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Ha A, Sun S, Kim YK, Jeoung JW, Kim HC, Park KH. Deep-learning-based prediction of glaucoma conversion in normotensive glaucoma suspects. Br J Ophthalmol 2024; 108:927-932. [PMID: 37918891 DOI: 10.1136/bjo-2022-323167] [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: 12/30/2022] [Accepted: 09/03/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND/AIMS To assess the performance of deep-learning (DL) models for prediction of conversion to normal-tension glaucoma (NTG) in normotensive glaucoma suspect (GS) patients. METHODS Datasets of 12 458 GS eyes were reviewed. Two hundred and ten eyes (105 eyes showing NTG conversion and 105 without conversion), followed up for a minimum of 7 years during which intraocular pressure (IOP) was lower than 21 mm Hg, were included. The features of two fundus images (optic disc photography and red-free retinal nerve fibre layer (RNFL) photography) were extracted by convolutional auto encoder. The extracted features as well as 15 clinical features including age, sex, IOP, spherical equivalent, central corneal thickness, axial length, average circumpapillary RNFL thickness, systolic/diastolic blood pressure and body mass index were used to predict NTG conversion. Prediction was performed using three machine-learning classifiers (ie, XGBoost, Random Forest, Gradient Boosting) with different feature combinations. RESULTS All three algorithms achieved high diagnostic accuracy for NTG conversion prediction. The AUCs ranged from 0.987 (95% CI 0.978 to 1.000; Random Forest trained with both fundus images and clinical features) and 0.994 (95% CI 0.984 to 1.000; XGBoost trained with both fundus images and clinical features). XGBoost showed the best prediction performance for time to NTG conversion (mean squared error, 2.24). The top three important clinical features for time-to-conversion prediction were baseline IOP, diastolic blood pressure and average circumpapillary RNFL thickness. CONCLUSION DL models, trained with both fundus images and clinical data, showed the potential to predict whether and when normotensive GS patients will show conversion to NTG.
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Affiliation(s)
- Ahnul Ha
- Department of Ophthalmology, Jeju National University, Jeju, Korea (the Republic of)
| | - Sukkyu Sun
- Department of AI Software Convergence, Dongguk University, Seoul, Korea (the Republic of)
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Hee Chan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
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2
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Iannucci V, Bruscolini A, Iannella G, Visioli G, Alisi L, Salducci M, Greco A, Lambiase A. Olfactory Dysfunction and Glaucoma. Biomedicines 2024; 12:1002. [PMID: 38790964 PMCID: PMC11117544 DOI: 10.3390/biomedicines12051002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Olfactory dysfunction is a well-known phenomenon in neurological diseases with anosmia and hyposmia serving as clinical or preclinical indicators of Alzheimer's disease, Parkinson's disease, and other neurodegenerative disorders. Since glaucoma is a neurodegenerative disease of the visual system, it may also entail alterations in olfactory function, warranting investigation into potential sensory interconnections. METHODS A review of the current literature of the last 15 years (from 1 April 2008 to 1 April 2023) was conducted by two different authors searching for topics related to olfaction and glaucoma. RESULTS three papers met the selection criteria. According to these findings, patients with POAG appear to have worse olfaction than healthy subjects. Furthermore, certain predisposing conditions to glaucoma, such as pseudoexfoliation syndrome and primary vascular dysregulation, could possibly induce olfactory changes that can be measured with the Sniffin Stick test. CONCLUSIONS the scientific literature on this topic is very limited, and the pathogenesis of olfactory changes in glaucoma is not clear. However, if the results of these studies are confirmed by further research, olfactory testing may be a non-invasive tool to assist clinicians in the early diagnosis of glaucoma.
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Affiliation(s)
| | | | | | | | | | | | | | - Alessandro Lambiase
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (V.I.); (A.B.); (G.I.); (G.V.); (L.A.); (M.S.); (A.G.)
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3
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Ho K, Bodi NE, Sharma TP. Normal-Tension Glaucoma and Potential Clinical Links to Alzheimer's Disease. J Clin Med 2024; 13:1948. [PMID: 38610712 PMCID: PMC11012506 DOI: 10.3390/jcm13071948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Glaucoma is a group of optic neuropathies and the world's leading cause of irreversible blindness. Normal-tension glaucoma (NTG) is a subtype of glaucoma that is characterized by a typical pattern of peripheral retinal loss, in which the patient's intraocular pressure (IOP) is considered within the normal range (<21 mmHg). Currently, the only targetable risk factor for glaucoma is lowering IOP, and patients with NTG continue to experience visual field loss after IOP-lowering treatments. This demonstrates the need for a better understanding of the pathogenesis of NTG and underlying mechanisms leading to neurodegeneration. Recent studies have found significant connections between NTG and cerebral manifestations, suggesting NTG as a neurodegenerative disease beyond the eye. Gaining a better understanding of NTG can potentially provide new Alzheimer's Disease diagnostics capabilities. This review identifies the epidemiology, current biomarkers, altered fluid dynamics, and cerebral and ocular manifestations to examine connections and discrepancies between the mechanisms of NTG and Alzheimer's Disease.
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Affiliation(s)
- Kathleen Ho
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Nicole E. Bodi
- Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Tasneem P. Sharma
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
- Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
- Stark Neurosciences Research Institute, Indianapolis, IN 46202, USA
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4
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Ramesh PV, Morya AK, Aradhya AK, Pannerselvam P, Gopalakrishnan ST, Ramesh SV, Devadas AK, Krishna N. Unveiling the silent link: Normal-tension glaucoma's enigmatic bond with cardiac blood flow. World J Cardiol 2024; 16:10-15. [PMID: 38313391 PMCID: PMC10835469 DOI: 10.4330/wjc.v16.i1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/14/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024] Open
Abstract
This comprehensive review embarks on a captivating journey into the complex relationship between cardiology and normal-tension glaucoma (NTG), a condition that continues to baffle clinicians and researchers alike. NTG, characterized by optic nerve damage and visual field loss despite normal intraocular pressure, has long puzzled clinicians. One emerging perspective suggests that alterations in ocular blood flow, particularly within the optic nerve head, may play a pivotal role in its pathogenesis. While NTG shares commonalities with its high-tension counterpart, its unique pathogenesis and potential ties to cardiovascular health make it a fascinating subject of exploration. It navigates through the complex web of vascular dysregulation, blood pressure and perfusion pressure, neurovascular coupling, and oxidative stress, seeking to uncover the hidden threads that tie the heart and eyes together in NTG. This review explores into the intricate mechanisms connecting cardiovascular factors to NTG, shedding light on how cardiac dynamics can influence ocular health, particularly in cases where intraocular pressure remains within the normal range. NTG's enigmatic nature, often characterized by seemingly contradictory risk factors and clinical profiles, underscores the need for a holistic approach to patient care. Drawing parallels to cardiac health, we examine into the shared vascular terrain connecting the heart and the eyes. Cardiovascular factors, including systemic blood flow, endothelial dysfunction, and microcirculatory anomalies, may exert a profound influence on ocular perfusion, impacting the delicate balance within the optic nerve head. By elucidating the subtle clues and potential associations between cardiology and NTG, this review invites clinicians to consider a broader perspective in their evaluation and management of this elusive condition. As the understanding of these connections evolves, so too may the prospects for early diagnosis and tailored interventions, ultimately enhancing the quality of life for those living with NTG.
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Affiliation(s)
- Prasanna Venkatesh Ramesh
- Department of Glaucoma and Research, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India.
| | - Arvind Kumar Morya
- Department of Ophthalmology, All India Institute of Medical Sciences, Hyderabad 508126, Telangana, India
| | - Ajanya K Aradhya
- Department of Optometry and Visual Science, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
| | | | | | - Shruthy Vaishali Ramesh
- Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
| | - Aji Kunnath Devadas
- Department of Optometry and Visual Science, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
| | - Navaneeth Krishna
- Department of Optometry and Visual Science, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
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5
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Zarzecki M, Obuchowska I, Ustymowicz A, Konopińska J. Glaucoma Surgery and Ocular Blood Flow in Colour Doppler Imaging: Is There a Link? Clin Ophthalmol 2024; 18:49-60. [PMID: 38205265 PMCID: PMC10778180 DOI: 10.2147/opth.s441805] [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: 09/24/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
Glaucoma is a common cause of blindness worldwide. This disease is characterised by increased intraocular pressure (IOP) and the concomitant disruption of ocular haemodynamic. Several studies have demonstrated that trabeculectomy is associated with changes in extraocular blood flow. In this study, we reviewed the available evidence on the use of colour Doppler imaging to evaluate and manage patients with open-angle glaucoma. We present the detailed anatomy of ocular blood flow to provide a background for the research findings. We also discuss the physiological foundations of ocular blood flow and detailed flow characteristics of specific extraocular vessels. Finally, we reviewed published studies that analysed the effects of glaucoma surgery on the blood flow parameters of the eye.
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Affiliation(s)
- Mateusz Zarzecki
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, Poland
| | - Iwona Obuchowska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, Poland
| | - Andrzej Ustymowicz
- Department of Radiology, Medical University of Bialystok, Bialystok, Poland
| | - Joanna Konopińska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, Poland
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6
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Salvetat ML, Pellegrini F, Spadea L, Salati C, Zeppieri M. Pharmaceutical Approaches to Normal Tension Glaucoma. Pharmaceuticals (Basel) 2023; 16:1172. [PMID: 37631087 PMCID: PMC10458083 DOI: 10.3390/ph16081172] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Normal tension glaucoma (NTG) is defined as a subtype of primary open-angle glaucoma (POAG) in which the intraocular pressure (IOP) values are constantly within the statistically normal range without treatment and represents approximately the 30-40% of all glaucomatous cases. The pathophysiology of this condition is multifactorial and is still not completely well known. Several theories have been proposed to explain the onset and progression of this disease, which can be divided into IOP-dependent and IOP-independent factors, suggesting different therapeutic strategies. The current literature strongly supports the fundamental role of IOP in NTG. The gold standard treatment for NTG tends to be based on the lowering IOP even if "statistically normal". Numerous studies have shown, however, that the IOP reduction alone is not enough to slow down or stop the disease progression in all cases, suggesting that other IOP-independent risk factors may contribute to the NTG pathogenesis. In addition to IOP-lowering strategies, several different therapeutic approaches for NTG have been proposed, based on vaso-active, antioxidant, anti-inflammatory and/or neuroprotective substances. To date, unfortunately, there are no standardized or proven treatment alternatives for NTG when compared to traditional IOP reduction treatment regimes. The efficacy of the IOP-independent strategies in decreasing the risk or treating NTG still remains inconclusive. The aim of this review is to highlight strategies reported in the current literature to treat NTG. The paper also describes the challenges in finding appropriate and pertinent treatments for this potentially vision-threatening disease. Further comprehension of NTG pathophysiology can help clinicians determine when to use IOP-lowering treatments alone and when to consider additional or alternatively individualized therapies focused on particular risk factors, on a case-by-case basis.
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Affiliation(s)
- Maria Letizia Salvetat
- Department of Ophthalmology, Azienda Sanitaria Friuli Occidentale, 33170 Pordenone, Italy
| | - Francesco Pellegrini
- Department of Ophthalmology, Azienda Sanitaria Friuli Occidentale, 33170 Pordenone, Italy
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, “Sapienza” University of Rome, 00142 Rome, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
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7
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Leveque AS, Bouisse M, Labarere J, Trucco E, Hogg S, MacGillivray T, Aptel F, Chiquet C. Retinal vessel architecture and geometry are not impaired in normal-tension glaucoma. Sci Rep 2023; 13:6713. [PMID: 37185916 PMCID: PMC10130140 DOI: 10.1038/s41598-023-33361-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
To investigate the associations between retinal vessel parameters and normal-tension glaucoma (NTG). We conducted a case-control study with a prospective cohort, allowing to record 23 cases of NTG. We matched NTG patient with one primary open-angle glaucoma (POAG) and one control per case by age, systemic hypertension, diabetes, and refraction. Central retinal artery equivalent (CRAE), central retinal venule equivalent (CRVE), Arteriole-To-Venule ratio (AVR), Fractal Dimension and tortuosity of the vascular network were measured using VAMPIRE software. Our sample consisted of 23 NTG, 23 POAG, and 23 control individuals, with a median age of 65 years (25-75th percentile, 56-74). No significant differences were observed in median values for CRAE (130.6 µm (25-75th percentile, 122.8; 137.0) for NTG, 128.4 µm (124.0; 132.9) for POAG, and 135.3 µm (123.3; 144.8) for controls, P = .23), CRVE (172.1 µm (160.0; 188.3), 172.8 µm (163.3; 181.6), and 175.9 µm (167.6; 188.4), P = .43), AVR (0.76, 0.75, 0.74, P = .71), tortuosity and fractal parameters across study groups. Vascular morphological parameters were not significantly associated with retinal nerve fiber layer thickness or mean deviation for the NTG and POAG groups. Our results suggest that vascular dysregulation in NTG does not modify the architecture and geometry of the retinal vessel network.
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Affiliation(s)
- Anne-Sophie Leveque
- Department of Ophthalmology, University Hospital of Grenoble, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 09, France
| | - Magali Bouisse
- Clinical Epidemiology Unit, Grenoble Alpes University Hospital, Grenoble, France
- Univ. Grenoble Alpes, CNRS, UMR 5525, TIMC, Grenoble, France
| | - José Labarere
- Clinical Epidemiology Unit, Grenoble Alpes University Hospital, Grenoble, France
- Univ. Grenoble Alpes, CNRS, UMR 5525, TIMC, Grenoble, France
| | - Emanuele Trucco
- VAMPIRE Project, Computing, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Stephen Hogg
- VAMPIRE Project, Computing, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Tom MacGillivray
- VAMPIRE Project, Centre for Clinical Brain Science, University of Edinburgh, Edinburgh, UK
| | - Florent Aptel
- Department of Ophthalmology, University Hospital of Grenoble, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 09, France
- Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, Grenoble, France
| | - Christophe Chiquet
- Department of Ophthalmology, University Hospital of Grenoble, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 09, France.
- Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, Grenoble, France.
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8
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Sex differences in the association between systemic oxidative stress status and optic nerve head blood flow in normal-tension glaucoma. PLoS One 2023; 18:e0282047. [PMID: 36827337 PMCID: PMC9955941 DOI: 10.1371/journal.pone.0282047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE To investigate the association of systemic oxidative stress markers and optic nerve head (ONH) blood flow in normal-tension glaucoma (NTG) patients, as well as sex differences in this association. METHODS This was a cross-sectional study of 235 eyes with NTG of 134 patients (56 male, 78 female; mean age, 60.9±14.1 years). Laser speckle flowgraphy (LSFG) was used to measure ONH blood flow (mean blur rate in the tissue area of the ONH; MBR-T) and LSFG pulse-waveform parameters, including flow acceleration index in the tissue area of the ONH (FAI-T). Oxidative stress markers, diacron-reactive oxygen metabolites (d-ROMs), and biological antioxidant potential (BAP) were measured with a free radical elective evaluator. Spearman's rank correlation test and a multivariate linear mixed-effect model were used to investigate factors associated with ONH blood flow. RESULTS MBR-T was significantly correlated with age (rs = -0.28, p < 0.001), mean arterial pressure (rs = -0.20, p = 0.002), intraocular pressure (rs = 0.24, p < 0.001), peripapillary retinal nerve fiber layer thickness (rs = 0.62, p < 0.001), and disc area (rs = -0.26, p < 0.001), but not with serum d-ROM level. Separate analyses of the subjects divided by sex showed that BAP was positively correlated to MBR-T (rs = 0.21, p = 0.036) and FAI-T (rs = 0.36, p < 0.001) only in male subjects. Similarly, BAP was significantly associated with MBR-T (β = 0.25, p = 0.026) and FAI-T (β = 0.37, p < 0.001) in male subjects in a multivariate linear mixed-effect model. CONCLUSION A lower serum antioxidant level, as indicated by BAP, was associated with reduced ONH blood flow only in male NTG patients. Our findings suggest that there are sex differences in the involvement of oxidative stress in the pathogenesis of reduced ocular blood flow in NTG.
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9
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Banou L, Dastiridou A, Giannoukas A, Kouvelos G, Baros C, Androudi S. The Role of Color Doppler Imaging in the Diagnosis of Glaucoma: A Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13040588. [PMID: 36832076 PMCID: PMC9954817 DOI: 10.3390/diagnostics13040588] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
Glaucoma is a progressive optic neuropathy and one of the leading causes of irreversible blindness worldwide. Elevated intraocular pressure (IOP) is the major risk factor for the onset and progression of glaucoma. In addition to elevated IOP, impaired intraocular blood flow is also considered to be involved in the pathogenesis of glaucoma. Various techniques have been used to assess ocular blood flow (OBF), including Color Doppler Imaging (CDI), a technique used in ophthalmology in recent decades. This article reviews the role of CDI in both the diagnosis and effective monitoring of glaucoma progression, presenting the protocol for imaging and its advantages, as well as the limitations of its use. Moreover, it analyzes the pathophysiology of glaucoma, focusing on vascular theory and its role in the onset and progression of the disease.
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Affiliation(s)
- Lamprini Banou
- Department of Ophthalmology, University of Thessaly, 41334 Larissa, Greece
| | - Anna Dastiridou
- Department of Ophthalmology, University of Thessaly, 41334 Larissa, Greece
- Correspondence:
| | | | - Georgios Kouvelos
- Department of Vascular Surgery, University of Thessaly, 41334 Larissa, Greece
| | - Christos Baros
- Department of Vascular Surgery, University of Thessaly, 41334 Larissa, Greece
| | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly, 41334 Larissa, Greece
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Van Eijgen J, Heintz A, van der Pluijm C, Delporte M, De Witte D, Molenberghs G, Barbosa-Breda J, Stalmans I. Normal tension glaucoma: A dynamic optical coherence tomography angiography study. Front Med (Lausanne) 2023; 9:1037471. [PMID: 36687434 PMCID: PMC9853195 DOI: 10.3389/fmed.2022.1037471] [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: 09/05/2022] [Accepted: 12/16/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose Vascular dysregulation seems to play a role in the pathogenesis of glaucoma, in particular normal tension glaucoma (NTG). The development of optical coherence tomography angiography (OCTA) enabled the measurement of the retinal microvasculature non-invasively and with high repeatability. Nonetheless, only a few studies transformed OCTA into a dynamic examination employing a sympathomimetic stimulus. The goal of this study was to use this dynamic OCTA exam (1) to differentiate healthy individuals from glaucoma patients and (2) to distinguish glaucoma subcategories, NTG and high-tension primary open angle glaucoma (POAG). Methods Retinal vessel density (VD) in NTG patients (n = 16), POAG patients (n = 12), and healthy controls (n = 14) was compared before and during a hand grip test with a hydraulic dynamometer. Results At baseline, mean peripapillary VD was lower in POAG and NTG (42.6 and 48.5%) compared to healthy controls (58.1%; p < 0.001) and higher in NTG compared to POAG (p = 0.024) when corrected for mean arterial pressure (MAP). Peripapillary and macular (superficial and deep) VD differences were found for gender, age, and baseline MAP. No change in VD occurred (pre-/post-stimulus) in any of the groups. Conclusion Retinal VD loss in glaucoma patients was confirmed and the necessity to correct for gender, age and especially MAP was established. Although replication in a larger population is necessary, OCTA might not be the most suitable method to dynamically evaluate the retinal microvasculature.
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Affiliation(s)
- Jan Van Eijgen
- Department of Neurosciences, Research Group of Ophthalmology, KU Leuven, Leuven, Belgium,Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
| | - Alexander Heintz
- Department of Neurosciences, Research Group of Ophthalmology, KU Leuven, Leuven, Belgium
| | - Claire van der Pluijm
- Department of Neurosciences, Research Group of Ophthalmology, KU Leuven, Leuven, Belgium
| | - Margaux Delporte
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | - Dries De Witte
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | - Geert Molenberghs
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | - João Barbosa-Breda
- Department of Neurosciences, Research Group of Ophthalmology, KU Leuven, Leuven, Belgium,Department of Surgery and Physiology, Cardiovascular R&D Centre - UnIC@RISE, University of Porto, Porto, Portugal,Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ingeborg Stalmans
- Department of Neurosciences, Research Group of Ophthalmology, KU Leuven, Leuven, Belgium,Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium,*Correspondence: Ingeborg Stalmans,
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11
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Shen WC, Huang BQ, Yang J. Regulatory mechanisms of retinal ganglion cell death in normal tension glaucoma and potential therapies. Neural Regen Res 2023; 18:87-93. [PMID: 35799514 PMCID: PMC9241424 DOI: 10.4103/1673-5374.344831] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Normal tension glaucoma (NTG) is a multifactorial optic neuropathy characterized by normal intraocular pressure, progressive retinal ganglion cell (RGC) death, and glaucomatous visual field loss. Recent studies have described the mechanisms underlying the pathogenesis of NTG. In addition to controlling intraocular pressure, neuroprotection and reduction of RGC degeneration may be beneficial therapies for NTG. In this review, we summarized the main regulatory mechanisms of RGC death in NTG, including autophagy, glutamate neurotoxicity, oxidative stress, neuroinflammation, immunity, and vasoconstriction. Autophagy can be induced by retinal hypoxia and axonal damage. In this process, ischemia can cause mutations of optineurin and activate the nuclear factor-kappa B pathway. Glutamate neurotoxicity is induced by the over-stimulation of N-methyl-D-aspartate membrane receptors by glutamate, which occurs in RGCs and induces progressive glaucomatous optic neuropathy. Oxidative stress also participates in NTG-related glaucomatous optic neuropathy. It impairs the mitochondrial and DNA function of RGCs through the apoptosis signal-regulating kinase-JUN N-terminal kinase pathway. Moreover, it increases inflammation and the immune response of RGCs. Endothelin 1 causes endothelial dysfunction and impairment of ocular blood flow, promoting vasospasm and glaucomatous optic neuropathy, as a result of NTG. In conclusion, we discussed research progress on potential options for the protection of RGCs, including TANK binding kinase 1 inhibitors regulating autophagy, N-methyl-D-aspartate receptor antagonists inhibiting glutamate toxicity, ASK1 inhibitors regulating mitochondrial function, and antioxidants inhibiting oxidative stress. In NTG, RGC death is regulated by a network of mechanisms, while various potential targets protect RGCs. Collectively, these findings provide insight into the pathogenesis of NTG and potential therapeutic strategies.
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12
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Shang X, Wang X, Zhou K, Pan X, Huang Q, Chu X, Hu C, Xu X, Liang Y. Faster Macular Vessel Density Loss in More Advanced Primary Open Angle Glaucoma Eyes. Ophthalmic Res 2022; 66:345-353. [PMID: 36380622 DOI: 10.1159/000526850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 08/14/2022] [Indexed: 12/23/2023]
Abstract
PURPOSE The aim of the study was to characterize and compare the longitudinal changes of macular vessel density (VD) in primary open angle glaucoma (POAG) eyes across different disease stages. METHODS This is a sub-analysis of a prospective cohort study. A total of 103 eyes (53 eyes in the mild stage, 50 eyes in the moderate-to-advanced stage) of 75 POAG patients followed for more than 1 year with at least 2 qualified optical coherence tomography (OCT) angiography (OCTA) images were included. The rates of macular VD change were determined by linear regression and compared using the generalized linear mixed models between groups. Mixed effect models were used to evaluate the demographic and ocular parameters associated with the VD loss rate. RESULTS With a mean follow-up time of 2.36 years, the rates of macular VD change were significantly different from zero in both groups. The rates of macular VD loss were significantly faster in moderate-to-advanced-stage group than in mild-stage group in whole image (-2.46%/year vs. -1.47%/year, p = 0.002);, superior hemifield (-2.42%/year vs. -1.30%/year, p = 0.001); parafovea (-2.35%/year vs. -1.26, p = 0.001); superior (-2.20%/year vs. -1.01%/year, p = 0.002), nasal (-2.41%/year vs. -1.04%/year, p = 0.001), inferior (-2.46%/year vs. -1.43%/year, p = 0.018), and temporal sectors (-2.32%/year vs. -1.58%/year, p = 0.012). Baseline mean deviation and OCT parameters were associated with the rates of macular VD loss. CONCLUSIONS OCTA measurements could detect vascular deterioration over time in POAG eyes at different stages. The rates of macular VD loss were significantly faster in more advanced POAG eyes.
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Affiliation(s)
- Xiao Shang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China,
- Glaucoma Research Institute of Wenzhou Medical University, Wenzhou, China,
- National Clinical Research Center for Ocular Diseases, Wenzhou, China,
| | - Xiaoyan Wang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Kun Zhou
- Department of Ophthalmology, Xi'an First Hospital, Xi'an, China
| | - Xiafei Pan
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiangjie Huang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Xizhong Chu
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Chengju Hu
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Xiang Xu
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Yuanbo Liang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- Glaucoma Research Institute of Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
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Chen X, Zhao Y, You S, Xia Q, Mo X, Yuan F. 7,8-Dihydroxyflavone Simultaneously Provides Neuroprotection of Retinal Explants and Proangiogenesis of Human Umbilical Vein Endothelial Cells via the Tropomyosin-Related Kinase Receptor B Signaling Pathway In Vitro. J Ocul Pharmacol Ther 2022; 38:635-644. [PMID: 36260383 DOI: 10.1089/jop.2022.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: This study aimed to investigate the simultaneous neuroprotective and proangiogenic effects of 7,8-dihydroxyflavone (7,8-DHF) and explore the potential underlying molecular mechanisms. Methods: A coculture system of rat retinal explants and human umbilical vein endothelial cells (HUVECs) was established to determine the optimal concentration of 7,8-DHF, promoting neurite regeneration and HUVEC proliferation. Subsequently, the neuroprotective effect, proangiogenesis properties, and action mechanism of 7,8-DHF at an optimal concentration were investigated. Results: The cell proliferation, survival, migration, tube formation and p-tropomyosin-related kinase receptor B (TrkB)/TrkB levels in HUVECs were significantly promoted by 5 μM 7,8-DHF. The ganglion cell layer neuron survival, neurite regeneration, and p-TrkB/TrkB levels in retinal explants were also significantly promoted by 5 μM 7,8-DHF. All of these pharmacological actions of 7,8-DHF were blocked by N-[2-[(2-oxoazepan-3-yl)carbamoyl]phenyl]-1-benzothiophene-2-carboxamide. Conclusions: 7,8-DHF yields neuroprotection of retinal explants and proangiogenesis of HUVECs through the TrkB signaling pathway in vitro.
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Affiliation(s)
- Xiangwu Chen
- Department of Ophthalmology, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Yingxi Zhao
- Department of Ophthalmology, Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shuqi You
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Qing Xia
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Xiaofen Mo
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Fei Yuan
- Department of Ophthalmology, Zhongshan Hospital of Fudan University, Shanghai, China
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14
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Maltsev DS, Kulikov AN, Burnasheva MA. Pulsatile Ocular Blood Flow Registered with Optical Coherence Tomography Angiography in Patients with High Intraocular Pressure. J Curr Ophthalmol 2022; 34:398-403. [PMID: 37180526 PMCID: PMC10170985 DOI: 10.4103/joco.joco_161_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/10/2022] [Accepted: 09/10/2022] [Indexed: 05/16/2023] Open
Abstract
Purpose To present a series of cases demonstrating pulsatile ocular blood flow registered with optical coherence tomography angiography (OCTA) and to describe the clinical characteristics of this phenomenon. Methods Seven primary open-angle glaucoma patients (eight eyes) were included, with a median age of 67.0 years (range, 39-73 years), who demonstrated alternating hypointense bands of OCTA flow signal on the macular scan at increased intraocular pressure (IOP). All patients received comprehensive ophthalmic examination, OCTA examination with RTVue-XR, and infrared video scanning laser ophthalmoscopy. Changes in retinal microcirculation were assessed on the raw OCTA scans as well as the resultant vessel density maps before and after IOP reduction. Results Median IOP in study eyes was 39.0 mmHg (range, 36-58 mmHg). Hypointense bands of OCTA flow signal were associated with arterial pulsation on video scanning laser ophthalmoscopy in all eyes and agreed with the heart rate and resulted in a spotted grid pattern of hypoperfusion on vessel density maps in seven eyes. Median vessel density in superficial capillary plexus and deep capillary plexus was 32.4% and 47.2%, respectively, at high IOP, and increased statistically significantly to 36.5% (P = 0.016) and 50.9% (P = 0.016), respectively, after IOP reduction. Conclusions Alternating hypointense flow signal bands on OCTA scans are possibly caused by the pulsatile character of retinal blood flow during the cardiac cycle in eyes with high IOP and may reflect the imbalance between IOP and perfusion pressure. This phenomenon is responsible for the reversible decrease of vessel density at high IOP.
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Affiliation(s)
- Dmitrii S. Maltsev
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
- Address for correspondence: Dmitrii S. Maltsev, Department of Ophthalmology, Military Medical Academy, 21, Botkinskaya Str., St. Petersburg 194 044, Russia. E-mail:
| | - Alexei N. Kulikov
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
| | - Maria A. Burnasheva
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
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15
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Wu X, Konieczka K, Liu X, Chen M, Yao K, Wang K, Flammer J. Role of ocular blood flow in normal tension glaucoma. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2022; 2:100036. [PMID: 37846223 PMCID: PMC10577859 DOI: 10.1016/j.aopr.2022.100036] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/06/2022] [Accepted: 02/14/2022] [Indexed: 10/18/2023]
Abstract
Background Normal tension glaucoma (NTG) is a multifactorial disease in the pathogenesis of which intraocular pressure (IOP)-independent factors play a key role. Main text There is considerable evidence that impairment of the ocular blood flow (OBF) is involved both in the onset and progression of this disease. With the development of the hypothesis of OBF in NTG, various imaging techniques have been developed to evaluate the OBF and blood vessels. Moreover, vascular dysregulation, which is a main factor in Flammer syndrome, was frequently observed in NTG patients. Disturbed OBF leads to increased oxidative stress, which plays an important role in the pathogenesis of glaucomatous optic neuropathy. These results suggested that IOP-independent management may provide alternative treatment options for NTG patients. Conclusions In this review, we mainly focus on the mechanisms of the abnormal OBF in NTG.
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Affiliation(s)
- Xingdi Wu
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Katarzyna Konieczka
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, Basel, 4031, Switzerland
| | - Xin Liu
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Min Chen
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Ke Yao
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Kaijun Wang
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Josef Flammer
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, Basel, 4031, Switzerland
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16
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Vinnett A, Kandukuri J, Le C, Cho KA, Sinha A, Asanad S, Thompson G, Chen V, Rege A, Saeedi OJ. Dynamic Alterations in Blood Flow in Glaucoma Measured with Laser Speckle Contrast Imaging. Ophthalmol Glaucoma 2022; 5:250-261. [PMID: 34673279 PMCID: PMC9013729 DOI: 10.1016/j.ogla.2021.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/30/2021] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the repeatability of blood flow velocity index (BFVi) metrics obtained with a recently Food and Drug Administration-cleared laser speckle contrast imaging device, the XyCAM RI (Vasoptic Medical, Inc), and to characterize differences in these metrics among control, glaucoma suspect, and glaucoma participants. DESIGN Prospective, observational study. PARTICIPANTS Forty-six participants: 20 control, 16 glaucoma suspect, and 10 glaucoma participants, 1 eye per participant. METHODS Key dynamic BFVi metrics-mean, peak, dip, volumetric rise index (VRI), volumetric fall index (VFI), time to rise (TtR), time to fall (TtF), blow-out time (BOT), skew, and acceleration time index-were measured in the optic disc, optic disc vessels, optic disc perfusion region, and macula in 4 imaging sessions on the same day. Intrasession and intersession variability were calculated using the coefficient of variation (CV) for each metric in each region of interest (ROI). Values for each dynamic BFVi variable were compared between glaucoma, glaucoma suspect, and control participants using bivariate and multivariate analysis. Pearson correlation coefficients were used to correlate each variable in each ROI with age, intraocular pressure, cup-to-disc ratio (CDR), mean deviation, pattern standard deviation, retinal nerve fiber layer thickness, and minimum rim width. MAIN OUTCOME MEASURES Coefficient of variation for the intrasession and intersession variability for each dynamic BFVi metric in each ROI and differences in each metric in each ROI between each diagnostic group. RESULTS Intersession CV for mean, peak, dip, VRI, VFI, TtR, and TtF ranged from 3.2 ± 2.5% to 11.0 ± 3.8%. Age, CDR, OCT metrics, and visual field metrics showed significant correlations with dynamic BFVi variables. Peak, mean, dip, VRI, and VFI were significantly lower in patients with glaucoma than in control participants in all ROIs except the fovea. These metrics also were significantly lower in glaucoma patients than glaucoma suspect patients in the disc vessels. CONCLUSIONS Dynamic blood flow metrics measured with the XyCAM RI are reliable, are associated with structural and functional glaucoma metrics, and are significantly different among glaucoma, glaucoma suspect, and control participants. The XyCAM RI may serve as an important tool in glaucoma management in the future.
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Affiliation(s)
- Alfred Vinnett
- Department of Ophthalmology and Visual Sciences, University of Maryland Baltimore, Baltimore, Maryland
| | | | - Christopher Le
- Department of Ophthalmology and Visual Sciences, University of Maryland Baltimore, Baltimore, Maryland
| | | | | | - Samuel Asanad
- Department of Ophthalmology and Visual Sciences, University of Maryland Baltimore, Baltimore, Maryland
| | - Ginger Thompson
- Department of Ophthalmology/Hamilton Eye Institute, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Victoria Chen
- Department of Ophthalmology and Visual Sciences, University of Maryland Baltimore, Baltimore, Maryland
| | | | - Osamah J Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland Baltimore, Baltimore, Maryland.
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17
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Shao SC, Su YC, Lai ECC, Chang KC, Lee CN, Hung MJ, Lai CC, Huang FC, Hung JH. Association between Sodium Glucose Co-transporter 2 Inhibitors and Incident Glaucoma in Patients with Type 2 Diabetes: A Multi-institutional Cohort Study in Taiwan. DIABETES & METABOLISM 2022; 48:101318. [PMID: 35017100 DOI: 10.1016/j.diabet.2022.101318] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE Type 2 diabetes (T2D) is an important risk factor for glaucoma, and sodium-glucose co-transporter 2 (SGLT2) inhibitors have been shown to protect the optic nerves. We therefore aimed to evaluate the association between SGLT2 inhibitors and incident glaucoma. METHODS This retrospective cohort study analyzed the largest multi-institutional electronic medical records database in Taiwan, containing data of over a million individuals. We included T2D patients newly prescribed SGLT2 inhibitors or glucagon-like peptide-1 receptor agonists (GLP-1 RAs) from 2016 to 2018. Our primary outcome was incident glaucoma diagnosis between initiation of SGLT2 inhibitors or GLP-1 RAs, and 31st March 2021. After applying inverse probability of treatment weighting (IPTW) to increase homogeneity between the two treatment groups, we estimated hazard ratios (HR) with 95% confidence intervals (CI) for the risk of glaucoma, based on Cox proportional hazards regression models. RESULTS We included 9,927 and 1,065 T2D patients who had been newly prescribed SGLT2 inhibitors or GLP-1 RAs, respectively. Lower risk of incident glaucoma was observed in patients receiving SGLT2 inhibitors (7.9 events per 1,000 person-years), compared to those receiving GLP-1 RAs (10.0 events per 1,000 person-years), with an HR of 0.81 (95% CI: 0.69-0.95). Multiple sensitivity analyses and a negative control outcome analysis confirmed the robustness of our main findings. CONCLUSION This study suggests that T2D patients newly prescribed SGLT2 inhibitors have a reduced risk of incident glaucoma, compared to those prescribed GLP-1 RAs, in clinical practice. Future prospective studies are suggested to confirm this association.
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Affiliation(s)
- Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Chen Su
- College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Cheng Chang
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pharmacy, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chaw-Ning Lee
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Jui Hung
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chi-Chun Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Fu-Chin Huang
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jia-Horung Hung
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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18
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Bayraktar S, İpek A, Takmaz T, Yildiz Tasci Y, Gezer MC. Ocular blood flow and choroidal thickness in ocular hypertension. Int Ophthalmol 2021; 42:1357-1368. [PMID: 34822054 DOI: 10.1007/s10792-021-02123-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 11/12/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Ocular hypertension (OHT) is a clinical entity characterized by elevated intraocular pressure (IOP) without optic nerve damage. In the presence of other risk factors, OHT may progress to glaucoma. This study aimed to evaluate ocular blood flow (OBF) and choroidal thickness (CT), which may be markers and/or risk factors that could assess the progression of OHT to glaucoma. MATERIAL AND METHODS Age and gender matched 60 eyes of 32 patients with OHT and 61 eyes of 31 control patients were included for this study. All participants underwent a detailed ophthalmological examination including best-corrected visual acuity, IOP measurement with Goldmann applanation tonometry, gonioscopy, optic nerve evaluation with 78 D lens, and visual field test with Humphrey visual field analyzer. Retinal nerve fiber layer, ganglion cell complex, and central corneal thickness measurements were performed by optical coherence tomography (OCT). CT was measured with OCT in the fovea, 1.5 mm, 2 mm, 2.5 mm nasal and temporal to the fovea and from nasal and temporal to the optic disk. OBF data including peak systolic velocity (PSV), end-diastolic velocity (EDV), resistivity index (RI) and pulsatility index (PI) were measured with color Doppler imaging (CDI) from the ophthalmic artery (OA), central retinal artery (CRA), medial and lateral branches of short posterior ciliary arteries (MPCA, LPCA). Systolic (SBP) and diastolic arterial blood pressure were also noted. RESULTS CT measurement at each point in the OHT group compared to the control group were found to be significantly thinner (p = 0.001). There was a decrement in CT from the fovea to the nasal and temporal retina in both groups. In the OHT group, there was a significant decrease in PSV and EDV of OA, CRA, MPCA, and LPCA, and a significant increase in PI and RI of measured arteries. (EDV p = 0.036, PI p = 0.006, RI p = 0.006 for OA and p = 0.001 for other arteries and all OBF measurements). There was a negative correlation between CT and age, IOP and axial length (AL) in OHT group (r = - 0.529, p = 0.001; r = - 0.258, p = 0.047; r = - 0.345, p = 0.007, respectively, for fovea). But there was no statistically significant correlation between CT and other measurements in the control group, except age (r = - 0.860 p = 0.001 for fovea). CONCLUSION We found that OBF decrement and choroidal thinning in OHT group compared with controls. Interpretation both of CT measurements with OCT and OBF parameters with CDI and new imaging technologies may help to prevent and reduce the possible optic nerve damage.
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Affiliation(s)
- Serdar Bayraktar
- Clinic of Ophthalmology, Ulucanlar Eye Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
| | | | - Tamer Takmaz
- Clinic of Ophthalmology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Yelda Yildiz Tasci
- Clinic of Ophthalmology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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19
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Comparison of Medical Comorbidity between Patients with Normal-Tension Glaucoma and Primary Open-Angle Glaucoma: A Population-Based Study in Taiwan. Healthcare (Basel) 2021; 9:healthcare9111509. [PMID: 34828558 PMCID: PMC8624536 DOI: 10.3390/healthcare9111509] [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: 09/06/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022] Open
Abstract
The objective was to investigate different comorbidities developed in normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG) patients. This was a case-control study, with 1489 people in the NTG group and 5120 people in the POAG group. Patient data were obtained from the Longitudinal Health Insurance Database 2010 (LHID2010) of Taiwan for the 2008-2013 period. The chi-square test was used to compare categorical variables, such as gender, income and urbanisation level, between NTG and POAG patients, and the two-tailed t test was used to compare continuity between the two groups. We use a multivariate logic regression model to assess the risk of each participant. The results are expressed in terms of odds ratio (OR) and 95% confidence intervals (CI). Patients with NTG had significantly higher proportions of hypotension (adjusted OR, 1.984; 95% CI, 1.128-3.490), sleep disturbances (adjusted OR, 1.323; 95% CI, 1.146-1.528), peptic ulcers (adjusted OR, 1.383; 95% CI, 1.188-1.609) and allergic rhinitis (adjusted OR, 1.484; 95% CI, 1.290-1.707) than those with POAG. Conversely, arterial hypertension (adjusted OR, 0.767; 95% CI, 0.660-0.893), diabetes (adjusted OR, 0.850; 95% CI, 0.728-0.993) and atopic dermatitis (adjusted OR, 0.869; 95% CI, 0.763-0.990) had a lower risk in the NTG group than in the POAG group. We found that comorbidities such a hypotension, sleep disturbances and peptic ulcer and allergic rhinitis are more highly associated to NTG than POAG.
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20
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Marino MJ, Gehlbach PL, Rege A, Jiramongkolchai K. Current and novel multi-imaging modalities to assess retinal oxygenation and blood flow. Eye (Lond) 2021; 35:2962-2972. [PMID: 34117399 PMCID: PMC8526664 DOI: 10.1038/s41433-021-01570-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/28/2021] [Accepted: 04/20/2021] [Indexed: 02/05/2023] Open
Abstract
Retinal ischemia characterizes the underlying pathology in a multitude of retinal diseases that can ultimately lead to vision loss. A variety of novel imaging modalities have been developed to characterize retinal ischemia by measuring retinal oxygenation and blood flow in-vivo. These technologies offer valuable insight into the earliest pathophysiologic changes within the retina and provide physicians and researchers with new diagnostic and monitoring capabilities. Future retinal imaging technologies with the capability to provide affordable, noninvasive, and comprehensive data on oxygen saturation, vasculature, and blood flow mechanics are needed. This review will highlight current and future trends in multimodal imaging to assess retinal blood flow and oxygenation.
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Affiliation(s)
- Michael J. Marino
- grid.415233.20000 0004 0444 3298Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD USA
| | - Peter L. Gehlbach
- grid.21107.350000 0001 2171 9311Retina Division, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Abhishek Rege
- grid.505446.6Vasoptic Medical, Inc., Baltimore, MD USA
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21
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Enhanced Physiological Stress Response in Patients with Normal Tension Glaucoma during Hypoxia. J Ophthalmol 2021; 2021:5826361. [PMID: 34430053 PMCID: PMC8049796 DOI: 10.1155/2021/5826361] [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: 07/20/2020] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate whether patients with normal tension glaucoma (NTG) show an enhanced stress response to reduced oxygen supply compared to age-matched healthy controls, measured by serum adrenaline and endothelin-1 (ET-1) levels and changes in distal finger temperature. Methods A thorough clinical characterization of patients with NTG and age-matched controls was performed prior to inclusion in the study. Twelve patients with NTG and eleven healthy controls met the inclusion criteria and were enrolled in the study. All subjects underwent a two-day investigation. Participants were randomly exposed to either hypoxia or normoxia during the first visit. Hypoxia or normoxia was induced for two hours through a tightly fitting face mask. In addition, the peripheral circulation was assessed with a thermographic camera. Blood samples were obtained before, during, and after hypoxia or normoxia to evaluate systemic stress molecules such as catecholamines and ET-1 levels. Results In patients with NTG, reduced oxygen supply induced an increase in peripheral blood adrenaline (p < 0.05) and a decrease during recovery (p < 0.01). A difference in distal finger temperature was shown in patients with NTG under hypoxia compared to normoxia (exposure: p < 0.05; recovery: p < 0.05). Hypoxia induced an increase in peripheral blood ET-1 levels in both groups (NTG: p < 0.01; controls: p < 0.05). Conclusion Patients with NTG had an enhanced physiological stress response as a consequence of hypoxia compared with age-matched controls. Although more studies are needed, the present study supports the involvement of vascular risk factors in the pathophysiology of NTG.
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22
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Lee T, Bae HW, Seong GJ, Kim CY, Lee SY. High Pulse Wave Velocity Is Associated With Decreased Macular Vessel Density in Normal-Tension Glaucoma. Invest Ophthalmol Vis Sci 2021; 62:12. [PMID: 34398200 PMCID: PMC8374976 DOI: 10.1167/iovs.62.10.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/14/2021] [Indexed: 01/27/2023] Open
Abstract
Purpose To investigate the relationship between pulse wave velocity (PWV) and retinal vessel density (VD) measured by optical coherence tomography angiography (OCTA) in patients with normal-tension glaucoma (NTG). Methods This retrospective study included 103 patients with NTG and 109 healthy controls who underwent glaucoma examination and PWV measurements. Each group was classified into two subgroups according to a brachial-ankle PWV of 1400 cm/s. NTG was diagnosed when the maximum untreated intraocular pressure was < 21 mmHg on three repeated measurements obtained at different times in the presence of glaucomatous optic discs (neuroretinal rim thinning and excavation), peripapillary retinal nerve fiber layer defects, and glaucomatous visual field defects. Healthy controls did not have glaucomatous optic discs or visual field defects and exhibited normal retinal nerve fiber layer thickness. The interval between glaucoma examination and PWV measurements did not exceed six months. Univariate and multivariate logistic regression analyses were performed to identify factors associated with high PWV. Results PWV was higher in the NTG group than in the control group, while peripapillary VD and macular VD (mVD) were lower (all P < 0.05). Stepwise logistic regression analysis revealed that high PWV was significantly associated with age, mean arterial pressure (MAP), and mVD in the NTG group. Meanwhile, high PWV was significantly associated with age, MAP, and low-density lipoprotein cholesterol levels in healthy controls. Conclusions High PWV is associated with decreased mVD in NTG patients, suggesting that systemic arterial stiffness might be involved in the pathogenesis of NTG.
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Affiliation(s)
| | - Hyoung Won Bae
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gong Je Seong
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chan Yun Kim
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Yeop Lee
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Republic of Korea
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Bhalla M, Heisler M, Mammo Z, Ju MJ, Sarunic MV, Navajas EV, Warner S, Schendel S, Gill KS. Investigation of the Peripapillary Choriocapillaris in Normal Tension Glaucoma, Primary Open-angle Glaucoma, and Control Eyes. J Glaucoma 2021; 30:682-689. [PMID: 33927150 DOI: 10.1097/ijg.0000000000001861] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/01/2021] [Indexed: 11/26/2022]
Abstract
PRECIS The peripapillary choriocapillaris (CC) was observed to be significantly impaired in normal tension glaucoma (NTG) subjects compared with normal controls using optical coherence tomography angiography (OCTA). PURPOSE The aim was to quantitatively evaluate the peripapillary CC in NTG, primary open-angle glaucoma (POAG), and control eyes using OCTA. MATERIALS AND METHODS Ninety eyes (30 controls, 30 NTG, and 30 POAG) from 73 patients were imaged using the Zeiss Plex Elite 9000. Five repeat 3×3 mm OCTA scans were acquired both nasally and temporally to the optic disc and subsequently averaged. Four CC flow deficit (FD) measures were calculated using the fuzzy C-means approach: FD density (FDD), mean FD size (MFDS), FD number (FDN), and FD area (FDA). RESULTS Temporal NTG CC parameters were associated with visual field index and mean deviation (P<0.05). The control group showed a significantly lower nasal FDD (nasal: 3.79±1.26%, temporal: 4.48±1.73%, P=0.03), FDN (nasal: 156.43±38.44, temporal: 178.40±45.68, P=0.02), and FDA (nasal: 0.22±0.08, temporal: 0.26±0.10, P=0.03) when compared with temporal optic disc. The NTG group showed a significantly higher FDD (NTG: 5.04±2.38%, control: 3.79±1.26%, P=0.03), FDN (NTG: 185.90±56.66, control: 156.43±38.44, P=0.04), and FDA (NTG: 0.30±0.14 mm2, control: 0.22±0.08 mm2, P=0.03) nasal to the optic disc compared with controls. CONCLUSIONS Association between CC parameters and glaucoma severity in NTG, but not POAG subjects, suggests vascular abnormalities may be a potential factor in the multifactorial process of glaucoma damage in NTG patients.
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Affiliation(s)
| | - Morgan Heisler
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
| | - Zaid Mammo
- Department of Ophthalmology and Visual Sciences
| | - Myeong Jin Ju
- Department of Ophthalmology and Visual Sciences
- School of Biomedical Engineering, University of British Columbia, Vancouver
| | - Marinko V Sarunic
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
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Juliano J, Burkemper B, Lee J, Nelson A, LeTran V, Chu Z, Zhou G, Jiang X, Wang RK, Varma R, Richter GM. Longer Axial Length Potentiates Relationship of Intraocular Pressure and Peripapillary Vessel Density in Glaucoma Patients. Invest Ophthalmol Vis Sci 2021; 62:37. [PMID: 34311470 PMCID: PMC8322720 DOI: 10.1167/iovs.62.9.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to investigate how axial length (AL) changes the relationship of intraocular pressure (IOP) with peripapillary vessel density (pVD) in glaucoma versus non-glaucomatous eyes. Methods A population-based, cross-sectional study of 2127 African Americans aged 40 years and older in Inglewood, California, were imaged with 6 × 6-mm optic disc optical coherence tomography angiography scans. There were 1028 healthy subjects (1539 eyes) and 65 subjects with glaucoma (86 eyes) who met inclusion criteria. A multivariable linear mixed effects regression model investigated the relationship of IOP on pVD after controlling for signal strength, retinal nerve fiber layer thickness, and age. These results were stratified by AL groups. Results Higher IOP was a significant predictor of lower pVD among subjects with glaucoma (P = 0.009), but not among healthy subjects (P = 0.26). After stratifying by the sample median AL (23.46 mm), higher IOP was associated with lower pVD among subjects with glaucoma with longer AL (≥ 23.46 mm, P = 0.005), but not among those in the shorter AL (< 23.46 mm, P = 0.45). IOP was not significantly associated with pVD among healthy subjects in either AL stratum. Conclusions Among subjects with glaucoma with longer AL, IOP was significantly associated with pVD. This relationship was not seen among subjects with glaucoma with shorter AL or non-glaucomatous subjects in either AL group. These findings support the hypothesis that disturbed retinal autoregulation may be present in subjects with glaucoma with longer AL. Longitudinal studies are needed to further investigate whether axial elongation increases glaucoma risk by compromising retinal autoregulation.
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Affiliation(s)
- Joseph Juliano
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - Bruce Burkemper
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - Jae Lee
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - Andrew Nelson
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - Vivian LeTran
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Gabriella Zhou
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Xuejuan Jiang
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California, United States
| | - Grace M Richter
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
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Kanar HS, Toz HT, Penbe A. Comparison of retinal nerve fiber layer, macular ganglion cell complex and choroidal thickness in patients with migraine with and without aura by using optical coherence tomography. Photodiagnosis Photodyn Ther 2021; 34:102323. [PMID: 33962058 DOI: 10.1016/j.pdpdt.2021.102323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/24/2021] [Accepted: 04/30/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND We compared the choroidal thickness (CT), peripapillary retinal nerve fibre layer thickness (pRNFLT) and macular ganglion cell complex thickness (mGCCT) by using spectral domain optic coherence tomography (SD-OCT) in patients with migraine with aura (MWA), migraine without aura (MWoA), and healthy controls. METHODS Thirty-seven patients with MWA, 40 patients with MWoA, and age and sex-matched 50 healthy controls were included in this cross-sectional study. CTs at fovea, nasal to fovea and temporal to fovea, global pRNFLT, four quadrants of pRNFLTs, mGCCTs in superior and inferior hemisphere were measured by SD-OCT. The duration of migraine, monthly attack number and the migraine disability assessment (MIDAS) questionnaire scores were recorded. RESULTS The mean foveal CT, nasal CT, and temporal CT in patients with MWA were significantly thinner than those of patients with MWoA and control (p < 0.001) while CTs of patients with MWoA were similar with those of controls. Patients with MWA and MWoA had thinner global pRNFLT, superior and inferior pRNFLT compared to controls but there were no significant differences between two migraineurs groups. Only nasal quadrant of pRNFLT was significantly thinner in patients with MWA than other groups. The superior and inferior mGCCTs were significantly thinner in patients with MWA and MWoA than controls. CONCLUSION Our results suggested that dysregulation of blood flow in ocular tissues caused by impairment of autoregulation in migraine. Patients with MWA might have an additional risk of choroidal and retinal ischemia than patients with MWoA and healthy controls.
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Affiliation(s)
- Hatice Selen Kanar
- Health Science University, Kartal Dr. Lutfi Kirdar Trainig and Research HospItal, Department of Ophthalmology, Cevizli, D-100 Güney Yanyol, Cevizli Mevkii No:47, 34865 Kartal, Istanbul, Turkey.
| | - Hilal Tastekin Toz
- Health Science University, Kartal Dr. Lutfi Kirdar Trainig and Research Hospital, Department of Neurology, Cevizli, D-100 Güney Yanyol, Cevizli Mevkii No:47, 34865 Kartal, Istanbul, Turkey.
| | - Aysegul Penbe
- Health Science University, Kartal Dr. Lutfi Kirdar Trainig and Research HospItal, Department of Ophthalmology, Cevizli, D-100 Güney Yanyol, Cevizli Mevkii No:47, 34865 Kartal, Istanbul, Turkey.
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Relationship between peripheral vasospasm and visual field progression rates in patients with normal-tension glaucoma with low-teen intraocular pressure. PLoS One 2021; 16:e0250085. [PMID: 33857246 PMCID: PMC8049327 DOI: 10.1371/journal.pone.0250085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate the association between peripheral vasospasm and the visual field (VF) progression rate in patients with normal-tension glaucoma (NTG) with low-teen intraocular pressure (IOP). Methods The finger temperature of 113 NTG patients was measured before and after exposure to ice water using a Temperature gun (cold pressor test). These patients had confirmed VF progression, despite a low-teen IOP during a follow-up period of >5 years. VF progression rates were calculated as the slope of the visual field index (VFI) and mean deviation (MD) over time. Demographic, systemic, and ocular factors and VF progression rates were compared, based on the cold pressor test results. A regression analysis was used to investigate the factors affecting VF progression rates. Results Mean age, initial IOP, mean IOP during the follow-up period, and initial VF MD were 57.1 years, 15.8 mmHg, 12.0 mmHg, and -5.2 dB, respectively. When patients were divided into two groups (less vasospasm and more vasospasm) according to changes in temperature after exposure to ice water, the VF progression rate was significantly faster in the group with more vasospasm. In a multiple regression analysis, older age, worse initial VF MD, and greater decrease in finger temperature after ice water exposure were significantly associated with faster VF progression rates. Conclusion An excessive drop in finger temperature after exposure to ice water was significantly associated with faster VF progression in patients with low-teen NTG. This suggests that the blood flow in the optic nerve head may also be disturbed by peripheral vasospasm, accelerating glaucomatous damage regardless of IOP.
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Samaha D. Normal‐tension glaucoma: managing a case of mistaken identity. Clin Exp Optom 2021; 102:523-527. [DOI: 10.1111/cxo.12870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 11/18/2018] [Accepted: 12/07/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Dan Samaha
- School of Optometry, University of Montreal, Montreal, Quebec, Canada,
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DeBuc DC, Rege A, Smiddy WE. Use of XyCAM RI for Noninvasive Visualization and Analysis of Retinal Blood Flow Dynamics During Clinical Investigations. Expert Rev Med Devices 2021; 18:225-237. [PMID: 33635742 DOI: 10.1080/17434440.2021.1892486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Ocular blood flow plays a critical role in eye health by nourishing the retinal and ocular tissues with oxygen and nutrients and removal of ocular metabolic waste. Imaging of retinal and optic blood flow may provide insights for early and more specific diagnoses of ocular vascular disorder and facilitate eye-based biomarkers applicable to neurological health assessment and research. AREAS COVERED The ability of the XyCAM RI (Vasoptic Medical Inc., MD, USA) to visualize and to analyze ocular blood flow dynamics XyCAM RI using laser speckle contrast imaging is reviewed and compared with concurrent clinical ophthalmic imaging technologies like optical coherence tomography - angiography (OCT-A), fundus imaging, fluorescein angiography (FA), indocyanine green angiography (ICGA), laser Doppler flowmetry (LDF), and laser speckle flowgraphy (LSFG). EXPERT OPINION XyCAM RI, with its unprecedented imaging capabilities to assess blood flow dynamics provides a powerful tool to ophthalmic researchers and doctors to obtain greater clinical insights into the physiological status of the posterior segment and treatment approaches for various diseases in a very patient-friendly, noninvasive manner, unlike dye-based angiographic techniques such as FA or ICG. XyCAM RI is well suited as a modality that could close the gap between current screening and comprehensive eye exams.
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Affiliation(s)
- Delia Cabrera DeBuc
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Hamarat Y, Bartusis L, Deimantavicius M, Lucinskas P, Siaudvytyte L, Zakelis R, Harris A, Mathew S, Siesky B, Janulevicienė I, Ragauskas A. Can the Treatment of Normal-Pressure Hydrocephalus Induce Normal-Tension Glaucoma? A Narrative Review of a Current Knowledge. ACTA ACUST UNITED AC 2021; 57:medicina57030234. [PMID: 33802375 PMCID: PMC7999145 DOI: 10.3390/medicina57030234] [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: 01/25/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/16/2022]
Abstract
Ventriculoperitoneal shunt placement is the most commonly used treatment of normal-pressure hydrocephalus (NPH). It has been hypothesized that normal-tension glaucoma (NTG) is caused by the treatment of NPH by using the shunt to reduce intracranial pressure (ICP). The aim of this study is to review the literature published regarding this hypothesis and to emphasize the need for neuro-ophthalmic follow-up for the concerned patients. The source literature was selected from the results of an online PubMed search, using the keywords "hydrocephalus glaucoma" and "normal-tension glaucoma shunt". One prospective study on adults, one prospective study on children, two retrospective studies on adults and children, two case reports, three review papers including medical hypotheses, and one prospective study on monkeys were identified. Hypothesis about the association between the treatment of NPH using the shunt to reduce ICP and the development of NTG were supported in all reviewed papers. This suggests that a safe lower limit of ICP for neurological patients, especially shunt-treated NPH patients, should be kept. Thus, we proposed to modify the paradigm of safe upper ICP threshold recommended in neurosurgery and neurology into the paradigm of safe ICP corridor applicable in neurology and ophthalmology, especially for shunt-treated hydrocephalic and glaucoma patients.
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Affiliation(s)
- Yasin Hamarat
- Health Telematics Science Institute, Kaunas University of Technology, K. Barsausko Str. 59-A557, LT-51423 Kaunas, Lithuania; (L.B.); (M.D.); (P.L.); (R.Z.); (A.R.)
- Correspondence:
| | - Laimonas Bartusis
- Health Telematics Science Institute, Kaunas University of Technology, K. Barsausko Str. 59-A557, LT-51423 Kaunas, Lithuania; (L.B.); (M.D.); (P.L.); (R.Z.); (A.R.)
| | - Mantas Deimantavicius
- Health Telematics Science Institute, Kaunas University of Technology, K. Barsausko Str. 59-A557, LT-51423 Kaunas, Lithuania; (L.B.); (M.D.); (P.L.); (R.Z.); (A.R.)
| | - Paulius Lucinskas
- Health Telematics Science Institute, Kaunas University of Technology, K. Barsausko Str. 59-A557, LT-51423 Kaunas, Lithuania; (L.B.); (M.D.); (P.L.); (R.Z.); (A.R.)
| | - Lina Siaudvytyte
- Eye Clinic, Lithuanian University of Health Sciences, Eiveniu Str. 2, LT-50009 Kaunas, Lithuania; (L.S.); (I.J.)
| | - Rolandas Zakelis
- Health Telematics Science Institute, Kaunas University of Technology, K. Barsausko Str. 59-A557, LT-51423 Kaunas, Lithuania; (L.B.); (M.D.); (P.L.); (R.Z.); (A.R.)
| | - Alon Harris
- Glaucoma Research and Diagnostic Center, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (A.H.); (S.M.); (B.S.)
| | - Sunu Mathew
- Glaucoma Research and Diagnostic Center, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (A.H.); (S.M.); (B.S.)
| | - Brent Siesky
- Glaucoma Research and Diagnostic Center, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (A.H.); (S.M.); (B.S.)
| | - Ingrida Janulevicienė
- Eye Clinic, Lithuanian University of Health Sciences, Eiveniu Str. 2, LT-50009 Kaunas, Lithuania; (L.S.); (I.J.)
| | - Arminas Ragauskas
- Health Telematics Science Institute, Kaunas University of Technology, K. Barsausko Str. 59-A557, LT-51423 Kaunas, Lithuania; (L.B.); (M.D.); (P.L.); (R.Z.); (A.R.)
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30
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Izumiya Y, Okuda Y, Ueki S, Takeda M, Sato K, Nakayama K. Unusual morphologies of blood eosinophils in GM-CSF-producing lung cancer. QJM 2021; 114:42-44. [PMID: 32343814 DOI: 10.1093/qjmed/hcaa144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y Izumiya
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Y Okuda
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - S Ueki
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - M Takeda
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - K Sato
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - K Nakayama
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
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Lin YH, Huang SM, Yeung L, Ku WC, Chen HSL, Lai CC, Chuang LH. Correlation of Visual Field With Peripapillary Vessel Density Through Optical Coherence Tomography Angiography in Normal-Tension Glaucoma. Transl Vis Sci Technol 2020; 9:26. [PMID: 33364080 PMCID: PMC7746955 DOI: 10.1167/tvst.9.13.26] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/08/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the retinal vessel density (VD) in healthy and normal-tension glaucoma (NTG) eyes through optical coherence tomography angiography (OCTA) and to determine the correlation between VD and the retinal nerve fiber layer (RNFL) thickness and functional visual field (VF) defects for different locations. Methods A total of 74 NTG eyes and 24 healthy eyes were included. OCTA VD at 4.5 × 4.5 mm peripapillary region and 3.0 × 3.0 mm macula area, RNFL thickness, and VF pattern deviation results were individually analyzed on the basis of the Garway-Heath sectorization. Correlations between VD and VF/RNFL and VF were compared. Results In the NTG group, peripapillary VD, superficial macula VD, RNFL thickness, and ganglion cell complex thickness were significantly lower. In the whole peripapillary area and inferotemporal sector, anatomic correlations between VD and VF pattern deviation values were significantly higher than those between the RNFL thickness and VF values. In the subgroup analysis, VD was anatomically correlated with VF in early-, moderate-, and severe-stage NTG eyes, whereas the RNFL thickness was correlated with VF in moderate- and severe-stage NTG eyes. Conclusions We observed VD reduction in the peripapillary retina and superficial macula area in NTG eyes. The microvascular dropout of VD in the peripapillary retina, especially in the inferotemporal sector, provided a more accurate anatomic correlation with functional VF defects than that of the RNFL thickness, especially in early-stage NTG eyes. Translational Relevance In patients who cannot comply VF exam, VD is a good tool for disease detection.
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Affiliation(s)
- Yun-Hsuan Lin
- Department of Electro-Optical Engineering, National Taipei University of Technology, Taipei, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Ming Huang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung, Taiwan.,Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ling Yeung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wan-Chen Ku
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Henry Shen-Lih Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lan-Hsin Chuang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Nowrouzi A, Benitez-Del-Castillo J, Kafi-Abasabadi S, Rodriguez-Calzadilla M, Diaz-Ramos A, Rodriguez-Suarez A, Mota-Chozas I. Peripheral vascular disease - a new vascular disease associated with normal tension glaucoma: a case report. J Med Case Rep 2020; 14:224. [PMID: 33208187 PMCID: PMC7677825 DOI: 10.1186/s13256-020-02533-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/14/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Normal-tension glaucoma is known as a multifactorial optic neuropathy. A number of lines of evidence suggested that vascular factors played a significant role in the development of normal-tension glaucoma. The mechanisms underlying the abnormal ocular blood flow in normal-tension glaucoma are still not clear. Peripheral vascular disease seems to be associated with glaucoma populations independent of other cardiovascular risk factors. We found this presentation, for the first time, to our knowledge, as another probable vascular abnormality related to our patient with normal-tension glaucoma, although it is necessary to confirm its pathological effect in future studies. CASE PRESENTATION Our patient was a 48-year-old Spanish man without any personal and family history of interest except for circulatory problems of the lower limbs with repetitive ulcers at the frontal and lateral aspects of his legs. His chief complaint was vision loss when he came to consult us. In exploration, his best corrected visual acuity was 20/20 in both eyes; initial intraocular pressure in the right eye was 14-16 mmHg and in the left eye was 16-18 mmHg, with a mild sclerosis of the lens in slit-lamp examination. No inflammation or pigmented lesion was detected in the anterior chamber. Open angle confirmed by Goldman four quadrants gonioscopy. Funduscopic examination revealed a vertical cup disc ratio of 0.6 in the right eye and 0.8 in the left eye. The patient's neuroretinal rim was normal in the right eye, and superior thinning in the left eye was determined. Examination of the patient's visual field showed inferior mild probable nasal scotoma in the right eye and an inferior deep arcuate scotoma defect in the left eye. His optical coherence tomography examination revealed thinning of the peripapillary nerve fiber layer thickness in the left eye and superior loss of macular retinal ganglion cells in the left eye. Normal intraocular pressure values were measured on the intraocular pressure curve without treatment (maximum value, 18-20 mmHg), discarding higher intraocular pressures measured out of office. Ultrasonic pachymetry measured 515/520 μm, and normal intraocular pressure measured with a PASCAL tonometer ruled out probable corneal biomechanical underestimations. The patient's polysomnography study was normal and excluded sleep apnea syndrome. The patient's serial mean blood pressure was normal, especially in the lower limbs (mean value, 125/70 mmHg), ruling out the possibility of systemic hypotension. Thyroidal and coagulation abnormalities, autoimmune disease, and inflammatory disease were excluded. Normal immunologic study and normal vascular biopsy were observed, as well as normal brain magnetic resonance imaging and a normal carotid vascular study. The primary diagnosis was moderate medium peripheral arterial disease in the lower limbs, which was confirmed by echography after ruling out other probable vascular abnormalities related to normal-tension glaucoma. CONCLUSION After ruling out other systemic diseases and vascular abnormalities related to normal-tension glaucoma, we found peripheral arterial disease as a probable vascular abnormality related to normal-tension glaucoma in our patient. To our knowledge, this is the first time such a case has been reported. Thus, further research is needed to determine the relevance of these results to the general population.
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Affiliation(s)
- Ali Nowrouzi
- Hospital Jerez de la Frontera, Ronda de Circunvalación, Jerez de la Frontera, 11407, Cádiz, Spain.
| | | | - Sepideh Kafi-Abasabadi
- Hospital Jerez de la Frontera, Ronda de Circunvalación, Jerez de la Frontera, 11407, Cádiz, Spain
| | | | - Antonio Diaz-Ramos
- Hospital Jerez de la Frontera, Ronda de Circunvalación, Jerez de la Frontera, 11407, Cádiz, Spain
| | - Alejo Rodriguez-Suarez
- Hospital Jerez de la Frontera, Ronda de Circunvalación, Jerez de la Frontera, 11407, Cádiz, Spain
| | - Inmaculada Mota-Chozas
- Hospital Jerez de la Frontera, Ronda de Circunvalación, Jerez de la Frontera, 11407, Cádiz, Spain
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Dolzhikov AA, Shevchenko OA, Pobeda AS, Peresypkina AA, Dolzhikova IN, Zhunusov NS, Lugovskoy SS. Review of a new concept of glaucoma pathogenesis based on the glymphatic theory of cerebrospinal fluid circulation. RESEARCH RESULTS IN PHARMACOLOGY 2020. [DOI: 10.3897/rrpharmacology.6.53634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
General aspects of glaucoma: Glaucoma is a heterogeneous multi-factorial disease that is one of the main causes of blindness, along with degeneration of retinal ganglion cells and optic nerve atrophy.
Theories of pathogenesis: There are three theories of glaucoma pathogenesis: biomechanical, vascular, and biochemical.
Basic theory of the glymphatic system: The classical knowledge of cerebrospinal fluid circulation has been revised, and in 2012 a new concept of glial-perivascular – glymphatic perfusion of the brain parenchyma was introduced. Due to experimental and clinical studies, it is approved by many scientists, especially in relation to Alzheimer’s disease (AD), in which amyloid pathology is the result of dysfunction of the para-/perivascular transport/cleansing pathways.
Features of the optic nerve and the cribriform plate: The cribriform plate forms a barrier at the border of intraocular (IOP) and intracranial (ICP) pressures, thus affecting the para-/periarterial flow of cerebrospinal fluid to the optic nerve and retina, as well as the para-/perivenous cleansing outflow.
Morphofunctional evidence of an ocular glymphatic system: The presence of an ocular glymphatic system is confirmed by in vivo experiments with the transfer of labeled substances through para-/perivascular structures from the ventricular or subarachnoid space to the optic nerve and by postmortem morphology.
Clinical evidence for the glymphatic system hypothesis: There is some clinical, including case-based, and epidemiological evidence for similarities between glaucomatous optic nerve/retinal injuries and AD, since both occur in the form of improper secretion of neurotoxic metabolites, and both are often diagnosed together.
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Kato K, Sugawara A, Nagashima R, Ikesugi K, Sugimoto M, Kondo M. Factors Affecting Photopic Negative Response Recorded with RET eval System: Study of Young Healthy Subjects. Transl Vis Sci Technol 2020; 9:19. [PMID: 32879775 PMCID: PMC7443124 DOI: 10.1167/tvst.9.9.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 06/01/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine whether there is a significant correlation between the amplitude of the photopic negative response (PhNR) and the peripapillary retinal nerve fiber layer thickness (pRNFLT) in eyes of young, healthy subjects. Methods We analyzed 136 eyes of 136 young, healthy subjects (89 males and 47 females; age, 20–29 years). The PhNRs were recorded with the RETeval system without mydriasis using red flashes on a blue background. PhNR amplitude was measured at two points: at 72 ms (P72) and at the negative trough following the b-wave (Pmin). Univariate and multivariable linear regression analyses were performed to identify the independent variables that were significantly correlated with P72 and Pmin. The variables included age, sex, axial length, pRNFLT, intraocular pressure (IOP), a-wave amplitude, b-wave amplitude, and pupillary area during the electroretinogram recordings. Results The amplitudes of P72 and Pmin were significantly larger in female subjects (P = 0.021 and P = 0.001, respectively). Univariate analyses showed that PhNR amplitudes were significantly correlated with pRNFLT (P72: r = 0.246, P = 0.004; Pmin: r = 0.219, P = 0.011). Female sex was significantly and negatively correlated with P72 (r = –0.206; P = 0.016) and Pmin (r = –0.271; P = 0.001). Multivariable regression analyses showed that greater pRNFLT was an independent factor significantly associated with a larger P72 (r = 0.283; P = 0.004) and Pmin (r = 0.299; P = 0.002). Female sex was an independent factor that was significantly associated with a larger Pmin (r = –0.208; P = 0.022). Conclusions These findings indicate that PhNR amplitude is significantly associated with pRNFLT and female sex in young, healthy subjects. Translational Relevance The amplitude of the PhNR recorded with RETeval is smaller in subjects with thinner pRNFLT not only in glaucoma patients but also in young healthy subjects.
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Affiliation(s)
- Kumiko Kato
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Asako Sugawara
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ryunosuke Nagashima
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kengo Ikesugi
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masahiko Sugimoto
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Mineo Kondo
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
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Balendra SI, Zollet P, Cisa Asinari Di Gresy E Casasca G, Cordeiro MF. Personalized approaches for the management of glaucoma. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2020. [DOI: 10.1080/23808993.2020.1756770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Shiama Indu Balendra
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College, London, UK
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, UK
| | - Piero Zollet
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College, London, UK
- Department of Ophthalmology, University Vita-Salute San Raffaele, San Raffaele Scientific Institute, Milan, Italy
| | - Gloria Cisa Asinari Di Gresy E Casasca
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College, London, UK
- Department of Ophthalmology, University Vita-Salute San Raffaele, San Raffaele Scientific Institute, Milan, Italy
| | - Maria Francesca Cordeiro
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College, London, UK
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, UK
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Chen SY, Yieh FS, Liao WL, Li TC, Hsieh CL. Effect of Acupuncture on Intraocular Pressure in Glaucoma Patients: A Single-Blinded, Randomized, Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:7208081. [PMID: 32419820 PMCID: PMC7204356 DOI: 10.1155/2020/7208081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/03/2020] [Accepted: 04/15/2020] [Indexed: 11/17/2022]
Abstract
Glaucoma is characterized by the degeneration of retinal ganglion cells that cause progressive optic neuropathy, finally resulting in changes to the optic nerve head. Lowering intraocular pressure (IOP) is the only method proven for treating glaucoma. Several studies have discovered that acupuncture can reduce IOP and also increase ocular perfusion and ocular blood flow. Therefore, the present study investigated the effect of acupuncture on IOP in glaucoma patients. We conducted a single-blinded, randomized, controlled trial involving 45 glaucoma patients. The results indicated that the difference between the IOP 60 min after the intervention and IOP immediately before the intervention was greater in the acupuncture group (AG) and electroacupuncture group (EG) than in the sham group (SG) for all four of the interventions performed and in both eyes (all p < 0.05). The IOP difference between immediately before the first intervention and after finishing the final intervention was also greater in the AG and EG than in the SG in both eyes (all p < 0.05). In conclusion, IOP was reduced at 60 min after acupuncture or electroacupuncture was performed at BL1 and EX-HN7. Additionally, IOP was reduced after finishing four acupuncture or electroacupuncture sessions. Therefore, our results suggest that acupuncture and electroacupuncture are beneficial for lowering IOP in glaucoma patients. This trial is registered with NCT04157530.
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Affiliation(s)
- Shu-Yuan Chen
- Graduate Institute of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
| | | | - Wen-Ling Liao
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
- Center for Personalized Medicine, China Medical University Hospital, Taichung, 40402, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung 40402, Taiwan
- Department of Healthcare Administration, College of Health Science, Asia University, Taichung 413, Taiwan
| | - Ching-Liang Hsieh
- Chinese Medicine Research Center, China Medical University, Taichung 40402, Taiwan
- Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung 40447, Taiwan
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Gardiner SK, Cull G, Fortune B, Wang L. Increased Optic Nerve Head Capillary Blood Flow in Early Primary Open-Angle Glaucoma. Invest Ophthalmol Vis Sci 2019; 60:3110-3118. [PMID: 31323681 PMCID: PMC6645706 DOI: 10.1167/iovs.19-27389] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Blood flow in the optic nerve head (ONH) is known to be reduced in eyes with advanced glaucoma. However, experimental results from non-human primates suggest an initial increase in ONH blood flow at the earliest stages of damage. This study assesses flow and pulsatile hemodynamics across a range of severities to test the hypothesis that this also occurs in human glaucoma. Methods Laser speckle flowgraphy was used to measure average mean blur rate (MBRave) within ONH tissue (a correlate of capillary blood flow) and the pulsatile waveform in 93 eyes with functional loss and 74 glaucoma suspect/fellow eyes without functional loss. These were compared against results from 92 healthy control eyes. Parameters produced by the instrument's software were age-corrected, then compared between groups using generalized estimating equation models. Results The mean MBRave in the control eyes was 12.5 units. In glaucoma suspect/fellow eyes, the mean was 16.4 units, higher with P < 0.0001. In eyes with functional loss, the mean was 13.8 units, lower than eyes without functional loss with P < 0.0001, although still higher than control eyes with P = 0.0096. Analysis of the pulsatile waveform suggested that the deceleration in flow as it approaches its maximum across the cardiac cycle was delayed in glaucoma. Conclusions Blood flow within ONH capillaries was higher in glaucoma suspect eyes than in healthy controls. It was less elevated in eyes that had developed functional loss. The mechanisms causing these changes and their relation to concurrent changes in pulsatile hemodynamics remain under investigation.
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Affiliation(s)
- Stuart K Gardiner
- Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| | - Grant Cull
- Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| | - Brad Fortune
- Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| | - Lin Wang
- Devers Eye Institute, Legacy Health, Portland, Oregon, United States
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Lee JW, Chan PP, Zhang X, Chen LJ, Jonas JB. Latest Developments in Normal-Pressure Glaucoma: Diagnosis, Epidemiology, Genetics, Etiology, Causes and Mechanisms to Management. Asia Pac J Ophthalmol (Phila) 2019; 8:457-468. [PMID: 31789648 PMCID: PMC6903364 DOI: 10.1097/01.apo.0000605096.48529.9c] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/01/2019] [Indexed: 01/09/2023] Open
Abstract
Normal-pressure glaucoma (NPG) is part of the spectrum of the open-angle glaucomas and morphologically characterized, as any glaucoma, by a loss of neuroretinal rim parallel to an enlargement and deepening of the optic cup, and development or enlargement of parapapillary beta zone. These morphological characteristics, in addition to the therapeutic benefit of lowering the intraocular pressure (IOP), make NPG differ from vascular-induced optic neuropathy. Based on the anatomy of the optic nerve as a cerebral fascicle, the physiological counter-pressure against the IOP is the orbital cerebrospinal fluid pressure (CSFP), with both pressures forming the trans-lamina cribrosa pressure difference (TLCPD). In contrast to the IOP, the TLCPD is the true pressure exerting force on the optic nerve fibers when passing through the lamina cribrosa. As a theoretical notion, an abnormally high TLCPD due to a low CSFP, in association with a low arterial blood pressure, could therefore be involved in the pathogenesis of NPG. It fits with the finding that the reduction of the IOP (and thus indirectly of the TLCPD) is (the only proven) procedure for NPG therapy. This review additionally highlights the genetic background, diagnostic methods, and therapeutic modalities of NPG.
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Affiliation(s)
- Jacky W.Y. Lee
- International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, People's Republic of China
- C-MER (Shenzhen) Dennis Lam Eye Hospital, 1 Tairan 9th Rd, Futian, Shenzhen, People's Republic of China
- C-MER Eye Center, Hong Kong
| | - Poemen P. Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - XiuJuan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Jost B. Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Germany
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Fan N, Tan J, Liu X. Is "normal tension glaucoma" glaucoma? Med Hypotheses 2019; 133:109405. [PMID: 31563827 DOI: 10.1016/j.mehy.2019.109405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 09/22/2019] [Accepted: 09/24/2019] [Indexed: 02/01/2023]
Abstract
Primary open angle glaucoma (POAG) represents a distinct disease entity with elevated intraocular pressure (IOP) as the main risk factor, even though the reasons for why the IOP is elevated remains to be elucidated. It is considered that normal tension glaucoma (NTG) is a subtype of POAG, comprising a special form of glaucomatous neurodegeneration or glaucomatous optic neuropathy (GON) almost exactly the same as that seen in POAG, but the IOP, as named, remains in the statistically normal range. Actually the disease entity of NTG has been a profound confusion and it is difficult to be accurately conceptualized. One of the reasons is that the IOP is closely linked to the occurrence of GON in POAG but not in NTG, and for the latter, it seems that GON is secondary to a number of local or systemic disorders. In recent years, increasing evidences suggest that NTG or IOP independent GON is a non-glaucomatous disease with different disease entities from POAG and with more diverse and complex etiologies. Here we hypothesized that NTG, at least for those with recognizable primary diseases, is not a glaucomatous disease; instead, it represents a group of disorders with GON as a characteristic clinical feature or phenotype.
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Affiliation(s)
- Ning Fan
- Shenzhen Eye Hospital, School of Optometry, Shenzhen University, China
| | - Junkai Tan
- Xiamen Eye Center, Xiamen University, China
| | - Xuyang Liu
- Xiamen Eye Center, Xiamen University, China.
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Chong Seong NT, Yaakub A, Jalil RA, Tirmandas Vn K, A/P Sandragasu T, Noor JBM, Husain NB, Mustari ZB, Hamid SAA, Mt Saad AB, At LS. Effect of physical activity on severity of primary angle closure glaucoma. Ther Adv Ophthalmol 2019; 11:2515841419864855. [PMID: 31384724 PMCID: PMC6664631 DOI: 10.1177/2515841419864855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 06/24/2019] [Indexed: 01/13/2023] Open
Abstract
Objective: To determine the association between physical activity and severity of
primary angle closure glaucoma in Malay patients. Methods: A cross-sectional study was conducted involving 150 primary angle closure
glaucoma patients between April 2014 and August 2016. Using the
International Physical Activity Questionnaire, the physical activity status
was assessed and divided into three categories: mild, moderate and heavy
physical activity. The duration of physical activity and corresponding
minimum energy requirements were calculated. Ocular examination was
performed including Humphrey visual field 24-2 analysis assessment. Based on
two consecutive reliable Humphrey visual fields, the severity of glaucoma
was scored according to modified Advanced Glaucoma Intervention Study and
classified as mild (0–5), moderate (6–11) and severe (12–20). Association
between physical activity and Advanced Glaucoma Intervention Study score was
determined with multiple linear regression analysis. Results: A total of 150 Malay patients with primary angle closure glaucoma were
included (50 patients with mild, 50 with moderate and 50 with severe
glaucoma). Physical activity showed inverse association with the severity of
primary angle closure glaucoma. After calculating adjustments for age, sex,
duration of glaucoma, body mass index, systemic co-morbidities, family
history of glaucoma, myopia and educational status [adjusted
b –3.41, 95% confidence interval (–5.23, –1.59),
p < 0.001], there was also an inverse relationship
with Advanced Glaucoma Intervention Study score. Every increase in physical
activity level reduces the Advanced Glaucoma Intervention Study score by 3.4
point. Conclusion: Physical activity is the potential modifiable risk factor in reducing the
severity of glaucoma among primary angle closure glaucoma patients. However,
there is possibility of the severity of glaucoma restricted the physical
activity of primary angle closure glaucoma patients.
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Affiliation(s)
- Niven Teh Chong Seong
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Azhany Yaakub
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Rohana Abdul Jalil
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Karunakar Tirmandas Vn
- Department of Ophthalmology, Hospital Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | | | - Jelinar Binti Mohd Noor
- Department of Ophthalmology, Hospital Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Norhalwani Bt Husain
- Department of Ophthalmology, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia
| | | | - Siti Azrin Ab Hamid
- Department of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Ahmad B Mt Saad
- Department of Ophthalmology, Hospital Sultanah Bahiyah, Alor Setar, Malaysia
| | - Liza-Sharmini At
- Professor of Ophthalmology and Senior Consultant Ophthalmologist (Glaucoma), Head of Department, Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kota Bharu, Kelantan, Malaysia
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Nelson AJ, Chang R, LeTran V, Vu B, Burkemper B, Chu Z, Fard A, Kashani A, Xu B, Wang R, Varma R, Richter GM. Ocular Determinants of Peripapillary Vessel Density in Healthy African Americans: The African American Eye Disease Study. Invest Ophthalmol Vis Sci 2019; 60:3368-3373. [PMID: 31917454 PMCID: PMC6681862 DOI: 10.1167/iovs.19-27035] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/03/2019] [Indexed: 01/01/2023] Open
Abstract
Purpose The African American (AA) population has unique ocular anatomic characteristics and a disproportionately high incidence of glaucoma, which is associated with lower peripapillary vessel density (VD). This study aimed to identify ocular determinants of peripapillary VD in healthy AAs. Methods This was a cross-sectional, population-based study of 1029 AAs, ages 40 and older. Participants underwent examination to obtain axial length (AL), IOP, central corneal thickness (CCT), mean retinal nerve fiber layer (RNFL) thickness, visual field mean deviation (MD), and 6 × 6-mm optical coherence tomography angiography scans of the optic nerve. Participants with glaucoma, vision-threatening diabetic retinopathy, or other relevant ocular disease were excluded. Prototype software was used to quantify VD. A multivariable regression model, controlling for age and signal strength, identified the ocular variables that predicted peripapillary VD. The contribution of each variable was assessed with the magnitude of standardized regression coefficients (SRC). Results Based on univariate regressions, AL, RNFL thickness, and MD had significant associations with peripapillary VD (all P < 0.001). In the final multivariate model, lower mean RNFL thickness (β = 0.0022, P < 0.001, SRC = 0.542) and longer AL (β = -0.0055, P < 0.001, SRC = -0.118) were associated with lower peripapillary VD, controlling for age and signal strength, with model R2 of 0.69. Conclusions Thinner RNFL and longer AL were the most influential ocular determinants of lower peripapillary perfusion in healthy AA eyes. Additional research is needed to clarify whether longer AL increases risk of glaucoma by affecting capillary perfusion.
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Affiliation(s)
- Andrew J. Nelson
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, California, United States
| | - Ryuna Chang
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, California, United States
| | - Vivian LeTran
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, California, United States
| | - Brian Vu
- University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Bruce Burkemper
- Departments of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, United States
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Washington, United States
| | - Ali Fard
- Carl Zeiss Meditec, Dublin, California, United States
| | - Amir Kashani
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, California, United States
| | - Benjamin Xu
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, California, United States
| | - Ruikang Wang
- Department of Bioengineering, University of Washington, Washington, United States
| | - Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California, United States
| | - Grace M. Richter
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, California, United States
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Kiyota N, Shiga Y, Yasuda M, Aizawa N, Omodaka K, Tsuda S, Kunikata H, Nakazawa T. Sectoral Differences in the Association of Optic Nerve Head Blood Flow and Glaucomatous Visual Field Defect Severity and Progression. ACTA ACUST UNITED AC 2019; 60:2650-2658. [DOI: 10.1167/iovs.19-27230] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Naoki Kiyota
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yukihiro Shiga
- 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
| | - Masayuki Yasuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Naoko Aizawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kazuko Omodaka
- 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
| | - Satoru Tsuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Retinal Disease Control, 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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Lee CY, Liu CH, Chen HC, Sun CC, Yao YP, Chao SC. Correlation between Basal Macular Circulation and Following Glaucomatous Damage in Progressed High-Tension and Normal-Tension Glaucoma. Ophthalmic Res 2019; 62:46-54. [DOI: 10.1159/000499695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/19/2019] [Indexed: 11/19/2022]
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Barbosa-Breda J, Van Keer K, Abegão-Pinto L, Nassiri V, Molenberghs G, Willekens K, Vandewalle E, Rocha-Sousa A, Stalmans I. Improved discrimination between normal-tension and primary open-angle glaucoma with advanced vascular examinations - the Leuven Eye Study. Acta Ophthalmol 2019; 97:e50-e56. [PMID: 30225863 DOI: 10.1111/aos.13809] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 04/05/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE Vascular factors have been suggested to influence the development and progression of glaucoma. They are thought to be especially relevant for normal-tension glaucoma (NTG) patients. We aim to investigate which vascular factors, including advanced vascular examinations, better describe patients with NTG comparing to those with primary open-angle glaucoma (POAG). METHODS The Leuven Eye Study database (182 NTG and 202 POAG patients; similar structural and functional damage) was used to compute three multivariate logistic regression models: a conventional model (conventional parameters only, including vascular-related self-reported phenomena, such as migraine or peripheral vasospasm); an advanced vascular model (advanced vascular parameters only: colour Doppler imaging (CDI), retinal oximetry, ocular pulse amplitude and choroidal thickness); and a global model, in which both types of parameters were allowed. Receiver operating characteristic (ROC) curves and corresponding areas under the curve (AUC) were calculated and compared between models. RESULTS Patients with NTG had a higher resistive index and lower early systolic acceleration (ESA) in their retrobulbar vessels and a smaller arteriovenous retinal oxygen saturation difference. The global model (AUC 0.743) showed a significantly better discriminative ability when compared to either the conventional (AUC 0.687, p = 0.049) or the advanced vascular (AUC 0.677, p = 0.005) models. Also, the conventional and the advanced vascular models showed a similar discriminative ability (p = 0.823). CONCLUSION Patients with NTG have more signs of vascular dysfunction. Clinical conventional parameters, such as asking simple vascular-related questions, combined with advanced vascular examinations provide information to better understand the value that non-IOP-related factors play in NTG.
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Affiliation(s)
- João Barbosa-Breda
- Research Group Ophthalmology; Department of Neurosciences; KU Leuven; Leuven Belgium
- Department of Ophthalmology; UZ Leuven; Leuven Belgium
- Ophthalmology Unit; Surgery and Physiology; Faculdade de Medicina da Universidade do Porto; Porto Portugal
| | - Karel Van Keer
- Research Group Ophthalmology; Department of Neurosciences; KU Leuven; Leuven Belgium
- Department of Ophthalmology; UZ Leuven; Leuven Belgium
| | - Luis Abegão-Pinto
- Visual Sciences Study Center; Faculdade de Medicina da Universidade de Lisboa; Lisbon Portugal
| | | | - Geert Molenberghs
- I-BioStat; Hasselt University; Hasselt Belgium
- I-BioStat; KU Leuven; Leuven Belgium
| | - Koen Willekens
- Research Group Ophthalmology; Department of Neurosciences; KU Leuven; Leuven Belgium
- Department of Ophthalmology; UZ Leuven; Leuven Belgium
| | - Evelien Vandewalle
- Research Group Ophthalmology; Department of Neurosciences; KU Leuven; Leuven Belgium
- Department of Ophthalmology; UZ Leuven; Leuven Belgium
| | - Amândio Rocha-Sousa
- Ophthalmology Unit; Surgery and Physiology; Faculdade de Medicina da Universidade do Porto; Porto Portugal
| | - Ingeborg Stalmans
- Research Group Ophthalmology; Department of Neurosciences; KU Leuven; Leuven Belgium
- Department of Ophthalmology; UZ Leuven; Leuven Belgium
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Lin JP, Lin PW, Lai IC, Tsai JC. Segmental inner macular layer analysis with spectral-domain optical coherence tomography for early detection of normal tension glaucoma. PLoS One 2019; 14:e0210215. [PMID: 30629663 PMCID: PMC6328176 DOI: 10.1371/journal.pone.0210215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 12/17/2018] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To segment the inner macular layers (IML) and compare the discriminating abilities of the macular and peripapillary retinal nerve fiber layer (mRNFL and pRNFL, respectively) thicknesses in patients with early-stage normal tension glaucoma (NTG). DESIGN Cross-sectional study. METHODS Forty-nine normal subjects and 69 preperimetric glaucoma (PPG) and 60 NTG patients were enrolled. Spectral-domain optical coherence tomography (SD-OCT) was used to obtain pRNFL and macular thickness parameters and segment the IML in all subjects. Area under the receiver operating characteristic (AUROC) curves were used to compare the diagnostic capabilities of different parameters. RESULTS The pRNFL, total macular layer (TML), mRNFL, and macular ganglion cell layer (mGCL) were significantly thinner in the NTG group than in the PPG and normal groups. The global and superotemporal pRNFL and the mGCL in the superior outer area were the three best parameters for detecting early NTG. The discriminating capabilities of the superior and inferior mGCL were comparable to those of the corresponding pRNFL (p = 0.573, 0.841). Concerning location, the mGCL had higher AUROCs in the outer sectors (0.863, 0.837) than in the inner sectors (0.747, 0.747). Pearson's correlation coefficients also revealed significant correlations between the mGCL and pRNFL (superior: r = 0.499, inferior: r = 0.624). The strongest correlation was between the mGCL and mean deviation (MD) (superior: r = 0.434 and inferior: r = 0.402). CONCLUSIONS The diagnostic value of mGCL thickness is comparable to that of pRNFL thickness. IMLs in the outer sectors had better diagnostic capabilities than those in the inner sector for detecting early NTG.
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Affiliation(s)
- Jih-Pin Lin
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C
| | - Pei-Wen Lin
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C
- Chang Gung University College of Medicine, Kaohsiung, Taiwan, R.O.C
- * E-mail:
| | - Ing-Chou Lai
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C
| | - Jen-Chia Tsai
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C
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Affiliation(s)
- Timothy E. Yap
- Imperial College Healthcare NHS Trust (ICHNT), The Western Eye Hospital, London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, UK
| | - Eduardo M. Normando
- Imperial College Healthcare NHS Trust (ICHNT), The Western Eye Hospital, London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, UK
| | - Maria Francesca Cordeiro
- Imperial College Healthcare NHS Trust (ICHNT), The Western Eye Hospital, London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, UK
- Department of Visual Neuroscience, Glaucoma and Retinal Neurodegeneration Group, UCL Institute of Ophthalmology, London, UK
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Chou JC, Cousins CC, Miller JB, Song BJ, Shen LQ, Kass MA, Wiggs JL, Pasquale LR. Fundus Densitometry Findings Suggest Optic Disc Hemorrhages in Primary Open-Angle Glaucoma Have an Arterial Origin. Am J Ophthalmol 2018; 187:108-116. [PMID: 29330062 DOI: 10.1016/j.ajo.2017.12.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/11/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To analyze optic disc hemorrhages (DH) associated with primary open-angle glaucoma by quantifying their geometric profile and comparing their densitometry with hemorrhages from retinal vein occlusions (RVO) and retinal macroaneurysms (MA), which have venous and arterial sources of bleeding, respectively. DESIGN Retrospective cross-sectional study. METHODS Setting: Massachusetts Eye & Ear. POPULATION Fundus images of DH (n = 40), MA (n = 14), and RVO (n = 25) were identified. Patient clinical backgrounds and demographics were obtained. MAIN OUTCOME MEASURES Grayscale pixel intensity units of hemorrhages and adjacent arteriole and venule over the same background tissue were measured. Densitometry differentials (arteriole or venule minus hemorrhage [ΔA and ΔV, respectively]) were calculated. The ratios of length (radial) to midpoint width for DH were calculated. Mean ΔA and ΔV between groups were compared with t tests. Multiple linear regression assessed the relation of retinal hemorrhage diagnosis to ΔA and ΔV and of DH shape to ΔA and ΔV. RESULTS Mean (± standard deviation) ΔA and ΔV for DH (6.9 ± 7.1 and -4.7 ± 8.0 pixel intensity units, respectively) and MA (5.3 ± 5.9 and -6.0 ± 4.6, respectively) were comparable (P ≥ .43). Mean ΔA (14.6 ± 7.7) and ΔV (6.4 ± 6.3) for RVO were significantly higher compared to DH and MA (P < .0001) and remained significant in multivariable analyses. A unit increase in DH length-to-width ratio was associated with 1.2 (0.5) and 1.3 (0.5) pixel intensity unit (standard error) decrease in ΔA and ΔV, respectively (P ≤ .014). CONCLUSIONS DH have densitometry profiles comparable to MA and different from RVO, suggesting that DH in glaucoma have an arterial origin.
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Mastropasqua R, Agnifili L, Borrelli E, Fasanella V, Brescia L, Di Antonio L, Mastropasqua L. Optical Coherence Tomography Angiography of the Peripapillary Retina in Normal-Tension Glaucoma and Chronic Nonarteritic Anterior Ischemic Optic Neuropathy. Curr Eye Res 2018; 43:778-784. [DOI: 10.1080/02713683.2018.1438630] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Ageing Science, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
| | - Enrico Borrelli
- Ophthalmology Clinic, Department of Medicine and Ageing Science, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Vincenzo Fasanella
- Ophthalmology Clinic, Department of Medicine and Ageing Science, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
| | - Lorenza Brescia
- Ophthalmology Clinic, Department of Medicine and Ageing Science, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
| | - Luca Di Antonio
- Ophthalmology Clinic, Department of Medicine and Ageing Science, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
| | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Ageing Science, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
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Al Owaifeer AM, Al Taisan AA. The Role of Diet in Glaucoma: A Review of the Current Evidence. Ophthalmol Ther 2018; 7:19-31. [PMID: 29423897 PMCID: PMC5997592 DOI: 10.1007/s40123-018-0120-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Indexed: 02/04/2023] Open
Abstract
Intraocular pressure (IOP) reduction by medications, laser, or surgery remains the mainstay of treatment in glaucoma. However, the role of complementary and alternative medicine (CAM) in glaucoma has received great interest from both patients and ophthalmologists. Previous evidence suggests that diet, a major domain of CAM, can influence an individual's IOP level. Furthermore, certain dietary components have been linked to the incidence and progression of glaucoma. In this review, we aim to provide a summary of the current evidence regarding the role of obesity, certain dietary components, and dietary supplements in glaucoma.
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Affiliation(s)
- Adi M Al Owaifeer
- Faculty of Ophthalmology, College of Medicine, King Faisal University, Al-Hasa, Saudi Arabia.
| | - Abdulaziz A Al Taisan
- Faculty of Ophthalmology, College of Medicine, King Faisal University, Al-Hasa, Saudi Arabia
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50
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Foveal Avascular Zone in Normal Tension Glaucoma Measured by Optical Coherence Tomography Angiography. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3079141. [PMID: 29392131 PMCID: PMC5748133 DOI: 10.1155/2017/3079141] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/22/2017] [Accepted: 11/27/2017] [Indexed: 12/17/2022]
Abstract
Aim To measure diameter of foveal avascular zone (FAZ), FAZ area, and vessel density using Optical Coherence Tomography Angiography (OCT-A) in patients with normal tension glaucoma (NTG) and to establish the possible role of OCT-A in diagnosis and follow-up of patients with NTG. Methods Twenty-one eyes of 21 patients with NTG and 30 eyes of 30 healthy subjects underwent complete ophthalmic examination as well as OCT-A on ZEISS AngioPlex. 3 × 3 macula scans were used to measure vertical, horizontal, and maximum diameter of FAZ by two graders. Mean values and interobserver variability were analyzed. Image J was used for analysis of FAZ area and vessel density. Results Mean vertical diameter (t = 5.58, p < 0.001), horizontal diameter (t = 3.59, p < 0.001), maximum diameter (t = 5.94, p < 0.001), and FAZ area (t = 5.76, p < 0.001) were statistically significantly enlarged in the NTG group compared to those in the control group. Vessel density (t = -5.80, p < 0.001) was statistically significantly decreased in the NTG group compared to that in the control group. Conclusion OCT-A could have an important role in the future in diagnosis of patients with NTG. In patients with NTG, there is larger FAZ area, while the vessel density is reduced in comparison to the control group.
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