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Chauhan MZ, Elhusseiny AM, Kishor KS, Sanvicente CT, Ali AA, Sallam AB, Bhattacharya SK, Uwaydat SH. Association of Primary Open-Angle Glaucoma with Diabetic Retinopathy among Patients with Type 1 and Type 2 Diabetes: A Large Global Database Study. Ophthalmology 2024; 131:827-835. [PMID: 38215989 DOI: 10.1016/j.ophtha.2024.01.016] [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: 08/12/2023] [Revised: 12/30/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024] Open
Abstract
PURPOSE To assess the correlation between primary open-angle glaucoma (POAG) and the risk of developing diabetic retinopathy (DR) in patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). DESIGN A retrospective cohort study leveraging the global patient database of TriNetX Research Network. PARTICIPANTS The study included 44 359 patients with diabetes mellitus (DM) with POAG and 4 393 300 patients with DM without any glaucoma ≥ 18 years of age. Propensity score matching harmonized the cohorts to 39 680 patients each, covering diagnoses from January 1, 2005, to January 1, 2023. METHODS We analyzed data using specific International Classification of Diseases, 10th Revision (ICD-10) codes for DM and glaucoma. We matched the cohorts using propensity score matching, adjusting for age, sex, race/ethnicity, blood markers, relevant medical history, and ophthalmic service use. MAIN OUTCOME MEASURES The primary outcome was the first-time occurrence of DR, including nonproliferative DR (NPDR) and proliferative DR (PDR), in patients with DM with and without glaucoma at 1-, 5-, and 10-year intervals from their individual index dates. RESULTS At 10 years, patients with T1DM with POAG exhibited a heightened risk for any DR (adjusted risk ratios [RRs], 4.12; 95% confidence interval [CI], 3.05-5.57, P < 0.0001) and PDR (RR, 7.02; 95% CI, 3.62-13.61, P < 0.0001). Patients with T2DM and POAG also faced an increased 10-year risk for any DR (RR, 2.47; 95% CI, 2.28-2.68, P < 0.0001) and PDR (RR, 3.82; 95% CI, 3.09-4.70, P < 0.0001). The combined association of POAG on DR risk in those with T1DM and T2DM at 10 years was found to be significantly higher among patients with POAG (5.45%) compared with those without glaucoma (2.12%) (adjusted hazard ratio [aHR], 2.33; 95% CI, 2.14-2.53). The cumulative incidence of DR was significantly higher in the POAG group compared with nonglaucoma counterparts after a decade (log-rank P < 0.001). CONCLUSIONS Our findings underscore a substantial association between POAG and DR development in both T1DM and T2DM patients, emphasizing the need for vigilant screening and comprehensive management in glaucomatous patients with DM to mitigate the risk of DR. Future research should delve into elucidating the causal mechanisms driving these observed associations. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Muhammad Z Chauhan
- Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Abdelrahman M Elhusseiny
- Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Krishna S Kishor
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, Florida
| | - Carina T Sanvicente
- Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Arsalan A Ali
- Anne Burnett Marion School of Medicine, Fort Worth, Texas
| | - Ahmed B Sallam
- Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sanjoy K Bhattacharya
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Sami H Uwaydat
- Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
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Wang J, Sadlak N, Fiorello MG, Desai M, Yi J. Macular Oxygen Saturation in Glaucoma Using Retinal Oximetry of Visible Light Optical Coherence Tomography. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.20.23300300. [PMID: 38196641 PMCID: PMC10775404 DOI: 10.1101/2023.12.20.23300300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Purpose Oxygen saturation (sO2) plays a critical role in retinal pathophysiology, especially at the macula, which undergoes significant energy consumption. While macular damage has been suggested to be involved in early-stage glaucoma, there has been no report to date on non-invasive macular sO2 in glaucoma. Therefore, we conducted this study to compare macular sO2 associated with other clinical measurements between normal and glaucoma subjects and evaluate whether there are significant differences. Method This is a cross-sectional study. We used visible light optical coherence tomography (VIS-OCT) for retinal oximetry in perifoveal vessels. The subjects from groups of normal, suspect/pre-perimetric glaucoma (GS/PPG) and perimetric glaucoma (PG) were scanned using VIS-OCT in the macular region with a sampling density of 512×256 in an area of 5×5 mm2. 48 eyes (16 normal, 17 GS/PPG and 15 PG) were included for the analysis. For each eye, we measured the sO2 of arterioles (AsO2), venules (VsO2), and calculated the difference between arterioles and venules (A-V sO2=AsO2-VsO2), oxygen extraction (OE=(AsO2-VsO2)/AsO2 ×100%). Additionally, we included Zeiss Cirrus OCT scans and 24-2 visual field test (VFT) for clinical benchmark. One-way ANOVA was used to compare the differences among the three groups. Spearman correlation tests were used for correlation sO2 markers to standard metrics including the thickness of ganglion cell layer and inner plexiform layer (GCL+IPL), circumpapillary retinal nerve fiber layer (cpRNFL) and mean deviation (MD) in VFT. Result Significant differences were found among three groups for all VIS-OCT, Zeiss OCT, and VFT variables. Macular AsO2, A-V sO2, OE decreased, and VsO2 increased along with severity. Macular AsO2 and A-V sO2 were statistically correlated with GCL+IPL and cpRNFL in all eyes, as well as only PG eyes. Within PG eyes, the correlation between AsO2 and GCL+IPL is dominant in more damaged lower hemifield. Conclusion The GS/PPG and PG subjects had significantly higher macular VsO2, lower A-V sO2 and OE indicating less oxygen consumption. The sO2 measured by retinal oximetry of VIS-OCT can be a potential metric for the early diagnosis of glaucoma.
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Affiliation(s)
- Jingyu Wang
- Department of Ophthalmology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Natalie Sadlak
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
| | | | - Manishi Desai
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
| | - Ji Yi
- Department of Ophthalmology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
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3
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Ramm L, Herber R, Lorenz G, Jasper CS, Pillunat LE, Pillunat KR. Evaluation of corneal biomechanical properties using the ocular response analyzer and the dynamic Scheimpflug-Analyzer Corvis ST in high pressure and normal pressure open-angle glaucoma patients. PLoS One 2023; 18:e0281017. [PMID: 36701409 PMCID: PMC9879466 DOI: 10.1371/journal.pone.0281017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/12/2023] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To characterize differences in corneal biomechanics in high (HPG) and normal pressure (NPG) primary open-angle glaucoma, and its association to disease severity. METHODS Corneal biomechanical properties were measured using the Ocular Response Analyzer (ORA) and the dynamic Scheimpflug-Analyzer Corvis ST (CST). Disease severity was functionally assessed by automated perimetry (Humphrey field analyzer) and structurally with the Heidelberg Retina Tomograph. To avoid a possible falsification by intraocular pressure, central corneal thickness and age, which strongly influence ORA and CST measurements, group matching was performed. Linear mixed models and generalized estimating equations were used to consider inter-eye correlation. RESULTS Following group matching, 60 eyes of 38 HPG and 103 eyes of 60 NPG patients were included. ORA measurement revealed a higher CRF in HPG than in NPG (P < 0.001). Additionally, the CST parameter integrated radius (P < 0.001) was significantly different between HPG and NPG. The parameter SSI (P < 0.001) representing corneal stiffness was higher in HPG than in NPG. Furthermore, regression analysis revealed associations between biomechanical parameters and indicators of disease severity. In HPG, SSI correlated to RNFL thickness. In NPG, dependencies between biomechanical readings and rim area, MD, and PSD were shown. CONCLUSION Significant differences in corneal biomechanical properties were detectable between HPG and NPG patients which might indicate different pathophysiological mechanisms underlying in both entities. Moreover, biomechanical parameters correlated to functional and structural indices of diseases severity. A reduced corneal deformation measured by dynamic methods was associated to advanced glaucomatous damage.
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Affiliation(s)
- Lisa Ramm
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Robert Herber
- Faculty of Medicine Carl Gustav Carus, Department of Ophthalmology, TU Dresden, Dresden, Germany
- * E-mail:
| | - Georg Lorenz
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Carolin S. Jasper
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Lutz E. Pillunat
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Karin R. Pillunat
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
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Al Zoubi H, Riemer T, Simon R, Vilser W, Hasan S, Meller D, Augsten R, Hammer M. Optic disc blood perfusion and oxygenation in glaucoma. Graefes Arch Clin Exp Ophthalmol 2022; 260:3587-3595. [PMID: 35666297 PMCID: PMC9581879 DOI: 10.1007/s00417-022-05722-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/29/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To investigate the haemoglobin concentration and oxygenation in the optic disc in glaucoma patients vs. controls. Methods Thirty-one eyes of primary open angle glaucoma patients (mean age: 64.9 ± 2.1 years) and 31 eyes of 31 healthy controls (65.5 ± 2.0 years) were included. Perimetry, optical coherence tomography (OCT), and OCT angiography were performed. Multispectral imaging was used to record the optic disc reflectance at wavelengths 522 nm, 548 nm, 555 nm, 586 nm, and 610 nm, and haemoglobin concentration and oxygenation (SO2) were calculated from these measures. This was done in the rest and under stimulation of neuronal activity by flicker light. Results The haemoglobin concentration was significantly lower (p < 0.001) in the rim (40.0 ± 6.3) and the excavation (35.7 ± 8.0) of the glaucoma patients’ discs than in controls (45.7 ± 7.5). SO2 was not different in general, but lower in a subgroup of 18 glaucoma patients with ischaemic disc rims than in non-ischaemic ones (median 26.8%, interquartile range (IQR): 29.5% vs. 51.9%, IQR 32.0%, p = 0.02) as well as in controls (41.0%, IQR 30.6%, p = 0.01). Flicker light stimulation significantly increased the haemoglobin concentration in the controls (+ 1.3 ± 3.6, p = 0.048) as well as in the rim of glaucoma discs (+ 2.6 ± 5.0, p = 0.006) and SO2 in the controls only (+ 15.4 ± 23.6%, p = 0.001). The haemoglobin concentration was significantly correlated with the perimetric mean defect, retinal nerve fibre layer (RNFL) thickness and para-papillary perfusion density. Conclusions The optic disc haemoglobin concentration and oxygenation are quantifiable from multispectral imaging and reduced in glaucoma. The correlation of haemoglobin concentration with perfusion density, RNFL thickness and visual field loss indicates its implication in glaucoma pathology. ![]()
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Affiliation(s)
- Hosni Al Zoubi
- Department of Ophthalmology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | | | - Rowena Simon
- Department of Ophthalmology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Walthard Vilser
- Institute for Biomedical Technique and Informatics, Technical University Ilmenau, Ilmenau, Germany
| | - Somar Hasan
- Department of Ophthalmology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Daniel Meller
- Department of Ophthalmology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Regine Augsten
- Department of Ophthalmology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Martin Hammer
- Department of Ophthalmology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany. .,Center for Medical Optics and Photonics, University of Jena, Jena, Germany.
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5
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Marola OJ, Howell GR, Libby RT. Vascular derived endothelin receptor A controls endothelin-induced retinal ganglion cell death. Cell Death Dis 2022; 8:207. [PMID: 35429992 PMCID: PMC9013356 DOI: 10.1038/s41420-022-00985-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/13/2022] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Abstract
Endothelin (EDN, also known as ET) signaling has been suggested to be an important mediator of retinal ganglion cell (RGC) death in glaucoma. Antagonism of EDN receptors (EDNRA and EDNRB, also known as ET-A and ET-B) prevented RGC death in mouse models of chronic ocular hypertension, and intravitreal injection of EDN ligand was sufficient to drive RGC death. However, it remains unclear which cell types EDN ligands directly affect to elicit RGC death. Multiple cell types in the retina and optic nerve express EDNRA and EDNRB and thus could respond to EDN ligands in the context of glaucoma. Here, we systematically deleted Edn receptors from specific cell types to identify the critical EDN receptor mediating RGC death in vivo. Deletion of both Ednra and Ednrb from retinal neurons (including RGCs) and macroglia did not prevent RGC loss after exposure to EDN1 ligands, suggesting EDN1 ligands cause RGC death via an indirect mechanism involving a secondary cell type. Deletion of Ednra from the full body, and then specifically from vascular mural cells, prevented EDN1-induced vasoconstriction and RGC death. Together, these data suggest EDN ligands cause RGC death via a mechanism initiated by vascular mural cells. It is possible RGC death is a consequence of vascular mural cell-induced vasoconstriction and its pathological sequelae. These results highlight the potential importance of neurovascular dysfunction in glaucoma.
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Marola OJ, Syc-Mazurek SB, Howell GR, Libby RT. Endothelin 1-induced retinal ganglion cell death is largely mediated by JUN activation. Cell Death Dis 2020; 11:811. [PMID: 32980857 PMCID: PMC7519907 DOI: 10.1038/s41419-020-02990-0] [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: 03/22/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 01/02/2023]
Abstract
Glaucoma is a neurodegenerative disease characterized by loss of retinal ganglion cells (RGCs), the output neurons of the retina. Multiple lines of evidence show the endothelin (EDN, also known as ET) system is important in glaucomatous neurodegeneration. To date, the molecular mechanisms within RGCs driving EDN-induced RGC death have not been clarified. The pro-apoptotic transcription factor JUN (the canonical target of JNK signaling) and the endoplasmic reticulum stress effector and transcription factor DNA damage inducible transcript 3 (DDIT3, also known as CHOP) have been shown to act downstream of EDN receptors. Previous studies demonstrated that JUN and DDIT3 were important regulators of RGC death after glaucoma-relevant injures. Here, we characterized EDN insult in vivo and investigated the role of JUN and DDIT3 in EDN-induced RGC death. To accomplish this, EDN1 ligand was intravitreally injected into the eyes of wildtype, Six3-cre+Junfl/fl (Jun-/-), Ddit3 null (Ddit3-/-), and Ddit3-/-Jun-/- mice. Intravitreal EDN1 was sufficient to drive RGC death in vivo. EDN1 insult caused JUN activation in RGCs, and deletion of Jun from the neural retina attenuated RGC death after EDN insult. However, deletion of Ddit3 did not confer significant protection to RGCs after EDN1 insult. These results indicate that EDN caused RGC death via a JUN-dependent mechanism. In addition, EDN signaling is known to elicit potent vasoconstriction. JUN signaling was shown to drive neuronal death after ischemic insult. Therefore, the effects of intravitreal EDN1 on retinal vessel diameter and hypoxia were explored. Intravitreal EDN1 caused transient retinal vasoconstriction and regions of RGC and Müller glia hypoxia. Thus, it remains a possibility that EDN elicits a hypoxic insult to RGCs, causing apoptosis via JNK-JUN signaling. The importance of EDN-induced vasoconstriction and hypoxia in causing RGC death after EDN insult and in models of glaucoma requires further investigation.
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Affiliation(s)
- Olivia J. Marola
- grid.412750.50000 0004 1936 9166Department of Ophthalmology, Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY USA ,grid.412750.50000 0004 1936 9166Cell Biology of Disease Graduate Program, University of Rochester Medical Center, Rochester, NY USA ,grid.16416.340000 0004 1936 9174The Center for Visual Sciences, University of Rochester, Rochester, NY USA
| | - Stephanie B. Syc-Mazurek
- grid.412750.50000 0004 1936 9166Department of Ophthalmology, Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY USA ,grid.412750.50000 0004 1936 9166Medical Scientist Training Program, University of Rochester Medical Center, Rochester, NY USA
| | - Gareth R. Howell
- grid.249880.f0000 0004 0374 0039The Jackson Laboratory, 600 Main Street, Bar Harbor, ME USA
| | - Richard T. Libby
- grid.412750.50000 0004 1936 9166Department of Ophthalmology, Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY USA ,grid.16416.340000 0004 1936 9174The Center for Visual Sciences, University of Rochester, Rochester, NY USA ,grid.412750.50000 0004 1936 9166Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY USA
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7
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Gerhard G, Chua J, Tan B, Wong D, Schmidl D, Schmetterer L. Retinal Neurovascular Coupling in Diabetes. J Clin Med 2020; 9:jcm9092829. [PMID: 32882896 PMCID: PMC7565465 DOI: 10.3390/jcm9092829] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/23/2020] [Accepted: 08/27/2020] [Indexed: 12/15/2022] Open
Abstract
Neurovascular coupling, also termed functional hyperemia, is one of the physiological key mechanisms to adjust blood flow in a neural tissue in response to functional activity. In the retina, increased neural activity, such as that induced by visual stimulation, leads to the dilatation of retinal arterioles, which is accompanied by an immediate increase in retinal and optic nerve head blood flow. According to the current scientific view, functional hyperemia ensures the adequate supply of nutrients and metabolites in response to the increased metabolic demand of the neural tissue. Although the molecular mechanisms behind neurovascular coupling are not yet fully elucidated, there is compelling evidence that this regulation is impaired in a wide variety of neurodegenerative and vascular diseases. In particular, it has been shown that the breakdown of the functional hyperemic response is an early event in patients with diabetes. There is compelling evidence that alterations in neurovascular coupling precede visible signs of diabetic retinopathy. Based on these observations, it has been hypothesized that a breakdown of functional hyperemia may contribute to the retinal complications of diabetes such as diabetic retinopathy or macular edema. The present review summarizes the current evidence of impaired neurovascular coupling in patients with diabetes. In this context, the molecular mechanisms of functional hyperemia in health and disease will be covered. Finally, we will also discuss how neurovascular coupling may in future be used to monitor disease progression or risk stratification.
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Affiliation(s)
- Garhöfer Gerhard
- Department of Clinical Pharmacology, Medical University Vienna, 1090 Vienna, Austria; (G.G.); (D.S.)
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (B.T.); (D.W.)
- Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (B.T.); (D.W.)
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (B.T.); (D.W.)
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
| | - Doreen Schmidl
- Department of Clinical Pharmacology, Medical University Vienna, 1090 Vienna, Austria; (G.G.); (D.S.)
| | - Leopold Schmetterer
- Department of Clinical Pharmacology, Medical University Vienna, 1090 Vienna, Austria; (G.G.); (D.S.)
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (B.T.); (D.W.)
- Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- Institute for Health Technologies, Nanyang Technological University, Singapore 308232, Singapore
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, 1090 Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, CH-4031 Basel, Switzerland
- Correspondence: ; Tel.: +43-1-40400-29810
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8
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Aref AA, Maleki S, Tan O, Huang D, Varma R, Shahidi M. Relating glaucomatous visual field loss to retinal oxygen delivery and metabolism. Acta Ophthalmol 2019; 97:e968-e972. [PMID: 31016869 DOI: 10.1111/aos.14120] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 03/28/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE To test the hypothesis that visual field (VF) loss is associated with decreased retinal blood flow, oxygen delivery and metabolism, and with increased retinal oxygen extraction fraction (OEF) in glaucomatous individuals. METHODS Glaucomatous subjects underwent automated perimetry, dual wavelength scanning laser ophthalmoscopy and Doppler optical coherence tomography imaging in order to measure mean deviation, central retinal arterial and venous diameter equivalents (CRAE and CRVE), oxygen saturation levels and total retinal blood flow (TRBF), respectively. Retinal oxygen delivery, metabolism and extraction fraction were derived from measurements of oxygen saturation and blood flow. RESULTS Twenty eyes of 14 subjects were included in the study. Mean deviation was on average -13.76 ± 8.70 dB. Mean CRAE and CRVE were 126 ± 28 and 191 ± 35 μm, respectively. Mean TRBF and oxygen delivery were 34.3 ± 11.7 μl/min and 6.5 ± 2.6 μl O2 /min, respectively. Mean oxygen metabolism and extraction fraction were 2.1 ± 0.94 μl O2 /min and 0.34 ± 0.15, respectively. Visual field (VF) loss was associated with reduced CRAE and CRVE, TRBF and oxygen delivery and associated with increased OEF. CONCLUSION Combined measurements of retinal blood flow and oxygen saturation in glaucomatous individuals suggest VF loss is associated with impaired oxygen delivery and augmented OEF.
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Affiliation(s)
- Ahmad A Aref
- Department of Ophthalmology and Visual Sciences University of Illinois at Chicago Chicago Illinois USA
| | - Shervin Maleki
- Department of Ophthalmology University of Southern California Los Angeles California USA
| | - Ou Tan
- Casey Eye Institute Oregon Health & Science University Portland Oregon USA
| | - David Huang
- Casey Eye Institute Oregon Health & Science University Portland Oregon USA
| | - Rohit Varma
- Department of Ophthalmology University of Southern California Los Angeles California USA
| | - Mahnaz Shahidi
- Department of Ophthalmology University of Southern California Los Angeles California USA
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9
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Sousa DC, Leal I, Moreira S, do Vale S, Silva-Herdade AS, Aguiar P, Dionísio P, Abegão Pinto L, Castanho MARB, Marques-Neves C. A Protocol to Evaluate Retinal Vascular Response Using Optical Coherence Tomography Angiography. Front Neurosci 2019; 13:566. [PMID: 31249500 PMCID: PMC6582622 DOI: 10.3389/fnins.2019.00566] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/17/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction Optical coherence tomography angiography (OCT-A) is a novel diagnostic tool with increasing applications in ophthalmology clinics that provides non-invasive high-resolution imaging of the retinal microvasculature. Our aim is to report in detail an experimental protocol for analyzing both vasodilatory and vasoconstriction retinal vascular responses with the available OCT-A technology. Methods A commercial OCT-A device was used (AngioVue®, Optovue, CA, United States), and all examinations were performed by an experienced technician using the standard protocol for macular examination. Two standardized tests were applied: (i) the hypoxia challenge test (HCT) and (ii) the handgrip test, in order to induce a vasodilatory and vasoconstriction response, respectively. OCT-A was performed at baseline conditions and during the stress test. Macular parafoveal vessel density of the superficial and deep plexuses was assessed from the en face angiograms. Statistical analysis was performed using STATA v14.1 and p < 0.05 was considered for statistical significance. Results Twenty-four eyes of 24 healthy subjects (10 male) were studied. Mean age was 31.8 ± 8.2 years (range, 18–57 years). Mean parafoveal vessel density in the superficial plexus increased from 54.7 ± 2.6 in baseline conditions to 56.0 ± 2.0 in hypoxia (p < 0.01). Mean parafoveal vessel density in the deep plexuses also increased, from 60.4 ± 2.2 at baseline to 61.5 ± 2.1 during hypoxia (p < 0.01). The OCT-A during the handgrip test revealed a decrease in vessel density in both superficial (55.5 ± 2.6 to 53.7 ± 2.9, p < 0.001) and deep (60.2 ± 1.8 to 56.7 ± 2.8, p < 0.001) parafoveal plexuses. Discussion In this work, we detail a simple, non-invasive, safe, and non-costly protocol to assess a central nervous system vascular response (i.e., the retinal circulation) using OCT-A technology. A vasodilatory response and a vasoconstriction response were observed in two physiologic conditions—mild hypoxia and isometric exercise, respectively. This protocol constitutes a new way of studying retinal vascular changes that may be applied in health and disease of multiple medical fields.
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Affiliation(s)
- David Cordeiro Sousa
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Vision Sciences Study Center, CECV, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Inês Leal
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Vision Sciences Study Center, CECV, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Susana Moreira
- Respiratory Medicine Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Sónia do Vale
- Endocrinology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Endocrinology Department, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana S Silva-Herdade
- Instituto de Bioquímica, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Patrício Aguiar
- Medicine I Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Clinica Universitária de Medicina I, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Patrícia Dionísio
- Respiratory Medicine Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Luís Abegão Pinto
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Vision Sciences Study Center, CECV, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Miguel A R B Castanho
- Instituto de Bioquímica, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Carlos Marques-Neves
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Vision Sciences Study Center, CECV, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Retinal oximetry: Metabolic imaging for diseases of the retina and brain. Prog Retin Eye Res 2019; 70:1-22. [DOI: 10.1016/j.preteyeres.2019.04.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/27/2019] [Accepted: 04/10/2019] [Indexed: 12/20/2022]
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Heitmar R, Vekria P, Cubbidge RP. Regulation of oxygen saturation in retinal blood vessels in response to dynamic exercise. Acta Ophthalmol 2018; 96:e298-e303. [PMID: 29098810 DOI: 10.1111/aos.13576] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/01/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the impact of dynamic exercise on retinal vessel oxygen saturation in healthy individuals. METHODS Twenty-six healthy participants underwent moderate dynamic exercise (modified Master's two-step exercise). In all subjects, intraocular pressures (IOP), systolic and diastolic blood pressures (SBP and DBP), retinal vessel calibres and retinal arterial and venous oxygen saturation were measured at baseline, immediately following exercise and 15 min postexercise. RESULTS Moderate dynamic exercise increased SBP and DBP immediately postexercise (SBP: 116 (±13) mmHg to 150 (±21) mmHg; p < 0.001 and DBP: 69 (±10) mmHg to 74 (±10); p < 0.001), while IOP decreased by an average of 2 mmHg (baseline: 13 (±3) mmHg)) immediately postexercise (11 (±2) mmHg). Oxygen saturation in retinal arteries remained unchanged (baseline = 93 ± 8%; immediately postexercise = 94 ± 9% and 15 min postexercise = 96 ± 8%; p = 0.069), but increased in retinal veins immediately postexercise and did not return to baseline values within 15 min postexercise (baseline = 54 ± 12%; immediately postexercise = 56 ± 15%; 15 min postexercise=57 ± 12%; p = 0.036). CONCLUSION There is a mild increase in retinal venous oxygen saturation and there is a trend towards an increase in arterial saturation in otherwise healthy individuals following dynamic exercise.
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Affiliation(s)
- Rebekka Heitmar
- School of Life and Health Sciences; Aston University; Birmingham UK
| | - Pravin Vekria
- School of Life and Health Sciences; Aston University; Birmingham UK
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12
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Lee SH, Kim GA, Lee W, Bae HW, Seong GJ, Kim CY. Vascular and metabolic comorbidities in open-angle glaucoma with low- and high-teen intraocular pressure: a cross-sectional study from South Korea. Acta Ophthalmol 2017; 95:e564-e574. [PMID: 28677865 DOI: 10.1111/aos.13487] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 04/23/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the associations between vascular and metabolic comorbidities and the prevalence of open-angle glaucoma (OAG) with low-teen and high-teen intraocular pressure (IOP) in Korea. METHODS Cross-sectional data from the Korean National Health and Nutrition Examination Survey from 2008 to 2012 were analysed. Participants diagnosed with OAG with normal IOP were further classified into low-teen IOP (IOP ≤ 15 mmHg) and high-teen IOP (15 mmHg < IOP ≤ 21 mmHg) groups. Using multiple logistic regression analyses, the associations between vascular and metabolic comorbidities and the prevalence of glaucoma were investigated for the low- and high-teen IOP groups. RESULTS The prevalences of hypertension, hyperlipidemia, ischaemic heart disease, stroke and metabolic syndrome were significantly higher among subjects with low-teen OAG compared with normal subjects, while only the prevalences of hypertension and stroke were higher among subjects with high-teen OAG compared with normal subjects. In multivariate logistic regression models adjusted for confounding factors, low-teen OAG was significantly associated with hypertension (OR, 1.68; 95% CI, 1.30-2.18), hyperlipidemia (OR, 1.49; 95% CI, 1.07-2.08), ischaemic heart disease (OR, 1.83; 95% CI, 1.07-3.11), stroke (OR, 1.91; 95% CI, 1.12-3.25) and metabolic syndrome (OR, 1.46; 95% CI, 1.12-1.90). High-teen OAG was only associated with stroke (OR, 2.58; 95% CI, 1.20-5.53). CONCLUSION Various vascular and metabolic comorbidities were significantly associated with low-teen OAG, but not with high-teen OAG. These data support the hypothesis that vascular factors play a more significant role in the pathogenesis of OAG with low-teen baseline IOP.
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Affiliation(s)
- Si Hyung Lee
- Institute of Vision Research; Department of Ophthalmology; Severance Hospital; College of Medicine; Yonsei University; Seoul Korea
- Department of Ophthalmology; College of Medicine; Bucheon Hospital; Soonchunhyang University; Asan Korea
| | - Gyu Ah Kim
- Institute of Vision Research; Department of Ophthalmology; Severance Hospital; College of Medicine; Yonsei University; Seoul Korea
| | - Wonseok Lee
- Institute of Vision Research; Department of Ophthalmology; Severance Hospital; College of Medicine; Yonsei University; Seoul Korea
| | - Hyoung Won Bae
- Institute of Vision Research; Department of Ophthalmology; Severance Hospital; College of Medicine; Yonsei University; Seoul Korea
| | - Gong Je Seong
- Institute of Vision Research; Department of Ophthalmology; Severance Hospital; College of Medicine; Yonsei University; Seoul Korea
| | - Chan Yun Kim
- Institute of Vision Research; Department of Ophthalmology; Severance Hospital; College of Medicine; Yonsei University; Seoul Korea
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Ramm L, Schwab B, Stodtmeister R, Hammer M, Sauer L, Spörl E, Pillunat LE, Terai N. Assessment of Optic Nerve Head Pallor in Primary Open-Angle Glaucoma Patients and Healthy Subjects. Curr Eye Res 2017; 42:1313-1318. [DOI: 10.1080/02713683.2017.1307415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Lisa Ramm
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Birte Schwab
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Richard Stodtmeister
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Martin Hammer
- Department of Ophthalmology, University Hospital Jena, Jena, Germany
| | - Lydia Sauer
- Department of Ophthalmology, University Hospital Jena, Jena, Germany
| | - Eberhard Spörl
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Lutz E. Pillunat
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Naim Terai
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
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Li M, Yan XQ, Song YW, Guo JM, Zhang H. Choroidal area assessment in various fundus sectors of patients at different stages of primary open-angle glaucoma by using enhanced depth imaging optical coherence tomography. Medicine (Baltimore) 2017; 96:e6293. [PMID: 28272255 PMCID: PMC5348203 DOI: 10.1097/md.0000000000006293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
To compare the choroidal area in different eye fundus sectors of subjects with normal eyes, early-stage primary open-angle glaucoma (POAG) eyes, and 10° tubular visual field POAG eyes using enhanced depth imaging optical coherence tomography.Twenty-five normal, 25 early-stage POAG, and 25 ten-degree tubular visual field POAG eyes were recruited. Enhanced depth imaging optical coherence tomography was used to measure the choroidal area in different fundus sectors (fovea; 10° superior, inferior, temporal, and 24° superior, inferior, temporal, nasal to the fovea) and the peripapillary sector.There were neither significant differences in the choroidal area at any of the 8 measured fundus sectors, nor significant differences in the percentage change between the choroidal area of the fovea and other 7 measured fundus sectors among the 3 groups (all P > 0.05). For the total peripapillary choroidal area, no significant difference was found among the 3 groups (P > 0.05); however, the temporal peripapillary choroidal area of 10° tubular visual field POAG eyes was significantly thicker than that of normal eyes (4,46,213 ± 1,16,267 vs 3,74,164 ± 1,21,658 μm; P = 0.048).Our study showed that there was no significant difference in the choroidal area of the 8 measured fundus sectors among normal, early-stage POAG, and 10° tubular visual field POAG eyes, suggesting that there might be no blood redistribution from the peripheral choroid to the subfoveal choroid. However, the thicker temporal peripapillary choroidal area might play a role in the central visual acuity protection in patients with POAG.
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Geyman LS, Garg RA, Suwan Y, Trivedi V, Krawitz BD, Mo S, Pinhas A, Tantraworasin A, Chui TYP, Ritch R, Rosen RB. Peripapillary perfused capillary density in primary open-angle glaucoma across disease stage:an optical coherence tomography angiography study. Br J Ophthalmol 2017; 101:1261-1268. [DOI: 10.1136/bjophthalmol-2016-309642] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/21/2016] [Accepted: 01/08/2017] [Indexed: 11/04/2022]
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Li GY, Al-wesabi SA, Zhang H. Retinal and choroidal oxygen saturation of the optic nerve head in open-angle glaucoma subjects by multispectral imaging. Medicine (Baltimore) 2016; 95:e5775. [PMID: 28033298 PMCID: PMC5207594 DOI: 10.1097/md.0000000000005775] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to determine whether differences exist in oxygen supply to the optic nerve head (ONH) from the retinal and choroidal vascular layers in patients with primary open angle glaucoma (POAG) using multispectral imaging (MSI).This ia an observational, cross-sectional study.Multispectral images were acquired from 38 eyes of 19 patients with POAG, and 42 healthy eyes from 21 matched volunteers with Annidis' RHA multispectral digital ophthalmoscopy. Superficial and deeper oxygen saturation of the optic disc was represented by the mean gray scale values on the retinal and choroidal oxy-deoxy maps, respectively. Statistical analysis was performed to detect differences in ONH oxygen saturation between the 2 groups. Oxygen saturation levels in the eyes of POAG patients with severe glaucoma were compared to those of fellow eyes from the same subjects. Linear correlation analysis was performed to assess the association between ONH oxygen saturation and systemic and ocular parameters.No statistical difference was found in retinal and choroidal oxygen saturation between the POAG and control groups. In the glaucoma patients, retinal oxygen saturation was lower for eyes with worse visual fields than in those with good visual fields (t = 4.009, P = 0.001). In POAG patients, retinal oxygen saturation was dependent on mean defect of visual field and retinal nerve fiber layer thickness (RNFLT) (r = 0.511, 0.504, P = 0.001, 0.001, respectively), whereas the choroid vasculature oxygen saturation was inversely related to RNFLT (r = -0.391, P = 0.015). An age-dependent increase in retinal oxygen saturation was found for both the POAG and control groups (r = 0.473, 0.410, P = 0.007, 0.003, respectively).MSI revealed a significant correlation between functional and structural impairments in glaucoma and retinal oxygen saturation. MSI could provide objective assessments of perfusion impairments of the glaucomatous ONH. This is a preliminary indication of the effectiveness of MSI for studying POAG.
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