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Zhang H, Li Y, Tang Y, Yan X, Geng Y, Li W, Shi K, Tang G, Guo H. Characteristics of optic disc hemorrhage and optic nerve changes following acute primary angle closure. Front Neurol 2024; 15:1333091. [PMID: 38854957 PMCID: PMC11157090 DOI: 10.3389/fneur.2024.1333091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/29/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Acute primary angle closure (APAC) is an emergency ophthalmic presentation and a major cause of irreversible blindness in China. However, only a few studies have focused on the characteristics of optic disc hemorrhage (ODH) during an APAC attack, including its shape, depth, location, scope, and duration after intraocular pressure (IOP) control, along with changes in the optic nerve. This study aimed to analyze the characteristics of ODH and optic nerve changes in patients during their first APAC episode. Methods This retrospective study involved 32 eyes from 32 patients with APAC who received sequential treatment and analyzed the following parameters: the highest IOP and its duration, ODH, retinal nerve fiber layer thickness (RNFLT), and mean deviation (MD). We compared parameters obtained from the affected eye (ODH group) and contralateral unaffected eye (control group), as well as intragroup comparisons. Results The mean IOP in the ODH group was 64.28 ± 10.36 mmHg, with a duration of 4.44 ± 2.35 days. Flame and splinter shapes accounted for 84.38% of the ODH. The mean ODH duration was 4.81 ± 3.25 weeks. ODH during APAC was isolated to one sector in 59.38% of cases, mostly occurring in the temporal superior and temporal inferior (each accounting for 21.88% of the cases). There was a positive correlation between the extent of hemorrhage and the highest IOP duration (p < 0.001). RNFLT was significantly thickened within 72 h post-IOP control but was thinned by 2 weeks. By 6 months, the thinning stabilized, and there was no difference noted between the ODH and control groups at 12 months. MD partly improved at 6 months post-IOP control, and ODH scope significantly affected the MD (p < 0.001). The duration of high IOP was positively correlated to the ODH scope and MD damage. Discussion Timely and effective IOP management is essential for recovering visual function following an APAC attack.
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Affiliation(s)
- Hengli Zhang
- Department of Ophthalmology, Shijiazhuang People’s Hospital, Shijiazhuang, China
| | - Yawen Li
- Department of Ophthalmology, Shijiazhuang People’s Hospital, Shijiazhuang, China
| | - Yizhen Tang
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaowei Yan
- Department of Ophthalmology, Shijiazhuang People’s Hospital, Shijiazhuang, China
| | - Yulei Geng
- Department of Ophthalmology, Shijiazhuang People’s Hospital, Shijiazhuang, China
| | - Weijia Li
- Department of Ophthalmology, Shijiazhuang People’s Hospital, Shijiazhuang, China
| | - Kuitang Shi
- Department of Ophthalmology, Shijiazhuang People’s Hospital, Shijiazhuang, China
| | - Guangxian Tang
- Department of Ophthalmology, Shijiazhuang People’s Hospital, Shijiazhuang, China
| | - Hongtao Guo
- Department of Orthopedics, Shijiazhuang People’s Hospital, Shijiazhuang, China
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Saks DG, Schulz A, Qassim A, Marshall H, Hewitt AW, MacGregor S, Craig JE, Graham SL. Genetic risk of glaucoma is associated with vascular and retinal nerve fibre wedge defects. Acta Ophthalmol 2024; 102:e185-e194. [PMID: 37800621 DOI: 10.1111/aos.15775] [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: 01/25/2023] [Revised: 08/31/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE To evaluate the association between localised vascular and retinal nerve fibre layer (RNFL) loss and genetic risk for glaucoma and cardiovascular disease using polygenic risk scores (PRS). METHODS 858 eyes were included from 455 individuals with suspect and early manifest primary open angle glaucoma. Eyes were characterised as having localised vascular and/or RNFL wedge-shaped defects by scrutiny of optical coherence tomography angiography (OCTA) and OCT images, respectively. Investigations included associations with pre-established scores for genetic risk of glaucoma and cardiovascular disease in the context of glaucoma risk factors and systemic vascular disease outcomes. RESULTS Higher genetic risk for glaucoma was associated with both vascular wedge defects and RNFL defects (p < 0.001 and p = 0.020, respectively). A greater genetic risk of glaucoma was associated with the presence of multiple vascular wedges per eye (p = 0.005). Glaucoma progression based on global RNFL loss was associated with vascular and RNFL wedge defects (p ≤ 0.001 and p = 0.008, respectively). The glaucoma PRS was significantly associated with vascular, but not RNFL, wedge defects after controlling for disc haemorrhage (p = 0.007 and p = 0.070, respectively). Vascular wedge defects were not related to the cardiovascular PRS. CONCLUSION Individuals with a higher genetic risk of glaucoma based on the PRS were more likely to have retinal vascular defects, as well as structural glaucomatous loss, but this did not relate to systemic cardiovascular risk. This possibly implies a local pathophysiology for the vascular defects in some cases, which may have clinical relevance in the early stages of glaucoma and in individuals at high genetic risk.
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Affiliation(s)
- Danit G Saks
- Macquarie Medical School, Macquarie University, Sydney, New South Wale, Australia
| | - Angela Schulz
- Macquarie Medical School, Macquarie University, Sydney, New South Wale, Australia
| | - Ayub Qassim
- Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Henry Marshall
- Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Alex W Hewitt
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Stuart MacGregor
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Jamie E Craig
- Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Stuart L Graham
- Macquarie Medical School, Macquarie University, Sydney, New South Wale, Australia
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Lee EJ, Han JC, Kee C. Ancillary PanoMap OCT shows the progression of glaucomatous papillomacular bundle defect with disc haemorrhage on the fovea-disc axis. Br J Ophthalmol 2023; 107:1630-1637. [PMID: 36002238 DOI: 10.1136/bjo-2021-320642] [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: 10/19/2021] [Accepted: 07/31/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To identify the spatial relationship between disc haemorrhage (DH) on the fovea-disc axis and retinal nerve fibre layer (RNFL) defect in the papillomacular bundle (PMB) using ancillary PanoMap optical coherence tomography (OCT). METHODS We investigated the presence and progression of spatially corresponding PMB defects in glaucomatous eyes with temporally located DH on the fovea-disc axis (FoDi-DH). We identified PMB defects using ancillary PanoMap OCT with guided progression analysis, in addition to red-free photographs. RESULTS We studied 36 eyes of 35 glaucoma patients with FoDi-DH, pre-existing PMB defects were observed in 18 eyes (50.0%) at the time and location of the initial FoDi-DH occurrence, 14 (38.9%) of which progressed during the follow-up period. New development of PMB defects occurred in 15 (41.7%) of 18 eyes without pre-existing PMB defects. Overall, FoDi-DH was associated with PMB defects in 33 (91.7%) eyes at locations spatially overlapping the PMB defect. Red-free photography and OCT were complementary in detecting PMB defects and progression. Among 47 cases, 20 were concordant, while 10 and 17 were detected only in photography and OCT, respectively. The central visual field defect increased significantly throughout the follow-up period (p=0.006). CONCLUSION Most FoDi-DH cases were related to the presence and progression of glaucomatous PMB defects at locations spatially overlapping the defect. OCT helped clarify changes in PMB defects detected by red-free photograph and the detection of photo-negative PMB defects as well. Similar to inferotemporal and superotemporal-direction DH, temporal DH on the PMB may be an indicator of ongoing RNFL damage that deserves close attention.
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Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
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Almeida INF, Taniguchi E, Tito CVA, Dias DT, Ushida M, Dorairaj S, Ritch R, Teixeira SH, Paranhos A, Gracitelli CPB, Kayser C, Prata TS. Vascular parameters and endothelin-1 measurements in glaucoma patients with low- and high-tension optic disc hemorrhages. Sci Rep 2023; 13:5023. [PMID: 36977700 PMCID: PMC10050085 DOI: 10.1038/s41598-023-31682-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
This prospective study aimed to compare vascular parameters (endothelin-1 [ET-1] blood levels, laser Doppler imaging [LDI] of distal phalanxes, and nailfold capillaroscopy) between open-angle glaucoma patients with low- and high-tension optic disc hemorrhages (LTDH and HTDH, respectively). The 33 enrolled patients (mean age, 62.3 ± 13 years) were classified as LTDH or HTDH if they presented at the time of DH detection an intraocular pressure (IOP) < 16 mmHg or ≥ 16 mmHg, respectively. Demographic and ophthalmological data, ET-1 concentrations, LDI (before and 1, 10, and 20 min after cold stimulation), and nailfold capillaroscopy findings were evaluated. The ET-1 blood level was 65% higher in the LTDH (2.27 ± 1.46 pg/ml) than in the HTDH (1.37 ± 0.57 pg/ml; p = 0.03) group. Moreover, there was a statistically significant negative correlation between ET-1 blood concentration and IOP at the time of DH detection (r = -0.45, p = 0.02). Blood flow measurements 10 and 20 min after cold stimulation were lower in the LTDH group than in the HTDH group (p < 0.01). Patients developing DH with lower IOPs have higher ET-1 blood levels and more peripheral vascular dysfunction as estimated by LDI than those with higher IOPs. These findings suggest that distinct underlying mechanisms may be involved in patients developing DH within different IOP ranges.
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Affiliation(s)
- Izabela N F Almeida
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil
| | - Elise Taniguchi
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil
| | | | - Diego Torres Dias
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, SP, Brazil
| | - Michele Ushida
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, SP, Brazil
| | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, USA
| | - Sérgio H Teixeira
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil
| | - Carolina P B Gracitelli
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil
- Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, Vinhedo, São Paulo, Brazil
| | - Cristiane Kayser
- Rheumatology Division, Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Tiago Santos Prata
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil.
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, SP, Brazil.
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA.
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Jin C, Park GS, Kim KN, Song MY, Hwang YH. Comparison of posterior vitreous detachment-related and glaucomatous optic disc hemorrhage. Sci Rep 2023; 13:5011. [PMID: 36973533 PMCID: PMC10042820 DOI: 10.1038/s41598-023-32327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/25/2023] [Indexed: 03/29/2023] Open
Abstract
This study compared the characteristics of posterior vitreous detachment (PVD)-related and glaucomatous optic disc hemorrhage (DH). Fundus photographs of eyes with PVD-related DH (PVD group) and glaucomatous DH (glaucoma group) were reviewed. The shape, type, layer, location (clock-hour sector), and DH/disc area (DH/DA) ratio of DH were investigated. In the PVD group, DH presented as a flame (60.9%), splinter (34.8%), and dot or blot (4.3%) shape. However, most of the glaucomatous DH revealed a splinter shape (92.3%), followed by a flame shape (7.7%, p < 0.001). In the PVD group, the most common type of DH was cup margin type (52.2%), whereas, in the glaucoma group it was disc rim type (53.8%, p = 0.003). Both PVD-related and glaucomatous DH were most commonly observed in the 7 o'clock sector. In the PVD group, DH was also found in the 2 and 5 o'clock sectors (p = 0.010). Mean DH/DA ratio in PVD group (0.15 ± 0.19) was greater than in glaucoma group (0.04 ± 0.04, p < 0.001). PVD-related DH showed a higher frequency of flame shape, cup margin type, nasal location, and greater area compared to the glaucomatous DH.
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Affiliation(s)
- Cho Jin
- Department of Ophthalmology, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Gi Seok Park
- Department of Ophthalmology, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Kyung Nam Kim
- Department of Ophthalmology, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Mi Yeon Song
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Hoon Hwang
- Department of Ophthalmology, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
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Braeu FA, Thiéry AH, Tun TA, Kadziauskiene A, Barbastathis G, Aung T, Girard MJA. Geometric Deep Learning to Identify the Critical 3D Structural Features of the Optic Nerve Head for Glaucoma Diagnosis. Am J Ophthalmol 2023; 250:38-48. [PMID: 36646242 DOI: 10.1016/j.ajo.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
PURPOSE To compare the performance of 2 relatively recent geometric deep learning techniques in diagnosing glaucoma from a single optical coherence tomographic (OCT) scan of the optic nerve head (ONH); and to identify the 3-dimensional (3D) structural features of the ONH that are critical for the diagnosis of glaucoma. DESIGN Comparison and evaluation of deep learning diagnostic algorithms. METHODS In this study, we included a total of 2247 nonglaucoma and 2259 glaucoma scans from 1725 participants. All participants had their ONHs imaged in 3D with Spectralis OCT. All OCT scans were automatically segmented using deep learning to identify major neural and connective tissues. Each ONH was then represented as a 3D point cloud. We used PointNet and dynamic graph convolutional neural network (DGCNN) to diagnose glaucoma from such 3D ONH point clouds and to identify the critical 3D structural features of the ONH for glaucoma diagnosis. RESULTS Both the DGCNN (area under the curve [AUC]: 0.97±0.01) and PointNet (AUC: 0.95±0.02) were able to accurately detect glaucoma from 3D ONH point clouds. The critical points (ie, critical structural features of the ONH) formed an hourglass pattern, with most of them located within the neuroretinal rim in the inferior and superior quadrant of the ONH. CONCLUSIONS The diagnostic accuracy of both geometric deep learning approaches was excellent. Moreover, we were able to identify the critical 3D structural features of the ONH for glaucoma diagnosis that tremendously improved the transparency and interpretability of our method. Consequently, our approach may have strong potential to be used in clinical applications for the diagnosis and prognosis of a wide range of ophthalmic disorders.
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Affiliation(s)
- Fabian A Braeu
- From the Ophthalmic Engineering & Innovation Laboratory, Singapore Eye Research Institute, Singapore National Eye Centre (F.A.B., M.J.A.G.), Singapore; Singapore-MIT Alliance for Research and Technology (F.A.B., G.B.), Singapore; Yong Loo Lin School of Medicine, National University of Singapore (F.A.B., T.A.), Singapore
| | - Alexandre H Thiéry
- Department of Statistics and Applied Probability, National University of Singapore (A.H.T.), Singapore
| | - Tin A Tun
- Singapore Eye Research Institute, Singapore National Eye Centre (T.A.T., T.A.), Singapore; Duke-NUS Graduate Medical School (T.A.T., T.A., M.J.A.G.), Singapore
| | - Aiste Kadziauskiene
- Clinic of Ears, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University (A.K.), Vilnius, Lithuania; Center of Eye diseases, Vilnius University Hospital Santaros Klinikos (A.K.), Vilnius, Lithuania
| | - George Barbastathis
- Singapore-MIT Alliance for Research and Technology (F.A.B., G.B.), Singapore; Department of Mechanical Engineering, Massachusetts Institute of Technology (G.B.), Cambridge, Massachusetts, USA
| | - Tin Aung
- Yong Loo Lin School of Medicine, National University of Singapore (F.A.B., T.A.), Singapore; Singapore Eye Research Institute, Singapore National Eye Centre (T.A.T., T.A.), Singapore; Duke-NUS Graduate Medical School (T.A.T., T.A., M.J.A.G.), Singapore
| | - Michaël J A Girard
- From the Ophthalmic Engineering & Innovation Laboratory, Singapore Eye Research Institute, Singapore National Eye Centre (F.A.B., M.J.A.G.), Singapore; Duke-NUS Graduate Medical School (T.A.T., T.A., M.J.A.G.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland.
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Screening fundus photography predicts and reveals risk factors for glaucoma conversion in eyes with large optic disc cupping. Sci Rep 2023; 13:81. [PMID: 36596820 PMCID: PMC9810728 DOI: 10.1038/s41598-022-26798-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/20/2022] [Indexed: 01/04/2023] Open
Abstract
This study aimed to investigate the risk factors for glaucoma conversion and progression in eyes with large optic disc cupping without retinal nerve fiber layer defect (RNFLD). Five hundred forty-two eyes of 271 subjects who had a vertical cup-to-disc ratio (CDR) ≥ 0.6 without RNFLD were enrolled. Characteristics for optic disc configuration (including CDR, vertical cupping, ISNT rule, disc ovality, peripapillary atrophy [PPA]-to-disc area [DA] ratio, and lamina cribrosa pore visibility) and blood vessels (including central retinal vessel trunk [CRVT] nasalization, bayoneting of vessels, baring of circumlinear vessels, history of disc hemorrhage [DH] and vessel narrowing/sclerotic change) were evaluated. From a median follow-up of 11.3 years, 26.6% of eyes (n = 144) developed RNFLD within a median of 5.1 years. Baseline factors, including vertical CDR ≥ 0.7 (hazard ratio [HR] = 2.12), vertical cupping (HR = 1.93), ISNT rule violation (HR = 2.84), disc ovality ≥ 1.2 (HR = 1.61), PPA-to-DA ratio ≥ 0.4 (HR = 1.77), CRVT nasalization ≥ 60% (HR = 1.77), vessel narrowing/sclerotic change (HR = 2.13), DH history (HR = 5.60), and baseline intraocular pressure ≥ 14 mmHg (HR = 1.70) were significantly associated with glaucoma conversion (all Ps < 0.05). An HR-matched scoring system based on initial fundus photography predicted glaucoma conversion with specificity of 90.4%. Careful examination of the optic nerve head and vascular structures can help to predict the risk of glaucoma conversion in eyes with large optic disc cupping.
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Jang M, Kim YK, Jeoung JW, Park KH. Analysis of Variation in Incidence of Optic Disc Hemorrhage According to Seasonal and Temperature Changes. Am J Ophthalmol 2022; 239:84-89. [PMID: 35192793 DOI: 10.1016/j.ajo.2022.02.007] [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: 12/09/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate seasonal variation in optic disc hemorrhage (DH) by review of fundus photographs representative of 2 calendar years (2019 and 2020). DESIGN Retrospective, observational trend study. METHODS Patients who visited the Glaucoma Clinic of Seoul National University Hospital and underwent fundus photography were included. All available stereo disc photographs and red-free retinal nerve fiber layer photographs taken between January 1, 2019 and December 31, 2020 were retrospectively reviewed. The monthly incidence rate of DH was determined by reference to the photographs. Seasonal temperature information and patients' intraocular pressure (IOP) information were obtained, organized, and analyzed. RESULTS Fundus images of 13,514 eyes were reviewed, and 454 eyes were confirmed to have DH. Poisson regression analyses revealed that as the temperature (T) increased by 1 °C, the DH risk ratio was reduced to 0.979 (95% confidence interval [CI] 0.969-0.989, P < .01). The DH incidence ratio was 1.53 (95% CI 1.23-1.91, P < .01) for the T <10 °C group relative to the T ≥20 °C group. The IOP of the patients with DH in winter was significantly higher than that measured in summer. CONCLUSION DH is affected by temperature, and as such, shows seasonal variability. This variability is believed to be caused by temperature-related factors such as IOP or hematological factors. © 2022 Elsevier Inc. All rights reserved.
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Affiliation(s)
- Mirinae Jang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
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LeTran VH, Burkemper B, O'Fee JR, Souverein EA, Lee JC, Phillips MJ, Dinh-Dang D, Song BJ, Xu BY, Wong BJ, Richter GM. Wedge Defects on Optical Coherence Tomography Angiography of the Peripapillary Retina in Glaucoma: Prevalence and Associated Clinical Factors. J Glaucoma 2022; 31:242-249. [PMID: 35089892 DOI: 10.1097/ijg.0000000000001991] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/14/2022] [Indexed: 11/25/2022]
Abstract
PRCIS Among subjects with glaucoma, wedge-shaped defects on optical coherence tomography angiography (OCTA) were associated with disc hemorrhages (DH), paracentral visual field (VF) defects, increased cup-to-disc ratio (CDR), and thinner retinal nerve fiber layer (RNFL). PURPOSE To examine determinants of wedge defects on peripapillary OCTA in glaucoma. MATERIALS AND METHODS A total of 278 eyes of 186 subjects with mild to severe primary open-angle glaucoma underwent 6×6 spectral-domain OCTA imaging of the superficial peripapillary retina from 2016 to 2020 at an academic practice. Wedge defects were defined as focal microvasculature loss that extends outward from the optic nerve in an arcuate, wedge shape. Logistic regression models controlling for intereye correlation identified variables significantly associated with wedge defects. Eyes with profound microvasculature loss in both hemispheres were excluded. Candidate variables included: age, sex, race or ethnicity, diabetes, hypertension, follow-up duration, baseline untreated intraocular pressure, intraocular pressure at time of imaging, DH history, paracentral VF defects, CDR, central corneal thickness, spherical equivalent, VF mean deviation, RNFL thickness, and glaucoma stage. RESULTS Of 278 eyes, 126 (45.3%) had wedge defects in at least 1 hemisphere. In our multivariable logistic regression model, wedge defects were associated with DH history [odds ratio (OR): 3.19, 95% confidence interval (CI): 1.05-9.69, P=0.041], paracentral VF defects [OR: 4.38 (95% CI: 2.11-9.11), P<0.0001], larger CDR [OR: 1.27 (95% CI: 1.03-1.56), P=0.024, per 0.1 increase], and thinner RNFL [OR: 1.71 (95% CI: 1.25-2.34), P=0.0009, per 10 μm decrease]. CONCLUSION DH history and paracentral VF defects were independently associated with wedge defects on OCTA, which was present in 45.3% of primary open-angle glaucoma patients. These findings may provide insight into glaucoma pathogenesis.
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Affiliation(s)
- Vivian H LeTran
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Bruce Burkemper
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - John R O'Fee
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Erik A Souverein
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Jae C Lee
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Mark J Phillips
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | | | - Brian J Song
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Benjamin Y Xu
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Brandon J Wong
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Grace M Richter
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
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10
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Prokosch V, Zwingelberg SB, Mercieca K. [Normal Tension Glaucoma]. Klin Monbl Augenheilkd 2022. [PMID: 35253131 DOI: 10.1055/a-1758-3486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Normal tension glaucoma (NTG) is a subvariant of primary open angle glaucoma (POAG) or a separate entity. NTG is defined as chronic open angle glaucoma without elevated intraocular pressure or normal intraocular pressure. Normal intraocular pressure is between 10 and 21 mmHg and is defined as two times the standard deviation of the mean intraocular pressure in the normal population. In addition to the absence of elevated intraocular pressure, all the classic symptoms of glaucoma are otherwise present. These include a conspicuous glaucomatous optic disc excavation, nerve fibre bundle defects, and corresponding visual field defects. Papillary rim haemorrhages are frequently found. The visual field defects in NDG are usually more central compared to POAG and are therefore described as more disturbing by the patient. The anterior chamber angle is open and there are no other changes suggestive of secondary glaucoma (pigment dispersion, pseudo-exfoliation). The exact pathophysiology of NDG is not well understood. Pathophysiologically, circulatory disturbances in the sense of arterial hypo- as well as hypertension may play an essential role or at least increase the susceptibility of the optic nerve to intraocular pressure fluctuations as well as blood pressure dips. Therefore, this requires not only a purely ophthalmologic but also interdisciplinary treatment of the patient with confirmed NDG. The primary goal of treatment is the reduction of intraocular pressure, which can stop the disease. This article gives an overview of epidemiology, aetiology, clinical findings and therapies.
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Prokosch V, Zwingelberg SB, Mercieca K. Normaldruckglaukome. AUGENHEILKUNDE UP2DATE 2022. [DOI: 10.1055/a-1262-3134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDas Normaldruckglaukom wird definiert wird als primär chronisches Offenwinkelglaukom, bei dem kein erhöhter Augeninnendruck vorliegt. Trotz normalem Augeninnendruck ist das primäre Ziel der
Behandlung die Augeninnendrucksenkung, mit der es gelingen kann, die Erkrankung aufzuhalten. Dieser Artikel soll eine Übersicht über Epidemiologie, Ätiologie, Pathogenese, klinische Befunde
sowie Therapien geben.
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Rates of Circumpapillary Retinal Nerve Fiber Layer Thinning and Capillary Density Loss in Glaucomatous Eyes with Disc Hemorrhage. Am J Ophthalmol 2022; 235:24-31. [PMID: 34587496 PMCID: PMC9904188 DOI: 10.1016/j.ajo.2021.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/08/2021] [Accepted: 09/15/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate longitudinal changes in rates of optic nerve head circumpapillary retinal nerve fiber layer (cpRNFL) thinning and vessel density loss in patients with primary open-angle glaucoma with or without a history of disc hemorrhage (DH). DESIGN Observational cohort. METHODS In this longitudinal study, 34 eyes with DH and 134 eyes without DH that had ≥1.5 years of follow-up and 3 optical coherence tomography and optical coherence tomography angiography follow-up scans were enrolled. A linear mixed-effects model was used to compare the rates of cpRNFL thinning and vessel density loss between DH and non-DH eyes. RESULTS Rates of whole image capillary density loss were faster in the DH group compared with the non-DH group (mean difference [95% confidence interval] -0.32% [-0.59% to -0.04%] per year; P = .027). Faster mean rates of vessel density loss were found in the inferotemporal, inferonasal, and nasal sectors in eyes with DH than without DH (P < .05). There was no statistically significant difference in the global rate of cpRNFL thinning between the 2 groups (P = .679). The mean rate of cpRNFL thinning was faster in the DH group compared with the non-DH group only in the inferotemporal sector (mean difference [95% confidence interval] -1.01 μm (-1.62 μm to -0.40 μm) per year; P = .001). CONCLUSIONS Mean rates of vessel density loss between DH and non-DH eyes were different not only in the affected area but also in the other regions. In contrast, a significant difference in cpRNFL thinning between the 2 groups was detected only in the inferotemporal sector. Disc hemorrhage is an independent predictor of faster vessel density loss in glaucoma suspects and patients with primary open-angle glaucoma.
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Lee SY, Yang H, Lee K, Seong GJ, Kim CY, Bae HW. Factors Associated With Differences in the Initial Location of Structural Progression in Normal-Tension Glaucoma. J Glaucoma 2022; 31:170-177. [PMID: 35019877 PMCID: PMC8876386 DOI: 10.1097/ijg.0000000000001983] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/28/2021] [Indexed: 11/26/2022]
Abstract
PRCIS Different clinical factors are associated with the location of the first structural progression in glaucoma. PURPOSE The aim was to investigate the underlying clinical parameters affecting the location of the initial structural progression of glaucoma in patients with normal-tension glaucoma (NTG). METHODS This retrospective study included 228 eyes of 228 patients with NTG. In total, 130 eyes of 130 patients demonstrated structural progression (as determined by event-based guided progression analysis using Cirrus HD-optical coherence tomography) in the peripapillary retinal nerve fiber layer (ppRNFL) or macular ganglion cell inner plexiform layer (mGCIPL). Depending on where the progression occurred first, it was defined as either ppRNFL first progression or mGCIPL first progression. Clinical parameters associated with each first progression were identified using logistic regression. RESULTS In total, 50 eyes showed ppRNFL first progression and 64 eyes showed mGCIPL first progression. ppRNFL first progression was significantly associated with female sex [odds ratio (OR)=5.705, P=0.015], lack of systemic hypertension (OR=0.199, P=0.014), disc hemorrhage (OR=4.188, P=0.029), higher mean intraocular pressure (OR=1.300, P=0.03), and lower pattern SD (OR=0.784, P=0.028). In contrast, male sex (OR=0.450, P=0.043), lower central corneal thickness (OR=0.987, P=0.032), higher intraocular pressure fluctuation (OR=1.753, P=0.047), lower systolic blood pressure fluctuation (OR=0.839, P=0.002), and higher diastolic blood pressure fluctuation (OR=1.208, P=0.015) were significantly associated with mGCIPL first progression. CONCLUSIONS Different clinical factors were associated with the initial site of structural glaucoma progression in patients with NTG depending on its peripapillary or macular location, and these findings suggest possible differences in underlying mechanisms of glaucoma damage.
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Affiliation(s)
- Sang Yeop Lee
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine
- Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin
| | | | - Kwanghyun Lee
- Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, Gyeonggi-do, Republic of Korea
| | - Gong Je Seong
- Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin
| | - Chan Yun Kim
- Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin
| | - Hyoung Won Bae
- Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin
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Saks D, Schulz A, Sheriff S, Shen T, Gupta V, Qassim A, Ridge B, Pham R, Craig J, Graham S. Quantification of localised vascular wedge-shaped defects in glaucoma. Clin Exp Ophthalmol 2022; 50:724-735. [PMID: 35796092 PMCID: PMC9796144 DOI: 10.1111/ceo.14134] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/15/2022] [Accepted: 07/03/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Vascular dysfunction plays a considerable role in glaucoma pathogenesis. Previous glaucoma case studies described localised wedge-shaped vascular defects, similar to retinal nerve fibre layer (RNFL) wedge defects. This study investigates the prevalence and quantification of this vessel loss, in relation to primary open angle glaucoma (POAG) parameters. METHODS This study included 608 eyes (351 participants): 192 PROGRESSA study participants (342 eyes) with suspect, preperimetric or early manifest POAG, observed for vascular wedge defect presence (cohort one); an additional 114 individuals (cohort two-208 eyes) with POAG at various stages of progression for wedge characterisation; and 38 controls (56 eyes). Vascular wedge defects were observed using optical coherence tomography angiography (OCTA). Wedge parameters and vessel densities were quantified using ImageJ software. RNFL and ganglion cell layer inner plexiform layer (GCLIPL) from OCT scans, and mean deviation (Humphrey visual field 24-2) were also assessed. RESULTS Vascular wedge defects were found in 45/342 eyes (13.2%) in cohort one, in 41/208 eyes (19.7%) in cohort two and were not found in controls. Wedge defects were mostly inferotemporal (80%), and present at all disease stages. They were associated with visual field loss in the opposite hemisphere, thinner RNFL (p < 0.001), thinner GCLIPL (p = 0.003), and focal RNFL loss corresponding with the vascular defect region. CONCLUSION Vascular wedge defects are present at all POAG stages even before functional change and are strongly concordant with focal RNFL loss. Further research is needed to explore these defects in particular their temporal relationship with clinical measures of POAG.
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Affiliation(s)
- Danit Saks
- Department of Clinical MedicineMacquarie UniversitySydneyNew South WalesAustralia
| | - Angela Schulz
- Department of Clinical MedicineMacquarie UniversitySydneyNew South WalesAustralia
| | - Samran Sheriff
- Department of Clinical MedicineMacquarie UniversitySydneyNew South WalesAustralia
| | - Ting Shen
- Department of Clinical MedicineMacquarie UniversitySydneyNew South WalesAustralia
| | - Vivek Gupta
- Department of Clinical MedicineMacquarie UniversitySydneyNew South WalesAustralia
| | - Ayub Qassim
- Department of Ophthalmology, Flinders Health and Medical Research InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Bronwyn Ridge
- Department of Ophthalmology, Flinders Health and Medical Research InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Ryan Pham
- Department of Ophthalmology, Flinders Health and Medical Research InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Jamie Craig
- Department of Ophthalmology, Flinders Health and Medical Research InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Stuart Graham
- Department of Clinical MedicineMacquarie UniversitySydneyNew South WalesAustralia
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Shalaby WS, Ahmed OM, Waisbourd M, Katz LJ. A Review of Potential Novel Glaucoma Therapeutic Options Independent of Intraocular Pressure. Surv Ophthalmol 2021; 67:1062-1080. [PMID: 34890600 DOI: 10.1016/j.survophthal.2021.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 02/06/2023]
Abstract
Glaucoma, a progressive optic neuropathy characterized by retinal ganglion cell degeneration and visual field loss, is the leading cause of irreversible blindness worldwide. Intraocular pressure (IOP) is presently the only modifiable risk factor demonstrated to slow or halt disease progression; however, glaucomatous damage persists in almost 50% of patients despite significant IOP reduction. Many studies have investigated the non-IOP-related risk factors that contribute to glaucoma progression as well as interventions that can prevent or delay glaucomatous neurodegeneration and preserve vision throughout life, independently of IOP. A vast number of experimental studies have reported effective neuroprotection in glaucoma, and clinical studies are ongoing attempting to provide strong evidence of effectiveness of these interventions. In this review, we look into the current understanding of the pathophysiology of glaucoma and explore the recent advances in non-IOP related strategies for neuroprotection and neuroregeneration in glaucoma.
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Key Words
- AMD, Age-related macular degeneration
- BDNF, Brain derived neurotrophic factor
- CNTF, Ciliary neurotrophic factor
- GDNF, Glial‐derived neurotrophic factor
- Glaucoma
- IOP, Intraocular pressure
- LoGTS, Low-Pressure Glaucoma Treatment Study
- MRI, Magnetic resonance imaging
- MSCs, Mesenchymal stem cells
- NGF, Nerve growth factor
- NTG, Normal tension glaucoma
- OCTA, Optical coherence tomography angiography
- PBM, hotobiomodulation
- PDGF, Platelet derived growth factor
- POAG, Primary open angle glaucoma
- RGCs, Retinal ganglion cells
- TNF-α, Tumor necrosis factor- α
- bFGF, Basic fibroblast growth factor
- gene therapy
- intracranial pressure
- intraocular pressure
- neuroprotection
- ocular blood flow
- oxidative stress
- retinal ganglion cells
- stem cell therapy
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Affiliation(s)
- Wesam Shamseldin Shalaby
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA; Department of Ophthalmology, Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Osama M Ahmed
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA; Yale University School of Medicine, New Haven, CT, USA
| | - Michael Waisbourd
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA; Department of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA.
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Progression of Parapapillary Choroidal Microvascular Dropout After Disc Hemorrhage in Glaucoma Patients: 2 Case Reports. J Glaucoma 2021; 30:e8-e12. [PMID: 33351550 DOI: 10.1097/ijg.0000000000001688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/09/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Microvasculature dropout (MvD) is a novel finding seen in optical coherence tomography angiography (OCTA), which is characterized by a localized dehiscence of the choriocapillaris in the parapapillary atrophy area. Disc hemorrhage (DH) is an important factor often associated with the development and especially progression of glaucoma. Here, we present 2 cases of MvD progression with DH. METHODS AND RESULTS Case 1: A 62-year-old female patient with normal tension glaucoma in both her eyes had recurrent DH at the inferior area of her right eye. A new DH was observed in the inferotemporal area of the right eye with MvD progression on OCTA in the same direction three months from the baseline.Case 2: A 57-year-old female patient with bilateral steroid-induced secondary glaucoma also had recurrent DH in her right eye. Four months from the baseline, DH occurred in the superotemporal and inferotemporal area of the right eye, and MvD was detected on OCTA in the superotemporal corresponding direction. After 19 months from the baseline, OCTA was repeated. The DH had resolved, but the superotemporal MvD persisted. CONCLUSIONS The 2 cases presented here are the first to report on the relationship between MvD progression and DH. MvD as visualized in OCTA imaging looks to be of clinical importance, and hopefully future studies will reveal the actual connection between MvD, DH, and glaucoma progression.
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Meer E, Qin VL, Gudiseva HV, McGeehan B, Salowe R, Pistilli M, He J, Daniel E, Ying GS, Chavali VRM, O’Brien JM. LMX1B Locus Associated with Low-Risk Baseline Glaucomatous Features in the POAAGG Study. Genes (Basel) 2021; 12:1252. [PMID: 34440426 PMCID: PMC8394298 DOI: 10.3390/genes12081252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 01/11/2023] Open
Abstract
Primary open-angle glaucoma (POAG) is the leading cause of irreversible blindness worldwide and has been associated with multiple genetic risk factors. The LMX1B gene is a genetic susceptibility factor for POAG, and several single-nucleotide polymorphisms (SNPs) were shown to be associated with POAG in our own prior Primary Open-Angle African American Glaucoma Genetics (POAAGG) study genome-wide association study (GWAS). This study evaluated the association of the LMX1B locus with baseline optic disc and clinical phenotypic characteristics of glaucoma patients from our African American cohort. Compared to the GG genotype in SNP rs187699205, the GC genotype in this SNP was found to be significantly associated with a smaller cup-to-disc ratio (CDR) and increased (better) visual field mean deviation (MD) in glaucoma cases. None of the glaucoma cases with the GC genotype had disc hemorrhages, disc notching, or beanpot disc appearance. In conclusion, glaucoma phenotypes differed significantly by LMX1B variant in African American patients with POAG, and a SNP variant was associated with certain disease features considered lower risk.
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Affiliation(s)
- Elana Meer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Vivian L. Qin
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.L.Q.); (H.V.G.); (B.M.); (R.S.); (M.P.); (J.H.); (E.D.); (G.S.Y.); (V.R.M.C.)
| | - Harini V. Gudiseva
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.L.Q.); (H.V.G.); (B.M.); (R.S.); (M.P.); (J.H.); (E.D.); (G.S.Y.); (V.R.M.C.)
| | - Brendan McGeehan
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.L.Q.); (H.V.G.); (B.M.); (R.S.); (M.P.); (J.H.); (E.D.); (G.S.Y.); (V.R.M.C.)
| | - Rebecca Salowe
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.L.Q.); (H.V.G.); (B.M.); (R.S.); (M.P.); (J.H.); (E.D.); (G.S.Y.); (V.R.M.C.)
| | - Maxwell Pistilli
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.L.Q.); (H.V.G.); (B.M.); (R.S.); (M.P.); (J.H.); (E.D.); (G.S.Y.); (V.R.M.C.)
| | - Jie He
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.L.Q.); (H.V.G.); (B.M.); (R.S.); (M.P.); (J.H.); (E.D.); (G.S.Y.); (V.R.M.C.)
| | - Ebenezer Daniel
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.L.Q.); (H.V.G.); (B.M.); (R.S.); (M.P.); (J.H.); (E.D.); (G.S.Y.); (V.R.M.C.)
| | - Gui Shang Ying
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.L.Q.); (H.V.G.); (B.M.); (R.S.); (M.P.); (J.H.); (E.D.); (G.S.Y.); (V.R.M.C.)
| | - Venkata R. M. Chavali
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.L.Q.); (H.V.G.); (B.M.); (R.S.); (M.P.); (J.H.); (E.D.); (G.S.Y.); (V.R.M.C.)
| | - Joan M. O’Brien
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.L.Q.); (H.V.G.); (B.M.); (R.S.); (M.P.); (J.H.); (E.D.); (G.S.Y.); (V.R.M.C.)
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Risk factors for open-angle glaucoma and recommendations for glaucoma screening. Ophthalmologe 2021; 118:145-152. [PMID: 33881589 DOI: 10.1007/s00347-021-01378-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
Open-angle glaucomas are a group of chronic progressive optic nerve neuropathies with a gonioscopic open anterior chamber angle. They are one of the main causes of visual impairment and blindness in industrialized countries. The aim of this article is to discuss and evaluate the epidemiology and risk factors for the development of open-angle glaucoma and to present the screening procedure for open-angle glaucoma according to the recently published S2e guidelines of the Association of the Scientific Medical Societies in Germany (AWMF).
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19
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Sakata R, Yoshitomi T, Araie M, Ishikawa M, Abe H, Fukuchi T, Sugiyama K, Ohkubo S, Nitta K, Tomidokoro A, Hirasawa H, Yoshikawa K, Iwase A, Negi A, Yamada Y, Tanihara H, Inatani M, Inoue T, Takihara Y, Ohhira S, Kojima S, Naitou C, Aihara M, Shirakashi M, Higashide T, Matsumoto C, Iwase A, Takada S, Aihara M, Saito H. The occurrence of optic disc haemorrhage in primary open-angle glaucoma eyes with lower normal pressure and its relating factors. Acta Ophthalmol 2021; 99:e28-e35. [PMID: 32533647 DOI: 10.1111/aos.14506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To report the occurrence probability of disc haemorrhage (DH) and risk factors for it in otherwise healthy Japanese normal-tension glaucoma (NTG) patients who had lower normal intraocular pressure (IOP) and were followed without treatment for 5 years. METHODS A prospective observational study. Normal-tension glaucoma (NTG) patients with IOP consistently ≤15 mmHg without treatment were enrolled. The presence or absence of DH was checked semi-annually on the fundus photographs by three independent observers, while patients were followed without treatment. Cox proportional hazards model taking inter-eye correlation into consideration was adopted to identify risk factors for DH occurrence. The main outcomes were DH occurrence probability during 5-year period and its risk factors. RESULTS One hundred seventeen eyes of 90 patients with mean age of 54.1 years, mean deviation value of -3.6 decibels and mean IOP during follow-up of 12.4 mmHg were included. Disc haemorrhage (DH) was observed at least once in 34 eyes and more than twice in 15 eyes during the follow-up. The DH occurrence probability at 5 years was 31% (95% confidence interval: 21-40%), and lower myopic refraction (HR = 1.18; p = 0.018), higher IOP during follow-up (HR = 1.35; p = 0.047) and presence of DH at baseline (HR = 4.19; p = 0.002) were its risk factors. CONCLUSION Disc haemorrhage (DH) occurrence probability of Japanese healthy NTG patients with mean IOP of 12.4 mmHg and no systemic and/or topical treatment was 31% at 5 years. Lower myopic refraction, higher IOP and its existence at baseline were its risk factors.
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Affiliation(s)
- Rei Sakata
- Department of Ophthalmology Graduate of Medicine and Faculty of Medicine The University of Tokyo Tokyo Japan
| | - Takeshi Yoshitomi
- Department of Ophthalmology Akita University Graduate School of Medicine Akita Japan
- Department of Orthoptics Fukuoka International University of Health and Welfare Fukuoka Japan
| | - Makoto Araie
- Department of Ophthalmology Graduate of Medicine and Faculty of Medicine The University of Tokyo Tokyo Japan
- Department of Ophthalmology Kanto Central Hospital of the Mutual Aid Association of Public‐School Teachers Tokyo Japan
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20
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Wang YX, Panda-Jonas S, Jonas JB. Optic nerve head anatomy in myopia and glaucoma, including parapapillary zones alpha, beta, gamma and delta: Histology and clinical features. Prog Retin Eye Res 2020; 83:100933. [PMID: 33309588 DOI: 10.1016/j.preteyeres.2020.100933] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/22/2020] [Accepted: 11/27/2020] [Indexed: 12/13/2022]
Abstract
The optic nerve head can morphologically be differentiated into the optic disc with the lamina cribrosa as its basis, and the parapapillary region with zones alpha (irregular pigmentation due to irregularities of the retinal pigment epithelium (RPE) and peripheral location), beta zone (complete RPE loss while Bruch's membrane (BM) is present), gamma zone (absence of BM), and delta zone (elongated and thinned peripapillary scleral flange) within gamma zone and located at the peripapillary ring. Alpha zone is present in almost all eyes. Beta zone is associated with glaucoma and may develop due to a IOP rise-dependent parapapillary up-piling of RPE. Gamma zone may develop due to a shift of the non-enlarged BM opening (BMO) in moderate myopia, while in highly myopic eyes, the BMO enlarges and a circular gamma zone and delta zone develop. The ophthalmoscopic shape and size of the optic disc is markedly influenced by a myopic shift of BMO, usually into the temporal direction, leading to a BM overhanging into the intrapapillary compartment at the nasal disc border, a secondary lack of BM in the temporal parapapillary region (leading to gamma zone in non-highly myopic eyes), and an ocular optic nerve canal running obliquely from centrally posteriorly to nasally anteriorly. In highly myopic eyes (cut-off for high myopia at approximately -8 diopters or an axial length of 26.5 mm), the optic disc area enlarges, the lamina cribrosa thus enlarges in area and decreases in thickness, and the BMO increases, leading to a circular gamma zone and delta zone in highly myopic eyes.
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Affiliation(s)
- Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.
| | - Songhomitra Panda-Jonas
- Institute for Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany
| | - Jost B Jonas
- Institute for Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany; Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karis-University, Mannheim, Germany
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21
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Schuster AK, Wagner FM, Pfeiffer N, Hoff Mann EM. [Risk factors for open-angle glaucoma and recommendations for glaucoma screening]. Ophthalmologe 2020; 117:1149-1160. [PMID: 33095295 DOI: 10.1007/s00347-020-01251-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Open-angle glaucomas are a group of chronic progressive optic nerve neuropathies with a gonioscopic open anterior chamber angle. They are one of the main causes of visual impairment and blindness in industrialized countries. The aim of this article is to discuss and evaluate the epidemiology and risk factors for the development of open-angle glaucoma and to present the screening procedure for open-angle glaucoma according to the recently published S2e guidelines of the Association of the Scientific Medical Societies in Germany (AWMF).
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Affiliation(s)
- Alexander K Schuster
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - Felix M Wagner
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Norbert Pfeiffer
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Esther M Hoff Mann
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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22
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Effect of systemic blood pressure on optical coherence tomography angiography in glaucoma patients. Eye (Lond) 2020; 35:1967-1976. [PMID: 33005044 DOI: 10.1038/s41433-020-01199-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 09/18/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The association between retinal microvascular structure and glaucoma has been revealed in multiple studies using optical tomography angiography (OCTA), but limited information on the macular vessel density (mVD) in patients with glaucoma is available. In this study, we tried to identity the factors that affected macular VD (mVD) in glaucomatous eyes. METHODS This retrospective cross-sectional study evaluated OCT and OCTA images from 92 eyes from 58 healthy subjects and 179 eyes from 103 glaucoma patients using the SD-OCT database from July 2017 to July 2018. Glaucomatous eyes were further divided into two groups according to history of disc haemorrhage (DH). Association between mVD and demographic characteristics, ganglion cell-inner plexiform layer (GCIPL) thickness, visual field mean deviation (MD) and systemic blood pressure was analysed in each group. RESULTS In both healthy and glaucomatous eyes, mVD was inversely associated with age (β = -0.035, P = 0.025; β = -0.039, P = 0.018). In the glaucomatous eyes, mVD was significantly decreased, as the MD value was worse (β = 0.109, P = 0.002). In glaucomatous eyes with DH, mVD decreased as blood pressure increased (β = -0.111, P = 0.003) CONCLUSIONS: Reduced mVD is more common in older individuals in both healthy and glaucomatous eyes, and correlates with functional deterioration than structural damage in glaucomatous eyes. In glaucomatous eyes with DH, high systemic BP is associated with a reduction in mVD. This may indicate that glaucoma patients with DH are more susceptible to vascular damage secondary to hypertension.
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Development of a nomogram using fundus photography to predict glaucoma progression in patients showing disc hemorrhage. Sci Rep 2020; 10:14650. [PMID: 32887917 PMCID: PMC7474082 DOI: 10.1038/s41598-020-71183-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 08/10/2020] [Indexed: 11/09/2022] Open
Abstract
To develop a nomogram to predict the progression of glaucoma by fundus photography in patients with disc hemorrhage. Retrospective review of the medical records of patients with disc hemorrhage, which was detected during follow up with open angle glaucoma, from January 2010 to March 2018. Patients were divided into glaucoma progression (n = 52) or non-progression (n = 38) groups. We assessed proximal location and morphology of disc hemorrhage; relationship to retinal nerve fiber layer defects with disc hemorrhage; and angular extent of disc hemorrhage, between groups using fundus photography. Multiple logistic regression analysis was performed to select prognostic factors, and we constructed a nomogram to predict glaucoma progression. The number of disc hemorrhage at the border of retinal nerve fiber layer defects (P = 0.001) and peripapillary disc hemorrhage (P = 0.008) were significantly higher in the progression group. We used angular extent; location of disc hemorrhage with retinal nerve fiber layer defects; and proximal location of disc hemorrhage to construct the nomogram. The area under the receiver operating characteristic curve of the nomogram was 0.847. We created the nomogram using fundus photography in patients showing disc hemorrhage as a novel and accurate screening method to predict glaucoma progression and aid clinicians to decide on the best treatment plan.
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Girard MJA, Schmetterer L. Artificial intelligence and deep learning in glaucoma: Current state and future prospects. PROGRESS IN BRAIN RESEARCH 2020; 257:37-64. [PMID: 32988472 DOI: 10.1016/bs.pbr.2020.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Over the past few years, there has been an unprecedented and tremendous excitement for artificial intelligence (AI) research in the field of Ophthalmology; this has naturally been translated to glaucoma-a progressive optic neuropathy characterized by retinal ganglion cell axon loss and associated visual field defects. In this review, we aim to discuss how AI may have a unique opportunity to tackle the many challenges faced in the glaucoma clinic. This is because glaucoma remains poorly understood with difficulties in providing early diagnosis and prognosis accurately and in a timely fashion. In the short term, AI could also become a game changer by paving the way for the first cost-effective glaucoma screening campaigns. While there are undeniable technical and clinical challenges ahead, and more so than for other ophthalmic disorders whereby AI is already booming, we strongly believe that glaucoma specialists should embrace AI as a companion to their practice. Finally, this review will also remind ourselves that glaucoma is a complex group of disorders with a multitude of physiological manifestations that cannot yet be observed clinically. AI in glaucoma is here to stay, but it will not be the only tool to solve glaucoma.
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Affiliation(s)
- Michaël J A Girard
- Ophthalmic Engineering & Innovation Laboratory (OEIL), Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
| | - Leopold Schmetterer
- Ocular Imaging, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore; School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore; Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; Institute of Clinical and Experimental Ophthalmology, Basel, Switzerland.
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Harris A, Guidoboni G, Siesky B, Mathew S, Verticchio Vercellin AC, Rowe L, Arciero J. Ocular blood flow as a clinical observation: Value, limitations and data analysis. Prog Retin Eye Res 2020; 78:100841. [PMID: 31987983 PMCID: PMC8908549 DOI: 10.1016/j.preteyeres.2020.100841] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 12/24/2022]
Abstract
Alterations in ocular blood flow have been identified as important risk factors for the onset and progression of numerous diseases of the eye. In particular, several population-based and longitudinal-based studies have provided compelling evidence of hemodynamic biomarkers as independent risk factors for ocular disease throughout several different geographic regions. Despite this evidence, the relative contribution of blood flow to ocular physiology and pathology in synergy with other risk factors and comorbidities (e.g., age, gender, race, diabetes and hypertension) remains uncertain. There is currently no gold standard for assessing all relevant vascular beds in the eye, and the heterogeneous vascular biomarkers derived from multiple ocular imaging technologies are non-interchangeable and difficult to interpret as a whole. As a result of these disease complexities and imaging limitations, standard statistical methods often yield inconsistent results across studies and are unable to quantify or explain a patient's overall risk for ocular disease. Combining mathematical modeling with artificial intelligence holds great promise for advancing data analysis in ophthalmology and enabling individualized risk assessment from diverse, multi-input clinical and demographic biomarkers. Mechanism-driven mathematical modeling makes virtual laboratories available to investigate pathogenic mechanisms, advance diagnostic ability and improve disease management. Artificial intelligence provides a novel method for utilizing a vast amount of data from a wide range of patient types to diagnose and monitor ocular disease. This article reviews the state of the art and major unanswered questions related to ocular vascular anatomy and physiology, ocular imaging techniques, clinical findings in glaucoma and other eye diseases, and mechanistic modeling predictions, while laying a path for integrating clinical observations with mathematical models and artificial intelligence. Viable alternatives for integrated data analysis are proposed that aim to overcome the limitations of standard statistical approaches and enable individually tailored precision medicine in ophthalmology.
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Affiliation(s)
- Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | | | - Brent Siesky
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Sunu Mathew
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alice C Verticchio Vercellin
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA; University of Pavia, Pavia, Italy; IRCCS - Fondazione Bietti, Rome, Italy
| | - Lucas Rowe
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Julia Arciero
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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Hou H, Moghimi S, Zangwill LM, Proudfoot JA, Akagi T, Shoji T, Girkin CA, Liebmann JM, Weinreb RN. Association between Rates of Retinal Nerve Fiber Layer Thinning after Intraocular Pressure-Lowering Procedures and Disc Hemorrhage. Ophthalmol Glaucoma 2020; 3:7-13. [PMID: 32632404 PMCID: PMC7337275 DOI: 10.1016/j.ogla.2019.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To compare the rates of retinal nerve fiber layer (RNFL) thinning after intraocular pressure (IOP) lowering procedures in eyes with or without disc hemorrhage (DH) history. Design Observational cohort study. Methods A total of 166 primary open angle glaucoma (POAG) eyes and glaucoma suspect eyes (37 eyes with DH history (DH group) and 129 eyes without DH (non-DH group)) were included from the African Decent and Glaucoma Evaluation Study (ADAGES) and the Diagnostic Innovations in Glaucoma Study (DIGS). Subjects underwent stereoscopic optic disc photography annually and spectral-domain optical coherence tomography (OCT) RNFL thickness measurements every 6 months. The rates of RNFL thinning were compared in eyes with and without DH using univariate and multivariable linear mixed effects models. Main Outcome Measures The rates of RNFL thinning. Results The mean follow-up of DH group and non-DH group was 4.6 years and 4.2 years, respectively. DH group had more procedures (2.4 vs. 1.9, P= 0.080) before follow-up, and more medications (1.8 vs. 1.4, P= 0.052) and lower mean IOP (12.69 mmHg vs. 14.41 mmHg, P= 0.012) during follow-up compared to non-DH group. When mean IOP was adjusted as a covariate in the model, the RNFL thinning rate in the DH group was 2-fold faster than in the non-DH group (-0.61 μm /year vs. -0.33 μm /year, P= 0.025). Higher mean IOP during follow-up was associated with a faster rate of RNFL thinning after procedures. Conclusions POAG or glaucoma suspect eyes with a history of DH should be carefully followed after IOP-lowering procedures. Additional IOP-lowering may be needed to slow structural progression of the DH eyes to the same rate as the non-DH eyes.
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Affiliation(s)
- Huiyuan Hou
- Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, CA
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, CA
| | - Linda M. Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, CA
| | - James A. Proudfoot
- Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, CA
| | - Tadamichi Akagi
- Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, CA
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takuhei Shoji
- Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, CA
- Department of Ophthalmology, Saitama Medical University, Saitama, Japan
| | | | - Jeffrey M. Liebmann
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, New York
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, CA
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Elevated Intraocular Pressure Causes Abnormal Reactivity of Mouse Retinal Arterioles. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:9736047. [PMID: 31976030 PMCID: PMC6954472 DOI: 10.1155/2019/9736047] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/27/2019] [Accepted: 11/27/2019] [Indexed: 11/20/2022]
Abstract
Objective Glaucoma is a leading cause of severe visual impairment and blindness. Although high intraocular pressure (IOP) is an established risk factor for the disease, the role of abnormal ocular vessel function in the pathophysiology of glaucoma gains more and more attention. We tested the hypothesis that elevated intraocular pressure (IOP) causes vascular dysfunction in the retina. Methods High IOP was induced in one group of mice by unilateral cauterization of three episcleral veins. The other group received sham surgery only. Two weeks later, retinal vascular preparations were studied by video microscopy in vitro. Reactive oxygen species (ROS) levels and expression of hypoxia markers and of prooxidant and antioxidant redox genes as well as of inflammatory cytokines were determined. Results Strikingly, responses of retinal arterioles to stepwise elevation of perfusion pressure were impaired in the high-IOP group. Moreover, vasodilation responses to the endothelium-dependent vasodilator, acetylcholine, were markedly reduced in mice with elevated IOP, while no differences were seen in response to the endothelium-independent nitric oxide donor, sodium nitroprusside. Remarkably, ROS levels were increased in the retinal ganglion cell layer including blood vessels. Expression of the NADPH oxidase isoform, NOX2, and of the inflammatory cytokine, TNF-α, was increased at the mRNA level in retinal explants. Expression of NOX2, but not of the hypoxic markers, HIF-1α and VEGF-A, was increased in the retinal ganglion cell layer and in retinal blood vessels at the protein level. Conclusion Our data provide first-time evidence that IOP elevation impairs autoregulation and induces endothelial dysfunction in mouse retinal arterioles. Oxidative stress and inflammation, but not hypoxia, appear to be involved in this process.
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Lee JS, Seong GJ, Kim CY, Lee SY, Bae HW. Risk factors associated with progressive nerve fiber layer thinning in open-angle glaucoma with mean intraocular pressure below 15 mmHg. Sci Rep 2019; 9:19811. [PMID: 31875007 PMCID: PMC6930196 DOI: 10.1038/s41598-019-56387-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 12/11/2019] [Indexed: 11/12/2022] Open
Abstract
The purpose of this study was to identify risk factors associated with progressive retinal nerve fiber layer(RNFL) thinning of open-angle glaucoma(OAG) in patients whose intraocular pressure(IOP) was maintained low with medical treatment. Based on a retrospective review of medical records, OAG patients with ≥60 months of follow-up and mean IOP below 15 mmHg were recruited. All eyes underwent IOP measurement with Goldmann applanation tonometer(GAT), standard automated perimetry(SAP), and cirrus optical coherence tomography(cirrus OCT) at 6 month or 1 year intervals. RNFL thinning was assessed using the Guided Progression Analysis(GPA) software. Forty-one eyes of 41 patients (mean age 54.9 ± 13.5) were followed up for 77.8 ± 7.8 months. GPA detected 20 eyes (48.8%) with progressive RNFL thinning(−1.5 ± 0.5 um/year), who were subsequently classified as the ‘rapid progression group.’ Those whose rate of change in RNFL thickness was slower than −1.00 µm/year was classified as the ‘slow progression group’ (n = 21, −0.0 ± 0.4 um/year, P < 0.001). Mean IOP after initiating therapy was 13.2 ± 1.1 mmHg in the rapid progression group and 13.1 ± 1.3 mmHg in the slow progression group (P = 0.300; 14.8 ± 10.0% vs. 19.6 ± 12.4% reduction, P = 0.155). Disc hemorrhage was found to more frequently occur in the rapid progression group (P = 0.001). Multivariate logistic regression analysis showed that patients with disc hemorrhage were at a higher risk for progressive RNFL thinning in OAG (OR 37.529 95% CI 2.915–483.140) after adjusting for baseline co-variates (P = 0.005). In conclusion, disc hemorrhage is associated with progressive RNFL thinning in OAG with well-maintained IOP. Factors other than IOP appear to also play a role in OAG progression.
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Affiliation(s)
- Jihei Sara Lee
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Seoul, Korea
| | - Gong Je Seong
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Seoul, Korea
| | - Chan Yun Kim
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Seoul, Korea
| | - Sang Yeop Lee
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Seoul, Korea
| | - Hyoung Won Bae
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Seoul, Korea.
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Kim YW, Lee WJ, Seol BR, Kim YK, Jeoung JW, Park KH. Rate of three-dimensional neuroretinal rim thinning in glaucomatous eyes with optic disc haemorrhage. Br J Ophthalmol 2019; 104:648-654. [DOI: 10.1136/bjophthalmol-2018-313595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 06/26/2019] [Accepted: 07/24/2019] [Indexed: 02/03/2023]
Abstract
BackgroundTo investigate the thinning rate of three-dimensional neuroretinal rim thickness (3D-NRT) in glaucoma eyes with optic disc haemorrhage (DH) and its relationship to retinal nerve fibre layer thickness (RNFLT) progression.MethodsNinety-five (95) eyes of 95 glaucoma patients with initial DH in the inferotemporal (n=69) and superotemporal (n=26) regions and 48 eyes of 48 glaucoma patients without DH were retrospectively reviewed. The rates of change for 3D-NRT and RNFLT were compared by linear mixed-effect model. For the direct comparison between 3D-NRT and RNFLT, dynamic-range-based normalised coefficient was used. The effect of DH frequency on the rates of thinning of 3D-NRT and RNFLT was evaluated.ResultsDuring a mean 7-year follow-up, the rates of thinning of 3D-NRT (–5.69±4.88 µm/year) and RNFLT (–2.03±2.03 µm/year) at 7 o’clock were faster than those at other locations (all p<0.05) in DH eyes. The dynamic-range-based normalised rate of thinning was significantly faster for RNFLT (–2.06%±1.62%/year) than for 3D-NRT (–1.15%±1.10%/year, p<0.001) in DH eyes, but not in non-DH eyes (p=0.43). DH frequency in the inferotemporal region was associated with the thinning rate of 3D-NRT as well as RNFLT.ConclusionDH eyes are associated with the progression of both 3D-NRT and RNFLT, especially in the inferotemporal region. DH eyes show a relatively faster thinning rate of average RNFLT than 3D-NRT. The frequency of DH can affect the progression of 3D-NRT as well as RNFLT.
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Hu R, Shen L, Wang X. Optic disk hemorrhage and vitreous hemorrhage after phacoemulsification in a normal tension glaucoma patient: A case report. Medicine (Baltimore) 2019; 98:e16215. [PMID: 31261575 PMCID: PMC6616900 DOI: 10.1097/md.0000000000016215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
RATIONALE Optic disk hemorrhage has been closely correlated with glaucoma for its development and progression. Phacoemulsification surgery results in large intraocular pressure (IOP) fluctuation. We report a case of optic disk hemorrhage and consequently progressive vitreous hemorrhage after an unsuccessful phacoemulsification surgery in an advanced normal tension glaucoma (NTG) patient. PATIENT CONCERNS An advanced NTG patient of 82 years old with chronic hypertension underwent an unsuccessful phacoemulsification surgery complicated by posterior capsule rupture. During the postoperative 2 weeks, recurrent episodes of fresh hyphema occurred and B ultrasonography scan revealed the progressive vitreous hemorrhage. The IOP went out of control under the maximum tolerable IOP-lowering medications. DIAGNOSIS Vitreous hemorrhage after phacoemulsification in an advanced NTG patient. INTERVENTIONS Vitrectomy was performed to search for the cause of the progressive vitreous hemorrhage. After removal of the thick vitreous hemorrhage, a fresh spot of optic disk hemorrhage was detected at the nasal margin of the significantly-cupping disk. OUTCOMES Postoperatively, the hemorrhagic vitreous opacity gradually resolved and the IOP remained stable at 10 ∼13 mmHg with topical prostaglandin analogue drops. Fundus examination revealed the dilated disk vessel with localized angiomatous change at the nasal disk margin. LESSONS Severe optic disk hemorrhage may occur after phacoemulsification in advanced glaucoma patients. Systemic vascular factors, such as chronic hypertension and old age, and surgical complications, such as posterior capsule rupture and postoperative IOP elevation, would further increase the risk. For phacoemulsification in advanced glaucoma cases, extra care should be taken to control intraoperative IOP fluctuations and monitor postoperative IOP.
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Yamamoto T. The impact of disc hemorrhage studies on our understanding of glaucoma: a systematic review 50 years after the rediscovery of disc hemorrhage. Jpn J Ophthalmol 2018; 63:7-25. [PMID: 30465174 DOI: 10.1007/s10384-018-0641-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/19/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW To trace the influence of disc hemorrhage studies on our understanding of glaucoma. SOURCES Major articles published during the last 50 years since the rediscovery of disc hemorrhage were identified. A total of 196 articles were selected from 435 articles retrieved using the keywords glaucoma and disc hemorrhage as of August 9 2018 from PubMed. RECENT FINDINGS The main characteristics of disc hemorrhage, including its morphology, recurrence rate, duration, increased incidence in glaucoma, and role in the progression of normal tension glaucoma was well understood by the year 2000. Since then, studies have focused on more sophisticated and accurate methods of elucidating both structural and functional progression, with special attention to the role of the lamina cribrosa. Nevertheless, both the mechanism of disc hemorrhage development and its fuller relationship with glaucoma remain unclear. Disc hemorrhage research requires careful study of glaucomatous optic neuropathy. This has been facilitated by recent advances in optical coherence tomography (OCT) angiography and other OCT technologies. Furthermore, animal studies of disc hemorrhage promise new insights into glaucomatous optic neuropathy.
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Affiliation(s)
- Tetsuya Yamamoto
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, 501-1194, Japan.
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Association between Rates of Retinal Nerve Fiber Layer Thinning and Previous Disc Hemorrhage in Glaucoma. Ophthalmol Glaucoma 2018; 1:23-31. [PMID: 32672629 DOI: 10.1016/j.ogla.2018.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/22/2018] [Accepted: 06/05/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate the relationship between previous disc hemorrhage (DH) and subsequent rates of retinal nerve fiber layer (RNFL) thinning. DESIGN Longitudinal, observational cohort study. PARTICIPANTS Twenty-eight patients with glaucoma and patients with suspected glaucoma who had a history of DH in 1 eye (unilateral DH), but not in the fellow eye, enrolled in the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study were included. METHODS All subjects underwent annual optic disc photography and semiannual spectral-domain OCT RNFL thickness measurements. Multivariable linear mixed-effects models were used to investigate the relationship between the presence of previous DH and RNFL thinning rates while adjusting for potential confounding factors, such as race, age, mean intraocular pressure (IOP), baseline disease severity, and central corneal thickness (CCT). The relationship between the timing of DH and the rates of RNFL thinning also was investigated in eyes with a history of DH. MAIN OUTCOME MEASURES Rates of global and local RNFL thinning. RESULTS Previous DH was significantly associated with faster RNFL thinning rates globally (-0.39 μm/year faster, P = 0.010), in DH quadrants (-0.77 μm/year faster, P = 0.012), and non-DH quadrants (-0.49 μm/year faster, P = 0.038) after adjustment for race, mean IOP, baseline age, baseline standard automated perimetry mean deviation, and CCT. Higher IOP was also significantly associated with faster thinning rates globally (-0.07 μm/year faster per 1 mmHg higher, P = 0.047) and in DH quadrants (-0.10 μm/year faster per 1 mmHg higher, P = 0.044). In eyes with a history of DH, the time elapsed from the latest DH episode to the first OCT examination was not significantly associated with the rate of RNFL thinning. CONCLUSIONS A history of DH is an independent risk factor for faster rates of RNFL thinning in non-DH quadrants and in DH quadrants; this risk is present even in eyes that exhibited DH several years earlier.
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Omodaka K, An G, Tsuda S, Shiga Y, Takada N, Kikawa T, Takahashi H, Yokota H, Akiba M, Nakazawa T. Classification of optic disc shape in glaucoma using machine learning based on quantified ocular parameters. PLoS One 2017; 12:e0190012. [PMID: 29261773 PMCID: PMC5736185 DOI: 10.1371/journal.pone.0190012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/06/2017] [Indexed: 12/20/2022] Open
Abstract
PURPOSE This study aimed to develop a machine learning-based algorithm for objective classification of the optic disc in patients with open-angle glaucoma (OAG), using quantitative parameters obtained from ophthalmic examination instruments. METHODS This study enrolled 163 eyes of 105 OAG patients (age: 62.3 ± 12.6, mean deviation of Humphrey field analyzer: -8.9 ± 7.5 dB). The eyes were classified into Nicolela's 4 optic disc types by 3 glaucoma specialists. Randomly, 114 eyes were selected for training data and 49 for test data. A neural network (NN) was trained with the training data and evaluated with the test data. We used 91 types of quantitative data, including 7 patient background characteristics, 48 quantified OCT (swept-source OCT; DRI OCT Atlantis, Topcon) values, including optic disc topography and circumpapillary retinal nerve fiber layer thickness (cpRNFLT), and 36 blood flow parameters from laser speckle flowgraphy, to build the machine learning classification model. To extract the important features among 91 parameters, minimum redundancy maximum relevance and a genetic feature selection were used. RESULTS The validated accuracy against test data for the NN was 87.8% (Cohen's Kappa = 0.83). The important features in the NN were horizontal disc angle, spherical equivalent, cup area, age, 6-sector superotemporal cpRNFLT, average cup depth, average nasal rim disc ratio, maximum cup depth, and superior-quadrant cpRNFLT. CONCLUSION The proposed machine learning system has proved to be good identifiers for different disc types with high accuracy. Additionally, the calculated confidence levels reported here should be very helpful for OAG care.
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Affiliation(s)
- Kazuko Omodaka
- Department of Ophthalmology, Graduate School of Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Guangzhou An
- R&D Division, TOPCON Corporation, Tokyo, Japan.,Cloud-Based Eye Disease Diagnosis Joint Research Team, RIKEN, Wako, Japan
| | - Satoru Tsuda
- Department of Ophthalmology, Graduate School of Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yukihiro Shiga
- Department of Ophthalmology, Graduate School of Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoko Takada
- Department of Ophthalmology, Graduate School of Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Hidetoshi Takahashi
- Division of Ophthalmology, Tohoku Medical and Pharmaceutical University, Department of Medicine, Sendai, Japan
| | - Hideo Yokota
- Cloud-Based Eye Disease Diagnosis Joint Research Team, RIKEN, Wako, Japan.,Image Processing Research Team, RIKEN, Wako, Japan
| | - Masahiro Akiba
- R&D Division, TOPCON Corporation, Tokyo, Japan.,Cloud-Based Eye Disease Diagnosis Joint Research Team, RIKEN, Wako, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Graduate School of Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan.,Image Processing Research Team, RIKEN, Wako, Japan.,Department of Retinal Disease Control, Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Sodhi PK, Garg E. Association Between Nocturnal Blood Pressure Dips and Optic Disc Hemorrhage in Patients With Normal-Tension Glaucoma. Am J Ophthalmol 2017; 181:176-177. [PMID: 28755760 DOI: 10.1016/j.ajo.2017.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 06/21/2017] [Indexed: 11/29/2022]
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