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Ameen Ismail A, Sadek S, Hatata R, Kamal M. Effect of brimonidine on vascular density and imagej-derived flow index of optic nerve head and macula in primary open angle glaucoma. Int Ophthalmol 2024; 44:311. [PMID: 38963456 DOI: 10.1007/s10792-024-03221-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/16/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE To study the effect of brimonidine on vascular density and flow index of optic nerve head (ONH) and macula in primary open angle glaucoma (POAG) using optical coherence tomography angiography (OCTA). METHODS Twenty-three brimonidine-naïve POAG patients were started on brimonidine. They underwent OCTA ONH and macula before commencing brimonidine and one month thereafter. Systemic arterial blood pressure (SABP) and intraocular pressure (IOP) were measured at each visit to calculate mean ocular perfusion pressure (MOPP). The OCT angiograms were analyzed using ImageJ software to calculate ONH and macular flow indices. RESULTS Thirty-seven eyes (23 patients) with a mean age of 56.7 ± 12.49 years were included of whom 60.8% were males. Brimonidine was associated with an increase in the superficial flow index (SFI) (P-value = 0.02) and optic nerve head flow index (ONHFI) (P-value = 0.01). Also, superficial vascular density (SVD) for whole image, superior-hemi and fovea increased (P-value = 0.03, 0.02, 0.03 respectively). ONH inferior-hemi vascular density decreased (P-value = 0.01) despite an increase in inferior quadrant retinal nerve fiber layer thickness (RNFLT) (P-value = 0.03). There was no statistically significant correlation between flow indices and MOPP at baseline and follow-up. A moderate negative correlation was found between SVD and DVD at the fovea and MOPP at baseline and follow-up (P-value = 0.03, 0.05) (P-value = 0.02, 0.01) respectively. CONCLUSIONS Brimonidine was associated with an increase in SFI, ONHFI and SVD indicating improved GCC and RNFL perfusion in POAG. Despite the increase in inferior quadrant RNFLT, the concomitant decrease in inferior-hemi ONHVD precluded a conclusion of hemodynamically-mediated improvement of RNFLT.
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Affiliation(s)
- Ahmed Ameen Ismail
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al-Fayoum, Egypt.
| | - Sherin Sadek
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al-Fayoum, Egypt
| | - Ragai Hatata
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al-Fayoum, Egypt
| | - Mahmoud Kamal
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al-Fayoum, Egypt
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Williams PJ, Gregory A, Komro J, You Q, Ross B, Colón C, Juzych MS, Hughes BA, Ridha F. The impact of intraocular pressure on optical coherence tomography angiography: A review of current evidence. Saudi J Ophthalmol 2024; 38:144-151. [PMID: 38988792 PMCID: PMC11232753 DOI: 10.4103/sjopt.sjopt_112_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/22/2023] [Accepted: 08/27/2023] [Indexed: 07/12/2024] Open
Abstract
A scoping review of 45 peer-reviewed manuscripts involving intraocular pressure (IOP) change and concurrent optical coherence tomography angiography (OCTA) assessments was performed to aggregate knowledge, summarize major findings, and identify gaps in literature and methodology relating to the effect of IOP change on OCTA. Articles were identified through PubMed/Medline, Google Scholar, Cochrane, Web of Science, and article reference lists. A total of 838 results were identified, and 45 articles met the inclusion and exclusion criteria for detailed analysis. OCTA metrics including vessel density (VD), perfusion density, and flow density of the superficial capillary plexus and the radial peripapillary capillaries were analyzed in relation to relative temporal IOP changes. Overall, IOP changes were found to affect superficial vascular plexus (VD) measurements on OCTA, especially when IOP elevated above the physiologic normal range (10-21 mmHg). No significant association was found between diurnal IOP variation and OCTA metrics. Cataract surgery improved the whole-image signal strength and VD regardless of changes in IOP. Beta-blockers were associated with paradoxically reduced vessel density in normal tension glaucoma patients in two studies. Although glaucoma surgical intervention studies were inconsistent and limited by scan quality and low sample sizes, patients requiring glaucoma surgery exhibited attenuated postoperative superficial VD recovery despite significant IOP reductions with surgical intervention. In addition to ensuring near-perfect signal strength with minimal media opacities and controlling for high myopia, central corneal thickness, and the presence of retinopathy, clinicians should consider the statistically significant impact of IOP on OCTA metrics when interpreting results.
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Affiliation(s)
- Parker J Williams
- Department of Ophthalmology, Kresge Eye Institute, Wayne State University, Detroit, MI, USA
- Department of Ophthalmology, Ascension Eye Institute, Ascension Macomb-Oakland Hospital, Warren, MI, USA
- Department of Internal Medicine, Lakeland Regional Health Medical Center, Lakeland, FL, USA
| | - Andrew Gregory
- Department of Ophthalmology, Kresge Eye Institute, Wayne State University, Detroit, MI, USA
| | - Jack Komro
- Department of Ophthalmology, Ascension Eye Institute, Ascension Macomb-Oakland Hospital, Warren, MI, USA
| | - Qisheng You
- Department of Ophthalmology, Kresge Eye Institute, Wayne State University, Detroit, MI, USA
| | - Bing Ross
- Department of Ophthalmology, Kresge Eye Institute, Wayne State University, Detroit, MI, USA
| | - Clara Colón
- Department of Ophthalmology, Kresge Eye Institute, Wayne State University, Detroit, MI, USA
| | - Mark S Juzych
- Department of Ophthalmology, Kresge Eye Institute, Wayne State University, Detroit, MI, USA
| | - Bret A Hughes
- Department of Ophthalmology, Kresge Eye Institute, Wayne State University, Detroit, MI, USA
| | - Faisal Ridha
- Department of Ophthalmology, Kresge Eye Institute, Wayne State University, Detroit, MI, USA
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Lestak J, Fus M, Pitrova S. Effect of treatment with carteolol and latanoprost in newly diagnosed primary open-angle glaucoma on peripapillary vessel density. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024. [PMID: 38516775 DOI: 10.5507/bp.2024.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND AND AIM In a previous follow-up of glaucoma patients taking carteolol or latanoprost, we found a greater progression of visual field changes with the prostaglandin than the betablocker. In the present study we compared the impact of carteolol and latanoprost on peripapillary vessel density in newly diagnosed primary open-angle glaucoma (POAG) patients. METHODS The study consisted of two groups of POAG patients. There were 46 patient eyes treated with carteolol (Carteol LP 2%) in the first group and 52 eyes treated with latanoprost (Xalatan 0.005%) in the second. Intraocular pressure (IOP), vessel density (VD) and visual field were assessed in all patients. VD was measured peripapillary by optical coherence tomography angiography (OCTA) with the Avanti RTVue XR in eight segments: Inferior Temporal - IT (1); Temporal Inferior -TI (2); Temporal Superior - TS (3); Superior Temporal - ST (4); Superior Nasal - SN (5); Nasal Superior - NS (6); Nasal Inferior - NI (7) and Inferior Nasal - IN (8). The measurements were compared before and after three months of treatment. The visual field was examined with a fast threshold glaucoma program using a Medmont M 700 instrument from Medmont International Pty Ltd. and only when a diagnosis of POAG was done. The overall defect (OD) was assessed. RESULTS Before treatment, there was no difference between groups in either OD or VD. After treatment, there was a decrease in IOP in both groups. In the carteolol-treated group, the mean decrease was 5.8 mmHg and in the latanoprost-treated eyes, the mean decrease was 7 mmHg. The difference was not statistically significant (P=0.133). After treatment with carteolol, there was a statistically significant increase in VD in segments 4, 5 and 6. After latanoprost treatment, VD was statistically significantly improved only in segment 5. A greater increase in VD values was found in eyes treated with carteolol than in eyes treated with latanoprost. CONCLUSION Carteolol had a better effect on vessel density than latanoprost.
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Affiliation(s)
- Jan Lestak
- CTU in Prague, Faculty of Biomedical Engineering, 272 01 Kladno 2, Czech Republic
| | - Martin Fus
- CTU in Prague, Faculty of Biomedical Engineering, 272 01 Kladno 2, Czech Republic
| | - Sarka Pitrova
- CTU in Prague, Faculty of Biomedical Engineering, 272 01 Kladno 2, Czech Republic
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Hong J, Tan SS, Chua J. Optical coherence tomography angiography in glaucoma. Clin Exp Optom 2024; 107:110-121. [PMID: 38266148 DOI: 10.1080/08164622.2024.2306963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024] Open
Abstract
The use of optical coherence tomography angiography (OCTA) holds significant promise for optometrists in the diagnosis and management of glaucoma. It offers reliable differentiation of glaucomatous eyes from healthy ones and extends monitoring capabilities for advanced cases. OCTA represents a valuable addition to traditional assessment methods, particularly in complex cases. Glaucoma, a major cause of irreversible blindness, is traditionally diagnosed using structural and functional metrics. With growing interest, OCTA is being explored to diagnose, monitor, and manage glaucoma. This review focuses on the application of OCTA in glaucoma patients. A database search was carried out using Embase Elsevier (n = 664), PubMed (n = 574), and Cochrane Central Register of Controlled Trials (n = 19) on 15 August 2023. After deduplication and screening, 272 original papers were included in the narrative review. Inclusion criteria comprised English-language original studies on OCTA use in human glaucoma patients, with or without healthy controls. Exclusion criteria encompassed animal studies, in-vivo/in-vitro research, reviews, and congress abstracts. OCTA has good repeatability and reproducibility. OCTA metrics have good discriminatory power to differentiate glaucomatous eyes from healthy eyes and show strong associations with structural changes and visual field defects. OCTA can extend the monitoring of advanced glaucoma, addressing the 'floor effect' of traditional structural measurements. OCTA metrics can be affected by the choice of OCTA machine, post-image processing algorithms, systemic diseases, and ocular factors. Image artefacts can affect the accuracy of OCTA measurements, and proper scan quality evaluation is crucial to ensure reliable results. Additionally, artificial intelligence techniques offer promise for enhancing the diagnostic accuracy of OCTA by combining data from various retinal layers and regions. OCTA complements traditional methods in assessing glaucoma, especially in challenging cases, providing valuable insights for detection and management. Further research and clinical validation are needed to integrate OCTA into routine practice.
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Affiliation(s)
- Jimmy Hong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Shayne S Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
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Micheletti E, Moghimi S, Nishida T, El-Nimri N, Mahmoudinedzah G, Kamalipour A, Mohammadzadeh V, Zangwill LM, Weinreb RN. Factors associated with choroidal microvascular dropout change. Br J Ophthalmol 2023; 107:1444-1451. [PMID: 35803672 PMCID: PMC10464525 DOI: 10.1136/bjo-2022-321157] [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: 01/20/2022] [Accepted: 06/23/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To investigate the factors associated with choroidal microvasculature drop-out (MvD) enlargement detected by optical coherence tomography angiography (OCT-A) in glaucomatous eyes. METHODS Ninety-one eyes of 68 primary open-angle glaucoma patients were enrolled. Only eyes with a minimum of four good quality OCT-A and OCT scans of the optic nerve head acquired at least and with a minimum of 2 years follow-up were included. Area and angular circumference of MvD were analysed on en face images. Univariable and multivariable mixed effects models were constructed to identify the factors contributing to MvD area and angular circumference change over time. RESULTS Peripapillary MvD was detected in 53 (58.2%) eyes at baseline and in an additional 17 (18.6%) eyes during follow-up, whereas MvD was not detected in 21 (23.0 %) eyes during the entire follow-up period. In multivariable analysis, worse baseline visual field (VF) mean deviation (MD) (ß=0.27, 95% CI 0.10 to 0.44, p=0.002), greater intraocular pressure (IOP) fluctuations (ß=0.86, 95% CI 0.24 to 1.48, p=0.007), higher peak IOP (ß=0.17, 95% CI -0.01 to 0.35, p=0.067) and greater number of IOP lowering medications (ß=1.36, 95% CI 0.67 to 2.05, p<0.001) were associated with faster MvD area enlargement. Worse baseline VF MD and greater IOP fluctuation were also associated with significantly faster MvD circumferential enlargement in multivariable models. CONCLUSION Greater IOP fluctuation, higher peak IOP, worse baseline VF MD and greater number of glaucoma medications were significantly associated with MvD enlargement in glaucomatous eyes. The identification of factors associated with MvD enlargement may improve our understanding of the role of choroidal vasculature in glaucoma.
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Affiliation(s)
- Eleonora Micheletti
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Sasan Moghimi
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Takashi Nishida
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Nevin El-Nimri
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Golnoush Mahmoudinedzah
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Alireza Kamalipour
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Vahid Mohammadzadeh
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Robert N Weinreb
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
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Gutiérrez Martín LC. Update on the diagnosis and treatment of normotensive glaucoma. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023:S2173-5794(23)00078-6. [PMID: 37209720 DOI: 10.1016/j.oftale.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/19/2023] [Indexed: 05/22/2023]
Abstract
The increased Knowledge of the multifactorial origin of glaucoma, and especially the vascular involvement in normotensive glaucoma, can be seen in the high number of publications on this subject in recent years, which obliges us to review its diagnosis and treatment.
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Affiliation(s)
- L C Gutiérrez Martín
- Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain.
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7
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Jiang GJ, You XG, Fan TJ. Carteolol triggers senescence via activation of β-arrestin-ERK-NOX4-ROS pathway in human corneal endothelial cells in vitro. Chem Biol Interact 2023; 380:110511. [PMID: 37120125 DOI: 10.1016/j.cbi.2023.110511] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/16/2023] [Accepted: 04/25/2023] [Indexed: 05/01/2023]
Abstract
Carteolol is a commonly-used topical medication for primary open-angle glaucoma. However, long-term and frequent ocular application of carteolol entails its residuals at low concentration in the aqueous humor for a long duration and may exert latent toxicity in the human corneal endothelial cells (HCEnCs). Here, we treated the HCEnCs in vitro with 0.0117% carteolol for 10 days. Thereafter, we removed the cartelolol and normally cultured the cells for 25 days to investigate the chronical toxicity of carteolol and the underlying mechanism. The results exhibited that 0.0117% carteolol induces senescent features in the HCEnCs, such as increased senescence-associated β-galactosidase positive rates, enlarged relative cell area and upregulated p16INK4A and senescence-associated secretory phenotypes, including IL-1α, TGF-β1, IL-10, TNF-α, CCL-27, IL-6 and IL-8, as well as decreased Lamin B1 expression and cell viability and proliferation. Thereby, further exploration demonstrated that the carteolol activates β-arrestin-ERK-NOX4 pathway to increase reactive oxygen species (ROS) production that imposes oxidative stress on energetic metabolism causing a vicious cycle between declining ATP and increasing ROS production and downregulation of NAD+ resulting in metabolic disturbance-mediated senescence of the HCEnCs. The excess ROS also impair DNA to activate the DNA damage response (DDR) pathway of ATM-p53-p21WAF1/CIP1 with diminished poly(ADP-Ribose) polymerase (PARP) 1, a NAD+-dependent enzyme for DNA damage repair, resulting in cell cycle arrest and subsequent DDR-mediated senescence. Taken together, carteolol induces excess ROS to trigger HCEnC senescence via metabolic disturbance and DDR pathway.
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Affiliation(s)
- Guo-Jian Jiang
- College of Marine Life Sciences, Ocean University of China, Qingdao, Shandong province, 266003, China
| | - Xin-Guo You
- School of Bioscience and Technology, Weifang Medical University, Weifang, Shandong province, 261053, China
| | - Ting-Jun Fan
- College of Marine Life Sciences, Ocean University of China, Qingdao, Shandong province, 266003, China.
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Association of Intraocular Pressure and Optical Coherence Tomography Angiography Parameters in Early Glaucoma Treatment. Diagnostics (Basel) 2022; 12:diagnostics12092174. [PMID: 36140574 PMCID: PMC9498188 DOI: 10.3390/diagnostics12092174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/18/2022] [Accepted: 09/05/2022] [Indexed: 12/05/2022] Open
Abstract
This prospective study aimed to explore the effect of medical intraocular pressure (IOP) reduction on structural and capillary vessel density (VD) change by optical coherence tomography (OCT) angiography in early glaucoma. Patients with newly diagnosed glaucoma and a follow-up of ≥6 months were enrolled. An ocular examination that included slit-lamp bio-microscopy, pneumatic tonometry, gonioscopy, standard automated perimetry, and OCT angiography was performed. Quantitative OCT angiography parameters were assessed using a linear mixed model that was adjusted for inter-eye correlation. The correlations between IOP changes and OCT angiography parameter changes were analyzed using Spearman’s correlation test. In total, 52 eyes of 36 participants, including 33 glaucoma eyes of 17 participants and 19 healthy eyes of 19 participants served as the case and control groups, respectively. The IOP of the case group decreased from a baseline mean of 20.4 ± 0.8 mmHg to 15.7 ± 0.5 mmHg at 3 months (p < 0.001) and to 16.1 ± 0.5 mmHg at 6 months (p < 0.001). For the subgroup with an IOP reduction of >20%, the deep macula VD was negatively correlated with baseline IOP and significantly decreased at 3 months follow-up. Additionally, change in retinal nerve fiber layer (RNFL) was positively correlated with a change in IOP at 6 months. In conclusion, the deep-layer macula VD was correlated with baseline IOP and influenced by the reduction in IOP in the short term. The changes in VD revealed the vulnerability of the deep vascular complex. The OCTA parameters provide in vivo monitoring information during medical treatment for early glaucoma.
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El-Nimri NW, Moghimi S, Penteado RC, Ghahari E, Yang D, Brye N, Proudfoot J, Do JL, Camp A, Salcedo M, Rubio V, Weinreb RN. Comparison of the Effects of Latanoprostene Bunod and Timolol on Retinal Blood Vessel Density: A Randomized Clinical Trial. Am J Ophthalmol 2022; 241:120-129. [PMID: 35526590 PMCID: PMC9444916 DOI: 10.1016/j.ajo.2022.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/30/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the differences in retinal vessel density (VD) between topical administration of latanoprostene bunod (LBN) ophthalmic solution 0.024% and timolol maleate 0.5% in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT) and normal subjects. DESIGN Randomized, single center, crossover clinical trial. METHODS Eligible subjects were examined during 6 study visits over 12 weeks. All subjects were randomized in a 1:1 ratio to LBN dosed once daily or timolol dosed twice daily in both eyes (OU) for a duration of 4 weeks each, separated by a 2-week washout period. A comprehensive eye examination OU was performed at each visit. Testing was performed with optical coherence tomography and optical coherence tomography angiography (optic nerve and macula), as well as visual field examination, on the study eye at baseline and before and after each treatment. RESULTS One eye from each of 50 patients was enrolled (10 healthy patients, 26 patients with OHT, and 14 patients with OAG). After administration of LBN there was significantly increased macular VD (0.76% [0.20%-1.33%], P = 0.009) and a trend in increasing peripapillary VD in patients with OAG and patients with OHT. In contrast, after administration of timolol, there were no differences in macular VD, and a decrease in peripapillary VD only was observed in the nasal inferior sector (-0.56% [-1.08% to -0.03%], P = .04) in patients with OAG and patients with OHT. No change in peripapillary or macular VD was observed in the normal subjects (P > .05 for all). CONCLUSIONS Topical administration of LBN enhanced macular VD in patients with OAG or patients with OHT. In contrast, timolol administration did not have any effect on VD.
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Affiliation(s)
- Nevin W El-Nimri
- From the Hamilton Glaucoma Center (N.W.E., S.M., R.C.P., E.G., N.B., J.P., J.L.D., A.C., M.S., V.R., R.N.W.), Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Sasan Moghimi
- From the Hamilton Glaucoma Center (N.W.E., S.M., R.C.P., E.G., N.B., J.P., J.L.D., A.C., M.S., V.R., R.N.W.), Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Rafaella C Penteado
- From the Hamilton Glaucoma Center (N.W.E., S.M., R.C.P., E.G., N.B., J.P., J.L.D., A.C., M.S., V.R., R.N.W.), Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Elham Ghahari
- From the Hamilton Glaucoma Center (N.W.E., S.M., R.C.P., E.G., N.B., J.P., J.L.D., A.C., M.S., V.R., R.N.W.), Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Diya Yang
- Beijing Tongren Eye Center (D.Y.), Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Nicole Brye
- From the Hamilton Glaucoma Center (N.W.E., S.M., R.C.P., E.G., N.B., J.P., J.L.D., A.C., M.S., V.R., R.N.W.), Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - James Proudfoot
- From the Hamilton Glaucoma Center (N.W.E., S.M., R.C.P., E.G., N.B., J.P., J.L.D., A.C., M.S., V.R., R.N.W.), Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Jiun L Do
- From the Hamilton Glaucoma Center (N.W.E., S.M., R.C.P., E.G., N.B., J.P., J.L.D., A.C., M.S., V.R., R.N.W.), Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Andrew Camp
- From the Hamilton Glaucoma Center (N.W.E., S.M., R.C.P., E.G., N.B., J.P., J.L.D., A.C., M.S., V.R., R.N.W.), Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Matthew Salcedo
- From the Hamilton Glaucoma Center (N.W.E., S.M., R.C.P., E.G., N.B., J.P., J.L.D., A.C., M.S., V.R., R.N.W.), Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Veronica Rubio
- From the Hamilton Glaucoma Center (N.W.E., S.M., R.C.P., E.G., N.B., J.P., J.L.D., A.C., M.S., V.R., R.N.W.), Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Robert N Weinreb
- From the Hamilton Glaucoma Center (N.W.E., S.M., R.C.P., E.G., N.B., J.P., J.L.D., A.C., M.S., V.R., R.N.W.), Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA.
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Enz TJ, Bittner M, Tribble JR, Williams PA, Thiel MA, Schmid MK, Bachmann LM, Bochmann F. Comparative Assessment of Retinal Blood Flow Velocity Changes Following Brimonidine and Brinzolamide Administration Using Retinal Function Imaging. Transl Vis Sci Technol 2022; 11:1. [PMID: 35103799 PMCID: PMC8819484 DOI: 10.1167/tvst.11.2.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Purpose Impaired ocular blood flow has been associated with the etiopathogenesis of glaucoma. Topical brimonidine lowers intraocular pressure, a major glaucoma risk factor. However, brimonidine's influence on retinal blood flow remains to be fully elucidated. Our aim was to compare the effect of topical brimonidine and brinzolamide administration on retinal blood flow velocity in second and third order vessels in healthy adults using the retinal function imager. Methods In 10 healthy probands between 23 and 32 years of age, one eye was randomly selected to receive 2 treatment rounds with 3 single doses of brimonidine 2 mg/mL and brinzolamide 10 mg/mL at 12-hour intervals each. The fellow eyes served as intra-individual controls. Immediately before the first drop and 2 hours after the last drop of each treatment round, all subjects were examined, including Goldmann tonometry, Pascal tonometry, assessment of retinal blood flow velocity using the retinal function imager, as well as blood pressure and pulse measurements. Results Intraocular pressure decreased significantly in treated eyes while remaining stable in control eyes, indicating reliable application of brimonidine and brinzolamide drops. In contrast, retinal blood flow velocities did not demonstrate any significant differences between groups after both treatment rounds. Conclusions Neither brimonidine nor brinzolamide appear to alter retinal blood flow velocity in a clinically relevant manner. The slight velocity changes detected in our study are likely physiologic fluctuations. Our findings do not support the rationale of a detrimental effect of topical brimonidine on ocular blood flow and hence brimonidine may be further administered for lowering intraocular pressure with the appropriate caution. However, our study is strongly limited by the small sample size and, thus, further research with larger cohorts of healthy volunteers and patients with glaucoma is needed to confirm the results. Translational Relevance The study provides information about the effect of the topically administered antiglaucoma medications brimonidine and brinzolamide on the ocular blood flow and its regulation. The findings indicate that beside the lowering of IOP there is no evidence for an additional effect on the development of glaucoma.
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Affiliation(s)
- Tim J Enz
- Department of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland.,Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mario Bittner
- Department of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - James R Tribble
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Pete A Williams
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Michael A Thiel
- Department of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Martin K Schmid
- Department of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Lucas M Bachmann
- Department of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Frank Bochmann
- Department of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland
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Combined wide-field optical coherence tomography angiography density map for high myopic glaucoma detection. Sci Rep 2021; 11:22034. [PMID: 34764370 PMCID: PMC8585951 DOI: 10.1038/s41598-021-01661-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/01/2021] [Indexed: 02/01/2023] Open
Abstract
The present study aimed to evaluate the diagnostic ability of wide-field optical coherence tomography angiography (OCTA) density map for detection of glaucomatous damage in high myopic (HM) eyes and to further compare the diagnostic ability of OCTA with that of conventional imaging approaches including red-free photography and swept-source OCT (SS-OCT) wide-field maps. A total of 77 healthy HM eyes and 72 HM eyes with open angle glaucoma (OAG) participated in this retrospective observational study. Patients underwent a comprehensive ocular examination, including wide-field SS-OCT scan and peripapillary area and macular OCTA scans. An integrated OCTA density map thereafter was merged by vascular landmark-guided superimposition of peripapillary and macular superficial vascular density maps onto the red-free photography (resulting in the OCTA-PanoMap). Glaucoma specialists then determined the presence of glaucomatous damage in HM eyes by reading the OCTA-PanoMap and compared its sensitivity and specificity with those of conventional images. Sensitivity and specificity of OCTA-PanoMap for HM-OAG diagnosis was 94.4% and 96.1%, respectively. Compared with other imaging methods, the sensitivity of OCTA-PanoMap was significantly higher than that of red-free photography (P = 0.022) and comparable to that of wide-field SS-OCT maps. Specificity of OCTA-PanoMap was significantly higher than those of other conventional imaging methods (except for wide-field thickness map). The OCTA-PanoMap showed good diagnostic ability for discrimination of HM-OAG eyes from healthy HM eyes. As a complementary method of an alternative imaging modality, OCTA-PanoMap can be a useful tool for detection of HM-OAG.
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