1
|
Jonas JB, Panda-Jonas S, Jonas RA. Drusen in the macula and parapapillary region. Graefes Arch Clin Exp Ophthalmol 2024; 262:2503-2513. [PMID: 38472430 DOI: 10.1007/s00417-024-06438-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/19/2024] [Accepted: 03/07/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE To examine histological characteristics and differences between drusen beneath the retinal pigment epithelium (small hard drusen) located in the macula and located in the parapapillary region. METHODS We histomorphometrically examined human eyes enucleated due to uveal melanomas or secondary angle-closure glaucoma. RESULTS The study included 106 eyes (age, 62.6 ± 15.2 years) with macular drusen (n = 7 globes) or parapapillary drusen (n = 29 eyes) and 70 eyes without drusen. In all drusen, periodic-acid-Schiff-positive material was located between the RPE basal membrane and the inner collagenous layer of Bruch's membrane (BM). Macular drusen as compared with parapapillary drusen had lower height (15.2 ± 10.1 µm versus 34.3 ± 19.8 µm; P = 0.003), while both groups did not differ significantly in basal drusen width (74.0 ± 36.3 µm versus 108.7 ± 101.0 µm; P = 0.95). Eyes with macular drusen and eyes without drusen did not differ significantly in BM thickness (2.74 ± 0.44 µm versus 2.55 ± 0.88 µm; P = 0.57) or in RPE cell density (35.4 ± 10.4 cells/480 µm versus 32.8 ± 7.5 cells/480 µm; P = 0.53), neither in the drusen region nor in the drusen vicinity, while BM thickness (4.60 ± 1.490 µm; P < 0.001) and RPE cell density (56.9 ± 26.8 cells/480 µm; P = 0.005) were higher at the parapapillary drusen. Eyes with macular drusen, eyes with parapapillary drusen, and eyes without drusen did not differ significantly in choriocapillaris density (all P > 0.10) and thickness (all P > 0.35). Limitations of the study, among others, were a small number and size of drusen examined, diseases leading to enucleation, lack of serial sections, limited resolution of light microscopy, and enucleation-related and histological preparation-associated artefacts. CONCLUSIONS The findings of this study, also taking into account its methodological limitations, suggest that macular drusen and parapapillary drusen shared the morphological feature of periodic-acid-Schiff-positive material between the RPE basal membrane and BM and that they did not vary significantly in choriocapillaris thickness and density. RPE cell density and BM thickness were higher in parapapillary drusen than in macular drusen.
Collapse
Affiliation(s)
- Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.
- Singapore Eye Research Institute, Singapore, Singapore.
| | | | - Rahul A Jonas
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| |
Collapse
|
2
|
Lim S, Kim C, Jafari S, Park J, Garcia SS, Demer JL. Postmortem Digital Image Correlation and Finite Element Modeling Demonstrate Posterior Scleral Deformations during Optic Nerve Adduction Tethering. Bioengineering (Basel) 2024; 11:452. [PMID: 38790319 PMCID: PMC11117839 DOI: 10.3390/bioengineering11050452] [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: 03/04/2024] [Revised: 04/25/2024] [Accepted: 04/28/2024] [Indexed: 05/26/2024] Open
Abstract
Postmortem human eyes were subjected to optic nerve (ON) traction in adduction and elevated intraocular pressure (IOP) to investigate scleral surface deformations. We incrementally adducted 11 eyes (age 74.1 ± 9.3 years, standard deviation) from 26° to 32° under normal IOP, during imaging of the posterior globe, for analysis by three-dimensional digital image correlation (3D-DIC). In the same eyes, we performed uniaxial tensile testing in multiple regions of the sclera, ON, and ON sheath. Based on individual measurements, we analyzed eye-specific finite element models (FEMs) simulating adduction and IOP loading. Analysis of 3D-DIC showed that the nasal sclera up to 1 mm from the sheath border was significantly compressed during adduction. IOP elevation from 15 to 30 mmHg induced strains less than did adduction. Tensile testing demonstrated ON sheath stiffening above 3.4% strain, which was incorporated in FEMs of adduction tethering that was quantitatively consistent with changes in scleral deformation from 3D-DIC. Simulated IOP elevation to 30 mmHg did not induce scleral surface strains outside the ON sheath. ON tethering in incremental adduction from 26° to 32° compressed the nasal and stretched the temporal sclera adjacent to the ON sheath, more so than IOP elevation. The effect of ON tethering is influenced by strain stiffening of the ON sheath.
Collapse
Affiliation(s)
- Seongjin Lim
- Department of Ophthalmology, Stein Eye Institute, Los Angeles, CA 90095, USA; (S.L.); (S.J.); (J.P.); (S.S.G.)
| | - Changzoo Kim
- Department of Ophthalmology, Kosin University, Busan 49267, Republic of Korea;
| | - Somaye Jafari
- Department of Ophthalmology, Stein Eye Institute, Los Angeles, CA 90095, USA; (S.L.); (S.J.); (J.P.); (S.S.G.)
| | - Joseph Park
- Department of Ophthalmology, Stein Eye Institute, Los Angeles, CA 90095, USA; (S.L.); (S.J.); (J.P.); (S.S.G.)
| | - Stephanie S. Garcia
- Department of Ophthalmology, Stein Eye Institute, Los Angeles, CA 90095, USA; (S.L.); (S.J.); (J.P.); (S.S.G.)
| | - Joseph L. Demer
- Department of Ophthalmology, Stein Eye Institute, Los Angeles, CA 90095, USA; (S.L.); (S.J.); (J.P.); (S.S.G.)
- Neuroscience Interdepartmental Program, University of California, Los Angeles, CA 90095, USA
- Department of Neurology, University of California, Los Angeles, CA 90095, USA
- Department of Bioengineering, University of California, Los Angeles, CA 90095, USA
| |
Collapse
|
3
|
Jonas JB, Jonas RA, Jonas SB, Panda-Jonas S. Parapapillary drusen of the retinal pigment epithelium. Acta Ophthalmol 2024; 102:342-348. [PMID: 37608705 DOI: 10.1111/aos.15741] [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: 05/01/2023] [Revised: 06/10/2023] [Accepted: 07/27/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE To describe the occurrence, morphology and associations of parapapillary drusen of the retinal pigment epithelium (RPE-drusen). METHODS Using light microscopy, we histomorphometrically examined enucleated human eyes. RESULTS The study included 83 eyes (axial length: 25.9 ± 3.2 mm; range: 20.0-35.0 mm). Eyes with parapapillary RPE-drusen (n = 29 (35%) eyes) as compared to those without drusen had a significantly shorter axial length (24.0 ± 1.8 mm vs 27.0 ± 3.3 mm; p < 0.001), higher prevalence (27/29 vs 12/54; p < 0.001) and longer width (213 ± 125 μm vs 96 ± 282 μm; p < 0.0001) of parapapillary alpha zone, and thicker BM in parapapillary beta zone (8.4 ± 2.7 μm vs 3.9 ± 2.0 μm; p < 0.001) and alpha zone (6.6 ± 3.9 μm vs 4.4 ± 1.5 μm; p = 0.02). Prevalence of parapapillary RPE-drusen was 27 (69%) out of 39 eyes with alpha zone. Beneath the RPE-drusen and in total alpha zone, choriocapillaris was open, while it was closed in the central part of parapapillary beta zone. BM thickness was thicker (p = 0.001) in alpha zone than beta zone, where it was thicker (p < 0.001) than in the region outside of alpha/beta zone. BM thickness outside of alpha/beta zone was not correlated with prevalence of parapapillary RPE-drusen (p = 0.47) or axial length (p = 0.31). RPE cell density was higher in alpha zone than in the region adjacent to alpha zone (22.7 ± 7.3 cells/240 μm vs 18.3 ± 4.1 cells/240 μm; p < 0.001). In the parapapillary RPE-drusen, RPE cells were connected with a PAS-positive basal membrane. CONCLUSIONS Parapapillary RPE-drusen as fibrous pseudo-metaplasia of the RPE were associated with shorter axial length, higher prevalence and larger size of alpha zone, and thicker BM in alpha zone and beta zone. The RPE-drusen may be helpful to differentiate glaucomatous parapapillary beta zone from myopic beta zone.
Collapse
Affiliation(s)
- Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore City, Singapore
- Privatpraxis Prof Jonas und Dr Panda-Jonas, Heidelberg, Germany
| | - Rahul A Jonas
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | | | | |
Collapse
|
4
|
Xiang F, Zhang Y, Zhang Q, Pan X, Feng H, Zhang M, Li C, Ji Q, Li Z, Li S. Characteristics of beta parapapillary atrophy in primary angle-closure suspect. BMJ Open Ophthalmol 2024; 9:e001529. [PMID: 38626931 PMCID: PMC11029359 DOI: 10.1136/bmjophth-2023-001529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE To investigate the characteristics of beta parapapillary atrophy (β-PPA) in patients with primary angle-closure suspect (PACS). METHODS AND ANALYSIS In total, 215 and 259 eyes with PACS and non-PACS (NPACS), respectively, were enrolled in this observational, cross-sectional study. Stereoscopic fundus and optical coherence tomography images were used to characterise β-PPA; the former was also used to measure the major β-PPA parameters. Univariate and multiple logistic regression analyses were used to identify the factors correlated with the presence of β-PPA and with β-PPA parameters. RESULTS The β-PPA occurrence rates were 48.80% and 44.40% in the PACS and NPACS groups, respectively, with no significant difference between groups. Compared with that in the NPACS group, the β-PPA area was significantly larger (p=0.005) in the PACS group, but the angular extent and maximum radial length did not differ between groups (p=0.110 and 0.657, respectively) after adjusting for age and axial length. The presence of β-PPA was associated with older age (OR 1.057, 95% CI 1.028 to 1.088, p<0.001) and larger disc area (OR 1.716, 95% CI 1.170 to 2.517, p=0.006). A larger β-PPA area was associated with older age (p=0.014), greater vertical cup-to-disc ratio (p=0.028), larger disc area (p<0.001) and PACS diagnosis (p=0.035). CONCLUSION 48.80% of participants with PACS had β-PPA, which is slightly larger than NPACS. The area of β-PPA was larger in PACS, while the angular extent and maximum radial length did not differ between groups.
Collapse
Affiliation(s)
- Fei Xiang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ye Zhang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qing Zhang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Ophthalmology, Beijing, China
| | - Xiaohua Pan
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, China
| | - Hui Feng
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Meijuan Zhang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Caixia Li
- School of Clinical Medicine, Dali University, Yunnan, China
| | - Qianqian Ji
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhi Li
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shuning Li
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
5
|
Moon S, Park J, Lim S, Suh SY, Le A, Demer JL. Scanning Laser Ophthalmoscopy Demonstrates Pediatric Optic Disc and Peripapillary Strain During Horizontal Eye Rotation. Curr Eye Res 2024; 49:437-445. [PMID: 38185657 DOI: 10.1080/02713683.2023.2295789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
Purpose: We employed automated analysis of scanning laser ophthalmoscopy (SLO) to determine if mechanical strains imposed on disc, and retinal and choroidal vessels during horizontal duction in children differ from those of adults.Methods: Thirty-one children aged 11.3 ± 2.7 (standard deviation) years underwent SLO in central gaze, and 35° ab- and adduction. Automated registration with deep learning-based optical flow analysis quantified vessel deformations as horizontal, vertical, shear, and equivalent strains. Choroidal vessel displacements in lightly pigmented fundi, and central disc vessel displacements, were also observed.Results: As in adults, strain in vessels during horizontal duction was greatest at the disc and decreased with distance from it. Strain in the pediatric disc was similar to published values in young adults,1 but in the peripapillary region was greater and propagated significantly more peripherally to at least three disc radii from it. During adduction in children, the nasal disc was compressed and disc vessels distorted, but the temporal half experienced tensile strain, while peripapillary tissues were compressed. The pattern was similar but strains were less in abduction (p < .001). Choroidal vessels were visualized in 24 of the 62 eyes and shifted directionally opposite overlying retinal vessels.Conclusions: Horizontal duction deforms the normal pediatric optic disc, central retinal vessels, peripapillary retina, and choroid, shearing the inner retina over the choroid. These mechanical effects occur at the sites of remodeling of the disc, sclera, and choroid associated with typical adult features that later emerge later, including optic cup enlargement, temporal disc tilting, and peripapillary atrophy.
Collapse
Affiliation(s)
- Sunghyuk Moon
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, CA, USA
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Joseph Park
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, CA, USA
| | - Seongjin Lim
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, CA, USA
- Department of Mechanical Engineering, University of California, Los Angeles, CA, USA
| | - Soh Youn Suh
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, CA, USA
| | - Alan Le
- Alcon Research, Ltd, Lake Forest, CA, USA
| | - Joseph L Demer
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, CA, USA
- Bioengineering Department, University of California, Los Angeles, CA, USA
- Neuroscience Interdepartmental Program, University of California, Los Angeles, CA, USA
- Department of Neurology, University of California, Los Angeles, CA, USA
| |
Collapse
|
6
|
Jonas JB, Jonas RA, Jonas SB, Panda-Jonas S. Choriocapillaris, Photoreceptors, and Inner Retinal Layer in Spatial Relationship to Parapapillary Alpha, Beta, Gamma, and Delta Zones. Invest Ophthalmol Vis Sci 2023; 64:12. [PMID: 37672285 PMCID: PMC10484042 DOI: 10.1167/iovs.64.12.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/09/2023] [Indexed: 09/07/2023] Open
Abstract
Purpose To examine the spatial relationships between the retinal inner nuclear layer (INL), outer nuclear layer (ONL), retinal pigment epithelium (RPE) layer, Bruch's membrane (BM), and choriocapillaris in the parapapillary region. Methods Human eyes enucleated due to uveal melanomas or secondary angle-closure glaucoma were histomorphometrically examined. We compared the tissue dimensions between four groups of eyes categorized based on the presence/absence of high myopia and glaucoma. Results The investigation consisted of 100 globes (axial length: 25.6 ± 3.1 mm; range: 20.0-35.0 mm). In non-highly myopic nonglaucomatous eyes, the INL, ONL, RPE, BM, and choriocapillaris ended approximately at the end of the RPE layer, with no significant (all P ≥ 0.10) difference between the layers in their distance to the RPE-layer end. From non-highly myopic nonglaucomatous eyes to non-highly myopic glaucomatous eyes, highly myopic nonglaucomatous eyes, and eventually highly myopic glaucomatous eyes, the choriocapillaris, INL, and ONL increasingly extended into the beta zone, most marked for the choriocapillaris and least marked for the ONL. A larger extension of the choriocapillaris into the parapapillary beta zone correlated with longer axial length (standardized regression coefficient β, 0.24; B, 23.0; 95% confidence interval [CI], 1.6-44.5; P = 0.04) and wider parapapillary beta zone (β, 0.59; B, 0.32; 95% CI, 0.22-0.41; P < 0.001); a larger extension of the INL correlated with longer axial length (β, 0.34; B, 43.7; 95% CI, 11.6-75.7; P = 0.009), longer gamma zone (β, 0.52; B, 0.28; 95% CI, 0.15-0.41; P < 0.001), and diagnosis of non-highly myopic glaucoma (β, 0.28; B, 267; 95% CI, 80.8-454; P = 0.006); and a larger extension of the ONL into parapapillary beta zone correlated with longer axial length (β, 0.50; B, 32.2; 95% CI, 21.6-42.8; P < 0.001) and wider parapapillary beta zone (β, 0.28; B, 0.10; 95% CI, 0.04-0.16; P < 0.001). Conclusions Nonglaucomatous non-highly myopic eyes differ from highly myopic eyes and glaucomatous eyes in the spatial relationship of the parapapillary tissue layers.
Collapse
Affiliation(s)
- Jost B. Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
- Singapore Eye Research Institute, Singapore
| | - Rahul A. Jonas
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | | | | |
Collapse
|
7
|
Jonas JB, Jonas RA, Bikbov MM, Wang YX, Panda-Jonas S. Myopia: Histology, clinical features, and potential implications for the etiology of axial elongation. Prog Retin Eye Res 2023; 96:101156. [PMID: 36585290 DOI: 10.1016/j.preteyeres.2022.101156] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/27/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022]
Abstract
Myopic axial elongation is associated with various non-pathological changes. These include a decrease in photoreceptor cell and retinal pigment epithelium (RPE) cell density and retinal layer thickness, mainly in the retro-equatorial to equatorial regions; choroidal and scleral thinning pronounced at the posterior pole and least marked at the ora serrata; and a shift in Bruch's membrane opening (BMO) occurring in moderately myopic eyes and typically in the temporal/inferior direction. The BMO shift leads to an overhang of Bruch's membrane (BM) into the nasal intrapapillary compartment and BM absence in the temporal region (i.e., parapapillary gamma zone), optic disc ovalization due to shortening of the ophthalmoscopically visible horizontal disc diameter, fovea-optic disc distance elongation, reduction in angle kappa, and straightening/stretching of the papillomacular retinal blood vessels and retinal nerve fibers. Highly myopic eyes additionally show an enlargement of all layers of the optic nerve canal, elongation and thinning of the lamina cribrosa, peripapillary scleral flange (i.e., parapapillary delta zone) and peripapillary choroidal border tissue, and development of circular parapapillary beta, gamma, and delta zone. Pathological features of high myopia include development of macular linear RPE defects (lacquer cracks), which widen to round RPE defects (patchy atrophies) with central BM defects, macular neovascularization, myopic macular retinoschisis, and glaucomatous/glaucoma-like and non-glaucomatous optic neuropathy. BM thickness is unrelated to axial length. Including the change in eye shape from a sphere in emmetropia to a prolate (rotational) ellipsoid in myopia, the features may be explained by a primary BM enlargement in the retro-equatorial/equatorial region leading to axial elongation.
Collapse
Affiliation(s)
- Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karis-University, Mannheim, Germany; Institute for Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany.
| | - Rahul A Jonas
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | | | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | | |
Collapse
|
8
|
Anatomic Peculiarities Associated with Axial Elongation of the Myopic Eye. J Clin Med 2023; 12:jcm12041317. [PMID: 36835853 PMCID: PMC9966891 DOI: 10.3390/jcm12041317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/08/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
PURPOSE To describe anatomical peculiarities associated with axial elongation in the human myopic eye. METHODS Reviewing the results of previous histomorphometrical investigations of enucleated human globes, as well as reviewing findings obtained in population-based studies and hospital-based clinical investigations of myopic patients and non-myopic individuals. RESULTS Myopic axial elongation is associated with a change from a mostly spherical eye shape to a prolate ellipsoid form. It is combined with choroidal and scleral thinning, most pronounced at the posterior pole and less pronounced in the fundus midperiphery. In the fundus midperiphery, the retina and density of the retinal pigment epithelium (RPE) and photoreceptors decrease with a longer axial length, while in the macular region, retinal thickness, RPE cell density, and choriocapillaris thickness are not related to axial length. With axial elongation, a parapapillary gamma zone develops, leading to an enlargement of the optic disc-fovea distance and a decrease in angle kappa. Axial elongation is also correlated with an increase in the surface and volume of Bruch's membrane (BM), while BM thickness remains unchanged. Axial elongation causes moderately myopic eyes to show a shift of BM opening to the foveal direction so that the horizontal disc diameter becomes shorter (with a consequent vertical ovalization of the optic disc shape), a temporal gamma zone develops, and the optic nerve exit takes an oblique course. Features of high myopia are an enlargement of the RPE opening (myopic parapapillary beta zone) and BM opening (secondary macrodisc), elongation and thinning of the lamina cribrosa, peripapillary scleral flange (parapapillary delta zone) and peripapillary choroidal border tissue, secondary BM defects in the macular region, myopic maculoschisis, macular neovascularization, and cobblestones in the fundus periphery. CONCLUSIONS These features combined may be explained by a growth in BM in the fundus midperiphery leading to axial elongation.
Collapse
|
9
|
Lei J, Fan Y, Wu Y, Yuan S, Ye Y, Huang K, Chen Q, Yang B, Xie P. Microvascular Alterations of Peripapillary Choriocapillaris in Young Adult High Myopia Detected by Optical Coherence Tomography Angiography. J Pers Med 2023; 13:jpm13020289. [PMID: 36836523 PMCID: PMC9965566 DOI: 10.3390/jpm13020289] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
(1) Background: The microstructural alterations of the peripapillary choriocapillaris in high myopes remain elusive. Here, we used optical coherence tomography angiography (OCTA) to explore factors involved in these alterations. (2) Methods: This cross-sectional control study included 205 young adults' eyes (95 with high myopia and 110 with mild to moderate myopia). The choroidal vascular network was imaged using OCTA, and the images underwent manual adjustments to determine the peripapillary atrophy (PPA)-β zone and microvascular dropout (MvD). The area of MvD and the PPA-β zone, spherical equivalent (SE), and axial length (AL) were collected and compared across groups. (3) Results: The MvD was identified in 195 eyes (95.1%). Highly myopic eyes exhibited a significantly greater area for the PPA-β zone (1.221 ± 0.073 vs. 0.562 ± 0.383 mm2, p = 0.001) and MvD (0.248 ± 0.191 vs. 0.089 ± 0.082 mm2, p < 0.001) compared with mildly to moderately myopic eyes, and a lower average density in the choriocapillaris. Linear regression analysis showed that the MvD area correlated with age, SE, AL, and the PPA-β area (all p < 0.05). (4) Conclusions: This study found that MvDs represent choroidal microvascular alterations in young-adult high myopes, which were correlated with age, SE, AL, and the PPA-β zone. In this disorder, OCTA is important for characterizing the underlying pathophysiological adaptations.
Collapse
Affiliation(s)
- Jie Lei
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yuanyuan Fan
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yan Wu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Songtao Yuan
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yurong Ye
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Kun Huang
- School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
| | - Qiang Chen
- School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
| | - Bin Yang
- Department of Ophthalmology, Yangzhong People’s Hospital, Yangzhong 212299, China
- Correspondence: (B.Y.); (P.X.); Tel.: +86-13812356086 (B.Y.); +86-13901585755 (P.X.)
| | - Ping Xie
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- Correspondence: (B.Y.); (P.X.); Tel.: +86-13812356086 (B.Y.); +86-13901585755 (P.X.)
| |
Collapse
|
10
|
Panda-Jonas S, Auffarth GU, Jonas JB, Jonas RA. Myopic macular Bruch's membrane defects. Heliyon 2023; 9:e13257. [PMID: 36793950 PMCID: PMC9922809 DOI: 10.1016/j.heliyon.2023.e13257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Abstract
Purpose To examine histologic characteristics of macular Bruchś membrane defects (BMD) in axially elongated eyes. Design Histomorphometric study. Methods Using light microscopy, we examined enucleated human globes for BMDs. Results In 247 eyes, BMDs were detected in 15 (6.1%) eyes (axial length:27.0-36.0 mm), in 10 of them in the macular region. Prevalence and size of BMDs (mean:1.93 ± 1.62 mm; range:0.22mm-6.24 mm) correlated with longer axial length (OR:1.52; 95%CI:1.19,1.94; P = 0.001) and higher prevalence of scleral staphylomas (OR:16.3; 95%CI:2.67,99.3; P < 0.001). The BMDs were smaller than corresponding gaps in the retinal pigment epithelium (RPE) (1.93 ± 1.62 mm versus 2.61 mm ± 1.73 mm; P = 0.003), and larger than corresponding gaps in the inner nuclear layer (0.43 ± 0.76 mm; P = 0.008) and inner limiting membrane bridges (0.13 ± 0.33 mm; P = 0.001). Choriocapillaris thickness, BM thickness and RPE cell density did not vary (all P > 0.05) between the BDM border and adjacent areas. In the BMD, choriocapillaris and RPE were absent. The sclera was thinner in the BDM area than in adjacent areas (0.28 ± 0.19 mm versus 0.36 ± 0.13 mm; P = 0.006). Conclusions BMDs as hallmarks of myopic macular degeneration are characterized by longer gaps in the RPE and smaller gaps in the outer nuclear layer and inner nuclear layer, by localized scleral thinning, and by a spatial association with scleral staphylomas. Thickness of the choriocapillaris and density of the RPE cell layer, both absent within the BDMs, do not vary between the BMD border and adjacent regions. The results suggest an association between BDMs and absolute scotomas, stretching of the adjacent retinal nerve fiver layer, and an axial elongation-associated stretching effect on BM as etiology of the BDMs.
Collapse
Affiliation(s)
- Songhomitra Panda-Jonas
- Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany
- Privatpraxis Prof Jonas und Dr Panda-Jonas, Heidelberg, Germany
- Corresponding author. Adenauerplatz 2, 69115 Heidelberg, Germany;
| | - Gerd U. Auffarth
- Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Jost B. Jonas
- Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Switzerland
| | - Rahul A. Jonas
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| |
Collapse
|
11
|
Finite element modeling of effects of tissue property variation on human optic nerve tethering during adduction. Sci Rep 2022; 12:18985. [PMID: 36347907 PMCID: PMC9643519 DOI: 10.1038/s41598-022-22899-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022] Open
Abstract
Tractional tethering by the optic nerve (ON) on the eye as it rotates towards the midline in adduction is a significant ocular mechanical load and has been suggested as a cause of ON damage induced by repetitive eye movements. We designed an ocular finite element model (FEM) simulating 6° incremental adduction beyond the initial configuration of 26° adduction that is the observed threshold for ON tethering. This FEM permitted sensitivity analysis of ON tethering using observed material property variations in measured hyperelasticity of the anterior, equatorial, posterior, and peripapillary sclera; and the ON and its sheath. The FEM predicted that adduction beyond the initiation of ON tethering concentrates stress and strain on the temporal side of the optic disc and peripapillary sclera, the ON sheath junction with the sclera, and retrolaminar ON neural tissue. However, some unfavorable combinations of tissue properties within the published ranges imposed higher stresses in these regions. With the least favorable combinations of tissue properties, adduction tethering was predicted to stress the ON junction and peripapillary sclera more than extreme conditions of intraocular and intracranial pressure. These simulations support the concept that ON tethering in adduction could induce mechanical stresses that might contribute to ON damage.
Collapse
|
12
|
Shang K, Zhuang D, Dai Y. Comparative analysis of OCT-defined parapapillary beta and gamma zones between primary open angle glaucoma and primary angle closure glaucoma. Sci Rep 2022; 12:11070. [PMID: 35773326 PMCID: PMC9246945 DOI: 10.1038/s41598-022-15457-3] [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: 04/01/2022] [Accepted: 06/23/2022] [Indexed: 11/27/2022] Open
Abstract
The ophthalmoscopic beta zone of parapapillary atrophy has recently been proposed to divide into a gamma zone and a (new) beta zone based on OCT imaging. The present study was undertaken to compare the microstructural characteristics of parapapillary gamma and beta zones and their influencing factors between primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG). Seventy-three PACG patients that had no evidence of an acute attack and 78 POAG patients were enrolled. Patients were matched by propensity scores for age and visual field mean defect (MD) value. The area and angular extent of both zones were measured. In multivariate analysis, a larger beta zone was correlated with older age, severe MD value and longer axial length. A larger gamma zone was correlated with longer axial length. Older age and severe MD value were correlated with the concentric shape of beta zone. Comparing the PACG and POAG groups that adjusted for age and MD value, gamma zone was larger and more prevalent in the POAG group, while beta zone showed no significant difference. Taken separately, MD value was associated with the area and shape of beta zone in the PACG group. Axial length was associated with the temporal shape of beta zone in the POAG group. These data indicated that OCT-defined parapapillary beta and gamma zones exhibited different characteristics in two types of glaucoma. Clinically, the size of parapapillary beta zone may serve as a better indicator of glaucoma severity in eyes with PACG than that in POAG.
Collapse
Affiliation(s)
- Kunte Shang
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, 200031, China
| | - Dongli Zhuang
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, 200031, China
| | - Yi Dai
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Road, Shanghai, 200031, China. .,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, 200031, China.
| |
Collapse
|
13
|
Baek J, Park HYL, Kim SA, Hong KE, Jeon SJ, Shin DY, Jung Y, Park CK. Parapapillary Choroidal Microvasculature Dropout in Branched Retinal Vein Occlusion and Glaucoma. Invest Ophthalmol Vis Sci 2022; 63:27. [PMID: 35348587 PMCID: PMC8976936 DOI: 10.1167/iovs.63.3.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate parapapillary choroidal microvasculature dropout (MvD) in branch retinal vein occlusion (BRVO) patients and compare them with open-angle glaucoma (OAG) patients using optical coherence tomography angiography (OCT-A). Methods In total, 85 eyes of BRVO patients and 85 eyes of OAG patients, matched by age, spherical equivalent, and baseline mean deviation (MD) of the visual field (VF), were assessed. MvD was defined as complete loss of microvasculature within the choroidal layer on OCT-A. Linear regression analysis was used to obtain the slope of the MD change of the VF. Results The presence of MvD on OCT-A was significantly more frequent in OAG eyes (63.1%) compared to BRVO eyes (31.8%). BRVO eyes with MvD showed worse baseline MD of the VF than BRVO eyes without MvD (−10.19 ± 8.50 and −7.77 ± 6.46 dB, respectively; P = 0.045). The presence of MvD was the only factor significantly associated with MD change of the VF in OAG eyes. Lower baseline average RNFL thickness, greater MvD angle, and lower macular superficial vessel density were significantly associated with MD change of the VF in BRVO eyes. Conclusions OCT-A of the parapapillary area showed choroidal microvasculature impairment in both BRVO and OAG patients. However, the frequency was higher in glaucoma patients with similar degrees of VF damage, which suggests that the glaucomatous process contributes to MvD development. The effect of MvD on VF change was different between BRVO and OAG, suggesting that the underlying pathogenesis may also be different.
Collapse
Affiliation(s)
- Jiwon Baek
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Bucheon St. Mary's Hospital, Gyeonggi-do, South Korea
| | - Hae-Young Lopilly Park
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Seoul St. Mary's Hospital, Seoul, South Korea
| | - Seong Ah Kim
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Seoul St. Mary's Hospital, Seoul, South Korea
| | - Kyung Euy Hong
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Seoul St. Mary's Hospital, Seoul, South Korea
| | - Soo Ji Jeon
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Bucheon St. Mary's Hospital, Gyeonggi-do, South Korea
| | - Da Young Shin
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Eunpyeong St. Mary's Hospital, Seoul, South Korea
| | - Younhea Jung
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Yeouido St. Mary's Hospital, Seoul, South Korea
| | - Chan Kee Park
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Seoul St. Mary's Hospital, Seoul, South Korea
| |
Collapse
|
14
|
Chen X, Hong Y, Di H, Wu Q, Zhang D, Zhang C. Change of Retinal Vessel Density After Lowering Intraocular Pressure in Ocular Hypertension. Front Med (Lausanne) 2021; 8:730327. [PMID: 34957136 PMCID: PMC8695549 DOI: 10.3389/fmed.2021.730327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 11/19/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose: To investigate the relationship between retinal microvasculature changes and intraocular pressure (IOP) for ocular hypertension (OHT) patients and further assess the factors associated with retinal microcirculation changes. Methods: This was a single-center prospective study designed for OHT patients, which consisted of two visits. After collecting baseline data of those who met the eligibility criteria, these patients were treated with latanoprost 0.005% ophthalmic solution for 4 weeks. Peripapillary vessel density (VD) of radial peripapillary capillaries (RPC) layer, macular VD in both superficial and deep layers, and foveal avascular zone (FAZ) area were measured by optical coherence tomography angiography (OCTA) before and after the treatment. We compared the changes in IOP and VD among the two visits by paired-sample t-test. Bonferroni correction was applied. Factors associated with VD changes were analyzed by linear regression analysis. Results: Thirty-four eyes of thirty-four patients were included. The mean IOP decreased by 6.5 ± 2.2 mmHg (p < 0.001). The peripapillary RPC VD increased significantly from 51.8 ± 2.5 to 53.0 ± 3.1% (Adjusted-p = 0.012). We found no significant difference in detailed sectors of the peripapillary region after correction. In the macular area, both the superficial and deep layers in foveal (superficial: 0.2 ± 1.9%, p = 0.523; deep: 0.0 ± 2.3%, p = 0.969) and parafoveal (superficial: 0.3 ± 3.0%, p = 0.565; deep: 0.5 ± 3.1%, p = 0.423) VD remained unchanged. The decrease of the mean FAZ area was insignificant (p = 0.295). The percentage of IOP reduction (β = 0.330, p = 0.031) and the baseline RNFL thickness (β = 0.450, p = 0.004) significantly correlated with the percentage of peripapillary RPC VD improvement in the multivariate linear regression analysis. Conclusion: The peripapillary VD in OHT patients increased after the reduction of IOP. The mild change of IOP did not alter the microcirculation in the macula. In addition, the percentage of IOP change and the baseline RNFL thickness were independent factors for the peripapillary RPC VD improvement.
Collapse
Affiliation(s)
- Xuhao Chen
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Ying Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Haohao Di
- Department of Ophthalmology, Zhengzhou Second Hospital, Zhengzhou, China
| | - Qianru Wu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Di Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Chun Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| |
Collapse
|
15
|
Abstract
PURPOSE To reveal clinical features of patchy atrophy in pathologic myopia and investigate the status of the Bruch membrane and retinal pigment epithelium by swept-source optical coherence tomography. METHODS This study reviewed highly myopic patients who visited the high myopia clinic between January 2015 and February 2018. Wide-field photographs and wide-field fundus autofluorescence fundus images were used as the primary method for identifying PAs, and swept-source optical coherence tomography images were used for investigating the retinochoroid status of PAs. RESULTS Four hundred fifty-six PAs were detected in 137 eyes (118 patients). Patchy atrophys were located most often in the macular area (28.3%), followed by the inferior (25.9%), temporal (18.9%), nasal (14.5%), and superior (12.5%) region. All 210, PAs which had been fully or partially scanned by swept-source optical coherence tomography, showed a retinal pigment epithelium defect, and 174 (82.9%) PAs showed a Bruch membrane defect on the available scans. In 101 (82.8%) of 122 PAs with clearly detectable borders of the retinal pigment epithelium and Bruch membrane defect, the Bruch membrane defects were smaller than the retinal pigment epithelium defects. A dome-shape inward bulging of the sclera was observed in 10 PAs. CONCLUSION These morphological findings may provide a basis for exploring the biomechanical etiology of the PAs as part of the development of pathologic myopia.
Collapse
|
16
|
The Relationship Between Corneal Hysteresis and Progression of Glaucoma After Trabeculectomy. J Glaucoma 2021; 29:912-917. [PMID: 32555063 DOI: 10.1097/ijg.0000000000001581] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate the association of corneal hysteresis (CH) measured with Ocular Response Analyzer on the progression of glaucoma after trabeculectomy. MATERIALS AND METHODS Twenty-four eyes of 19 patients with primary open-angle glaucoma underwent trabeculectomy. A series of visual fields (Humphery Field Analyzer 24-2 SITA-standard) were measured starting after 6 months after trabeculectomy (4.2±5.0 y, mean±SD). The mean total deviation (mTD) of the 52 test points were calculated. In addition, the mTD was divided into the following areas: central area (within central 10 degrees), superior area and inferior area: mTDcentre, mTDsuperior, and mTDinferior, respectively. The relationship between each area's progression rate of mTD and the 7 variables of baseline age, central corneal thickness, baseline mTD, mean intraocular pressure (IOP), SD of IOP divided by the mean IOP, the difference between baseline IOP obtained before the initiation of any treatment, mean IOP, and CH were analyzed using the linear mixed model, and the optimal model was selected using the model selection method with the second ordered Akaike Information Criterion. RESULTS In the optimal model for mTD progression rate, only CH was selected with the coefficient of 0.11. The optimal model for the mTDcentre progression rate included mean IOP with the coefficient of -0.043 and CH with the coefficient of 0.12, and that for mTDinferior included only CH with the coefficient of 0.089. There was no variable selected in the optimal model for the mTDsuperior progression rate. CONCLUSION CH is a useful measure in the management of glaucoma after trabeculectomy.
Collapse
|
17
|
Wang YX, Panda-Jonas S, Jonas JB. Optic nerve head anatomy in myopia and glaucoma, including parapapillary zones alpha, beta, gamma and delta: Histology and clinical features. Prog Retin Eye Res 2020; 83:100933. [PMID: 33309588 DOI: 10.1016/j.preteyeres.2020.100933] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/22/2020] [Accepted: 11/27/2020] [Indexed: 12/13/2022]
Abstract
The optic nerve head can morphologically be differentiated into the optic disc with the lamina cribrosa as its basis, and the parapapillary region with zones alpha (irregular pigmentation due to irregularities of the retinal pigment epithelium (RPE) and peripheral location), beta zone (complete RPE loss while Bruch's membrane (BM) is present), gamma zone (absence of BM), and delta zone (elongated and thinned peripapillary scleral flange) within gamma zone and located at the peripapillary ring. Alpha zone is present in almost all eyes. Beta zone is associated with glaucoma and may develop due to a IOP rise-dependent parapapillary up-piling of RPE. Gamma zone may develop due to a shift of the non-enlarged BM opening (BMO) in moderate myopia, while in highly myopic eyes, the BMO enlarges and a circular gamma zone and delta zone develop. The ophthalmoscopic shape and size of the optic disc is markedly influenced by a myopic shift of BMO, usually into the temporal direction, leading to a BM overhanging into the intrapapillary compartment at the nasal disc border, a secondary lack of BM in the temporal parapapillary region (leading to gamma zone in non-highly myopic eyes), and an ocular optic nerve canal running obliquely from centrally posteriorly to nasally anteriorly. In highly myopic eyes (cut-off for high myopia at approximately -8 diopters or an axial length of 26.5 mm), the optic disc area enlarges, the lamina cribrosa thus enlarges in area and decreases in thickness, and the BMO increases, leading to a circular gamma zone and delta zone in highly myopic eyes.
Collapse
Affiliation(s)
- Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.
| | - Songhomitra Panda-Jonas
- Institute for Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany
| | - Jost B Jonas
- Institute for Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany; Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karis-University, Mannheim, Germany
| |
Collapse
|
18
|
Central Retinal Vessel Trunk Caliber Changes After Short-term Intraocular Pressure Elevation. J Glaucoma 2020; 29:467-472. [PMID: 32097258 DOI: 10.1097/ijg.0000000000001472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PRECIS After a short-term intraocular pressure (IOP) elevation, the central retinal vein caliber may be widened at lower IOP rise levels, while be compressed at higher IOP rise values. PURPOSE The purpose of this study was to investigate changes in the calibers of the central retinal vein trunk (CRVT) and central retinal artery trunk (CRAT) trunk during a short-term elevation of IOP. METHODS A prospective observational study. Acute primary angle-closure suspects underwent a dark room prone provocative test (DRPPT) for 2 hours. Before and at the end of the test, tonometry, swept-source optical coherence tomography, and nonmydriatic fundus photography were performed. The calibers of the CRVT and CRAT were measured on the fundus photos taken at baseline and at the end of the DRPPT. RESULTS The study included 101 eyes (61 individuals; mean age: 54.8±9.3 y; range: 30 to 70 y) which showed an increase in IOP by 9.6±9.0 mm Hg (range: 2.3 to 46.7 mm Hg). From baseline to the end of the DRPPT, the mean CRVT caliber increased from 101.8±25.9 to 107.7±26.6 μm (P<0.001), while the CRAT caliber did not differ significantly (110.3±24.2 vs. 109.7±21.5 μm; P=0.54) during the test. The CRVT widening was larger in the subgroup with IOP rise of <6 mm Hg than in the subgroup with an IOP rise of 6 to 15 mm Hg, while in the subgroup with an IOP rise of >15 mm Hg the CRVT caliber did not change significantly (P=0.20) during the test. CONCLUSIONS A physiological short-term IOP rise at lower levels of IOP elevation led to a widening of the CRVT, while at higher IOP values, the further IOP-rise may have compressed the retinal vein. Because of higher intraluminal pressure values, the retinal artery diameters were not affected by the IOP-rise.
Collapse
|
19
|
Chen JY, Le A, Caprioli J, Giaconi JA, Nouri-Mahdavi K, Law SK, Bonelli L, Coleman AL, Demer JL. Orbital Fat Volume After Treatment with Topical Prostaglandin Agonists. Invest Ophthalmol Vis Sci 2020; 61:46. [PMID: 32455434 PMCID: PMC7405708 DOI: 10.1167/iovs.61.5.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Topical prostaglandin analogs (PGAs) are common treatment for primary open-angle glaucoma (POAG) but reportedly may cause adnexal fat atrophy. We asked if patients with POAG treated with PGAs have abnormalities in orbital fat volume (OFV). Methods We studied 23 subjects with POAG who had never experienced intraocular pressure (IOP) exceeding 21 mm Hg and were treated long term with PGAs, in comparison with 21 age-matched controls. Orbital volume, non-fat orbital tissue volume, and OFV were measured using high-resolution magnetic resonance imaging. Results Subjects with POAG had been treated with PGAs for 39 ± 19 months (SD) and were all treated within the 4 months preceding study. In the region from trochlea to orbital apex, OFV in POAG was significantly less at 9.8 ± 1.9 mL than in the control subjects at 11.1 ± 1.3 mL (P = 0.019). However, between the globe-optic nerve junction (GONJ) and trochlea, OFV was similar in both groups. Width and cross sectional area of the bony orbit were significantly smaller in POAG than in controls (P < 0.0001). Posterior to the GONJ, the average orbital cross-sectional area was 68.2 mm2 smaller, and the orbital width averaged 1.5 mm smaller throughout the orbit, in patients with POAG than in controls. Conclusions Patients with POAG who have been treated with PGAs have lower overall OFV than controls, but OFV in the anterior orbit is similar in both groups. Lower overall OFV in POAG may be a primary association of this disorder with a horizontally narrower bony orbit, which may be a risk factor for POAG at nonelevated IOPs.
Collapse
|
20
|
Clark RA, Suh SY, Caprioli J, Giaconi JA, Nouri-Mahdavi K, Law SK, Bonelli L, Coleman AL, Demer JL. Adduction-Induced Strain on the Optic Nerve in Primary Open Angle Glaucoma at Normal Intraocular Pressure. Curr Eye Res 2020; 46:568-578. [PMID: 32911989 DOI: 10.1080/02713683.2020.1817491] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE/AIM The optic nerve (ON) becomes taut during adduction beyond ~26° in healthy people and patients with primary open angle glaucoma (POAG), but only retracts the globe in POAG. We used magnetic resonance imaging (MRI) to investigate this difference. MATERIALS AND METHODS MRI was obtained in 2-mm quasi-coronal planes in central gaze, and smaller (~23-25°) and larger (~30-31°) adduction and abduction in 21 controls and 12 POAG subjects whose intraocular pressure never exceeded 21 mmHg. ON cross-sections were analyzed from the globe to 10 mm posteriorly. Area centroids were used to calculate ON path lengths and changes in cross-sections to calculate elongation assuming volume conservation. RESULTS For both groups, ON path was nearly straight (<102.5% of minimum path) in smaller adduction, with minimal further straightening in larger adduction. ON length was redundant in abduction, exceeding 103% of minimum path for both groups. For normals, the ON elongated 0.4 ± 0.5 mm from central gaze to smaller adduction, and 0.4 ± 0.5 mm further from smaller to larger adduction. For POAG subjects, the ON did not elongate on average from central gaze to smaller adduction and only 0.2 ± 0.4 mm from smaller to larger adduction (P = .045 vs normals). Both groups demonstrated minimal ON elongation not exceeding 0.25 mm from central gaze to smaller and larger abduction. The globe retracted significantly more during large adduction in POAG subjects than normals (0.6 ± 0.7 mm vs 0.2 ± 0.5 mm, P = .027), without appreciable retraction in abduction. For each mm increase in globe axial length, ON elongation in large adduction similarly increased by 0.2 mm in each group. CONCLUSIONS The normal ON stretches to absorb force and avert globe retraction in adduction. In POAG with mild to severe visual field loss, the relatively inelastic ON tethers and retracts the globe during adduction beyond ~26°, transfering stress to the optic disc that could contribute to progressive neuropathy during repeated eye movements.
Collapse
Affiliation(s)
- Robert A Clark
- Department of Ophthalmology, University of California, Los Angeles, USA.,Stein Eye Institute, University of California, Los Angeles, USA
| | - Soh Youn Suh
- Department of Ophthalmology, University of California, Los Angeles, USA.,Stein Eye Institute, University of California, Los Angeles, USA
| | - Joseph Caprioli
- Department of Ophthalmology, University of California, Los Angeles, USA.,Stein Eye Institute, University of California, Los Angeles, USA
| | - JoAnn A Giaconi
- Department of Ophthalmology, University of California, Los Angeles, USA.,Stein Eye Institute, University of California, Los Angeles, USA
| | - Kouros Nouri-Mahdavi
- Department of Ophthalmology, University of California, Los Angeles, USA.,Stein Eye Institute, University of California, Los Angeles, USA
| | - Simon K Law
- Department of Ophthalmology, University of California, Los Angeles, USA.,Stein Eye Institute, University of California, Los Angeles, USA
| | - Laura Bonelli
- Department of Ophthalmology, University of California, Los Angeles, USA.,Stein Eye Institute, University of California, Los Angeles, USA
| | - Anne L Coleman
- Department of Ophthalmology, University of California, Los Angeles, USA.,Stein Eye Institute, University of California, Los Angeles, USA.,Department of Epidemiology Fielding School of Public Health, University of California, Los Angeles, USA
| | - Joseph L Demer
- Department of Ophthalmology, University of California, Los Angeles, USA.,Stein Eye Institute, University of California, Los Angeles, USA.,Department of Neurology, University of California, Los Angeles, USA.,Neuroscience Interdepartmental Program, University of California, Los Angeles, USA.,Bioengineering Interdepartmental Program, University of California, Los Angeles, USA
| |
Collapse
|
21
|
Shin A, Park J, Le A, Poukens V, Demer JL. Bilaminar Mechanics of the Human Optic Nerve Sheath. Curr Eye Res 2020; 45:854-863. [PMID: 31821056 PMCID: PMC7286774 DOI: 10.1080/02713683.2019.1701689] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE/AIM The adult human optic nerve (ON) sheath has recently been recognized to be bilaminar, consisting of inner layer (IL) and outer layer (OL). Since the ON and sheath exert tension on the globe in large angle adduction as these structures transmit reaction force of the medial rectus muscle to the globe, this study investigated the laminar biomechanics of the human ON sheath. MATERIALS AND METHODS Biomechanical characterization was performed in ON sheath specimens from 12 pairs of fresh, post-mortem adult eyes. Some ON sheath specimens were tested completely, while others were separated into IL and OL. Uniaxial tensile loading under physiological temperature and humidity was used to characterize a linear approximation as Young's modulus, and hyperelastic non-linear behavior using the formulation of Ogden. Micro-indentation was performed by imposing small compressive deformations with small, hard spheres. Specimens of the same sheaths were paraffin embedded, sectioned at 10 micron thickness, and stained with van Gieson's stain for anatomical correlation. RESULTS Mean (± standard error of the mean, SEM) tensile Young's modulus of the inner sheath at 19.8 ± 1.6 MPa significantly exceeded that for OL at 9.7 ± 1.2 MPa; the whole sheath showed intermediate modulus of 15.4 ± 1.1 MPa. Under compression, the inner sheath was stiffer (7.9 ± 0.5 vs 5.2 ± 0.5 kPa) and more viscous (150.8 ± 10.6 vs 75.6 ± 6 kPa s) than outer sheath. The inner sheath had denser elastin fibers than outer sheath, correlating with greater stiffness. CONCLUSIONS We conclude that maximum tensile stiffness occurs in the elastin-rich ON sheath IL that inserts near the lamina cribrosa where tension in the sheath exerted during adduction tethering may be concentrated adjacent the ON head.
Collapse
Affiliation(s)
- Andrew Shin
- Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles
- Wellman Center for Photomedicine, Harvard Medical School & Massachusetts General Hospital, Boston
| | - Joseph Park
- Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles
- Department of Bioengineering, University of California, Los Angeles
| | - Alan Le
- Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles
- Department of Bioengineering, University of California, Los Angeles
| | - Vadims Poukens
- Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles
| | - Joseph L. Demer
- Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles
- Biomedical Engineering Interdepartmental Program, University of California, Los Angeles
- Neuroscience Interdepartmental Program, University of California, Los Angeles
- Department of Neurology, University of California, Los Angeles
| |
Collapse
|
22
|
Reply to Comment on Age-Dependent Deformation of the Optic Nerve Head and Peripapillary Retina by Horizontal Duction. Am J Ophthalmol 2020; 215:157-159. [PMID: 32359700 DOI: 10.1016/j.ajo.2020.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/06/2020] [Indexed: 11/21/2022]
|
23
|
Asano S, Asaoka R, Yamashita T, Aoki S, Matsuura M, Fujino Y, Murata H, Nakakura S, Nakao Y, Kiuchi Y. Visualizing the dynamic change of Ocular Response Analyzer waveform using Variational Autoencoder in association with the peripapillary retinal arteries angle. Sci Rep 2020; 10:6592. [PMID: 32313133 PMCID: PMC7170838 DOI: 10.1038/s41598-020-63601-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/31/2020] [Indexed: 12/20/2022] Open
Abstract
The aim of the current study is to identify possible new Ocular Response Analyzer (ORA) waveform parameters related to changes of retinal structure/deformation, as measured by the peripapillary retinal arteries angle (PRAA), using a generative deep learning method of variational autoencoder (VAE). Fifty-four eyes of 52 subjects were enrolled. The PRAA was calculated from fundus photographs and was used to train a VAE model. By analyzing the ORA waveform reconstructed (noise filtered) using VAE, a novel ORA waveform parameter (Monot1-2), was introduced, representing the change in monotonicity between the first and second applanation peak of the waveform. The variables mostly related to the PRAA were identified from a set of 41 variables including age, axial length (AL), keratometry, ORA corneal hysteresis, ORA corneal resistant factor, 35 well established ORA waveform parameters, and Monot1-2, using a model selection method based on the second-order bias-corrected Akaike information criterion. The optimal model for PRAA was the AL and six ORA waveform parameters, including Monot1-2. This optimal model was significantly better than the model without Monot1-2 (p = 0.0031, ANOVA). The current study suggested the value of a generative deep learning approach in discovering new useful parameters that may have clinical relevance.
Collapse
Affiliation(s)
- Shotaro Asano
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan.
- Seirei General Hospital, Shizuoka, 430-8558, Japan.
- Seirei Christopher University, Shizuoka, 433-8558, Japan.
| | - Takehiro Yamashita
- Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, 890-0075, Japan
| | - Shuichiro Aoki
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Masato Matsuura
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
- Department of Ophthalmology, Graduate School of Medical Sciences, Kitasato University, Kanagawa, 252-0374, Japan
| | - Yuri Fujino
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
- Seirei General Hospital, Shizuoka, 430-8558, Japan
- Department of Ophthalmology, Graduate School of Medical Sciences, Kitasato University, Kanagawa, 252-0374, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Shunsuke Nakakura
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Hyogo, 671-1227, Japan
| | - Yoshitaka Nakao
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, 739-8511, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, 739-8511, Japan
| |
Collapse
|
24
|
Abstract
PURPOSE/AIM We aimed to characterize the connective tissue microanatomy, elastin abundance, and fiber orientation in the human optic nerve sheath, also known as the optic nerve dura mater, for correlation with its biomechanical properties. MATERIALS AND METHODS Seven whole human orbits aged 4-93 years, and five isolated human optic nerve sheaths aged 26-75 years were formalin fixed, paraffin embedded, coronally sectioned, stained by Masson trichrome and van Gieson's elastin methods, and analyzed quantitatively for elastin fiber abundance and orientation. Elastin area fraction was defined as area stained for elastin divided by total area. RESULTS While unilaminar in children, the adult ON sheath exhibited distinct inner and outer layers. Collagen was denser and more compact in the inner layer. Elastin area fraction was significantly greater at 6.0 ± 0.4% (standard error of mean) in the inner than outer layer at 3.6 ± 0.4% (P < 10-5). Elastin fibers had three predominant orientations: longitudinal, diagonal, and circumferential. Of circumferential fibers, 63 ± 4.7% were in the inner and 37 ± 4.7% in the outer layer (P < 10-4). Longitudinal and diagonal fibers were uniformly distributed in both layers. Elastin density and sheath thickness increased significantly with age (P < .01). CONCLUSIONS The adult human optic nerve sheath is bilaminar, with each layer containing elastin fibers oriented in multiple directions consistent with isotropic properties. Differences in laminar elastin density and orientation may reflect greater tensile loading in the inner than in the outer layer.
Collapse
Affiliation(s)
- Alan Le
- Department of Bioengineering, University of California , Los Angeles, California, USA.,Department of Ophthalmology and Stein Eye Institute, University of California , Los Angeles, California, USA
| | - Andrew Shin
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital , Boston, Massachusetts, USA
| | - Joseph Park
- Department of Bioengineering, University of California , Los Angeles, California, USA.,Department of Ophthalmology and Stein Eye Institute, University of California , Los Angeles, California, USA
| | - Vadims Poukens
- Department of Ophthalmology and Stein Eye Institute, University of California , Los Angeles, California, USA
| | - Joseph L Demer
- Department of Ophthalmology and Stein Eye Institute, University of California , Los Angeles, California, USA.,Department of Neurology, University of California , Los Angeles, California, USA.,Neuroscience, University of California , Los Angeles, California, USA.,Bioengineering Interdepartmental Programs, University of California , Los Angeles, California, USA.,David Geffen Medical School, University of California , Los Angeles, California, USA
| |
Collapse
|
25
|
Demer JL, Clark RA, Suh SY, Giaconi JA, Nouri-Mahdavi K, Law SK, Bonelli L, Coleman AL, Caprioli J. Optic Nerve Traction During Adduction in Open Angle Glaucoma with Normal versus Elevated Intraocular Pressure. Curr Eye Res 2020; 45:199-210. [PMID: 31453714 PMCID: PMC7398593 DOI: 10.1080/02713683.2019.1660371] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/05/2019] [Accepted: 08/21/2019] [Indexed: 12/15/2022]
Abstract
Purpose/Aim: We used magnetic resonance imaging (MRI) to investigate effects of intraocular pressure (IOP), race, and other factors on optic nerve (ON) traction in adduction, a phenomenon proposed as neuropathic in open angle glaucoma (OAG).Materials and Methods: Thirty-five patients with OAG (26 with maximal untreated IOP ≤21 mmHg, 9 with IOP >21mmHg) and 48 controls underwent axial and quasi-coronal MRI in central gaze and large (27-33°) abduction and adduction. Some underwent MRI at smaller ductions (21-28°). Effects of presence vs. absence of OAG; within OAG whether maximum IOP level was ≤21 mmHg vs. >21 mmHg; adduction angle; race; age; and gender on ON path length and globe translation were analyzed using generalized estimating equations to account for possible intereye correlations of individual subjects.Results: Average visual field mean deviation (±standard error of mean, SEM) was -8.2 ± 1.2 dB in OAG with normal IOP, and -6.1 ± 1.4 in high IOP. In central gaze, ON path in OAG was significantly more redundant than in controls but in both groups the ON became significantly and almost equally straighter in small (~21°) or large (~27°) adduction than in central gaze. With progressive adduction only, globes retracted in OAG (P < 0.005) but not in controls; this was only weakly related to globe size and not to IOP elevation. Globe retraction in adduction was significant only in OAG, and in that group was significantly greater in Asian than white patients (P < 0.02).Conclusions: Although ON tethering in adduction is normal, progressive adduction is associated with abnormal globe retraction in OAG regardless of IOP level. This phenomenon is more prominent in Asians who have OAG. Traction in adduction may cause repetitive strain injury to the ON and peripapillary sclera, thus contributing to the optic neuropathy of glaucoma independent of IOP.
Collapse
Affiliation(s)
- Joseph L. Demer
- Department of Ophthalmology, University of California, Los Angeles
- Stein Eye Institute; University of California, Los Angeles
- Biomedical Engineering Interdepartmental Program; University of California, Los Angeles
- Neuroscience Interdepartmental Program; University of California, Los Angeles
- Department of Neurology, University of California, Los Angeles
| | - Robert A. Clark
- Department of Ophthalmology, University of California, Los Angeles
- Stein Eye Institute; University of California, Los Angeles
| | - Soh Youn Suh
- Department of Ophthalmology, University of California, Los Angeles
| | - JoAnn A. Giaconi
- Department of Ophthalmology, University of California, Los Angeles
- Stein Eye Institute; University of California, Los Angeles
| | - Kouros Nouri-Mahdavi
- Department of Ophthalmology, University of California, Los Angeles
- Stein Eye Institute; University of California, Los Angeles
| | - Simon K. Law
- Department of Ophthalmology, University of California, Los Angeles
- Stein Eye Institute; University of California, Los Angeles
| | - Laura Bonelli
- Department of Ophthalmology, University of California, Los Angeles
- Stein Eye Institute; University of California, Los Angeles
| | - Anne L. Coleman
- Department of Ophthalmology, University of California, Los Angeles
- Stein Eye Institute; University of California, Los Angeles
| | - Joseph Caprioli
- Department of Ophthalmology, University of California, Los Angeles
- Stein Eye Institute; University of California, Los Angeles
| |
Collapse
|
26
|
Glaucoma neurodegeneration and myopia. PROGRESS IN BRAIN RESEARCH 2020; 257:1-17. [DOI: 10.1016/bs.pbr.2020.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
27
|
Pi S, Hormel TT, Wei X, Cepurna W, Camino A, Guo Y, Huang D, Morrison J, Jia Y. Monitoring retinal responses to acute intraocular pressure elevation in rats with visible light optical coherence tomography. NEUROPHOTONICS 2019; 6:041104. [PMID: 31312671 PMCID: PMC6624745 DOI: 10.1117/1.nph.6.4.041104] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/21/2019] [Indexed: 05/08/2023]
Abstract
Elevated intraocular pressure (IOP) is an important risk factor for glaucoma. However, the role of IOP in glaucoma progression, as well as retinal physiology in general, remains incompletely understood. We demonstrate the use of visible light optical coherence tomography to measure retinal responses to acute IOP elevation in Brown Norway rats. We monitored retinal responses in reflectivity, angiography, blood flow, oxygen saturation ( sO 2 ), and oxygen metabolism over a range of IOP from 10 to 100 mmHg. As IOP was elevated, nerve fiber layer reflectivity was found to decrease. Vascular perfusion in the three retinal capillary plexuses remained steady until IOP exceeded 70 mmHg and arterial flow was noted to reverse periodically at high IOPs. However, a significant drop in total retinal blood flow was observed first at 40 mmHg. As IOP increased, the venous sO 2 demonstrated a gradual decrease despite steady arterial sO 2 , which is consistent with increased arterial-venous oxygen extraction across the retinal capillary beds. Calculated total retinal oxygen metabolism was steady, reflecting balanced responses of blood flow and oxygen extraction, until IOP exceeded 40 mmHg, and fell to 0 at 70 and 80 mmHg. Above this, measurements were unattainable. All measurements reverted to baseline when the IOP was returned to 10 mmHg, indicating good recovery following acute pressure challenge. These results demonstrate the ability of this system to monitor retinal oxygen metabolism noninvasively and how it can help us understand retinal responses to elevated IOP.
Collapse
Affiliation(s)
- Shaohua Pi
- Oregon Health and Science University, Casey Eye Institute, Portland, Oregon, United States
| | - Tristan T. Hormel
- Oregon Health and Science University, Casey Eye Institute, Portland, Oregon, United States
| | - Xiang Wei
- Oregon Health and Science University, Casey Eye Institute, Portland, Oregon, United States
| | - William Cepurna
- Oregon Health and Science University, Casey Eye Institute, Portland, Oregon, United States
| | - Acner Camino
- Oregon Health and Science University, Casey Eye Institute, Portland, Oregon, United States
| | - Yukun Guo
- Oregon Health and Science University, Casey Eye Institute, Portland, Oregon, United States
| | - David Huang
- Oregon Health and Science University, Casey Eye Institute, Portland, Oregon, United States
| | - John Morrison
- Oregon Health and Science University, Casey Eye Institute, Portland, Oregon, United States
| | - Yali Jia
- Oregon Health and Science University, Casey Eye Institute, Portland, Oregon, United States
- Address all correspondence to Yali Jia, E-mail:
| |
Collapse
|
28
|
Wang YX, Zhang Q, Yang H, Chen JD, Wang N, Jonas JB. Lamina cribrosa pore movement during acute intraocular pressure rise. Br J Ophthalmol 2019; 104:800-806. [PMID: 31488430 PMCID: PMC7286041 DOI: 10.1136/bjophthalmol-2019-314016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 02/03/2023]
Abstract
Purpose To assess changes in the position of lamina cribrosa pores (LCPs) induced by acute intraocular pressure (IOP) elevation. Methods A prospective observational study. Acute angle-closure suspects who underwent the 2-hour dark room prone provocative test (DRPPT) were included. At baseline and within 5 min after the DRPPT end, tonometry, fundus photography and optical coherence tomography were performed. Optic disc photos taken before and after the DRPPT were aligned and moving distance of each visible LCP was measured (LCPMD). Results 38 eyes from 27 participants (age: 52.5±10.8 years) were included. The IOP rose from 16.7±3.2 mm Hg at baseline to 23.9±4.3 mm Hg at the DRPPT end. The mean lateral LCPMD was 28.1±14.6 µm (range: 5.0–77.2 µm), which increased with higher IOP rise (p=0.01) and deeper optic cup (p=0.02) in multivariate analysis. The intralamina range and SD of the LCPMD increased with younger age (p=0.01 and p=0.02, respectively) and with wider optic cup (p=0.01 and p=0.02, respectively). The LCP movements were headed to the superior direction in 12 (33%) eyes, inferior direction in 10 (28%) eyes, temporal direction in 9 (25%) eyes, and nasal direction in 5 (14%) eyes. Conclusions IOP rise is associated with LCP movements in the frontal plane, which are more pronounced with higher IOP rise and deeper optic cup. The intralamina variability in the IOP rise-associated LCPMD increased with younger age and wider optic cup. IOP variation-associated lateral LCP movements may be of interest to elucidate glaucomatous optic nerve damage.
Collapse
Affiliation(s)
- Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Qi Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Hongli Yang
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, United States
| | - Jian Dong Chen
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Jost B Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.,Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Mannheim, Germany
| |
Collapse
|
29
|
Lee KM, Choung HK, Kim M, Oh S, Kim SH. Change of β-Zone Parapapillary Atrophy During Axial Elongation: Boramae Myopia Cohort Study Report 3. Invest Ophthalmol Vis Sci 2019; 59:4020-4030. [PMID: 30098190 DOI: 10.1167/iovs.18-24775] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate changes of β-zone parapapillary atrophy (PPA) during axial elongation. Methods Change of β-zone PPA was evaluated by spectral-domain optical coherence tomography (SD-OCT) in myopic children for 2 years, prospectively. Using the infrared images acquired by a fixed scan circle in the glaucoma progression analysis (GPA) mode, the retinal pigment epithelial opening (RPEO) and the clinical disc margin (CDM) were manually delineated. The area and position of β-zone PPA was calculated as the differences from those of the RPEO and CDM, respectively. The β-zone PPA was further differentiated into βBM PPA (β-zone PPA with Bruch's membrane [BM]) and γ-zone PPA (β-zone PPA without BM). The change of β-zone PPA was compared between the first and final visits. Results The area of β-zone PPA increased in 35 eyes (76%). This increase was associated with RPEO area increase and CDM area decrease. The center of β-zone PPA moved along the direction of vascular trunk dragging, but to a lesser extent. The β-zone PPA enlargement was correlated with the extent of vascular trunk dragging (P = 0.014). In all eyes with β-zone PPA increase, the γ-zone portion had increased. Even in childhood, βBM PPA existed next to their γ-zone PPA in 11 eyes (24%), including 4 eyes that showed increase of both γ-zone and βBM portion during axial elongation. Conclusions Enlargement of β-zone PPA during axial elongation was affected by the extent and direction of vascular trunk dragging, thus implicating disproportionate growth between the retina and sclera.
Collapse
Affiliation(s)
- Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ho-Kyung Choung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Martha Kim
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seok Hwan Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, Korea
| |
Collapse
|
30
|
Wang X, Teoh CKG, Chan ASY, Thangarajoo S, Jonas JB, Girard MJA. Biomechanical Properties of Bruch's Membrane-Choroid Complex and Their Influence on Optic Nerve Head Biomechanics. Invest Ophthalmol Vis Sci 2019; 59:2808-2817. [PMID: 30029276 DOI: 10.1167/iovs.17-22069] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to measure the rupture pressure and the biomechanical properties of porcine Bruch's membrane (BM)-choroid complex (BMCC) and the influences of BM on optic nerve head (ONH) tissues. Methods The biomechanical properties of BMCC were extracted through uniaxial tensile tests of 10 BMCC specimens from 10 porcine eyes; the rupture pressures of BMCC were measured through burst tests of 20 porcine eyes; and the influence of BM on IOP-induced ONH deformations were investigated using finite element (FE) analysis. Results Uniaxial experimental results showed that the average elastic (tangent) moduli of BMCC samples at 0% and 5% strain were 1.60 ± 0.81 and 2.44 ± 1.02 MPa, respectively. Burst tests showed that, on average, BMCC could sustain an IOP of 82 mm Hg before rupture. FE simulation results predicted that, under elevated IOP, prelamina tissue strains increased with increasing BM stiffness. On the contrary, lamina cribrosa strains showed an opposite trend but the effects were small. Conclusions BMCC stiffness is comparable or higher than those of other ocular tissues and can sustain a relatively high pressure before rupture. Additionally, BM may have a nonnegligible influence on IOP-induced ONH deformations.
Collapse
Affiliation(s)
- Xiaofei Wang
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Clarence Ken Guan Teoh
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Anita S Y Chan
- Translational Ophthalmic Pathology, Singapore Eye Research Institute, Ophthalmic Pathology Service, Singapore National Eye Centre, Singapore.,Duke-National University of Singapore Medical School, Singapore
| | - Sathiyan Thangarajoo
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Heidelberg, Germany.,Beijing Institute of Ophthalmology, Beijing Tongren Eye Centre, Beijing Tongren Hospital, Capital Medical University, and Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Michaël J A Girard
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore.,Translational Ophthalmic Pathology, Singapore Eye Research Institute, Ophthalmic Pathology Service, Singapore National Eye Centre, Singapore
| |
Collapse
|
31
|
Development of a Novel Corneal Concavity Shape Parameter and Its Association with Glaucomatous Visual Field Progression. Ophthalmol Glaucoma 2019; 2:47-54. [PMID: 32672557 DOI: 10.1016/j.ogla.2018.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/14/2018] [Accepted: 10/30/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE To develop a novel Corvis ST (Oculus Co. Ltd, Wetzlar, Germany) corneal concavity shape parameter (concavity shape index [CSI]) and investigate its association with glaucomatous visual field (VF) progression. DESIGN Retrospective longitudinal study. PARTICIPANTS A total of 103 eyes with primary open-angle glaucoma in 68 patients with 8 reliable VFs using the Humphrey Field Analyzer (HFA) (Carl Zeiss Meditec Inc, Dublin, CA). METHODS The mean total deviation (mTD) of the 52 test points in the 24-2 HFA test pattern was calculated for each VF, and the mTD progression rate was determined. A Corvis ST measurement was performed, and CSI was calculated as the ratio of (peak distance × curvature radius at the time of highest concavity [HC] state) to (the deflection amplitude at the time of HC × curvature radius at the undeformed state). The association between mTD progression rate and CSI, as well as other variables (including age, intraocular pressure, corneal hysteresis [CH], and 35 standard Corvis ST parameters), was investigated using the linear mixed model. The optimal linear mixed model to describe mTD progression rate was selected using the Random Forest method followed by variable selection using the second order bias corrected Akaike Information Criterion (AICc) index. MAIN OUTCOME MEASURES Optimal linear mixed models for the mTD progression rate, as determined by AICc index. RESULTS Univariate analysis revealed mTD progression rate was significantly associated with CSI (P = 0.0042), CH, HC radius, A1 deflection length, max inverse radius, and integrated radius. The optimal model to describe mTD progression rate included CSI, max inverse radius, Ambrósio rational thickness horizontal, and age (AICc = 41.59). CONCLUSIONS A novel corneal concavity shape parameter, CSI, was closely related to glaucomatous VF progression.
Collapse
|
32
|
Kim YC, Hwang HS, Park HYL, Park CK. Transverse Separation of the Outer Retinal Layer at the Peripapillary in Glaucomatous Myopes. Sci Rep 2018; 8:12446. [PMID: 30127501 PMCID: PMC6102290 DOI: 10.1038/s41598-018-30523-5] [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: 03/22/2018] [Accepted: 08/01/2018] [Indexed: 11/10/2022] Open
Abstract
Glaucoma specialists often overlook the outer retinal changes because the glaucomatous optic neuropathy typically involves retinal nerve fiber layer (RNFL). By detailed inspection of the outer retina in myopic eyes, we observed a separation of the inner nuclear layer (INL) from the outer nuclear layer (ONL) at the peripapillary sclera (pp-sclera). Therefore, we conducted a retrospective observation of 108 eyes of 108 Korean subjects with myopia assessed by swept-source optical coherence tomography (SSOCT) and divided into normal and glaucomatous eyes. Mean subject age, refractive error and axial length difference between 2 groups were insignificant, respectively. To quantify the ONL-INL separation, straight-line distance from ONL endpoint to INL endpoint was measured at the center of the optic disc by SSOCT horizontal scan. The glaucomatous group had significantly large ONL-INL separation than the non-glaucomatous group (p = 0.027) but had no significant difference in INL – Anterior scleral canal opening (ASCO) separation. The width of ONL-INL separation were associated with β-peripapillary atrophy (β-PPA), degree of horizontal tilt of the optic disc and worse glaucomatous RNFL defect by Pearson’s correlation analysis (all p < 0.001, respectively). In conclusion, we demonstrate transverse separation of INL from ONL at the peripapillary region, which was significantly associated with glaucomatous optic nerve damage. These observations may be of interest to elucidate the role of PPA in glaucoma pathogenesis and a clinical index to take notice for myopic subjects.
Collapse
Affiliation(s)
- Yong Chan Kim
- Department of Ophthalmology, College of medicine, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Ho Sik Hwang
- Department of Ophthalmology, College of medicine, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Hae-Young Lopilly Park
- Department of Ophthalmology, College of medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Kee Park
- Department of Ophthalmology, College of medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
| |
Collapse
|
33
|
Asano S, Nakajima K, Kure K, Azuma K, Shimizu K, Murata H, Inoue T, Obata R, Asaoka R. Corneal biomechanical properties are associated with the activity and prognosis of Angioid Streaks. Sci Rep 2018; 8:8130. [PMID: 29802262 PMCID: PMC5970224 DOI: 10.1038/s41598-018-26430-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/08/2018] [Indexed: 11/26/2022] Open
Abstract
The aim of the current study is to investigate corneal biomechanical properties in detail using Ocular Response Analyzer (ORA) and Corvis ST (CST) tonometry and to analyze the association between corneal biomechanical properties and the frequency of intravitreal anti-vascular endothelial growth factor (VEGF) injections (FIV) in AS eyes with choroidal neovascularization (CNV). Twenty-eight eyes of 15 patients with AS were enrolled. Mean age of AS patients was 67.9 ± 9.8 years. ORA and CST measurements were carried out, in addition to comprehensive ophthalmic examinations. LogMAR visual acuity (VA) and ΔVA (the change of VA from baseline to the final visit) were calculated in each eye. Also, the relationships between FIV, and the variables of initial age at the observation period, axial length, and corneal biomechanical properties were investigated in eyes with AS using linear mixed model with model selection using AICc. In 28 AS eyes, 16 eyes underwent intravitreal anti-VEGF injections during follow-up period. Lower corneal hysteresis (CH), higher corneal resistant factor (CRF) and higher CST measured the DA ratio were associated with the increase of FIV in AS eyes (p = 0.01, p = 0.002, p = 0.027, respectively), suggesting the usefulness for monitoring of corneal biomechanical properties.
Collapse
Affiliation(s)
- Shotaro Asano
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Kosuke Nakajima
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Kana Kure
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Keiko Azuma
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Kimiko Shimizu
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Tatsuya Inoue
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Ryo Obata
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan.
| |
Collapse
|
34
|
Zhang Q, Jonas JB, Wang Q, Chan SY, Xu L, Wei WB, Wang YX. Optical Coherence Tomography Angiography Vessel Density Changes after Acute Intraocular Pressure Elevation. Sci Rep 2018; 8:6024. [PMID: 29662112 PMCID: PMC5902444 DOI: 10.1038/s41598-018-24520-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/05/2018] [Indexed: 01/08/2023] Open
Abstract
To investigate changes in retinal vessel density in optic nerve head (ONH) and macula after acute intraocular pressure (IOP) elevation, we conducted a prospective observational study. Eyes with IOP rise ≥5 mmHg after 2-hour dark room prone provocative test (DRPPT) were included. Vasculature of ONH and macula was examined by optical coherence tomography angiography (OCTA) at baseline and after DRPPT. Among the 65 eyes of 42 individuals, 40 eyes with qualified images were enrolled. Mean IOP rise was 9.6 ± 4.2 mmHg (5.0-23.3 mmHg) after DRPPT. Retinal vessel density did not differ after IOP rise for either the papillary region (optic nerve head and radial peripapillary capillary layer) or the macula region (superficial, deep and outer retinal layer) (P > 0.05). Vessel density in each subregion did not change either. If only enrolled eyes with IOP rise ≥10 mmHg, similar results were obtained in condition of IOP increase by 15.0 ± 3.6 mmHg. To conclude, eyes with an acute IOP elevation by 10 or 15 mmHg for two hours, while the blood pressure remained constant, the vessel density in both ONH and macula region examined by OCTA did not show significant changes. The observations fit with an IOP-related autoregulation in retinal blood flow for a moderate elevation of IOP.
Collapse
Affiliation(s)
- Qi Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Jost B Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Seegartenklinik, Heidelberg, Germany
| | - Qian Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Szy Yann Chan
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Liang Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Wen Bin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.
| |
Collapse
|
35
|
Shin A, Yoo L, Park J, Demer JL. Finite Element Biomechanics of Optic Nerve Sheath Traction in Adduction. J Biomech Eng 2018; 139:2648719. [PMID: 28787473 DOI: 10.1115/1.4037562] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Indexed: 02/01/2023]
Abstract
Historical emphasis on increased intraocular pressure (IOP) in the pathogenesis of glaucoma has been challenged by the recognition that many patients lack abnormally elevated IOP. We employed finite element analysis (FEA) to infer contribution to optic neuropathy from tractional deformation of the optic nerve head (ONH) and lamina cribrosa (LC) by extraocular muscle (EOM) counterforce exerted when optic nerve (ON) redundancy becomes exhausted in adduction. We characterized assumed isotropic Young's modulus of fresh adult bovine ON, ON sheath, and peripapillary and peripheral sclera by tensile elongation in arbitrary orientations of five specimens of each tissue to failure under physiological temperature and humidity. Physical dimensions of the FEA were scaled to human histological and magnetic resonance imaging (MRI) data and used to predict stress and strain during adduction 6 deg beyond ON straightening at multiple levels of IOP. Young's modulus of ON sheath of 44.6 ± 5.6 MPa (standard error of mean) greatly exceeded that of ON at 5.2 ± 0.4 MPa, peripapillary sclera at 5.5 ± 0.8 MPa, and peripheral sclera at 14.0 ± 2.3 MPa. FEA indicated that adduction induced maximum stress and strain in the temporal ONH. In the temporal LC, the maximum stress was 180 kPa, and the maximum strain was ninefold larger than produced by IOP elevation to 45 mm Hg. The simulation suggests that ON sheath traction by adduction concentrates far greater mechanical stress and strain in the ONH region than does elevated IOP, supporting the novel concept that glaucomatous optic neuropathy may result at least partly from external traction on the ON, rather than exclusively on pressure on the ON exerted from within the eye.
Collapse
Affiliation(s)
- Andrew Shin
- Department of Ophthalmology, Stein Eye Institute, Los Angeles, CA 90095
| | - Lawrence Yoo
- Department of Ophthalmology, Stein Eye Institute, Los Angeles, CA 90095; Intelon Optics Inc., Cambridge, MA 02138-4430
| | - Joseph Park
- Department of Ophthalmology, Stein Eye Institute, Los Angeles, CA 90095; Department of Mechanical Engineering, University of California, Los Angeles, CA 90095
| | - Joseph L Demer
- Arthur L. Rosenbaum Professor of Pediatric Ophthalmology Department of Ophthalmology, Stein Eye Institute, Los Angeles, CA 90095 e-mail: ; Biomedical Engineering Interdepartmental Program, University of California, Los Angeles, CA 90095;Neuroscience Interdepartmental Program, University of California, Los Angeles, CA 90095; Department of Neurology, University of California, Los Angeles, CA 90095
| |
Collapse
|
36
|
The Relationship between the Waveform Parameters from the Ocular Response Analyzer and the Progression of Glaucoma. Ophthalmol Glaucoma 2018; 1:123-131. [PMID: 32672562 DOI: 10.1016/j.ogla.2018.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/14/2018] [Accepted: 08/17/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE To investigate the usefulness of waveform parameters measured with the Ocular Response Analyzer (Reichert Ophthalmic Instruments, Depew, NY) in assessing the progression of glaucomatous visual field (VF). DESIGN Observational cross-sectional study. PARTICIPANTS One hundred and one eyes with primary open-angle glaucoma in 68 patients with 8 reliable VFs using the Humphrey Field Analyzer (Carl Zeiss Meditec, Inc., Dublin, CA). METHODS The mean of total deviation (mTD) value of the 52 test points in the 24-2 Humphrey Field Analyzer VF test pattern was calculated, and the progression rate of mTD was determined using 8 VFs. Ocular Response Analyzer measurement was performed 3 times in the same day, and the average values of the 3 measurements were used in the analysis. Then, the optimal linear mixed model was selected using 7 parameters: age, mean and standard deviation of intraocular pressure with the Goldmann applanation tonometry during the observation period, central corneal thickness, axial length, mTD in the initial VF, and corneal hysteresis (CH) other than waveform parameters, henceforth known as the basic model. In addition, using the 37 waveform parameters, the optimal model for the mTD progression rate was identified, according to the second-order bias-corrected Akaike information criterion (AICc) index, using 15 preselected waveform parameters with the least absolute shrinkage and selection operator regression (henceforth known as the waveform model). MAIN OUTCOME MEASURES Optimal linear mixed models for the mTD progression rate, as determined by AICc index. RESULTS The mean ± standard deviation mTD progression rate was -0.25±0.31 dB/year. The basic model was mTD progression rate = -0.94 + 0.075 × CH (AICc = 46.71). The waveform model was mTD progression rate = 1.25 - 0.066 × path2 - 0.000099 × p2area + 0.0021 × mslew2 (AICc = 44.95). The relative likelihood of the latter model being the optimal model was 6.23 times greater than that of the former model. CONCLUSIONS Ocular Response Analyzer waveform parameters were correlated significantly with glaucomatous VF progression and showed a stronger than correlation with VF progression than CH.
Collapse
|
37
|
Jonas JB, Aung T, Bourne RR, Bron AM, Ritch R, Panda-Jonas S. Glaucoma. Lancet 2017; 390:2183-2193. [PMID: 28577860 DOI: 10.1016/s0140-6736(17)31469-1] [Citation(s) in RCA: 782] [Impact Index Per Article: 111.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 04/11/2017] [Accepted: 04/26/2017] [Indexed: 12/28/2022]
Abstract
Glaucoma is a heterogeneous group of diseases characterised by cupping of the optic nerve head and visual-field damage. It is the most frequent cause of irreversible blindness worldwide. Progression usually stops if the intraocular pressure is lowered by 30-50% from baseline. Its worldwide age-standardised prevalence in the population aged 40 years or older is about 3·5%. Chronic forms of glaucoma are painless and symptomatic visual-field defects occur late. Early detection by ophthalmological examination is mandatory. Risk factors for primary open-angle glaucoma-the most common form of glaucoma-include older age, elevated intraocular pressure, sub-Saharan African ethnic origin, positive family history, and high myopia. Older age, hyperopia, and east Asian ethnic origin are the main risk factors for primary angle-closure glaucoma. Glaucoma is diagnosed using ophthalmoscopy, tonometry, and perimetry. Treatment to lower intraocular pressure is based on topical drugs, laser therapy, and surgical intervention if other therapeutic modalities fail to prevent progression.
Collapse
Affiliation(s)
- Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany.
| | - Tin Aung
- Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rupert R Bourne
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - Alain M Bron
- Department of Ophthalmology, University Hospital, Dijon, France; Eye and Nutrition Research Group, Bourgogne Franche-Comté University, Dijon, France
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Songhomitra Panda-Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
38
|
Hirasawa K, Matsuura M, Murata H, Nakakura S, Nakao Y, Kiuchi Y, Asaoka R. Association between Corneal Biomechanical Properties with Ocular Response Analyzer and Also CorvisST Tonometry, and Glaucomatous Visual Field Severity. Transl Vis Sci Technol 2017. [PMID: 28626602 PMCID: PMC5472364 DOI: 10.1167/tvst.6.3.18] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the association between corneal biomechanical properties measured with the Ocular Response Analyzer (ORA) and also CorvisST (CST) tonometry, and glaucomatous visual field (VF) severity. Methods One hundred forty-six eyes of 91 patients with primary open-angle glaucoma who performed Humphrey Field Analyzer 30-2 or 24-2 SITA-Standard, ORA, and CST within 180 days were included in this multicentral, observational cross-sectional study. The association between ORA parameters (corneal hysteresis [CH] and corneal resistant factor [CRF]), CST parameters (A1 and A2 time, A1 and A2 length, A1 and A2 velocity, A1 and A2 deformation amplitude, highest deformation amplitude, highest concavity time, peak distance, and radius), and other basic parameters (age, intraocular pressure with Goldmann applanation tonometry, central corneal thickness, and axial length) against mean total deviation (mTD) were analyzed using a linear mixed-model and model selection with corrected Akaike Information Criterion (AICc). Results The optimal model of VF severity included ORA's CH as well as a number of CST parameters, including A1 length, A2 time, radius, and highest concavity deformation amplitude (AICc: 971.7). The possibility this model describes visual field severity more accurately than the optimal model without CST parameters was 99.98%. Conclusion Glaucomatous VF severity was best described by both ORA and CST parameters. Eyes with corneas that experience sharp and deep indentation at the maximum deformation, wide indentation at the first applanation, and early second applanation in the CST measurement are more likely to show advanced VF severity. Translational Relevance CorvisST tonometry parameters are related to VF severity in glaucoma patients.
Collapse
Affiliation(s)
- Kazunori Hirasawa
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Department of Orthoptics and Visual Science, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Masato Matsuura
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Shunsuke Nakakura
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Hyogo, Japan
| | - Yoshitaka Nakao
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
39
|
Using CorvisST tonometry to assess glaucoma progression. PLoS One 2017; 12:e0176380. [PMID: 28472062 PMCID: PMC5417509 DOI: 10.1371/journal.pone.0176380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 04/10/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate the utility of the Corneal Visualization Scheimpflug Technology instrument (CST) to assess the progression of visual field (VF) damage in primary open angle glaucoma patients. Method A total of 75 eyes from 111 patients with primary open-angle glaucoma were investigated. All patients underwent at least nine VF measurements with the Humphrey Field Analyzer, CST measurements, axial length (AL), central corneal thickness (CCT) and intraocular pressure (IOP) with Goldmann applanation tonometry (GAT). Mean total deviation (mTD) progression rates of the eight VFs, excluding the first VF, were calculated and the association between progression rate and the other listed measurements was analyzed using linear regression, and the optimal to describe mTD progression rate was selected based on the second order bias corrected Akaike Information Criterion (AICc) index. Results VF progression was described best in a model that included CST parameters as well as other ocular measurements. The optimal linear model to describe mTD progression rate was given by the equation: -8.9–0.068 x mean GAT + 0.68 x A1 time + 0.31 x A2 time -0.39 x A2 length– 1.26 x highest deformation amplitude. Conclusion CST measurements are useful when assessing VF progression in glaucoma patients. In particular, careful consideration should be given to patients where: (i) an eye is observed to be applanated fast in the first and second applanations, (ii) the applanated area is wide in the second applanation and (iii) the indentation is deep at the maximum deformation, since these eyes appear to be at greater risk of VF progression.
Collapse
|
40
|
Re: Wang et al.: Acute peripapillary retinal pigment epithelium changes associated with acute intraocular pressure elevation (Ophthalmology 2015,122:2022-8). Ophthalmology 2016; 123:e34-5. [DOI: 10.1016/j.ophtha.2015.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 11/02/2015] [Indexed: 11/19/2022] Open
|
41
|
Wang YX, Jonas JB. Reply. Ophthalmology 2016; 123:e35. [DOI: 10.1016/j.ophtha.2015.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 11/23/2015] [Indexed: 10/21/2022] Open
|
42
|
Jonas RA, Wang YX, Yang H, Li JJ, Xu L, Panda-Jonas S, Jonas JB. Optic Disc-Fovea Distance, Axial Length and Parapapillary Zones. The Beijing Eye Study 2011. PLoS One 2015; 10:e0138701. [PMID: 26390438 PMCID: PMC4577126 DOI: 10.1371/journal.pone.0138701] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/02/2015] [Indexed: 12/03/2022] Open
Abstract
Purpose To measure the distance between the optic disc center and the fovea (DFD) and to assess its associations. Methods The population-based cross-sectional Beijing Eye Study 2011 included 3468 individuals aged 50+ years. The DFD was measured on fundus photographs. Results Readable fundus photographs were available for 2836 (81.8%) individuals. Mean DFD was 4.76 ± 0.34mm (median: 4.74 mm; range: 3.76–6.53mm). In multivariate analysis, longer DFD was associated with longer axial length (P<0.001; standardized correlation coefficient beta: 0.62), higher prevalence of axially high myopia (P<0.001; beta:0.06), shallower anterior chamber depth (P<0.001; beta:-0.18), thinner lens thickness (P = 0.004; beta: -0.06), smaller optic disc-fovea angle (P = 0.02; beta: -0.04), larger parapapillary alpha zone (P = 0.008; beta: 0.05), larger parapapillary beta/gamma zone (P<0.001; beta: 0.11), larger optic disc area (P<0.001; beta: 0.08), lower degree of cortical cataract (P = 0.002; beta: -0.08), and lower prevalence of age-related macular degeneration (P = 0.001; beta: -0.06). Bruch´s membrane opening-fovea distance (DFD minus disc radius minus parapapillary beta/gamma zone width) in non-glaucomatous eyes was not significantly (P = 0.60) related with axial length in emmetropic or axially myopic eyes (axial length ≥23.5 mm), while it increased significantly (P<0.001; r: 0.32) with longer axial length in eyes with an axial length of <23.5mm. Ratio of mean DFD to disc diameter was 2.65 ± 0.30. If the ratio of disc-fovea distance to disc diameter was considered constant and if the individual disc diameter was calculated as the individual disc-fovea distance divided by the constant factor of 2.65, the resulting calculated disc diameter differed from the directly measured disc diameter by 0.16 ±0.13 mm (median: 0.13 mm, range: 0.00–0.89 mm) or 8.9 ± 7.3% (median: 7.4%; range: 0.00–70%) of the measured disc diameter. Conclusions DFD (mean: 4.76mm) increases with longer axial length, larger parapapillary alpha zone and parapapillary beta/gamma zone, and larger disc area. The axial elongation associated increase in DFD was due to an enlargement of parapapillary beta/gamma zone while the Bruch’s membrane opening-fovea distance did not enlarge with longer axial length. This finding may be of interest for the process of emmetropization and myopization. Due to its variability, the disc-fovea distance has only limited clinical value as a relative size unit for structures at the posterior pole.
Collapse
Affiliation(s)
- Rahul Arvo Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
- * E-mail:
| | - Hua Yang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Jian Jun Li
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Liang Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Songhomitra Panda-Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - Jost Bruno Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| |
Collapse
|