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Jordan JA, Daniel E, Chen Y, Salowe RJ, Zhu Y, Miller-Ellis E, Addis V, Sankar PS, Zhu D, Smith EJ, Lee R, Ying GS, O’Brien JM. Features Associated with Visible Lamina Cribrosa Pores in Individuals of African Ancestry with Glaucoma: Primary Open-Angle African Ancestry Glaucoma Genetics (POAAGG) Study. Vision (Basel) 2024; 8:24. [PMID: 38651445 PMCID: PMC11036295 DOI: 10.3390/vision8020024] [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: 02/23/2024] [Revised: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024] Open
Abstract
There are scarce data regarding the rate of the occurrence of primary open-angle glaucoma (POAG) and visible lamina cribrosa pores (LCPs) in the eyes of individuals with African ancestry; the potential impact of these features on disease burden remains unknown. We recruited subjects with POAG to the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study. Through regression models, we evaluated the association between the presence of LCPs and various phenotypic features. In a multivariable analysis of 1187 glaucomatous eyes, LCPs were found to be more likely to be present in eyes with cup-to-disc ratios (CDR) of ≥0.9 (adjusted risk ratio (aRR) 1.11, 95%CI: 1.04-1.19, p = 0.005), eyes with cylindrical-shaped (aRR 1.22, 95%CI: 1.11-1.33) and bean pot (aRR 1.24, 95%CI: 1.13-1.36) cups versus conical cups (p < 0.0001), moderate cup depth (aRR 1.24, 95%CI: 1.06-1.46) and deep cups (aRR 1.27, 95%CI: 1.07-1.50) compared to shallow cups (p = 0.01), and the nasalization of central retinal vessels (aRR 1.33, 95%CI: 1.23-1.44), p < 0.0001). Eyes with LCPs were more likely to have a higher degree of African ancestry (q0), determined by means of SNP analysis (aRR 0.96, 95%CI: 0.93-0.99, p = 0.005 for per 0.1 increase in q0). Our large cohort of POAG cases of people with African ancestry showed that LCPs may be an important risk factor in identifying severe disease, potentially warranting closer monitoring by physicians.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Joan M. O’Brien
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA 19104, USA; (J.A.J.); (E.D.); (Y.C.); (R.J.S.); (Y.Z.); (E.M.-E.); (V.A.); (P.S.S.); (D.Z.); (E.J.S.); (R.L.); (G.-S.Y.)
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Barquet-Pizá V, Siegfried CJ. Understanding racial disparities of glaucoma. Curr Opin Ophthalmol 2024; 35:97-103. [PMID: 37922412 DOI: 10.1097/icu.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
PURPOSE OF REVIEW Increased prevalence, earlier onset, and more rapid progression to vision loss from glaucoma has demonstrated racial disparity in numerous studies over decades. Precise etiologies of these important differences among patients of African and Hispanic ancestral background have not been elucidated. This review focuses on currently available epidemiologic/population, genetic, socioeconomic and physiologic studies of racial disparities in this blinding disease. RECENT FINDINGS In depth reviews of several landmark studies of glaucoma prevalence in various racial groups have highlighted potential challenges of lack of recruitment of diverse populations in genetic studies and clinical trials, challenges of racial stratification of subjects, and the impact of socioeconomic variables. SUMMARY Through a more comprehensive analysis of racial disparities of glaucoma, both clinicians and researchers may provide more effective population screening and management with a holistic approach for individualized patient care to provide improved outcomes. Future studies of interventions in sociodemographic factors and genetic/physiologic variables that influence the prevalence, access, and consequential vision loss from glaucoma will be crucial to minimize/eliminate racial disparities and improve outcomes for all.
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Affiliation(s)
- Viviana Barquet-Pizá
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
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Gunasegaran G, Moghimi S, Nishida T, Walker E, Kamalipour A, Wu JH, Mahmoudinezhad G, Zangwill LM, Weinreb RN. Racial Differences in the Diagnostic Accuracy of OCT Angiography Macular Vessel Density for Glaucoma. Ophthalmol Glaucoma 2024; 7:197-205. [PMID: 37783272 DOI: 10.1016/j.ogla.2023.09.003] [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: 05/19/2023] [Revised: 08/29/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To evaluate and compare the diagnostic accuracy of macular vessel density (VD) measured by OCT angiography (OCTA) in individuals of African descent (AD) and European descent (ED) with open-angle glaucoma. DESIGN Observational, cross sectional study. PARTICIPANTS A total of 176 eyes of 123 patients with glaucoma and 140 eyes of 88 healthy participants from the Diagnostic Innovations in Glaucoma Study. METHODS Whole-image ganglion cell complex (wiGCC) thickness and macular VD (parafoveal VD and perifoveal VD) were obtained from 6 × 6 macula scans. Area under the receiver operating characteristic (AUROC) curves were used to evaluate the diagnostic accuracy of macular VD and ganglion cell complex (GCC) thickness in AD and ED participants after adjusting for confounders such as age, visual field mean deviation (VF MD), signal strength index, axial length, self-reported hypertension and diabetes. MAIN OUTCOME MEASURES Macular VD and wiGCC measurements. RESULTS Parafoveal and perifoveal VD were significantly lower in ED than AD patients with glaucoma. Parafoveal and perifoveal VD performed significantly worse in AD participants compared with ED participants for detection of glaucoma (adjusted AUROC, 0.75 [95% confidence interval (CI), 0.62, 0.87], 0.85 [95% CI, 0.79, 0.90], P = 0.035; and 0.82 [95% CI, 0.70, 0.92], 0.91 [95% CI, 0.87, 0.94], respectively; P = 0.020). In contrast to VD, diagnostic accuracy of GCC thickness was similar in AD and ED individuals (adjusted AUROC, 0.89 [95% CI, 0.79, 0.96], 0.92 [95% CI, 0.86, 0.96], respectively; P = 0.313). The diagnostic accuracies of both macular VD and GCC thickness for differentiating between glaucoma and healthy eyes increased with increasing VF MD in both AD and ED participants. CONCLUSIONS Diagnostic performance of OCTA macular VD, but not GCC thickness, for glaucoma detection varies by race. Moreover, macular VD parameters had lower accuracy for detecting glaucoma in AD individuals than in ED individuals. The diagnostic performance of macular VD is race-dependent, and, therefore, race should be taken into consideration when interpreting macular OCTA results. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Gopikasree Gunasegaran
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Sasan Moghimi
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Takashi Nishida
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Evan Walker
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Alireza Kamalipour
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Jo-Hsuan Wu
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Golnoush Mahmoudinezhad
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Linda M Zangwill
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Robert N Weinreb
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California.
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Guo X, Li R, Lu X, Zhang X, Wu Q, Tian Q, Guo B, Tang G, Xu J, Feng J, Zhao L, Ling S, Dong Z, Song J, Bi H. Quantization of Optic Disc Characteristics in Young Adults Based on Artificial Intelligence. Curr Eye Res 2023; 48:1068-1077. [PMID: 37555317 DOI: 10.1080/02713683.2023.2244700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE This study aimed to automatically and quantitatively analyse the characteristics of the optic disc by applying artificial intelligence (AI) to fundus images. METHODS A total of 1084 undergraduates were recruited in this cross-sectional study. The optic disc area, cup-to-disc ratio (C/D), optic disc tilt, and the area, width, and height of peripapillary atrophy (PPA) were automatically and quantitatively detected using AI. Based on axial length (AL), participants were divided into five groups: Group 1 (AL ≤ 23 mm); Group 2 (23 mm < AL≤ 24 mm); Group 3 (24 mm < AL≤ 25 mm); Group 4 (25 mm < AL< 26 mm) and Group 5 (AL ≥ 26 mm). Relationships between ocular parameters and optic disc characteristics were analysed. RESULT A total of 999 undergraduates were included in the analysis. The prevalence of optic disc tilting and PPA were 47.1% and 92.5%, respectively, and increased with the severity of myopia. The mean optic disc area, PPA area, C/D, and optic disc tilt ratio were 1.97 ± 0.46 mm2, 0.84 ± 0.59 mm2, 0.18 ± 0.07, and 0.81 ± 0.08, respectively. In Group 5, the average optic disc area (1.84 ± 0.41 mm2) and optic disc tilt ratio (0.79 ± 0.08) were significantly smaller and the PPA area (1.12 ± 0.61 mm2) was significantly larger than those in the other groups. AL was negatively correlated with optic disc area and optic disc tilt ratio (r=-0.271, -0.219; both p < 0.001) and positively correlated with PPA area, width, and height (r = 0.421, 0.426, 0.345; all p < 0.01). A greater AL (β = 0.284, p < 0.01) and a smaller optic disc tilt ratio (β=-0.516, p < 0.01) were related to a larger PPA area. CONCLUSION The characteristics of the optic disc can be feasibly and efficiently extracted using AI. The quantization of the optic disc might provide new indicators for clinicians to evaluate the degree of myopia.
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Affiliation(s)
- Xiaoxiao Guo
- Shandong University of Traditional Chinese Medicine, Jinan, P. R. China
| | - Runkuan Li
- Shandong University of Traditional Chinese Medicine, Jinan, P. R. China
| | - Xiuzhen Lu
- Affiliated Eye Hospital of Shandong, University of Traditional Chinese Medicine, Jinan, P. R. China
- Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Universities of Shandong; Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, P. R. China
| | - Xiuyan Zhang
- Affiliated Eye Hospital of Shandong, University of Traditional Chinese Medicine, Jinan, P. R. China
- Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Universities of Shandong; Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, P. R. China
| | - Qiuxin Wu
- Affiliated Eye Hospital of Shandong, University of Traditional Chinese Medicine, Jinan, P. R. China
- Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Universities of Shandong; Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, P. R. China
| | - Qingmei Tian
- Affiliated Eye Hospital of Shandong, University of Traditional Chinese Medicine, Jinan, P. R. China
- Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Universities of Shandong; Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, P. R. China
| | - Bin Guo
- Shandong University of Traditional Chinese Medicine, Jinan, P. R. China
- Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Universities of Shandong; Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, P. R. China
| | - Guodong Tang
- Affiliated Eye Hospital of Shandong, University of Traditional Chinese Medicine, Jinan, P. R. China
- Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Universities of Shandong; Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, P. R. China
| | - Jing Xu
- Affiliated Eye Hospital of Shandong, University of Traditional Chinese Medicine, Jinan, P. R. China
- Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Universities of Shandong; Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, P. R. China
| | - Jiaojiao Feng
- Shandong University of Traditional Chinese Medicine, Jinan, P. R. China
| | - Lili Zhao
- Shandong University of Traditional Chinese Medicine, Jinan, P. R. China
| | - Saiguang Ling
- EVision Technology (Beijing) Co., Ltd, Beijing, P. R. China
| | - Zhou Dong
- EVision Technology (Beijing) Co., Ltd, Beijing, P. R. China
| | - Jike Song
- Shandong University of Traditional Chinese Medicine, Jinan, P. R. China
- Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Universities of Shandong; Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, P. R. China
| | - Hongsheng Bi
- Affiliated Eye Hospital of Shandong, University of Traditional Chinese Medicine, Jinan, P. R. China
- Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Universities of Shandong; Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, P. R. China
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Jonas JB, Jonas RA, Jonas SB, Panda-Jonas S. Choriocapillaris, Photoreceptors, and Inner Retinal Layer in Spatial Relationship to Parapapillary Alpha, Beta, Gamma, and Delta Zones. Invest Ophthalmol Vis Sci 2023; 64:12. [PMID: 37672285 PMCID: PMC10484042 DOI: 10.1167/iovs.64.12.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/09/2023] [Indexed: 09/07/2023] Open
Abstract
Purpose To examine the spatial relationships between the retinal inner nuclear layer (INL), outer nuclear layer (ONL), retinal pigment epithelium (RPE) layer, Bruch's membrane (BM), and choriocapillaris in the parapapillary region. Methods Human eyes enucleated due to uveal melanomas or secondary angle-closure glaucoma were histomorphometrically examined. We compared the tissue dimensions between four groups of eyes categorized based on the presence/absence of high myopia and glaucoma. Results The investigation consisted of 100 globes (axial length: 25.6 ± 3.1 mm; range: 20.0-35.0 mm). In non-highly myopic nonglaucomatous eyes, the INL, ONL, RPE, BM, and choriocapillaris ended approximately at the end of the RPE layer, with no significant (all P ≥ 0.10) difference between the layers in their distance to the RPE-layer end. From non-highly myopic nonglaucomatous eyes to non-highly myopic glaucomatous eyes, highly myopic nonglaucomatous eyes, and eventually highly myopic glaucomatous eyes, the choriocapillaris, INL, and ONL increasingly extended into the beta zone, most marked for the choriocapillaris and least marked for the ONL. A larger extension of the choriocapillaris into the parapapillary beta zone correlated with longer axial length (standardized regression coefficient β, 0.24; B, 23.0; 95% confidence interval [CI], 1.6-44.5; P = 0.04) and wider parapapillary beta zone (β, 0.59; B, 0.32; 95% CI, 0.22-0.41; P < 0.001); a larger extension of the INL correlated with longer axial length (β, 0.34; B, 43.7; 95% CI, 11.6-75.7; P = 0.009), longer gamma zone (β, 0.52; B, 0.28; 95% CI, 0.15-0.41; P < 0.001), and diagnosis of non-highly myopic glaucoma (β, 0.28; B, 267; 95% CI, 80.8-454; P = 0.006); and a larger extension of the ONL into parapapillary beta zone correlated with longer axial length (β, 0.50; B, 32.2; 95% CI, 21.6-42.8; P < 0.001) and wider parapapillary beta zone (β, 0.28; B, 0.10; 95% CI, 0.04-0.16; P < 0.001). Conclusions Nonglaucomatous non-highly myopic eyes differ from highly myopic eyes and glaucomatous eyes in the spatial relationship of the parapapillary tissue layers.
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Affiliation(s)
- Jost B. Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
- Singapore Eye Research Institute, Singapore
| | - Rahul A. Jonas
- Department of Ophthalmology, University of Cologne, Cologne, Germany
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Jonas JB, Jonas RA, Bikbov MM, Wang YX, Panda-Jonas S. Myopia: Histology, clinical features, and potential implications for the etiology of axial elongation. Prog Retin Eye Res 2023; 96:101156. [PMID: 36585290 DOI: 10.1016/j.preteyeres.2022.101156] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/27/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022]
Abstract
Myopic axial elongation is associated with various non-pathological changes. These include a decrease in photoreceptor cell and retinal pigment epithelium (RPE) cell density and retinal layer thickness, mainly in the retro-equatorial to equatorial regions; choroidal and scleral thinning pronounced at the posterior pole and least marked at the ora serrata; and a shift in Bruch's membrane opening (BMO) occurring in moderately myopic eyes and typically in the temporal/inferior direction. The BMO shift leads to an overhang of Bruch's membrane (BM) into the nasal intrapapillary compartment and BM absence in the temporal region (i.e., parapapillary gamma zone), optic disc ovalization due to shortening of the ophthalmoscopically visible horizontal disc diameter, fovea-optic disc distance elongation, reduction in angle kappa, and straightening/stretching of the papillomacular retinal blood vessels and retinal nerve fibers. Highly myopic eyes additionally show an enlargement of all layers of the optic nerve canal, elongation and thinning of the lamina cribrosa, peripapillary scleral flange (i.e., parapapillary delta zone) and peripapillary choroidal border tissue, and development of circular parapapillary beta, gamma, and delta zone. Pathological features of high myopia include development of macular linear RPE defects (lacquer cracks), which widen to round RPE defects (patchy atrophies) with central BM defects, macular neovascularization, myopic macular retinoschisis, and glaucomatous/glaucoma-like and non-glaucomatous optic neuropathy. BM thickness is unrelated to axial length. Including the change in eye shape from a sphere in emmetropia to a prolate (rotational) ellipsoid in myopia, the features may be explained by a primary BM enlargement in the retro-equatorial/equatorial region leading to axial elongation.
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Affiliation(s)
- Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karis-University, Mannheim, Germany; Institute for Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany.
| | - Rahul A Jonas
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | | | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
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Mohammadzadeh V, Moghimi S, Nishida T, Mahmoudinezhad G, Kamalipour A, Micheletti E, Zangwill L, Weinreb RN. Effect of Corneal Hysteresis on the Rates of Microvasculature Loss in Glaucoma. Ophthalmol Glaucoma 2023; 6:177-186. [PMID: 35995420 DOI: 10.1016/j.ogla.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/19/2022] [Accepted: 08/12/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the association between corneal hysteresis (CH) and rates of optic nerve head whole image capillary density (wiCD) loss over time in open-angle glaucoma (OAG). DESIGN Observational cohort. PARTICIPANTS One hundred seventy-four eyes (122 OAG and 52 glaucoma suspect eyes) from 112 patients over more than 2 years and 4 visits or more. METHODS Baseline CH measurements were acquired with the Ocular Response Analyzer. Linear mixed-effect models were designed to investigate the effect of CH, average intraocular pressure (IOP) during follow-up, and baseline visual field (VF) mean deviation (MD) on the rates of wiCD loss and circumpapillary retinal nerve fiber layer (cpRNFL) thinning over time, while adjusting for confounders. Interaction between CH or baseline MD and average IOP during follow-up were included in final models to evaluate the effect of baseline MD or average IOP during follow-up on structural changes for different values of CH. MAIN OUTCOME MEASURE Effect of CH, IOP, and baseline MD on the rates of wiCD loss and cpRNFL thinning over time. RESULTS The average follow-up time was 3.9 years. In the multivariable model, non-Black race, higher average IOP during follow-up, lower baseline CH, lower baseline VF MD, and higher numbers of IOP-lowering medications were associated with faster rates of wiCD loss over time. For CH values 6 mmHg and 12 mmHg, every 1-mmHg increase in average IOP during follow-up was associated with 0.23% per year faster and 0.07% per year slower rates of wiCD loss over time, respectively. While every 1-mmHg decrease in CH was associated with 1.89% per year faster rate of wiCD loss for MD of -12 dB, it was associated with 0.81% per year faster rate of wiCD loss for MD of -3 dB. CONCLUSION Lower CH values were significantly associated with faster rates of wiCD loss over time. In eyes with lower CH, both higher average IOP during follow-up and more severe glaucoma damage at baseline were associated with faster rates of wiCD loss and cpRNFL thinning. These results support CH as a useful parameter for risk assessment of glaucoma progression. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Vahid Mohammadzadeh
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Takashi Nishida
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Golnoush Mahmoudinezhad
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Alireza Kamalipour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Eleonora Micheletti
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Linda Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California.
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Elam AR, Tseng VL, Rodriguez TM, Mike EV, Warren AK, Coleman AL. Disparities in Vision Health and Eye Care. Ophthalmology 2022; 129:e89-e113. [PMID: 36058735 PMCID: PMC10109525 DOI: 10.1016/j.ophtha.2022.07.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 10/14/2022] Open
Abstract
Significant disparities in vision health and eye care exist. To achieve health equity, we must understand the root causes and drivers of health disparities and inequities, including social determinants of health and systemic racism.
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Affiliation(s)
- Angela R Elam
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
| | - Victoria L Tseng
- UCLA Stein and Doheny Eye Institutes, David Geffen School of Medicine, University of California, Los Angeles, California
| | | | - Elise V Mike
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexis K Warren
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Anne L Coleman
- UCLA Stein and Doheny Eye Institutes, David Geffen School of Medicine, University of California, Los Angeles, California; Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
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Zhou D, Cao M, Duan X. Prevalence and diagnostic ability of β-zone parapapillary atrophy in open-angle glaucoma: a systematic review and meta-analysis. BMC Ophthalmol 2022; 22:72. [PMID: 35151269 PMCID: PMC8840052 DOI: 10.1186/s12886-022-02282-5] [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: 09/29/2020] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
β-Zone parapapillary atrophy (β-PPA) is a common sign in patients with open-angle glaucoma (OAG). Some studies have suggested that β-PPA can aid in the diagnosis of OAG. We performed a systematic review and meta-analysis of the prevalence and diagnostic ability of β-PPA in OAG.
Methods
We performed a literature search in PubMed, Web of Science, Embase and Google Scholar from inception to 1st November, 2021. Both hospital-based and population-based studies that reported details of β-PPA in OAG were included.
Results
We screened 1404 articles from these databases and ultimately included 24 articles in our meta-analysis. The prevalence of β-PPA in OAG was 0.73 (95% CI 0.67 to 0.78). The results of subgroup analysis by country revealed prevalence rates of 0.83 (95% CI 0.78 to 0.88) in Japan, 0.85 (95% CI 0.64 to 0.97) in Korea, 0.64 (95% CI 0.55 to 0.73) in the USA, 0.61 (95% CI 0.58 to 0.63) in Germany and 0.57 (95% CI 0.39 to 0.74) in China. Fundus photography, Heidelberg retina tomography (HRT), Heidelberg retina angiography (HRA) + indocyanine green angiography (ICGA), Spectral domain optical coherence tomography (SD-OCT)and Swept source optical coherence tomography(SS-OCT) values were 0.65 (95% CI 0.58 to 0.71), 0.70 (95% CI 0.50 to 0.86), 0.78 (95% CI 0.61 to 0.91), 0.77 (95% CI 0.65 to 0.88) and 0.99(95% CI 0.87 to 1.00) respectively. The sensitivity and specificity of β-PPA as a diagnostic marker were 0.78 (95% CI 0.68 to 0.85) and 0.63 (95% CI 0.51 to 0.73), respectively.
Conclusions
β-PPA is a potential diagnostic marker for OAG. However, a more detailed understanding of β-PPA characteristics is needed to improve the ability to predict OAG.
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Margeta MA, Ratanawongphaibul K, Tsikata E, Zemplenyi M, Ondeck CL, Kim J, Coleman AL, Yu F, de Boer JF, Chen TC. Disc Hemorrhages Are Associated With Localized Three-Dimensional Neuroretinal Rim Thickness Progression in Open-Angle Glaucoma. Am J Ophthalmol 2022; 234:188-198. [PMID: 34214455 PMCID: PMC8714862 DOI: 10.1016/j.ajo.2021.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 06/11/2021] [Accepted: 06/19/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the relationship between the occurrence of optic disc hemorrhages (DH) and glaucoma progression as determined by multiple glaucoma testing modalities. DESIGN Prospective cohort study. METHODS A longitudinal study was undertaken of 124 open-angle glaucoma patients who had yearly disc photography, visual fields (VFs), spectral-domain optical coherence tomography (SD-OCT), retinal nerve fiber layer (RNFL) thickness scans, and optic nerve volume scans (Spectralis), all performed on the same day over a 5-year period. The minimum distance band (MDB) thickness, a 3-dimensional (3D) neuroretinal rim parameter, was calculated from optic nerve volume scans. Patients were classified as glaucoma progressors or glaucoma nonprogressors using event-based analysis. RESULTS Of 124 open-angle glaucoma patients, 19 (15.3%) had 1 or more DHs on yearly disc photographs. Presence of a DH was associated with localized 3D neuroretinal rim thickness progression (superior MDB progression; odds ratio: 3.96; P = .04) but not with global or inferior MDB progression (P = .14 and .81, respectively), DP progression (P = .08), VF progression (P = .45), or RNFL global, inferior, or superior progression (P = .17, .26, and .76, respectively). In the majority of patients with MDB progression (14/17 or 82%), the progression was noted before or concurrently with the first instance of DH. CONCLUSIONS Glaucoma progression detected by high-density 3D SD-OCT neuroretinal rim measurements preceded DH occurrence in the majority of patients. These findings support the hypothesis that DHs are indicators of ongoing glaucoma progression rather than discrete events that cause subsequent progression.
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Affiliation(s)
- Milica A Margeta
- From the Department of Ophthalmology (M.A.M, K.R., E.T., C.L.O., TC.C.), Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts, USA; Harvard Medical School (M.A.M., K.R., E.T., C.L.O., J.K., T.C.C.), Boston, Massachusetts, USA
| | - Kitiya Ratanawongphaibul
- From the Department of Ophthalmology (M.A.M, K.R., E.T., C.L.O., TC.C.), Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts, USA; Harvard Medical School (M.A.M., K.R., E.T., C.L.O., J.K., T.C.C.), Boston, Massachusetts, USA; Glaucoma Research Unit (K.R.), Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Edem Tsikata
- From the Department of Ophthalmology (M.A.M, K.R., E.T., C.L.O., TC.C.), Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts, USA; Harvard Medical School (M.A.M., K.R., E.T., C.L.O., J.K., T.C.C.), Boston, Massachusetts, USA
| | - Michele Zemplenyi
- Department of Biostatistics (M.Z.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Courtney L Ondeck
- From the Department of Ophthalmology (M.A.M, K.R., E.T., C.L.O., TC.C.), Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts, USA; Harvard Medical School (M.A.M., K.R., E.T., C.L.O., J.K., T.C.C.), Boston, Massachusetts, USA; Department of Ophthalmology (C.L.O.), VA Boston Hospital, Boston, Massachusetts, USA
| | - Janice Kim
- From the Department of Ophthalmology (M.A.M, K.R., E.T., C.L.O., TC.C.), Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts, USA; Harvard Medical School (M.A.M., K.R., E.T., C.L.O., J.K., T.C.C.), Boston, Massachusetts, USA
| | - Anne L Coleman
- Department of Ophthalmology (A.L.C., F.Y.), Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA
| | - Fei Yu
- Department of Ophthalmology (A.L.C., F.Y.), Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA; Department of Biostatistics (F.Y.), University of California Los Angeles Fielding School of Public Health, Los Angeles, California, USA
| | - Johannes F de Boer
- LaserLaB Amsterdam (J.F.d.B.), Department of Physics and Astronomy, Vrijie Universiteit, Amsterdam, The Netherlands; Department of Ophthalmology, Vrijie Universiteit Medical Center, Amsterdam, The Netherlands
| | - Teresa C Chen
- From the Department of Ophthalmology (M.A.M, K.R., E.T., C.L.O., TC.C.), Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts, USA; Harvard Medical School (M.A.M., K.R., E.T., C.L.O., J.K., T.C.C.), Boston, Massachusetts, USA.
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11
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David RCC, Moghimi S, Do JL, Hou H, Proudfoot J, Zangwill LM, Kamalipour A, Nishida T, De Moraes CG, Girkin CA, Liebmann JM, Weinreb RN. Characteristics of Central Visual Field Progression in Eyes with Optic Disc Hemorrhage. Am J Ophthalmol 2021; 231:109-119. [PMID: 34107310 DOI: 10.1016/j.ajo.2021.05.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 05/28/2021] [Accepted: 05/30/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the characteristics and rate of central visual field loss after optic disc hemorrhage (DH). DESIGN Prospective cohort study. METHODS Three hundred forty-three eyes of 220 subjects who had ≥3 years of follow-up with a minimum of 5 visits with 10-2 and 24-2 visual field (VF) were recruited. Rates of 10-2 mean deviation (MD) loss in each hemifield and predefined zones were compared using linear mixed-effects models in DH and non-DH eyes. Clustered pointwise regression analysis was also used to define central VF progressors and compared with 24-2 VF loss using guided progression analysis. RESULTS Thirty-nine eyes with DH and 304 eyes without DH had a mean follow-up of 5.2 years. Eyes with DH had rates of 10-2 MD loss that were 3 times faster than non-DH eyes (mean difference -0.36 dB/year [95% confidence interval 0.54-0.18]; P < .001) and were 3.7 times more likely to progress (P = .002). A larger proportion of glaucomatous eyes showed central VF progression rather than peripheral VF progression in the DH group (30.8% vs. 20.5%) compared with the non-DH group (10.9% vs. 9.2%). In early glaucoma, the rate of 10-2 MD loss was 5.5 times faster in DH eyes than in non-DH eyes (P < .001). Superonasal and superotemporal central VF regions progressed more rapidly than other regions, especially in DH eyes. CONCLUSION Central VF loss is accelerated in glaucoma eyes with DH and it corresponds topographically to the DH location. In patients with glaucoma with DH, one should consider supplementing 10-2 VFs with 24-2 VFS to monitor the disease.
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Affiliation(s)
- Ryan Caezar C David
- From the Hamilton Glaucoma Center (R.C.C.D., S.M., J.L.D., H.H., J.P., L.M.Z., A.K., T.N., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Sasan Moghimi
- From the Hamilton Glaucoma Center (R.C.C.D., S.M., J.L.D., H.H., J.P., L.M.Z., A.K., T.N., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Jiun L Do
- From the Hamilton Glaucoma Center (R.C.C.D., S.M., J.L.D., H.H., J.P., L.M.Z., A.K., T.N., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Huiyuan Hou
- From the Hamilton Glaucoma Center (R.C.C.D., S.M., J.L.D., H.H., J.P., L.M.Z., A.K., T.N., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - James Proudfoot
- From the Hamilton Glaucoma Center (R.C.C.D., S.M., J.L.D., H.H., J.P., L.M.Z., A.K., T.N., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Linda M Zangwill
- From the Hamilton Glaucoma Center (R.C.C.D., S.M., J.L.D., H.H., J.P., L.M.Z., A.K., T.N., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Alireza Kamalipour
- From the Hamilton Glaucoma Center (R.C.C.D., S.M., J.L.D., H.H., J.P., L.M.Z., A.K., T.N., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Takashi Nishida
- From the Hamilton Glaucoma Center (R.C.C.D., S.M., J.L.D., H.H., J.P., L.M.Z., A.K., T.N., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Carlos Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory (C.G.D.M., J.M.L.), Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Christopher A Girkin
- and the Bernard School of Medicine (C.A.G.), University of Alabama-Birmingham, AL, United States
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory (C.G.D.M., J.M.L.), Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Robert N Weinreb
- From the Hamilton Glaucoma Center (R.C.C.D., S.M., J.L.D., H.H., J.P., L.M.Z., A.K., T.N., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California.
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Central Visual Field Defects in Patients with Distinct Glaucomatous Optic Disc Phenotypes. Am J Ophthalmol 2021; 223:229-240. [PMID: 33129812 DOI: 10.1016/j.ajo.2020.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/21/2020] [Accepted: 10/20/2020] [Indexed: 01/29/2023]
Abstract
PURPOSE To investigate central visual field (VF) defects among 4 phenotypes of glaucomatous optic discs. DESIGN Cross-sectional study. METHODS Optic disc phenotypes were determined in eyes with definite or suspected glaucoma that had a 24-2 VF with mean deviation (MD) better than -12 dB and a 10-2 VF. 10-2 VFs were classified as abnormal based on a cluster criterion. Additionally, the average of the total deviation values at each 10-2 test point was compared by optic disc phenotype. RESULTS The following 4 glaucomatous optic disc phenotypes were identified in 448 eyes of 309 patients: focal ischemic (FI) (n = 121); generalized cup enlargement (GE) (n = 109); myopic glaucoma (MY) (n = 66); and senile sclerotic (SS) (n = 152). Although 24-2 VF MD values were similar among optic disc phenotypes, GE eyes had higher 10-2 VF MD (P = .004), as well as lower 24-2 VF pattern standard deviations (PSD) (P < .001) and VF 10-2 PSD (P < .001) than the other phenotypes. The prevalence of an abnormal VF 10-2 was highest in FI eyes (78.5%) and lowest in GE eyes (50.5%) (P < .001). In glaucoma suspects, the prevalence of an abnormal 10-2 VF was highest in the MY eyes (31.2%) and FI eyes (23.5%) and lowest in GE eyes (8.6%). In mild glaucoma, the prevalence of abnormal 10-2 VF test results was highest in FI eyes (79.2%) and lowest in GE eyes (44.4%) (P = .013). CONCLUSIONS The severity and prevalence of central VF loss varied among different glaucomatous optic disc phenotypes. Glaucomatous eyes with FI and MY optic disc phenotypes are more likely to have 10-2 VF loss, particularly in early disease, and especially may benefit from testing with both 10-2 and 24-2 VF tests.
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13
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Gurung NK, Alsoudi AF, Gautam P, Kandel RP, O'Brien KS, Wittberg DM, Moe CA, Stamper RL, Keenan JD. Cutaneous melanin and glaucoma: a case control study. Curr Eye Res 2021; 46:1428-1431. [PMID: 33550863 DOI: 10.1080/02713683.2021.1887274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: Previous studies have used subjective assessments to implicate darker skin color as a risk factor for glaucoma. This study used objective measurements to determine whether skin melanin is a risk factor for glaucoma.Methods: In a case-control study conducted at a tertiary eye hospital in Nepal, patients aged 40 years or older from the glaucoma clinic were enrolled as cases and age-matched patients without glaucoma from other clinics at the eye hospital were enrolled as controls. A colorimeter was used to capture melanin measurements in triplicate from the inner arm and forehead of each participant. The exposure variable of interest was the median skin melanin value, in arbitrary units. The outcome of interest was the presence of glaucoma.Results: 100 glaucoma cases and 100 matched controls were enrolled. Agreement between the triplicate melanin measurements was high, with an intra-class correlation of 0.99 (95% CI, 0.99-0.99) for inner arm measurements and 0.97 (95% CI 0.96-0.98) for forehead measurements. Mean inner arm melanin values were 604 units (standard deviation [SD] 177) in cases and 602 units (SD 179) in controls; forehead values were 650 (SD 146) in cases and 652 (SD 152) in controls. After adjusting for sex and country of residence, skin melanin was not associated with the presence of glaucoma (odds ratio 1.04, 95%CI 0.78-1.38 for inner arm values and 0.97, 95%CI 0.70-1.35 for forehead values).Conclusion: This study failed to find a significant association between skin pigmentation and glaucoma.
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Affiliation(s)
- Nanda K Gurung
- Department of Glaucoma, Lumbini Eye Institute, Bhairahawa, Nepal
| | - Amer F Alsoudi
- School of Medicine, University of California, San Francisco (Medical Student), California, USA.,Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Prachand Gautam
- Department of Glaucoma, Lumbini Eye Institute, Bhairahawa, Nepal
| | | | - Kieran S O'Brien
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA.,Division of Epidemiology, School of Public Health, University of California, Berkeley, California, USA
| | - Dionna M Wittberg
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Caitlin A Moe
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Robert L Stamper
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA.,Department of Ophthalmology, University of California, San Francisco, California, USA
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14
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Progressive Thinning of Retinal Nerve Fiber Layer and Ganglion Cell-Inner Plexiform Layer in Glaucoma Eyes with Disc Hemorrhage. Ophthalmol Glaucoma 2021; 4:541-549. [PMID: 33529795 DOI: 10.1016/j.ogla.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/13/2021] [Accepted: 01/21/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the thinning of the circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell-inner plexiform layer (mGCIPL) in primary open-angle glaucoma eyes with and without a history of disc hemorrhage (DH). DESIGN Observational cohort study. PARTICIPANTS Thirty-nine 39 eyes (34 participants) with DH and 117 eyes (104 participants) without DH from the Diagnostic Innovations in Glaucoma Study and the African Decent and Glaucoma Evaluation Study. METHODS Participants had at least 1.5 years of follow-up, with a minimum of 3 visits with biannual spectral-domain OCT cpRNFL and mGCIPL thickness measurements and visual fields (VFs). The rates of cpRNFL and mGCIPL thinning were calculated using mixed-effects models. The dynamic range-based normalized rates of cpRNFL and mGCIPL thinning were calculated and compared between the DH and non-DH groups. MAIN OUTCOME MEASURES Rates of cpRNFL and mGCIPL thinning. RESULTS The rate of mGCIPL thinning was significantly faster in the DH group compared with the non-DH group (-0.62 μm/year vs. -0.38 μm/year; P = 0.024). The rate of cpRNFL thinning in the DH quadrant and rate of mGCIPL thinning in the inferotemporal sector in the DH group were faster than the corresponding regions in the non-DH group after adjusting for intraocular pressure (-1.33 μm/year vs. -0.58 μm/year; P = 0.053) and race (-0.82 μm/year vs. -0.44 μm/year; P = 0.048). In the DH group, percent rate of loss was significantly faster for the mGCIPL than the cpRNFL (-1.59 %/year vs. -1.31 %/year; P = 0.046). Rates of mGCIPL thinning were associated weakly with mean deviation slope, VF index slope, and guided progression analysis (GPA). The areas under the receiver operating characteristic curve for VF progression were 0.75 for mGCIPL and 0.56 for cpRNFL in the DH group. CONCLUSIONS The rate of mGCIPL and cpRNFL thinning was faster in DH eyes than non-DH eyes. Compared with cpRNFL, mGCIPL showed higher proportional rates of thinning and greater association with functional progression. In addition to cpRNFL, clinicians should consider incorporating mGCIPL imaging to monitor glaucoma progression, especially in glaucoma eyes with DH.
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15
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Wang YX, Panda-Jonas S, Jonas JB. Optic nerve head anatomy in myopia and glaucoma, including parapapillary zones alpha, beta, gamma and delta: Histology and clinical features. Prog Retin Eye Res 2020; 83:100933. [PMID: 33309588 DOI: 10.1016/j.preteyeres.2020.100933] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [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.
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Affiliation(s)
- Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.
| | - Songhomitra Panda-Jonas
- Institute for Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany
| | - Jost B Jonas
- Institute for Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany; Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karis-University, Mannheim, Germany
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16
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The Relationship Between Melanin and Glaucoma: A Case-control Study. J Glaucoma 2020; 29:1143-1146. [PMID: 32890103 DOI: 10.1097/ijg.0000000000001652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PRéCIS:: In a case-control study, skin pigmentation was not statistically significantly different when comparing glaucoma patients to those without glaucoma. PURPOSE Darker skin color has been implicated as a risk factor for glaucoma based on previous studies' subjective assessments of skin pigmentation. This study used objective measurements to determine whether cutaneous pigmentation is a risk factor for glaucoma. METHODS This case-control study was conducted at Menelik II Tertiary Referral Hospital in Addis Ababa, Ethiopia. Patients aged 40 years or older from the glaucoma clinic who were being scheduled for trabeculectomy were enrolled as cases and age-matched patients without glaucoma from other clinics at Menelik II Tertiary Referral Hospital were enrolled as controls. A Dermacatch device was used to capture melanin measurements in triplicate from the inner arm of each participant. The exposure variable of interest was the median of the triplicate skin melanin measurements, in arbitrary units. The outcome of interest was presence of glaucoma. RESULTS Agreement between the triplicate inner arm melanin measurements was high, with an intraclass correlation of 0.99 (95% confidence interval, 0.98-0.99). Mean melanin values were 704 units (SD 94) in 76 cases and 694 units (SD 93) in 152 controls. Melanin was not statistically significantly associated with glaucoma after adjusting for sex and season of measurement (ie, dry vs. rainy), with an odds ratio of 1.15 (95% confidence interval, 0.59-2.24) per 100 units of inner arm melanin. CONCLUSION This study failed to find a significant association between skin pigmentation and glaucoma using an objective and reproducible assessment of pigmentation.
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Cousins CC, Pan BX, Chou JC, Shen LQ, Gordon MO, Kass MA, Ritch R, Pasquale LR. Densitometric Profiles of Optic Disc Hemorrhages in the Ocular Hypertension Treatment Study. Am J Ophthalmol 2020; 217:10-19. [PMID: 32335057 DOI: 10.1016/j.ajo.2020.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The origin of blood in glaucoma-related disc hemorrhages (DH) remains unknown. A prior clinic-based study of primary open-angle glaucoma (POAG)-related DH showed that they had grayscale pixel intensities more similar to blood from retinal macroaneurysms and adjacent retinal arterioles than to blood from retinal vein occlusions or adjacent retinal venules, suggesting an arterial source. Here we assessed the densitometric profile of DH from fundus photographs in the Ocular Hypertension Treatment Study (OHTS). DESIGN Retrospective cross-sectional study of prospectively collected images. METHODS Stereo disc photographs of 161 DH events from 83 OHTS participants (mean age [standard deviation (SD)]: 65.6 [9.2] years; 46.6% female; 13.0% black race) were imported into ImageJ to measure densitometry differences (adjacent arterioles minus DH [ΔA] or venules minus DH [ΔV]). Their size as percentage of disc area, ratio of length to midpoint width, and location relative to the disc margin were also analyzed. We performed t tests to compare ΔA and ΔV, analysis of variance to compare ΔA and ΔV across DH recurrent events, and multivariable linear regression to identify determinants of ΔA and ΔV. RESULTS Mean (SD) ΔA and ΔV were -2.2 (8.7) and -11.4 (9.7) pixel intensity units, respectively (P < .001). ΔA and ΔV each did not differ significantly across recurrence of DH (P ≥ .92) or between DH events with and without POAG (P ≥ .26). CONCLUSIONS OHTS DH had densitometric measurements more similar in magnitude to adjacent arterioles than venules, supporting an arterial origin for DH. Vascular dysregulation may contribute to disc hemorrhage formation in ocular hypertension.
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He M, Chen H, Wang W. Refractive Errors, Ocular Biometry and Diabetic Retinopathy: A Comprehensive Review. Curr Eye Res 2020; 46:151-158. [PMID: 32589053 DOI: 10.1080/02713683.2020.1789175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To summarize the association between diabetic retinopathy and refractory status as well as ocular biometric parameters; To review the theories of the protective effect of high myopia against diabetic retinopathy. Methods: A comprehensive literature search on MEDLINE, EMBASE, Web of Science and Scopus databases as well as reference list search, and systematic review of relevant publications. Results: Myopia may delay the onset and progression of diabetic retinopathy. Increased axial length in myopia is associated with reduced risk of any diabetic retinopathy and vision-threatening diabetic retinopathy. The possible mechanisms for the protective effect of myopia against diabetic retinopathy may include posterior vitreous detachment, change in retinal blood flow and oxygen demand, choroidal thinning and altered cytokine profiles. Conclusions: High myopia may be a protective factor against the onset and progression of diabetic retinopathy. Further studies about the mechanisms of how myopia, axial length and ocular biometrics influence the onset and progression of DR are needed.
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Affiliation(s)
- Miao He
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences , Guangzhou, People's Republic of China
| | - Haiying Chen
- The Royal Melbourne Hospital , Melbourne, Victoria, Australia
| | - Wei Wang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University , Guangzhou, People's Republic of China
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Moghimi S, Zangwill LM, Hou H, Wong B, Proudfoot J, Penteado RC, Ekici E, Bowd C, Weinreb RN. Comparison of Peripapillary Capillary Density in Glaucoma Patients of African and European Descent. Ophthalmol Glaucoma 2020; 4:51-62. [PMID: 32693049 DOI: 10.1016/j.ogla.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate racial differences in optic nerve head peripapillary capillary density measured by OCT angiography (OCTA) in patients with open-angle glaucoma. DESIGN Observational, cross-sectional study. PARTICIPANTS Two hundred eighty-four eyes of 195 glaucoma patients and 108 eyes of 58 healthy participants from the Diagnostic Innovations in Glaucoma Study. METHODS Global and sectoral circumpapillary capillary density (cpCD) loss in participants of European descent (ED) and African descent (AD) were compared. Areas under the receiver operating characteristic curve (AUROCs) were used to evaluate diagnostic accuracy of cpCD and global circumpapillary retinal nerve fiber layer (cpRNFL) thickness in the 2 groups after adjusting for confounders. MAIN OUTCOME MEASURES Peripapillary capillary density and cpRNFL thickness measurements and their estimated loss. RESULTS Participants of AD and ED with glaucoma were of similar age and glaucoma severity. After adjusting for age, disc area, and other confounders, significantly lower cpCD was found in ED eyes compared with AD eyes in mild glaucoma (mean, 42.2% [95% confidence interval (CI), 41.2%-43.2%] and 46.5% [95% CI, 44.8%-48.1%], respectively; adjusted difference, 4.4 [95% CI, 2.6-6.2]; P < 0.001) and moderate to advanced glaucoma (mean, 34.7% and 38.5%, respectively; adjusted difference, 4.8 [95% CI, 1.6-8.1]; P = 0.005). Although capillary density loss was greater in all sectors in ED compared with AD participants, a similar sectoral pattern of density loss was observed in both racial groups. Lower mean deviation and older age were associated with lower cpCD in both races in multivariate models. The adjusted AUROC for discriminating between healthy and glaucomatous eyes for cpCD was higher for ED (0.95) compared with AD (0.68) patients (P < 0.001). Sensitivity at 95% specificity in AD participants was lower than in ED participants for cpCD (0.32 [95% CI, 0.11-0.64] vs. 0.83 [95% CI, 0.69-0.93], respectively; P < 0.001). CONCLUSIONS Although peripapillary capillary density parameters showed good diagnostic accuracy for detecting glaucoma in ED patients, their diagnostic accuracy was only modest in AD patients. Diagnostic performance of cpCD is race dependent, and clinicians should be aware that it has poorer performance in AD patients.
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Affiliation(s)
- Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Huiyuan Hou
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Brandon Wong
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California; USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - James Proudfoot
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Rafaella C Penteado
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Ophthalmology, University of São Paulo, São Paulo, Brazil
| | - Eren Ekici
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Ophthalmology, Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Christopher Bowd
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California.
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Quist TS, Johnson CA, Robin AL, Fingert JH. Long-Term Follow-Up of Normal Tension Glaucoma Patients With TBK1 Gene Mutations in One Large Pedigree. Am J Ophthalmol 2020; 214:52-62. [PMID: 31987900 PMCID: PMC7282998 DOI: 10.1016/j.ajo.2020.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE To characterize features of glaucoma associated with a TANK binding kinase 1 (TBK1) gene duplication, which is among the most common molecularly defined causes of normal tension glaucoma (NTG). DESIGN Retrospective observational case series. METHODS We conducted a retrospective case series, by reviewing medical records of 7 members of a pedigree with NTG caused by TBK1 gene duplications. Clinical features of these patients at diagnosis, throughout management, and at latest follow-up were identified, including age, intraocular pressure (IOP), central corneal thickness (CCT), optic nerve head appearance, and mean deviation (MD) assessed with Humphrey visual field (HVF) testing protocols. RESULTS At initial diagnosis, the mean age was 35 ± 7 years, IOP was 16 ± 2.1 mm Hg, cup-to-disc (C/D) ratio was 0.9 ± 0.08, and MD assessed via HVF 30-2 and/or 24-2 testing protocols was -9.0 ± 8.9 (range: -1.8 to -27) dB in the 14 study eyes. At initial diagnosis, 4 of 14 eyes (28%) had no visual field defect, 4 (28%) had early visual field defects, and 6 (43%) had severe visual field defects. Patients had a mean follow-up of 21.5 ± 9.0 years and experienced an average reduction of IOP by 28%. Four of 12 eyes (33%) had stable visual fields throughout follow-up, while 8 eyes (67%) had slow-to-moderate progression. The 30-2 and/or 24-2 HVF tests had an average change in MD of -0.53 ± 0.26 dB/year. No eyes had rapid progression with an MD >1.0 dB/year. At final follow-up, the mean IOP was 11.5 ± 2.9, and C/D ratio was 0.94 ± 0.4. At final follow-up, 3 of 14 eyes (21%) had early visual field defects, 4 (29%) had moderate visual field defects, and 7 (50%) had severe visual field defects. Six of 14 eyes (43%) met criteria for legal blindness. CONCLUSIONS We provide the first report of the clinical features and long-term clinical course in a family of NTG patients with TBK1 gene duplications. TBK1-associated glaucoma exhibits classic features of NTG. Patients present with severe disease at a relatively early age and most (67%) have slow-to-moderate progression of their visual field defects. The rate of visual field change appears correlated with the magnitude of IOP, suggesting that it may be advantageous to set extremely low IOP targets for some patients with TBK1-associated glaucoma.
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Affiliation(s)
- Tyler S Quist
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Chris A Johnson
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA; Institute for Vision Research, University of Iowa, Iowa City, Iowa, USA
| | - Alan L Robin
- Department of Ophthalmology, School of Medicine, The Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA; Department of International Health, The Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA; Department of Ophthalmology, University of Michigan, Ann Arbor, Michigan, USA
| | - John H Fingert
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
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Ahmad SS, Tanveer Y, Siddique M, Saleem Z. Controversies in the association of parapapillary atrophy with glaucoma. Taiwan J Ophthalmol 2019; 10:243-249. [PMID: 33437595 PMCID: PMC7787084 DOI: 10.4103/tjo.tjo_64_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/28/2019] [Indexed: 11/11/2022] Open
Abstract
Parapapillary atrophy is a condition which is seen in around 70% of normal individuals. Classically divided into zone alpha and beta, recently, it has been further categorized into zone gamma and delta. Some of these zones of parapapillary atrophy are more prevalent and larger in size in glaucoma patients. Studies have also found the rate of progression of glaucomatous change to be faster in patients with this anomaly. This condition is of clinical significance in glaucoma suspects, as it could be another pointer indicating potential risk of converting to glaucoma. On the contrary, there are other studies which question the relevance of these clinical features in glaucoma patients. In the light of these conflicting reports, it becomes an interesting exercise to explore this controversial area further. This review attempts to determine the role of parapapillary atrophy and its relevance with glaucoma. With this purpose, an online search for this term was conducted on search engines such as PubMed, Google Scholar, and others.
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Affiliation(s)
- Syed Shoeb Ahmad
- Ajmal Khan Tibbiya College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Yusra Tanveer
- Ajmal Khan Tibbiya College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Musab Siddique
- Ajmal Khan Tibbiya College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Zeba Saleem
- Ajmal Khan Tibbiya College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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22
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Nelson AJ, Chang R, LeTran V, Vu B, Burkemper B, Chu Z, Fard A, Kashani A, Xu B, Wang R, Varma R, Richter GM. Ocular Determinants of Peripapillary Vessel Density in Healthy African Americans: The African American Eye Disease Study. Invest Ophthalmol Vis Sci 2019; 60:3368-3373. [PMID: 31917454 PMCID: PMC6681862 DOI: 10.1167/iovs.19-27035] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/03/2019] [Indexed: 01/01/2023] Open
Abstract
Purpose The African American (AA) population has unique ocular anatomic characteristics and a disproportionately high incidence of glaucoma, which is associated with lower peripapillary vessel density (VD). This study aimed to identify ocular determinants of peripapillary VD in healthy AAs. Methods This was a cross-sectional, population-based study of 1029 AAs, ages 40 and older. Participants underwent examination to obtain axial length (AL), IOP, central corneal thickness (CCT), mean retinal nerve fiber layer (RNFL) thickness, visual field mean deviation (MD), and 6 × 6-mm optical coherence tomography angiography scans of the optic nerve. Participants with glaucoma, vision-threatening diabetic retinopathy, or other relevant ocular disease were excluded. Prototype software was used to quantify VD. A multivariable regression model, controlling for age and signal strength, identified the ocular variables that predicted peripapillary VD. The contribution of each variable was assessed with the magnitude of standardized regression coefficients (SRC). Results Based on univariate regressions, AL, RNFL thickness, and MD had significant associations with peripapillary VD (all P < 0.001). In the final multivariate model, lower mean RNFL thickness (β = 0.0022, P < 0.001, SRC = 0.542) and longer AL (β = -0.0055, P < 0.001, SRC = -0.118) were associated with lower peripapillary VD, controlling for age and signal strength, with model R2 of 0.69. Conclusions Thinner RNFL and longer AL were the most influential ocular determinants of lower peripapillary perfusion in healthy AA eyes. Additional research is needed to clarify whether longer AL increases risk of glaucoma by affecting capillary perfusion.
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Affiliation(s)
- Andrew J. Nelson
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, California, United States
| | - Ryuna Chang
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, California, United States
| | - Vivian LeTran
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, California, United States
| | - Brian Vu
- University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Bruce Burkemper
- Departments of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, United States
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Washington, United States
| | - Ali Fard
- Carl Zeiss Meditec, Dublin, California, United States
| | - Amir Kashani
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, California, United States
| | - Benjamin Xu
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, California, United States
| | - Ruikang Wang
- Department of Bioengineering, University of Washington, Washington, United States
| | - Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California, United States
| | - Grace M. Richter
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, California, United States
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Yamamoto T. The impact of disc hemorrhage studies on our understanding of glaucoma: a systematic review 50 years after the rediscovery of disc hemorrhage. Jpn J Ophthalmol 2018; 63:7-25. [PMID: 30465174 DOI: 10.1007/s10384-018-0641-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/19/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW To trace the influence of disc hemorrhage studies on our understanding of glaucoma. SOURCES Major articles published during the last 50 years since the rediscovery of disc hemorrhage were identified. A total of 196 articles were selected from 435 articles retrieved using the keywords glaucoma and disc hemorrhage as of August 9 2018 from PubMed. RECENT FINDINGS The main characteristics of disc hemorrhage, including its morphology, recurrence rate, duration, increased incidence in glaucoma, and role in the progression of normal tension glaucoma was well understood by the year 2000. Since then, studies have focused on more sophisticated and accurate methods of elucidating both structural and functional progression, with special attention to the role of the lamina cribrosa. Nevertheless, both the mechanism of disc hemorrhage development and its fuller relationship with glaucoma remain unclear. Disc hemorrhage research requires careful study of glaucomatous optic neuropathy. This has been facilitated by recent advances in optical coherence tomography (OCT) angiography and other OCT technologies. Furthermore, animal studies of disc hemorrhage promise new insights into glaucomatous optic neuropathy.
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Affiliation(s)
- Tetsuya Yamamoto
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, 501-1194, Japan.
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24
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Association between Rates of Retinal Nerve Fiber Layer Thinning and Previous Disc Hemorrhage in Glaucoma. Ophthalmol Glaucoma 2018; 1:23-31. [PMID: 32672629 DOI: 10.1016/j.ogla.2018.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/22/2018] [Accepted: 06/05/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate the relationship between previous disc hemorrhage (DH) and subsequent rates of retinal nerve fiber layer (RNFL) thinning. DESIGN Longitudinal, observational cohort study. PARTICIPANTS Twenty-eight patients with glaucoma and patients with suspected glaucoma who had a history of DH in 1 eye (unilateral DH), but not in the fellow eye, enrolled in the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study were included. METHODS All subjects underwent annual optic disc photography and semiannual spectral-domain OCT RNFL thickness measurements. Multivariable linear mixed-effects models were used to investigate the relationship between the presence of previous DH and RNFL thinning rates while adjusting for potential confounding factors, such as race, age, mean intraocular pressure (IOP), baseline disease severity, and central corneal thickness (CCT). The relationship between the timing of DH and the rates of RNFL thinning also was investigated in eyes with a history of DH. MAIN OUTCOME MEASURES Rates of global and local RNFL thinning. RESULTS Previous DH was significantly associated with faster RNFL thinning rates globally (-0.39 μm/year faster, P = 0.010), in DH quadrants (-0.77 μm/year faster, P = 0.012), and non-DH quadrants (-0.49 μm/year faster, P = 0.038) after adjustment for race, mean IOP, baseline age, baseline standard automated perimetry mean deviation, and CCT. Higher IOP was also significantly associated with faster thinning rates globally (-0.07 μm/year faster per 1 mmHg higher, P = 0.047) and in DH quadrants (-0.10 μm/year faster per 1 mmHg higher, P = 0.044). In eyes with a history of DH, the time elapsed from the latest DH episode to the first OCT examination was not significantly associated with the rate of RNFL thinning. CONCLUSIONS A history of DH is an independent risk factor for faster rates of RNFL thinning in non-DH quadrants and in DH quadrants; this risk is present even in eyes that exhibited DH several years earlier.
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Vinod K, Salim S. Primary Open Angle Glaucoma: Is It Just One Disease? CURRENT OPHTHALMOLOGY REPORTS 2018. [DOI: 10.1007/s40135-018-0165-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Ozturker ZK, Munro K, Gupta N. Optic disc hemorrhages in glaucoma and common clinical features. Can J Ophthalmol 2017; 52:583-591. [DOI: 10.1016/j.jcjo.2017.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/09/2017] [Accepted: 04/12/2017] [Indexed: 11/17/2022]
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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: 763] [Impact Index Per Article: 109.0] [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.
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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
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De Moraes CG, Murphy JT, Kaplan CM, Reimann JJ, Skaat A, Blumberg DM, Al-Aswad L, Cioffi GA, Girkin CA, Medeiros FA, Weinreb RN, Zangwill L, Liebmann JM. β-Zone Parapapillary Atrophy and Rates of Glaucomatous Visual Field Progression: African Descent and Glaucoma Evaluation Study. JAMA Ophthalmol 2017; 135:617-623. [PMID: 28494060 DOI: 10.1001/jamaophthalmol.2017.1082] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance β-zone parapapillary atrophy (βPPA) has been reported as a risk factor for glaucoma onset and progression. Previous studies have shown that the prevalence of βPPA differs between individuals of African descent (AD) and European descent (ED). Objective To test whether the association between the presence and progression of βPPA vs visual field progression of glaucoma differs between these 2 ancestry groups. Design, Setting, and Participants In a prospective, multicenter, longitudinal cohort study, 634 individuals (1090 eyes) enrolled in the African Descent and Evaluation Study (ADAGES) with a diagnosis of glaucomatous optic neuropathy (GON) or ocular hypertension (OHT) and at least 2 disc stereophotographs were included. Two graders masked to clinical and ancestry data reviewed and graded the baseline and last disc stereophotographs for the presence of βPPA at baseline and βPPA progression (development or enlargement). Mixed-effects linear models were tested with visual field mean deviation as a dependent variable and time (alone and with interaction terms) as independent variables. ADAGES enrollment began in January 2003 and ended in July 2006; follow-up ended in 2016. Exposures Disc stereophotographs. Main Outcomes and Measures Progression of βPPA in AD and ED individuals. Results In 634 patients, a total of 814 eyes of AD (395 eyes) and ED (419) patients with GON and 276 eyes of AD (106) and ED (170) patients with OHT who were enrolled in ADAGES were analyzed. There were 336 (53.0%) women in the study; mean (SD) age was 61.9 (12.7) years. In the OHT group, the association between βPPA at baseline and visual field progression was not significantly different between AD and ED eyes (β = 0.071; 95% CI, -0.016 to 0.158; P = .11), nor was the association between βPPA progression and visual field progression (β = 0.020; 95% CI, -0.465 to 0.506; P = .93). In the GON group, ED eyes with baseline βPPA progressed faster than did AD eyes with baseline βPPA (β = -0.124; 95% CI, -0.241 to -0.007; P = .04), although the association between βPPA progression and visual field progression did not differ significantly between race groups (β = -0.101; 95% CI, -0.323 to 0.119; P = .37). Conclusions and Relevance Race had a significant effect on the association between baseline βPPA and rates of visual field progression in eyes with GON. Progression of βPPA was not associated with faster visual field progression in either racial group.
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Affiliation(s)
- C Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - James T Murphy
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - Chad M Kaplan
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - Jeremy J Reimann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - Alon Skaat
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana M Blumberg
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - Lama Al-Aswad
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - George A Cioffi
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - Christopher A Girkin
- Department of Ophthalmology, School of Medicine, University of Alabama, Birmingham
| | - Felipe A Medeiros
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego
| | - Linda Zangwill
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
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Razeghinejad MR, Nowroozzadeh MH. Optic disk hemorrhage in health and disease. Surv Ophthalmol 2017; 62:784-802. [PMID: 28400276 DOI: 10.1016/j.survophthal.2017.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/31/2017] [Accepted: 04/03/2017] [Indexed: 12/19/2022]
Abstract
Optic disk hemorrhage occurs in all age groups from neonates to the elderly. Optic disk hemorrhage is best known for its association with visual field loss and progression in patients with glaucoma; however, it may occur in conjunction with other ocular or systemic conditions as well as in healthy individuals. It may also be the first sign of a sight-threatening condition. Variations in the shape, location, and size of the optic disk hemorrhage, as well as associated ocular and systemic signs or symptoms, may help determine the underlying pathology. We address the epidemiology, demographics, pathophysiology, clinical presentations and implications, differential diagnoses, and management of eyes with optic disk hemorrhage in diseased and healthy subjects.
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Affiliation(s)
- M Reza Razeghinejad
- Glaucoma Service, Wills Eye Institute, Philadelphia, PA, USA; Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Kwon J, Lee J, Choi J, Jeong D, Kook MS. Association Between Nocturnal Blood Pressure Dips and Optic Disc Hemorrhage in Patients With Normal-Tension Glaucoma. Am J Ophthalmol 2017; 176:87-101. [PMID: 28088510 DOI: 10.1016/j.ajo.2017.01.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the effect of nocturnal blood pressure (BP) dips on the occurrence of optic disc hemorrhage (ODH) in normal-tension glaucoma (NTG) patients and determine whether ODH is associated with greater likelihood of visual field progression (VFP). DESIGN Prospective case-control study. METHODS This study enrolled 698 eyes of 349 consecutive NTG patients who were ≥40 years old, underwent 24-hour intraocular pressure and ambulatory BP monitoring in the habitual position, were examined for ODH every 4-6 months with optic disc photography, and had ≥5 reliable visual field tests with minimum follow-up of 3 years. NTG patients were classified into 2 groups: "nonphysiologic" dippers, including nondippers and overdippers, and "physiologic" dippers. Odds ratios for the association between the "nonphysiologic" group and ODH were calculated using logistic regression models. Kaplan-Meier analyses were performed to compare outcomes with reference to the presence of ODH for VFP. RESULTS Overall, ODH and VFP were detected in 107 (15.3%) eyes and 60 (8.6%) eyes among total 698 eyes, respectively. Overdippers showed a significantly greater frequency of ODH than nondippers or dippers. Being an overdipper was a significant and an independent risk factor for ODH occurrence during follow-up. The rates of VFP were 6%, 7%, and 24% for dippers, nondippers, and overdippers, respectively. Eyes with ODH were associated with greater likelihoods of subsequent VFP than those without. VFP occurred only in eyes with ODH. CONCLUSIONS Being an overdipper is a significant risk factor for ODH in NTG eyes. The detection of ODH during follow-up is a potent predictor of future VFP.
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Kim KE, Park KH. Optic disc hemorrhage in glaucoma: pathophysiology and prognostic significance. Curr Opin Ophthalmol 2017; 28:105-112. [PMID: 27820751 DOI: 10.1097/icu.0000000000000345] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This article reviews the recent findings with regard to the pathophysiology and clinical significance of optic disc hemorrhage in glaucoma. RECENT FINDINGS Even though the pathophysiology of disc hemorrhage has been investigated in depth, its underlying mechanism remains unclear. The key disc hemorrhage mechanisms currently under discussion are mechanical vascular disruption and associated vascular susceptibilities. Recent technical advances in spectral-domain optical coherence tomography have yielded more compelling evidence of mechanical vascular disruption behind the pathogenesis of disc hemorrhage in glaucoma. Studies show that disc hemorrhage is associated with structural and functional glaucoma progression. Furthermore, recent findings suggest that disc hemorrhage can have different significances according to its location, recurrence, and associated underlying mechanism. SUMMARY The underlying mechanism of disc hemorrhage is complex like that of glaucoma. The ongoing controversy respecting the role of disc hemorrhage as a risk factor for glaucoma progression notwithstanding, special attention entailing closer follow-up and/or treatment escalation is recommended for patients with disc hemorrhage. Further studies investigating the unrevealed pathogenesis of disc hemorrhage and its prognostic value in glaucoma are warranted.
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Affiliation(s)
- Ko Eun Kim
- aDepartment of Ophthalmology, Nowon Eulji Medical Center, Eulji University bDepartment of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea
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