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Han Y, Wang X, Xue CC, Jonas JB, Wang YX. Lamina Cribrosa Configurations in Highly Myopic and Non-Highly Myopic Eyes: The Beijing Eye Study. Invest Ophthalmol Vis Sci 2024; 65:28. [PMID: 39023442 PMCID: PMC11262544 DOI: 10.1167/iovs.65.8.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/01/2024] [Indexed: 07/20/2024] Open
Abstract
Purpose The purpose of this study was to examine characteristics of lamina cribrosa (LC) configuration in highly myopic (HM) eyes. Methods Participants from the Beijing Eye Study 2011, free of optic nerve or retinal diseases, were randomly selected to examine LC depth (LCD) and LC tilt (LCT) using three-dimensional optical coherent tomography images of the optic nerve head (ONH). LCD and LCT were measured as the distance and angle between the LC plane with two reference planes, including the Bruch's membrane opening (BMO) plane and the peripapillary sclera (PPS) plane, respectively. Each parameter was measured in both horizontal and vertical B-scans. Results The study included 685 individuals (685 eyes) aged 59.6 ± 7.7 years, including 72 HM eyes and 613 non-HM eyes. LCD measurements showed no significant differences between HM eyes and non-HM eyes in both horizontal (LCD-BMO = 421.83 ± 107.86 µm for HM eyes vs. 447.24 ± 104.94 µm for non-HM eyes, P = 0.18; and LCD-PPS = 406.39 ± 127.69 µm vs. 394.00 ± 101.64 µm, P = 1.00) and vertical directions (LCD-BMO = 435.78 ± 101.29 µm vs. 450.97 ± 106.54 µm, P = 0.70; and LCD-PPS = 401.62 ± 109.9 µm vs. 379.85 ± 110.35 µm, P = 0.35). However, the LCT was significantly more negative (tilted) in HM eyes than in non-HM eyes horizontally (LCT-BMO = -4.38 ± 5.94 degrees vs. -0.04 ± 5.86 degrees, P < 0.001; and LCT-PPS = -3.16 ± 5.23 degrees vs. -0.94 ± 4.71 degrees, P = 0.003), but not vertically (P = 1.00). Conclusions Although LCD did not differ significantly between HM and non-HM eyes, LCT was more negative in HM eyes, suggesting that the temporal or inferior side of the LC was closer to the reference plane. These findings provide insights into morphological and structural changes in the LC and ONH between HM and non-HM eyes.
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Affiliation(s)
- Yingxiang Han
- Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xiaofei Wang
- Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Can Can Xue
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Jost B. Jonas
- Rothschild Foundation Hospital, Institut Français de Myopie, Paris, France
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
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Jiravarnsirikul A, Yang H, Jeoung JW, Hong SW, Rezapour J, Gardiner S, Fortune B, Girard MJA, Nicolela M, Zangwill LM, Chauhan BC, Burgoyne CF. OCT Optic Nerve Head Morphology in Myopia IV: Neural Canal Scleral Flange Remodeling in Highly Myopic Eyes. Am J Ophthalmol 2024; 261:141-164. [PMID: 38311154 PMCID: PMC11031338 DOI: 10.1016/j.ajo.2024.01.023] [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: 11/15/2023] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To compare the prevalence, location and magnitude of optic nerve head (ONH) OCT-detected, exposed neural canal (ENC), externally oblique choroidal border tissue (EOCBT) and exposed scleral flange (ESF) regions in 122 highly myopic (Hi-Myo) versus 362 nonhighly myopic healthy (Non-Hi-Myo-Healthy) eyes. DESIGN Cross-sectional study. METHODS After OCT radial B-scan, ONH imaging, Bruch's membrane opening (BMO), the anterior scleral canal opening (ASCO), and the scleral flange opening (SFO) were manually segmented in each B-scan and projected to BMO reference plane. The direction and magnitude of BMO/ASCO offset and BMO/SFO offset as well as the location and magnitude of ENC, EOCBT and ESF regions, perineural canal (pNC) retinal nerve fiber layer thickness (RNFLT) and pNC choroidal thickness (CT) were calculated within 30° sectors relative to the Foveal-BMO (FoBMO) axis. Hi-ESF eyes were defined to be those with an ESF region ≥100 µms in at least 1 sector. RESULTS Hi-Myo eyes more frequently demonstrated Hi-ESF regions (87/122) than Non-Hi-myo-Healthy eyes (73/362) and contained significantly larger ENC, EOCBT, and ESF regions (P < .001) which were greatest in magnitude and prevalence within the inferior-temporal FoBMO sectors where Hi-Myo pNC-RNFLT and pNCCT were thinnest. BMO/ASCO offset and the BMO/SFO offset were both significantly increased (P < .001) in the Hi-Myo eyes, with the latter demonstrating a greater increase. CONCLUSIONS ENC region tissue remodeling that includes the scleral flange is enhanced in Hi-Myo compared to Non-Hi-Myo-Healthy eyes. Longitudinal studies are necessary to determine whether the presence of an ENC region influences ONH susceptibility to aging and/or glaucoma.
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Affiliation(s)
- Anuwat Jiravarnsirikul
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory (A.J., H.Y., C.F.B.), Legacy Research Institute, Portland, Oregon, USA; Department of Ophthalmology (A.J.), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Hongli Yang
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory (A.J., H.Y., C.F.B.), Legacy Research Institute, Portland, Oregon, USA
| | - Jin Wook Jeoung
- Department of Ophthalmology (J.W.J.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | | | - Jasmin Rezapour
- Viterbi Family Department of Ophthalmology (J.R., L.Z.), Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, California, USA; Department of Ophthalmology (J.R.), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stuart Gardiner
- Devers Eye Institute, Discoveries in Sight Research Laboratories (S.G., B.F.), Legacy Research Institute, Portland, Oregon, USA
| | - Brad Fortune
- Devers Eye Institute, Discoveries in Sight Research Laboratories (S.G., B.F.), Legacy Research Institute, Portland, Oregon, USA
| | - Michaël J A Girard
- Department of Biomedical Engineering (M.J.A.G.), Ophthalmic Engineering & Innovation Laboratory, National University of Singapore, Singapore, Singapore
| | - Marcelo Nicolela
- Ophthalmology and Visual Sciences (M.N., B.C.C.), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Linda M Zangwill
- Viterbi Family Department of Ophthalmology (J.R., L.Z.), Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, California, USA
| | - Balwantray C Chauhan
- Ophthalmology and Visual Sciences (M.N., B.C.C.), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Claude F Burgoyne
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory (A.J., H.Y., C.F.B.), Legacy Research Institute, Portland, Oregon, USA.
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Lee KM, Rhim JH, Ahn HJ, Kim M, Oh S, Park SW, Kim SH. Association between eyeball asymmetry and offset of openings in optic nerve head canal assessed by posterior polar eyeball topography. Sci Rep 2024; 14:9952. [PMID: 38688983 PMCID: PMC11061147 DOI: 10.1038/s41598-024-60716-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/26/2024] [Indexed: 05/02/2024] Open
Abstract
We investigated three-dimensional (3D) eyeball protrusion and its association with the offset between the lamina cribrosa (LC) and Bruch's membrane opening (BMO). 3D-MRI scans were taken from 93 subjects (186 eyes). An ellipsoid was fitted along the posterior 2/3 contour of each eyeball. Eyeball asymmetry with focal bulging was determined by the existence of an adjacent outward protrusion/reciprocal inward depression pair, and the angular deviation of the outermost protruded point (OPP) was measured from the nasal side of the fovea-BMO axis. The LC/BMO offset was evaluated by measuring the central retinal vascular trunk (CRVT) location from the BMO center: (1) the angular deviation and (2) the offset index as the ratio between the CRVT-BMO center distance and the BMO radius in the same direction. Seventy-nine eyes (42%) were classified as having eyeball asymmetry, which had a more superior LC/BMO offset (P < 0.001) and a larger offset index (P = 0.002). In those eyes, the angular deviation of the OPP showed a significant correlation with that of the LC/BMO offset (r = -0.724, P < 0.001), as did protrusion depth with the offset index (r = 0.291, P = 0.009). The presence of eyeball asymmetry was associated with superior LC/BMO offset (P = 0.004) and larger offset index (P = 0.009). Superior LC/BMO offset was associated with older age (P < 0.001), shorter axial length (P < 0.001) and inferior location of OPP (P < 0.001). The location and extent of focal bulging were closely associated with those of LC/BMO offset. This indicates that focal bulging during expansion might be associated with diverse directionality of LC/BMO offset.
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Affiliation(s)
- Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
- Department of Ophthalmology, Seoul National University Boramae Medical Center, 39 Boramae Road, Dongjak-gu, Seoul, 07061, Korea.
| | - Jung Hyo Rhim
- Department of Radiology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyoung Jun Ahn
- Department of Mathematical Modeling, Mind Flow Lab, Seoul, Korea
| | - Martha Kim
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sun-Won Park
- Department of Radiology, Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok Hwan Kim
- Department of Ophthalmology, The One Seoul Eye Clinic, Seoul, Korea
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Bak E, Kim M, Kim SH, Lee KM. Optic nerve head factors associated with initial central visual field defect in primary open-angle glaucoma. Sci Rep 2024; 14:8000. [PMID: 38580736 PMCID: PMC10997601 DOI: 10.1038/s41598-024-58749-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/02/2024] [Indexed: 04/07/2024] Open
Abstract
We investigated optic nerve head factors associated with initial parafoveal scotoma (IPFS) in primary open-angle glaucoma. Eighty (80) patients with an IPFS and 84 patients with an initial nasal step (INS) were compared. Central retinal vascular trunk (CRVT) deviation from the Bruch's membrane opening (BMO) center was measured as a surrogate of lamina cribrosa (LC)/BMO offset, and its obliqueness was defined as the absolute value of angular deviation from the fovea-BMO axis. Proximity of retinal nerve fiber layer defect (RNFLD) was defined as the angular deviation of the inner RNFLD margin from the fovea-BMO axis. Microvasculature dropout (MvD) was defined as a focal sectoral capillary dropout with no visible microvascular network identified in the choroidal layer. Factors associated with IPFS, as compared with INS, were assessed using logistic regression analyses and conditional inference tree analysis. The IPFS group had more oblique CRVT offset (P < 0.001), RNFLD closer to the fovea (P < 0.001), more MvD (P < 0.001), and more LC defects (P < 0.001) compared to the INS group. In logistic regression analyses, obliqueness of CRVT offset (P = 0.002), RNFLD proximity (P < 0.001), and MvD (P = 0.001) were significant factors influencing the presence of IPFS. Conditional inference tree analysis showed that RNFLD closer to the fovea (P < 0.001) in the upper level, more oblique CRVT offset (P = 0.013) and presence of MvD (P = 0.001) in the lower level were associated with the probability of having IPFS. IPFS was associated with closer RNFLD location to the fovea when assessed from the BMO. Oblique LC/BMO offset may not only mask RNFLD proximity to the fovea due to a deviated funduscopic disc appearance, but also potentiate IPFS via focal LC defect and MvD.
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Affiliation(s)
- Eunoo Bak
- Department of Ophthalmology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Martha Kim
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | | | - Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Ophthalmology, Seoul National University Boramae Medical Center, 39 Boramae Road, Dongjak-gu, Seoul, 07061, Korea.
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Joo CW, Choi YJ, Kim HU, Park SP, Na KI. Morphological differences of the neuroretinal rim between temporally tilted and non-tilted optic discs in healthy eyes. Sci Rep 2024; 14:6070. [PMID: 38480784 PMCID: PMC10937920 DOI: 10.1038/s41598-024-54116-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/08/2024] [Indexed: 03/17/2024] Open
Abstract
This study aimed to compare morphological differences of the neuroretinal rim between the temporally tilted and non-tilted optic discs in healthy eyes. We prospectively enrolled participants aged 20-40 years with temporally tilted or non-tilted optic discs. The optic nerve head parameters were analyzed using spectral domain-optical coherence tomography. The angle between the Bruch's membrane opening (BMO) plane and BMO-minimum rim width (BMO-MRW) was termed "BMO-MRW angle". Peripapillary retinal nerve fiber layer thickness (pRNFLT) and BMO-based parameters were compared between the temporally tilted and non-tilted disc groups. As a result, 55 temporally tilted disc eyes and 38 non-tilted disc eyes were analyzed. Global pRNFLT, global BMO-MRW, and total BMO-minimum rim area (BMO-MRA) were similar between the two groups (p = 0.138, 0.161, and p = 0.410, respectively). In the sectoral analysis, temporally tilted disc group exhibited thicker BMO-MRW in the temporal sector (p = 0.032) and thinner in the nasal superior and nasal sectors (p = 0.025 and p = 0.002, respectively). Temporally tilted disc group showed larger BMO-MRA in the temporal, temporal superior, and temporal inferior sectors (p < 0.001, p < 0.001, and p < 0.016, respectively), alongside a higher BMO-MRW angle in the temporal sector and lower in the nasal superior and nasal sectors. In conclusion, the neuroretinal rim, represented by BMO-MRW and BMO-MRA, showed morphological differences between temporally tilted and non-tilted optic discs in healthy eyes. BMO-MRW and BMO-MRA showed temporalization in the same manner as pRNFLT in the temporally tilted disc eyes. The BMO-MRW angle showed that in temporally tilted disc eyes, optic nerve fibers met the BMO plane steeply in the nasal sector and gently in the temporal sector than in non-tilted disc eyes, suggesting potential stress region of optic nerve fibers in temporally tilted disc eyes.
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Affiliation(s)
- Chan Woong Joo
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, #150 Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea
| | - Youn Joo Choi
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, #150 Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea
| | - Han Ul Kim
- Department of Ophthalmology, Armed Forces Seoul District Hospital, Seoul, South Korea
| | - Sung Pyo Park
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, #150 Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea
| | - Kyeong Ik Na
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, #150 Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea.
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Lee EJ, Han JC, Kee C. Deep Optic Nerve Head Morphology in Tilted Disc Syndrome and Its Clinical Implication on Visual Damage. Invest Ophthalmol Vis Sci 2023; 64:10. [PMID: 37796490 PMCID: PMC10561776 DOI: 10.1167/iovs.64.13.10] [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: 06/09/2023] [Accepted: 08/22/2023] [Indexed: 10/06/2023] Open
Abstract
Purpose To study deep optic nerve head (ONH) morphology in tilted disc syndrome (TDS) and identify factors associated with retinal nerve fiber layer (RNFL) defect. Methods In patients with TDS, we evaluated the optic disc shape using the Bruch's membrane opening (BMO)-anterior scleral canal opening (ASCO) offset and measured the border tissue (BT) length, depth, and angle in the direction of the tilt, using radial ONH optical coherence tomography (OCT). We compared the parameters between the TDS groups with and without RNFL defects. Results Twenty-one eyes had no glaucomatous RNFL defect, and 38 eyes had a glaucomatous RNFL defect. The group with RNFL defects had a higher baseline IOP, larger tilt axis of BMO-ASCO optic disc margin (76.4° ± 14.5° vs. 87.9° ± 15.4°, P = 0.012), larger BMO-lamina cribrosa insertion (LCI) angle (25.6° ± 9.3° vs. 43.6° ± 15.2°, P < 0.001), and more lamina cribrosa (LC) defects (4.3% vs. 30.6%, P = 0.028) than without RNFL defects. The tilt axis and BMO-LCI angle were significant factors after adjusting for baseline IOP and LC defect. The BMO-LCI angle had excellent diagnostic power for glaucomatous RNFL defect in TDS, similar to the visual field mean deviation. Conclusions OCT-based large deep ONH BT angle and tilt axis were factors associated with the presence of RNFL defects in TDS. The results suggest a mechanism of RNFL defect associated with structural ONH deformation. Further investigations are warranted to understand the role of ONH structures in a general population with and without optic disc tilt.
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Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Oh R, Lee KM, Kim M, Oh S, Kim SH. Hemisphere opposite to central retinal vascular trunk deviation is earlier affected by glaucomatous damage in primary angle-closure glaucoma. Acta Ophthalmol 2023; 101:e252-e260. [PMID: 36134905 DOI: 10.1111/aos.15258] [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: 03/10/2022] [Revised: 08/15/2022] [Accepted: 09/03/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of the study was to investigate whether the position of the central retinal vascular trunk (CRVT), as a surrogate for lamina cribrosa (LC) offset, is associated with the dominant hemisphere of visual field defect in primary angle-closure glaucoma (PACG) eyes. METHODS Central retinal vascular trunk deviation was measured from Bruch's membrane opening (BMO) centre, which was delineated by OCT imaging, using the horizontal midline as a reference. The dominant hemisphere developing visual field defect was defined as three connected abnormal points (having a p-value < 5% probability of being normal) appearing in only one hemisphere or each point of the hemisphere having a statistically worse value compared with its mirrored point in the opposite hemisphere on pattern deviation plots. RESULTS One hundred five (80%) of 132 eyes with PACG had dominant hemisphere of visual field defect initially: 70 eyes (67%) in the superior and 35 eyes (33%) in the inferior hemisphere. The CRVT was located superiorly in the dominant superior visual field defect group (p < 0.001). A logistic regression analysis revealed that superior deviation of the CRVT was the only factor associated with dominant superior visual field defect (p < 0.001). Externally oblique border (EOB) presence was associated with larger BMO (p = 0.005) and angular deviation of CRVT (p = 0.002). CONCLUSIONS Central retinal vascular trunk deviation was associated with the dominant hemisphere of visual field defect in PACG eyes. This finding implies that the LC position relative to the BMO centre (LC/BMO offset) may incur structural vulnerability in the optic nerve head of PACG eyes.
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Affiliation(s)
- Richul Oh
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
| | - Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Martha Kim
- Department of Ophthamology, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Seok Hwan Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, South Korea
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