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Pham AT, Bradley C, Hou K, Herbert P, Boland MV, Ramulu PY, Yohannan J. The Impact of Achieving Target Intraocular Pressure on Glaucomatous Retinal Nerve Fiber Layer Thinning in a Treated Clinical Population. Am J Ophthalmol 2024; 262:213-221. [PMID: 38035974 DOI: 10.1016/j.ajo.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE To estimate the effect of being below and above the clinician-set target intraocular pressure (IOP) on rates of glaucomatous retinal nerve fiber layer (RNFL) thinning in a treated real-world clinical population. DESIGN Retrospective cohort study. METHODS A total of 3256 eyes (1923 patients) with ≥5 reliable optical coherence tomography scans and 1 baseline visual field test were included. Linear mixed-effects modeling estimated the effects of the primary independent variables (mean target difference [measured IOP - target IOP] and mean IOP, mm Hg) on the primary dependent variable (RNFL slope, µm/y) while accounting for additional confounding variables (age, biological sex, race, baseline RNFL, baseline pachymetry, and disease severity). A spline term accounted for differential effects when above (target difference >0 mm Hg) and below (target difference ≤0 mm Hg) target pressure. RESULTS Eyes below and above target had significantly different mean RNFL slopes (-0.44 vs -0.71 µm/y, P < .001). Each 1 mm Hg increase above target had a 0.143 µm/y faster rate of RNFL thinning (P < .001). Separating by disease severity, suspect, mild, moderate, and advanced glaucoma had 0.135 (P = .002), 0.116 (P = .009), 0.203 (P = .02), and 0.65 (P = .22) µm/y faster rates of RNFL thinning per 1 mm Hg increase, respectively. CONCLUSIONS Being above the clinician-set target pressure is associated with more rapid RNFL thinning in suspect, mild, and moderate glaucoma. Faster rates of thinning were also present in advanced glaucoma, but statistical significance was limited by the lower sample size of eyes above target and the optical coherence tomography floor effect.
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Affiliation(s)
- Alex T Pham
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (A.T.P., C.B., P.Y.R., J.Y.), Baltimore, Maryland
| | - Chris Bradley
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (A.T.P., C.B., P.Y.R., J.Y.), Baltimore, Maryland
| | - Kaihua Hou
- Malone Center for Engineering in Healthcare, Johns Hopkins University (K.H., P.H., J.Y.), Baltimore, Maryland
| | - Patrick Herbert
- Malone Center for Engineering in Healthcare, Johns Hopkins University (K.H., P.H., J.Y.), Baltimore, Maryland
| | - Michael V Boland
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts (M. V. B.), USA
| | - Pradeep Y Ramulu
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (A.T.P., C.B., P.Y.R., J.Y.), Baltimore, Maryland
| | - Jithin Yohannan
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (A.T.P., C.B., P.Y.R., J.Y.), Baltimore, Maryland; Malone Center for Engineering in Healthcare, Johns Hopkins University (K.H., P.H., J.Y.), Baltimore, Maryland.
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Fu C, Xu J, Chen SL, Chen CB, Liang JJ, Liu Z, Huang C, Wu Z, Ng TK, Zhang M, Liu Q. Profile of Lipoprotein Subclasses in Chinese Primary Open-Angle Glaucoma Patients. Int J Mol Sci 2024; 25:4544. [PMID: 38674129 PMCID: PMC11050298 DOI: 10.3390/ijms25084544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
To investigate the plasma lipoprotein subclasses in patients with primary open-angle glaucoma (POAG), a total of 20 Chinese POAG patients on intraocular pressure (IOP)-lowering treatment and 20 age-matched control subjects were recruited. Based on the levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), the study subjects were divided into elevated- and normal-level subgroups. The plasma lipoprotein, lipoprotein subclasses, and oxidized LDL (oxLDL) levels were quantitatively measured. The discrimination potential of the lipoproteins was evaluated using the area under the receiver operating characteristic curve (AUC), and their correlation with clinical parameters was also evaluated. Compared to the control subjects with elevated TC and/or LDL-C levels, the levels of TC, LDL-C, non-high-density lipoprotein cholesterol (non-HDL), LDL subclass LDL3 and small dense LDL (sdLDL), and oxLDL were significantly higher in POAG patients with elevated TC and/or LDL-C levels. No differences in any lipoproteins or the subclasses were found between the POAG patients and control subjects with normal TC and LDL-C levels. Moderate-to-good performance of TC, LDL-C, non-HDL, LDL3, sdLDL, and oxLDL was found in discriminating between the POAG patients and control subjects with elevated TC and/or LDL-C levels (AUC: 0.710-0.950). Significant negative correlations between LDL3 and sdLDL with retinal nerve fiber layer (RNFL) thickness in the superior quadrant and between LDL3 and average RNFL thickness were observed in POAG patients with elevated TC and/or LDL-C levels. This study revealed a significant elevation of plasma lipoproteins, especially the LDL subclasses, in POAG patients with elevated TC and/or LDL-C levels, providing insights on monitoring specific lipoproteins in POAG patients with elevated TC and/or LDL-C.
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Affiliation(s)
- Changzhen Fu
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou 515041, China; (C.F.); (J.X.); (S.-L.C.); (C.-B.C.); (J.-J.L.); (Z.L.); (C.H.); (Z.W.); (T.K.N.)
| | - Jianming Xu
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou 515041, China; (C.F.); (J.X.); (S.-L.C.); (C.-B.C.); (J.-J.L.); (Z.L.); (C.H.); (Z.W.); (T.K.N.)
| | - Shao-Lang Chen
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou 515041, China; (C.F.); (J.X.); (S.-L.C.); (C.-B.C.); (J.-J.L.); (Z.L.); (C.H.); (Z.W.); (T.K.N.)
| | - Chong-Bo Chen
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou 515041, China; (C.F.); (J.X.); (S.-L.C.); (C.-B.C.); (J.-J.L.); (Z.L.); (C.H.); (Z.W.); (T.K.N.)
| | - Jia-Jian Liang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou 515041, China; (C.F.); (J.X.); (S.-L.C.); (C.-B.C.); (J.-J.L.); (Z.L.); (C.H.); (Z.W.); (T.K.N.)
| | - Zibo Liu
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou 515041, China; (C.F.); (J.X.); (S.-L.C.); (C.-B.C.); (J.-J.L.); (Z.L.); (C.H.); (Z.W.); (T.K.N.)
| | - Chukai Huang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou 515041, China; (C.F.); (J.X.); (S.-L.C.); (C.-B.C.); (J.-J.L.); (Z.L.); (C.H.); (Z.W.); (T.K.N.)
| | - Zhenggen Wu
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou 515041, China; (C.F.); (J.X.); (S.-L.C.); (C.-B.C.); (J.-J.L.); (Z.L.); (C.H.); (Z.W.); (T.K.N.)
| | - Tsz Kin Ng
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou 515041, China; (C.F.); (J.X.); (S.-L.C.); (C.-B.C.); (J.-J.L.); (Z.L.); (C.H.); (Z.W.); (T.K.N.)
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou 515041, China; (C.F.); (J.X.); (S.-L.C.); (C.-B.C.); (J.-J.L.); (Z.L.); (C.H.); (Z.W.); (T.K.N.)
| | - Qingping Liu
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou 515041, China; (C.F.); (J.X.); (S.-L.C.); (C.-B.C.); (J.-J.L.); (Z.L.); (C.H.); (Z.W.); (T.K.N.)
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Angeli A, Chelli I, Lucarini L, Sgambellone S, Marri S, Villano S, Ferraroni M, De Luca V, Capasso C, Carta F, Supuran CT. Novel Carbonic Anhydrase Inhibitors with Dual-Tail Core Sulfonamide Show Potent and Lasting Effects for Glaucoma Therapy. J Med Chem 2024; 67:3066-3089. [PMID: 38266245 DOI: 10.1021/acs.jmedchem.3c02254] [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: 01/26/2024]
Abstract
Glaucoma, a leading cause of irreversible vision loss worldwide, is characterized by elevated intraocular pressure (IOP), a well-established risk factor across all its forms. We present the design and synthesis of 39 novel carbonic anhydrase inhibitors by a dual-tailed approach, strategically crafted to interact with distinct hydrophobic and hydrophilic pockets of CA active sites. The series was investigated against the CA isoforms implicated in glaucoma (hCA II, hCA IV, and hCA XII), and the X-ray crystal structures of compounds 25a, 25f, and 26a with CA II, along with 14b in complex with a hCA XII mimic, were determined. Selected compounds (14a, 25a, and 26a) underwent evaluation for their ability to reduce IOP in rabbits with ocular hypertension. Derivative 26a showed significant potency and sustained IOP-lowering effects, surpassing the efficacy of the drugs dorzolamide and bimatoprost. This positions compound 26a as a promising candidate for the development of a novel anti-glaucoma medication.
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Affiliation(s)
- Andrea Angeli
- NEUROFARBA Department, Sezione di Scienze Farmaceutiche, University of Florence, Via Ugo Schiff 6, 50019 Florence, Italy
| | - Irene Chelli
- NEUROFARBA Department, Sezione di Scienze Farmaceutiche, University of Florence, Via Ugo Schiff 6, 50019 Florence, Italy
| | - Laura Lucarini
- NEUROFARBA Department, Pharmaceutical and Nutraceutical Section, University of Florence, 50139 Florence, Italy
| | - Silvia Sgambellone
- NEUROFARBA Department, Pharmaceutical and Nutraceutical Section, University of Florence, 50139 Florence, Italy
| | - Silvia Marri
- NEUROFARBA Department, Pharmaceutical and Nutraceutical Section, University of Florence, 50139 Florence, Italy
| | - Serafina Villano
- NEUROFARBA Department, Pharmaceutical and Nutraceutical Section, University of Florence, 50139 Florence, Italy
| | - Marta Ferraroni
- Department of Chemistry "Ugo Schiff", University of Florence, Via della Lastruccia 3-13, 50019 Florence, Italy
| | - Viviana De Luca
- Istituto di Bioscienze e Biorisorse, CNR, 80131 Naples, Italy
| | | | - Fabrizio Carta
- NEUROFARBA Department, Sezione di Scienze Farmaceutiche, University of Florence, Via Ugo Schiff 6, 50019 Florence, Italy
| | - Claudiu T Supuran
- NEUROFARBA Department, Sezione di Scienze Farmaceutiche, University of Florence, Via Ugo Schiff 6, 50019 Florence, Italy
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Mahmoudinezhad G, Moghimi S, Nishida T, Micheletti E, Du KH, Mohammadzadeh V, Wu JH, Kamalipour A, Weinreb RN. Intraocular pressure increases the rate of macular vessel density loss in glaucoma. Br J Ophthalmol 2024; 108:181-187. [PMID: 36535749 PMCID: PMC10277316 DOI: 10.1136/bjo-2022-322261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIMS To evaluate the relationship over time between intraocular pressure (IOP) and the rate of macula whole image vessel density (wiVD) loss and whole image ganglion cell complex (wiGCC) thinning in glaucoma METHODS: From 62 patients in the Diagnostic Innovations in Glaucoma Study, 59 Primary open-angle glaucoma and 27 glaucoma suspect eyes with mean follow-up of 3.2 years were followed. Optical coherence tomography angiography (OCT-A)-based vessel density and OCT-based structural thickness of the same 6×6 mm GCC scan slab were evaluated. Univariable and multivariable linear mixed models were performed for all eyes and also a subset of them in which peak IOP <18 mm Hg to investigate the effect of IOP parameters on the rate of wiVD and wiGCC change. RESULTS The mean baseline visual field mean deviation (95% CI) was -3.3 dB (-4.4 to -2.1). Higher mean IOP (-0.07%/year per 1 mm Hg (-0.14 to -0.01), p=0.033), peak IOP (-0.07%/year per 1 mm Hg (-0.13 to -0.02), p=0.004) and IOP fluctuation (IOP SD) (-0.17%/year per 1 mm Hg (-0.32 to 0.02), p=0.026) were associated with faster macular vessel density loss. Faster wiGCC thinning was associated with higher mean IOP (-0.05 µm/year per 1 mm Hg (-0.10 to -0.01), p=0.015), peak IOP (-0.05 µm/year per 1 mm Hg (-0.08 to -0.02), p=0.003) and IOP fluctuation (-0.12 µm/year per 1 mm Hg (-0.22 to -0.01), p=0.032). In eyes with peak <18 mm Hg, faster wiVD progression was associated with higher mean IOP (p=0.042). Faster wiGCC progression was associated with higher mean IOP in these eyes (p=0.025). CONCLUSION IOP metrics were associated with faster rates of overall macular microvascular loss and also in the eyes with peak IOP <18 mm Hg. Future studies are needed to examine whether additional IOP lowering reduces the rate of microvascular loss in patients with glaucoma. TRIAL REGISTRATION NUMBER NCT00221897.
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Affiliation(s)
- Golnoush Mahmoudinezhad
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Sasan Moghimi
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Takashi Nishida
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Eleonora Micheletti
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology-IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Kelvin H Du
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Vahid Mohammadzadeh
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Jo-Hsuan Wu
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Alireza Kamalipour
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Robert N Weinreb
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
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Ahmed A, Jammal AA, Estrela T, Berchuck SI, Medeiros FA. Intraocular Pressure and Rates of Macular Thinning in Glaucoma. Ophthalmol Glaucoma 2023; 6:457-465. [PMID: 37037307 PMCID: PMC10523920 DOI: 10.1016/j.ogla.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE To evaluate the effect of intraocular pressure (IOP) on the rates of macular thickness (ganglion cell layer [GCL] and ganglion cell-inner plexiform layer [GCIPL]) change over time measured by spectral-domain (SD) OCT. DESIGN Retrospective cohort study. PARTICIPANTS Overall, 451 eyes of 256 patients with primary open-angle glaucoma. METHODS Data were extracted from the Duke Ophthalmic Registry, a database of electronic medical records of patients observed under routine clinical care at the Duke Eye Center, and satellite clinics. All records from patients with a minimum of 6 months of follow-up and at least 2 good-quality Spectralis SD-OCT macula scans were included. Linear mixed models were used to investigate the relationship between average IOP during follow-up and rates of GCL and GCIPL thickness change over time. MAIN OUTCOME MEASURES The effect of IOP on the rates of GCL and GCIPL thickness loss measured by SD-OCT. RESULTS Eyes had a mean follow-up of 1.8 ± 1.3 years, ranging from 0.5 to 10.2 years. The average rate of change for GCL thickness was -0.220 μm/year (95% confidence interval [CI], -0.268 to -0.172 μm/year) and for GCIPL thickness was -0.231 μm/year (95% CI, -0.302 to -0.160 μm/year). Each 1-mmHg higher mean IOP during follow-up was associated with an additional loss of -0.021 μm/year of GCL thickness (P = 0.001) and -0.032 μm/year of GCIPL thickness (P = 0.001) after adjusting for potentially confounding factors, such as baseline age, disease severity, sex, race, central corneal thickness, and follow-up time. CONCLUSIONS Higher IOP was significantly associated with faster rates of GCL and GCIPL loss over time measured by SD-OCT, even during relatively short follow-up times. These findings support the use of SD-OCT GCL and GCIPL thickness measurements as structural biomarkers for the evaluation of the efficacy of IOP-lowering therapies in slowing down the progression of glaucoma. 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)
- Abia Ahmed
- Vision, Imaging, and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Biology, University of North Carolina, Chapel Hill, North Carolina
| | - Alessandro A Jammal
- Vision, Imaging, and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Tais Estrela
- Vision, Imaging, and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Samuel I Berchuck
- Vision, Imaging, and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Statistical Science and Forge, Duke University, Durham, North Carolina
| | - Felipe A Medeiros
- Vision, Imaging, and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina.
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Kang JM, Jammal AA, Medeiros FA. Association between statin use and rates of structural and functional loss in glaucoma. Br J Ophthalmol 2023; 107:1269-1274. [PMID: 35537803 PMCID: PMC10287059 DOI: 10.1136/bjophthalmol-2021-320734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/25/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To evaluate the association between statin use and rates of standard automated perimetry (SAP) and retinal nerve fibre layer (RNFL) change in patients with glaucoma and glaucoma suspects. METHODS This retrospective cohort study included subjects from the Duke Glaucoma Registry with primary open-angle glaucoma and glaucoma suspects. Subjects were assigned to groups according to history of statin use. Rates of change in SAP mean deviation (MD) and spectral-domain optical coherence tomography (SD OCT) RNFL thickness over time were estimated using linear mixed models and compared in the statin versus control groups. The effect of duration of statin use was also assessed. Patients with glaucoma versus suspects were analysed separately. Analyses were adjusted for potential confounding factors of age, gender, race, intraocular pressure and follow-up time. RESULTS The study included 10 049 SAP tests and 14 198 SD OCT tests from 3007 eyes (1978 patients) followed for an average of 4.7±2.0 years. Of these, 775 subjects (1179 eyes) had a history of statin use. No difference in rates of change was seen between the statin versus control groups for MD (-0.07±0.16 dB/year vs -0.07±0.15 dB/year; p=0.873, respectively) or RNFL thickness (-0.70±0.60 µm/year vs -0.70±0.61 µm/year; p=0.923, respectively). Multivariable models controlling for potential confounders showed no significant association between duration of statin use and rates of MD or RNFL thickness change. CONCLUSIONS We did not find a statistically significant association between statin use or duration of statin use and rates of structural and functional change in those with glaucoma or glaucoma suspects.
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Affiliation(s)
- Jessica Minjy Kang
- Department of Ophthalmology, Northwestern University, Chicago, Illinois, USA
| | | | - Felipe A Medeiros
- Department of Ophthalmology, Duke University, Durham, North Carolina, USA
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA
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Huang X, Kong X, Shen Z, Ouyang J, Li Y, Jin K, Ye J. GRAPE: A multi-modal dataset of longitudinal follow-up visual field and fundus images for glaucoma management. Sci Data 2023; 10:520. [PMID: 37543686 PMCID: PMC10404253 DOI: 10.1038/s41597-023-02424-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2023] Open
Abstract
As one of the leading causes of irreversible blindness worldwide, glaucoma is characterized by structural damage and functional loss. Glaucoma patients often have a long follow-up and prognosis prediction is an important part in treatment. However, existing public glaucoma datasets are almost cross-sectional, concentrating on segmentation on optic disc (OD) and glaucoma diagnosis. With the development of artificial intelligence (AI), the deep learning model can already provide accurate prediction of future visual field (VF) and its progression with the support of longitudinal datasets. Here, we proposed a public longitudinal glaucoma real-world appraisal progression ensemble (GRAPE) dataset. The GRAPE dataset contains 1115 follow-up records from 263 eyes, with VFs, fundus images, OCT measurements and clinical information, and OD segmentation and VF progression are annotated. Two baseline models demonstrated the feasibility in prediction of VF and its progression. This dataset will advance AI research in glaucoma management.
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Affiliation(s)
- Xiaoling Huang
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Xiangyin Kong
- State Key Laboratory of Industrial Control Technology, College of Control Science and Engineering, Zhejiang University, Hangzhou, 310013, China
| | - Ziyan Shen
- Zhejiang Baima Lake Laboratory Co., Ltd, Hangzhou, 310051, China
| | - Jing Ouyang
- State Key Laboratory of Industrial Control Technology, College of Control Science and Engineering, Zhejiang University, Hangzhou, 310013, China
| | - Yunxiang Li
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75235, USA
| | - Kai Jin
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China.
| | - Juan Ye
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China.
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Naithani R, Jammal AA, Estrela T, Onyekaba NAE, Medeiros FA. Association of an Objective Structural and Functional Reference Standard for Glaucoma with Quality of Life Outcomes. Ophthalmol Glaucoma 2023; 6:160-168. [PMID: 36038106 PMCID: PMC10697472 DOI: 10.1016/j.ogla.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 04/26/2023]
Abstract
PURPOSE To compare self-reported quality-of-life (QoL) outcomes of patients diagnosed as normal, glaucoma suspect, and glaucoma based on an objective reference standard for glaucomatous optic neuropathy (GON). DESIGN Cross-sectional study. PARTICIPANTS 1884 eyes of 1019 patients were included in the study. METHODS The data was sourced from the Duke Glaucoma Registry. Eyes were classified according to the presence and topographic correspondence of functional and structural damage, as assessed by parameters from standard automated perimetry (SAP) and spectral-domain OCT (SD-OCT). The objective diagnosis of the worse eye was used to define patient-level diagnosis. To assess QoL in the diagnostic groups, 14 unidimensional vision-related items of the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) were used to assess QoL in the diagnostic groups. Association between NEI VFQ-25 Rasch-calibrated scores and diagnostic groups was assessed through multivariable regression that controlled for confounding demographic and socioeconomic variables such as age, sex, race, income, marriage status, insurance status, and highest education level. MAIN OUTCOME MEASURES NEI VFQ-25 Rasch scores compared with objective criteria diagnosis based on SAP mean deviation (MD) and SD-OCT retinal nerve fiber layer (RNFL) thickness. RESULTS Overall, eyes classified as normal, glaucoma suspect, and glaucoma had decreasing mean scores in SAP MD (0.2 ± 1.0 dB, -0.9 ± 2.4 dB, -6.2 ± 7.0 dB, respectively; P < 0.001) and SD-OCT RNFL thickness (97.8 ± 9.5 μm, 89.0 ± 13.1 μm, 64.5 ± 12.8 μm, respectively; P < 0.001). The mean Rasch-calibrated NEI VFQ-25 score was significantly different among normal, suspect, and glaucoma groups (82.9 ± 13.0, 78.2 ± 14.8, and 72.6 ± 16.2, respectively; P < 0.001). When adjusted for confounding socioeconomic variables, glaucoma patients had significantly worse QoL than those classified as normal (β = -6.8 Rasch score units; P < 0.001). CONCLUSION A glaucoma diagnosis, based on an objective reference standard for GON, was significantly associated with worse Rasch-adjusted scores of QoL. Utilization of such objective criteria may provide clinically relevant metrics with potential to improve comparability of research findings and validation of newly proposed diagnostic tools. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Rizul Naithani
- Vision, Imaging and Performance Laboratory (VIP), Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolin; Campbell University School of Medicine, Lillington, North Carolina
| | - Alessandro A Jammal
- Vision, Imaging and Performance Laboratory (VIP), Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolin
| | - Tais Estrela
- Vision, Imaging and Performance Laboratory (VIP), Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolin
| | - Ndidi-Amaka E Onyekaba
- Vision, Imaging and Performance Laboratory (VIP), Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolin
| | - Felipe A Medeiros
- Vision, Imaging and Performance Laboratory (VIP), Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolin; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina.
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Detecting disease progression in mild, moderate and severe glaucoma. Curr Opin Ophthalmol 2023; 34:168-175. [PMID: 36730773 DOI: 10.1097/icu.0000000000000925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine contemporary techniques for detecting the progression of glaucoma. We provide a general overview of detection principles and review evidence-based diagnostic strategies and specific considerations for detecting glaucomatous progression in patients with mild, moderate and severe disease. RECENT FINDINGS Diagnostic techniques and technologies for glaucoma have dramatically evolved in recent years, affording clinicians an expansive toolkit with which to detect glaucoma progression. Each stage of glaucoma, however, presents unique diagnostic challenges. In mild disease, either structural or functional changes can develop first in disease progression. In moderate disease, structural or functional changes can occur either in tandem or in isolation. In severe disease, standard techniques may fail to detect further disease progression, but such detection can still be measured using other modalities. SUMMARY Detecting disease progression is central to the management of glaucoma. Glaucomatous progression has both structural and functional elements, both of which must be carefully monitored at all disease stages to determine when interventions are warranted.
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Xu K, Yu L, Wang Z, Lin P, Zhang N, Xing Y, Yang N. Use of gene therapy for optic nerve protection: Current concepts. Front Neurosci 2023; 17:1158030. [PMID: 37090805 PMCID: PMC10117674 DOI: 10.3389/fnins.2023.1158030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
Gene therapy has become an essential treatment for optic nerve injury (ONI) in recent years, and great strides have been made using animal models. ONI, which is characterized by the loss of retinal ganglion cells (RGCs) and axons, can induce abnormalities in the pupil light reflex, visual field defects, and even vision loss. The eye is a natural organ to target with gene therapy because of its high accessibility and certain immune privilege. As such, numerous gene therapy trials are underway for treating eye diseases such as glaucoma. The aim of this review was to cover research progress made in gene therapy for ONI. Specifically, we focus on the potential of gene therapy to prevent the progression of neurodegenerative diseases and protect both RGCs and axons. We cover the basic information of gene therapy, including the classification of gene therapy, especially focusing on genome editing therapy, and then we introduce common editing tools and vector tools such as Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) -Cas9 and adeno-associated virus (AAV). We also summarize the progress made on understanding the roles of brain derived neurotrophic factor (BDNF), ciliary neurotrophic factor (CNTF), phosphatase-tensin homolog (PTEN), suppressor of cytokine signal transduction 3 (SOCS3), histone acetyltransferases (HATs), and other important molecules in optic nerve protection. However, gene therapy still has many challenges, such as misalignment and mutations, immunogenicity of AAV, time it takes and economic cost involved, which means that these issues need to be addressed before clinical trials can be considered.
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Affiliation(s)
- Kexin Xu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Lu Yu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Department of Ophthalmology, Aier Eye Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhiyi Wang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Pei Lin
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Ningzhi Zhang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yiqiao Xing
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Department of Ophthalmology, Aier Eye Hospital of Wuhan University, Wuhan, Hubei, China
- *Correspondence: Yiqiao Xing,
| | - Ning Yang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Ning Yang,
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Mahmoudinezhad G, Nishida T, Weinreb RN, Baxter SL, Eslani M, Micheletti E, Liebmann JM, Fazio MA, Girkin CA, Zangwill LM, Moghimi S. Impact of Smoking on Visual Field Progression in a Long-term Clinical Follow-up. Ophthalmology 2022; 129:1235-1244. [PMID: 35752211 PMCID: PMC10002405 DOI: 10.1016/j.ophtha.2022.06.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To investigate the effect of smoking on rates of progressive visual field (VF) damage over time in glaucoma. DESIGN Retrospective cohort study. PARTICIPANTS Five hundred eleven eyes of 354 patients with glaucoma followed up from multicenter glaucoma registries. METHODS In this longitudinal study, 354 patients with primary open-angle glaucoma with a minimum of 3 years of follow-up and 5 VF tests were enrolled from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Univariate and multivariate linear mixed models were used to investigate the effects of smoking on rates of 24-2 VF mean deviation loss. Visual field progression was defined using pointwise linear and significant negative VF mean deviation loss. Logistic regression was used to identify baseline factors and whether different levels of smoking intensity were associated with VF progression. Kaplan-Meier survival analysis and the log-rank test were used to compare the cumulative risk ratio of progression between smoker and never smoker groups. MAIN OUTCOME MEASURES Visual field progression. RESULTS Five hundred eleven eyes of 354 patients were included over the median follow-up of 12.5 years. Median baseline age was 64.8 years. Of the 354 patients, 124 (35%) were Black, and 149 (42.1%) and 168 (59.8%) had reported a history of smoking or alcohol consumption, respectively. In a multivariate model, higher smoking intensity was associated with faster VF loss (coefficient, -0.05 decibels (dB)/year per 10 pack-years; 95% confidence interval [CI], -0.08 to -0.01 dB/year per 10 pack-years; P = 0.010). Developing VF progression in eyes of heavy smokers (≥ 20 pack-years) was 2.2 times more than in eyes of patients without smoking history (odds ratio, 2.21; 95% CI, 1.02-4.76; P = 0.044). Statistically significant differences were found between heavy smokers (≥ 20 pack-years) and never smokers by Kaplan-Meier analysis (P = 0.011, log-rank test). CONCLUSIONS Heavy smokers are more likely to sustain VF loss in eyes with glaucoma. The prospective longitudinal design of this study supports the hypothesis that levels of smoking may be a significant predictor for glaucoma progression. Additionally, this information can be used for clinically relevant tobacco prevention and intervention messages.
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Affiliation(s)
- Golnoush Mahmoudinezhad
- 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
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Sally L Baxter
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Biomedical Informatics, University of California, San Diego, La Jolla, California
| | - Medi Eslani
- 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
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Massimo A Fazio
- Bernard School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christopher A Girkin
- Bernard School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Linda M Zangwill
- 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.
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12
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Rao HL, Dasari S, Puttaiah NK, Pradhan ZS, Moghimi S, Mansouri K, Webers CAB, Weinreb RN. Optical Microangiography and Progressive Ganglion Cell-Inner Plexiform Layer Loss in Primary Open-Angle Glaucoma. Am J Ophthalmol 2022; 238:36-44. [PMID: 34902324 PMCID: PMC10069711 DOI: 10.1016/j.ajo.2021.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate the association between optical microangiography (OMAG) measurements and progressive ganglion cell-inner plexiform layer (GCIPL) loss in patients with primary open-angle glaucoma (POAG). DESIGN Prospective case series. METHODS Sixty-three eyes of 38 patients with POAG were studied for ≥2 years and with ≥ 3 optical coherence tomography examinations. Only those hemifields with mild to moderate functional damage at baseline (106 hemifields) were included in the analysis. OMAG imaging was performed at the baseline visit. The effects of clinical parameters (age, gender, central corneal thickness, presence of disc hemorrhage, and mean and fluctuation of intraocular pressure), baseline mean deviation, retinal nerve fiber layer, and GCIPL thickness and baseline OMAG measurements (peripapillary and macular perfusion density [PD] and vessel density [VD]) on the rate of change of GCIPL thickness were evaluated using linear mixed models. RESULTS Average (± standard deviation) mean deviation, quadrant retinal nerve fiber layer, and sector GCIPL thickness of the analyzed hemifields respectively at baseline were -5.2 ± 2.8 dB, 94.5 ± 20.0 µm, and 72.4 ± 8.7 µm, respectively. Peripapillary PD and VD in the quadrant were 43.1% ± 7.0% and 17.0 ± 2.6 mm/mm2, respectively. Macular PD and VD in the quadrant were 37.2% ± 6.9% and 15.1 ± 2.6 mm/mm2, respectively. Rate of sector GCIPL change was -0.97 ± 0.15 µm per year. Multivariate mixed models showed that lower peripapillary PD (coefficient 0.04, P = .01) and VD (coefficient 0.09, P = .05) were significantly associated with a faster rate of GCIPL loss. CONCLUSIONS Lower baseline peripapillary OMAG measurements were significantly associated with a faster rate of GCIPL loss in patients with mild to moderate POAG.
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Affiliation(s)
- Harsha L Rao
- From Narayana Nethralaya, Hulimavu (H.L.R., S.D., N.K.P.); University Eye Clinic Maastricht (H.L.R., C.A.B.W.), University Medical Center, Maastricht, the Netherlands.
| | | | | | - Zia S Pradhan
- Narayana Nethralaya, Rajaji Nagar (Z.S.P.), Bangalore, India
| | - Sasan Moghimi
- Hamilton Glaucoma Center (S.M., R.N.W.), Shiley Eye Institute, and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Kaweh Mansouri
- Glaucoma Research Center (K.M.), Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland; Department of Ophthalmology (K.M.), University of Colorado, Denver, Colorado, USA
| | - Carroll A B Webers
- University Eye Clinic Maastricht (H.L.R., C.A.B.W.), University Medical Center, Maastricht, the Netherlands
| | - Robert N Weinreb
- Hamilton Glaucoma Center (S.M., R.N.W.), Shiley Eye Institute, and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
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Li F, Su Y, Lin F, Li Z, Song Y, Nie S, Xu J, Chen L, Chen S, Li H, Xue K, Che H, Chen Z, Yang B, Zhang H, Ge M, Zhong W, Yang C, Chen L, Wang F, Jia Y, Li W, Wu Y, Li Y, Gao Y, Zhou Y, Zhang K, Zhang X. A deep-learning system predicts glaucoma incidence and progression using retinal photographs. J Clin Invest 2022; 132:157968. [PMID: 35642636 PMCID: PMC9151694 DOI: 10.1172/jci157968] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/12/2022] [Indexed: 02/05/2023] Open
Abstract
BackgroundDeep learning has been widely used for glaucoma diagnosis. However, there is no clinically validated algorithm for glaucoma incidence and progression prediction. This study aims to develop a clinically feasible deep-learning system for predicting and stratifying the risk of glaucoma onset and progression based on color fundus photographs (CFPs), with clinical validation of performance in external population cohorts.MethodsWe established data sets of CFPs and visual fields collected from longitudinal cohorts. The mean follow-up duration was 3 to 5 years across the data sets. Artificial intelligence (AI) models were developed to predict future glaucoma incidence and progression based on the CFPs of 17,497 eyes in 9346 patients. The area under the receiver operating characteristic (AUROC) curve, sensitivity, and specificity of the AI models were calculated with reference to the labels provided by experienced ophthalmologists. Incidence and progression of glaucoma were determined based on longitudinal CFP images or visual fields, respectively.ResultsThe AI model to predict glaucoma incidence achieved an AUROC of 0.90 (0.81-0.99) in the validation set and demonstrated good generalizability, with AUROCs of 0.89 (0.83-0.95) and 0.88 (0.79-0.97) in external test sets 1 and 2, respectively. The AI model to predict glaucoma progression achieved an AUROC of 0.91 (0.88-0.94) in the validation set, and also demonstrated outstanding predictive performance with AUROCs of 0.87 (0.81-0.92) and 0.88 (0.83-0.94) in external test sets 1 and 2, respectively.ConclusionOur study demonstrates the feasibility of deep-learning algorithms in the early detection and prediction of glaucoma progression.FUNDINGNational Natural Science Foundation of China (NSFC); the High-level Hospital Construction Project, Zhongshan Ophthalmic Center, Sun Yat-sen University; the Science and Technology Program of Guangzhou, China (2021), the Science and Technology Development Fund (FDCT) of Macau, and FDCT-NSFC.
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Affiliation(s)
- Fei Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yuandong Su
- State Key Laboratory of Biotherapy and Center for Translational Innovations, West China Hospital and Sichuan University, Chengdu, China.,PKU-MUST Center for Future Technology, Faculty of Medicine, Macao University of Science and Technology, Macau, China
| | - Fengbin Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Zhihuan Li
- PKU-MUST Center for Future Technology, Faculty of Medicine, Macao University of Science and Technology, Macau, China
| | - Yunhe Song
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Sheng Nie
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease and Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jie Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Linjiang Chen
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shiyan Chen
- Department of Ophthalmology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Hao Li
- Department of Ophthalmology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Kanmin Xue
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Huixin Che
- He Eye Specialist Hospital, Shenyang, Liaoning Province, China
| | - Zhengui Chen
- Jiangmen Xinhui Aier New Hope Eye Hospital, Jiangmen, Guangdong, China
| | - Bin Yang
- Department of Ophthalmology, Zigong Third People's Hospital, Zigong, China
| | - Huiying Zhang
- Department of Ophthalmology, Fujian Provincial Hospital, Fuzhou, China
| | - Ming Ge
- Department of Ophthalmology and Optometry, Guizhou Nursing Vocational College, Guiyang, China
| | - Weihui Zhong
- Department of Ophthalmology, Guangzhou Development District Hospital, Guangzhou, China
| | - Chunman Yang
- Department of Ophthalmology, The Second Affiliated Hospital of Guizhou Medical University, Kaili, China
| | - Lina Chen
- Department of Ophthalmology, The Third People's Hospital of Dalian, Dalian, Liaoning Province, China
| | - Fanyin Wang
- Department of Ophthalmology, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Yunqin Jia
- Department of Ophthalmology, Dali Bai Autonomous Prefecture People's Hospital, Dali, China
| | - Wanlin Li
- Department of Ophthalmology, Wuwei People's Hospital, Wuwei, Gansu Province, China
| | - Yuqing Wu
- Department of Ophthalmology, Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Yingjie Li
- Department of Ophthalmology, The First Hospital of Nanchang City, Nanchang, China
| | - Yuanxu Gao
- PKU-MUST Center for Future Technology, Faculty of Medicine, Macao University of Science and Technology, Macau, China.,State Key Laboratory of Lunar and Planetary Sciences, Macao University of Science and Technology, Taipa, Macau, China
| | - Yong Zhou
- Clinical Research Institute, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kang Zhang
- PKU-MUST Center for Future Technology, Faculty of Medicine, Macao University of Science and Technology, Macau, China
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Salehi MA, Karimi A, Mohammadi S, Arevalo JF. Spectral-domain OCT measurements in obesity: A systematic review and meta-analysis. PLoS One 2022; 17:e0267495. [PMID: 35476846 PMCID: PMC9045631 DOI: 10.1371/journal.pone.0267495] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 04/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Previous studies proposed possible applications of spectral-domain optical coherence tomography (SD-OCT) measurements in prognosticating pathologies observed in overweight/obesity, including ocular, vascular, and neurologic consequences. Therefore, we conducted a systematic review and meta-analysis to investigate the changes in the in SD-OCT measurements of the patients with higher body mass index (BMI) compared to normal weight individuals. Materials and methods We conducted a systematic search on PubMed, Scopus, and Embase. The search results underwent two-phase title/abstract and full-text screenings. We then analyzed SD-OCT measurements differences in patients with high BMI and controls, and performed meta-regression, sub-group analysis, quality assessment, and publication bias assessment. The measurements included macular thickness, cup to disc ratio, ganglion cell-inner plexiform layer (GC-IPL) and its sub-sectors, RNFL and peripapillary RNFL (pRNFL) and their sub-layers, and choroidal thickness and its sub-sectors. Results 19 studies were included in this meta-analysis accounting for 1813 individuals, 989 cases and 824 controls. There was an overall trend towards decreased thickness in high BMI patients, but only two measurements reached statistical significance: temporal retinal nerve fiber layer (RNFL) (Standardized mean difference (SMD): -0.33, 95% confidence interval (CI): -0.53 to -0.14, p<0.01) and the choroidal region 1.0 mm nasal to fovea (SMD: -0.38, 95% CI: -0.60 to -0.16, p<0.01). Conclusion Some ocular layers are thinner in patients with higher BMI than the controls. These SD-OCT measurements might correlate with adverse events related to increased body weight and have prognostic abilities. As SD-OCT is a robust, rapid and non-invasive tool, future guidelines and studies are needed to evaluate the possibility of their integration into care of the patients with obesity.
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Affiliation(s)
| | - Amirali Karimi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Mohammadi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - J. Fernando Arevalo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, United States of America
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Zhang XJ, Lau YH, Wang YM, Chan HN, Chan PP, Kam KW, Ip P, Zhang W, Young AL, Tham CC, Pang CP, Chen LJ, Yam JC. Thicker Retinal Nerve Fiber Layer with Age among Schoolchildren: The Hong Kong Children Eye Study. Diagnostics (Basel) 2022; 12:diagnostics12020500. [PMID: 35204590 PMCID: PMC8870939 DOI: 10.3390/diagnostics12020500] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 12/18/2022] Open
Abstract
This study aims to investigate the effect of age on the peripapillary retinal nerve fiber layer (p-RNFL) thickness among schoolchildren. A total of 4034 children aged 6–8 years old received comprehensive ophthalmological examinations. p-RNFL thickness was measured from a circular scan (⌀ = 3.4 mm) captured using spectral-domain optical coherence tomography (SD-OCT). Associations between p-RNFL thickness with ocular and systemic factors were determined by multivariate linear regression after adjusting potential confounders using generalized estimating equations (GEE). The mean global p-RNFL thickness was 106.60 ± 9.41 μm (range: 72 to 171 μm) in the right eyes, 105.99 ± 9.30 μm (range: 76 to 163 μm) in the left eyes, and 106.29 ± 9.36 μm (range: 72 to 171 μm) across both eyes. Age was positively correlated with p-RNFL after adjusting for axial length (AL) and confounding factors (β = 0.509; p = 0.001). Upon multivariable analysis, AL was positively associated with temporal p-RNFL thickness (β = 3.186, p < 0.001) but negatively with non-temporal p-RNFL thickness (β = (10.003, −2.294), p < 0.001). Sectoral p-RNFL was the thickest in the inferior temporal region (155.12 ± 19.42 μm, range 68 to 271 μm), followed by the superior temporal region (154.67 ± 19.99 μm, range 32 to 177 μm). To conclude, p-RNFL increased significantly with older age among children 6 to 8 years old in a converse trend compared to adults. Our results provide a reference for interpreting OCT information in children and suggest that stable p-RNFL thickness may not indicate a stable disease status in pediatric patients due to the age effects.
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Affiliation(s)
- Xiu-Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; (X.-J.Z.); (Y.-H.L.); (Y.-M.W.); (H.-N.C.); (P.P.C.); (K.-W.K.); (A.L.Y.); (C.C.T.); (C.-P.P.); (L.-J.C.)
- Division of Pediatric Ophthalmology and Strabismus, Tianjin Eye Hospital, Tianjin 300020, China;
| | - Yi-Han Lau
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; (X.-J.Z.); (Y.-H.L.); (Y.-M.W.); (H.-N.C.); (P.P.C.); (K.-W.K.); (A.L.Y.); (C.C.T.); (C.-P.P.); (L.-J.C.)
| | - Yu-Meng Wang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; (X.-J.Z.); (Y.-H.L.); (Y.-M.W.); (H.-N.C.); (P.P.C.); (K.-W.K.); (A.L.Y.); (C.C.T.); (C.-P.P.); (L.-J.C.)
| | - Hei-Nga Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; (X.-J.Z.); (Y.-H.L.); (Y.-M.W.); (H.-N.C.); (P.P.C.); (K.-W.K.); (A.L.Y.); (C.C.T.); (C.-P.P.); (L.-J.C.)
| | - Poemen P. Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; (X.-J.Z.); (Y.-H.L.); (Y.-M.W.); (H.-N.C.); (P.P.C.); (K.-W.K.); (A.L.Y.); (C.C.T.); (C.-P.P.); (L.-J.C.)
- Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China
| | - Ka-Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; (X.-J.Z.); (Y.-H.L.); (Y.-M.W.); (H.-N.C.); (P.P.C.); (K.-W.K.); (A.L.Y.); (C.C.T.); (C.-P.P.); (L.-J.C.)
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China;
| | - Wei Zhang
- Division of Pediatric Ophthalmology and Strabismus, Tianjin Eye Hospital, Tianjin 300020, China;
| | - Alvin L. Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; (X.-J.Z.); (Y.-H.L.); (Y.-M.W.); (H.-N.C.); (P.P.C.); (K.-W.K.); (A.L.Y.); (C.C.T.); (C.-P.P.); (L.-J.C.)
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Clement C. Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; (X.-J.Z.); (Y.-H.L.); (Y.-M.W.); (H.-N.C.); (P.P.C.); (K.-W.K.); (A.L.Y.); (C.C.T.); (C.-P.P.); (L.-J.C.)
- Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi-Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; (X.-J.Z.); (Y.-H.L.); (Y.-M.W.); (H.-N.C.); (P.P.C.); (K.-W.K.); (A.L.Y.); (C.C.T.); (C.-P.P.); (L.-J.C.)
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Li-Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; (X.-J.Z.); (Y.-H.L.); (Y.-M.W.); (H.-N.C.); (P.P.C.); (K.-W.K.); (A.L.Y.); (C.C.T.); (C.-P.P.); (L.-J.C.)
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jason C. Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; (X.-J.Z.); (Y.-H.L.); (Y.-M.W.); (H.-N.C.); (P.P.C.); (K.-W.K.); (A.L.Y.); (C.C.T.); (C.-P.P.); (L.-J.C.)
- Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong SAR, China
- Correspondence: ; Tel.: +852-3943-5892; Fax: +852-2715-9490
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16
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Swaminathan SS, Berchuck SI, Jammal AA, Rao JS, Medeiros FA. Rates of Glaucoma Progression Derived from Linear Mixed Models Using Varied Random Effect Distributions. Transl Vis Sci Technol 2022; 11:16. [PMID: 35138343 PMCID: PMC8842468 DOI: 10.1167/tvst.11.2.16] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare the ability of linear mixed models with different random effect distributions to estimate rates of visual field loss in glaucoma patients. Methods Eyes with five or more reliable standard automated perimetry (SAP) tests were identified from the Duke Glaucoma Registry. Mean deviation (MD) values from each visual field and associated timepoints were collected. These data were modeled using ordinary least square (OLS) regression and linear mixed models using the Gaussian, Student's t, or log-gamma (LG) distributions as the prior distribution for random effects. Model fit was compared using the Watanabe–Akaike information criterion (WAIC). Simulated eyes of varying initial disease severity and rates of progression were created to assess the accuracy of each model in predicting the rate of change and likelihood of declaring progression. Results A total of 52,900 visual fields from 6558 eyes of 3981 subjects were included. Mean follow-up period was 8.7 ± 4.0 years, with an average of 8.1 ± 3.7 visual fields per eye. The LG model produced the lowest WAIC, demonstrating optimal model fit. In simulations, the LG model declared progression earlier than OLS (P < 0.001) and had the greatest accuracy in predicted slopes (P < 0.001). The Gaussian model significantly underestimated rates of progression among fast and catastrophic progressors. Conclusions Linear mixed models using the LG distribution outperformed conventional approaches for estimating rates of SAP MD loss in a population with glaucoma. Translational Relevance Use of the LG distribution in models estimating rates of change among glaucoma patients may improve their accuracy in rapidly identifying progressors at high risk for vision loss.
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Affiliation(s)
- Swarup S Swaminathan
- Vision, Imaging and Performance Laboratory, Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA.,Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Samuel I Berchuck
- Vision, Imaging and Performance Laboratory, Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA.,Department of Statistical Science and Duke Forge, Duke University, Durham, NC, USA
| | - Alessandro A Jammal
- Vision, Imaging and Performance Laboratory, Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA
| | - J Sunil Rao
- Department of Biostatistics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Felipe A Medeiros
- Vision, Imaging and Performance Laboratory, Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA
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17
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Jammal AA, Berchuck SI, Mariottoni EB, Tanna AP, Costa VP, Medeiros FA. Blood Pressure and Glaucomatous Progression in a Large Clinical Population. Ophthalmology 2022; 129:161-170. [PMID: 34474070 PMCID: PMC8792171 DOI: 10.1016/j.ophtha.2021.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/04/2021] [Accepted: 08/24/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To investigate the effect of systemic arterial blood pressure (BP) on rates of progressive structural damage over time in glaucoma. DESIGN Retrospective cohort study. PARTICIPANTS A total of 7501 eyes of 3976 subjects with glaucoma or suspected of glaucoma followed over time from the Duke Glaucoma Registry. METHODS Linear mixed models were used to investigate the effects of BP on the rates of retinal nerve fiber layer (RNFL) loss from spectral-domain OCT (SD-OCT) over time. Models were adjusted for intraocular pressure (IOP), gender, race, diagnosis, central corneal thickness (CCT), follow-up time, and baseline disease severity. MAIN OUTCOME MEASURE Effect of mean arterial pressure (MAP), systolic arterial pressure (SAP), and diastolic arterial pressure (DAP) on rates of RNFL loss over time. RESULTS A total of 157 291 BP visits, 45 408 IOP visits, and 30 238 SD-OCT visits were included. Mean rate of RNFL change was -0.70 μm/year (95% confidence interval, -0.72 to -0.67 μm/year). In univariable models, MAP, SAP, and DAP during follow-up were not significantly associated with rates of RNFL loss. However, when adjusted for mean IOP during follow-up, each 10 mmHg reduction in mean MAP (-0.06 μm/year; P = 0.007) and mean DAP (-0.08 μm/year; P < 0.001) but not SAP (-0.01 μm/year; P = 0.355) was associated with significantly faster rates of RNFL thickness change over time. The effect of the arterial pressure metrics remained significant after additional adjustment for baseline age, diagnosis, sex, race, follow-up time, disease severity, and corneal thickness. CONCLUSIONS When adjusted for IOP, lower MAP and DAP during follow-up were significantly associated with faster rates of RNFL loss, suggesting that levels of systemic BP may be a significant factor in glaucoma progression.
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Affiliation(s)
- Alessandro A Jammal
- Vision, Imaging and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Ophthalmology, Universidade Estadual de Campinas, São Paulo, Brazil
| | - Samuel I Berchuck
- Vision, Imaging and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Statistical Science and Forge, Duke University, Durham, North Carolina
| | - Eduardo B Mariottoni
- Vision, Imaging and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Angelo P Tanna
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Vital P Costa
- Department of Ophthalmology, Universidade Estadual de Campinas, São Paulo, Brazil
| | - Felipe A Medeiros
- Vision, Imaging and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina.
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18
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Cheung CY, Ling Li S, Chan N, Chan PP, Wang Y, Wong M, Lai I, Tham CC. Intraocular Pressure Control Predicts Retinal Nerve Fiber Layer Thinning in Primary Angle Closure Disease: The CUPAL Study. Am J Ophthalmol 2022; 234:205-214. [PMID: 34416183 DOI: 10.1016/j.ajo.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 08/01/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the relationship of intraocular pressure (IOP) control with subsequent retinal nerve fiber layer (RNFL) thinning in patients with primary angle closure disease (PACD). DESIGN Prospective cohort study. METHODS The study monitored 517 treated PACD eyes from 280 Chinese patients at least 24 months. IOP was measured every 3 months using Goldmann applanation tonometry, and RNFLs were measured by spectral-domain optical coherence tomography (Spectralis, Heidelberg Engineering) every 6 months. IOP mean and fluctuation were calculated as the average and the coefficient of variation of IOP measurements during the first 18 months of the study period. The relationship between IOP and subsequent RNFL changes over time were examined using multivariable linear mixed models. Intraclass correlations at the patient and eye levels were also controlled using nested random intercepts in the models. RESULTS IOP mean (β = -1.20 µm/y per 1 mm Hg, P < .001) and IOP fluctuation (β = -3.10 µm/y per 10% unit change in the coefficient of variation, P < .001) were independently negatively associated with subsequent progressive global RNFL changes, after adjustment for age, sex, and baseline RNFL thickness. In the sectoral analysis, both higher mean IOP and IOP fluctuation predicted progressive RNFL thinning in the inferotemporal, superotemporal, superonasal, and temporal sectors in the order of strength of association. In the subgroup analysis by disease category, IOP fluctuation showed greater association with global RNFL thinning in eyes with primary angle closure glaucoma (P = .010) than in eyes without glaucomatous changes (P = .07). CONCLUSIONS In treated PACD eyes, large IOP fluctuation is an independent predictor for subsequent progressive RNFL thinning in addition to high mean IOP during follow-up.
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Merola RV, Cronemberger S, Veloso AW, Diniz-Filho A. Twenty-four hours intraocular pressure in keratoconic eyes assessed by applanation tonometry and Tono-Pen AVIA. Int J Ophthalmol 2022; 15:52-58. [PMID: 35047356 DOI: 10.18240/ijo.2022.01.08] [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: 03/27/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To assess intraocular pressure (IOP) during the daily curve of intraocular pressure (DCPo) in keratoconic eyes and compare Goldmann applanation tonometer (GAT), without and with astigmatism correction (nGAT and cGAT) and Tono-Pen AVIA (TPA) assessment methods. METHODS Thirty-nine keratoconic eyes of 24 patients were assessed. DCPo was evaluated with five IOP measurements; four were performed with a GAT (nGAT and cGAT), and a Tono-Pen AVIA (TPA) at various times throughout the day. RESULTS Mean IOP DCPo values (mm Hg) were: nGAT, 9.9±2.6; cGAT, 11.3±2.6; TPA 12.3±3.1. Mean IOP DCPo differences (mm Hg) and Spearman's correlation coefficients were as follows: cGATc-nGAT, 1.32±1.31, r s=0.879 (P<0.01); cGAT-TPA, -1.02±2.08, r s=0.723 (P<0.01); and nGAT-TPA, -2.35±2.23, r s=0.730 (P<0.01). Bland-Altman analysis for agreement between cGAT-TPA and nGAT-TPA mean IOP DCPo measurements revealed a mean difference of 1.02 (95%CI, 0.35-1.70) and 2.35 (95%CI, 1.62-3.07) mm Hg, respectively. Regression analysis yielded the following equation: TPA IOP=5.49+0.775×cGAT-0.015×ACD-0.299×corneal astig matism, which allowed us to infer TPA IOP values from other parameters. CONCLUSION In keratoconic eyes, IOP peaks of DCPo measurements are identified at 6 a.m., independent of the tonometer. The mean DCPo values are: TPA>cGAT>nGAT. IOP TPA measures are predictive of cGAT values, adjusted according to anterior chamber depth and corneal astigmatism.
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Affiliation(s)
- Rafael Vidal Merola
- Nassim Calixto Glaucoma Service of São Geraldo Eye Hospital, Clinic Hospital, Federal University of Minas Gerais-Belo Horizonte, Belo Horizonte 30130-100, State of Minas Gerais, Brazil
| | - Sebastião Cronemberger
- Nassim Calixto Glaucoma Service of São Geraldo Eye Hospital, Clinic Hospital, Federal University of Minas Gerais-Belo Horizonte, Belo Horizonte 30130-100, State of Minas Gerais, Brazil
| | - Artur William Veloso
- Nassim Calixto Glaucoma Service of São Geraldo Eye Hospital, Clinic Hospital, Federal University of Minas Gerais-Belo Horizonte, Belo Horizonte 30130-100, State of Minas Gerais, Brazil
| | - Alberto Diniz-Filho
- Nassim Calixto Glaucoma Service of São Geraldo Eye Hospital, Clinic Hospital, Federal University of Minas Gerais-Belo Horizonte, Belo Horizonte 30130-100, State of Minas Gerais, Brazil
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20
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Optical Microangiography and Progressive Retinal Nerve Fiber Layer Loss in Primary Open Angle Glaucoma. Am J Ophthalmol 2022; 233:171-179. [PMID: 34320375 PMCID: PMC8678163 DOI: 10.1016/j.ajo.2021.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To evaluate the association between optical microangiography (OMAG) measurements and progressive retinal nerve fiber layer (RNFL) loss in primary open angle glaucoma (POAG). DESIGN Prospective case series. METHODS Sixty-four eyes of 40 patients with POAG (108 quadrants) with mild to moderate functional damage were longitudinally studied for at least 2 years and with a minimum of 3 optical coherence tomography examinations. OMAG imaging was performed at the baseline visit. Effect of clinical parameters (age, sex, presence of systemic diseases, central corneal thickness, presence of disc hemorrhage, and mean and fluctuation of intraocular pressure during follow-up), baseline hemifield mean deviation, baseline quadrant optical coherence tomography RNFL and ganglion cell inner plexiform layer thickness), and OMAG (peripapillary and macular perfusion density [PD] and vessel density [VD]) on the rate of RNFL change was evaluated using linear mixed models. RESULTS Average (±SD) mean deviation, RNFL, and ganglion cell inner plexiform layer thickness of the analyzed quadrants at baseline were -5.5 ± 2.9 dB, 96.5 ± 17.9 µm, and 73.8 ± 8.6 µm, respectively. Peripapillary PD and VD in the quadrant were 44.6% ± 5.9% and 17.5 ± 2.2 mm/mm2, respectively. Rate of quadrant RNFL change was -1.8 ± 0.6 µm/y. Multivariate mixed models showed that lower peripapillary PD (coefficient = 0.08, P = .01) and lower VD (coefficient = 0.21, P = .02) were significantly associated with a faster rate of RNFL loss. CONCLUSIONS Lower baseline peripapillary PD and VD measured using OMAG were significantly associated with a faster rate of RNFL loss in POAG. OMAG imaging provides useful information about the risk of glaucoma progression and the rate of disease worsening.
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Sood S, Heilenbach N, Sanchez V, Glied S, Chen S, Al-Aswad LA. Cost-Effectiveness Analysis of Minimally Invasive Trabecular Meshwork Stents with Phacoemulsification. Ophthalmol Glaucoma 2021; 5:284-296. [PMID: 34563713 DOI: 10.1016/j.ogla.2021.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the costs and effects of implanting trabecular meshwork bypass stents during cataract surgery from a societal perspective in the United States. DESIGN Cost-utility analysis using Markov models and efficacy/safety data from published pivotal or randomized control trials (RCTs) of devices investigated. PARTICIPANTS Patients aged 65 years and older with mild to moderate primary open-angle glaucoma with or without visually significant cataract. METHODS With the use of Markov models, glaucoma progression through 4 glaucoma states (mild, moderate, advanced, severe/blind) and death were simulated over 35 years. The cohort with cataract entered the model and received cataract surgery with or without device implantation. We included a medication management only reference group to calculate total costs and outcomes for those without cataract. Intraocular pressure (IOP) reductions from RCTs were converted to glaucoma state transition probabilities using visual field (VF) mean deviation (MD) decline rates from the Early Manifest Glaucoma Trial. Progressive thinning of the retinal nerve fiber layer (RNFL) on OCT imaging related to IOP control warranted further intervention, including adding medication, selective laser trabeculoplasty (SLT), or incisional glaucoma surgery. We estimated whole costs at Medicare rates and obtained utility values for glaucoma states from previous studies. Incremental costs per quality-adjusted life-year (QALY) gained were evaluated at a QALY threshold of $50 000. One-way deterministic sensitivity analysis, scenario analyses, and probabilistic sensitivity analyses addressed parameter uncertainty and demonstrated model robustness. MAIN OUTCOME MEASURES Total costs, QALY, and incremental cost-effectiveness ratio (ICER). RESULTS Over 35 years in the base case, the Hydrus (Ivantis, Inc.) implanted with cataract surgery arm cost $48 026.13 and gained 12.26 QALYs. The iStent inject (Glaukos Corp.) implanted with cataract surgery arm cost $49 599.86 and gained 12.21 QALYs. Cataract surgery alone cost $54 409.25 and gained 12.04 QALYs. Initial nonsurgical management cost $57 931.22 and gained 11.74 QALY. The device arms dominated or were cost-effective compared with cataract surgery alone within 5 years and throughout sensitivity analyses. The iStent inject arm was cost-effective in 94.19% of iterations in probabilistic sensitivity analyses, whereas the Hydrus arm was cost-effective in 94.69% of iterations. CONCLUSIONS Implanting the Hydrus Microstent or iStent inject during cataract surgery is cost-effective at a conservative QALY threshold.
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Affiliation(s)
- Shefali Sood
- New York University, Grossman School of Medicine, Department of Ophthalmology, New York, New York; New York University, Robert F. Wagner School of Public Service, New York, New York
| | - Noah Heilenbach
- New York University, Grossman School of Medicine, Department of Ophthalmology, New York, New York
| | - Victor Sanchez
- New York University, Grossman School of Medicine, Department of Ophthalmology, New York, New York
| | - Sherry Glied
- New York University, Robert F. Wagner School of Public Service, New York, New York
| | - Sien Chen
- New York University, Grossman School of Medicine, Department of Ophthalmology, New York, New York
| | - Lama A Al-Aswad
- New York University, Grossman School of Medicine, Department of Ophthalmology, New York, New York; New York University, Grossman School of Medicine, Department of Population Health, New York, New York.
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22
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Datta S, Mariottoni EB, Dov D, Jammal AA, Carin L, Medeiros FA. RetiNerveNet: using recursive deep learning to estimate pointwise 24-2 visual field data based on retinal structure. Sci Rep 2021; 11:12562. [PMID: 34131181 PMCID: PMC8206091 DOI: 10.1038/s41598-021-91493-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 05/27/2021] [Indexed: 11/09/2022] Open
Abstract
Glaucoma is the leading cause of irreversible blindness in the world, affecting over 70 million people. The cumbersome Standard Automated Perimetry (SAP) test is most frequently used to detect visual loss due to glaucoma. Due to the SAP test’s innate difficulty and its high test-retest variability, we propose the RetiNerveNet, a deep convolutional recursive neural network for obtaining estimates of the SAP visual field. RetiNerveNet uses information from the more objective Spectral-Domain Optical Coherence Tomography (SDOCT). RetiNerveNet attempts to trace-back the arcuate convergence of the retinal nerve fibers, starting from the Retinal Nerve Fiber Layer (RNFL) thickness around the optic disc, to estimate individual age-corrected 24-2 SAP values. Recursive passes through the proposed network sequentially yield estimates of the visual locations progressively farther from the optic disc. While all the methods used for our experiments exhibit lower performance for the advanced disease group (possibly due to the “floor effect” for the SDOCT test), the proposed network is observed to be more accurate than all the baselines for estimating the individual visual field values. We further augment the proposed network to additionally predict the SAP Mean Deviation values and also facilitate the assignment of higher weightage to the underrepresented groups in the data. We then study the resulting performance trade-offs of the RetiNerveNet on the early, moderate and severe disease groups.
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Affiliation(s)
- Shounak Datta
- Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC, 27708, USA
| | - Eduardo B Mariottoni
- Vision, Imaging and Performance (VIP) Laboratory, Duke Eye Center, Duke University, Durham, NC, 27705, USA
| | - David Dov
- Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC, 27708, USA
| | - Alessandro A Jammal
- Vision, Imaging and Performance (VIP) Laboratory, Duke Eye Center, Duke University, Durham, NC, 27705, USA
| | - Lawrence Carin
- Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC, 27708, USA
| | - Felipe A Medeiros
- Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC, 27708, USA. .,Vision, Imaging and Performance (VIP) Laboratory, Duke Eye Center, Duke University, Durham, NC, 27705, USA.
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23
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Zaman F, Gieser SC, Schwartz GF, Swan C, Williams JM. A multicenter, open-label study of netarsudil for the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension in a real-world setting. Curr Med Res Opin 2021; 37:1011-1020. [PMID: 33733980 DOI: 10.1080/03007995.2021.1901222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Assess the real-world efficacy of netarsudil, either as monotherapy or concomitant therapy, in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT) requiring modification of intraocular pressure (IOP)-lowering treatment. METHODS Multicenter, prospective, interventional, open-label, Phase 4 study, clinical trial registration number: NCT03808688. Netarsudil ophthalmic solution 0.02% was prescribed at the recommended once-daily dosage, with treatment regimens determined by the investigators. Netarsudil could be used alone or in combination with other IOP-lowering medications, consistent with standard clinical practice. Primary efficacy endpoint: percentage reduction from baseline IOP at week 12. RESULTS Among 261 enrolled patients, 242 received ≥1 netarsudil dose and had ≥1 follow-up IOP measurement (efficacy population). Mean IOP in patients who were treatment-naïve at baseline and using netarsudil as monotherapy (n = 24) decreased by 16.9%. Netarsudil monotherapy was comparable in efficacy to prior therapy across subgroups, and those who replaced prostaglandin analog (n = 57) monotherapy demonstrated reduction of 2.5% from prostaglandin analog-treated baseline values. Among patients who used netarsudil as concomitant therapy (n = 151), reductions in mean IOP (± standard deviation) to week 12 were seen across subgroups who added netarsudil to a single agent (4.3 ± 2.88 mmHg; 20.5%) or ≥2 classes of concomitant therapy (4.5 ± 4.08 mmHg; 20.9%) and who used netarsudil to replace ≥1 other drug classes (0.4 ± 2.47 mmHg; 1.7%). Of 260 netarsudil-treated patients, 41 (15.8%) discontinued, including 29 (11.2%) due to adverse events. CONCLUSIONS In the real-world treatment of patients with OAG or OHT, netarsudil consistently maintained IOP control when it replaced previous IOP-lowering therapies and provided additional IOP-lowering efficacy when added to other treatments.
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Affiliation(s)
- Fiaz Zaman
- Houston Eye Associates, Houston, TX, USA
| | | | | | - Cayla Swan
- Aerie Pharmaceuticals, Inc., Durham, NC, USA
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24
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Wang J, Struebing FL, Geisert EE. Commonalities of optic nerve injury and glaucoma-induced neurodegeneration: Insights from transcriptome-wide studies. Exp Eye Res 2021; 207:108571. [PMID: 33844961 PMCID: PMC9890784 DOI: 10.1016/j.exer.2021.108571] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 02/03/2023]
Abstract
Glaucoma is a collection of diseases that lead to an irreversible vision loss due to damage of retinal ganglion cells (RGCs). Although the underlying events leading to RGC death are not fully understood, recent research efforts are beginning to define the genetic changes that play a critical role in the initiation and progression of glaucomatous injury and RGC death. Several genetic and experimental animal models have been developed to mimic glaucomatous neurodegeneration. These models differ in many respects but all result in the loss of RGCs. Assessing transcriptional changes across different models could provide a more complete perspective on the molecular drivers of RGC degeneration. For the past several decades, changes in the retinal transcriptome during neurodegeneration process were defined using microarray methods, RNA sequencing and now single cell RNA sequencing. It is understood that these methods have strengths and weaknesses due to technical differences and variations in the analytical tools used. In this review, we focus on the use of transcriptome-wide expression profiling of the changes occurring as RGCs are lost across different glaucoma models. Commonalities of optic nerve crush and glaucoma-induced neurodegeneration are identified and discussed.
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Affiliation(s)
- Jiaxing Wang
- Emory Eye Center, Department of Ophthalmology, Emory University, 1365B Clifton Road NE, Atlanta, GA, 30322, USA
| | - Felix L. Struebing
- Center for Neuropathology and Prion Research, Ludwig Maximilian University of Munich, Germany,Department for Translational Brain Research, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Eldon E. Geisert
- Emory Eye Center, Department of Ophthalmology, Emory University, 1365B Clifton Road NE, Atlanta, GA, 30322, USA,Corresponding author: (E.E. Geisert)
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25
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Jammal AA, Berchuck SI, Thompson AC, Costa VP, Medeiros FA. The Effect of Age on Increasing Susceptibility to Retinal Nerve Fiber Layer Loss in Glaucoma. Invest Ophthalmol Vis Sci 2021; 61:8. [PMID: 33151281 PMCID: PMC7645210 DOI: 10.1167/iovs.61.13.8] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Purpose To determine whether aging modifies the effect of intraocular pressure (IOP) on progressive glaucomatous retinal nerve fiber layer (RNFL) thinning over time. Methods This was a retrospective cohort study involving patients with glaucoma or suspected of having glaucoma who were followed over time from the Duke Glaucoma Registry. Rates of RNFL loss from spectral-domain optical coherence tomography (SD-OCT) were used to assess disease progression. Generalized estimating equations with robust sandwich variance estimators were used to investigate the effects of the interaction of age at baseline and mean IOP on rates of RNFL loss over time. Models were adjusted for gender, race, diagnosis, central corneal thickness, follow-up time, and baseline disease severity. Results The study included 85,475 IOP measurements and 60,026 SD-OCT tests of 14,739 eyes of 7814 patients. Eyes had a mean follow-up time of 3.5 ± 1.9 years. The average rate of change in RNFL thickness was –0.70 µm/year (95% confidence interval, –0.72 to –0.67). There was a significant interaction between age and mean IOP and the rate of RNFL loss (P = 0.001), with older eyes having significantly faster rates of RNFL loss than younger ones for the same level of IOP. The effect of IOP on rates of change was greater in the inferior and superior regions of the optic disc. Conclusions Age is a significant modifier of the relationship between IOP and glaucomatous loss in RNFL thickness over time. Older patients may be more susceptible to glaucomatous progression than younger patients at the same level of IOP.
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Affiliation(s)
- Alessandro A Jammal
- Vision, Imaging and Performance Laboratory, Duke Eye Center, and Department of Ophthalmology, Duke University, Durham, North Carolina, United States.,Department of Ophthalmology, Universidade Estadual de Campinas, Campinas, Brazil
| | - Samuel I Berchuck
- Vision, Imaging and Performance Laboratory, Duke Eye Center, and Department of Ophthalmology, Duke University, Durham, North Carolina, United States.,Department of Statistical Science and Forge, Duke University, Durham, North Carolina, United States
| | - Atalie C Thompson
- Vision, Imaging and Performance Laboratory, Duke Eye Center, and Department of Ophthalmology, Duke University, Durham, North Carolina, United States
| | - Vital P Costa
- Department of Ophthalmology, Universidade Estadual de Campinas, Campinas, Brazil
| | - Felipe A Medeiros
- Vision, Imaging and Performance Laboratory, Duke Eye Center, and Department of Ophthalmology, Duke University, Durham, North Carolina, United States.,Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina, United States
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