have not been reported. This study aimed to characterize the ONH structures and glaucomatous damage in diabetic OAG patients, using age-matched non-diabetic OAG patients and control subjects. METHODS The locations of visual field defects of OAG patients were classified and the prelaminar thickness and lamina cribrosa depth were measured in 64 OAG patients with type 2 diabetes (OAG+DM), 68 OAG patients without diabetes (OAG-DM), and 36 controls. All participants were scanned by spectral domain-optical coherence tomography. The anterior prelaminar depth and lamina cribrosa depth were measured at the center of the reference line (the Bruch's membrane opening plane). The prelaminar tissue thickness was obtained by subtracting the anterior prelaminar depth from the anterior lamina cribrosa depth. RESULTS The visual field defects in the OAG+DM group were more commonly found in the inferior hemifield (P = 0.010), and tended to involve the central visual field compared to the OAG-DM group (P = 0.044). In the comparison of ONH parameters, the prelaminar thickness was highest in the OAG+DM group, followed by the control subjects and the OAG-DM group (P = 0.035). Post-hoc testing showed that prelaminar thickness was significantly greater in the OAG+DM group than in the OAG-DM group (P = 0.033). The lamina cribrosa depth was deepest in the OAG+DM group, followed by the OAG-DM group and the control subjects (P = 0.006). CONCLUSIONS Diabetic and non-diabetic OAG patients exhibit different characteristics of glaucoma, particularly increased prelaminar thickening in diabetics.
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Kim YN, Shin JW, Sung KR. Relationship between Progressive Changes in Lamina Cribrosa Depth and Deterioration of Visual Field Loss in Glaucomatous Eyes. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 32:470-477. [PMID: 30549470 PMCID: PMC6288017 DOI: 10.3341/kjo.2018.0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/02/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose To investigate the relationship between the progression of visual field (VF) loss and changes in lamina cribrosa depth (LCD) as determined by spectral-domain optical coherence tomography (SD-OCT) enhanced depth imaging in patients with primary open angle glaucoma (POAG). Methods Data from 60 POAG patients (mean follow-up, 3.5 ± 0.7 years) were included in this retrospective study. The LCD was measured in the optic disc image using SD-OCT enhanced depth imaging scanning at each visit. Change in the LCD was considered to either ‘increase’ or ‘decrease’ when the differences between baseline and the latest two consecutive follow-up visits were greater than the corresponding reproducibility coefficient value (23.08 µm, as determined in a preliminary reproducibility study). All participants were divided into three groups: increased LCD (ILCD), decreased LCD (DLCD), and no LCD change (NLCD). The Early Manifest Glaucoma Trial criteria were used to define VF deterioration. Kaplan-Meier survival analysis and Cox's proportional hazard models were performed to explore the relationship between VF progression and LCD change. Results Of the 60 eyes examined, 35.0% (21 eyes), 28.3% (17 eyes), and 36.7% (22 eyes) were classified as the ILCD, DLCD, and NLCD groups, respectively. Kaplan-Meier survival analysis showed a greater cumulative probability of VF progression in the ILCD group than in the NLCD (p < 0.001) or DLCD groups (p = 0.018). Increased LCD was identified as the only risk factor for VF progression in the Cox proportional hazard models (hazard ratio, 1.008; 95% confidence interval, 1.000 to 1.015; p = 0.047). Conclusions Increased LCD was associated with a greater possibility of VF progression. The quantitative measurement of LCD changes, determined by SD-OCT, is a potential biomarker for the prediction of VF deterioration in patients with POAG.
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Affiliation(s)
- You Na Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joong Won Shin
- Department of Ophthalmology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Kyung Rim Sung
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Li F, Yu K, Zhang L, Gao K, Chen X, Zhang X. Automatic Assessment of Biometric Parameters in Optic Nerve Head Area by "Zhongshan ONH Calculator (ZOC)". Curr Eye Res 2018; 44:551-557. [PMID: 30582375 DOI: 10.1080/02713683.2018.1563703] [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: 10/27/2022]
Abstract
PURPOSE To test the repeatability and reproducibility of the Zhongshan ONH Calculator (ZOC) software in terms of selected optic nerve head (ONH) parameters commonly used in clinical research of glaucoma. MATERIALS AND METHODS Forty-two horizontal single-line scans were selected to test the repeatability and reproducibility of the ZOC software. Clinically relevant 2D parameters of the ONH area were selected to test repeatability of ZOC, including length of BMO, minimum rim thickness on both sides (RIML and RIMR), optic cup depth (OCD), and depth of the anterior surface of the LC (ALCD). RESULTS Intraobserver test showed higher the intra-class correlation coefficient (ICC) of BMO ((0.991 vs. 0.777), RIML (0.988 vs. 0.890), RIMR (0.972 vs. 0.846), OCD (0.997 vs. 0.992), and ALCD (0.993 vs. 0.949) by single researcher using ZOC software than manual measurement. BA analysis showed acceptable agreement between automatic and manual measurements. SDs and limits of agreement (95% CI) of BMO, RIML, RIMR, OCD, and ALCD were 0.05 (-0.13, 0.07), 0.03 (-0.05, 0.05), 0.03 (-0.06, 0.07), 0.015 (-0.035, 0.024), and 0.04 (-0.07, 0.08), respectively. CONCLUSION This study presented the design and development of software for the automatic measurement of OCT images of ONH area with good reproducibility. In the future, with advances of OCTs and improvements to the resolution of the LC, ZOC will become a powerful tool in glaucoma research.
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Affiliation(s)
- Fei Li
- a Zhongshan Ophthalmic Center, the State Key Laboratory of Ophthalmology , Sun Yat-sen University , Guangzhou , China
| | - Kai Yu
- b School of Electronics and Information Engineering , Soochow University , Suzhou , China
| | - Lichun Zhang
- b School of Electronics and Information Engineering , Soochow University , Suzhou , China
| | - Kai Gao
- a Zhongshan Ophthalmic Center, the State Key Laboratory of Ophthalmology , Sun Yat-sen University , Guangzhou , China
| | - Xinjian Chen
- b School of Electronics and Information Engineering , Soochow University , Suzhou , China
| | - Xiulan Zhang
- a Zhongshan Ophthalmic Center, the State Key Laboratory of Ophthalmology , Sun Yat-sen University , Guangzhou , China
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Kim JA, Kim TW, Lee EJ, Girard MJA, Mari JM. Lamina Cribrosa Morphology in Glaucomatous Eyes with Hemifield Defect in a Korean Population. Ophthalmology 2018; 126:692-701. [PMID: 30590077 DOI: 10.1016/j.ophtha.2018.12.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/27/2018] [Accepted: 12/12/2018] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To compare regional variations in lamina cribrosa (LC) curvature and depth between healthy eyes (group 1) and naïve eyes with primary open-angle glaucoma (POAG) having superior (group 2), inferior (group 3), and both (group 4) hemifield retinal nerve fiber layer (RNFL) defects. DESIGN Cross-sectional study. PARTICIPANTS Each group consisted of 39 eyes of 39 Korean patients who were matched for age, sex, and axial length. METHODS The LC curvature index (LCCI) and LC depth (LCD) were measured in B-scan images obtained using enhanced depth imaging OCT at 7 locations spaced equidistantly across the vertical optic disc diameter. Superior and inferior LCCI and LCD were compared by calculating the superior-to-inferior (Sup/Inf) ratios. MAIN OUTCOME MEASURES Comparisons of LCCI, LCD, and Sup/Inf ratio among the 4 groups. RESULTS Compared with healthy eyes (group 1), LCCIs were larger at the superior and middle planes in group 2, at the inferior and middle planes in group 3, and at all planes in group 4 (P ≤ 0.003). The LCD showed similar results, but there was no difference in superior planes between groups 1 and 2. The Sup/Inf ratio of LCCI differed significantly between groups 1 (1.03) and 2 (1.20), groups 1 and 3 (0.79), groups 2 and 3, groups 2 and 4 (0.96), and groups 3 and 4 (all P < 0.001), but not between groups 1 and 4 (P = 0.273). The Sup/Inf ratio of LCD differed only between groups 2 and 3 (P = 0.002). CONCLUSIONS Eyes with POAG showed regional differences in LC morphology, corresponding with the location of RNFL defects. The regional variations in LCCI suggest that LC morphology in POAG would be better assessed on a regional basis than by a global index.
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Affiliation(s)
- Ji-Ah Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae-Woo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Eun Ji Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Michaël J A Girard
- Department of Biomedical Engineering, National University of Singapore, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Jean Martial Mari
- GePaSud, Université de la Polynésie Française, Tahiti, French Polynesia
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Ha A, Kim TJ, Girard MJ, Mari JM, Kim YK, Park KH, Jeoung JW. Baseline Lamina Cribrosa Curvature and Subsequent Visual Field Progression Rate in Primary Open-Angle Glaucoma. Ophthalmology 2018; 125:1898-1906. [DOI: 10.1016/j.ophtha.2018.05.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 05/02/2018] [Accepted: 05/11/2018] [Indexed: 11/17/2022] Open
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Krzyżanowska-Berkowska P, Czajor K, Helemejko I, Iskander DR. Relationship between the rate of change in lamina cribrosa depth and the rate of retinal nerve fiber layer thinning following glaucoma surgery. PLoS One 2018; 13:e0206040. [PMID: 30399148 PMCID: PMC6219770 DOI: 10.1371/journal.pone.0206040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 10/05/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To assess whether lamina cribrosa depth (LCD) reduction and the rate of change in LCD over time (ΔLCD/Δt) is associated with retinal nerve fiber layer (RNFL) thickness and the rate of RNFL thinning over time (ΔRNFL/Δt) to test the hypothesis that, in a long term, RNFL thinning occurs irrespectively to the displacement of the lamina cribrosa following glaucoma surgery. METHODS Twenty-nine primary open-angle glaucoma patients underwent glaucoma surgery. Sixteen patients underwent trabeculectomy and 13 patients undertook non-penetrating deep sclerectomy. Images of optic nerve head using spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging technology were obtained preoperatively, at one-, three-, six-month and follow-up postoperative visit from 12 to 29 months after surgery (1pv, 3pv, 6pv, and FUpv, respectively). Correspondingly, measurements of the circumpapillary RNFL thickness were acquired. RESULTS Intraocular pressure decreased from 24.0±8.9 to 10.9±3.9mmHg at 6pv (P<0.001) and to 12.7±4.4mmHg at FUpv (P<0.001). LCD was reduced from 465.3±136.4μm to 402.9±126.4μm at 1pv (P<0.001) and maintained similar position at 6pv (394.3±118.4μm; P = 0.170 with respect to 1pv). A significant decrease in the LCD was noted at FUpv (342.8±90.3μm, P<0.001) with respect to 6pv. RNFL thickness increased significantly to 64.9±19.8μm at 1pv (P = 0.005) and subsequently decreased to baseline level at 3pv. Further statistically significant decrease in RNFL thickness with respect to previous visit was found at 6pv and at FUpv (56.4±15.6μm and 55.0±14.0μm, P = 0.023 and P = 0.045, respectively). A thinner RNFL thickness at FUpv was not related to the LCD at FUpv (P = 0.129) but was correlated with ΔLCD/Δt at FUpv (P = 0.003). The ΔRNFL/Δt at FUpv was statistically significantly correlated with ΔLCD/Δt at FUpv (P<0.001). CONCLUSIONS This is the first study that considers direct correlation between the rate of change in LCD with the rate of RNFL thinning over time. A thinner RNFL thickness following glaucoma surgery was associated with the rate of LCD reduction, not with position of the lamina cribrosa at the FUpv.
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Affiliation(s)
| | - Karolina Czajor
- Department of Ophthalmology, Wroclaw Medical University, Wroclaw, Poland
| | - Iwona Helemejko
- Department of Ophthalmology, Wroclaw Medical University, Wroclaw, Poland
| | - D Robert Iskander
- Department of Biomedical Engineering, Faculty of Fundamental Problems of Technology, Wroclaw University of Science and Technology, Wroclaw, Poland
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Kim JA, Kim TW, Lee EJ, Girard MJA, Mari JM. Microvascular Changes in Peripapillary and Optic Nerve Head Tissues After Trabeculectomy in Primary Open-Angle Glaucoma. ACTA ACUST UNITED AC 2018; 59:4614-4621. [DOI: 10.1167/iovs.18-25038] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Ji-Ah Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae-Woo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Ji Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Michaël J. A. Girard
- Department of Biomedical Engineering, National University of Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Jean Martial Mari
- GePaSud, Université de la Polynésie Française, Tahiti, French Polynesia
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Comparison between Lamina Cribrosa Depth and Curvature as a Predictor of Progressive Retinal Nerve Fiber Layer Thinning in Primary Open-Angle Glaucoma. Ophthalmol Glaucoma 2018; 1:44-51. [PMID: 32672632 DOI: 10.1016/j.ogla.2018.05.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/31/2018] [Accepted: 05/31/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare the ability of lamina cribrosa (LC) depth (LCD) and LC curvature to predict the rate of progressive retinal nerve fiber layer (RNFL) thinning in patients with primary open-angle glaucoma (POAG). DESIGN Observational case series. PARTICIPANTS A total of 114 eyes of 114 patients diagnosed with POAG, in which RNFL thickness had been measured by serial spectral-domain (SD) OCT for at least 2.5 years. METHODS The optic nerves of all participants underwent enhanced depth imaging volume scanning, and their circumpapillary RNFL thickness was measured using SD OCT, followed by regular serial measurements of RNFL thickness at intervals of ≥6 months. The LCD from the levels of Bruch's membrane (BM, LCD-BM) and the anterior sclera (AS, LCD-AS), and LC curvature index (LCCI) were measured by SD OCT at 3 locations: superior midperipheral, midhorizontal, and inferior midperipheral. The rate of RNFL thinning over time was determined by linear regression of serial OCT measurements of RNFL thickness. MAIN OUTCOME MEASURES Factors associated with the rate of OCT RNFL thinning. RESULTS Univariate analysis showed that larger LCD-BM (P = 0.001), LCD-AS (P < 0.001), and LCCI (P < 0.001) were all significantly associated with a faster rate of global RNFL thinning. The LCCI showed a stronger correlation with the rate of global RNFL thinning than LCD-BM (P < 0.001) or LCD-AS (P < 0.001). Of the 3 variables, only LCCI remained significant on multivariate analysis (P < 0.001). Disc hemorrhage during follow-up (P = 0.003), wider parapapillary atrophy β-zone (P = 0.017), and greater global RNFL thickness (P = 0.040) were also significantly associated with a faster rate of global RNFL thinning. CONCLUSIONS Morphology of LC was significantly associated with the rate of progressive RNFL thinning. Curvature of LC better predicted progressive RNFL thinning than did LCD measured from the BM or AS.
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Ersöz MG, Kunak Mart D, Hazar L, Ayıntap E, Botan Güneş İ, Konya HÖ. Evaluation of Prelaminar Region and Lamina Cribrosa with Enhanced Depth Imaging Optical Coherence Tomography in Pseudoexfoliation Glaucoma. Turk J Ophthalmol 2018; 48:109-114. [PMID: 29988813 PMCID: PMC6032959 DOI: 10.4274/tjo.05882] [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: 06/01/2017] [Accepted: 12/18/2017] [Indexed: 12/01/2022] Open
Abstract
Objectives: To analyze optic nerve head images of pseudoexfoliative glaucoma (PXG) patients and healthy volunteers obtained with enhanced depth imaging spectral domain-optical coherence tomography (SD-OCT). Materials and Methods: Seventy patients with PXG and 68 age- and gender-matched healthy subjects were included in this prospective study. The prelaminar tissue and lamina cribrosa were imaged using spectralis OCT with the enhanced depth imaging technique. PXG disease stage was determined with visual field to evaluate relationships between prelaminar tissue thickness (PTT), lamina cribrosa thickness (LT) and disease severity. Results: There was no significant difference between the PXG group and control group with regard to age, gender, central corneal thickness, or axial length. The mean PTT (93.1±44.5 μm, p<0.05) and LT (206.3±33.6 μm p<0.05) values of the PXG group were significantly lower compared to the control group in enhanced depth imaging OCT measurements. The PXG patients were divided into stages according to visual field defect severity. While a significant difference was not detected in PTT based on disease stage (p>0.05), a statistically significant difference was detected between stages for LT (p<0.05). Conclusion: A thinner PTT was correlated with the presence of PXG but not with the severity of glaucoma. In addition, LT has a stronger relationship with disease severity and progression compared to PTT.
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Affiliation(s)
| | - Duygu Kunak Mart
- University of Health Sciences, İzmir Tepecik Training and Research Hospital, Ophthalmology Clinic, İzmir, Turkey
| | - Leyla Hazar
- Kızıltepe State Hospital, Ophthalmology Clinic, Mardin, Turkey
| | - Emre Ayıntap
- University of Health Sciences, İzmir Tepecik Training and Research Hospital, Ophthalmology Clinic, İzmir, Turkey
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Ocular and Clinical Characteristics Associated with the Extent of Posterior Lamina Cribrosa Curve in Normal Tension Glaucoma. Sci Rep 2018; 8:961. [PMID: 29343781 PMCID: PMC5772559 DOI: 10.1038/s41598-018-19321-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/22/2017] [Indexed: 11/25/2022] Open
Abstract
Although normal-tension glaucoma (NTG) is pathogenetically heterogenous, there have been few attempts to subclassify NTG patients according to the mechanism and anatomy of optic nerve damage. This cross-sectional study was performed to investigate differences in the clinical and ocular characteristics between NTG patient groups stratified according to the degree of posterior lamina cribrosa (LC) curve which was assessed by calculating LC curvature index (LCCI). A total of 101 eyes of 101 treatment naïve NTG patients were included. The optic nerve head was imaged using enhanced-depth-imaging spectral-domain optical coherence tomography in three horizontal B-scan images in each eye. The patients were divided into two groups based on the magnitude of LCCI using a cutoff of known upper 95 percentile value in healthy subjects: a steeply curved LC group (Group 1, 75 eyes, 74.3%) and a relatively flat LC group (Group 2, 26 eyes, 25.7%). NTG eyes with relatively flat LC had lower intraocular pressure, and were associated with greater parapapillary structural alternation and systemic risk factors. These data suggest that assessment of LC morphology may help clinicians seek additional risk factors and make inferences about the mechanism of optic nerve damage in individual patients.
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