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Hondur G, Bayraktar S, Sen E, Kiziltoprak H, Doguizi S, Elgin U. Macula vessel density and its relationship with the central visual field mean sensitivity across different stages of exfoliation glaucoma. Clin Exp Optom 2024; 107:184-191. [PMID: 37844422 DOI: 10.1080/08164622.2023.2259390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 09/12/2023] [Indexed: 10/18/2023] Open
Abstract
CLINICAL RELEVANCE Alterations in ocular microvasculature may contribute to pathogenesis of exfoliation glaucoma (XFG) and may improve monitoring this aggressive type of open angle glaucoma. BACKGROUND This work aims to compare the macula vessel density and the relationship between macula vessel density and central visual field mean sensitivity between eyes with XFG and eyes with primary open-angle glaucoma (POAG) of different stages. METHODS In this cross-sectional observational study, the macula vessel density values were compared among 52 POAG cases (26 early stage, 26 moderate to advanced stage) and 53 XFG cases (27 early stage, 26 moderate to advanced stage). The vessel density values were evaluated with optical coherence tomography angiography. Vasculature-function and structure-function relationships were analysed by comparing macula vessel density, inner macula thickness and visual field mean sensitivity in early and moderate to advanced stages of XFG and POAG eyes separately. RESULTS The early stage XFG eyes had a significantly lower global macula vessel density compared with early stage POAG eyes (42.81 ± 3.85% and 46.56 ± 3.90%, respectively; p = 0.02). However, the tendency of XFG eyes for a lower vessel density compared with the POAG eyes did not exhibit any significance in moderate to advanced stages of glaucoma (37.39 ± 5.65% and 38.35 ± 4.67%, respectively; p = 0.9). The macula vessel density (%)-visual field mean sensitivity (1/Lambert) correlation was statistically significant in early stage XFG eyes (r = 0.464 p = 0.01), while no such correlation was notable for the early stage POAG eyes (r = -0.029 p = 0.89). CONCLUSION The macula vessel density appears to be more severely affected in early stage XFG than POAG of similar severity, suggesting a relatively greater value of vascular insufficiency in XFG. The significant vasculature-function association in early stage XFG, which was absent in early stage POAG, may infer the importance of macula vessel density in monitoring functional loss in early stages of XFG.
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Affiliation(s)
- Gozde Hondur
- Ulucanlar Eye Training and Research Hospital, Department of Ophthalmology, University of Health Sciences, Ankara, Turkey
| | - Serdar Bayraktar
- Ulucanlar Eye Training and Research Hospital, Department of Ophthalmology, University of Health Sciences, Ankara, Turkey
| | - Emine Sen
- Ulucanlar Eye Training and Research Hospital, Department of Ophthalmology, University of Health Sciences, Ankara, Turkey
| | - Hasan Kiziltoprak
- Ulucanlar Eye Training and Research Hospital, Department of Ophthalmology, University of Health Sciences, Ankara, Turkey
| | - Sibel Doguizi
- Ulucanlar Eye Training and Research Hospital, Department of Ophthalmology, University of Health Sciences, Ankara, Turkey
| | - Ufuk Elgin
- Ulucanlar Eye Training and Research Hospital, Department of Ophthalmology, University of Health Sciences, Ankara, Turkey
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Sato M, Kiyota N, Yabana T, Maekawa S, Tsuda S, Omodaka K, Himori N, Yokoyama Y, Nakazawa T. The association between intraocular pressure dynamics during dark-room prone testing and intraocular pressure over a relatively long-term follow-up period in primary open-glaucoma patients. Graefes Arch Clin Exp Ophthalmol 2024; 262:949-956. [PMID: 37864634 PMCID: PMC10907413 DOI: 10.1007/s00417-023-06257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 10/23/2023] Open
Abstract
PURPOSE To investigate the relationship between the dynamics of intraocular pressure (IOP) during dark-room prone testing (DRPT) and IOP over a relatively long-term follow-up period. METHODS This retrospective study enrolled 84 eyes of 51 primary open-angle glaucoma patients who underwent DRPT for whom at least three IOP measurements made using Goldmann applanation tonometry were available over a maximum follow-up period of two years. We excluded eyes with a history of intraocular surgery or laser treatment and those with changes in topical anti-glaucoma medication during the follow-up period. In DRPT, IOP was measured in the sitting position, and after 60 min in the prone position in a dark room, IOP was measured again. In this study, IOP fluctuation refers to the standard deviation (SD) of IOP, and IOP max indicates the maximum value of IOP during the follow-up. The relationship between these parameters was analyzed with a linear mixed-effects model, adjusting for clinical parameters including age, gender, and axial length. RESULTS IOP increased after DRPT with a mean of 6.13 ± 3.55 mmHg. IOP max was significantly associated with IOP after DRPT (β = 0.38; p < 0.001). IOP fluctuation was significantly associated with IOP change in DRPT (β = 0.29; p = 0.007). CONCLUSION Our findings suggest that short-term and relatively long-term IOP dynamics are associated. Long-term IOP dynamics can be predicted by DRPT to some extent.
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Affiliation(s)
- Masataka Sato
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Naoki Kiyota
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Takeshi Yabana
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Shigeto Maekawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Satoru Tsuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kazuko Omodaka
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Noriko Himori
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Aging Vision Healthcare, Tohoku University Graduate School of Biomedical Engineering, Miyagi, Japan
| | - Yu Yokoyama
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan.
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Miyagi, Japan.
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Miyagi, Japan.
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan.
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García Caride S, Sáenz-Francés San Baldomero F, Morales Fernández L, Perucho González L, García Feijoo J, Martínez de la Casa JM. Basal evaluation and rates of progression based on visual fields in six different glaucoma types of a large population. Eur J Ophthalmol 2024; 34:186-192. [PMID: 37157825 DOI: 10.1177/11206721231173172] [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] [Indexed: 05/10/2023]
Abstract
PURPOSE The aim of this study is to analyze the distribution of visual field (VF) mean defect (MD) in six subgroups of glaucoma patients at baseline and follow-up. METHODS We assessed glaucoma patients treated in a Spanish tertiary care setting with a follow-up of at least 10 months. We have included 1036 visual fields and the following glaucoma subtypes: open-Angle Glaucoma (OAG); Angle-Closure Glaucoma (ACG); Congenital Glaucoma (CG); Ocular hypertension (OHT); Pseudoexfoliative Glaucoma (PSXG); Pigmentary Glaucoma (PG). We have calculated the baseline MD and the progression MD. We have stratified the MD progression in slow (MD rate > -0.5 dB/year); moderate (MD rate between -0.5 and -1 dB/year) fast (MD rate between -1 and -2 dB/year) and catastrophic (<-2 dB/year) progression and their glaucoma subtype. RESULTS The glaucoma types with the worse baseline MD were CG and PG. We found significant differences after comparing the baseline MD of CG and OAG, ACG, OHT and between PG and OHT. Concerning the MD progression rate: OAG 73.54% showed slow MD progression rate; 9.85% fast; 7.3% moderate and 9.3% catastrophic. ACG 82.22% slow; 8.89% moderate; 2.22% fast and 6.67% catastrophic. CG 68.83% slow; 9.09% fast; 7.79% moderate and 14.29% catastrophic. OHT 88.6% slow; 6.14% moderate; 4.39% fast and 0.88% catastrophic. PSXG 63.24% slow, 13.24% moderate; 8.8% fast and 14.7% catastrophic. PG 89.29% slow; 3.57% moderate and 7.1% fast. CONCLUSIONS The CG requires special attention because of its aggressive presentation and progression.
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Affiliation(s)
- Sara García Caride
- Ophthalmology department, Hospital Clínico San Carlos Madrid, Madrid, Spain
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Ayala M. Estimating functions for visual field progression in newly diagnosed exfoliation glaucoma patients in Sweden. Sci Rep 2023; 13:20979. [PMID: 38017090 PMCID: PMC10684494 DOI: 10.1038/s41598-023-48336-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/25/2023] [Indexed: 11/30/2023] Open
Abstract
This study aimed to determine whether glaucoma progression was linear or not in newly diagnosed exfoliation glaucoma patients. A total of 96 patients with newly diagnosed exfoliation glaucoma were included. These patients were required to undergo at least seven visual field tests within 3 years (± 1 month), and all were treated at the time of inclusion. The study was a non-randomized, prospective cohort study. The outcome of the study was visual field progression. Progression was assessed based on mean deviation (MD), visual field index (VFI), and "Guided Progression Analysis". The MD and VFI values were plotted against time, and distribution and curve fit were calculated. The results showed that the general rate of progression of the cohort was - 3.84 (± 2.61) dB for the MD values and 9.66 (± 6.25)% for the VFI values over 3 years. The best-fitted curve for MD and VFI values in the 36 months period was significant for both linear and exponential curves (p ≤ 0.001; p ≤ 0.001). However, in the MD group, the F and the R2 values were higher for exponential than for linear function (linear: F = 42.60, R2 = 0.059; exponential: F = 53.26, R2 = 0.073). The opposite results were found among VFI values. The F and the R2 values were slightly better for linear than for exponential (linear: F = 37.22, R2 = 0.052; exponential: F = 35.55, R2 = 0.050). In conclusion, the study found that visual field progression between diagnosis and 18 months seemed to be exponential. However, after 18 months, the IOP reduction effects probably ameliorated progression, making the curve linear.
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Affiliation(s)
- Marcelo Ayala
- Eye Department, Skaraborg Hospital, Skövde, Sahlgrenska Academy, Gothenburg University & Karolinska Institute, 541 85, Skövde, Sweden.
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Balci AS, Cakir I, Altan C. Optic Nerve Head, Peripapillary and Macular Microvascular Characteristics in Patients With Unilateral Pseudoexfoliation Glaucoma. J Glaucoma 2023; 32:989-997. [PMID: 37523619 DOI: 10.1097/ijg.0000000000002265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/08/2023] [Indexed: 08/02/2023]
Abstract
PRCIS In unilateral pseudoexfoliation glaucoma (PEXG), there may be decreased choroidal vascularity index (CVI), radial peripapillary capillary plexus' perfusion and flow. CVI may also be reduced in fellow eyes, suggesting that PEXG is bilateral disease. PURPOSE Evaluation of peripapillary and macular choroidal microvascularity and radial peripapillary capillary plexus in both eyes with unilateral PEXG and healthy eyes. MATERIALS AND METHODS Ninety-six eyes of 48 patients with unilateral PEXG [PEX (+): 48 eyes with PEXG; PEX (-): 48 eyes without PEX] and the right eyes of 45 age- and sex-matched healthy controls were included in the study. CVI was calculated on enhanced depth imaging optical coherence tomography scans. Radial peripapillary capillary vascular layer were evaluated by OCT-angiography. RESULTS Macular CVI (mCVI), temporal and nasal peripapillary CVI (pCVI) was significantly decreased in the PEX (+) compared with the PEX (-) and control group ( P <0.05 for all). Although there was a significant difference between PEX (-) and the control group in terms of mCVI and temporal pCVI, there was no significant difference between the 2 groups in terms of nasal pCVI ( P =0.008, P =0.036, and P =0.604, respectively). There was a significant difference in perfusion density (PD) and flux index (FI) between PEX (+) group, PEX (-) group and control group in all quadrants and average value ( P <0.05 for all). Although the PD and FI values in all quadrants and average values of the PEX (-) group were lower than the control group, this difference was not significant. CONCLUSIONS CVI in the macula and peripapillary region was significantly decreased in eyes with PEXG. Similarly, PD and FI were lower in eyes with PEXG. Low mCVI and temporal pCVI can also be seen in eyes without PEX.
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Affiliation(s)
- Ali Safa Balci
- University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, Beyoglu, Istanbul, Turkey
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Rao A, D’Cruz RP. Visual Field Progression After Glaucoma Surgery in Pseudoexfoliation versus Primary Glaucoma. Clin Ophthalmol 2023; 17:3037-3045. [PMID: 37850050 PMCID: PMC10578175 DOI: 10.2147/opth.s431723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/25/2023] [Indexed: 10/19/2023] Open
Abstract
Purpose To compare visual field progression in severity-matched pseudoexfoliation glaucoma (XFG) and primary glaucoma after intraocular pressure (IOP) reduction by filtering surgery. Methods Patients with XFG (n=32), primary open-angle glaucoma (POAG, n=33) or primary angle closure glaucoma (PACG, n=28) that underwent routine cataract and glaucoma filtering surgery by the same surgeon (APR) between May 2017 and September 2021, were included for this prospective study. Rate of progression (ROP) was determined using guided progression analysis and compared between XFG and primary glaucoma. Multivariate regression was done to analyse the factors responsible for progression in each group. Results Visual field progression after surgery was noted in 48 eyes (n=11 XFG, 18 POAG and 19 PACG eyes) at a mean follow-up of 10±5.6 months after surgery with RVI seen in 18 of 48 eyes. The final IOP (p=0.8) and mean ROP (p=0.09) were not significantly different between XFG and primary glaucoma. The XFG eyes had a greater number of eyes (36%) showing an ROP worse than -5dB/yr, with 45% of eyes showing an IOP spike >5mm Hg, and a higher mean IOP spike between visits. The ROP in eyes with RVO and >5mm Hg IOP spikes was greater in XFG than in POAG or PACG. In the multivariate analysis, higher IOP fluctuations >5mm Hg, and associated retinal vein occlusions (RVO) were significant factors for visual progression greater than -5dB/year (R2=53.5%) in POAG and XFG eyes. Age, gender, baseline MD, and number of medications before surgery or at final follow-up did not influence visual progression rates in either group. Conclusion A higher IOP fluctuation >5mm Hg and associated RVO were the significant factors predicting visual field progression after filtering surgery in XFG and POAG eyes. Control of both IOP-dependent and -independent mechanisms of VF progression is therefore essential in these eyes.
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Affiliation(s)
- Aparna Rao
- Glaucoma Service, LV Prasad Eye Institute, MTC Campus, Bhubaneswar, India
| | - Rakhi P D’Cruz
- Glaucoma Service, LV Prasad Eye Institute, MTC Campus, Bhubaneswar, India
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Palakkamanil MM, Nicolela MT. The rates of visual field progression in glaucoma and its clinical importance. REVISTA BRASILEIRA DE OFTALMOLOGIA 2022. [DOI: 10.37039/1982.8551.20220102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ogawa S, Takemura H, Horiguchi H, Miyazaki A, Matsumoto K, Masuda Y, Yoshikawa K, Nakano T. Multi-Contrast Magnetic Resonance Imaging of Visual White Matter Pathways in Patients With Glaucoma. Invest Ophthalmol Vis Sci 2022; 63:29. [PMID: 35201263 PMCID: PMC8883150 DOI: 10.1167/iovs.63.2.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 02/03/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Glaucoma is a disorder that involves visual field loss caused by retinal ganglion cell damage. Previous diffusion magnetic resonance imaging (dMRI) studies have demonstrated that retinal ganglion cell damage affects tissues in the optic tract (OT) and optic radiation (OR). However, because previous studies have used a simple diffusion tensor model to analyze dMRI data, the microstructural interpretation of white matter tissue changes remains uncertain. In this study, we used a multi-contrast MRI approach to further clarify the type of microstructural damage that occurs in patients with glaucoma. Methods We collected dMRI data from 17 patients with glaucoma and 30 controls using 3-tesla (3T) MRI. Using the dMRI data, we estimated three types of tissue property metrics: intracellular volume fraction (ICVF), orientation dispersion index (ODI), and isotropic volume fraction (IsoV). Quantitative T1 (qT1) data, which may be relatively specific to myelin, were collected from all subjects. Results In the OT, all four metrics showed significant differences between the glaucoma and control groups. In the OR, only the ICVF showed significant between-group differences. ICVF was significantly correlated with qT1 in the OR of the glaucoma group, although qT1 did not show any abnormality at the group level. Conclusions Our results suggest that, at the group level, tissue changes in OR caused by glaucoma might be explained by axonal damage, which is reflected in the intracellular diffusion signals, rather than myelin damage. The significant correlation between ICVF and qT1 suggests that myelin damage might also occur in a smaller number of severe cases.
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Affiliation(s)
- Shumpei Ogawa
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiromasa Takemura
- Center for Information and Neural Networks (CiNet), Advanced ICT Research Institute, National Institute of Information and Communications Technology, Suita, Japan
| | - Hiroshi Horiguchi
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Kenji Matsumoto
- Brain Science Institute, Tamagawa University, Machida, Japan
| | - Yoichiro Masuda
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiji Yoshikawa
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
- Yoshikawa Eye Clinic, Machida, Japan
| | - Tadashi Nakano
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
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Testing the eligibility of glaucoma patients for potential gene therapy among a clinic population. Int Ophthalmol 2022; 42:785-797. [PMID: 34989952 DOI: 10.1007/s10792-021-02044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/22/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Glaucoma patients who deteriorate despite standard treatment may benefit from novel gene therapies. Key inclusion criteria for a glaucoma gene therapy trial were devised. A retrospective chart review in a glaucoma clinic population was conducted. Feasibility of gene therapy inclusion criteria and factors associated with progression and fast progression < -1 decibels/year (dB/y) were evaluated. METHODS Three hundred and seventy-four primary open-angle glaucoma patients all of whom had performed at least five Swedish interactive threshold algorithm standard visual fields within a 58-month period. Two definitions were applied to characterize visual field progression rate using Guided Progression Analysis for an individual patient based on A, the eye with the greatest visual field loss, or B, the eye with the most rapid progression rate. RESULTS Mean rate of visual field progression was -0.50 dB/y (Definition A) and -0.64 dB/y (Definition B). 19.0% (A) and 21.9% (B) of eyes, 71 (A) and 82 (B) eyes, were 'fast progressors' (< -1 dB/y). 37 (A) and 43 (B) eyes met the putative gene therapy inclusion criteria (≥ 50 years; mean deviation ≤ -4 to ≥ -12 or ≤ -20 dB, progression rate between -1 and -4 dB/y). Beta blockers (Odds ratio (OR) with 95% Confidence Intervals (CI): 2.84 (1.39-5.80); p = 0.004) (A), (OR (95%CI): 2.48 (1.30-4.75); p = 0.006) (B) and alpha agonists (OR (95%CI): 2.18 (1.14-4.17); p = 0.02) (A), (OR (95%CI) 2.00 (1.08-3.73); p = 0.028) (B) were significantly associated with fast progression. CONCLUSION A substantial proportion (10%) of patients in this clinic population would meet recommended gene therapy inclusion criteria.
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Cheng YC, Sun MH, Wu WC, Su WW. Cataract extraction slowed the visual field progression rate in patients with angle-closure glaucoma. Taiwan J Ophthalmol 2021; 11:386-388. [PMID: 35070668 PMCID: PMC8757517 DOI: 10.4103/tjo.tjo_42_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/06/2020] [Indexed: 11/17/2022] Open
Abstract
PURPOSE: The purpose of this study is to evaluate the rate of progression of Humphrey visual field before and after the cataract surgery in patients with angle-closure glaucoma. MATERIAL AND METHODS: Patients with angle-closure glaucoma who underwent regular visual field (VF) examination and received cataract surgery during the follow-up periods were retrospectively reviewed. The visual field rate of progression, visual acuity (VA), intraocular pressure (IOP), and number of glaucoma medication before and after cataract surgery were compared. RESULTS: A total of 26 eyes were included. The mean follow-up duration before and after the cataract surgery were 5.14 ± 3.31 years and 5.97 ± 2.35 years. After cataract surgery, the IOP and VA improved significantly. The visual field rate of progression significantly slowed down after cataract surgery from − 1.39 ± 1.31 dB/year preoperatively to − 0.34 ± 0.64 dB/year postoperatively (P = 0.003). CONCLUSION: The ACG eyes had rapid VF decline before cataract extraction, which was slowed down significantly after cataract removal.
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Affiliation(s)
- Yu-Chun Cheng
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Hui Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Wen Su
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Optical Coherence Tomography Angiography and Visual Field Progression in Primary Angle Closure Glaucoma. J Glaucoma 2021; 30:e61-e67. [PMID: 33273281 DOI: 10.1097/ijg.0000000000001745] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/06/2020] [Indexed: 11/27/2022]
Abstract
PRECIS Lower whole enface disc (coefficient: 0.02, P=0.03) and macular vessel densities (coefficient: 0.04, P=0.02) on optical coherence tomography angiography (OCTA) were significantly associated with faster rate of mean deviation (MD) decline. PURPOSE To evaluate the association between OCTA features and prior visual field (VF) progression in primary angle closure glaucoma (PACG). METHODS In a cross-sectional study, 46 eyes of 31 PACG patients with 5 reliable VF examinations performed over ≥3 years of follow-up underwent OCTA imaging. Effect of clinical (age, sex, number of antiglaucoma medications, mean, and SD of intraocular pressure during follow-up), optical coherence tomography (average retinal nerve fiber layer and ganglion cell complex thickness) and OCTA (whole enface vessel density of disc and macular scan, deep-layer microvascular dropout) parameters on the rate of MD change was evaluated using linear mixed models. RESULTS Average (±SD) MD of the baseline VF was -7.4±7.3 dB, and rate of MD change was -0.32±0.29 dB/y. Whole enface vessel density of disc and macular scans was 39.5%±8.1% and 38.7%±4.4%, respectively. Microvascular dropout was noted in 33.3% of the eyes. Multivariate mixed models showed that lower whole enface disc (coefficient: 0.02, P=0.03) and macular vessel densities (coefficient: 0.04, P=0.02) were significantly associated with faster rate of MD decline. Other factors significantly associated with faster progression in multivariate models were older age (coefficient: -0.02, P<0.05) and the presence of systemic hypertension (coefficient: -0.37, P=0.01) and diabetes (coefficient: -0.28, P=0.05). CONCLUSIONS Lower superficial vessel density measured using OCTA was significantly associated with faster VF progression in PACG. In these eyes, OCTA parameters can serve as biomarker suggestive of past VF progression.
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Comparison of Visual Field Progression Rate before and after Cataract Surgery in Patients with Open-Angle and Angle-Closure Glaucoma. J Ophthalmol 2021; 2021:7655747. [PMID: 34239721 PMCID: PMC8241496 DOI: 10.1155/2021/7655747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/10/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose To evaluate Humphrey visual field (VF) progression rate before and after cataract surgery in patients with open-angle glaucoma (OAG) and angle-closure glaucoma (ACG). Methods After reviewing all records in our Humphrey VF database from July 1, 2001, to December 31, 2018, eyes of OAG and ACG that had received uncomplicated phacoemulsification with intraocular lens implantation during the period and had been followed up regularly for more than one year with ≥3 reliable VF tests before and after cataract surgery, respectively, were enrolled. The VF progression rate, visual acuity, and intraocular pressure (IOP) before and after cataract surgery were compared. Results Seventy-seven eyes (OAG: 51; ACG: 26) from 60 patients were enrolled. The mean preoperative and postoperative follow-up durations were 4.89 ± 2.70 and 5.48 ± 2.30 years in the OAG group and 5.14 ± 3.31 and 5.97 ± 2.35 years in the ACG group. IOP and visual acuity significantly improved postoperatively in both groups. In the OAG group, there was no significant change in the VF progression rate (pre-op: −0.39 ± 0.94 dB/year; post-op: −0.47 ± 0.72 dB/year) (P=0.619), whereas, in the ACG group, the rate significantly flattened after surgery from −1.39 ± 1.31 dB/year to −0.34 ± 0.64 dB/year (P=0.003). Conclusions The VF progression rate did not differ between preoperative and postoperative eyes with OAG, but those with ACG exhibited rapid VF decline preoperatively, which was significantly flattened postoperatively.
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Detection of Primary Angle Closure Glaucoma Progression by Optical Coherence Tomography. J Glaucoma 2021; 30:410-420. [PMID: 33710065 DOI: 10.1097/ijg.0000000000001829] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the role of spectral-domain optical coherence tomography (SD-OCT) in regard to retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) assessment in the detection of primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) progression. MATERIALS AND METHODS In the prospective study, 131 subjects with PACG and POAG were examined during 72 months with follow-up visits every 6 months. Visual field (VF) progression was detected using the Guided Progression Analysis (GPA) of the Humphrey visual field analyzer and structural change using SD-OCT while a significant negative trend for the RNFL and GCC was gauged. The diagnostic accuracy of RNFL and GCC thinning in the detection of glaucoma progression was compared between PACG and POAG eyes using the Kaplan-Meier method with the calculation of the log-rank test. RESULTS Progression was detected in 57% of eyes with POAG and 59% of eyes with PACG. The rate of thinning of RNFL (-2.95±1.85 μm/y) and GCC (-3.22±2.96 μm/y) was significantly higher in PACG progression eyes compared with POAG [-1.64±2.00 μm/y (P=0.018) and -1.74±2.05 μm/y (P=0.046), respectively]. The progression was associated with initial pattern standard deviation in both glaucoma subtypes, while only in PACG-with long-term intraocular pressure fluctuations (cutoff >5.2 mm Hg) and lens thickness (cutoff >4.92 mm), and only in POAG-with initial focal loss volume of GCC (cutoff >1.5%).In PACG, the rate of the visual function deterioration correlated with GCC thinning rate (r=0.330, P=0.027), but not with the RNFL thinning rate (r=-0.010, P=0.79), while in POAG, it was significant for both RNFL thinning (r=0.296, P=0.039) and GCC thinning (r=0.359, P=0.011). In PACG patients with progressive GCC thinning, functional progression was detected earlier (log-rank test P≤0.001) than in patients with progressive RNFL thinning (log-rank test P=0.457), while for POAG, these results were P=0.012 and ≤0.001 for GCC and RNFL thinning, respectively. CONCLUSIONS SD-OCT plays an important role in detecting PACG progression. In contrast to POAG, GCC thinning predicted functional loss better than RNFL thinning in PACG.
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Topographic Relationship with a Retinal Nerve Fiber Layer Defect Differs between β-Zone and γ-Zone Parapapillary Atrophy. J Ophthalmol 2020; 2020:6279689. [PMID: 32908683 PMCID: PMC7463418 DOI: 10.1155/2020/6279689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/09/2020] [Accepted: 06/25/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction γ-Zone parapapillary atrophy (PPA), an associated feature in myopic tilted optic disc, is considered to be relevant with glaucomatous optic nerve damage in myopic eyes. This study determines the topographic relationship of γ-zone PPA with a retinal nerve fiber layer defect. Purpose To determine the topographic relationship of γ-zone PPA with a RNFL defect and to compare it with that of β-zone PPA. Design Cross-sectional, observational study. Participants. Eighty-nine eyes from 89 patients with primary open-angle glaucoma who had β-zone PPA (n = 49) or γ-zone PPA (n = 40) and a single localized RNFL defect. Methods PPA was classified according to the presence or absence of Bruch's membrane on the PPA bed in spectral-domain optical coherence tomography. The angular location of the point of maximum radial extent of PPA (PMRE) and the RNFL defect was measured with the fovea-disc axis set at 0° in color and red-free fundus photographs. Main Outcome Measures. Angular distance between the RNFL defect and the PMRE. Results There was no significant intergroup difference in the extent of the RNFL defect (P=0.920). The angular distance between the RNFL defect and the PMRE was significantly greater in γ-zone than β-zone PPA (26.49 ± 17.27° vs. 60.31 ± 17.12°, P < 0.001). The angular location of the PMRE was significantly correlated with the location of the RNFL defect in the β-zone group (r = 0.822, P < 0.001) but not in the γ-zone group. The RNFL defect was mostly located near the edge of γ-zone PPA in the γ-zone group (10.56 ± 9.47°). Conclusions An RNFL defect was observed near the edge of PPA in eyes with γ-zone PPA, in contrast to it being close to the PMRE in eyes with β-zone PPA.
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Ayala M. Comparison of visual field progression in new-diagnosed primary open-angle and exfoliation glaucoma patients in Sweden. BMC Ophthalmol 2020; 20:322. [PMID: 32758192 PMCID: PMC7404924 DOI: 10.1186/s12886-020-01592-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/29/2020] [Indexed: 12/01/2022] Open
Abstract
Background The present study aimed to compare visual field progression in new-diagnosed exfoliation versus open-angle glaucoma patients. Methods Retrospective study. The study included patients with new-diagnosed primary open-angle and exfoliation glaucoma. All patients were followed for 3 years with reliable visual fields. At least five reliable fields were needed for inclusion. Exfoliation and open-angle glaucoma were defined based on the European Glaucoma Society guidelines. Visual field evaluation was performed using the software threshold 24–2 of the Humphrey Field Analysis. Outcomes: Visual field progression. For visual field progression, three different strategies were used: mean deviation (MD), visual field index (VFI), and the guided progression analysis (GPA). Results The study included 128 subjects, of the 54 in the open-angle and 74 in the exfoliation glaucoma group. The MD difference values were higher in the exfoliation (− 3.17 dB) than in the primary open-angle (− 1.25 dB) glaucoma group in the three-year follow-up period. The difference between groups was significant (t-test, p = < 0.001). The difference in VFI was calculated for the 3 years follow-up period. The difference was higher in the exfoliation (− 7.65%) than in the primary open (− 1.90%) glaucoma group (t-test, p = < 0.001). The GPA showed progression in 58% of cases in exfoliation, and 13% in primary open glaucoma group (Chi-square, p = < 0.001). Conclusion The present study found a more frequent and faster visual field progression in exfoliation than in primary open-angle glaucoma patients. New-diagnosed exfoliation glaucoma patients must be controlled and treated more strictly than primary open-angle glaucoma patients to avoid visual field deterioration.
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Affiliation(s)
- Marcelo Ayala
- Eye Department, Skaraborg Hospital, Skövde, Sahlgrenska Academy, Gothenburg University & Karolinska Institute, 541 85, Skövde, Sweden.
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Demirtaş AA, Karahan M, Ava S, Çilem Han Ç, Keklikçi U. Evaluation of Diurnal Fluctuation in Parafoveal and Peripapillary Vascular Density Using Optical Coherence Tomography Angiography in Patients with Exfoliative Glaucoma and Primary Open-Angle Glaucoma. Curr Eye Res 2020; 46:96-106. [PMID: 32546011 DOI: 10.1080/02713683.2020.1784437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the diurnal variations in parafoveal and peripapillary vessel density using optical coherence tomography angiography in patients with exfoliative glaucoma, patients with primary open-angle glaucoma and healthy individuals. MATERIALS AND METHODS In this prospective cross-sectional study, 36 exfoliative glaucoma patients, 34 primary open-angle glaucoma patients and 35 healthy individuals were examined. Optical coherence tomography angiography was used for examining the vessel density of peripapillary (radial peripapillary capillary) and parafoveal (superficial layer) regions. Optical coherence tomography angiography readings were obtained at 09:00, 11:00, 14:00 and 16:00 on the same day. Intraocular pressure values were assessed accordingly. The intraclass correlation coefficients were used to evaluate test-retest variability. RESULTS Diurnal variation in intraocular pressure or vessel density values was not found in any parafoveal or peripapillary region in any of the groups at any hour of measurement. The vessel density in the temporal sector of the exfoliative glaucoma group was significantly lower than in the primary open-angle glaucoma group at all time points. (Mann-Whitney U test; 09:00, P= .015; 11:00, P= .002; 14:00, P= .040; and 16:00, P= .048, respectively). The test-retest repeatability was high and almost excellent for the parafoveal and peripapillary regions in each group (XFG range: 0.757 - 0.985, POAG range: 0.834 - 0.985, and control range: 0.708 - 0.983). CONCLUSIONS It may be important to estimate the diurnal fluctuation occurring in retinal haemodynamics in patients with exfoliative glaucoma and primary open-angle glaucoma despite the lack of any considerable variation in intraocular pressure and retinal vessel density values in one day. The study found that at any point of time, vessel density of radial peripapillary capillary in temporal region was lower in exfoliative glaucoma patients than in primary open-angle glaucoma patients having the same glaucoma severity.
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Affiliation(s)
- Atılım Armağan Demirtaş
- Department of Ophthalmology, Health Sciences University, Tepecik Training and Research Hospital , Izmir, Turkey
| | - Mine Karahan
- Department of Ophthalmology, Dicle University Faculty of Medicine , Diyarbakır, Turkey
| | - Sedat Ava
- Department of Ophthalmology, Dicle University Faculty of Medicine , Diyarbakır, Turkey
| | - Çağla Çilem Han
- Department of Ophthalmology, Dicle University Faculty of Medicine , Diyarbakır, Turkey
| | - Uğur Keklikçi
- Department of Ophthalmology, Dicle University Faculty of Medicine , Diyarbakır, Turkey
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Köse HC, Tekeli O. Optical coherence tomography angiography of the peripapillary region and macula in normal, primary open angle glaucoma, pseudoexfoliation glaucoma and ocular hypertension eyes. Int J Ophthalmol 2020; 13:744-754. [PMID: 32420221 DOI: 10.18240/ijo.2020.05.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/25/2019] [Indexed: 02/07/2023] Open
Abstract
AIM To evaluate and compare the peripapillary and retinal vasculature changes in primary open angle glaucoma (POAG), pseudoexfoliation glaucoma (PXG), ocular hypertension (OHT) and normal eyes using optical coherence tomography angiography (OCTA). METHODS A total of 114 POAG, PXG and OHT eyes of 60 patients and 46 eyes of 23 healthy control participants with good quality OCTA images were included. The PXG, POAG, OHT, and control groups (aged 68.17±6.30y, 61.11±10.26y, 58.1±8.9y, and 56.9±4.6y, respectively) contained of 46, 36, 32, and 46 eyes, respectively. Measurements of vessel density (VD) in the peripapillary region and macula, average retinal inner thickness, and retinal nerve fiber layer thickness (RNFLT) were compared among groups. In order to test the accuracy of differentiation between eyes with and without glaucoma, the area was calculated under the receiver operating characteristic (ROC) curves. RESULTS The VD in glaucomatous eyes was significantly lower than the control group in all peripapillary sectors (44.35%±6.78% vs 50.47%±1.83%, P<0.001), the superficial (44.08%±5.46% vs 51.28%±2.85%, P<0.001) and the deep (45.13%±8.55% vs 54.20%±5.44%, P<0.001) vascular plexus. There was a significant difference in peripapillary VD between glaucomatous and OHT eyes (44.35%±6.78% vs 49.86%±2.45%, P<0.001). The OHT group featured a lower superficial (48.06%±4.32% vs 51.28%±2.85%, P=0.027) and deep plexus (48.70%±5.99% vs 54.20%±5.44%, P=0.013) whole image vessel density (wiVD) than did the control group. The average macular superficial plexus wiVD was significantly lower in eyes with PXG than in eyes with POAG (42.22%±5.36% vs 46.54%±5.56%, P=0.046). CONCLUSION OCTA can measure reduced peripapillary and macular VD in eyes with glaucoma and OHT, and these results are correlated to functional and structural glaucomatous alterations. Peripapillary and macular superficial plexus VD is lower in eyes with PXG than in eyes with POAG. Furthermore, the OHT eyes demonstrate impaired macular vasculature in both superficial and deep plexus.
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Affiliation(s)
- Helin Ceren Köse
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara 06620, Turkey
| | - Oya Tekeli
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara 06620, Turkey
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Simsek M, Kocer AM, Cevik S, Sen E, Elgin U. Evaluation of the optic nerve head vessel density in the patients with asymmetric pseudoexfoliative glaucoma: an OCT angiography study. Graefes Arch Clin Exp Ophthalmol 2020; 258:1493-1501. [PMID: 32300958 DOI: 10.1007/s00417-020-04668-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/22/2020] [Accepted: 03/27/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate vascular microcirculation changes of the optic nerve head (ONH) in the patients with asymmetric pseudoexfoliative glaucoma (XFG) using optical coherence tomography angiography (OCTA) and to compare vessel density (VD) results with healthy individuals. METHODS This prospective study enrolled 120 eyes in total. The eyes were divided into 3 groups: 40 glaucomatous and 40 non-glaucomatous fellow eyes without clinically pseudoexfoliation material (XFM) of patients with asymmetric XFG, and 40 healthy eyes as controls. The optic disc region was evaluated with OCTA (Optovue, Inc., Fremont, CA). VD was assessed as the ratio of the area formed by the vessels in 3 different regions: (1) inside disc; (2) in the peripapillary area defined as a 1-mm wide elliptical annulus around the disc; and (3) in the whole image defined as a 4-mm wide papillary region. RESULTS There were significant decreases in VD values of all regions in XFG eyes compared to fellow and control eyes (p < 0.05 for all comparisons). The mean VD values of peripapillary area and whole image were lower in the non-glaucomatous fellow eyes compared with control eyes (p = 0.011 and p = 0.015, respectively). The receiver operating characteristic analysis for differentiating fellow eyes from healthy eyes had highest area under the curve and sensitivity at 90% specificity for superior-hemi (0.811, 65.2%), followed by ppVD (0.775, 61.8%) and whole image (0.743, 55.9%). CONCLUSIONS OCTA as a novel imaging may be a valuable structural test in diagnosis and follow-up of glaucoma.
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Affiliation(s)
- Mert Simsek
- Department of Ophthalmology, Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Kale Mahallesi, Ulucanlar Caddesi, No:59, 06250, Altındağ/Ankara, Turkey.
| | - Ali Mert Kocer
- Department of Ophthalmology, Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Kale Mahallesi, Ulucanlar Caddesi, No:59, 06250, Altındağ/Ankara, Turkey
| | - Seda Cevik
- Department of Ophthalmology, Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Kale Mahallesi, Ulucanlar Caddesi, No:59, 06250, Altındağ/Ankara, Turkey
| | - Emine Sen
- Department of Ophthalmology, Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Kale Mahallesi, Ulucanlar Caddesi, No:59, 06250, Altındağ/Ankara, Turkey
| | - Ufuk Elgin
- Department of Ophthalmology, Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Kale Mahallesi, Ulucanlar Caddesi, No:59, 06250, Altındağ/Ankara, Turkey
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Ballae Ganeshrao S, Senthil S, Choudhari N, Sri Durgam S, Garudadri CS. Comparison of Visual Field Progression Rates Among the High Tension Glaucoma, Primary Angle Closure Glaucoma, and Normal Tension Glaucoma. Invest Ophthalmol Vis Sci 2019; 60:889-900. [PMID: 30835290 DOI: 10.1167/iovs.18-25421] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare the visual field (VF) progression among high tension glaucoma (HTG), primary angle closure glaucoma (PACG), and normal tension glaucoma (NTG) subjects in routine clinical care. Methods All patients had ≥5 VF tests using HFA, 24-2, SITA-standard strategy. We compared the progression between glaucoma subtypes after matching the VFs for baseline severity (mean deviation [MD]) and the age at presentation. Global VF progression was evaluated by linear regression analysis (LRA) of MD. For local VF progression, scotoma expansion (SE) defined as appearance of new scotoma and scotoma deepening (SD) defined by pointwise LRA were calculated. SE and SD were analyzed in three VF zones: superior arcuate (SA), inferior arcuate (IA), and central (C). Results A total of 310 HTG, 304 PACG, and 165 NTG eyes were included. When VFs were matched by baseline MD, a greater number (n = 20/76) of eyes with HTG showed significant progression compared to PACG (n = 9/76; P = 0.04). The number of progressing eyes were not significantly different between HTG and NTG (n = 11/76; P = 0.10) and between NTG and PACG (P = 0.65). When the baseline VFs were matched by age, the number of eyes showing significant progression were similar in all the subtypes. SA zone in HTG and NTG showed greater SE and SD compared to other zones (P < 0.05), whereas IA zone in PACG showed greater SE and SD compared to other zones (P < 0.05). Conclusions In our cohort of treated primary glaucoma with matched baseline severity, a greater proportion of HTG eyes progressed faster compared to PACG. SA zone in HTG and NTG and IA zone in PACG showed greater VF progression.
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Affiliation(s)
- Shonraj Ballae Ganeshrao
- VST Centre for Glaucoma Care, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India.,Brien Holden Institute of Optometry and Vision Science, Hyderabad Eye Research Foundation, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India.,Department of Optometry, School of Allied Health Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Sirisha Senthil
- VST Centre for Glaucoma Care, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Nikhil Choudhari
- VST Centre for Glaucoma Care, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Shravya Sri Durgam
- VST Centre for Glaucoma Care, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
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Yousefi S, Sakai H, Murata H, Fujino Y, Matsuura M, Garway-Heath D, Weinreb R, Asaoka R. Rates of Visual Field Loss in Primary Open-Angle Glaucoma and Primary Angle-Closure Glaucoma: Asymmetric Patterns. Invest Ophthalmol Vis Sci 2019; 59:5717-5725. [PMID: 30513532 DOI: 10.1167/iovs.18-25140] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the rate of visual field (VF) loss in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Methods Four hundred forty eyes of 282 patients with POAG (aged 53.4 ± 12.0: mean ± standard deviation, years) and 79 eyes of 49 patients with PACG (aged 62.7 ± 9.0 years) with at least six or more reliable VF tests were studied. Point-wise, region-wise, and global rates of VF change were assessed for POAG and PACG eyes. Only the VF records prior to laser iridotomy or cataract surgery were included in PACG eyes. The global and superior-inferior asymmetric rates of VF loss were compared between POAG and PACG eyes. Results The mean total deviation (mTD) values at baseline were -6.4 ± 5.7 dB in POAG patients and -6.4 ± 7.3 dB in PACG patients. There was not a significant difference in the progression rates of mTD between POAG eyes (-0.23 ± 0.38 dB/y) and PACG eyes (-0.29 ± 0.45 dB/y). In POAG eyes, the VF progression rate was significantly asymmetric across the horizontal line; the central, paracentral, and peripheral arcuate 2 regions in the superior hemifield had a significantly faster rate of VF loss than their inferior counterparts. In contrast, this asymmetry was not observed in the rate of VF loss in PACG eyes. Conclusions POAG eyes showed a faster rate of VF loss in the superior hemifield compared to in the inferior hemifield, particularly in central and paracentral regions. This difference was not observed in PACG eyes.
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Affiliation(s)
- Siamak Yousefi
- Department of Ophthalmology, University of Tokyo, Tokyo, Japan.,Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Hiroshi Sakai
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, University of Tokyo, Tokyo, Japan
| | - Yuri Fujino
- Department of Ophthalmology, University of Tokyo, Tokyo, Japan.,Department of Ophthalmology, Graduate School of Medical Science, Kitasato University, Sagamihara Kanagawa, Japan
| | - Masato Matsuura
- Department of Ophthalmology, University of Tokyo, Tokyo, Japan.,Department of Ophthalmology, Graduate School of Medical Science, Kitasato University, Sagamihara Kanagawa, Japan
| | - David Garway-Heath
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Robert Weinreb
- Hamilton Glaucoma Center and the Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Ryo Asaoka
- Department of Ophthalmology, University of Tokyo, Tokyo, Japan
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Anderson AJ, Chaurasia AK, Sharma A, Gupta A, Gupta S, Khanna A, Gupta V. Comparison of Rates of Fast and Catastrophic Visual Field Loss in Three Glaucoma Subtypes. Invest Ophthalmol Vis Sci 2019; 60:161-167. [PMID: 30640968 DOI: 10.1167/iovs.18-25391] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare the distribution of visual field progression rates in three subgroups of glaucoma, being primary angle-closure glaucoma (PACG), POAG, and juvenile open-angle glaucoma (JOAG). Methods We assessed glaucoma patients treated in an Indian tertiary care setting with at least four visual field assessments. We determined rates from a single eye of each of 525 patients using linear regression of the summary index mean deviation (MD) over time. The main outcome measures were the proportions of fast (<-1.0 to -2.0 dB/y) and catastrophic (<-2 dB/y) visual field progression. Bootstrapped 95% CIs allowed comparison with published data from a large clinical cohort in Canada. Results The combined proportion of fast and catastrophic progressors in our cohort was less than half that in the Canada dataset (2.3% vs. 5.8%), despite median progression rates differing by only 0.03 dB/y. PACG, POAG, and JOAG represented 45%, 32%, and 12% of our cohort, respectively. Baseline MD values were similarly distributed between these subtypes. All subtypes showed a similar shaped distribution for progression rates, with median progression rates of -0.03, -0.05, and 0.02 dB/y for PACG, POAG, and JOAG, respectively. Combined proportions of fast and catastrophic progression rates did not significantly differ between subtypes. Conclusions Differences in fast and catastrophic visual field progression can exist despite only small changes in median progression rates, highlighting the importance of considering the full shape of the progression rate distribution when comparing the risk of devastating visual field loss.
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Affiliation(s)
- Andrew J Anderson
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Australia
| | - Abadh K Chaurasia
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Amisha Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shikha Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anurag Khanna
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Viney Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Yousefi S, Mahmoudi Nezhad GS, Pourahmad S, Vermeer KA, Lemij HG. Distribution and Rates of Visual Field Loss across Different Disease Stages in Primary Open-Angle Glaucoma. Ophthalmol Glaucoma 2018; 1:52-60. [PMID: 32672633 DOI: 10.1016/j.ogla.2018.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/26/2018] [Accepted: 05/29/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To identify patterns and rates of visual field (VF) loss in primary open-angle glaucoma (POAG) across different levels of severity. DESIGN Retrospective, observational case series. PARTICIPANTS Visual fields of 278 eyes of 139 patients with POAG (9 years of follow-up with ∼17 visits) from the Rotterdam Eye Hospital in The Netherlands were analyzed to identify patterns and rates of VF loss. MAIN OUTCOME MEASURES Rate of VF decline for the entire VF, each region, and test point. Hemifield asymmetric rate if VF decline for each region and test point. METHODS Total deviation (TD) values were extracted from the Humphrey VF Analyzer (Carl Zeiss Meditec, Dublin, CA). Eyes were stratified into 3 glaucoma stages by means of the mean deviation (MD): better than -6 decibels (dB), worse than -6 dB and better than -12 dB, and worse than -12 dB. Each hemifield was divided into 5 regions according to the Glaucoma Hemifield Test (GHT): central, paracentral, nasal, and peripheral arcuates 1 and 2. Point-wise and region-wise asymmetric patterns of VF loss and rate of VF loss were identified by comparing the values in the superior hemifield and the inferior hemifield at each severity level using a generalized estimating equation. RESULTS The mean age of the patients was 60.2±10.3 years (mean ± standard deviation [SD]). The rate of MD loss, for all eyes taken together, was -0.11 dB/year. In the cross-sectional analysis, in eyes in the early and moderate stages, central and peripheral arcuate 2 regions in the superior hemifield were worse than their inferior counterpart, whereas in the advanced stage all GHT regions in the superior hemifield were significantly worse than the corresponding regions in the inferior hemifield (P ≤ 0.05). In the longitudinal analysis, there was no significant difference in the rate of VF loss between the GHT regions in the superior and inferior hemifields. CONCLUSIONS Our findings suggest that in POAG, VF damage is worse in the superior hemifield than in the inferior hemifield.
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Affiliation(s)
- Siamak Yousefi
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee.
| | | | - Saeedeh Pourahmad
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Koenraad A Vermeer
- Rotterdam Ophthalmic Institute, The Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - Hans G Lemij
- Rotterdam Ophthalmic Institute, The Rotterdam Eye Hospital, Rotterdam, The Netherlands
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Visual Subfield Progression in Glaucoma Subtypes. J Ophthalmol 2018; 2018:7864219. [PMID: 29750123 PMCID: PMC5883978 DOI: 10.1155/2018/7864219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 01/18/2018] [Indexed: 12/18/2022] Open
Abstract
Purpose To investigate visual field progression pattern and factors associated with progression in patients with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), and chronic angle-closure glaucoma (CACG). Methods The raw data of the 30-2 Humphrey Field Analyzer from glaucoma patients with definite visual field progression were processed with pointwise linear regression (PLR) analysis. The rate of change of retinal threshold sensitivity in the ten glaucoma hemifield test (GHT) zones, the upper and the lower hemifields, and the whole field was evaluated and was correlated with patients' basic demographic data. Results An average follow-up of 6.94 ± 2.69 years that showed the rate of change of visual field threshold sensitivity was correlated with the peak posttreatment intraocular pressure (IOP) and the long-term IOP fluctuations in all GHT zones except in the inferior arcuate area. The baseline IOP, the trough posttreatment IOP, the refractive status, and the CCT were not correlated with VF progression. Conclusion The rate of visual field progression was correlated with the peak posttreatment IOP and the long-term IOP fluctuation but with subfield differences.
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Abstract
Automated perimetry still represents the gold standard in long term glaucoma monitoring. On a daily practice basis, glaucoma progression analysis could be difficult due to the long time needed to detect, confirm, and quantify the progression rate. Moreover, "trend" and "event" analysis require a good theoretical basis to perform and interpret. Aim of study was to present an alternative method to conventional Glaucoma Progression Analysis (Humphrey Visual Field Analyzer, Carl Zeiss® Inc.) applied for the early detection of glaucoma progression. Such an "event" analysis orients the clinician in a fast manner on the progression profile in glaucoma patients and might adapt the follow up visits accordingly. Method and material: 41 eyes from 41 patients with open angle glaucoma were studied in a longitudinal manner, over a 24 months' time interval from diagnosis. Results: in the GPA analysis, a positive "event" (progression) was detected in 11/ 41 eyes (26.82%). Non-parametric analysis confirmed progression in all GPA cases, and additionally found 8 more eyes with positive progression (46.34% studied eyes). Mc Nemar concordance analysis between tests was good and relevant (kappa index k=0.596, p=0.000), with positive correlation (r=0.652, p=0.008). In conclusion, NPA tends to overestimate the number of progression cases in a cohort, but it can easily orient the clinician on the profile of the followed patients. In the first years, the GPA analysis can be highly inaccurate, but there is a great need to detect which patients are at significant risk for vision loss (fast progressors). Yet, combining the two methods of detection of glaucoma progression, the practitioners might direct their selected interest and attention towards observing a larger than expected number of patients who are at risk for vision loss over time due to glaucoma, but not necessarily in a fast manner.
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Affiliation(s)
- Anca Pantalon
- Ophthalmology Clinic, "Sf. Spiridon" University Hospital, Iași, Romania
| | - Crenguța Feraru
- Surgery Department, Ophthalmology Unit, "Gr. T. Popa" University of Medicine and Pharmacy, Iași, Romania
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Clinical Outcomes and Intraocular Pressure Control After Scleral-glued Intraocular Lens Insertion in Eyes With Pseudoexfoliation. J Glaucoma 2018; 27:164-169. [DOI: 10.1097/ijg.0000000000000839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schweitzer C. [Pseudoexfoliation syndrome and pseudoexfoliation glaucoma]. J Fr Ophtalmol 2018; 41:78-90. [PMID: 29329947 DOI: 10.1016/j.jfo.2017.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/16/2017] [Indexed: 01/26/2023]
Abstract
Pseudoexfoliation syndrome is an age-related systemic disease that mainly affects the anterior structures of the eye. Despite a worldwide distribution, reported incidence and prevalence of this syndrome vary widely between ethnicities and geographical areas. The exfoliative material is composed mainly of abnormal cross-linked fibrils that accumulate progressively in some organs such as the heart, blood vessels, lungs or meninges, and particularly in the anterior structures of the eye. The exact pathophysiological process still remains unclear but the association of genetic and environmental factors are thought to play a role in the development and progressive extracellular accumulation of exfoliative material. Hence, LOXL1 gene polymorphisms, responsible for metabolism of some components of elastic fibers and extracellular matrix, and increased natural exposure to ambient ultraviolet or caffeine consumption have been associated with pseudoexfoliation syndrome. Ophthalmological manifestations are commonly bilateral with an asymmetric presentation and can lead to severe visual impairment and blindness more frequently than in the general population, mainly related to glaucoma and cataract. Pseudoexfoliation glaucoma is a major complication of pseudoexfoliation syndrome and represents the main cause of identifiable glaucoma worldwide. Visual field progression is more rapid than that observed in primary open angle glaucoma, and filtering surgery is more frequently required. Nuclear cataract is more frequent and occurs earlier than in the general population. Owing to poorer pupil dilation and increased zonular instability, cataract surgery with pseudoexfoliation is associated with a 5- to 10-fold increase in surgical complications compared to cataract surgery without pseudoexfoliation. Some specific treatments targeting production, formation or accumulation of exfoliative material could improve the prognosis of this syndrome.
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Affiliation(s)
- C Schweitzer
- Service d'ophtalmologie, CHU de Bordeaux, 33000 Bordeaux, France; UMR 1219, Inserm, Bordeaux Population Health Research Center, team LEHA, université Bordeaux, 33000 Bordeaux, France.
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Optic Disc Characteristics and Visual Field Progression in Normal Tension Glaucoma Patients With Tilted Optic Discs. J Glaucoma 2017; 25:901-907. [PMID: 27755347 DOI: 10.1097/ijg.0000000000000565] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF THE STUDY The purpose of the study was to evaluate the optic disc characteristics associated with visual field (VF) progression in normal tension glaucoma (NTG) eyes with tilted optic discs. METHODS Sixty-six eyes of 66 NTG patients with tilted optic disc were included in this cross-sectional study, who were examined by at least 5 Humphrey 30-2 VFs. Glaucomatous VF progression was evaluated using pointwise linear regression. Optic nerve heads were scanned with enhanced-depth imaging optical coherence tomography (EDI-OCT), and evaluated for the focal lamina cribrosa (LC) defects and LC thicknesses. Optic disc torsion degrees and tilt ratios were measured from disc photographs. Logistic regression analyses were used to identify the risk factors for VF progression and focal LC defects. RESULTS Multivariate analysis showed that VF progression was associated with the presence of focal LC defects and greater number of VFs. The eyes with focal LC defects were associated with greater torsion degree and tilt ratio in multivariate analysis. The VF mean deviation slopes and localized VF progression rates in eyes with focal LC defects were greater than those without defects. CONCLUSIONS The greater optic disc tilt and torsion in NTG eyes with tilted optic disc were associated with focal LC defects, but not with VF progression. The focal LC defects were associated with VF progression. This study suggests that the focal LC defects in NTG patients with tilted optic disc may be an independent risk factor for glaucomatous VF progression, and the development of focal LC defects could be influenced by optic disc torsion or tilt.
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Tojo N, Abe S, Miyakoshi M, Hayashi A. Comparison of intraocular pressure fluctuations before and after ab interno trabeculectomy in pseudoexfoliation glaucoma patients. Clin Ophthalmol 2017; 11:1667-1675. [PMID: 28979095 PMCID: PMC5606685 DOI: 10.2147/opth.s143061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Ab interno trabeculectomy (AIT) with the Trabectome has been shown to reduce intraocular pressure (IOP) in eyes with pseudoexfoliation (PEX) glaucoma. Here, we examined the change of IOP fluctuations before and after only AIT or AIT with cataract surgery in PEX patients using the contact lens sensor Triggerfish®. METHODS This was a prospective open-label study. Twenty-four consecutive patients with PEX glaucoma were included. Twelve patients underwent cataract surgery and AIT (triple-surgery group), and 12 patients underwent only AIT (single-surgery group). In each eye, IOP fluctuations over 24 h were measured with the contact lens sensor before and at 3 months after the surgery. We compared the change of IOP fluctuation before and after operation. We also evaluated the difference in IOP changes between the triple- and single-surgery groups. RESULTS At 3 months after the surgeries, the mean IOP was significantly reduced from 23.5±6.5 mmHg to 14.6±2.8 mmHg in the single-surgery group and from 22.5±3.0 mmHg to 11.5±2.9 mmHg in the triple-surgery group. The mean IOP reduction rate was significantly higher in the triple-surgery group compared to the single-surgery group (p=0.0358). In both groups, the mean range of IOP fluctuations was significantly decreased during nocturnal periods. The mean range of 24 h IOP fluctuations was decreased in the triple-surgery group (p=0.00425), not in the single-surgery group (p=0.970). CONCLUSION Triple surgery could decrease IOP value and the IOP fluctuations to a greater extent than single surgery in PEX glaucoma patients.
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Affiliation(s)
- Naoki Tojo
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Shinya Abe
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Mari Miyakoshi
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Atsushi Hayashi
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
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Verma S, Nongpiur ME, Atalay E, Wei X, Husain R, Goh D, Perera SA, Aung T. Visual Field Progression in Patients with Primary Angle-Closure Glaucoma Using Pointwise Linear Regression Analysis. Ophthalmology 2017; 124:1065-1071. [DOI: 10.1016/j.ophtha.2017.02.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/16/2017] [Accepted: 02/22/2017] [Indexed: 10/19/2022] Open
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Sawada A, Manabe Y, Yamamoto T, Nagata C. Long-term clinical course of normotensive preperimetric glaucoma. Br J Ophthalmol 2017; 101:1649-1653. [PMID: 28416494 DOI: 10.1136/bjophthalmol-2016-309401] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 11/30/2016] [Accepted: 03/24/2017] [Indexed: 11/04/2022]
Abstract
AIMS To evaluate the long-term clinical course of normotensive preperimetric glaucoma (PPG). METHODS We retrospectively analysed 130 eyes of 130 patients initially diagnosed as having preperimetric normal tension glaucoma and followed these cases for at least 5 years with reliable visual field (VF) examinations by standard automated perimetry. When the VF defect (VFD) met Anderson-Patella's criteria on three or more consecutive examinations, and consistently met the criteria on subsequent examinations, we concluded that a glaucomatous VFD was present. Predictive factors for developing a VFD were assessed. RESULTS Seventy-one eyes (54.6%) developed a glaucomatous VFD during the follow-up period. The mean deviation slope varied from -0.90 to 0.41 dB/year. A Cox proportional hazard model showed that having a greater initial pattern SD (p=0.005), the presence of optic disc haemorrhage (p=0.022) and higher mean intraocular pressure (IOP) prior to developing a VFD (p=0.039) were related to developing a VFD. CONCLUSIONS Our findings confirmed that the mean IOP, but not the IOP fluctuation, is strongly associated with the development of a VFD in cases of PPG.
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Affiliation(s)
- Akira Sawada
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yusuke Manabe
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tetsuya Yamamoto
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Chisato Nagata
- Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
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Feraru C, Chiseliţă D, Pantalon A. Long-term progression and risk factors in primary open-angle glaucoma in clinical care. SPEKTRUM DER AUGENHEILKUNDE 2016. [DOI: 10.1007/s00717-016-0315-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fluctuations of the Intraocular Pressure in Pseudoexfoliation Syndrome and Normal Eyes Measured by a Contact Lens Sensor. J Glaucoma 2016; 25:e463-8. [DOI: 10.1097/ijg.0000000000000292] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Geeraerts E, Dekeyster E, Gaublomme D, Salinas-Navarro M, De Groef L, Moons L. A freely available semi-automated method for quantifying retinal ganglion cells in entire retinal flatmounts. Exp Eye Res 2016; 147:105-113. [PMID: 27107795 DOI: 10.1016/j.exer.2016.04.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/08/2016] [Accepted: 04/18/2016] [Indexed: 01/13/2023]
Abstract
Glaucomatous optic neuropathies are characterized by progressive loss of retinal ganglion cells (RGCs), the neurons that connect the eye to the brain. Quantification of these RGCs is a cornerstone in experimental optic neuropathy research and commonly performed via manually quantifying parts of the retina. However, this is a time-consuming process subject to inter- and intra-observer variability. Here we present a freely available ImageJ script to semi-automatically quantify RGCs in entire retinal flatmounts after immunostaining for the RGC-specific transcription factor Brn3a. The blob-like signal of Brn3a-immunopositive RGCs is enhanced via eigenvalues of the Hessian matrix and the resulting local maxima are counted as RGCs. After the user has outlined the retinal flatmount area, the total RGC number and retinal area are reported and an isodensity map, showing the RGC density distribution across the retina, is created. The semi-automated quantification shows a very strong correlation (Pearson's r ≥ 0.99) with manual counts for both widefield and confocal images, thereby validating the data generated via the developed script. Moreover, application of this method in established glaucomatous optic neuropathy models such as N-methyl-D-aspartate-induced excitotoxicity, optic nerve crush and laser-induced ocular hypertension revealed RGC loss conform with literature. Compared to manual counting, the described automated quantification method is faster and shows user-independent consistency. Furthermore, as the script detects the RGC number in entire retinal flatmounts, the method allows detection of regional differences in RGC density. As such, it can help advance research investigating the degenerative mechanisms of glaucomatous optic neuropathies and the effectiveness of new neuroprotective treatments. Because the script is flexible and easy to optimize due to a low number of critical parameters, it can potentially be applied in combination with other tissues or alternative labeling protocols.
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Affiliation(s)
- E Geeraerts
- Laboratory of Neural Circuit Development and Regeneration, Animal Physiology and Neurobiology Section, Department of Biology, KU Leuven, Leuven, Belgium
| | - E Dekeyster
- Laboratory of Neural Circuit Development and Regeneration, Animal Physiology and Neurobiology Section, Department of Biology, KU Leuven, Leuven, Belgium
| | - D Gaublomme
- Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre, Ghent University, Ghent, Belgium; Laboratory for Molecular Immunology and Inflammation, Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - M Salinas-Navarro
- Laboratory of Neural Circuit Development and Regeneration, Animal Physiology and Neurobiology Section, Department of Biology, KU Leuven, Leuven, Belgium
| | - L De Groef
- Laboratory of Neural Circuit Development and Regeneration, Animal Physiology and Neurobiology Section, Department of Biology, KU Leuven, Leuven, Belgium
| | - L Moons
- Laboratory of Neural Circuit Development and Regeneration, Animal Physiology and Neurobiology Section, Department of Biology, KU Leuven, Leuven, Belgium.
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Malik R, O'Leary N, Mikelberg FS, Balazsi AG, LeBlanc RP, Lesk MR, Nicolela MT, Trope GE, Chauhan BC. Neuroretinal Rim Area Change in Glaucoma Patients With Visual Field Progression Endpoints and Intraocular Pressure Reduction. The Canadian Glaucoma Study: 4. Am J Ophthalmol 2016; 163:140-147.e1. [PMID: 26705093 DOI: 10.1016/j.ajo.2015.11.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/23/2015] [Accepted: 11/23/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare rim area rates in patients with and without the visual field (VF) progression endpoint in the Canadian Glaucoma Study and determine whether intraocular pressure (IOP) reduction following the endpoint altered rim area rate. DESIGN Prospective multicenter cohort study. METHODS setting: University hospitals. PATIENT POPULATION Two hundred and six patients with open-angle glaucoma were examined at 4-month intervals with standard automated perimetry and confocal scanning laser tomography. INTERVENTION After the endpoint, IOP was reduced by ≥20%. OUTCOME MEASURES Univariate analysis for change in rim area rate and multivariable analysis to adjust for independent covariates (eg, age, sex, and IOP). RESULTS Patients with an endpoint (n = 59) had a worse rim area rate prior to the endpoint compared to those without (n = 147; median [interquartile range]: -14 [-32, 11] × 10(-3) mm(2)/y and -5 [-14, 5] × 10(-3) mm(2)/y, respectively, P = .02). In univariate analysis, there was no difference in rim area rate before and after the endpoint (median difference [95% CI], 8 (-10, 24) × 10(-3) mm(2)/y), but the muItivariate analysis showed that IOP reduction >2 mm Hg after the endpoint was strongly linked to a reduction in rim area rate decline (8 × 10(-3) mm(2)/y for each additional 1 mm Hg reduction). CONCLUSIONS Patients with a VF endpoint had a median rim area rate that was nearly 3 times worse than those without an endpoint. Lower mean follow-up IOP was independently associated with a slower decline in rim area.
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Affiliation(s)
- Rizwan Malik
- Departments of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada
| | - Neil O'Leary
- Departments of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada
| | - Frederick S Mikelberg
- Departments of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - A Gordon Balazsi
- Department of Ophthalmology, McGill University, Montreal, Canada
| | - Raymond P LeBlanc
- Departments of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada
| | - Mark R Lesk
- Department of Ophthalmology, Université de Montréal, Montreal, Canada
| | - Marcelo T Nicolela
- Departments of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada
| | - Graham E Trope
- Departments of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Canada
| | - Balwantray C Chauhan
- Departments of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada.
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Aptel F, Aryal-Charles N, Giraud JM, El Chehab H, Delbarre M, Chiquet C, Romanet JP, Renard JP. Progression of visual field in patients with primary open-angle glaucoma - ProgF study 1. Acta Ophthalmol 2015; 93:e615-20. [PMID: 26095771 DOI: 10.1111/aos.12788] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 05/21/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the visual field rate of progression of patients with treated ocular hypertension (OHT) and primary open-angle glaucoma (POAG) in clinical practice, using the mean deviation (MD) and the visual field index (VFI). METHODS Non-interventional cohort study. From a large multicentre database representative of the French population, 441 eyes of 228 patients with treated OHT or POAG followed up at least 6 years with Humphrey 24.2 Sita-Standard visual field examination at least twice a year were identified. From initial data, eyes were classified in five groups: 121 with OHT, 188 with early glaucoma (MD greater than -6 dB), 45 with moderate glaucoma (MD -6 to -12 dB), 41 with advanced glaucoma (MD -12 to -18 dB) and 46 with severe glaucoma (MD less than -18 dB). Rate of progression during the follow-up period was calculated using the trend analysis of the Guided Progression Analysis software. RESULTS The mean duration of follow-up was 8.4 ± 2.7 years and the mean number of visual field, 18.4 ± 3.5. In eyes with OHT, rate of progression was -0.09 dB/year (-0.17%VFI/year). In eyes with POAG, rate of progression was -0.32 dB/year (-0.83%VFI/year) in eyes with early glaucoma, -0.52 dB/year (-1.81%VFI/year) in moderate glaucoma, -0.54 dB/year (-2.35%VFI/year) in advanced glaucoma and -0.45 dB/year (-1.97%VFI/year) in severe glaucoma. In eyes with POAG, a significant progression (p < 0.05) was detected in 159 of 320 eyes (49.7%) with trend analysis and 117 of 320 eyes (36.6%, likely progression) or 183 of 320 eyes (57.2%, possible and likely progression) with event analysis. CONCLUSIONS Primary open-angle glaucoma is a progressive disease in the majority of patients despite cautioned treatment and follow-up. The rate of progression varies greatly among subjects.
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Affiliation(s)
- Florent Aptel
- Department of Ophthalmology; CHU Grenoble; Université Grenoble Alpes; Grenoble France
| | - Nishal Aryal-Charles
- Department of Ophthalmology; CHU Grenoble; Université Grenoble Alpes; Grenoble France
| | | | | | - Maxime Delbarre
- Department of Ophthalmology; HIA du Val de Grâce; Paris France
| | - Christophe Chiquet
- Department of Ophthalmology; CHU Grenoble; Université Grenoble Alpes; Grenoble France
| | - Jean-Paul Romanet
- Department of Ophthalmology; CHU Grenoble; Université Grenoble Alpes; Grenoble France
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A Genetic Variant in TGFBR3-CDC7 Is Associated with Visual Field Progression in Primary Open-Angle Glaucoma Patients from Singapore. Ophthalmology 2015; 122:2416-22. [DOI: 10.1016/j.ophtha.2015.08.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/18/2015] [Accepted: 08/12/2015] [Indexed: 01/07/2023] Open
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Lu W, Hu H, Sévigny J, Gabelt BT, Kaufman PL, Johnson EC, Morrison JC, Zode GS, Sheffield VC, Zhang X, Laties AM, Mitchell CH. Rat, mouse, and primate models of chronic glaucoma show sustained elevation of extracellular ATP and altered purinergic signaling in the posterior eye. Invest Ophthalmol Vis Sci 2015; 56:3075-83. [PMID: 26024091 DOI: 10.1167/iovs.14-15891] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The cellular mechanisms linking elevated IOP with glaucomatous damage remain unresolved. Mechanical strains and short-term increases in IOP can trigger ATP release from retinal neurons and astrocytes, but the response to chronic IOP elevation is unknown. As excess extracellular ATP can increase inflammation and damage neurons, we asked if sustained IOP elevation was associated with a sustained increase in extracellular ATP in the posterior eye. METHODS No ideal animal model of chronic glaucoma exists, so three different models were used. Tg-Myoc(Y437H) mice were examined at 40 weeks, while IOP was elevated in rats following injection of hypertonic saline into episcleral veins and in cynomolgus monkeys by laser photocoagulation of the trabecular meshwork. The ATP levels were measured using the luciferin-luciferase assay while levels of NTPDase1 were assessed using qPCR, immunoblots, and immunohistochemistry. RESULTS The ATP levels were elevated in the vitreal humor of rats, mice, and primates after a sustained period of IOP elevation. The ecto-ATPase NTPDase1 was elevated in optic nerve head astrocytes exposed to extracellular ATP for an extended period. NTPDase1 was also elevated in the retinal tissue of rats, mice, and primates, and in the optic nerve of rats, with chronic elevation in IOP. CONCLUSIONS A sustained elevation in extracellular ATP, and upregulation of NTPDase1, occurs in the posterior eye of rat, mouse, and primate models of chronic glaucoma. This suggests the elevation in extracellular ATP may be sustained in chronic glaucoma, and implies a role for altered purinergic signaling in the disease.
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Affiliation(s)
- Wennan Lu
- Department of Anatomy and Cell Biology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - HuiLing Hu
- Department of Physiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States 3State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jean Sévigny
- Département de Microbiologie-Infectiologie et D'immunologie, Faculté de Médecine, Université Laval, and Centre de Recherche du CHU de Québec, Québec, Québec, Canada
| | - B'Ann T Gabelt
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, United States
| | - Paul L Kaufman
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, United States
| | - Elaine C Johnson
- Kenneth C. Swan Ocular Neurobiology Laboratory, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, United States
| | - John C Morrison
- Kenneth C. Swan Ocular Neurobiology Laboratory, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, United States
| | - Gulab S Zode
- Howard Hughes Medical Institute, University of Iowa, Iowa City, Iowa, United States 8Department of Cell Biology and Immunology, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Val C Sheffield
- Howard Hughes Medical Institute, University of Iowa, Iowa City, Iowa, United States
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Alan M Laties
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Claire H Mitchell
- Department of Anatomy and Cell Biology, University of Pennsylvania, Philadelphia, Pennsylvania, United States 2Department of Physiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Foulsham WS, Fu L, Tatham AJ. Prior rates of visual field loss and lifetime risk of blindness in glaucomatous patients undergoing trabeculectomy. Eye (Lond) 2015; 29:1353-9. [PMID: 26315699 DOI: 10.1038/eye.2015.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 07/17/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Trend-based analyses examining rates of visual field (VF) loss in glaucoma are useful for predicting risk of vision-related morbidity. Although patients with faster losses are likely to require treatment escalation, little is known about rates that might trigger a decision to intervene surgically. The aims of this study were to investigate prior rates of VF loss in patients attending for trabeculectomy and to estimate, in the absence of surgical intervention, lifetime risk of visual impairment, and blindness. PATIENTS AND METHODS A retrospective analysis of 117 eyes of 86 consecutive patients with glaucoma attending for trabeculectomy, including 53 patients referred from general ophthalmology clinics and 33 patients from specialist glaucoma clinics. Rates of change in standard automated perimetry mean deviation were examined using linear regression and random coefficient models. Risk of lifetime visual impairment and blindness was calculated using life expectancy data. RESULTS Mean age at surgery was 71.0±9.7 years. Patients were followed for 10.7±7.5 years prior to surgery with an average of seven useable fields per eye. On average patients referred from general clinics lost 1.04 dB/year compared with 0.77 dB/year in those referred from glaucoma clinics (P=0.070). Patients referred from general clinics had more medication changes prior to surgery (3.4 and 2.6 changes, respectively; P=0.004). Given Scottish life expectancy data, untreated, 61 eyes (52%) would have passed the threshold for visual impairment, whereas 40 (34%) would have passed the threshold demarcating blindness. CONCLUSION Patients attending for trabeculectomy had faster average rates of field loss prior to surgery than published values for the general glaucoma population with over one-third of eyes studied predicted to have become blind without intervention. Those managed by glaucoma specialists had fewer changes in medication and tended to slower rates of VF loss, although the latter did not reach statistical significance.
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Affiliation(s)
- W S Foulsham
- Department of Ophthalmology, Princess Alexandra Eye Pavilion, University of Edinburgh, Edinburgh, UK.,Forth Valley Royal Hospital, Larbert, UK
| | - L Fu
- Department of Ophthalmology, Princess Alexandra Eye Pavilion, University of Edinburgh, Edinburgh, UK
| | - A J Tatham
- Department of Ophthalmology, Princess Alexandra Eye Pavilion, University of Edinburgh, Edinburgh, UK
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Bowe A, Grünig M, Schubert J, Demir M, Hoffmann V, Kütting F, Pelc A, Steffen HM. Circadian Variation in Arterial Blood Pressure and Glaucomatous Optic Neuropathy--A Systematic Review and Meta-Analysis. Am J Hypertens 2015; 28:1077-82. [PMID: 25767134 DOI: 10.1093/ajh/hpv016] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/21/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Epidemiological studies have led to equivocal results concerning the role of arterial blood pressure as a risk factor for the development of glaucomatous damage and progressive visual field loss in glaucoma has been attributed to low nighttime blood pressure, especially when oral antihypertensives have been combined with beta-blocking eyedrops. In order to answer the question whether nocturnal blood pressure or blood pressure dip during ambulatory blood pressure monitoring are associated with progressive visual field loss we performed a systematic review and meta-analysis of studies in patients with primary open-angle glaucoma and normal tension glaucoma. METHODS After searching MEDLINE, the Cochrane Library, and EMBASE, only 5 studies could be found reporting information on the method of ambulatory blood pressure measurements, separate data for daytime and nighttime blood pressure, definition of nocturnal blood pressure dip, and assessment of visual fields over a period of at least 2 years. RESULTS There was no difference in mean systolic or diastolic diurnal and nocturnal blood pressure between patients with or without progressive visual field loss. The odds ratio for deteriorating visual fields over 2 years with nocturnal dips >10% in systolic or diastolic blood pressure was 3.32 (1.84-6.00) and 2.09 (1.20-3.64), respectively. Data allowing a separate analysis of over-dipping were not available. CONCLUSIONS Nocturnal blood pressure fall is a risk factor for progressive visual field loss in glaucoma. However, prospective studies are needed to define a tolerable degree of dipping. Antihypertensive therapy in glaucomatous patients should be controlled with ambulatory blood pressure monitoring.
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Affiliation(s)
- Andrea Bowe
- EbM Working Group, Clinic for Gastroenterology and Hepatology, University Hospital of Cologne, Cologne, Germany.
| | - Michael Grünig
- EbM Working Group, Clinic for Gastroenterology and Hepatology, University Hospital of Cologne, Cologne, Germany
| | - Jens Schubert
- EbM Working Group, Clinic for Gastroenterology and Hepatology, University Hospital of Cologne, Cologne, Germany
| | - Münevver Demir
- EbM Working Group, Clinic for Gastroenterology and Hepatology, University Hospital of Cologne, Cologne, Germany
| | - Vera Hoffmann
- EbM Working Group, Clinic for Gastroenterology and Hepatology, University Hospital of Cologne, Cologne, Germany
| | - Fabian Kütting
- EbM Working Group, Clinic for Gastroenterology and Hepatology, University Hospital of Cologne, Cologne, Germany
| | - Agnes Pelc
- EbM Working Group, Clinic for Gastroenterology and Hepatology, University Hospital of Cologne, Cologne, Germany
| | - Hans-Michael Steffen
- EbM Working Group, Clinic for Gastroenterology and Hepatology, University Hospital of Cologne, Cologne, Germany
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Kocatürk T, Bekmez S, Katrancı M, Çakmak H, Dayanır V. Long Term Results of Visual Field Progression Analysis in Open Angle Glaucoma Patients Under Treatment. Open Ophthalmol J 2015; 9:116-20. [PMID: 26311586 PMCID: PMC4541337 DOI: 10.2174/1874364101509010116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 04/14/2015] [Accepted: 04/14/2015] [Indexed: 11/22/2022] Open
Abstract
Purpose : To evaluate visual field progression with trend and event analysis in open angle glaucoma patients under treatment. Materials and Methods : Fifteen year follow-up results of 408 eyes of 217 glaucoma patients who were followed at Adnan Menderes University, Department of Ophthalmology between 1998 and 2013 were analyzed retrospectively. Visual field data were collected for Mean Deviation (MD), Visual Field Index (VFI), and event occurrence. Results : There were 146 primary open-angle glaucoma (POAG), 123 pseudoexfoliative glaucoma (XFG) and 139 normal tension glaucoma (NTG) eyes. MD showed significant change in all diagnostic groups (p<0.001). The difference of VFI between first and last examinations were significantly different in POAG (p<0.001), and XFG (p<0.003) but not in NTG. VFI progression rates were -0.3, -0.43, and -0.2 % loss/year in treated POAG, XFG, and NTG, respectively. The number of empty triangles were statistically different between POAG-NTG (p=0.001), and XFG-NTG (p=0.002) groups. The number of half-filled (p=0.002), and full-filled (p=0.010) triangles were significantly different between XFG-NTG groups. Conclusion : Functional long-term follow-up of glaucoma patients can be monitored with visual field indices. We herein report our fifteen year follow-up results in open angle glaucoma.
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Affiliation(s)
- Tolga Kocatürk
- Department of Ophthalmology, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Sinan Bekmez
- Department of Ophthalmology, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Merve Katrancı
- Department of Biostatistics, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Harun Çakmak
- Department of Ophthalmology, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Volkan Dayanır
- Department of Ophthalmology, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
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Kim KE, Jeoung JW, Kim DM, Ahn SJ, Park KH, Kim SH. Reply: To PMID 25448320. Am J Ophthalmol 2015; 159:816-7. [PMID: 25773286 DOI: 10.1016/j.ajo.2015.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/12/2015] [Indexed: 10/23/2022]
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Kim KE, Jeoung JW, Kim DM, Ahn SJ, Park KH, Kim SH. Long-term follow-up in preperimetric open-angle glaucoma: progression rates and associated factors. Am J Ophthalmol 2015; 159:160-8.e1-2. [PMID: 25448320 DOI: 10.1016/j.ajo.2014.10.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 10/07/2014] [Accepted: 10/07/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the rate of progressive visual field (VF) loss and associated factors for structural or functional progression in preperimetric open-angle glaucoma (OAG). DESIGN Longitudinal, observational study. METHODS We included 127 eyes of 127 preperimetric OAG patients who were treated with topical medication and followed for more than 5 years. All patients underwent stereo optic disc photography, red-free retinal nerve fiber layer (RNFL) photography, frequency doubling technology perimetry, and standard automated perimetry (SAP). Progression was defined as a structural (glaucomatous change confirmed by stereo optic disc and red-free RNFL photography) or functional (new glaucomatous defect on SAP) deterioration. The progression rate of SAP mean deviation (dB/year) and factors associated with progression were evaluated. RESULTS Glaucoma progression was detected in 72 of 127 eyes (56.7%). Mean rate of VF progression was -0.39 ± 0.64 dB/year in all patients; -0.66 ± 0.60 dB/year in progressors and -0.03 ± 0.24 dB/year in nonprogressors. A multivariate Cox proportional hazard model revealed that optic disc hemorrhage (hazard ratio [HR] = 1.718, P = .031) and the percentage reduction in intraocular pressure (IOP; HR = 0.964, P = .002) were significantly associated with disease progression. Patients with disc hemorrhage had a greater cumulative probability of progression than those without disc hemorrhage (P = .014 by log-rank test). CONCLUSIONS Our results support the importance of lowering IOP, even at the preperimetric stage. Preperimetric glaucoma patients with disc hemorrhage and insufficient IOP control should be carefully monitored for greater risk of progression.
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Affiliation(s)
- Ko Eun Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea.
| | - Dong Myung Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
| | - Seong Joon Ahn
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea; Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
| | - Seok Hwan Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea; Department of Ophthalmology, Seoul National University Boramae Hospital, Seoul, South Korea
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Åström S, Stenlund H, Lindén C. Diagnosed open-angle glaucoma in screened versus unscreened subjects--a long-term age cohort study. Acta Ophthalmol 2014; 92:501-6. [PMID: 25259395 DOI: 10.1111/aos.12291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate and compare the cumulative incidence of diagnosed open-angle glaucoma (OAG) in an age cohort of elderly people, of which one group was screened. METHODS Cohort study comprising all 856 individuals born in 1915 and living in the municipality of Skellefteå in1981. A randomly selected subgroup of the cohort (40%) was repeatedly screened, and suspected OAG cases were followed until 2002 for the development of OAG. Medical records were collected and analysed for OAG. The numbers of OAG cases were compared between the screened group and the remaining part of the cohort (the unscreened group). RESULTS The cohort consisted of 339 screened and 517 unscreened persons. Before 1981, there were six known cases of OAG in the screened group and nine cases in the unscreened group. During the follow-up from 1981 to 2002, there were 33 new cases in the screened group and 31 new cases of OAG in the unscreened group. The incidence of diagnosed OAG in women was higher in the screened group than in the unscreened group, incidence rate ratio = 1.94 (p = 0.035). In contrast, the cumulative incidence of diagnosed OAG in men was similar in the two groups (p = 0.58). For the whole population, there was no significant difference (p = 0.053). CONCLUSION In this population with a high prevalence of PEX and increased risk for glaucoma, there was a non-significant difference between the screened and unscreened groups regarding the proportion of diagnosed OAG. The failure to reach significance may be due to the limited sample size. OAG was diagnosed twice as often among women in the screened group than in the unscreened group.
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Affiliation(s)
- Siv Åström
- Department of Clinical Sciences, Ophthalmology; Umeå University; Umeå Sweden
| | - Hans Stenlund
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health; Umeå University; Umeå Sweden
| | - Christina Lindén
- Department of Clinical Sciences, Ophthalmology; Umeå University; Umeå Sweden
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Kirwan JF, Hustler A, Bobat H, Toms L, Crabb DP, McNaught AI. Portsmouth visual field database: an audit of glaucoma progression. Eye (Lond) 2014; 28:974-9. [PMID: 24875227 DOI: 10.1038/eye.2013.294] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 11/11/2013] [Indexed: 11/09/2022] Open
Abstract
AIM To explore visual field (VF) progression in a cohort of secondary care-treated glaucoma and ocular hypertensive (OHT) patients. METHODS We extracted VFs from our database drawn from our normal clinical practice. VF series from 4177 eyes from 2208 patients who had five or more VFs were obtained, the 'better' eye was selected and the rate of VF progression was calculated using mean deviation (MD) data. RESULTS The median rate of progression for the whole sample was -0.1 dB/year (interquartile range (IQR) -4 to 0 dB/year) over a median of 6.7 years (IQR 4.9-8.7). Of 2208 patients, 477 (21.2%) progressed at > -0.5 dB/year; 46 (2.1%) progressed at >-2.0 dB/year. Of those with a 'final MD' of worse than -10 dB (N=244) in their better eye; 14.0% were 'fast progressors' (>-2 dB/year), 33.7% 'moderate progressors' (-1 to -2 dB/year), and 28.8% 'slow progressors' (-0.3 dB to -1 dB/year). Of those with 'initial MD' better than -3 dB and those with worse than -3 dB, 31/1679 (1.8%) and 213/529 (40.3%) respectively, had a final MD of worse than -10 dB. CONCLUSION Fast progressors, while important, are relatively rare. Moderate and slow progressors make up the majority of the progressing population within this data set. The risk of significant visual loss is much higher in those with initial damage. With increasing life expectancy, moderate and slow progressors may become increasingly clinically important.
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Affiliation(s)
- J F Kirwan
- Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, UK
| | - A Hustler
- Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, UK
| | - H Bobat
- Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, UK
| | - L Toms
- Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, UK
| | - D P Crabb
- Department of Optometry and Visual Science, City University London, London, UK
| | - A I McNaught
- Ophthalmology Department, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Cheltenham, UK
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Jeong JH, Park KH, Jeoung JW, Kim DM. Preperimetric normal tension glaucoma study: long-term clinical course and effect of therapeutic lowering of intraocular pressure. Acta Ophthalmol 2014; 92:e185-93. [PMID: 24456145 DOI: 10.1111/aos.12277] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 08/22/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to investigate the long-term clinical course of normotensive preperimetric glaucoma (PPG). METHODS The medical records of 71 eyes of 71 patients with normotensive PPG who underwent intraocular pressure (IOP)-lowering therapy were reviewed retrospectively. The patients had been regularly followed up at 3- to 6-month intervals between 1996 and 2011. Progression was evaluated by comparing the structural changes of serial stereoscopic colour disc and red-free retinal nerve fibre layer (RNFL) photographs and by comparing serial visual field (VF) test results for functional changes. RESULTS Over an average follow-up period of 6.8 years, 41 eyes (57.7%) showed progression in either structural or functional evaluation. Disc haemorrhage (DH) was observed significantly more frequently in the progressing group (p < 0.005); however, there were no differences in mean age, gender ratio, follow-up period and ocular characteristics at baseline such as IOP, RNFL defects and global indices of VF between the non-progressing and progressing groups. Thirty eyes (42.3%) showed significant angular widening of the localized RNFL defect towards the macula at a mean rate of approximately 1°/year. Perimetric glaucoma developed in 19 eyes (26.8%), and the rate of change in the mean deviation was -0.23 dB/year. Preperimetric glaucoma patients with DH or IOP reductions of <20% from the baseline had a higher probability of RNFL deterioration than patients without DH or IOP reductions of ≥20% from the baseline by multivariate analysis. CONCLUSION Although the rates of change were typically slow, more than half of normotensive patients with PPG showed statistically significant progressive structural or functional changes in medically treated cases. DH or IOP reductions of <20% from the baseline were shown as a significant risk factor for the progression of PPG.
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Affiliation(s)
- Jae Hoon Jeong
- Department of Ophthalmology; Seoul National University Hospital; Seoul Korea
| | - Ki Ho Park
- Department of Ophthalmology; Seoul National University Hospital; Seoul Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology; Seoul National University Hospital; Seoul Korea
| | - Dong Myung Kim
- Department of Ophthalmology; Seoul National University Hospital; Seoul Korea
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