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Lee NY, Shin DY, Park CK. Associations of long-term fluctuation in blood pressure and ocular perfusion pressure with visual field progression in normal-tension glaucoma. BMC Ophthalmol 2024; 24:209. [PMID: 38724962 PMCID: PMC11084016 DOI: 10.1186/s12886-024-03454-1] [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: 02/13/2023] [Accepted: 04/14/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUD The aim of this study was to investigate the associations between fluctuation in blood pressure (BP), ocular perfusion pressure (OPP) and visual field (VF) progression in normal-tension glaucoma (NTG). METHODS This prospective, longitudinal study included 44 patients with NTG. Only newly diagnosed NTG patients who had not been treated with a glaucoma medication were included. Patients were examined every year for 7 years. Intraocular pressure (IOP), heart rate (HR), systolic BP (SBP), diastolic BP (DBP), ocular perfusion pressure (OPP), and diastolic ocular perfusion pressure (DOPP) were measured at the same time. Ophthalmic examinations, including perimetry, were performed also. Initial VF were compared with follow-up data after 7 years. RESULTS After 7 years of follow-up, 9 of the 44 patients showed VF progression. The standard deviation (SD) of SBP and OPP were significantly associated with VF progression (P = 0.007, < 0.001, respectively). Multiple regression analysis showed that VF progression was significantly associated with SD of OPP (odds ratio, OR = 2.012, 95% CI = 1.016-3.985; P = 0.045). CONCLUSIONS Fluctuation in OPP was associated with VF progression in patients with NTG.
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Affiliation(s)
- Na Young Lee
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-ku, 137-701, Seoul, Korea
- Department of Ophthalmology, Eunpyeong St. Mary's Hospital, Seoul, Korea
| | - Da Young Shin
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-ku, 137-701, Seoul, Korea
- Department of Ophthalmology, Eunpyeong St. Mary's Hospital, Seoul, Korea
| | - Chan Kee Park
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-ku, 137-701, Seoul, Korea.
- Department of Ophthalmology, Seoul St. Mary's Hospital, Seoul, Korea.
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2
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Mohammadi M, Yarmohammadi A, Salehi-Abargouei A, Ghasemirad H, Shirvani M, Ghoshouni H. Uric acid and glaucoma: a systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1159316. [PMID: 37575992 PMCID: PMC10422028 DOI: 10.3389/fmed.2023.1159316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 07/07/2023] [Indexed: 08/15/2023] Open
Abstract
Background Glaucoma, the leading cause of irreversible blindness, is a common disorder that contributes to gradual optic nerve degeneration. The beneficial impacts of uric acid (UA) have been reported in some neurodegenerative conditions such as Parkinson's disease, Alzheimer's disease, and amyotrophic lateral sclerosis. But the results of current studies about the association between serum UA level and glaucoma are conflicting. The present meta-analysis was conducted to provide a better understanding of the association between serum UA level and glaucoma. Methods We searched the databases of PubMed, Scopus, Web of Science, and Google Scholar systematically until November 20, 2022 to identify case-control studies, comparing the serum UA concentrations of the patients with glaucoma and controls. The mean ± standard division difference was used to assess the difference in serum UA concentrations between the glaucoma patients and controls. Results Six studies involving 1,221 glaucoma patients and 1,342 control group were included in the present meta-analysis. This meta-analysis using a random effect model indicated that the mean UA level in glaucoma patients was 0.13 (I2 = 91.92%, 95% CI = -0.42 to 0.68) higher than the controls; however, it was not statistically significant. Conclusions Our findings provide evidence that glaucoma patients have a higher serum UA level compared to the controls, but this difference is not statistically significant. Prospective studies are needed to determine the possible association between increased UA and glaucoma pathogenesis. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022364055, identifier: CRD42022364055.
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Affiliation(s)
- Mohammad Mohammadi
- Students' Research and Technology Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- NeuroTRACT Association, Student's Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Amin Salehi-Abargouei
- Research Center for Food Hygiene and Safety, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hamidreza Ghasemirad
- Students' Research and Technology Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Shirvani
- Geriatric Ophthalmology Research Center, Shahid Sadoughi University of Medical Science, Yazd, Iran
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Ghoshouni
- Students' Research and Technology Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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3
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Shi A, Berchuck SI, Jammal AA, Singh G, Hunt S, Roche K, Mukherjee S, Medeiros FA. Identifying Risk Factors for Blindness From Glaucoma at First Presentation to a Tertiary Clinic. Am J Ophthalmol 2023; 250:130-137. [PMID: 36764425 PMCID: PMC10281761 DOI: 10.1016/j.ajo.2023.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/03/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE Glaucoma is the leading cause of irreversible blindness, a crippling disability resulting in higher risks of chronic health conditions. To better understand disparities in blindness risk, we identified risk factors of blindness on first presentation to a glaucoma clinic using a large clinical database. DESIGN Retrospective cross-sectional study. METHODS We used electronic health records of glaucoma patients from the Duke Ophthalmic Registry. International Classification of Diseases codes were used to identify glaucoma and exclude concurrent diseases. Blindness classification was based on the definition of legal blindness. Risk factors included gender, race, marital status, age, intraocular pressure, diabetes history, income level, and education. Odds ratios (ORs) and 95% CIs were calculated for risk factors using univariable and multivariable logistic regression. RESULTS Our cohort consisted of 3753 patients, with 192 (5%) blind on first presentation. In univariable models, African American / Black race (OR 2.48, 95% CI 1.83-3.36), single marital status (1.74, 95% CI 1.25-2.44), prior diabetes diagnosis (2.23, 95% CI 1.52-3.27), and higher intraocular pressure (1.29 per 1 SD higher, 95% CI 1.13-1.46) were associated with increased risk of presenting blind, whereas higher annual income (0.75, 95% CI 0.65-0.86) and education (0.77, 95% CI 0.69-0.85) were associated with lower risk. These associations remained significant and in the same direction in a multivariable model apart from income, which became insignificant. CONCLUSIONS Using a large real-world clinical database, we identified risk factors associated with presentation with blindness among glaucoma patients. Our results highlight disparities in health care outcomes and indicate the importance of targeted education to reduce disparities in blindness.
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Affiliation(s)
- Alyssa Shi
- From Duke University (A.S., S.H.), Durham, North Carolina, USA
| | - Samuel I Berchuck
- Department of Statistical Science, Duke University (S.I.B., S.M.), Durham, North Carolina, USA
| | - Alessandro A Jammal
- Duke Eye Center and Department of Ophthalmology, Duke University (A.A.J., F.A.M.), Durham, North Carolina, USA
| | | | - Sydney Hunt
- From Duke University (A.S., S.H.), Durham, North Carolina, USA
| | | | - Sayan Mukherjee
- Department of Statistical Science, Duke University (S.I.B., S.M.), Durham, North Carolina, USA; Departments of Mathematics, Computer Science, Biostatistics & Bioinformatics, Duke University (S.M.), Durham, North Carolina, USA; Center for Scalable Data Analytics and Artificial Intelligence, Universität Leipzig (S.M.), Leipzig, Germany; Max Planck Institute for Mathematics in the Sciences (S.M.), Leipzig, Germany
| | - Felipe A Medeiros
- Duke Eye Center and Department of Ophthalmology, Duke University (A.A.J., F.A.M.), Durham, North Carolina, USA.
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4
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Belamkar A, Harris A, Zukerman R, Siesky B, Oddone F, Verticchio Vercellin A, Ciulla TA. Sustained release glaucoma therapies: Novel modalities for overcoming key treatment barriers associated with topical medications. Ann Med 2022; 54:343-358. [PMID: 35076329 PMCID: PMC8794062 DOI: 10.1080/07853890.2021.1955146] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Glaucoma is a progressive optic neuropathy and a leading cause of irreversible blindness. The disease has conventionally been characterized by an elevated intraocular pressure (IOP); however, recent research has built the consensus that glaucoma is not only dependent on IOP but rather represents a multifactorial optic neuropathy. Although many risk factors have been identified ranging from demographics to co-morbidities to ocular structural predispositions, IOP is currently the only modifiable risk factor, most often treated by topical IOP-lowering medications. However, topical hypotensive regimens are prone to non-adherence and are largely inefficient, leading to disease progression in spite of treatment. As a result, several companies are developing sustained release (SR) drug delivery systems as alternatives to topical delivery to potentially overcome these barriers. Currently, Bimatoprost SR (DurystaTM) from Allergan plc is the only FDA-approved SR therapy for POAG. Other SR therapies under investigation include: bimatoprost ocular ring (Allergan) (ClinicalTrials.gov identifier: NCT01915940), iDose® (Glaukos Corporation) (NCT03519386), ENV515 (Envisia Therapeutics) (NCT02371746), OTX-TP (Ocular Therapeutix) (NCT02914509), OTX-TIC (Ocular Therapeutix) (NCT04060144), and latanoprost free acid SR (PolyActiva) (NCT04060758). Additionally, a wide variety of technologies for SR therapeutics are under investigation including ocular surface drug delivery systems such as contact lenses and nanotechnology. While challenges remain for SR drug delivery technology in POAG management, this technology may shift treatment paradigms and dramatically improve outcomes.
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Affiliation(s)
- Aditya Belamkar
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alon Harris
- Department of Opthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ryan Zukerman
- Department of Opthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Opthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Brent Siesky
- Department of Opthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Thomas A Ciulla
- Indiana University School of Medicine, Indianapolis, IN, USA.,Vitreoretinal Medicine and Surgery, Midwest Eye Institute, Indianapolis, IN, USA
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5
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Cabrera MT, Chen A. It's Time We Reform Our Perspectives on Race and Glaucoma. Transl Vis Sci Technol 2022; 11:22. [PMID: 36149645 PMCID: PMC9520514 DOI: 10.1167/tvst.11.9.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Michelle T Cabrera
- Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington e-mail: .,Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Andrew Chen
- Department of Ophthalmology, University of Washington, Seattle, Washington
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6
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Glaucoma Treatment Outcomes in Open Angle Glaucoma Patients of African Descent. J Glaucoma 2022; 31:479-487. [PMID: 35353787 PMCID: PMC9246921 DOI: 10.1097/ijg.0000000000002027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/19/2022] [Indexed: 01/31/2023]
Abstract
Open angle glaucoma (OAG), characterized by structural changes to the optic nerve head and retinal nerve fiber layer, is a progressive multifactorial optic neuropathy and a leading cause of irreversible blindness globally. Currently, intraocular pressure is the only modifiable risk factor; however, others have been identified, including genetics and race. Importantly, OAG is much more prevalent in persons of African descent (AD) compared with those of European descent (ED). OAG patients of AD are also known to have a more severe course of the disease, a finding potentially explained by structural and/or vascular differences within eye tissues. In addition, disparities in treatment outcomes have been identified in OAG patients of AD. Specifically, prostaglandin analogues have been suggested to be more effective in patients of AD than in those ED, while beta-adrenergic receptors have been suggested to be less effective, although the evidence is inconsistent. AD has also been identified as a risk factor for trabeculectomy failure while laser trabeculoplasty has been conversely found to be very effective in lowering intraocular pressure in patients of AD. Alternative surgical options, including Ex-Press shunt implantation, viscocanalostomy, and canaloplasty are promising in equivalence but require further research to evaluate disparity in outcome properly. In addition to treatment outcomes, social disparities affecting clinical care also exist for AD persons in the form of reduced adherence, access, and choice. Overall, data suggest the need for properly designed prospective trials with AD populations as a primary focus to identify the potential mechanisms driving disparities in treatment and address overall potential bias in glaucoma management.
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7
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Asian Race and Primary Open-Angle Glaucoma: Where Do We Stand? J Clin Med 2022; 11:jcm11092486. [PMID: 35566612 PMCID: PMC9099679 DOI: 10.3390/jcm11092486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/19/2022] [Accepted: 04/24/2022] [Indexed: 01/27/2023] Open
Abstract
Primary open-angle glaucoma (POAG) is an optic neuropathy characterized by irreversible retinal ganglion cell damage and visual field loss. The global POAG prevalence is estimated to be 3.05%, and near term is expected to significantly rise, especially within aging Asian populations. Primary angle-closure glaucoma disproportionately affects Asians, with up to four times greater prevalence of normal-tension glaucoma reported compared with high-tension glaucoma. Estimates for overall POAG prevalence in Asian populations vary, with Chinese and Indian populations representing the majority of future cases. Structural characteristics associated with glaucoma progression including the optic nerve head, retina, and cornea are distinct in Asians, serving as intermediates between African and European descent populations. Patterns in IOP suggest some similarities between races, with a significant inverse relationship between age and IOP only in Asian populations. Genetic differences have been suggested to play a role in these differences, however, a clear genetic pattern is yet to be established. POAG pathogenesis differs between Asians and other ethnicities, and it may differ within the broad classification of the Asian race. Greater awareness and further research are needed to improve treatment plans and outcomes for the increasingly high prevalence of normal tension glaucoma within aging Asian populations.
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8
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Salazar-Quiñones L, Yu-Wai-Man C, De Antonio Ramirez A, Méndez-Hernández CD, Daas A, Garcia Feijoo J, Guzman-Almagro E, Fernández-Pérez C, Sheng Lim K. Peripapillary and optic nerve head vessel density of glaucoma and healthy subjects from Afro-Caribbean and European descent: A pilot study. J Fr Ophtalmol 2021; 45:207-215. [PMID: 34972574 DOI: 10.1016/j.jfo.2021.07.010] [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: 04/20/2021] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 12/09/2022]
Abstract
PURPOSE To compare the peripapillary and optic nerve head vessel density (PP-ONH VD) between glaucoma patients (all, early, moderated, and advanced) and healthy subjects of Afro-Caribbean descent (AD) and European descent (ED). METHODS This was a cross-sectional study. One eye was evaluated in 90 subjects, including 66 glaucoma patients and 24 healthy subjects, who underwent PP-ONH VD imaging using SPECTRALIS® Optical Coherence Tomography Angiography (OCT-A). We analysed the superficial vascular complex using the AngioTool version 0.6a software. The correlation between the PP-ONH VD and visual field mean deviation (MD) was evaluated using a scatter plot and Spearman's rho correlation coefficient. RESULTS Among the healthy subjects, the AD group had a lower superficial PP-ONH VD [43.29±3.25% (mean±standard deviation)] than the ED group (46.06±1.75%) (P=0.016). Overall, superficial PP-ONH VD did not show any significant differences between the total AD and ED glaucoma patients or in the subgroup analyses (early/moderate/advanced) (AD: 32.73±6.70%, 37.11±5.72%, 32.48±5.73%, 27.76±4.74%, respectively; ED: 33.94±6.89%, 38.52±3.82%, 35.56±4.18%; 27.65±6.31%, respectively) (P>0.05 for all). A strong, statistically significant correlation was established between vessel density and mean deviation among AD and ED glaucoma patients (r=0.709 and r=0.704, respectively) (P<0.001 for both). CONCLUSION This pilot study shows that healthy subjects of AD had lower peripapillary and optic nerve head superficial vessel density than healthy subjects of ED, but no significant differences were found between AD and ED glaucoma groups (all, early, moderate, or advanced).
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Affiliation(s)
- L Salazar-Quiñones
- Department of Ophthalmology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto de Investigaciones Oftalmológicas Ramón Castroviejo. Departamento de Inmunología, Oftalmología y ORL. Facultad de Medicina. Universidad Complutense, OFTARED, Hospital Clínico San Carlos, Madrid, Spain; King's College London, SE1 7EH, London, United Kingdom
| | - C Yu-Wai-Man
- King's College London, SE1 7EH, London, United Kingdom; Department of Ophthalmology, Saint-Thomas' Hospital, SE1 7EH, London, United Kingdom
| | - A De Antonio Ramirez
- Department of Epidemiology and Preventive Medicine, Hospital Clinico San Carlos, Universidad Complutense, Madrid, Spain
| | - C D Méndez-Hernández
- Department of Ophthalmology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto de Investigaciones Oftalmológicas Ramón Castroviejo. Departamento de Inmunología, Oftalmología y ORL. Facultad de Medicina. Universidad Complutense, OFTARED, Hospital Clínico San Carlos, Madrid, Spain
| | - A Daas
- Department of Ophthalmology, Saint-Thomas' Hospital, SE1 7EH, London, United Kingdom
| | - J Garcia Feijoo
- Department of Ophthalmology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto de Investigaciones Oftalmológicas Ramón Castroviejo. Departamento de Inmunología, Oftalmología y ORL. Facultad de Medicina. Universidad Complutense, OFTARED, Hospital Clínico San Carlos, Madrid, Spain
| | - E Guzman-Almagro
- Department of Ophthalmology, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - C Fernández-Pérez
- Department of Epidemiology and Preventive Medicine, Hospital Clinico San Carlos, Universidad Complutense, Madrid, Spain
| | - K Sheng Lim
- King's College London, SE1 7EH, London, United Kingdom; Department of Ophthalmology, Saint-Thomas' Hospital, SE1 7EH, London, United Kingdom.
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9
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Torabi R, Harris A, Siesky B, Zukerman R, Oddone F, Mathew S, Januleviciene I, Vercellin ACV. Prevalence Rates and Risk Factors for Primary Open Angle Glaucoma in the Middle East. J Ophthalmic Vis Res 2021; 16:644-656. [PMID: 34840687 PMCID: PMC8593541 DOI: 10.18502/jovr.v16i4.9755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/09/2021] [Indexed: 12/16/2022] Open
Abstract
Glaucoma is a multifactorial disease and a leading cause of irreversible blindness worldwide. Current data has demonstrated the approximate distribution of primary open-angle glaucoma (POAG) in patients of European, African, Hispanic, and Eastern Asian descent. However, a significant gap in the literature exists regarding the prevalence of POAG in Middle Eastern (ME) populations. Current studies estimate ME POAG prevalence based on a European model. Herein we screened 65 total publications on ME prevalence of POAG and specific risk factors using keywords: "glaucoma", "prevalence", "incidence", "risk factor", "Middle East", "Mideast", "Persian", "Far East", as well as searching by individual ME countries through PubMed, Embase, Ovid, Scopus, and Trip searches with additional reference list searches from relevant articles published up to and including March 1, 2021. Fifty qualifying records were included after 15 studies identified with low statistical power, confounding co-morbid ophthalmic diseases, and funding bias were excluded. Studies of ME glaucoma risk factors that identify chromosomes, familial trend, age/gender, socioeconomic status, lifestyle, intraocular pressure, vascular influences, optic disc hemorrhage, cup-to-disc ratio, blood pressure, obstructive sleep apnea, and diabetes mellitus were included in this systematic review. We conclude that the prevalence of POAG in the ME is likely higher than the prevalence rate that European models suggest, with ME specific risk factors likely playing a role. However, these findings are severely limited by the paucity of population-level data in the ME. Well-designed, longitudinal population-based studies with rigorous inclusion and exclusion criteria are ultimately needed to accurately assess the epidemiology and specific mechanistic risk factors of glaucoma in ME populations.
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Affiliation(s)
- Rana Torabi
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana, University School of Medicine, Indianapolis, IN, USA
| | - Alon Harris
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brent Siesky
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ryan Zukerman
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Sunu Mathew
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana, University School of Medicine, Indianapolis, IN, USA
| | - Ingrida Januleviciene
- Eye Clinic of Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania
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10
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Zhang Y, Zhang Q, Thomas R, Li SZ, Wang NL. Association of Hypertriglyceridemia and Incident Glaucoma in a Rural Chinese Population: The Handan Eye Study. Transl Vis Sci Technol 2021; 10:25. [PMID: 34319388 PMCID: PMC8322711 DOI: 10.1167/tvst.10.8.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this paper was to investigate the association between baseline metabolic risk factors and incident glaucoma over a 5-year period in rural Chinese adults. Methods Population-based prospective cohort study. Participants aged 30 years and older without glaucoma at baseline who underwent comprehensive examinations at baseline and after a 5-year interval in the Handan Eye Study were enrolled. Incident glaucoma was defined as people without glaucoma in either eye at baseline that had developed glaucoma in at least one eye in the 5-year follow-up. Five metabolic syndrome components, mean blood pressure, fasting plasma glucose, total cholesterol, triglycerides (TGs), low density lipoprotein cholesterol, high-density lipoprotein cholesterol, and obesity, determined as body mass index ≥30 kg/m2 at baseline were considered as potential metabolic risk factors for incident glaucoma. Univariate and multivariate logistic regression analyses were carried out to determine baseline metabolic risk factors associated with incident glaucoma. Results A total of 5184 participants were included in our study. During the 5-year follow-up, incident glaucoma developed in 82 subjects. Age (odds ratio [OR] = 1.060, 95% confidence interval [CI] = 1.034, 1.086, P < 0.001) and TGs level (OR = 1.213, 95% CI = 1.030, 1.429, P = 0.021) were independently and positively associated with incident glaucoma. Conclusions Our study revealed that increased age and high TGs level, one of the baseline metabolic features, were independent risk factors for incident glaucoma. The data implied that the metabolic features be involved in the pathogenesis of glaucoma. Translational Relevance This study shed the light on that the TGs level was involved in the pathogenesis of glaucoma.
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Affiliation(s)
- Ye Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Qing Zhang
- Beijing Institute of Ophthalmology, Beijing, China
| | - Ravi Thomas
- University of Queensland, Brisbane, Australia
| | - Si Zhen Li
- Nanjing Tongren Hospital, Jiangsu, China
| | - Ning Li Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China.,Beijing Institute of Ophthalmology, Beijing, China
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11
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Siesky B, Harris A, Vercellin ACV, Guidoboni G, Tsai JC. Ocular blood flow as it relates to race and disease on glaucoma. ADVANCES IN OPHTHALMOLOGY AND OPTOMETRY 2021; 6:245-262. [PMID: 35252630 PMCID: PMC8896810 DOI: 10.1016/j.yaoo.2021.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Glaucoma is a multifactorial progressive and degenerative optic neuropathy representing one of the world's leading cause of irreversible blindness. Currently, reduction of intraocular pressure remains the only universally approved therapy, yet a wealth of studies has identified significant vascular contributions to the disease process in certain individuals. Population-based studies have identified important racial disparities and differential risk factors in glaucoma prevalence, incidence, and progression. A more significant vascular component has been identified in persons of African descent. Elucidating risk modifiers, including genetic and racial influence, is important when considering individually tailored clinical management of glaucoma. The application of artificial intelligence and mathematical modeling inclusive of demographic considerations, vascular health, and clinical biomarkers may help reduce disease disparities, advance personalized medicine, and provide a comprehensive model of glaucoma.
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Affiliation(s)
- Brent Siesky
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Alon Harris
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Alice C. Verticchio Vercellin
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Ophthalmology, University of Pavia, Pavia, Italy
- IRCCS - Fondazione Bietti, Rome, Italy
| | - Giovanna Guidoboni
- Department of Electrical Engineering and Computer Science, Department of Mathematics, University of Missouri, Columbia, MO, United States
| | - James C. Tsai
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
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12
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Molecular Genetics of Glaucoma: Subtype and Ethnicity Considerations. Genes (Basel) 2020; 12:genes12010055. [PMID: 33396423 PMCID: PMC7823611 DOI: 10.3390/genes12010055] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 12/11/2022] Open
Abstract
Glaucoma, the world’s leading cause of irreversible blindness, is a complex disease, with differential presentation as well as ethnic and geographic disparities. The multifactorial nature of glaucoma complicates the study of genetics and genetic involvement in the disease process. This review synthesizes the current literature on glaucoma and genetics, as stratified by glaucoma subtype and ethnicity. Primary open-angle glaucoma (POAG) is the most common cause of glaucoma worldwide, with the only treatable risk factor (RF) being the reduction of intraocular pressure (IOP). Genes associated with elevated IOP or POAG risk include: ABCA1, AFAP1, ARHGEF12, ATXN2, CAV1, CDKN2B-AS1, FOXC1, GAS7, GMDS, SIX1/SIX6, TMCO1, and TXNRD2. However, there are variations in RF and genetic factors based on ethnic and geographic differences; it is clear that unified molecular pathways accounting for POAG pathogenesis remain uncertain, although inflammation and senescence likely play an important role. There are similar ethnic and geographic complexities in primary angle closure glaucoma (PACG), but several genes have been associated with this disorder, including MMP9, HGF, HSP70, MFRP, and eNOS. In exfoliation glaucoma (XFG), genes implicated include LOXL1, CACNA1A, POMP, TMEM136, AGPAT1, RBMS3, and SEMA6A. Despite tremendous progress, major gaps remain in resolving the genetic architecture for the various glaucoma subtypes across ancestries. Large scale carefully designed studies are required to advance understanding of genetic loci as RF in glaucoma pathophysiology and to improve diagnosis and treatment options.
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Carichino L, Harris A, Lapin S, Guidoboni G, Cassani S, De Silvestri A, Tinelli C, Milano G, Siesky B, Verticchio Vercellin AC. Waveform parameters of retrobulbar vessels in glaucoma patients with different demographics and disease severity. Eur J Ophthalmol 2020; 30:1019-1027. [DOI: 10.1177/1120672119848259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: To identify novel velocity waveform parameters of the ophthalmic artery and central retinal artery by computer-aided image processing of Doppler ultrasonography measurements, and to evaluate correlations between the waveform parameters and different demographics and disease severity of open-angle glaucoma patients. Methods: Thirty-six images of 36 open-angle glaucoma patients were considered. A semiautomated image processing code was used to detect the digitalized ophthalmic artery and central retinal artery velocity waveforms and to extract the waveform parameters. Concordance correlation coefficient, two-sample t-test, and Pearson’s correlation coefficient were used to test for similarities, differences, and associations among variables. Results: Female glaucoma patients showed a statistically higher ophthalmic artery normalized distance between ascending and descending limb (p = 0.004), hypertensive glaucoma patients a statistically higher ophthalmic artery peak systolic velocity time (p = 0.025), glaucoma patients with hyperlipidemia a statistically higher ophthalmic artery resistivity index (p = 0.023) and a statistically higher ophthalmic artery peak systolic velocity acceleration (p = 0.025), glaucoma patients with cardiovascular diseases a statistically lower central retinal artery normalized distance between ascending and descending limb of the wave (p = 0.033) and a statistically higher central retinal artery period (p = 0.028), and patients with different body mass index a statistically different central retinal artery normalized distance between ascending and descending limb of the wave (p = 0.016). Groups with different disease severity, classified following the Brusini glaucoma staging system 2, showed statistically different central retinal artery normalized distance between ascending and descending limb of the wave (p < 0.001) and central retinal artery period (p = 0.016). No statistical differences were found in regard to race, diabetes status, glaucoma family history, and smoking. Discussion: Ophthalmic artery and central retinal artery computer-aided analysis of velocity waveforms could identify novel waveform parameters capable of differentiating among different demographics and disease severity of open-angle glaucoma patients.
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Affiliation(s)
- Lucia Carichino
- Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Alon Harris
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sergey Lapin
- Department of Mathematics and Statistics, Washington State University, Pullman, WA, USA
| | - Giovanna Guidoboni
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
| | - Simone Cassani
- Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometric Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, Pavia, Italy
| | - Carmine Tinelli
- Clinical Epidemiology and Biometric Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, Pavia, Italy
| | - Giovanni Milano
- University Eye Clinic, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, Pavia, Italy
| | - Brent Siesky
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
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Pseudoexfoliative Glaucoma, Endothelial Dysfunction, and Arterial Stiffness: The Role of Circulating Apoptotic Endothelial Microparticles. J Glaucoma 2020; 28:749-755. [PMID: 31188231 DOI: 10.1097/ijg.0000000000001303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PRéCIS:: Pseudoexfoliative glaucoma (PExG) patients present with not only endothelial dysfunction and arterial stiffness but also with a specific profile of circulating apoptotic endothelial microparticles which may be owing to the accumulation of pseudoexfoliative material in vessels walls. PURPOSE PExG is characterized by the deposition of pseudoexfoliative material in several tissues and organs including in the cardiovascular system. This study aimed to evaluate the vascular endothelial function, arterial stiffness, inflammatory status, and circulating microparticle (MP) levels in PExG patients compared with those in primary open-angle glaucoma (POAG) patients and control subjects. METHODS Vascular endothelial function was evaluated by flow-mediated dilation. Pulse wave velocity and augmentation index were measured as indices of aortic stiffness and arterial wave reflections, respectively. Growth-differentiation factor-15 and intercellular adhesion molecule1 levels were measured to evaluate the systemic inflammatory status. Circulating MPs that constitute an emerging marker of vascular endothelial dysfunction and platelet activation were isolated and analyzed by flow cytometry. RESULTS There was a stepwise impairment from the control to the POAG patients and PExG subjects in the flow-mediated dilation (8.21%±2.94% vs. 7.56%±3.12% vs. 5.79±3.13, P=0.005), pulse wave velocity (8.14±1.79 vs. 9.21±2.27 vs. 9.95±3.28 m/s, P=0.007), augmentation index (24.71%±7.84% vs. 26.78%±7.21% vs. 29.96%±7.58%, P=0.02), and growth-differentiation factor-15 (P=0.001) and intercellular adhesion molecule1 levels (P=0.08). PExG patients expressed greater levels of total circulating MPs (Annexin V+) (P=0.004) and endothelial-derived MPs (CD144+) (P<0.001) compared with POAG and control subjects. CONCLUSIONS PExG patients with an accumulation of pseudoexfoliative microfibrillar material presented with vascular endothelial dysfunction and arterial wall impairment associated with the levels of circulating proinflammatory molecules and circulating apoptotic endothelial MPs. These findings highlight the underlying systemic pathophysiological mechanisms associated with the progress of the pseudoexfoliative syndrome.
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Central Corneal Thickness Variances Among Different Asian Ethnicities in Glaucoma and Nonglaucoma Patients. J Glaucoma 2020; 28:223-230. [PMID: 30624387 DOI: 10.1097/ijg.0000000000001180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the central corneal thickness (CCT) between different ethnicities and particularly Asian subethnic groups that may contribute to the different glaucoma diagnoses using the optical low-coherence reflectometry technique. METHODS A retrospective study of 6 years including 1512 eyes of 929 patients of the Beckman vision center, University of California, San Francisco from 2011 to 2017 had their biometric parameters, including CCT, measured with the Lenstar. Patients were categorized into African Americans, Caucasians, Hispanics, Pacific Islanders, and Asians. Asians were further subcategorized into Chinese, Vietnamese, Koreans, Filipinos, and Japanese. RESULTS Among 1356 patients who had their CCT measured by Lenstar from 2011 to 2017, 1512 eyes of 929 patients were included. The study population included 462 Caucasians (52.96%), 60 African Americans (6.46%), 92 Hispanics (9.9%), 32 Pacific Islanders (3.44%), 130 Chinese (13.99%), 52 Filipinos (5.6%), 37 Vietnamese (3.98%), 34 Koreans (3.66%), and 30 Japanese (3.23%). African Americans had the thinnest CCT with a mean of 518.62±40.3 followed by Asians with a mean of 539.29±34.1. Among the Asian study sample, the Chinese had the thinnest CCT with a mean of 537.66±32.5. CCT was adjusted for age, sex, glaucoma diagnosis, diabetes status, and prostaglandin analogs use for >12 months. CONCLUSIONS Optical low-coherence reflectometry is a widely used technology, which can measure CCT. Our study confirms that African Americans have the thinnest corneas followed by Asians. In the latter group, relatively thin CCT may partly explain their high rates of normal-tension glaucoma.
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Harris A, Guidoboni G, Siesky B, Mathew S, Verticchio Vercellin AC, Rowe L, Arciero J. Ocular blood flow as a clinical observation: Value, limitations and data analysis. Prog Retin Eye Res 2020; 78:100841. [PMID: 31987983 PMCID: PMC8908549 DOI: 10.1016/j.preteyeres.2020.100841] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 12/24/2022]
Abstract
Alterations in ocular blood flow have been identified as important risk factors for the onset and progression of numerous diseases of the eye. In particular, several population-based and longitudinal-based studies have provided compelling evidence of hemodynamic biomarkers as independent risk factors for ocular disease throughout several different geographic regions. Despite this evidence, the relative contribution of blood flow to ocular physiology and pathology in synergy with other risk factors and comorbidities (e.g., age, gender, race, diabetes and hypertension) remains uncertain. There is currently no gold standard for assessing all relevant vascular beds in the eye, and the heterogeneous vascular biomarkers derived from multiple ocular imaging technologies are non-interchangeable and difficult to interpret as a whole. As a result of these disease complexities and imaging limitations, standard statistical methods often yield inconsistent results across studies and are unable to quantify or explain a patient's overall risk for ocular disease. Combining mathematical modeling with artificial intelligence holds great promise for advancing data analysis in ophthalmology and enabling individualized risk assessment from diverse, multi-input clinical and demographic biomarkers. Mechanism-driven mathematical modeling makes virtual laboratories available to investigate pathogenic mechanisms, advance diagnostic ability and improve disease management. Artificial intelligence provides a novel method for utilizing a vast amount of data from a wide range of patient types to diagnose and monitor ocular disease. This article reviews the state of the art and major unanswered questions related to ocular vascular anatomy and physiology, ocular imaging techniques, clinical findings in glaucoma and other eye diseases, and mechanistic modeling predictions, while laying a path for integrating clinical observations with mathematical models and artificial intelligence. Viable alternatives for integrated data analysis are proposed that aim to overcome the limitations of standard statistical approaches and enable individually tailored precision medicine in ophthalmology.
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Affiliation(s)
- Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | | | - Brent Siesky
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Sunu Mathew
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alice C Verticchio Vercellin
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA; University of Pavia, Pavia, Italy; IRCCS - Fondazione Bietti, Rome, Italy
| | - Lucas Rowe
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Julia Arciero
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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Kim JM, Lee MY, Kim JW, Lee J, Kim HJ, Cha SC, Kim NR. Open-angle Glaucoma and Sensorineural Hearing Impairment in the Korean Population. Curr Eye Res 2020; 45:992-999. [PMID: 31935130 DOI: 10.1080/02713683.2020.1712424] [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: 10/25/2022]
Abstract
PURPOSE This study identifies the prevalence and risk factors of sensorineural hearing loss and primary open-angle glaucoma (POAG). MATERIALS AND METHODS Patients aged 19 years or older who had undergone both ophthalmologic examination and audiometry as part of the Korea National Health and Nutrition Examination Survey V (2010-2012) were analyzed. Hearing loss was defined as the pure-tone average over 40 decibels based on the automatic hearing test to determine the threshold of airway hearing for each frequency. We investigated the prevalence of glaucoma and hearing loss when they occurred alone or simultaneously. The risk factors for concurrent glaucoma and hearing loss were examined. RESULT Among the participants, 6.6% had hearing loss alone, 2.3% had glaucoma alone, and 0.5% had both glaucoma and hearing loss. The weighted prevalence of glaucoma in patients with hearing loss was 7.5%; however, the weighted prevalence of glaucoma was 3.2% among patients without hearing loss, with a significant difference (P < .001). Multivariable logistic regression analysis revealed that the risk factors associated with concurrent glaucoma and hearing loss were age (3.786 times per 10 years, P < .001) and triglyceride level (1.002 times per 1 mg/dL, P = .028). CONCLUSION Sensorineural hearing loss and POAG are relevant. If hearing impairment and visual impairment occur together, the quality of life of the patient is worsened and the social burden is greater. Therefore, care should be taken when treating elderly patients with glaucoma.
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Affiliation(s)
- Joon Mo Kim
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Mi Yeon Lee
- Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Jong Woo Kim
- Department of Ophthalmology and Inha Vision Science Laboratory, Inha University School of Medicine , Incheon, Korea
| | - Jungmin Lee
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Hyun Ji Kim
- Department of Otorhinolaryngology, Inha University School of Medicine , Incheon, Korea
| | - Soon Cheol Cha
- Department of Ophthalmology, Yeungnam University College of Medicine , Daegu, Korea
| | - Na Rae Kim
- Department of Ophthalmology and Inha Vision Science Laboratory, Inha University School of Medicine , Incheon, Korea
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Khamar MB, Sthapak AP, Vijayevarshcini D, Patel PM. Association between hypertriglyceridemia and open angle glaucoma: A case report. Indian J Ophthalmol 2019; 67:1202-1204. [PMID: 31238465 PMCID: PMC6611287 DOI: 10.4103/ijo.ijo_1618_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Hypertriglyseridemia is a metabolic disorder that can cause vascular dysfucntion and be causally associated with glaucoma. Herein we present the case of a 16-year-old boy with hypertriglyseridemia with open-angle glaucoma.
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Affiliation(s)
- Mayuri Bakulesh Khamar
- Department of Glaucoma, Raghudeep Eye Hospital, Gurukul Road, Memnagar, Ahmedabad, India
| | - Arpita P Sthapak
- Department of Glaucoma, Raghudeep Eye Hospital, Gurukul Road, Memnagar, Ahmedabad, India
| | - D Vijayevarshcini
- Department of Glaucoma, Raghudeep Eye Hospital, Gurukul Road, Memnagar, Ahmedabad, India
| | - Priyanka M Patel
- Department of Glaucoma, Raghudeep Eye Hospital, Gurukul Road, Memnagar, Ahmedabad, India
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Chou CC, Hsu MY, Lin CH, Lin CC, Wang CY, Shen YC, Wang IJ. Risk of developing open-angle glaucoma in patients with carotid artery stenosis: A nationwide cohort study. PLoS One 2018; 13:e0194533. [PMID: 29684030 PMCID: PMC5912741 DOI: 10.1371/journal.pone.0194533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/05/2018] [Indexed: 11/19/2022] Open
Abstract
Whether carotid artery stenosis (CAS) is an independent risk factor for open-angle glaucoma remains unclear. In this study, we investigated the association between CAS and the development of open-angle glaucoma in the Taiwanese population-based cohort derived from a longitudinal database containing claims data from the Taiwan National Health Insurance (NHI) program; this study enrolled 2093 patients with CAS and 8372 patients without CAS matched by age and sex from 1999 to 2010. Diagnoses of open-angle glaucoma (OAG) were identified during a follow-up period lasting through December 31, 2013. A Cox proportional hazards model was applied to evaluate the hazard ratio (HR) for OAG in the CAS cohort compared with the matched cohort. We found that the HR for open-angle glaucoma in the CAS cohort compared with the matched cohort. The adjusted HR for OAG in the CAS cohort was 1.50 (95% confidence interval, 1.11-2.02, P = .008). The Kaplan-Meier analysis revealed that the CAS cohort had a higher cumulative incidence of OAG than did the matched cohort during the follow-up period (log-rank test, P < .001). We concluded that CAS is a significantly independent risk factor for the development of OAG. Our finding is clinically important for the aging population, which has an increasing prevalence of CAS.
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Affiliation(s)
- Chien-Chih Chou
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min-Yen Hsu
- Department of Ophthalmology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Che-Chen Lin
- Healthcare Service Research Center (HSRC), Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chun-Yuan Wang
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ying-Cheng Shen
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - I-Jong Wang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail:
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Asokan P, Mitra RN, Periasamy R, Han Z, Borrás T. A Naturally Fluorescent Mgp Transgenic Mouse for Angiogenesis and Glaucoma Longitudinal Studies. Invest Ophthalmol Vis Sci 2018; 59:746-756. [PMID: 29392320 PMCID: PMC5795899 DOI: 10.1167/iovs.17-22992] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/02/2018] [Indexed: 12/21/2022] Open
Abstract
Purpose Our goal was to generate and characterize a new mouse model in which only angiogenesis- and glaucoma-relevant tissues would be naturally fluorescent. The Matrix Gla (MGP) gene is highly expressed in vascular smooth muscle cells (VSMC) and trabecular meshwork (TM). We sought to direct our Mgp-Cre.KI mouse recombinase to VSMC/TM cells to produce their longitudinal fluorescent profiles. Methods Homozygous Mgp-Cre.KI mice were crossed with Ai9 homozygous reporter mice harboring a loxP-flanked STOP cassette preventing transcription of a DsRed fluorescent protein (tdTomato). The F1 double-heterozygous (Mgp-tdTomato) was examined by direct fluorescence, whole mount, histology, and fundus photography. Custom-made filters had 554/23 emission and 609/54 exciter nanometer wavelengths. Proof of concept of the model's usefulness was conducted by inducing guided imaging laser burns. Evaluation of a vessel's leakage and proliferation was followed by noninvasive angiography. Results The Mgp-tdTomato mouse was viable, fertile, with normal IOP and ERG. Its phenotype exhibited red paws and snout (cartilage expression), which precluded genotyping. A fluorescent red ring was seen at the limbus and confirmed to be TM expression by histology. The entire retinal vasculature was red fluorescent (VSMC) and directly visualized by fundus photography. Laser burns on the Mgp-tdTomato allowed separation of leakiness and neovascularization evaluation parameters. Conclusions The availability of a transgenic mouse naturally fluorescent in glaucoma-relevant tissues and retinal vasculature brings the unique opportunity to study a wide spectrum of single and combined glaucomatous conditions in vivo. Moreover, the Mgp-tdTomato mouse provides a new tool to study mechanisms and therapeutics of retinal angiogenesis longitudinally.
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Affiliation(s)
- Priyadarsini Asokan
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
| | - Rajendra N. Mitra
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
| | - Ramesh Periasamy
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
| | - Zongchao Han
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Teresa Borrás
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
- Gene Therapy Center, University of North Carolina, Chapel Hill, North Carolina, United States
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Primary open-angle glaucoma in patients of Middle Eastern descent. Saudi J Ophthalmol 2017; 31:209-210. [PMID: 29234220 PMCID: PMC5717505 DOI: 10.1016/j.sjopt.2017.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 11/06/2017] [Indexed: 12/02/2022] Open
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Gross JC, Harris A, Siesky BA, Sacco R, Shah A, Guidoboni G. Mathematical modeling for novel treatment approaches to open-angle glaucoma. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1383896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Josh C Gross
- Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alon Harris
- Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brent A Siesky
- Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Riccardo Sacco
- Dipartimento di Matematica, Politecnico di Milano, Milano, Italy
| | - Aaditya Shah
- Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Giovanna Guidoboni
- Department of Mathematical Sciences, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
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Pertl L, Mossböck G, Wedrich A, Weger M, Königsbrügge O, Silbernagel G, Posch F. Triglycerides and Open Angle Glaucoma - A Meta-analysis with meta-regression. Sci Rep 2017; 7:7829. [PMID: 28798341 PMCID: PMC5552857 DOI: 10.1038/s41598-017-08295-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/27/2017] [Indexed: 12/16/2022] Open
Abstract
Although intraocular pressure is the main the risk factor for the development of glaucoma, other risk factors such as vascular dysfunction might play an additional pathogenic role. Hypertriglyceridemia, which may lead to vascular dysfunction, has been implicated in the development of glaucoma. The objective of this meta-analysis was to investigate the association of triglyceride levels with the risk of glaucoma in case-control studies. Seventeen case-control studies were included investigating the difference in triglyceride levels in patients with glaucoma (N = 1 391) compared to subjects without glaucoma (N = 25 575). In random effects meta-analysis, the pooled mean triglyceride level across all studies and patients with and without glaucoma was 132.9 mg/dL (95%CI: 124.0-141.7). Patients with glaucoma had significantly higher mean triglyceride levels than patients without glaucoma (absolute difference = 14.2 mg/dL, 95%CI: 5.8-22.5, p < 0.0001). A considerable amount of heterogeneity of included studies was observed (I2 = 66.2%, heterogeneity χ2 = 47.4 on 16 degrees of freedom, p < 0.0001). In conclusion, this meta-analysis of case-control studies found that patients with glaucoma had higher mean triglyceride levels than patients without glaucoma. This finding is consistent with the concept that hypertriglyceridemia represents an additional risk factor for glaucoma. Whether this association is causal and/or might be modified by glaucoma medications remains to be investigated.
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Affiliation(s)
- Laura Pertl
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036, Graz, Austria.
| | - Georg Mossböck
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Andreas Wedrich
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Martin Weger
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Oliver Königsbrügge
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Günther Silbernagel
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Florian Posch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
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Pillunat KR, Spoerl E, Terai N, Pillunat LE. Effect of selective laser trabeculoplasty on ocular haemodynamics in primary open-angle glaucoma. Acta Ophthalmol 2017; 95:374-377. [PMID: 28139066 DOI: 10.1111/aos.13360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 11/07/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE Selective laser trabeculoplasty (SLT) is known to reduce intraocular pressure (IOP) effectively. The aim of this study, however, was to evaluate the effect of SLT on ocular haemodynamics. METHODS A total of 69 eyes of 69 patients (age 67.8 ± 9.9 years) with already treated primary open-angle glaucoma who were assigned for SLT for further IOP reduction were consecutively enrolled in this prospective interventional case series. Intraocular pressure, the ocular pulse amplitude (OPA), ocular pulse volume (OPV) and pulsatile ocular blood flow (pOBF) were assessed with the Ocular Blood Flow Analyzer prior to and 3 months after SLT. RESULTS Intraocular pressure was statistically significantly reduced from 16.0 ± 5.4 mmHg to 12.8 ± 4.0 mmHg (p = 0.001). The OPA did not change (p = 0.783) after IOP reduction following SLT. OPV and pOBF increased statistically significantly. OPV increased from 7.33 ± 3.05 to 8.59 ± 3.35 μl (17.2%; p = 0.001) and pOBF from 17.11 ± 5.42 to 19.74 ± 6.59 μl/s (15.4%; p = 0.002). CONCLUSION Selective laser trabeculoplasty probably does not induce any pharmacological changes effecting systemic blood pressure or ocular blood flow as topical IOP-lowering medication might do, nor does it change biomechanical properties of the eye as surgery could. Therefore, an increase in ocular blood flow following SLT can only be explained by the reduction in IOP and might be a sign of dysfunctional autoregulation in glaucoma patients.
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Affiliation(s)
| | - Eberhard Spoerl
- Department of Ophthalmology; University of Dresden; Dresden Germany
| | - Naim Terai
- Department of Ophthalmology; University of Dresden; Dresden Germany
| | - Lutz E. Pillunat
- Department of Ophthalmology; University of Dresden; Dresden Germany
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Borrás T. A single gene connects stiffness in glaucoma and the vascular system. Exp Eye Res 2017; 158:13-22. [PMID: 27593913 PMCID: PMC6067113 DOI: 10.1016/j.exer.2016.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/26/2016] [Accepted: 08/31/2016] [Indexed: 12/13/2022]
Abstract
Arterial calcification results in arterial stiffness and higher systolic blood pressure. Arterial calcification is prevented by the high expression of the Matrix-Gla gene (MGP) in the vascular smooth muscle cells (VSMC) of the arteries' tunica media. Originally, MGP, a gene highly expressed in cartilage and VSMC, was found to be one of the top expressed genes in the trabecular meshwork. The creation of an Mgp-lacZ Knock-In mouse and the use of mouse genetics revealed that in the eye, Mgp's abundant expression is localized and restricted to glaucoma-associated tissues from the anterior and posterior segments. In particular, it is specifically expressed in the regions of the trabecular meshwork and of the peripapillary sclera that surrounds the optic nerve. Because stiffness in these tissues would significantly alter outflow facility and biomechanical scleral stress in the optic nerve head (ONH), we propose MGP as a strong candidate for the regulation of stiffness in glaucoma. MGP further illustrates the presence of a common function affecting key glaucomatous parameters in the front and back of the eye, and thus offers the possibility for a sole therapeutic target for the disease.
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Affiliation(s)
- Teresa Borrás
- Department of Ophthalmology, University of North Carolina School of Medicine, 4109C Neuroscience Research Building CB 7041, 105 Mason Farm Road, Chapel Hill, NC 27599-7041, USA.
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Abegão Pinto L, Willekens K, Van Keer K, Shibesh A, Molenberghs G, Vandewalle E, Stalmans I. Ocular blood flow in glaucoma - the Leuven Eye Study. Acta Ophthalmol 2016; 94:592-8. [PMID: 26895610 DOI: 10.1111/aos.12962] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/24/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Elevated intra-ocular pressure (IOP) has been identified as a major risk factor for glaucoma. Additionally, extensive literature depicts a vascular dysfunction to exist in these patients. However, a large ocular blood flow-oriented trial to integrate these findings in the clinical setting is lacking. This study would likely help to identify which of these vascular data can be used as a clinical tool for screening and disease stratification. METHOD Prospective, cross-sectional, case-control hospital-based study. Patients with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), ocular hypertension (OHT), glaucoma suspects and healthy volunteers were recruited. In addition to a comprehensive ophthalmological examination, a vascular-oriented questionnaire was completed and ocular blood flow assessment (colour Doppler imaging of retrobulbar vessels, retinal oximetry, dynamic contour tonometry, optical coherent tomography enhanced-depth imaging of the choroid) were performed. Statistical analysis was based on multiple imputation to account for missingness. RESULTS A total of 614 subjects (291 males) were recruited between March and December 2013 (POAG: 214, NTG: 192; OHT: 27; glaucoma suspect: 41; healthy controls: 140). Glaucoma groups (NTG and POAG) were age and gender matched with the control group (p > 0.05). Glaucoma groups were paired in terms of functional and structural parameters (p > 0.08). Mean ocular perfusion pressure was higher in the glaucoma groups than in controls (p < 0.001). Glaucoma groups had lower retrobulbar velocities, higher retinal venous saturation and choroidal thickness asymmetries when compared to the healthy group, in line with the current literature. CONCLUSIONS The Leuven Eye Study stands as one of the largest clinical trials on ocular blood flow in glaucoma. The creation of this vast database may help integrate the vascular aspects of glaucoma into the clinical practice of glaucoma.
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Affiliation(s)
- Luís Abegão Pinto
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
- Visual Sciences Study Center; Faculty of Medicine of Lisbon University; Lisbon Portugal
| | - Koen Willekens
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - Karel Van Keer
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | | | - Geert Molenberghs
- I-BioStat; KU Leuven; Leuven Belgium
- I-BioStat; Hasselt University; Hasselt Belgium
| | - Evelien Vandewalle
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - Ingeborg Stalmans
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
- Department of Ophthalmology Neurosciences; Laboratory of Ophthalmology; KU Leuven; Leuven Belgium
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Abstract
Open-angle glaucoma (OAG) is characterized by optic nerve fiber atrophy and deterioration of the visual field, corresponding to damage to the optic nerve head. Intraocular pressure (IOP) is currently the only evidence-based, treatable risk factor for OAG. However, normal-tension glaucoma, the most common type of OAG in Asia, is a type of glaucoma with an unclear pathogenesis. Glaucoma is suspected to be a multifactorial disease with IOP-dependent and IOP-independent risk factors, including decreased ocular blood flow (OBF), oxidative stress, decreased axoplasmic flow, and genetic background. A number of epidemiological studies have generated strong evidence that OBF may be an especially important risk factor for the progression of glaucoma. Recent innovations in laser speckle flowgraphy and optical coherence tomography-based angiography have allowed us to noninvasively monitor changes in the microcirculation of the optic nerve head with high reproducibility. Laser speckle flowgraphy-derived measurement parameters include mean blur rate and pulse wave form parameters, whereas the main optical coherence tomography angiography-derived parameter is the vessel index. Decreases in these parameters are associated with the severity of glaucomatous damage, and changes are detectible even in the earliest, preperimetric stage of glaucoma. In the future, OBF analysis may improve significantly because of continuing progress in the development of the relevant instruments. This review will summarize possible connections between systemic and OBF abnormalities and OAG, describe the scientific rationale for these connections, and discuss their potential implications. Thus, this review will summarize the role of OBF in glaucoma pathogenesis and discuss the wide range of IOP-independent risk factors.
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Affiliation(s)
- Toru Nakazawa
- From the Department of Ophthalmology, Retinal Disease Control, Ophthalmology, and Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Pillunat KR, Spoerl E, Jasper C, Furashova O, Hermann C, Borrmann A, Passauer J, Middeke M, Pillunat LE. Nocturnal blood pressure in primary open-angle glaucoma. Acta Ophthalmol 2015; 93:e621-6. [PMID: 25913492 DOI: 10.1111/aos.12740] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/18/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the nocturnal blood pressure (BP) dipping-pattern in patients with manifest primary open-angle glaucoma (POAG) and to find possible associations with the severity of visual field damage. METHODS A number of 314 patients suffering from POAG were consecutively enrolled in this cross-sectional hospital-based study. Each patient had diurnal intraocular pressure (IOP) measurements, 24-hr BP monitoring and computerized perimetry with the Humphrey 30-2 sita Standard program. Inclusion criteria were a mean IOP of less than 15 mmHg with fluctuations of less than 5 mmHg and a visual acuity of at least 20/40. One eye was randomly selected. Based on the night-day BP ratio, a mean arterial nocturnal BP drop of less than 10% was considered as non-dipping, between 10% and 20% as physiological dipping and of more than 20% as over-dipping. RESULTS Glaucoma patients with daytime systemic normotension on the average had more visual field loss in the over-dipper group (MD = - 16.6 dB, IQR = -18.9 to -2.7 dB) than glaucoma patients with daytime systemic hypertension, who had less visual field defects in the over-dipper group (MD = -3.9 dB, IQR = -6.2 to -1.9 dB) (p = 0.004). This result was also found taking age, glaucoma duration, visual acuity, gender, systemic and topical medication as covariates into account. CONCLUSIONS To judge the nocturnal BP situation of an individual patient, it is important to do this in relation to the daytime BP level. Twenty-four-hour BP evaluation might be important for all patients with POAG, as nocturnal BP could be a modifiable risk factor for glaucoma severity and progression.
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Affiliation(s)
- Karin R. Pillunat
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Eberhard Spoerl
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Carolin Jasper
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Olga Furashova
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Cosima Hermann
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Anne Borrmann
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Jens Passauer
- Department of Internal Medicine; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Martin Middeke
- Hypertension Center Munich; Excellence Centre of the European Society of Hypertension; Munich Germany
| | - Lutz E. Pillunat
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
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The Association between Primary Open-Angle Glaucoma and Blood Pressure: Two Aspects of Hypertension and Hypotension. BIOMED RESEARCH INTERNATIONAL 2015; 2015:827516. [PMID: 26557702 PMCID: PMC4628713 DOI: 10.1155/2015/827516] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/31/2015] [Indexed: 11/18/2022]
Abstract
Glaucoma is the second leading cause of blindness worldwide. Although the mechanism of the development of primary open-angle glaucoma (POAG) is not fully understood, elevated intraocular pressure (IOP) is considered the most important risk factor. Several vascular factors have also been identified as risk factors and can lead to hypoperfusion of the optic nerve head and thus may play an important role in the pathogenesis and progression of POAG. The results of the present study suggest that both high and low blood pressure (BP) are associated with an increased risk of POAG based on a comprehensive literature review. Elevated BP is associated with elevated IOP, leading to increased risk of glaucoma, but excessive BP lowering in glaucoma patients may cause a drop in ocular perfusion pressure (OPP) and subsequent ischemic injury. The relationship between IOP, OPP, and BP suggests that the relationship between BP and glaucoma progression is U-shaped.
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