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Wang Q, Li T, Zhang X, Zeng Y, Yang Y, Zhou Y, Gu X, Xie X, Ling S. Distinctive Imaging Characteristics of Retinal and Cerebral Vessels between Central and Branch Retinal Vein Occlusion by MRI and AI-Based Image Analyzer. Diagnostics (Basel) 2024; 14:267. [PMID: 38337783 PMCID: PMC10854905 DOI: 10.3390/diagnostics14030267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/04/2024] [Accepted: 01/13/2024] [Indexed: 02/12/2024] Open
Abstract
Retinal vessels have been good predictive and prognostic imaging biomarkers for systemic or eye diseases. Numerous studies have shown that the two retinal vein occlusion entities may correlate with cardiovascular and cerebrovascular events or primary open-angle glaucoma. This study aims to investigate if there is a disparity in the correlations between branch RVO (BRVO) and central RVO (CRVO) with systemic disorders or POAG, thus explaining the pathogenic difference between BRVO and CRVO. This retrospective case-control study enrolled 59 RVO subjects (118 eyes), including 25 CRVO and 34 BRVO subjects, who received routine eye and brain MRI examinations. The geometric characteristics of the caliber of the retinal and cerebral blood vessels and the optic nerve subarachnoid space width (ONSASW) were measured. Multivariable logistic regression analysis showed that ONSASW at 3 mm behind the globe (p = 0.044) and the relative retinal venular calibers (p = 0.031) were independent risk factors for the CRVO-affected eyes group in comparison with the BRVO-affected eyes group after adjusting for age, duration of hypertension, BMI, and IOP. In the CRVO-affected eyes, narrower relative retinal arteriolar calibers (p = 0.041) and wider relative venular calibers (p = 0.011) were independent risk factors compared with the CRVO-contralateral normal eyes when adjusting for IOP. We concluded that BRVO may be more associated with cerebrovascular diseases, and CRVO may be correlated with primary angle glaucoma. The geometric characteristics difference between the retinal and cerebrovascular may explain the pathological difference between CRVO and BRVO.
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Affiliation(s)
- Qiyun Wang
- Beijing Tongren Eye Center, Tongren Hospital, Capital Medical University, Beijing 100730, China; (Q.W.); (Y.Z.); (Y.Y.); (X.G.)
- Beijing Retinal and Choroidal Vascular Disorders Study Group, Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Ting Li
- Department of Radiology, Capital Medical University, Beijing Tongren Hospital, Beijing 100176, China;
| | - Xinyuan Zhang
- Beijing Tongren Eye Center, Tongren Hospital, Capital Medical University, Beijing 100730, China; (Q.W.); (Y.Z.); (Y.Y.); (X.G.)
- Beijing Retinal and Choroidal Vascular Disorders Study Group, Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yiyun Zeng
- Beijing Tongren Eye Center, Tongren Hospital, Capital Medical University, Beijing 100730, China; (Q.W.); (Y.Z.); (Y.Y.); (X.G.)
- Beijing Retinal and Choroidal Vascular Disorders Study Group, Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yang Yang
- Beijing Tongren Eye Center, Tongren Hospital, Capital Medical University, Beijing 100730, China; (Q.W.); (Y.Z.); (Y.Y.); (X.G.)
- Beijing Retinal and Choroidal Vascular Disorders Study Group, Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yun Zhou
- China National Clinical Research Center for Neurological Diseases, Tiantan Hospital, Capital Medical University, Beijing 100730, China;
| | - Xinming Gu
- Beijing Tongren Eye Center, Tongren Hospital, Capital Medical University, Beijing 100730, China; (Q.W.); (Y.Z.); (Y.Y.); (X.G.)
- Beijing Retinal and Choroidal Vascular Disorders Study Group, Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Xiaobin Xie
- Eye Hospital of China Academy of Chinese Medical Sciences, Beijing 100040, China;
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Lin Z, Li D, Wen L, Wang Y, Wang FH, Liang YB. ASSOCIATION OF OCULAR PERFUSION PRESSURE AND CEREBROSPINAL FLUID PRESSURE WITH CHANGES IN DIABETIC RETINOPATHY. Retina 2023; 43:1107-1113. [PMID: 36977320 DOI: 10.1097/iae.0000000000003792] [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: 03/30/2023]
Abstract
PURPOSE To investigate the association between mean ocular perfusion pressure (MOPP), estimated cerebrospinal fluid pressure (CSFP), and changes in diabetic retinopathy (DR) in a Northeastern Chinese population with Type 2 diabetes. METHODS A total of 1,322 subjects from the Fushun Diabetic Retinopathy Cohort Study were enrolled. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and intraocular pressure (IOP) were recorded. MOPP was calculated by the following formula: MOPP = 2/3 [DBP + 1/3 (SBP - DBP)] - IOP, and CSFP was estimated according to the following formula: CSFP = 0.44 × body mass index + 0.16 × DBP - 0.18 × age - 1.91. New development, progression, and regression of DR were graded based on fundus photographs at baseline and during follow-up examinations with a mean interval of 21.2 months using the modified Early Treatment Diabetic Retinopathy Study criteria. RESULTS Increasing MOPP was associated with the incidence of DR in the multivariate model (per 1-mmHg increase: relative risk, 1.06; 95% confidence interval, 1.02-1.10; P = 0.007) and showed a borderline negative association with DR regression (per 1-mmHg increase: relative risk, 0.98; 95% confidence interval, 0.97-1.00; P = 0.053). However, MOPP was not associated with progression of DR. Cerebrospinal fluid pressure was not associated with new development, progression, or regression of DR. CONCLUSION The MOPP, but not the CSFP, was found to influence the development, but not the progression of DR in this Northeastern Chinese cohort.
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Affiliation(s)
- Zhong Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Dong Li
- Fushun Eye Hospital, Fushun, Liaoning, China; and
| | - Liang Wen
- Fushun Eye Hospital, Fushun, Liaoning, China; and
| | - Yu Wang
- Fushun Eye Hospital, Fushun, Liaoning, China; and
| | - Feng Hua Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Science Key Lab, Beijing, China
| | - Yuan Bo Liang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Machiele R, Frankfort BJ, Killer HE, Fleischman D. Problems in CSF and Ophthalmic Disease Research. FRONTIERS IN OPHTHALMOLOGY 2022; 2:896680. [PMID: 38983539 PMCID: PMC11182282 DOI: 10.3389/fopht.2022.896680] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/30/2022] [Indexed: 07/11/2024]
Abstract
There has been significant interest and progress in the understanding of cerebrospinal fluid pressure and its relationship to glaucoma and other ophthalmic diseases. However, just as every physiologic fluid pressure fluctuates, cerebrospinal fluid pressure (CSFP) is similarly dynamic. Coupling this with the difficulty in measuring the pressure, there are many obstacles in furthering this field of study. This review highlights some of the difficulties in CSFP research, including fluid compartmentalization, estimation equations, and pressure fluctuation. Keeping these limitations in mind will hopefully improve the quality and context of this burgeoning field.
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Affiliation(s)
- Ryan Machiele
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Hanspeter Esriel Killer
- Department of Ophthalmology, Kantonsspital Aarau, Aarau, Switzerland
- Center for Biomedicine University of Basel, Basel, Switzerland
| | - David Fleischman
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Liu Y, Chen J, Huang L, Yan S, Bian Q, Yang F. Relationships Among Retinal Nerve Fiber Layer Thickness, Vascular Endothelial Growth Factor, and Cognitive Impairment in Patients with Schizophrenia. Neuropsychiatr Dis Treat 2021; 17:3597-3606. [PMID: 34916796 PMCID: PMC8668245 DOI: 10.2147/ndt.s336077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Studies have suggested retinal nerve fiber layer (RNFL) involvement in the pathogenesis of schizophrenia. Additionally, research has shown that vascular endothelial growth factor (VEGF) potentially contributes to the pathophysiology of psychiatric disorders. Therefore, this study aimed to investigate VEGF, RNFL, and correlations with cognitive impairments in schizophrenia patients. METHODS Patients with schizophrenia (n = 138) were compared to healthy controls (n = 160). RNFLs were measured with optical coherence tomography (OCT). The Stroop color and word test (SCWT) was used to evaluate neurocognition. Blood samples were collected to measure VEGF. SPSS 20.0 was used to perform analysis of covariance, t-tests, partial correlation analysis, and linear regression. RESULTS Thinner RNFLs were found in schizophrenia patients (p < 0.001). RNFL showed a significant correlation with SCWT scores (all p < 0.05). Serum level of VEGF was lower in patients with schizophrenia (p = 0.010). Total and inferior RNFL thicknesses of right eyes were positively correlated to VEGF level (RNFL total thickness p = 0.032, inferior thickness p = 0.014).Total RNFL thicknesses were shown to be reduced following a prolonged duration of illness (both p < 0.01). CONCLUSION These findings suggest that patients with schizophrenia have degeneration with RNFL thickness following illness duration, which may contribute to neurocognitive impairments observed in schizophrenia. VEGF is speculated to play some important role on RNFL degeneration with schizophrenia patients.
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Affiliation(s)
- Yanhong Liu
- Huilongguan Clinical Medical School, Peking University, Beijing, People's Republic of China.,Beijing Huilongguan Hospital, Beijing, People's Republic of China
| | - Jingxu Chen
- Huilongguan Clinical Medical School, Peking University, Beijing, People's Republic of China.,Beijing Huilongguan Hospital, Beijing, People's Republic of China
| | - Lvzhen Huang
- Ophthalmology Department, People's Hospital of Peking University, Beijing, People's Republic of China
| | - Shaoxiao Yan
- Huilongguan Clinical Medical School, Peking University, Beijing, People's Republic of China.,Beijing Huilongguan Hospital, Beijing, People's Republic of China
| | - Qingtao Bian
- Huilongguan Clinical Medical School, Peking University, Beijing, People's Republic of China.,Beijing Huilongguan Hospital, Beijing, People's Republic of China
| | - Fude Yang
- Huilongguan Clinical Medical School, Peking University, Beijing, People's Republic of China.,Beijing Huilongguan Hospital, Beijing, People's Republic of China
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Liu Y, Huang L, Tong Y, Chen J, Gao D, Yang F. Association of retinal nerve fiber abnormalities with serum CNTF and cognitive functions in schizophrenia patients. PeerJ 2020; 8:e9279. [PMID: 32676219 PMCID: PMC7335503 DOI: 10.7717/peerj.9279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 05/12/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Recent studies have reported reductions in retinal nerve fiber layers (RNFL) in schizophrenia. Ciliary neurotrophic factor (CNTF) has shown protective effects on both the neurogenesis and retina. This study aimed at investigating retinal abnormalities and establishing their correlation with serum CNTF and cognitive impairments in schizophrenic Chinese patients. METHODS In total, 221 patients diagnosed with schizophrenia and 149 healthy controls were enrolled. Serum CNTF and clinical features of patients were investigated. Cognitive functions were evaluated with Repeatable Battery for the Assessment of Neuropsychology Status (RBANS). RNFL thickness and macular thickness (MT) of both eyes were measured with optical coherence tomography (OCT). T-tests and analysis of covariance were used to compare the variables between the patient and control groups, while multiple linear regression analysis was performed to determine the associations of RNFL thickness, CNTF and cognitive impairments. RESULTS RNFL was found thinner in patients than in healthy controls (right: 88.18 ± 25.84 µm vs.102.13 ± 14.32 µm, p = 0.001; left: 92.84 ± 13.54 µm vs.103.71 ± 11.94 µm, p < 0.001). CNTF was lower in the schizophrenia group (1755.45 ± 375.73 pg/ml vs. 1909.99 ± 368.08 pg/ml, p = 0.001). Decline in RNFL thickness was found correlated with course of illness and serum CNTF in patients (all p < 0.05). Similarly, cognitive functions such as immediate memory and visuospatial functions were also found correlated with decline in RNFL thickness. CONCLUSION Decline in RNFL thickness was associated with cognitive impairments of schizophrenia and CNFT serum concentration. The possibility of reduction in RNFL thickness as a biomarker for schizophrenia needs to be further examined.
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Affiliation(s)
- Yanhong Liu
- Peking University Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, Peking University, Beijing, China
| | - Lvzhen Huang
- People's Hospital of Peking University, Peking University, Beijing, China
| | - Yongsheng Tong
- Peking University Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, Peking University, Beijing, China
| | - Jingxu Chen
- Peking University Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, Peking University, Beijing, China
| | - Dongfang Gao
- Peking University Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, Peking University, Beijing, China
| | - Fude Yang
- Peking University Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, Peking University, Beijing, China
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Yao X, Ke M, Ho Y, Lin E, Wong DWK, Tan B, Schmetterer L, Chua J. Comparison of retinal vessel diameter measurements from swept-source OCT angiography and adaptive optics ophthalmoscope. Br J Ophthalmol 2020; 105:426-431. [PMID: 32461263 PMCID: PMC7907556 DOI: 10.1136/bjophthalmol-2020-316111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/14/2020] [Accepted: 05/01/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND/IMS To compare the retinal vessel diameter measurements obtained from the swept-source optical coherence tomography angiography (OCTA; Plex Elite 9000, Carl Zeiss Meditec, USA) and adaptive optics ophthalmoscope (AOO; RTX1, Imagine Eyes, France). METHODS Fifteen healthy subjects, 67% women, mean age (SD) 30.87 (6.19) years, were imaged using OCTA and AOO by a single experienced operator on the same day. Each eye was scanned using two OCTA protocols (3×3 mm2 and 9×9 mm2) and two to five AOO scans (1.2×1.2 mm2). The OCTA and AOO scans were scaled to the same pixel resolution. Two independent graders measured the vessel diameter at the same location on the region-of-interest in the three coregistered scans. Differences in vessel diameter measurements between the scans were assessed. RESULTS The inter-rater agreement was excellent for vessel diameter measurement in both OCTA protocols (ICC=0.92) and AOO (ICC=0.98). The measured vessel diameter was widest from the OCTA 3×3 mm2 (55.2±16.3 µm), followed by OCTA 9×9 mm2 (54.7±14.3 µm) and narrowest by the AOO (50.5±15.6 µm; p<0.001). Measurements obtained from both OCTA protocols were significantly wider than the AOO scan (OCTA 3×3 mm2: mean difference Δ=4.7 µm, p<0.001; OCTA 9×9 mm2: Δ=4.2 µm, p<0.001). For vessels >45 µm, it appeared to be larger in OCTA 3×3 mm2 scan than the 9×9 mm2 scan (Δ=1.9 µm; p=0.005), while vessels <45 µm appeared smaller in OCTA 3×3 mm2 scan (Δ=-1.3 µm; p=0.009) CONCLUSIONS: The diameter of retinal vessels measured from OCTA scans were generally wider than that obtained from AOO scans. Different OCTA scan protocols may affect the vessel diameter measurements. This needs to be considered when OCTA measures such as vessel density are calculated.
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Affiliation(s)
- Xinwen Yao
- Institute of Health Technologies, Nanyang Technological University, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore.,Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | - Mengyuan Ke
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | - Yijie Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Emily Lin
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | - Damon W K Wong
- Institute of Health Technologies, Nanyang Technological University, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore.,Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | - Bingyao Tan
- Institute of Health Technologies, Nanyang Technological University, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore.,Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | - Leopold Schmetterer
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore.,Singapore Eye Research Institute, Singapore National Eye Center, Singapore.,School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Academic Clinical Program, Duke-NUS Medical School, Singapore.,Institute of Ophthalmology, Basel, Switzerland
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore .,Academic Clinical Program, Duke-NUS Medical School, Singapore
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Mirra S, Marfany G, Garcia-Fernàndez J. Under pressure: Cerebrospinal fluid contribution to the physiological homeostasis of the eye. Semin Cell Dev Biol 2019; 102:40-47. [PMID: 31761444 DOI: 10.1016/j.semcdb.2019.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 01/27/2023]
Abstract
The cerebrospinal fluid (CSF) is a waterly, colorless fluid contained within the brain ventricles and the cranial and spinal subarachnoid spaces. CSF physiological functions range from hydromechanical protection of the central nervous system (CNS) to CNS modulation of developmental processes and regulation of interstitial fluid homeostasis. Optic nerve (ON) is surrounded by CSF circulating in the subarachnoid spaces and is exposed to both CSF (CSFP) and intra ocular (IOP) pressures, which converge at the lamina cribrosa (LC) as two opposite forces. The trans-lamina cribrosa pressure gradient (TLPG) is defined as IOP - CSFP and its alterations (due either to an elevation in IOP or a reduction in ICP) could result in structural damaging of the ON, including glaucomatous changes. The purpose of this review is to update the readers on the CSF contribution in controlling the functions/dysfunctions of ON by regulating homeostasis at LC. We also highlight emerging parallelisms regarding the expression of cilia-related genes in the regulation of common functions of body fluids in both brain and eye structures.
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Affiliation(s)
- Serena Mirra
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, and Institut de Biomedicina (IBUB), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain.
| | - Gemma Marfany
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, and Institut de Biomedicina (IBUB), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain.
| | - Jordi Garcia-Fernàndez
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, and Institut de Biomedicina (IBUB), University of Barcelona, Barcelona, Spain.
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Solianik R, Streckis V, Imbrasiene D, Paunksnis A. Acute and chronic effects of soccer game on the retinal vessel diameters in middle-aged adults. J Sports Med Phys Fitness 2018; 59:1085-1092. [PMID: 30317840 DOI: 10.23736/s0022-4707.18.09164-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although changes in retinal vessel diameter is a new biomarker for the evaluation of cardiovascular risk factors, limited information is available regarding the effects of endurance exercises on retinal microcirculation. Thus, we aimed to evaluate both chronic and acute effects of soccer game on the diameters of retinal vessels in middle-aged players. METHODS Retinal vessel diameters were measured in 12 middle-aged amateur players (44.4±7.0 years of age) with more than four years of soccer playing experience and 12 age-matched sedentary adults (49.7±7.1 years of age). In soccer players, diameters were also measured immediately after the soccer game. Cardiovascular risk profiles (anthropometry and body composition and blood pressure [BP]) and physical activity levels were also measured. RESULTS Soccer players had wider retinal vessels than controls (P<0.05), resulting in greater arteriolar-to-venular diameter ratio (AVR) (P<0.05). Greater sports-related physical activity, lower body mass index (BMI) and fat mass were observed for soccer players compared to the controls (P<0.05), whereas BP did not differ. Physical activity level correlated positively with temporal retinal arteriolar (TRA) diameter and with AVR (P<0.05), whereas TRA diameter correlated negatively with BMI and fat mass (P<0.05). A significant correlation between temporal retinal venule (TRV) diameter and TRA diameter (P<0.05) was observed. The acute soccer game increased BP (P<0.05) and induced TRV dilatation (P<0.05). CONCLUSIONS In middle-aged amateur soccer players, improvement of the retinal microcirculation was observed. Cardiovascular risk factors and physical inactivity were associated with adverse retinal microvascular alterations. In terms of acute effects, soccer play causes venular, but not arteriolar dilatation for middle-aged adults.
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Affiliation(s)
- Rima Solianik
- Institute of Sports Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania - .,Department of Applied Biology and Rehabilitation, Lithuanian Sports University, Kaunas, Lithuania -
| | - Vytautas Streckis
- Institute of Sports Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania.,Department of Trainings Systems, Lithuanian Sports University, Kaunas, Lithuania
| | - Daiva Imbrasiene
- Department of Applied Biology and Rehabilitation, Lithuanian Sports University, Kaunas, Lithuania
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Abstract
PURPOSE To review the pathophysiology, diagnosis, and updated treatments of retinal vein occlusions (RVOs). METHODS A review of the literature was performed, focusing on the epidemiology, pathophysiology, diagnosis, and treatments (including both medical and surgical treatments) of RVO. Based on this review, a comprehensive overview was provided regarding the topic of RVO and focused on recent treatment updates. RESULTS Retinal vein occlusions have an age- and sex-standardized prevalence of 5.20 per 1,000 for any RVO, 4.42 per 1,000 for branch RVO, 0.80 per 1,000 for central RVO. Worldwide, an estimated 16.4 million adults are affected by RVOs, with 2.5 million affected by central RVO and 13.9 million affected by branch RVO. Retinal vein occlusion is recognized as an important cause of blindness and the diagnostic approaches and treatment options for RVO are reviewed and reported. The current treatment options including medical treatments (bevacizumab, ranibizumab, aflibercept, triamcinolone, and dexamethasone implants) and surgical alternatives were reviewed and reported with summaries on the corresponding strength of evidence. CONCLUSION Despite the understanding of this disease entity, challenges persist in the long-term treatment of RVO-related complications and visual loss. This review provided a detailed summary on the rationality and efficacy of recently developed treatment regimes and evaluated the potential benefit of combination therapy.
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Wang Q, Chan S, Yang JY, You B, Wang YX, Jonas JB, Wei WB. Vascular Density in Retina and Choriocapillaris as Measured by Optical Coherence Tomography Angiography. Am J Ophthalmol 2016; 168:95-109. [PMID: 27183862 DOI: 10.1016/j.ajo.2016.05.005] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To measure the density of the superficial retinal small vessel network (SRSVN), superficial retinal capillary network (SRCN), deep retinal capillary network (DRCN), and choriocapillaris and the size of the foveal avascular zone (FAZ) in the superficial retinal layer in normal eyes. DESIGN Prospective observational cross-sectional study. METHODS In healthy Chinese volunteers, the retinal and choroidal vasculature was visualized by split-spectrum amplitude decorrelation angiography-associated optical coherence tomography (RTVueXR Avanti device; Optovue Inc, Fremont, California, USA). RESULTS Among 105 healthy participants (age: 35.9 ± 13.8 years) mean FAZ measured 0.35 ± 0.12 mm(2), and mean density of SRSVN, SRCN, DRCN, and choriocapillaris was 8.54% ± 0.92%, 31.8% ± 2.6%, 45.8% ± 3.3%, 44.4% ± 3.3%, and 44.5% ± 2.7%, respectively. In multivariate analysis, higher SRSVN density was associated with younger age (P = .001; standardized regression coefficient β: -0.28), male sex (P = .008; β: -0.23), lower SRCN density (P < .001; β: -0.40), and larger mean choriocapillaris vessel diameter (P = .001; β: 0.30). Higher SRCN density was correlated with male sex (P = .007; β: -0.19), lower SRSVN density (P < .001; β: -0.44), and higher density of the radial peripapillary capillary density (P = .004; β: 0.20). Higher DRCN density was correlated with younger age (P < .001; β: -0.31), female sex (P = .002; β: 0.22), higher SRCN density (P < .001; β: 0.38), and higher choriocapillaris density (P < .001; β: 0.39). Higher choriocapillaris network density in the central region was associated with higher DRCN density (P < .001; β: 0.43) and lower radial peripapillary capillary density (P = .005; β: -0.26). All retinal vascular parameters were not significantly correlated with axial length or subfoveal choroidal thickness. CONCLUSIONS The density of the macular vascular networks decreases with older age and is independent of axial length and subfoveal choroidal thickness in healthy individuals.
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Jonas JB, Wang N, Yang D. Translamina Cribrosa Pressure Difference as Potential Element in the Pathogenesis of Glaucomatous Optic Neuropathy. Asia Pac J Ophthalmol (Phila) 2016; 5:5-10. [PMID: 26713405 DOI: 10.1097/apo.0000000000000170] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The main proven risk factor for glaucomatous optic neuropathy (GON) is an intraocular pressure (IOP) higher than the pressure sensibility of the optic nerve head allows. Fulfilling Koch postulates, numerous studies have shown that the presence of high IOP leads to GON, that lowering IOP stops the progression of GON, and that a re-increase in IOP again causes the progression of GON. There are, however, many patients with glaucoma who have statistically normal or low IOP, and despite low IOP values, they develop progressing GON. These observations led to findings that IOP is only 1 of 2 determinants of the translamina cribrosa pressure difference (TLCPD), which is the main pressure-related parameter for the physiology and pathophysiology of the optic nerve head. The second parameter influencing TLCPD is orbital cerebrospinal fluid pressure (CSFP) as the counter pressure against IOP across the lamina cribrosa. Recent experimental and clinical studies have suggested that a low CSFP could be associated with GON in normal-pressure glaucoma. These investigations included studies with an experimental long-term reduction in CSFP in monkeys, population-based studies, and clinical retrospective and prospective investigations on patients with normal-pressure glaucoma. Besides TLCPD, other ocular parameters influenced by CSFP may be choroidal thickness, retinal vein pressure and diameter, occurrence of retinal vein occlusions, and occurrence and severity of diabetic retinopathy.
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Affiliation(s)
- Jost B Jonas
- From the *Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University, Seegartenklinik Heidelberg, Germany; †Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory; and ‡Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
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12
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Jonas JB, Wang N, Wang YX, You QS, Yang D, Xie X, Xu L. Incident retinal vein occlusions and estimated cerebrospinal fluid pressure. The Beijing Eye Study. Acta Ophthalmol 2015; 93:e522-6. [PMID: 25996958 DOI: 10.1111/aos.12575] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 09/22/2014] [Indexed: 12/16/2022]
Abstract
PURPOSE To examine whether the incidence of retinal vein occlusions (RVOs) is associated with estimated cerebrospinal fluid pressure (CSFP). METHODS The population-based Beijing Eye Study, which included 4439 subjects (age: 40 + years) in 2001, was repeated in 2011 with 2695 subjects participating (66.4% of the survivors). Fundus photographs were examined for the new development of RVOs, differentiated into central RVOs (CRVOs) and branch RVOs (BRVOs). CSFP was calculated as CSFP [mmHg] = 0.44 × Body Mass Index [kg/m(2) ] + 0.16 × Diastolic Blood Pressure [mmHg]-0.18 × Age[Years]. RESULTS Incident BRVOs were detected in 50 eyes and incident CRVOs in 8 eyes. BRVOs were located at arterio-venous crossings in 39 eyes. In multivariate analysis, a higher estimated CSFP was associated with a higher incidence of CRVOs (p = 0.004; standardized coefficient beta: 0.06; regression coefficient B: 5.35; 95% confidence interval (CI):1.73, 8.96) after adjusting for urban region (p < 0.001; beta: -0.52; B: -3.93; 95% CI: -4.29, -3.57), higher educational level (p = 0.001; beta: 0.13; B: 0.44; 95% CI: 0.28, 0.60), higher blood concentrations of triglycerides (p < 0.001; beta: 0.08; B: 0.11; 95% CI: 0.05, 0.16) and higher intraocular pressure (p < 0.001; beta: 0.16; B:0.21; 95% CI: 0.16, 0.27). As a corollary, a higher incidence of RVOs as a whole, as well as a higher incidence of CRVOs combined with a higher incidence of BRVOs originating at the optic nerve head, both were significantly associated with higher estimated CSFP (p = 0.002; odds ratio (OR): 1.15; 95% CI: 1.05, 1.25; and p = 0.037; OR: 1.17; 95% CI: 1.01, 1.35, respectively) after adjusting for older age. CONCLUSIONS A higher estimated CSFP was associated with a higher incidence of RVOs originating at the optic nerve head (i.e. CRVOs, hemi-central RVOs and BRVOs originating at the optic nerve head), and vice versa, a higher incidence of RVOs was associated with a higher estimated CSFP. It suggested an influence of higher estimated CSFP on higher central retinal vein pressure.
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Affiliation(s)
- Jost B. Jonas
- Beijing Ophthalmology and Visual Science Key Lab; Beijing Institute of Ophthalmology; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
- Department of Ophthalmology; Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg; Heidelberg Germany
| | - Ningli Wang
- Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Ya Xing Wang
- Beijing Ophthalmology and Visual Science Key Lab; Beijing Institute of Ophthalmology; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Qi Sheng You
- Beijing Ophthalmology and Visual Science Key Lab; Beijing Institute of Ophthalmology; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Diya Yang
- Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Xiaobin Xie
- Beijing Ophthalmology and Visual Sciences Key Laboratory; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
- Eye Hospital of China Academy of Chinese Medical Sciences; Beijing China
| | - Liang Xu
- Beijing Ophthalmology and Visual Science Key Lab; Beijing Institute of Ophthalmology; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
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Jonas JB, Xu L, Xu J, Wei WB, Wang YX. Prevalence of Diabetic Retinopathy and Vision Loss in the Beijing Eye Study: the Potential Role of the Cerebrospinal Fluid Pressure. Curr Diab Rep 2015; 15:71. [PMID: 26275444 DOI: 10.1007/s11892-015-0649-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In the Beijing Eye Study, a population-based study carried out in 2001, 2006, and 2011, prevalence of diabetic retinopathy (DR) was 2.9 ± 0.3 % (95 % confidence interval 2.3, 3.5) per individual in 2011. Correspondingly, only 1.1 % of blindness and 0.8 % of visual impairment were caused by DR in East Asia. As in other populations, prevalence, severity, and 10-year incidence of DR were associated with higher levels of HbA1c, higher blood glucose concentration, longer known duration of diabetes, lower educational level, and higher blood pressure. Interestingly, the presence, severity, and 10-year incidence of DR were additionally correlated with higher estimated cerebrospinal fluid pressure and shorter ocular length. Higher cerebrospinal fluid pressure may lead to higher retinal vein pressure and subsequently higher retinal capillary blood pressure increasing fluid and blood extravasation. Shorter axial length or hyperopia may be associated with higher intraocular concentration of cytokines. Aging of the society, improvements in medical infrastructure, and lifestyle changes may profoundly increase prevalence of, and burden by, DR in China in the future.
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Affiliation(s)
- Jost B Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, 1 Dong Jiao Min Lane, Beijing, China, 100730,
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Jonas JB, Ritch R, Panda-Jonas S. Cerebrospinal fluid pressure in the pathogenesis of glaucoma. PROGRESS IN BRAIN RESEARCH 2015; 221:33-47. [PMID: 26518071 DOI: 10.1016/bs.pbr.2015.06.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The optic nerve head forms the interface between the intraocular compartment and the retrobulbar compartment. The former is characterized by what we term intraocular pressure (IOP) and the latter by orbital cerebrospinal fluid pressure (CSFP). The trans-lamina cribrosa pressure difference (TLCPD) is defined as the difference between the pressures in the two compartments. Any change in one of them can be associated with a disturbance of homeostasis of the optic nerve head, such as papilledema or glaucomatous optic neuropathy. In particular, glaucomatous optic neuropathy may be due to either an elevated IOP and/or an abnormally low orbital CSFP, or due to a change in the time-dependent relationship between the pulse-synchronous changes in IOP and orbital CSFP. Based on the triangular relationships between IOP, CSFP, and blood pressure, glaucoma may be described as an imbalance between these three pressure parameters, eventually leading to an increased TLCPD. Because the retinal and choroidal venous blood drains through the CSFP space, elevated CSFP may be associated with dilated retinal veins, increased incidence of retinal vein occlusions, higher prevalence and severity of diabetic retinopathy, and thicker choroid.
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Affiliation(s)
- Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Heidelberg, Germany; Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China.
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Ear Eye and Ear Infirmary of Mt. Sinai, New York, NY, USA
| | - Songhomitra Panda-Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Heidelberg, Germany
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Literature review and meta-analysis of translaminar pressure difference in open-angle glaucoma. Eye (Lond) 2015; 29:1242-50. [PMID: 26183286 PMCID: PMC4815687 DOI: 10.1038/eye.2015.127] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 06/10/2015] [Indexed: 01/28/2023] Open
Abstract
There is increasing evidence in the literature regarding translaminar pressure difference's (TPD) role in the pathophysiology of glaucoma. The optic nerve is exposed not only to intraocular pressure in the eye, but also to intracranial pressure (ICP), as it is surrounded by cerebrospinal fluid in the subarachnoid space. Although pilot studies have identified the potential importance of TPD in glaucoma, limited available data currently prevent a comprehensive description of the role that TPD may have in glaucomatous pathophysiology. In this review, we present all available qualified data from a systematic review of the literature of the role of TPD in open-angle glaucoma (OAG). PubMed (Medline), OVID Medline, ScienceDirect, SpringerLink, and all available library databases were reviewed and subsequent meta-analysis of pooled mean differences are presented where appropriate. Five papers including 396 patients met criteria for inclusion to the analysis. Importantly, we included all observational studies despite differences in ICP measurement methods, as there is no consensus regarding best-practice ICP measurements in glaucoma. Our results show that not only TPD is higher in glaucoma patients compared with healthy subjects, it is related to structural glaucomatous changes of the optic disc. Our analysis suggests further longitudinal prospective studies are needed to investigate the influence of TPD in OAG, with a goal of overcoming methodological weaknesses of previous studies.
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Facts and myths of cerebrospinal fluid pressure for the physiology of the eye. Prog Retin Eye Res 2015; 46:67-83. [DOI: 10.1016/j.preteyeres.2015.01.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 01/09/2015] [Accepted: 01/13/2015] [Indexed: 01/19/2023]
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Jonas JB, Wang NL, Wang YX, You QS, Xie XB, Yang DY, Xu L. Estimated trans-lamina cribrosa pressure difference versus intraocular pressure as biomarker for open-angle glaucoma. The Beijing Eye Study 2011. Acta Ophthalmol 2015; 93:e7-e13. [PMID: 24961652 DOI: 10.1111/aos.12480] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 05/17/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine whether an estimated trans-lamina cribrosa pressure difference (TLCPD) better than intraocular pressure (IOP) correlated with markers for glaucoma. METHODS The population-based Beijing Eye Study 2011 included 3468 individuals. Cerebrospinal fluid pressure (CSFP) was calculated as CSFP [mmHg] = 0.44 × Body Mass Index [kg/m(2) ] + 0.16 × Diastolic Blood Pressure [mmHg] - 0.18 × Age [Years] - 1.91. TLCPD was IOP-CSFP. RESULTS In the non-glaucomatous population, mean TLCPD was 5.8 ± 4.1 mmHg and mean estimated CSFP was 8.9 ± 3.7 mmHg. IOP was higher (p = 0.008), CSFP was lower (p < 0.001), and TLCPD was (p < 0.001) higher in the glaucoma group than in the non-glaucomatous group. The intergroup difference was highest for TLCPD (2.1 mmHg) followed by CSFP (1.7 mmHg) and IOP (0.4 mmHg). Open-angle glaucoma (OAG) was associated with higher TLCPD [p < 0.001; odds ratio (OR): 1.14; 95% confidence intervals (CI): 1.08, 1.19] but not with IOP (p = 0.22; OR: 0.96; 95% CI: 0.89, 1.03). In contrast, angle-closure glaucoma (ACG) was associated with higher IOP (p = 0.03; B: 0.14; OR: 1.15; 95% CI: 1.01, 1.30) but not with TLCPD (p = 0.98), after adjustment for age and anterior chamber depth. Retinal nerve fibre layer thickness was associated with lower TLCPD (p = 0.036) but not with IOP (p = 0.96), after adjusting for gender, age, region of habitation, optic disc area and refractive error. Neuroretinal area and volume were associated with smaller TLCPD (p = 0.002, and p < 0.001, respectively), after adjusting for gender, optic disc area and refractive error, but not with IOP (p = 0.43 and p = 0.25, resp.). CONCLUSIONS In OAG, but not in ACG, calculated TLCPD versus IOP showed a better association with glaucoma presence and amount of glaucomatous optic neuropathy. It supports the notion of a potential role of low CSFP in the pathogenesis of OAG.
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Affiliation(s)
- Jost B. Jonas
- Beijing Institute of Ophthalmology; Beijing Tongren Hospital; Capital Medical University; Beijing China
- Department of Ophthalmology; Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg; Mannheim Germany
| | - Ning Li Wang
- Beijing Tongren Eye Center; Beijing Tongren Hospital; Beijing Ophthalmology and Visual Sciences Key Laboratory; Capital Medical University; Beijing China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Qi Sheng You
- Beijing Institute of Ophthalmology; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Xiao Bin Xie
- Beijing Tongren Eye Center; Beijing Tongren Hospital; Beijing Ophthalmology and Visual Sciences Key Laboratory; Capital Medical University; Beijing China
| | - Di Ya Yang
- Beijing Tongren Eye Center; Beijing Tongren Hospital; Beijing Ophthalmology and Visual Sciences Key Laboratory; Capital Medical University; Beijing China
| | - Liang Xu
- Beijing Institute of Ophthalmology; Beijing Tongren Hospital; Capital Medical University; Beijing China
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Xu J, Xu L, Wang YX, You QS, Jonas JB, Wei WB. Ten-year cumulative incidence of diabetic retinopathy. The Beijing Eye Study 2001/2011. PLoS One 2014; 9:e111320. [PMID: 25347072 PMCID: PMC4210166 DOI: 10.1371/journal.pone.0111320] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 09/30/2014] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the cumulative 10-year incidence of diabetic retinopathy (DR) and its associated factors in a population living in Greater Beijing. METHODS The population-based longitudinal Beijing Eye Study, which included 4439 subjects (age in 2001: 40+years) in 2001, was repeated in 2011 with 2695 subjects participating (66.4% of the survivors). The study participants underwent a detailed ophthalmic examination. Fundus photographs were examined for the new development of DR. RESULTS After excluding individuals with DR at baseline (n = 87) or no sufficient fundus photographs in 2011 (n = 6), the study included 2602 subjects with a mean age of 64.6±9.7 years (median: 64.0 years; range: 50 to 93 years). In the 10-year period, 109 subjects (39 men) developed new DR with an incidence of 4.2% (95% confidence interval (CI): 3.45,5.03). In multiple logistic regression analysis, incident DR was significantly associated with higher HbA1c value (P<0.001; Odds Ratio (OR): 1.73; 95% Confidence Interval (CI): 1.35,2.21), longer duration of diabetes mellitus (P<0.001; OR: 1.16; 95% CI: 1.10,1.22), higher serum concentration of creatinine (P = 0.02; OR: 1.01; 95% CI: 1.002,1.022), lower educational level (P = 0.049; OR: 0.74; 95% CI: 0.55,0.99), higher estimated cerebrospinal fluid pressure (P = 0.038; OR: 1.10; 95% CI: 1.01,1.22), and shorter axial length (P<0.001; OR: 0.48; 95% CI: 0.33,0.71). CONCLUSIONS The cumulative 10-year incidence (mean: 4.2%) of DR in a North Chinese population was significantly associated with a higher HbA1c value, longer known duration of diabetes mellitus, higher estimated CSFP and shorter axial length (P<0.001). Shorter axial length (or hyperopia) and, potentially, higher CSFP may be additional risk factors to be taken into account when counseling and treating patients with diabetes mellitus.
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Affiliation(s)
- Jie Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Liang Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qi Sheng You
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jost B Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Heidelberg, Germany
| | - Wen Bin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Intraocular pressure and estimated cerebrospinal fluid pressure. The Beijing Eye Study 2011. PLoS One 2014; 9:e104267. [PMID: 25105777 PMCID: PMC4126772 DOI: 10.1371/journal.pone.0104267] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/03/2014] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To examine a potential association between intraocular pressure (IOP) and cerebrospinal fluid pressure (CSFP) in a population-based setting. METHODS The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years (range: 50-93 years). A detailed ophthalmic examination was performed. Based on a previous study with lumbar cerebrospinal fluid pressure (CSFP) measurements, CSFP was calculated as CSFP [mm Hg] = 0.44×Body Mass Index [kg/m2]+0.16×Diastolic Blood Pressure [mm Hg]-0.18×Age [Years]. RESULTS In multivariate analysis, IOP was associated with higher estimated CSFP (P<0.001; standardized correlation coefficient beta: 0.27; regression coefficient B: 0.20; 95% confidence interval (CI): 0.16, 0.24), after adjusting for thinner central corneal thickness (P<0.001; beta: 0.45; B: 0.04;95%CI: 0.04,0.04), smaller corneal curvature radius (P<0.001; beta:-0.11; B:-1.13;95%CI:-1.61,-0.64), shallower anterior chamber depth (P = 0.01; beta:-0.05; B:-0.33;95%CI:-0.59,-0.08) and longer axial length (P = 0.002; beta: 0.08; B: 0.20;95%CI: 0.08,0.32)), and after adjusting for the systemic parameters of higher pulse rate (P<0.001; beta: 0.08; B: 0.02;95%CI: 0.01,0.03), higher prevalence of arterial hypertension (P = 0.002; beta: 0.06; B: 0.32;95%CI: 0.12,0.53)), frequency of drinking alcohol (P = 0.02; beta: 0.04; B: 0.09;95%CI: 0.01,0.17), higher blood concentration of triglycerides (P = 0.001; beta: 0.06; B: 0.06;95%CI: 0.02,0.10) and cholesterol (P = 0.049; beta: 0.04; B: 0.08;95%CI: 0.00,0.17), and body mass index (P<0.001; beta:-0.13; B:-0.09;95%CI:-0.13,-0.06). In a parallel manner, estimated CSFP (mean: 10.8±3.7 mm Hg) was significantly associated with higher IOP (P<0.001; beta: 0.13; B: 0.18;95%CI: 0.13,0.23) after adjusting for rural region of habitation (P<0.001; beta:-0.37; B:-2.78;95%CI:-3.07,-2.48), higher systolic blood pressure (P<0.001; beta: 0.34; B: 0.06;95%CI: 0.05,0.07), higher pulse rate (P = 0.003; beta: 0.05; B: 0.02;95%CI: 0.01,0.03), taller body height (P<0.001; beta: 0.11; B: 0.05;95%CI: 0.03,0.07), higher blood concentration of cholesterol (P = 0.003; beta: 0.05; B: 0.17;95%CI: 0.06,0.28) and higher level of education (P = 0.003; beta: 0.09; B: 0.30;95%CI: 0.16,0.45). CONCLUSIONS IOP was positively associated with estimated CSFP after adjusting for other ocular and systemic parameters. As a corollary, higher estimated CSFP was significantly associated with higher IOP in multivariate analysis. It fits with the notion that the arterial blood pressure, estimated CSFP and IOP are physiologically correlated with each other.
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Jonas JB, Wang N, Wang YX, You QS, Yang D, Xu L. Ocular hypertension: general characteristics and estimated cerebrospinal fluid pressure. The Beijing Eye Study 2011. PLoS One 2014; 9:e100533. [PMID: 24988292 PMCID: PMC4079553 DOI: 10.1371/journal.pone.0100533] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 05/23/2014] [Indexed: 11/18/2022] Open
Abstract
Purpose To examine characteristics of ocular hypertensive subjects and potential associations with estimated cerebrospinal fluid pressure (estCSFP). Methods The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years. Ocular hypertension was defined as intraocular pressure (IOP) >21 mmHg, normal optic nerve head appearance and normal retinal nerve fiber layer thickness. IOP was corrected for its dependence on central corneal thickness (CCT) and corneal curvature radius. Estimated CSFP was calculated as CSFP [mmHg] = 0.44×Body Mass Index [kg/m2]+0.16×Diastolic Blood Pressure [mmHg]−0.18×Age [Years]−1.91. Estimated trans-lamina cribrosa pressure difference (estTLCPD) was IOP–estCSFP. Results EstCSFP (10.5±3.6 mmHg versus 9.0±3.7 mmHg; P = 0.003) and estTLCPD (12.0±4.4 mmHg versus 5.4±3.8 mmHg; P<0.001) were higher in the ocular hypertensive group than in the normotensive group. In binary regression analysis, ocular hypertension was associated with increased estCSFP (P = 0.03; odds ratio (OR): 1.08; 95% confidence interval (CI): 1.01, 1.17) after adjusting for prevalence of arterial hypertension (P = 0.07; OR: 1.79; 95%CI: 0.96, 3.34), retinal nerve fiber layer thickness (P = 0.03; OR: 0.97; 95%CI: 0.95, 0.997) and blood glucose concentration (P = 0.006; OR: 1.17; 95%CI: 1.04, 1.30). Conclusions Ocular hypertensive subjects (with IOP correction for CCT and corneal curvature) as compared to ocular normotensive subjects had a significantly higher estCSFP in univariate analysis and in multivariate analysis. Despite of a higher estCSFP, estTLCPD was still markedly higher in ocular hypertensive eyes than in ocular normotensive eyes.
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Affiliation(s)
- Jost B. Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Qi Sheng You
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Diya Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Liang Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
- * E-mail:
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Jonas JB, Wang N, Xu J, Wang YX, You QS, Yang D, Xie XB, Xu L. Diabetic retinopathy and estimated cerebrospinal fluid pressure. The Beijing Eye Study 2011. PLoS One 2014; 9:e96273. [PMID: 24789334 PMCID: PMC4006875 DOI: 10.1371/journal.pone.0096273] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 03/28/2014] [Indexed: 11/19/2022] Open
Abstract
Purpose The cerebrospinal fluid pressure (CSFP) is a major determinant of central retinal vein pressure and thus of retinal capillary pressure. We tested the hypothesis whether prevalence and severity of diabetic retinopathy are associated with CSFP. Methods The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years. A detailed ophthalmic examination was performed including fundus photography for the assessment of diabetic retinopathy according. Based on a previous study with lumbar cerebrospinal fluid pressure (CSFP) measurements, CSFP was calculated as CSFP[mmHg] = 0.44xBody Mass Index[kg/m2]+0.16 Diastolic Blood Pressure[mmHg]–0.18xAge[Years]−1.91. Results In binary regression analysis, presence of diabetic retinopathy was significantly associated with higher levels of HbA1c (P<0.001; regression coefficient B:0.25; odds ratio (OR):1.28; 95% confidence interval (CI):1.15,1.43), higher blood concentration of glucose (P<0.001; B:0.40;OR:1.49;95%CI:1.36,1.63), longer known duration of diabetes mellitus (P<0.001; B:0.14;OR:1.15; 95%CI:1.11,1.19), higher systolic blood pressure (P<0.001; B:0.03;OR:1.03;95%CI:1.02,1.04), lower diastolic blood pressure (P<0.001; B:−0.06;OR:0.94;95%CI:0.91,0.97), and higher CSFP (P = 0.002; B:0.13;OR:1.14;95%CI:1.05,1.24). Severity of diabetic retinopathy was significantly associated with higher HbA1c value (P<0.001; standardized coefficient beta: 0.19; correlation coefficient B: 0.07;95%CI:0.05,0.08), higher blood concentration of glucose (P<0.001; beta:0.18;B:0.04;95%CI:0.04,0.05), longer known duration of diabetes mellitus (P<0.001; beta:0.20;B:0.03;95%CI:0.02,0.03), lower level of education (P = 0.001; beta:−0.05;B:−0.02;95%CI:−0.03,−0.01), lower diastolic blood pressure (P = 0.002; beta:−0.08;B:−0.001;95%CI:−0.004,−0.001), higher systolic blood pressure (P = 0.006; beta:0.06;B:0.001;95%CI:0.000,0.001), and higher CSFP (P = 0.006; beta:0.06;B:0.006;95%CI:0.002,0.010). Conclusions Higher prevalence and severity of diabetic retinopathy were associated with higher estimated CSFP after adjusting for systemic parameters. Higher CSFP through a higher retinal vein pressure may lead to more marked retinal venous congestion and vascular leakage in diabetic retinae.
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Affiliation(s)
- Jost B. Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
- * E-mail: (LX); (JBJ)
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Jie Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Qi Sheng You
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Diya Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Xiao Bin Xie
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Liang Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
- * E-mail: (LX); (JBJ)
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