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Pan M, Kwok S, Pan X, Liu J. Biomechanical Correlations Between the Cornea and the Optic Nerve Head. Invest Ophthalmol Vis Sci 2024; 65:34. [PMID: 38776117 PMCID: PMC11127493 DOI: 10.1167/iovs.65.5.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 05/10/2024] [Indexed: 05/27/2024] Open
Abstract
Purpose A thin cornea is a potent risk factor for glaucoma. The underlying mechanisms remain unexplained. It has been postulated that central corneal thickness (CCT) may be a surrogate for biomechanical parameters of the posterior eye. In this study, we aimed to explore correlations of biomechanical responses between the cornea and the optic nerve head (ONH) and the peripapillary sclera (PPS) to elevated intraocular pressure (IOP), the primary risk factor of glaucoma. Methods Inflation tests were performed in nine pairs of human donor globes. One eye of each pair was randomly assigned for cornea or posterior eye inflation. IOP was raised from 5 to 30 millimeters of mercury (mmHg) at 0.5 mmHg steps in the whole globe and the cornea or the ONH/PPS was imaged using a 50 MHz ultrasound probe. Correlation-based ultrasound speckle tracking was used to calculate tissue displacements and strains. Associations of radial, tangential, and shear strains at 30 mmHg between the cornea and the ONH or PPS were evaluated. Results Corneal shear strain was significantly correlated with ONH shear strain (R = 0.857, P = 0.003) and PPS shear strain (R = 0.724, P = 0.028). CCT was not correlated with any strains in the cornea, ONH, or PPS. Conclusions Our results suggested that an eye that experiences a larger shear strain in the cornea would likely experience a larger shear strain in its ONH and PPS at IOP elevations. The strong correlation between the cornea's and the ONH's shear response to IOP provides new insights and suggests a plausible explanation of the cornea's connection to glaucoma risk.
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Affiliation(s)
- Manqi Pan
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, United States
| | - Sunny Kwok
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, United States
| | - Xueliang Pan
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, United States
| | - Jun Liu
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, United States
- Department of Ophthalmology and Visual Sciences, The Ohio State University, Columbus, Ohio, United States
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Aoki S, Asaoka R, Fujino Y, Nakakura S, Murata H, Kiuchi Y. Comparing corneal biomechanic changes among solo cataract surgery, microhook ab interno trabeculotomy and iStent implantation. Sci Rep 2023; 13:19148. [PMID: 37932377 PMCID: PMC10628136 DOI: 10.1038/s41598-023-46709-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023] Open
Abstract
Minimally invasive glaucoma surgery has expanded the surgical treatment options in glaucoma, particularly when combined with cataract surgery. It is clinically relevant to understand the associated postoperative changes in biomechanical properties because they are influential on the measurement of intraocular pressure (IOP) and play an important role in the pathogenesis of open-angle glaucoma (OAG). This retrospective case-control study included OAG patients who underwent cataract surgery combined with microhook ab interno trabeculotomy (µLOT group: 53 eyes of 36 patients) or iStent implantation (iStent group: 59 eyes of 37 patients) and 62 eyes of 42 solo cataract patients without glaucoma as a control group. Changes in ten biomechanical parameters measured with the Ocular Response Analyzer and Corneal Visualization Scheimpflug Technology (Corvis ST) at 3 and 6 months postoperatively relative to baseline were compared among the 3 groups. In all the groups, IOP significantly decreased postoperatively. In the µLOT and control groups, significant changes in Corvis ST-related parameters, including stiffness parameter A1 and stress‒strain index, indicated that the cornea became softer postoperatively. In contrast, these parameters were unchanged in the iStent group. Apart from IOP reduction, the results show variations in corneal biomechanical changes from minimally invasive glaucoma surgery combined with cataract surgery.
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Affiliation(s)
- Shuichiro Aoki
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-Ku, Hamamatsu City, Shizuoka, Japan.
- Seirei Christopher University, Hamamatsu City, Shizuoka, Japan.
- The Graduate School for the Creation of New Photonics Industries, Hamamatsu City, Shizuoka, Japan.
| | - Yuri Fujino
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-Ku, Hamamatsu City, Shizuoka, Japan
- Department of Ophthalmology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Shunsuke Nakakura
- Department of Ophthalmology, Tsukazaki Memorial Hospital, Hyogo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
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Asaoka R, Murata H. Prediction of visual field progression in glaucoma: existing methods and artificial intelligence. Jpn J Ophthalmol 2023; 67:546-559. [PMID: 37540325 DOI: 10.1007/s10384-023-01009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/13/2023] [Indexed: 08/05/2023]
Abstract
Timely treatment is essential in the management of glaucoma. However, subjective assessment of visual field (VF) progression is not recommended, because it can be unreliable. There are two types of artificial intelligence (AI) strong and weak (machine learning). Weak AIs can perform specific tasks. Linear regression is a method of weak AI. Using linear regression in the real-world clinic has enabled analyzing and predicting VF progression. However, caution is still required when interpreting the results, because whenever the number of VF data sets investigated is small, the predictions can be inaccurate. Several other non-ordinal, or modern AI methods have been constructed to improve prediction accuracy, such as clustering and more modern AI methods of Analysis with Non-Stationary Weibull Error Regression and Spatial Enhancement (ANSWERS), Variational Bayes Linear Regression (VBLR), Kalman Filter and sparse modeling (The least absolute shrinkage and selection operator regression: Lasso). It is also possible to improve the prediction performance using retinal thickness measured with optical coherence tomography by using machine learning methods, such as multitask learning.
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Grants
- 19H01114 ministry of education, culture, sports, science, and technology of Japan
- 18KK0253 ministry of education, culture, sports, science and technology of Japan
- 20K09784 ministry of education, culture, sports, science and technology of Japan
- 80635748 ministry of education, culture, sports, science and technology of Japan
- TR-SPRINT japan agency for medical reserach and development
- Grant the Japan Glaucoma Society Project Support Program
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Affiliation(s)
- Ryo Asaoka
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, Japan.
- Seirei Christopher University, Hamamatsu, Shizuoka, Japan.
- The Graduate School for the Creation of New Photonics Industries, Hamamatsu, Shizuoka, Japan.
| | - Hiroshi Murata
- Department of Ophthalmology, National Center for Global health and Medicine, Tokyo, Japan
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Sánchez-Barahona C, Bolívar G, Teus MA. Comparison of Goldmann and ORA tonometers in newly diagnosed, untreated, POAG and OHT eyes. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:528-532. [PMID: 37595792 DOI: 10.1016/j.oftale.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/12/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND AND OBJECTIVE The corneal biomechanical properties in naïve, untreated glaucoma and ocular hypertension (OHT) eyes is interesting, because it may be a source of error in intraocular pressure (IOP) measurements by Goldmann applanation tonometer (GAT) and Ocular Response Analyzer (ORA) The main objective of this study was to evaluate the IOP values obtained using GAT and the ORA, in primary open angle glaucoma (POAG) and in OHT untreated eyes. MATERIAL AND METHODS Observational, masked, cross sectional observational study. Newly diagnosed, untreated POAG and OHT eyes were included. RESULTS 51 POAG and 34 OHT eyes were analyzed. We found that IOPcc (IOP corneal-compensated) was significantly higher than GAT IOP in POAG (p = 0.0002) while we did not find any significant difference between both tonometers in OHT (p = 0.1). CONCLUSIONS GAT seems to underestimate the real IOP in untreated POAG eyes and it seems to be quite accurate in OHT eyes.
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Affiliation(s)
- C Sánchez-Barahona
- Departamento de Oftalmologia, Hospital General Universitario de Guadalajara, Guadalajara, Spain
| | - G Bolívar
- Departamento de Oftalmología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain; Departamento de Oftalmología, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain.
| | - M A Teus
- Departamento de Oftalmología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain; Departamento de Oftalmología, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
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Sekimitsu S, Xiang D, Smith SL, Curran K, Elze T, Friedman DS, Foster PJ, Luo Y, Pasquale LR, Peto T, Segrè AV, Shweikh Y, Warwick A, Zhao Y, Wiggs JL, Zebardast N. Deep Ocular Phenotyping Across Primary Open-Angle Glaucoma Genetic Burden. JAMA Ophthalmol 2023; 141:891-899. [PMID: 37589995 PMCID: PMC10436188 DOI: 10.1001/jamaophthalmol.2023.3645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/25/2023] [Indexed: 08/18/2023]
Abstract
Importance Better understanding of primary open-angle glaucoma (POAG) genetics could enable timely screening and promote individualized disease risk prognostication. Objective To evaluate phenotypic features across genetic burden for POAG. Design, Setting, and Participants This was a cross-sectional, population-based study conducted from 2006 to 2010. Included participants were individuals from the UK Biobank aged 40 to 69 years. Individuals with non-POAG forms of glaucoma were excluded from the analysis. Data were statistically analyzed from October 2022 to January 2023. Main Outcomes and Measures POAG prevalence based on structural coding, self-reports, and glaucoma-related traits. Results Among 407 667 participants (mean [SD] age, 56.3 [8.1] years; 219 183 majority sex [53.8%]) were 14 171 POAG cases. Area under receiver operating characteristic curve for POAG detection was 0.748 in a model including polygenic risk score (PRS), age, sex, and ancestry. POAG prevalence in the highest decile of PRS was 7.4% (3005 of 40 644) vs 1.3% (544 of 40 795) in lowest decile (P < .001). A 1-SD increase in PRS was associated with 1.74 times higher odds of POAG (95% CI, 1.71-1.77), a 0.61-mm Hg increase in corneal-compensated intraocular pressure (IOP; 95% CI, 0.59-0.64), a -0.09-mm Hg decrease in corneal hysteresis (95% CI, -0.10 to -0.08), a 0.08-mm Hg increase in corneal resistance factor (95% CI, 0.06-0.09), and a -0.08-diopter decrease in spherical equivalent (95% CI, -0.11 to -0.07; P < .001 for all). A 1-SD increase in PRS was associated with a thinning of the macula-region retinal nerve fiber layer (mRNFL) of 0.14 μm and macular ganglion cell complex (GCC) of 0.26 μm (P < .001 for both). In the subset of individuals with fundus photographs, a 1-SD increase in PRS was associated with 1.42 times higher odds of suspicious optic disc features (95% CI, 1.19-1.69) and a 0.013 increase in cup-disc ratio (CDR; 95% CI, 0.012-0.014; P < .001 for both). A total of 22 of 5193 fundus photographs (0.4%) in decile 10 had disc hemorrhages, and 27 of 5257 (0.5%) had suspicious optic disc features compared with 9 of 5158 (0.2%) and 10 of 5219 (0.2%), respectively, in decile 1 (P < .001 for both). CDR in decile 10 was 0.46 compared with 0.41 in decile 1 (P < .001). Conclusion and Relevance Results suggest that PRS identified a group of individuals at substantially higher risk for POAG. Higher genetic risk was associated with more advanced disease, namely higher CDR and corneal-compensated IOP, thinner mRNFL, and thinner GCC. Associations with POAG PRS and corneal hysteresis and greater prevalence of disc hemorrhages were identified. These results suggest that genetic risk is an increasingly important parameter for risk stratification to consider in clinical practice.
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Affiliation(s)
| | - David Xiang
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Harvard Medical School, Boston, Massachusetts
| | | | - Katie Curran
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Tobias Elze
- Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts
| | - David S. Friedman
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Paul J. Foster
- NIHR Biomedical Research Centre, Moorfields Eye Hospital & UCL Institute of Ophthalmology, London, United Kingdom
| | - Yuyang Luo
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Ocular Genomics Institute, Harvard Medical School, Boston, Massachusetts
| | - Louis R. Pasquale
- Icahn School of Medicine at Mount Sinai, Department of Ophthalmology, New York, New York
| | - Tunde Peto
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Ayellet V. Segrè
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Ocular Genomics Institute, Harvard Medical School, Boston, Massachusetts
| | - Yusrah Shweikh
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Sussex, United Kingdom
| | - Alasdair Warwick
- University College London, Institute of Cardiovascular Science, London, United Kingdom
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Yan Zhao
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Ocular Genomics Institute, Harvard Medical School, Boston, Massachusetts
| | - Janey L. Wiggs
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Ocular Genomics Institute, Harvard Medical School, Boston, Massachusetts
| | - Nazlee Zebardast
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
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Brazuna R, Alonso RS, Salomão MQ, Fernandes BF, Ambrósio R. Ocular Biomechanics and Glaucoma. Vision (Basel) 2023; 7:vision7020036. [PMID: 37218954 DOI: 10.3390/vision7020036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/11/2023] [Accepted: 04/21/2023] [Indexed: 05/24/2023] Open
Abstract
Biomechanics is a branch of biophysics that deals with mechanics applied to biology. Corneal biomechanics have an important role in managing patients with glaucoma. While evidence suggests that patients with thin and stiffer corneas have a higher risk of developing glaucoma, it also influences the accurate measurement of intraocular pressure. We reviewed the pertinent literature to help increase our understanding of the biomechanics of the cornea and other ocular structures and how they can help optimize clinical and surgical treatments, taking into consideration individual variabilities, improve the diagnosis of suspected patients, and help monitor the response to treatment.
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Affiliation(s)
- Rodrigo Brazuna
- Department of Ophthalmology, Federal University of the State of Rio de Janeiro, Rio de Janeiro 22290-240, RJ, Brazil
| | - Ruiz S Alonso
- Department of Ophthalmology, Antonio Pedro University Hospital, Fluminense Federal University, Niterói 24033-900, RJ, Brazil
| | - Marcella Q Salomão
- Department of Ophthalmology, Federal University of São Paulo, São Paulo 04023-062, SP, Brazil
| | | | - Renato Ambrósio
- Department of Ophthalmology, Federal University of the State of Rio de Janeiro, Rio de Janeiro 22290-240, RJ, Brazil
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Zhang Y, Bian A, Hang Q, Li L, Zhang S, Cheng G, Zhou Q. Corneal Biomechanical Properties of Various Types of Glaucoma and Their Impact on Measurement of Intraocular Pressure. Ophthalmic Res 2023; 66:749-756. [PMID: 36958304 PMCID: PMC10326840 DOI: 10.1159/000530291] [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: 07/01/2022] [Accepted: 03/10/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Corneal biomechanical properties could affect intraocular pressure (IOP) measurement. The aim of this study was to evaluate the differences in corneal biomechanical properties of various types of glaucoma, assess their effect on IOP measurements. METHODS This is an observational clinical study of 486 subjects including 102 normal subjects, 104 ocular hypertension (OHT), 89 normal tension glaucoma (NTG), and 191 high tension glaucoma (HTG). Corneal biomechanical parameters were measured using an ocular response analyzer. The main parameters assessed were corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated pressure measurement (IOPg), and corneal-compensated intraocular pressure (IOPcc). Ultrasound pachymetry was used to measure central corneal thickness (CCT). IOP was measured by a Goldmann applanation tonometer (GAT) and a noncontact tonometer (NCT). Visual field (VF) and refractive status were also recorded. Results were analyzed by one-way analysis of variance, univariate and multivariate linear regression analyses, and Bland-Altman plots. RESULTS Multiple comparison by analysis of variance showed significantly lower CH and CRF in NTG compared to HTG, OHT, and normal subjects (CH: 0.011, 0.015, and 0.033; CRF: 0.001, <0.001, and 0.042, respectively). CRF and CH associated with IOP were measured using either GAT, NCT and IOPcc-GAT, IOPcc-NCT, yet CCT was not. GAT correlated strongly with IOPg (r = 0.79; p < 0.001) and IOPcc (r = 0.77; p < 0.001), but limits of agreement between the measurements were poor. CH and CRF were both negatively correlated with VF change (p < 0.01). CONCLUSION CH and CRF affect the measurement of IOP and were related to types of glaucoma or severity of glaucoma. Pure CCT should not be used to correct IOP values or estimate the risk of disease.
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Affiliation(s)
- Yang Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China,
| | - Ailing Bian
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qijun Hang
- Department of Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lüe Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shunhua Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Gangwei Cheng
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Zhou
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Mohammadzadeh V, Moghimi S, Nishida T, Mahmoudinezhad G, Kamalipour A, Micheletti E, Zangwill L, Weinreb RN. Effect of Corneal Hysteresis on the Rates of Microvasculature Loss in Glaucoma. Ophthalmol Glaucoma 2023; 6:177-186. [PMID: 35995420 DOI: 10.1016/j.ogla.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/19/2022] [Accepted: 08/12/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the association between corneal hysteresis (CH) and rates of optic nerve head whole image capillary density (wiCD) loss over time in open-angle glaucoma (OAG). DESIGN Observational cohort. PARTICIPANTS One hundred seventy-four eyes (122 OAG and 52 glaucoma suspect eyes) from 112 patients over more than 2 years and 4 visits or more. METHODS Baseline CH measurements were acquired with the Ocular Response Analyzer. Linear mixed-effect models were designed to investigate the effect of CH, average intraocular pressure (IOP) during follow-up, and baseline visual field (VF) mean deviation (MD) on the rates of wiCD loss and circumpapillary retinal nerve fiber layer (cpRNFL) thinning over time, while adjusting for confounders. Interaction between CH or baseline MD and average IOP during follow-up were included in final models to evaluate the effect of baseline MD or average IOP during follow-up on structural changes for different values of CH. MAIN OUTCOME MEASURE Effect of CH, IOP, and baseline MD on the rates of wiCD loss and cpRNFL thinning over time. RESULTS The average follow-up time was 3.9 years. In the multivariable model, non-Black race, higher average IOP during follow-up, lower baseline CH, lower baseline VF MD, and higher numbers of IOP-lowering medications were associated with faster rates of wiCD loss over time. For CH values 6 mmHg and 12 mmHg, every 1-mmHg increase in average IOP during follow-up was associated with 0.23% per year faster and 0.07% per year slower rates of wiCD loss over time, respectively. While every 1-mmHg decrease in CH was associated with 1.89% per year faster rate of wiCD loss for MD of -12 dB, it was associated with 0.81% per year faster rate of wiCD loss for MD of -3 dB. CONCLUSION Lower CH values were significantly associated with faster rates of wiCD loss over time. In eyes with lower CH, both higher average IOP during follow-up and more severe glaucoma damage at baseline were associated with faster rates of wiCD loss and cpRNFL thinning. These results support CH as a useful parameter for risk assessment of glaucoma progression. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Vahid Mohammadzadeh
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Takashi Nishida
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Golnoush Mahmoudinezhad
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Alireza Kamalipour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Eleonora Micheletti
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Linda Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California.
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Yuhas PT, Roberts CJ. Clinical Ocular Biomechanics: Where Are We after 20 Years of Progress? Curr Eye Res 2023; 48:89-104. [PMID: 36239188 DOI: 10.1080/02713683.2022.2125530] [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: 02/08/2023]
Abstract
Purpose: Ocular biomechanics is an assessment of the response of the structures of the eye to forces that may lead to disease development and progression, or influence the response to surgical intervention. The goals of this review are (1) to introduce basic biomechanical principles and terminology, (2) to provide perspective on the progress made in the clinical study and assessment of ocular biomechanics, and (3) to highlight critical studies conducted in keratoconus, laser refractive surgery, and glaucoma in order to aid interpretation of biomechanical parameters in the laboratory and in the clinic.Methods: A literature review was first conducted of basic biomechanical studies related to ocular tissue. The subsequent review of ocular biomechanical studies was limited to those focusing on keratoconus, laser refractive surgery, or glaucoma using the only two commercially available devices that allow rapid assessment of biomechanical response in the clinic.Results: Foundational studies on ocular biomechanics used a combination of computer modeling and destructive forces on ex-vivo tissues. The knowledge gained from these studies could not be directly translated to clinical research and practice until the introduction of non-contact tonometers that quantified the deformation response of the cornea to an air puff, which represents a non-destructive, clinically appropriate load. The corneal response includes a contribution from the sclera which may limit corneal deformation. Two commercial devices are available, the Ocular Response Analyzer which produces viscoelastic parameters with a customized load for each eye, and the Corvis ST which produces elastic parameters with a consistent load for every eye. Neither device produces the classic biomechanical properties reported in basic studies, but rather biomechanical deformation response parameters which require careful interpretation.Conclusions: Research using clinical tools has enriched our understanding of how ocular disease alters ocular biomechanics, as well as how ocular biomechanics may influence the pathophysiology of ocular disease and response to surgical intervention.
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Affiliation(s)
- Phillip T Yuhas
- College of Optometry, The Ohio State University, Columbus, OH, USA
| | - Cynthia J Roberts
- Department of Ophthalmology and Visual Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA.,Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH, USA
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10
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Aoki S, Asaoka R, Fujino Y, Nakakura S, Murata H, Kiuchi Y. Comparison of two analyzer measurements focusing on material stiffness among normal, treatment-naïve, and treated glaucoma eyes. Sci Rep 2023; 13:96. [PMID: 36596840 PMCID: PMC9810725 DOI: 10.1038/s41598-022-27346-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023] Open
Abstract
To investigate differences in biomechanical properties focusing on stiffness parameters between normal, treatment-naïve primary open-angle glaucoma (POAG), and treated POAG eyes. Retrospective case-control study, This study included 46 treatment-naïve POAG eyes, 46 POAG eyes treated with prostaglandin analogues, and 49 normal eyes used as controls; matched in terms of age and axial length. Corneal hysteresis (CH) and corneal resistance factor (CRF) were measured using an ocular response analyzer (ORA). Fifteen biomechanical parameters were measured with the Corneal Visualization Scheimpflug Technology (Corvis ST), including biomechanical glaucoma factor (BGF) and two stiffness parameters of 'SP A1' and 'stress-strain index (SSI)', which were compared among the three groups. Additionally, the area under the curve (AUC) values of the receiver-operating curve to discriminate control and treatment-naïve POAG eyes were calculated for BGF and CH. Treatment-naïve POAG eyes had higher 'SSI' than normal eyes even after controlling for IOP (p < 0.05, Tukey-Cramer test). Treated POAG eyes had significantly lower CRF, and higher BGF than treatment-naïve POAG eyes. There were also significant differences in CH or SP A1 among the three groups. BGF and CH had similar AUC values (0.61 and 0.59). Treatment-naïve POAG eyes had stiffer corneas compared to normal eyes, which seemed to result from the material/structure of the cornea rather than higher intraocular pressure. Antiglaucoma topical medication alters biomechanical properties measured with Corvis ST. These results are important for understanding the pathogenesis and improving the management of POAG.
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Affiliation(s)
- Shuichiro Aoki
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu City, Shizuoka, Japan.
- Seirei Christopher University, Hamamatsu City, Shizuoka, Japan.
- The Graduate School for the Creation of New Photonics Industries, Hamamatsu City, Shizuoka, Japan.
| | - Yuri Fujino
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu City, Shizuoka, Japan
- Department of Ophthalmology, Faculty of Medicine, Shimane University, Matsue, Japan
| | - Shunsuke Nakakura
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Hyogo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
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11
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Baseline 10-2 Visual Field Loss as a Predictor for Future Glaucoma Progression. J Glaucoma 2023; 32:1-8. [PMID: 36223285 DOI: 10.1097/ijg.0000000000002138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 10/03/2022] [Indexed: 01/24/2023]
Abstract
PRCIS Presence of baseline 10-2 visual field (VF) loss was the strongest predictor of future rate of 24-2 VF loss and development of new 24-2 progression events, suggesting a role for 10-2 VF testing in baseline glaucoma risk analysis. PURPOSE The purpose of this study is to examine the relationship between baseline 10-2 VF loss and future 24-2 VF loss. MATERIALS AND METHODS Subjects were participating in a prospective longitudinal study within a VA Medical Center outpatient eye clinic. Eligibility required 2 good quality baseline 10-2 VF tests followed by a minimum of 5 good quality 24-2 VF tests over at least 3 years. Longitudinal 24-2 VF testing was completed every 4-6 months after baseline 10-2 testing. Mixed model regression analyses and Cox Proportional Hazard regression analyses were completed to identify predictors of 24-2 mean deviation change rate and new VF loss events. RESULTS We studied 394 eyes of 202 subjects (119 primary open angle glaucoma and 83 glaucoma suspect). Over 6.7 (±1.5) years, 9.9 (±2.3) good quality 24-2 VF tests were completed. In mixed model regression analyses, baseline variables that predicted faster rate of 24-2 VF loss in order of strength of association were presence of baseline 10-2 VF defect, lower 24-2 mean deviation, and higher age. When analyses were completed without 10-2 variables, predictive capability of the model was reduced compared with when 10-2 variables were included. In Cox Proportional Regression analyses evaluating progression events, baseline 10-2 VF defect demonstrated the largest hazard ratio (22 times greater risk for developing future VF loss event in eyes with vs. without baseline 10-2 VF loss). CONCLUSIONS Baseline 10-2 VF defect was the most effective predictor of subsequent 24-2 VF progression in this study. These findings imply that presence of baseline 10-2 VF loss may provide unique value for predicting future glaucoma progression.
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12
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Diurnal Variation of Corneal Hysteresis in Patients With Untreated Primary Open Angle Glaucoma and Normal Individuals. J Glaucoma 2022; 31:891-897. [PMID: 35980846 DOI: 10.1097/ijg.0000000000002112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023]
Abstract
PRCIS Corneal hysteresis in both patients with untreated open angle glaucoma and normal individuals demonstrated significant diurnal variation independent of confounding factors and was higher in the nighttime than in the daytime. PURPOSE To investigate diurnal variations in corneal hysteresis (CH) in patients with untreated primary open angle glaucoma (POAG) and normal individuals by using an ocular response analyzer. MATERIALS AND METHODS This prospective study included 72 eyes of 53 patients with untreated POAG and 53 eyes of 47 normal individuals. Intraocular pressure (IOP) and CH were measured using Goldmann applanation tonometry (GAT) and ocular response analyzer, respectively, every 3 hours from 9:00 to 24:00. Mixed-effects models were used to determine factors associated with CH values and CH amplitude (maximum values minus minimum values) and to examine the diurnal variations in GAT IOP and CH in each group. Significant differences between time points were defined as significant variations. RESULTS The diurnal average GAT IOP and CH in patients with POAG were significantly higher and lower than those in normal individuals ( P =0.001, 0.002). In the multivariate analysis, the larger central corneal thickness was associated with larger CH values in POAG and normal eyes (both P <0.001). A larger amplitude of GAT IOP was significantly associated with a larger CH amplitude in POAG and normal eyes ( P =0.010, 0.013). CH, in both groups, showed similar significant diurnal variation and was higher in the nighttime than in the daytime, even after adjusting for confounding factors, while IOP showed an antiphase pattern. CONCLUSION CH in both untreated POAG patients and normal participants demonstrated similar diurnal variations, that is, higher at night, independent of confounding factors. These findings suggest that viscoelastic properties of the cornea may fluctuate diurnally independent of IOP.
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Jammal AA, Medeiros FA. Corneal Hysteresis and Rates of Neuroretinal Rim Change in Glaucoma. Ophthalmol Glaucoma 2022; 5:483-489. [PMID: 35331968 PMCID: PMC10278201 DOI: 10.1016/j.ogla.2022.03.006] [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: 01/24/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE To evaluate the impact of corneal hysteresis (CH) as a risk factor for progressive neuroretinal rim loss in glaucoma, as measured by spectral-domain OCT of the Bruch's membrane opening minimum rim width (MRW). DESIGN Prospective, observational cohort study. PARTICIPANTS The study group included 118 eyes of 70 subjects with glaucoma. The average follow-up time for the cohort was 3.9 ± 1.3 years, with an average of 6.4 ± 2.0 spectral-domain OCT tests, ranging from 4 to 12. METHODS Corneal hysteresis measurements were acquired at baseline using the Ocular Response Analyzer (Reichert Instruments). Linear mixed models were used to investigate the relationship between the rates of MRW loss and baseline CH. Multivariable analyses adjusted for other putative predictive factors for progression, including mean intraocular pressure (IOP), central corneal thickness (CCT), age, race, and baseline disease severity. MAIN OUTCOME MEASURES Effects of CH on the rate of MRW change over time. RESULTS Corneal hysteresis had a significant effect on rates of MRW progression over time. Each 1-mmHg lower CH was associated with -0.38 μm/year faster MRW loss (95% confidence interval [CI], -0.70 to -0.06; P = 0.019), after adjustment for other predictive factors. The mean IOP was also significantly associated with progression, with -0.35 μm/year (95% CI, -0.47 to -0.23 μm/year) faster MRW change for each 1-mmHg higher pressure (P < 0.001). In the analysis of predictive strength, the mean IOP was the strongest predictive factor (R2 = 23%), followed by CH (R2 = 14%) and baseline disease severity (R2 = 6%). Central corneal thickness explained only 3% of the variability in slopes of change in global MRW. CONCLUSIONS Lower CH measurements were associated with faster loss of the neuroretinal rim in glaucoma, as measured by MRW. The predictive ability of CH was superior to that of CCT. These findings suggest that CH is an important parameter to be considered in assessing the risk of glaucoma progression.
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Affiliation(s)
- Alessandro A Jammal
- Vision, Imaging and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Felipe A Medeiros
- Vision, Imaging and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina.
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14
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Effect of prostaglandin analogues on the biomechanical corneal properties in patients with open-angle glaucoma and ocular hypertension measured with dynamic scheimpflug analyzer. Graefes Arch Clin Exp Ophthalmol 2022; 260:3927-3933. [PMID: 35841397 DOI: 10.1007/s00417-022-05752-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/18/2022] [Accepted: 06/29/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The aim of the study is to evaluate the effect of topical prostaglandin (PG) treatment on the corneal biomechanical properties in treatment-naïve patients with either primary open-angle glaucoma (POAG) or ocular hypertension (OHT) using the Corvis ST device. METHODS This is an observational study. We analyzed the Corvis ST dynamic corneal response parameters of our database using the newest software available. Thirty-four eyes of 34 patients were included. They were all newly diagnosed and treatment-naïve. Patients were evaluated at baseline and after 6 months of treatment with prostaglandin analogues. Ultrasound pachymetry, Optical Coherence Tomography (OCT) and a 24-2 visual field test were performed in baseline visit. Goldman Applanation Tonometry (GAT-IOP) and Corvis ST dynamic corneal response parameters were registered at baseline and at the 6-month visit. RESULTS After 6 months of treatment, the IOP decrease (Δ) values obtained with the different tonometers were ΔGAT -6.5 ± 3.7, ΔIOPnct -4.4 ± 5.7 and ΔbIOP -3.8 ± 5.4. The differences between ΔGAT vs ΔIOPnct, ΔGAT vs ΔbIOP, and ΔIOPnct vs ΔbIOP, were statistically significant (p < 0.05 for all comparisons). Statistically significant lower values of the stress-strain index (SSI) (1.77 ± 0.3 at baseline vs 1.54 ± 0.27 at the 6-month visit) were found (p = 0.0002). CONCLUSION The SSI provided by the Corvis ST seems to decrease significantly after topical prostaglandin therapy. We believe that our results support the hypothesis that topical PG therapy does decrease the corneal stiffness and thus, that the ocular hypotensive effect of these drugs is overestimated if GAT is used for IOP measurement.
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15
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Corneal Hysteresis, Intraocular Pressure, and Progression of Glaucoma: Time for a “Hyst-Oric” Change in Clinical Practice? J Clin Med 2022; 11:jcm11102895. [PMID: 35629021 PMCID: PMC9148097 DOI: 10.3390/jcm11102895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/14/2022] [Accepted: 05/15/2022] [Indexed: 12/04/2022] Open
Abstract
It is known that as people age their tissues become less compliant and the ocular structures are no different. Corneal Hysteresis (CH) is a surrogate marker for ocular compliance. Low hysteresis values are associated with optic nerve damage and visual field loss, the structural and functional components of glaucomatous optic neuropathy. Presently, a range of parameters are measured to monitor and stratify glaucoma, including intraocular pressure (IOP), central corneal thickness (CCT), optical coherence tomography (OCT) scans of the retinal nerve fibre layer (RNFL) and the ganglion cell layer (GCL), and subjective measurement such as visual fields. The purpose of this review is to summarise the current evidence that CH values area risk factor for the development of glaucoma and are a marker for its progression. The authors will explain what precisely CH is, how it can be measured, and the influence that medication and surgery can have on its value. CH is likely to play an integral role in glaucoma care and could potentially be incorporated synergistically with IOP, CCT, and visual field testing to establish risk stratification modelling and progression algorithms in glaucoma management in the future.
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Abstract
PURPOSE OF THE REVIEW This review summarizes recent findings on corneal hysteresis, a biomechanical property of the cornea. Corneal hysteresis measurements can be easily acquired clinically and may serve as surrogate markers for biomechanical properties of tissues in the back of the eye, like the lamina cribrosa and peripapillary sclera, which may be related to the susceptibility to glaucomatous damage. RECENT FINDINGS Several studies have provided evidence of the associations between corneal hysteresis and clinically relevant outcomes in glaucoma. Corneal hysteresis has been shown to be predictive of glaucoma development in eyes suspected of having the disease. For eyes already diagnosed with glaucoma, lower corneal hysteresis has been associated with higher risk of progression and faster rates of visual field loss over time. Such associations appear to be stronger than those for corneal thickness, suggesting that corneal hysteresis may be a more important predictive factor. Recent evidence has also shown that cornealcorrected intraocular pressure measurements may present advantages compared to conventional Goldmann tonometry in predicting clinically relevant outcomes in glaucoma. SUMMARY Given the evidence supporting corneal hysteresis as an important risk factor for glaucoma development and its progression, practitioners should consider measuring corneal hysteresis in all patients at risk for glaucoma, as well as in those already diagnosed with the disease.
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Affiliation(s)
| | - Felipe A Medeiros
- Duke Eye Center and Department of Ophthalmology
- Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina, USA
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17
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Glaucoma – risk factors and current challenges in the diagnosis of a leading cause of visual impairment. Maturitas 2022; 163:15-22. [DOI: 10.1016/j.maturitas.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/01/2022] [Accepted: 05/09/2022] [Indexed: 11/21/2022]
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18
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Pillunat KR, Herber R, Pillunat LE. Corneal Biomechanics in Glaucoma. Klin Monbl Augenheilkd 2022; 239:158-164. [PMID: 35211937 DOI: 10.1055/a-1667-6648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Now that is possible to measure the biomechanical parameters of the cornea in vivo, scientific and clinical interest has increased in changes in these parameters in glaucoma. These parameters may act as biomarkers for early diagnosis, but also serve to emphasize the increased vulnerability to intraocular pressure, reduced blood flow or changing ocular perfusion pressure. Measuring and interpreting these parameters may help in achieving better and individually tailored glaucoma management.
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Affiliation(s)
- Karin R Pillunat
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - Robert Herber
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - Lutz E Pillunat
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
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19
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Choi YJ, Lee EJ. The Effects of Anti-glaucoma Eyedrops on Corneal Hysteresis in Patients with Open-angle Glaucoma and Glaucoma-suspect. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2022. [DOI: 10.3341/jkos.2022.63.1.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: We explored the effects of topical anti-glaucoma medications on the corneal biochemical properties of patients with open-angle glaucoma (OAG) and glaucoma suspect (GS patients).Methods: We retrospectively reviewed data on 115 OAG and 98 GS patients (225 and 128 eyes respectively). Corneal hysteresis (CH) was measured using an ocular response analyzer. Factors influencing CH were determined using a generalized estimation equation.Results: The mean CH was lower in OAG than GS patients (p < 0.001). A lower cornea-compensated intraocular pressure, concomitant use of a beta-adrenergic blocker and an alpha2-adrenergic agonist, a higher visual field mean deviation, and a larger central corneal thickness were associated with a higher CH in the OAG group.Conclusions: Concomitant use of a topical beta-adrenergic blocker and an alpha2-adrenergic agonist was associated with a higher CH.
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20
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Sallam MA, Elghareib ME. Use of corneal hysteresis and corneal resistance factor in target intraocular pressure estimation in patients with early primary open-angle glaucoma. Int Ophthalmol 2021; 42:891-902. [PMID: 34633607 DOI: 10.1007/s10792-021-02070-y] [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: 05/21/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To introduce a new method for estimation of the target intraocular pressure (TIOP) in naïve eyes with early primary open-angle glaucoma (POAG) using corneal hysteresis (CH) and corneal resistance factor (CRF). METHODS A prospective quasi-experimental study was conducted on naïve 90 eyes of 45 patients who were newly diagnosed with early primary open-angle glaucoma (POAG). They were compared to 72 eyes of 36 normal subjects. The TIOP was determined for each eye. The IOP Goldmann (IOPg), IOP corneal-compensated (IOPcc), CH and CRF were estimated by ocular response analyzer (ORA, Reichert) device. Measurements were taken for each patient prior to treatment and after 1, 3, 6, 9 and 12 months of receiving medications; either monotherapy or combination therapy. RESULTS For all patients, there was a significant negative correlation (p < 0.05) between IOP, either IOPg or IOPcc, and CH, while a significant positive relationship (p < 0.05) existed between IOP and CRF. For patients with early POAG, the CH was significantly increased (p ≤ 0.001), while CRF was significantly decreased (p ≤ 0.001) when TIOP was achieved. At IOP levels higher than TIOP, CH value was lower than CRF with a significant negative correlation between them in contrast to controls. This correlation was reversed on reaching TIOP and CH values became higher than CRF similar to controls. CONCLUSION CH, CRF and IOP measured by ORA can be used for TIOP estimation. This provides us with a guide for assessing the effectiveness of medications introduced to patients with POAG.
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Affiliation(s)
- Moataz A Sallam
- Ophthalmology Department, Suez Canal University Hospitals, 4.5 kilo, The Ring Road, Ismailia, 41522 , Egypt.
| | - Mervat E Elghareib
- Ophthalmology Department, Suez Canal University Hospitals, 4.5 kilo, The Ring Road, Ismailia, 41522 , Egypt
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21
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Bolivar G, Sanchez-Barahona C, Ketabi S, Kozobolis V, Teus MA. Corneal Factors Associated with the Amount of Visual Field Damage in Eyes with Newly Diagnosed, Untreated, Open-angle Glaucoma. Ophthalmol Ther 2021; 10:669-676. [PMID: 34279846 PMCID: PMC8319248 DOI: 10.1007/s40123-021-00375-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/01/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the correlation between several ocular parameters (intraocular pressure [IOP], corneal biomechanical properties) and the visual field (VF) mean deviation (VF MD) in eyes with open-angle glaucoma (OAG). METHODS We conducted a cross-sectional, observational study in which we measured the IOP with Goldmann applanation tonometry, the central corneal thickness (CCT), and the corneal parameters obtained from the Ocular Response Analyzer® (ORA®) and the Corvis® ST non-contact tonometer, in newly diagnosed and treatment-naïve eyes with OAG, to investigate whether there was any correlation between these ocular parameters and the VF MD. RESULTS A total of 51 eyes were analyzed. A statistically significant correlation was found only between the VF MD and corneal hysteresis (CH) (P = 0.003, r2 = 0.16) and CCT (P = 0.03, r2 = 0.08). CONCLUSIONS These results demonstrate that CH and CCT are associated with the amount of VF damage in treatment-naïve OAG eyes.
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Affiliation(s)
- Gema Bolivar
- Department of Ophthalmology, University Hospital Principe de Asturias, Carretera Alcalá-Meco S/N, Alcalá de Henares, 28805, Madrid, Spain.
- Department of Ophthalmology, University of Alcalá, Alcalá de Henares, Spain.
| | | | - Samira Ketabi
- Department of Ophthalmology, University of Alcalá, Alcalá de Henares, Spain
- Department of Ophthalmology, University Hospital of Mostoles, Madrid, Spain
| | - Vassilios Kozobolis
- Department of Ophthalmology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Miguel A Teus
- Department of Ophthalmology, University Hospital Principe de Asturias, Carretera Alcalá-Meco S/N, Alcalá de Henares, 28805, Madrid, Spain
- Department of Ophthalmology, University of Alcalá, Alcalá de Henares, Spain
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22
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Goyal M, Tiwari US, Jaseja H. Pathophysiology of the comorbidity of glaucoma with obstructive sleep apnea: A postulation. Eur J Ophthalmol 2021; 31:2776-2780. [PMID: 33478247 DOI: 10.1177/1120672121990580] [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: 02/05/2023]
Abstract
Glaucoma is a serious and progressive optic neuropathy, the exact pathophysiology of which is still poorly understood. Furthermore, glaucoma exhibits significant comorbidity with obstructive sleep apnea (OSA) that warrants an in-depth study in view of highly probable beneficial and far-reaching clinical implications. In this brief paper, the authors have studied the existing theories in an attempt to explain the comorbidity and its underlying pathophysiology. From the ensuing evidence, the role of connective tissue strength has emerged as a major factor and which appears to play a pivotal role not only in the development of glaucoma but also in the underlying pathophysiology of its enigmatic comorbidity with OSA. Understanding the pathophysiology of the comorbidity can stimulate newer therapeutic strategies targeted toward strengthening of connective tissues that may at least retard if not arrest the progression of glaucomatous changes and their complications.
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Affiliation(s)
- Manish Goyal
- Department of Physiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Uma Sharan Tiwari
- Department of Ophthalmology, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India
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23
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Corneal Biomechanical Changes Caused by Acute Elevation of IOP in Eyes with and without Glaucoma. Optom Vis Sci 2021; 98:367-373. [PMID: 33828042 DOI: 10.1097/opx.0000000000001668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Although corneal biomechanical parameters are well linked with glaucoma, their clinical utility has not yet been fully elucidated. This study was designed to provide unique evidence about the dynamic nature of corneal biomechanical parameters and their potential prognostic ability for glaucoma. PURPOSE This study aimed to evaluate the effect of acute intraocular pressure (IOP) elevation on corneal hysteresis (CH) and corneal resistance factor (CRF) and the associations of these biomechanical parameters with glaucomatous disease. METHODS Subjects participating in a prospective, longitudinal glaucoma research study had CH and CRF measured before and during ophthalmodynamometry during visits in the years 2011 to 2012. All participants were diagnosed with primary open-angle glaucoma, ocular hypertension, glaucoma suspect, or normal eyes and had a minimum of 3 years of study participation with at least five reliable visual field (VF) tests. Changes in CH, CRF, and IOP induced by ophthalmodynamometry were compared between diagnostic groups and evaluated for relationships with existing and future glaucomatous VF loss. RESULTS In 248 eyes of 248 subjects followed up for 7.7 ± 2.3 years, ophthalmodynamometry induced a mean IOP increase from 15.1 to 29.9 mmHg, causing a mean 34 ± 28% increase in CRF and 21 ± 25% decrease in CH. Magnitude of CH change did not differ between diagnostic groups or between eyes that did (n = 20) and did not (n = 95) develop new VF loss during the study period, nor was it related to rate of future VF progression. CONCLUSIONS Ophthalmodynamometry-induced IOP elevation resulted in significant acute changes in CH and CRF in this study; this suggests accounting for IOP may be important in clinical interpretation of these parameters. However, because the degree of CH change was not related to glaucoma or its progression, acute changes in CH and CRF do not seem to have a prognostic value for glaucoma.
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Aoki S, Miki A, Omoto T, Fujino Y, Matsuura M, Murata H, Asaoka R. Biomechanical Glaucoma Factor and Corneal Hysteresis in Treated Primary Open-Angle Glaucoma and Their Associations With Visual Field Progression. Invest Ophthalmol Vis Sci 2021; 62:4. [PMID: 34086046 PMCID: PMC8185393 DOI: 10.1167/iovs.62.7.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the relationship between biomechanical glaucoma factor (BGF) measured with Corvis ST and glaucomatous visual field (VF) progression, compared to corneal hysteresis (CH) measured with ocular response analyzer using a longitudinal dataset of primary open-angle glaucoma (POAG). The discriminative powers of BGF and CH were also compared using a cross-sectional dataset. Methods The longitudinal dataset included 166 POAG eyes. The rate of VF change during the follow-up period was evaluated using the mean of 52 pointwise total deviations in the Humphrey 24-2 field test. Variables associated with the VF progression rate were identified from BGF, CH, age, baseline VF severity, and intraocular pressure during the VF follow-up period by identifying the optimal model. The cross-sectional dataset included 68 POAG eyes and 68 healthy eyes. Using this dataset, the area under the curve (AUC) values of the receiver-operating curve were compared between CH and BGF. Results The optimal multivariate linear mixed model to describe the VF rate included age and CH, but not BGF. Between POAG and healthy eyes, CH was statistically different (P < 0.001), although this was not the case with BGF. The AUC values were 0.61 and 0.71 for BGF and CH, respectively (P = 0.027). Conclusions CH, but not BGF, was associated with VF progression in POAG patients under treatment. BGF was not useful to discriminate POAG between treated and normal eyes.
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Affiliation(s)
- Shuichiro Aoki
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan.,Department of Ophthalmology, the University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Atsuya Miki
- Department of Ophthalmology and Visual Science, Osaka University, Osaka, Japan.,Department of Innovative Visual Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Omoto
- Department of Ophthalmology, the University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yuri Fujino
- Department of Ophthalmology, the University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Masato Matsuura
- Department of Ophthalmology, the University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Orthopic and Visual Science, Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan.,Department of Ophthalmology, Saneikai Tsukazaki Hospital, Hyogo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, the University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, the University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.,Nanovision Research Division, Research Institute of Electronics, Shizuoka University, Shizuoka, Japan.,The Graduate School for the Creation of New Photonics Industries, Shizuoka, Japan
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25
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Corneal hysteresis as a risk factor for optic nerve head surface depression and retinal nerve fiber layer thinning in glaucoma patients. Sci Rep 2021; 11:11677. [PMID: 34083548 PMCID: PMC8175353 DOI: 10.1038/s41598-021-90588-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022] Open
Abstract
To evaluate the role of corneal hysteresis (CH) as a risk factor for progressive ONH surface depression and RNFL thinning measured by confocal scanning laser ophthalmoscopy (CSLO) and spectral-domain optical coherence tomography (SD-OCT), respectively in glaucoma patients. Prospective study. A total of 146 eyes of 90 patients with glaucoma were recruited consecutively. The CH measurements were acquired at baseline and 4-months interval using the Ocular Response Analyzer (Reichert Instruments, Depew, NY). Eyes were imaged by CSLO (Heidelberg Retinal Tomograph [HRT]; Heidelberg Engineering, GmbH, Dossenheim, Germany) and SD-OCT (Cirrus HD-OCT; Carl Zeiss Meditec AG, Dublin, CA) at approximately 4-month intervals for measurement of ONH surface topography and RNFL thickness, respectively. Significant ONH surface depression and RNFL thinning were defined with reference to Topographic Change Analysis (TCA) with HRT and Guided Progression Analysis (GPA) with Cirrus HD-OCT, respectively. Multivariate cox proportional hazards models were used to investigate whether CH is a risk factor for ONH surface depression and RNFL progression after adjusting potential confounding factors. All patients with glaucoma were followed for an average of 6.76 years (range, 4.56–7.61 years). Sixty-five glaucomatous eyes (44.5%) of 49 patients showed ONH surface depression, 55 eyes (37.7%) of 43 patients had progressive RNFL thinning and 20 eyes (13.7%) of 17 patients had visual field progression. In the cox proportional hazards model, after adjusting baseline diastolic IOP, CCT, age, baseline disc area and baseline MD, baseline CH was significantly associated with ONH surface depression and visual field progression (HR = 0.71, P = 0.014 and HR = 0.54, P = 0.018, respectively), but not with RNFL thinning (HR = 1.03, P = 0.836). For each 1-mmHg decrease in baseline CH, the hazards for ONH surface depression increase by 29%, and the hazards for visual field progression increase by 46%. The CH measurements were significantly associated with risk of glaucoma progression. Eyes with a lower CH were significantly associated with an increased risk of ONH surface depression and visual field progression in glaucoma patients.
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Synergic effect of corneal hysteresis and central corneal thickness in the risk of early-stage primary open-angle glaucoma progression. Graefes Arch Clin Exp Ophthalmol 2021; 259:2743-2751. [PMID: 33961110 DOI: 10.1007/s00417-021-05212-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 03/09/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate corneal hysteresis (CH), acquired with ocular response analyzer (ORA), as a risk factor for glaucoma progression in early-stage primary open-angle glaucoma (POAG). METHODS In a historical cohort study, patients diagnosed in 2011 with early-stage POAG according to the Hodapp, Parrish and Anderson classification modified for Octopus perimetry and followed up until glaucomatous progression development; otherwise, observations were censored in October 2018. Cox regression was used to obtain hazard ratios (HR) to evaluate baseline variables (CH, central corneal thickness, gender, age IOP and glaucoma family history) as risk factors for perimetric glaucoma progression. A likelihood ratio test for interaction was performed in order to assess the effect of the combination of CH and CCT on the risk of progression. RESULTS Of the cohort of 1573 patients, 11.38% developed early-stage POAG progression during the follow-up. The mean follow-up time was 3.28 ± 1.92 years. Patients without progression had a higher CH (11.35 ± 1.43 vs 9.07 ± 1.69 mmHg; p < 0.001) and CCT (570.75 ± 17.71 vs 554.51 ± 23.20; p < 0.001). In the multivariate analysis, each 1 mmHg of lower CH was associated with an increase of 2.13 times in the HR of progression (95% CI: 1.92-2.32; p < 0.001). CH hazard ratio was modified by CCT, with higher values of CCT and CH resulting in a higher HR of early glaucoma progression (p < 0.001). CONCLUSIONS CH can be considered as a risk factor of progression in early-stage POAG. The risk associated with CH changed depending on CCT values, acting synergistically slowing the risk of glaucoma progression with higher values.
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Sayah DN, Mazzaferri J, Descovich D, Costantino S, Lesk MR. The Association Between Ocular Rigidity and Neuroretinal Damage in Glaucoma. Invest Ophthalmol Vis Sci 2021; 61:11. [PMID: 33151280 PMCID: PMC7671866 DOI: 10.1167/iovs.61.13.11] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Ocular rigidity (OR) is an important biomechanical property, thought to be relevant in the pathophysiology of open-angle glaucoma (OAG). This study aims to evaluate the relationship between OR and neuroretinal damage caused by glaucoma. Methods One hundred eight subjects (22 with healthy eyes, 23 with suspect discs, and 63 with OAG) were included in this study. OR was measured using a noninvasive optical coherence tomography (OCT)-based method developed by our group. We also measured central corneal thickness (CCT), corneal hysteresis (CH), and corneal resistance factor (CRF). Pearson and partial correlations were performed to evaluate the relationship between OR and glaucomatous damage represented by ganglion cell complex (GCC), retinal nerve fiber layer (RNFL) thicknesses, and neuroretinal rim area. Results Significant positive correlations were found between OR and minimum GCC thickness (r = 0.325, P = 0.001), average GCC thickness (r = 0.320, P = 0.002), rim area (r = 0.344, P < 0.001), and RNFL thickness in the superior (r = 0.225, P = 0.023), and inferior (r = 0.281, P = 0.004) quadrants. These correlations were generally greater than those found for CCT, CH, and CRF. Furthermore, no correlation was found between OR and corneal biomechanical parameters. After adjusting for age, sex, and ethnicity, significant correlations were found between OR and minimum and average GCC thickness (r = 0.357, P = 0.001 and r = 0.344, P = 0.001, respectively), rim area (r = 0.327, P = 0.001), average RNFL thickness (r = 0.331, P = 0.001), and RNFL thickness in the superior (r = 0.296, P = 0.003) and inferior (r = 0.317, P = 0.001) quadrants. Conclusions In this study, we found a positive correlation between structural OCT-based parameters and OR, indicating more neuroretinal damage in eyes with lower OR. These findings could provide insight into the pathophysiology of OAG.
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Affiliation(s)
- Diane N Sayah
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada.,Department of Ophthalmology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Javier Mazzaferri
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada
| | - Denise Descovich
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada
| | - Santiago Costantino
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada.,Department of Ophthalmology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Centre Universitaire d'ophtalmologie de l'Université de Montréal de l'Hôpital Maisonneuve-Rosemont, CIUSSS-E, Montreal, Quebec, Canada
| | - Mark R Lesk
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada.,Department of Ophthalmology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Centre Universitaire d'ophtalmologie de l'Université de Montréal de l'Hôpital Maisonneuve-Rosemont, CIUSSS-E, Montreal, Quebec, Canada
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Doolan E, O'Brien C. Abnormal corneal properties in osteogenesis imperfecta and glaucoma: a case series. BMJ Open Ophthalmol 2021; 6:e000684. [PMID: 33928192 PMCID: PMC8055117 DOI: 10.1136/bmjophth-2020-000684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/21/2021] [Accepted: 04/09/2021] [Indexed: 12/29/2022] Open
Abstract
Objective We aimed to carry out ocular examination and genetic studies in a family in which some members are affected with osteogenesis imperfecta (OI) and primary open-angle glaucoma (POAG). We compared the corneal properties of affected and unaffected members (ie, cases and controls). Methods Eight family members from two generations, both affected and unaffected, were examined. Corneal hysteresis (CH), intraocular pressure (IOP) measured with Goldmann applanation tonometer, central corneal thickness (CCT) and cornea-corrected IOP (IOPcc) were recorded. Blood samples were obtained from seven family members, both affected and unaffected, and tested for a panel of genes associated with OI. Results Family members affected with OI (n=6) had a heterozygous splice site mutation in intron 26 of the COL1A1 gene. The family members affected with OI had reduced CCT (476.5±24.6 µm) and CH (7.9 ±1.4 mmHg) compared with the unaffected controls (CCT, 575.8±10.8 µm; CH, 12.3±0.8 mmHg). Two of the six patients affected with OI had a glaucoma diagnosis and were on topical therapy and under regular clinical review. Conclusions Patients affected with OI have a significant risk of developing POAG due to the effects of abnormal collagen on various ocular structures. Two of these effects which place them at risk are reduced CCT and CH. They should be screened and monitored for glaucoma from a young age, and the examination should include corneal biomechanical measurements and CCT to identify those most at risk. IOPcc may be a more accurate way to monitor IOP in the presence of abnormal corneal properties.
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Affiliation(s)
- Emer Doolan
- Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Colm O'Brien
- Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
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The Relationship Between Corneal Hysteresis and Progression of Glaucoma After Trabeculectomy. J Glaucoma 2021; 29:912-917. [PMID: 32555063 DOI: 10.1097/ijg.0000000000001581] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate the association of corneal hysteresis (CH) measured with Ocular Response Analyzer on the progression of glaucoma after trabeculectomy. MATERIALS AND METHODS Twenty-four eyes of 19 patients with primary open-angle glaucoma underwent trabeculectomy. A series of visual fields (Humphery Field Analyzer 24-2 SITA-standard) were measured starting after 6 months after trabeculectomy (4.2±5.0 y, mean±SD). The mean total deviation (mTD) of the 52 test points were calculated. In addition, the mTD was divided into the following areas: central area (within central 10 degrees), superior area and inferior area: mTDcentre, mTDsuperior, and mTDinferior, respectively. The relationship between each area's progression rate of mTD and the 7 variables of baseline age, central corneal thickness, baseline mTD, mean intraocular pressure (IOP), SD of IOP divided by the mean IOP, the difference between baseline IOP obtained before the initiation of any treatment, mean IOP, and CH were analyzed using the linear mixed model, and the optimal model was selected using the model selection method with the second ordered Akaike Information Criterion. RESULTS In the optimal model for mTD progression rate, only CH was selected with the coefficient of 0.11. The optimal model for the mTDcentre progression rate included mean IOP with the coefficient of -0.043 and CH with the coefficient of 0.12, and that for mTDinferior included only CH with the coefficient of 0.089. There was no variable selected in the optimal model for the mTDsuperior progression rate. CONCLUSION CH is a useful measure in the management of glaucoma after trabeculectomy.
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Jayaram H. Intraocular pressure reduction in glaucoma: Does every mmHg count? Taiwan J Ophthalmol 2021; 10:255-258. [PMID: 33437597 PMCID: PMC7787090 DOI: 10.4103/tjo.tjo_63_20] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 09/09/2020] [Indexed: 11/04/2022] Open
Abstract
The reduction of intraocular pressure is currently the only known modifiable risk factor for the treatment of Glaucoma, which is the leading cause of irreversible worldwide blindness. This concise review discusses the evidence underpinning the reduction of intraocular pressure in the treatment of glaucoma, the role of target intraocular pressure in clinical practice and appraises clinical data supporting the concept that every mmHg of intraocular pressure reduction is important in reducing the risk of developing glaucoma and the progression of existing disease. Every mmHg in IOP reduction is important, with evidence showing an impact on both functional and structural progression but does not however explain all glaucoma risk.
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Affiliation(s)
- Hari Jayaram
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom.,NIHR Moorfields Biomedical Research Centre, London, United Kingdom
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Gedde SJ, Vinod K, Wright MM, Muir KW, Lind JT, Chen PP, Li T, Mansberger SL. Primary Open-Angle Glaucoma Preferred Practice Pattern®. Ophthalmology 2021; 128:P71-P150. [DOI: 10.1016/j.ophtha.2020.10.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022] Open
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The Relationship Between Corvis ST Tonometry Parameters and Ocular Response Analyzer Corneal Hysteresis. J Glaucoma 2020; 29:479-484. [PMID: 32134829 DOI: 10.1097/ijg.0000000000001486] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PRECIS Corvis ST Tonometry and Ocular Response Analyzer (ORA) measurements were conducted in primary open-angle glaucoma and normative subjects. Many parameters were significantly correlated, however, the strengths were weak to moderate. PURPOSE Reichert ORA parameters are derived from pressure information following the application of air-jet, whereas detailed structural observation can be made using the Corneal Visualization Scheimpflug Technology instrument (CST). The purpose of the study was to investigate the association between CST measurements and ORA measured corneal hysteresis (CH). METHODS Measurements of CST, ORA, axial length, average corneal curvature, central corneal thickness (CCT) and intraocular pressure with Goldmann applanation tonometry were carried out in 104 eyes of 104 patients with primary open-angle glaucoma and 35 eyes from normative subjects. The association between CST and ORA parameters was assessed using linear regression analysis, with model selection based on the second order bias corrected Akaike Information Criterion index. RESULTS Deformation amplitude ratio (corneal softness, R=-0.51), SP A1 (corneal stiffness, R=0.41), and Inverse Radius (integrated area under the curve of the inverse concave radius, R=-0.44) were significantly correlated with CH (P <0.05). The optimal model to explain CH using CST measurements was given by: CH=-76.3+4.6×A1 time (applanation time in the corneal inward movement)+1.9×A2 time (second applanation time in the corneal outward movement) + 3.1 × highest concavity deformation amplitude (magnitude of movement of the corneal apex from before deformation to its highest concavity) + 0.016×CCT (R=0.67; P<0.001). CONCLUSIONS CST parameters are significant, but weakly or moderately, related to ORA measured CH.
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Gazzard G, Jayaram H, Roldan AM, Friedman DS. When gold standards change: time to move on from Goldmann tonometry? Br J Ophthalmol 2020; 105:1-2. [PMID: 32972917 DOI: 10.1136/bjophthalmol-2020-317112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/30/2020] [Accepted: 09/07/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Gus Gazzard
- Glaucoma Service, Moorfields Eye Hospital, London, UK .,University College London Institute of Ophthalmology, London, UK
| | - Hari Jayaram
- University College London Institute of Ophthalmology, London, UK.,Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Ana M Roldan
- Glaucoma Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - David S Friedman
- Ophthalmology, Harvard University, Cambridge, Massachusetts, USA
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Tracer N, Ayoub S, Radcliffe NM. The association between corneal hysteresis and surgical outcomes from trabecular meshwork microinvasive glaucoma surgery. Graefes Arch Clin Exp Ophthalmol 2020; 259:475-481. [DOI: 10.1007/s00417-020-04921-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 08/04/2020] [Accepted: 09/05/2020] [Indexed: 12/15/2022] Open
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Miki A, Yasukura Y, Weinreb RN, Maeda N, Yamada T, Koh S, Asai T, Ikuno Y, Nishida K. Dynamic Scheimpflug Ocular Biomechanical Parameters in Untreated Primary Open Angle Glaucoma Eyes. Invest Ophthalmol Vis Sci 2020; 61:19. [PMID: 32298437 PMCID: PMC7401753 DOI: 10.1167/iovs.61.4.19] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose To characterize the corneal biomechanical properties of glaucoma eyes by comparing the dynamic Scheimpflug biomechanical parameters between untreated glaucoma and control eyes. Methods Cross-sectional observational data of dynamic Scheimpflug analyzer (Corvis ST) examinations were retrospectively collected from 35 eyes of 35 consecutive patients with untreated normal tension glaucoma and 35 eyes of 35 healthy patients matched on age and IOP. Ten biomechanical parameters were compared between the two groups using multivariable models adjusting for IOP, central corneal thickness, age, and axial length. The Benjamini-Hochberg method was used to correct for multiple comparison. Results In multivariable models, glaucoma was associated with smaller applanation 1 time (P < 0.001, coefficient = −0.5865), applanation 2 time (P = 0.012, coefficient = −0.1702), radius (P = 0.006, coefficient = −0.5447), larger peak distance (P = 0.011, coefficient = 0.1023), deformation amplitude ratio at 1 mm (P < 0.001, coefficient = 0.072), and integrated radius (P < 0.001, coefficient = 1.094). These associations consistently indicate greater compliance of the cornea in glaucoma eyes. Conclusions Untreated normal tension glaucoma eyes were more compliant than healthy eyes. The greater compliance (smaller stiffness) of normal tension glaucoma eyes may increase the risk of optic nerve damage. These results suggest the relevance of measuring biomechanical properties of glaucoma eyes.
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Zimprich L, Diedrich J, Bleeker A, Schweitzer JA. Corneal Hysteresis as a Biomarker of Glaucoma: Current Insights. Clin Ophthalmol 2020; 14:2255-2264. [PMID: 32848355 PMCID: PMC7429407 DOI: 10.2147/opth.s236114] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022] Open
Abstract
The diagnosis and management of glaucoma has long been dependent on making decisions based on family history, optic nerve head evaluation, intraocular pressure, visual field testing, and optical coherence testing. Other pieces to aid in understanding glaucoma have presented throughout the years, including the role of corneal thickness. The discussion and debate on the mechanism of glaucoma have been attributed to resistance at the level of the conventional outflow pathway, perfusion pressure to the optic nerve head, cerebral spinal fluid pressure, and many more. Another piece that has emerged is corneal hysteresis, an assessment of the cornea’s ability to absorb and dissipate energy. There is abundant published literature supporting corneal hysteresis being associated with the presence and severity of glaucoma, the structural and functional progression of glaucoma, and the conversion to glaucoma. The supported data in these studies add another piece, corneal hysteresis, to consider in the diagnosis and management of glaucoma.
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Affiliation(s)
| | | | - Adam Bleeker
- University of South Dakota Sanford School of Medicine, Vermillion, SD 57069, USA
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The Relationship Between Asymmetries of Corneal Properties and Rates of Visual Field Progression in Glaucoma Patients. J Glaucoma 2020; 29:872-877. [PMID: 32769735 DOI: 10.1097/ijg.0000000000001625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PRéCIS:: In this study, asymmetries in corneal hysteresis (CH) between eyes of glaucoma patients were significantly associated with asymmetries in rates of visual field loss, suggesting a role of hysteresis as a risk factor for disease progression. PURPOSE The purpose of this study was to investigate the relationship between asymmetries in rates of glaucoma progression and asymmetries of corneal properties between eyes of subjects with primary open-angle glaucoma. PARTICIPANTS AND METHODS This prospective study followed 126 binocular subjects with glaucoma for an average of 4.3±0.8 years. CH was measured at baseline using the Ocular Response Analyzer. Standard automated perimetry (SAP) and intraocular pressure were measured at baseline and every 6 months. Rates of visual field progression were calculated using ordinary least square regression of SAP mean deviation (MD) values over time for each eye. Eyes were defined as "better" and "worse" based on the slopes of SAP MD. Pearson correlation test, and univariable and multivariable regression models were used to investigate the relationship between inter-eye asymmetry in CH and central corneal thickness and inter-eye differences in rates of visual field progression. RESULTS Only asymmetry of CH was significantly associated with the asymmetry in SAP MD rates of change between eyes (r=0.22; P=0.01). In a multivariable model adjusting for age, race, central corneal thickness, mean intraocular pressure and baseline disease severity, CH asymmetry remained significantly associated with asymmetric progression (P=0.032). CONCLUSION CH asymmetry between eyes was associated with asymmetry on rates of visual field change, providing further support for the role of CH as a risk factor for glaucoma progression.
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Rahman N, O'Neill E, Irnaten M, Wallace D, O'Brien C. Corneal Stiffness and Collagen Cross-Linking Proteins in Glaucoma: Potential for Novel Therapeutic Strategy. J Ocul Pharmacol Ther 2020; 36:582-594. [PMID: 32667842 DOI: 10.1089/jop.2019.0118] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Biomechanical properties of the cornea have recently emerged as clinically useful in risk assessment of diagnosing glaucoma and predicting disease progression. Corneal hysteresis (CH) is a dynamic tool, which measures viscoelasticity of the cornea. It represents the overall deformability of the cornea, and reduces significantly with age. Low CH has also been associated with optic nerve damage and progression of visual field loss in glaucoma. The extracellular matrix (ECM) constituents of the cornea, trabecular meshwork (TM), sclera, and lamina cribrosa (LC) are similar, as they are predominantly made of fibrillar collagen. This suggests that biomechanical changes in the cornea may also reflect optic nerve compliance in glaucomatous optic neuropathy, and in the known increase of TM tissue stiffness in glaucoma. Increased collagen cross-linking contributes to tissue stiffening throughout the body, which is observed in normal aging and occurs at an accelerated rate in systemic conditions such as fibrotic and cardiovascular diseases, cancer, and glaucoma. We reviewed 3 ECM cross-linking proteins that may have a potential role in the disease process of increased tissue stiffness in glaucoma, including lysyl oxidase (LOX)/lysyl oxidase-like 1 (LOXL1), tissue transglutaminase (TG2), and advanced glycation end products. We also report elevated messenger RNA (mRNA) levels of LOX and TG2 in glaucoma LC cells to support our proposed theory that increased levels of cross-linking proteins in glaucoma play a role in LC tissue stiffness. We highlight areas of research that are needed to better understand the role of cross-linking in glaucoma pathogenesis, leading potentially to a novel therapeutic strategy.
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Affiliation(s)
- Najiha Rahman
- UCD Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Evelyn O'Neill
- UCD Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Mustapha Irnaten
- UCD Clinical Research, Catherine Mcauley Centre, Dublin, Ireland
| | - Deborah Wallace
- UCD Clinical Research, Catherine Mcauley Centre, Dublin, Ireland
| | - Colm O'Brien
- UCD Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland.,UCD Clinical Research, Catherine Mcauley Centre, Dublin, Ireland
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Asano S, Asaoka R, Yamashita T, Aoki S, Matsuura M, Fujino Y, Murata H, Nakakura S, Nakao Y, Kiuchi Y. Visualizing the dynamic change of Ocular Response Analyzer waveform using Variational Autoencoder in association with the peripapillary retinal arteries angle. Sci Rep 2020; 10:6592. [PMID: 32313133 PMCID: PMC7170838 DOI: 10.1038/s41598-020-63601-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/31/2020] [Indexed: 12/20/2022] Open
Abstract
The aim of the current study is to identify possible new Ocular Response Analyzer (ORA) waveform parameters related to changes of retinal structure/deformation, as measured by the peripapillary retinal arteries angle (PRAA), using a generative deep learning method of variational autoencoder (VAE). Fifty-four eyes of 52 subjects were enrolled. The PRAA was calculated from fundus photographs and was used to train a VAE model. By analyzing the ORA waveform reconstructed (noise filtered) using VAE, a novel ORA waveform parameter (Monot1-2), was introduced, representing the change in monotonicity between the first and second applanation peak of the waveform. The variables mostly related to the PRAA were identified from a set of 41 variables including age, axial length (AL), keratometry, ORA corneal hysteresis, ORA corneal resistant factor, 35 well established ORA waveform parameters, and Monot1-2, using a model selection method based on the second-order bias-corrected Akaike information criterion. The optimal model for PRAA was the AL and six ORA waveform parameters, including Monot1-2. This optimal model was significantly better than the model without Monot1-2 (p = 0.0031, ANOVA). The current study suggested the value of a generative deep learning approach in discovering new useful parameters that may have clinical relevance.
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Affiliation(s)
- Shotaro Asano
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan.
- Seirei General Hospital, Shizuoka, 430-8558, Japan.
- Seirei Christopher University, Shizuoka, 433-8558, Japan.
| | - Takehiro Yamashita
- Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, 890-0075, Japan
| | - Shuichiro Aoki
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Masato Matsuura
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
- Department of Ophthalmology, Graduate School of Medical Sciences, Kitasato University, Kanagawa, 252-0374, Japan
| | - Yuri Fujino
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
- Seirei General Hospital, Shizuoka, 430-8558, Japan
- Department of Ophthalmology, Graduate School of Medical Sciences, Kitasato University, Kanagawa, 252-0374, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Shunsuke Nakakura
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Hyogo, 671-1227, Japan
| | - Yoshitaka Nakao
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, 739-8511, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, 739-8511, Japan
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Wong BJ, Moghimi S, Zangwill LM, Christopher M, Belghith A, Ekici E, Bowd C, Fazio MA, Girkin CA, Weinreb RN. Relationship of Corneal Hysteresis and Anterior Lamina Cribrosa Displacement in Glaucoma. Am J Ophthalmol 2020; 212:134-143. [PMID: 31770514 DOI: 10.1016/j.ajo.2019.11.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate the relationship between corneal hysteresis (CH) and anterior lamina cribrosa surface (ALCS) displacement over time in a cohort of patients with glaucoma. DESIGN Prospective observational case series. METHODS In this study, 147 eyes from 96 glaucoma or glaucoma suspect patients were followed for a mean of 3.5 years and 7.9 visits. Baseline CH measurements were obtained using the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments Inc, Depew, New York, USA). The mean anterior lamina cribrosa surface depth (ALCSD) and choroidal thickness were by automated segmentation of spectral-domain optical coherence tomography (SD-OCT) scans. The rate of change of ALCSD was calculated using linear mixed effects models. Relationship between baseline CH and follow-up ALCSD rate of change was adjusted for confounding factors, including age, intraocular pressure (IOP), and choroidal thickness. RESULTS The mean baseline CH was 9.4 mm Hg (95% confidence interval [CI] 9.1-9.7). Overall, the ALCS was displaced posteriorly at a rate of 0.78 μm/y (95% CI -1.82, 0.26). Seventeen eyes (11.5%) showed a significant posterior displacement of ALCS, whereas 22 eyes (15.0%) showed a significant anterior displacement of ALCS. The choroidal thickness thinned at a rate of -1.09 μm/y during the follow-up (P = .001). Multivariable mixed modeling showed that choroidal thinning, lower IOP change, and lower corneal hysteresis were significantly associated with posterior ALCS displacement over time (P = .034, P = .037, and P = .048). Each 1 mm lower CH was associated with 0.66 μm/y posterior displacement of the ALCS. CONCLUSIONS Lower corneal hysteresis was significantly associated with posterior displacement of the anterior lamina cribrosa over time. These data provide additional support for lower corneal hysteresis being a risk factor for glaucoma progression.
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Lee KM, Kim TW, Lee EJ, Girard MJA, Mari JM, Weinreb RN. Association of Corneal Hysteresis With Lamina Cribrosa Curvature in Primary Open Angle Glaucoma. Invest Ophthalmol Vis Sci 2020; 60:4171-4177. [PMID: 31598628 DOI: 10.1167/iovs.19-27087] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate whether corneal biomechanical properties are associated with the lamina cribrosa (LC) curvature in eyes with primary open angle glaucoma (POAG). Methods Corneal biomechanical properties and LC curvature were assessed in 65 treatment-naïve POAG patients. Corneal biomechanical properties, including corneal hysteresis (CH), corneal resistance factor (CRF), and corneal-compensated intraocular pressure (IOPcc), were measured using an ocular response analyzer (ORA; Reichert Ophthalmic Instruments). LC curvature was assessed by measuring the LC curvature index (LCCI) on B-scan images obtained using spectral-domain optical coherence tomography (OCT). The LCCI was determined by measuring LC curve depth on the anterior LC surface and the width of the reference line. Results The LCCI was correlated with CH (P = 0.001), CRF (P = 0.012) and IOPcc (P = 0.001) in the univariate analysis. To adjust multicollinearity, principal component analysis was performed, and multivariate regression analyses were conducted using one variable from each component. The larger LCCI was associated with larger IOPcc (P < 0.001), smaller CRF (P = 0.001) and smaller CH (P < 0.001). Conclusions Lower CH was associated with a more posteriorly curved LC in treatment naïve POAG patients. This finding may provide a basic explanation for the reported association between CH and an increased risk for glaucoma development and progression, and support a potential value of CH for risk assessment for glaucoma.
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Affiliation(s)
- Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Tae-Woo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Ji Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Michaël J A Girard
- Department of Bioengineering, National University of Singapore, Singapore.,Singapore Eye Research Institute, Singapore
| | | | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, and Viterbi Family Department of Ophthalmology, University of California, San Diego, California, United States
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Association between optic nerve head morphology in open-angle glaucoma and corneal biomechanical parameters measured with Corvis ST. Graefes Arch Clin Exp Ophthalmol 2019; 258:629-637. [PMID: 31865467 DOI: 10.1007/s00417-019-04572-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSES To investigate associations between Corvis ST-measured corneal biomechanical parameters and glaucomatous optic nerve head (ONH) morphology. METHODS In total, 118 eyes of 70 patients with open-angle glaucoma were examined in this retrospective cross-sectional study. We measured Heidelberg retina tomograph and Corvis ST values in all eyes. We used the linear mixed model in four sectors (temporal superior, TS; temporal inferior, TI; nasal superior, NS; and nasal inferior, NI) to detect associations between six ONH-related parameters and 14 Corvis ST-related parameters, controlling for age, intraocular pressure, axial length, and central corneal thickness. We calculated the ONH temporal and nasal sector vertical asymmetries (TS-TI and NS-NI asymmetries) and identified the optimal linear mixed models to describe them using model selection with the second-order bias corrected Akaike Information Criterion. RESULTS The Corvis ST A2 velocity was negatively associated with the rim volume in the NS sector (p < 0.05). The optimal model for TS-TI asymmetry was TS-TI asymmetry = - 3.22 + 0.15 × HC time + 0.88 × HC deflection amplitude, whereas that for NS-NI asymmetry was 0.49-0.048 × axial length - 2.45 × A2 velocity. CONCLUSION Glaucomatous ONH superior-inferior asymmetries were associated with biomechanical properties measured with Corvis ST. Eyes with superior-dominant rim volume reduction of ONH were associated with small deformations and slow recovery of the cornea.
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Jung Y, Chun H, Moon JI. Corneal deflection amplitude and visual field progression in primary open-angle glaucoma. PLoS One 2019; 14:e0220655. [PMID: 31404083 PMCID: PMC6690643 DOI: 10.1371/journal.pone.0220655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/20/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the relationship between corneal deflection amplitude and visual field progression rate in patients with primary open-angle glaucoma (POAG). Methods This study included 113 eyes of 65 patients with POAG followed for an average of 4.81 ± 1.24 years. Evaluation of visual field progression rate was performed using mean deviation of standard automated perimetry. Corneal deflection amplitude was measured using Corvis ST (Oculus Optikgeräte GmbH, Wetzlar, Germany). Linear mixed models were performed to determine the relationship between corneal deflection amplitude, intraocular pressure (IOP), and visual field progression rate. Results Mean age was 56.36 ± 14.58 years. Baseline average mean deviation was -8.20 ± 9.12 dB and mean treated IOP was 14.38 ± 3.08 mmHg. Average deflection amplitude was 0.90 ± 0.13 mm. In both univariate and multivariate analysis, IOP (P = 0.028 and P < 0.001, respectively) and deflection amplitude (P = 0.034 and P < 0.001, respectively) significantly affected visual field progression rate. Eyes with high IOP and greater deflection amplitude showed faster progression rate. Conclusions Corneal deflection amplitude was significantly related with glaucoma progression. Eyes with greater corneal deflection amplitude showed faster visual field progression rate in patients with POAG.
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Affiliation(s)
- Younhea Jung
- Department of Ophthalmology, College of Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Heejeong Chun
- Department of Ophthalmology, College of Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Il Moon
- Department of Ophthalmology, College of Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
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Susanna BN, Ogata NG, Jammal AA, Susanna CN, Berchuck SI, Medeiros FA. Corneal Biomechanics and Visual Field Progression in Eyes with Seemingly Well-Controlled Intraocular Pressure. Ophthalmology 2019; 126:1640-1646. [PMID: 31519385 DOI: 10.1016/j.ophtha.2019.07.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the incidence and risk factors for glaucomatous visual field progression in eyes with well-controlled intraocular pressure (IOP). DESIGN Prospective cohort. PARTICIPANTS A total of 460 eyes of 334 patients with glaucoma under treatment. METHODS Study subjects had a mean follow-up of 4.3±0.8 years. Patients were classified as well controlled if all IOP measurements were less than 18 mmHg. Rates of visual field progression were calculated using ordinary least-squares linear regression of standard automated perimetry (SAP) mean deviation (MD) values over time. Progression was defined as a significantly negative MD slope (alpha = 0.05). MAIN OUTCOME MEASURES Rates of SAP MD change; mean and peak IOP, and IOP fluctuation; and corneal biomechanics: corneal hysteresis (CH), central corneal thickness (CCT), and corneal index. RESULTS Of the 179 eyes with well-controlled IOP, 42 (23.5%) demonstrated visual field progression. There was no significant difference between progressing and stable patients in baseline MD (-6.4±7.1 decibels [dB] vs. -6.0±6.2 dB; P = 0.346), mean IOP (11.7±2.0 mmHg vs. 12.1±2.3 mmHg; P = 0.405), IOP fluctuation (1.6±0.6 mmHg vs. 1.6±0.5 mmHg; P = 0.402), or peak IOP (14.3±1.9 mmHg vs. 14.6±2.1 mmHg; P = 0.926). Progressing eyes had significantly lower CH (8.6±1.3 mmHg vs. 9.4±1.6 mmHg; P = 0.014) and thinner CCT (515.1±33.1 μm vs. 531.1±42.4 μm; P = 0.018, respectively) compared with stable eyes. In the multivariate analysis, a 1 standard deviation lower corneal index, a summation of normalized versions of CH and CCT, resulted in a 68% higher risk of progression (odds ratio, 1.68; 95% confidence interval, 1.08-2.62; P = 0.021). CONCLUSIONS Approximately one-quarter of eyes with well-controlled IOP may show visual field progression over time. Thin cornea and low CH are main risk factors.
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Affiliation(s)
- Bianca N Susanna
- Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; ABC Foundation School of Medicine, Santo André, Brazil; Hamilton Glaucoma Center, University of California, San Diego, La Jolla, California
| | - Nara G Ogata
- Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Alessandro A Jammal
- Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Carolina N Susanna
- Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; ABC Foundation School of Medicine, Santo André, Brazil; Hamilton Glaucoma Center, University of California, San Diego, La Jolla, California
| | - Samuel I Berchuck
- Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Statistical Science and Forge, Duke University, Durham, North Carolina
| | - Felipe A Medeiros
- Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina.
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Sorkhabi R, Najafzadeh F, Sadeghi A, Ahoor M, Mahdavifard A. Corneal biomechanical changes after trabeculectomy with mitomycin C in primary open-angle glaucoma and pseudoexfoliation glaucoma. Int Ophthalmol 2019; 39:2741-2748. [PMID: 31134423 DOI: 10.1007/s10792-019-01118-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/22/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to examine the effect of trabeculectomy with mitomycin C on corneal biomechanical characteristics in PEXG and POAG patients. METHODS In this prospective comparative case series study, 32 glaucoma patients of whom 17 patients were suffering from PEXG and 15 patients from POAG were enrolled. All patients underwent complete ocular examination, CCT using ultrasound pachymetry and corneal biomechanical study using ORA. The patients were hospitalized, and trabeculectomy surgery with mitomycin was done. Three months after surgery, patients were examined and ORA was obtained again. RESULTS The mean CH in patients with PEXG was lower compared to patients with POAG (5.66 ± 1.13, 7.49 ± 0.88, respectively) before surgery, which had a statistically significant difference (P < 0.001). CRF in patients with PEXG was significantly lower compared to patients with POAG (8.19 ± 1.48 vs. 9.35 ± 1.60, respectively) before surgery, with P = 0.049. CH remarkably increased and reached 6.69 ± 0.78 (P < 0.001) in the PEXG group after TBX + MMC surgery. CH increased in the POAG group after TBX + MIC surgery and reached 8.23 ± 1.09, which was statistically significant (P = 0.001). There was a significant relationship between CH and IOPg changes in both PEXG and POAG groups (P < 0.001 and P = 0.01, respectively). Although TBX + MMC surgery changed the amount of CH in PEXG and POAG groups, no significant difference was shown in the parameters between the two groups comparing the CH changes (P = 0.33). CONCLUSION According to the results of this study, the biomechanical characteristics of cornea, particularly CH, shows certain changes following surgery and is increased, reflecting the dynamic nature of these parameters. Our knowledge of the biomechanical changes after glaucoma surgery can help us better understand the pathophysiology of glaucoma diseases and make the right decisions for follow-up of the patients.
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Affiliation(s)
- Rana Sorkhabi
- Nikookari Hospital (Eye Center), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farhad Najafzadeh
- Nikookari Hospital (Eye Center), Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ali Sadeghi
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohamadhosein Ahoor
- Nikookari Hospital (Eye Center), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Mahdavifard
- Nikookari Hospital (Eye Center), Tabriz University of Medical Sciences, Tabriz, Iran
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Ivarsdottir EV, Benonisdottir S, Thorleifsson G, Sulem P, Oddsson A, Styrkarsdottir U, Kristmundsdottir S, Arnadottir GA, Thorgeirsson G, Jonsdottir I, Zoega GM, Thorsteinsdottir U, Gudbjartsson DF, Jonasson F, Holm H, Stefansson K. Sequence variation at ANAPC1 accounts for 24% of the variability in corneal endothelial cell density. Nat Commun 2019; 10:1284. [PMID: 30894546 PMCID: PMC6427039 DOI: 10.1038/s41467-019-09304-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/28/2019] [Indexed: 12/20/2022] Open
Abstract
The corneal endothelium is vital for transparency and proper hydration of the cornea. Here, we conduct a genome-wide association study of corneal endothelial cell density (cells/mm2), coefficient of cell size variation (CV), percentage of hexagonal cells (HEX) and central corneal thickness (CCT) in 6,125 Icelanders and find associations at 10 loci, including 7 novel. We assess the effects of these variants on various ocular biomechanics such as corneal hysteresis (CH), as well as eye diseases such as glaucoma and corneal dystrophies. Most notably, an intergenic variant close to ANAPC1 (rs78658973[A], frequency = 28.3%) strongly associates with decreased cell density and accounts for 24% of the population variance in cell density (β = -0.77 SD, P = 1.8 × 10-314) and associates with increased CH (β = 0.19 SD, P = 2.6 × 10-19) without affecting risk of corneal diseases and glaucoma. Our findings indicate that despite correlations between cell density and eye diseases, low cell density does not increase the risk of disease.
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Affiliation(s)
- Erna V Ivarsdottir
- deCODE genetics/Amgen, Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | | | | | | | | | | | | | | | - Gudmundur Thorgeirsson
- deCODE genetics/Amgen, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Division of Cardiology, Department of Internal Medicine, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Ingileif Jonsdottir
- deCODE genetics/Amgen, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Immunology, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Gunnar M Zoega
- Department of Ophthalmology, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Unnur Thorsteinsdottir
- deCODE genetics/Amgen, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Daniel F Gudbjartsson
- deCODE genetics/Amgen, Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | - Fridbert Jonasson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Ophthalmology, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Hilma Holm
- deCODE genetics/Amgen, Reykjavik, Iceland.
| | - Kari Stefansson
- deCODE genetics/Amgen, Reykjavik, Iceland.
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
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Lee SH, Moon JI, Jung YH. Comparison of Intraocular Pressures Measured by the Corvis ST and Other Tonometers in Normal Eyes. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.12.1250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seung-hoon Lee
- Department of Ophthalmology, College of Medicine, The Catholic University, Seoul, Korea
| | - Jung-il Moon
- Department of Ophthalmology, College of Medicine, The Catholic University, Seoul, Korea
| | - Youn Hea Jung
- Department of Ophthalmology, College of Medicine, The Catholic University, Seoul, Korea
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Development of a Novel Corneal Concavity Shape Parameter and Its Association with Glaucomatous Visual Field Progression. Ophthalmol Glaucoma 2019; 2:47-54. [PMID: 32672557 DOI: 10.1016/j.ogla.2018.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/14/2018] [Accepted: 10/30/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE To develop a novel Corvis ST (Oculus Co. Ltd, Wetzlar, Germany) corneal concavity shape parameter (concavity shape index [CSI]) and investigate its association with glaucomatous visual field (VF) progression. DESIGN Retrospective longitudinal study. PARTICIPANTS A total of 103 eyes with primary open-angle glaucoma in 68 patients with 8 reliable VFs using the Humphrey Field Analyzer (HFA) (Carl Zeiss Meditec Inc, Dublin, CA). METHODS The mean total deviation (mTD) of the 52 test points in the 24-2 HFA test pattern was calculated for each VF, and the mTD progression rate was determined. A Corvis ST measurement was performed, and CSI was calculated as the ratio of (peak distance × curvature radius at the time of highest concavity [HC] state) to (the deflection amplitude at the time of HC × curvature radius at the undeformed state). The association between mTD progression rate and CSI, as well as other variables (including age, intraocular pressure, corneal hysteresis [CH], and 35 standard Corvis ST parameters), was investigated using the linear mixed model. The optimal linear mixed model to describe mTD progression rate was selected using the Random Forest method followed by variable selection using the second order bias corrected Akaike Information Criterion (AICc) index. MAIN OUTCOME MEASURES Optimal linear mixed models for the mTD progression rate, as determined by AICc index. RESULTS Univariate analysis revealed mTD progression rate was significantly associated with CSI (P = 0.0042), CH, HC radius, A1 deflection length, max inverse radius, and integrated radius. The optimal model to describe mTD progression rate included CSI, max inverse radius, Ambrósio rational thickness horizontal, and age (AICc = 41.59). CONCLUSIONS A novel corneal concavity shape parameter, CSI, was closely related to glaucomatous VF progression.
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Esfandiari H, Efatizadeh A, Hassanpour K, Doozandeh A, Yaseri M, Loewen NA. Factors associated with lamina cribrosa displacement after trabeculectomy measured by optical coherence tomography in advanced primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2018; 256:2391-2398. [PMID: 30251201 DOI: 10.1007/s00417-018-4135-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/25/2018] [Accepted: 09/03/2018] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To investigate the relationship of lamina cribrosa displacement to corneal biomechanical properties and visual function after mitomycin C-augmented trabeculectomy. METHOD Eighty-one primary open-angle eyes were imaged before and after trabeculectomy using an enhanced depth spectral domain optical coherence tomography (SDOCT). Corneal biomechanical properties were measured with the ocular response analyzer before the surgery. The anterior lamina cribrosa (LC) was marked at several points in each of the six radial scans to evaluate LC displacement in response to intraocular pressure (IOP) reduction. A Humphrey visual field test (HVF) was performed before the surgery as well as 3 and 6 months, postoperatively. RESULTS Factors associated with a deeper baseline anterior lamina cribrosa depth (ALD) were cup-disc ratio (P = 0.04), baseline IOP (P = 0.01), corneal hysteresis (P = 0.001), and corneal resistance factor (P = 0.001). After the surgery, the position of LC became more anterior (negative), posterior (positive), or remained unchanged. The mean LC displacement was - 42 μm (P = 0.001) and was positively correlated with the magnitude of IOP reduction (regression coefficient = 0.251, P = 0.02) and negatively correlated with age (regression coefficient = - 0.224, P = 0.04) as well as baseline cup-disk ratio (Regression coefficient = - 0.212, P = 0.05). Eyes with a larger negative LC displacement were more likely to experience an HVF improvement of more than a 3 dB gain in mean deviation (P = 0.002). CONCLUSION A larger IOP reduction and younger age was correlated with a larger negative LC displacement and improving HVF. The correlation between lower SDOCT cup-disc ratio and postoperative negative LC displacement was borderline (P = 0.05). Corneal biomechanics did not predict LC displacement.
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Affiliation(s)
- Hamed Esfandiari
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, 203 Lothrop St., Pittsburgh, PA, 15213, USA
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Efatizadeh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kiana Hassanpour
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azadeh Doozandeh
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, 203 Lothrop St., Pittsburgh, PA, 15213, USA
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nils A Loewen
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, 203 Lothrop St., Pittsburgh, PA, 15213, USA.
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Aoki S, Murata H, Nakakura S, Nakao Y, Matsuura M, Kiuchi Y, Asaoka R. Correlation between elastic energy stored in an eye and visual field progression in glaucoma. PLoS One 2018; 13:e0204451. [PMID: 30240430 PMCID: PMC6150541 DOI: 10.1371/journal.pone.0204451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/07/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To investigate whether the elastic energy stored in an eyeball at highest concavity (highest concavity energy; HCE), calculated with Corivs ST (CST, OCULUS), correlates with glaucomatous visual field (VF) progression. METHODS 108 eyes from 70 primary open angle-glaucoma patients were studied. The HCE was calculated using CST parameters. For each eye, the mean total deviation (mTD) of the 52 test points in the 24-2 Humphrey Field Analyzer test pattern was calculated and the mTD progression rate was determined from eight reliable VFs. Eyes were subdivided into: subgroups with low- or high-whole eye motion maximal length (WEM-d) and subgroups with short- or long-time taken to reach WEM-d (WEM-t), as measured with CST. The associations between mTD progression rate and HCE and other ocular/systemic parameters including age, Goldmann applanation tonometry based-intraocular pressure [GAT-IOP], and corneal hysteresis [CH] from the Ocular Response Analyzer (ORA®, Reichert) were investigated using the linear mixed model. The optimal model to describe mTD progression rate was selected from all possible combinations according to the second order bias corrected Akaike Information Criterion index. RESULTS Optimal models to describe mTD progression rate included: CH in the model for all eyes, age and HCE in the model for the WEM-d low group, HCE in the model for the WEM-t short group, mean GAT-IOP in the model for the WEM-d high group, and age in the model for the WEM-t long-group. CONCLUSIONS HCE was associated with glaucomatous VF progression in eyes with minimal whole eye motion (low WEM-d and WEM-t subgroups).
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Affiliation(s)
- Shuichiro Aoki
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Shunsuke Nakakura
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Hyogo, Japan
| | - Yoshitaka Nakao
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
| | - Masato Matsuura
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
- Orthopic and Visual Science, Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
- * E-mail:
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