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Kambayashi M, Saito H, Araie M, Enomoto N, Murata H, Kikawa T, Sugiyama K, Higashide T, Miki A, Iwase A, Tomita G, Nakazawa T, Aihara M, Ohno-Matsui K, Kim TW, Leung CKS, Zangwill LM, Weinreb RN. Effects of Deep Optic Nerve Head Structures on Bruch's Membrane Opening- Minimum Rim Width and Peripapillary Retinal Nerve Fiber Layer. Am J Ophthalmol 2024; 263:99-108. [PMID: 38403100 DOI: 10.1016/j.ajo.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE To explore the effects of deep optic nerve head (ONH) structures on Bruch's membrane opening (BMO)-minimum rim width (MRW) and peripapillary retinal nerve fiber layer thickness (pRNFLT) in healthy eyes. DESIGN Prospective cross-sectional study. METHODS Two hundred five healthy eyes of 141 subjects (mean ± standard deviation of age and axial length (AXL): 46.9 ± 10.0 years and 24.79 ± 1.15 mm) were enrolled. Best fit multivariable linear mixed models identified factors associated with BMO-MRW and pRNFLT. Explanatory variables included age, gender, AXL, BMO and anterior scleral canal opening (ASCO) area and ovality, magnitude of BMO and ASCO shift, peripapillary choroidal thickness, lamina cribrosa (LC) parameters, prelaminar thickness, and peripapillary scleral (PPS) angle. RESULTS Thinner BMO-MRW was associated with older age, smaller ASCO/BMO offset magnitude, larger BMO area, thinner prelaminar thickness, deeper LC, and thinner pRNFLT (P = .011, <.001, .004, <.001, <.001, <.001 respectively). Thinner pRNFLT was associated with shorter AXL, smaller ASCO area, a more posteriorly bowed PPS, shallower LC and thinner BMO-MRW. (P = .030, .002, .035, .012, <.001 respectively) CONCLUSIONS: BMO-MRW and pRNFLT were influenced by several deep ONH structures such as BMO and ASCO position shift, BMO or ASCO area, prelaminar thickness, PPS bowing and LC depth in addition to patient characteristics such as age and AXL. The degree and/or direction of associations varied between deep ONH structures and BMO-MRW or pRNFLT. Despite both BMO-MRW and pRNFLT being surrogate parameters for RGC loss, a complex relationship with ONH deep-layer morphology was indicated.
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Affiliation(s)
- Mitsuki Kambayashi
- From the Department of Ophthalmology (M.K., H.S., M.A.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hitomi Saito
- From the Department of Ophthalmology (M.K., H.S., M.A.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Makoto Araie
- Kanto Central Hospital of the Mutual Aid Association of Public School Teachers (M.A.), Tokyo, Japan
| | | | - Hiroshi Murata
- Center Hospital of the National Center for Global Health and Medicine (H.M.), Tokyo, Japan
| | | | - Kazuhisa Sugiyama
- Department of Ophthalmology (K.S., T.H.), Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Tomomi Higashide
- Department of Ophthalmology (K.S., T.H.), Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Atsuya Miki
- Department of Innovative Visual Science (A.M.), Osaka University Graduate School of Medicine, Osaka, Japan; Department of Myopia Control Research (A.M.), Aichi Medical University Medical School, Nagakute, Japan
| | - Aiko Iwase
- Tajimi Iwase Eye Clinic (A.I.), Tajimi, Japan
| | - Goji Tomita
- Department of Ophthalmology (G.T.), Toho University Ohashi Medical Center, Tokyo, Japan
| | - Toru Nakazawa
- Department of Ophthalmology (T.N.), Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Makoto Aihara
- From the Department of Ophthalmology (M.K., H.S., M.A.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science (K.O.-M.), Tokyo Medical and Dental University, Tokyo, Japan
| | - Tae-Woo Kim
- Department of Ophthalmology (T.-W.K.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Christopher Kai Shun Leung
- Department of Ophthalmology, LKS Faculty of Medicine (C.S.K.L.), the University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology (L.M.Z., R.N.W.), University of California San Diego, La Jolla, CA, United States
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology (L.M.Z., R.N.W.), University of California San Diego, La Jolla, CA, United States
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Venkata Srinivasan V, Carter-Dawson L, Patel NB. Retinal Ganglion Cell Content Underlying Standard Automated Perimetry Size I to V Visual Sensitivities in the Non-Human Primate Experimental Glaucoma Model. Invest Ophthalmol Vis Sci 2024; 65:22. [PMID: 38995114 PMCID: PMC11246096 DOI: 10.1167/iovs.65.8.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
Purpose To determine the relationship between visual sensitivities from white-on-white Goldmann size I to V stimuli and the underlying retinal ganglion cell (RGC) content in the non-human primate (NHP) experimental glaucoma model. Methods Normative data were collected from 13 NHPs. Unilateral experimental glaucoma was induced in seven animals with the least variable fields who were monitored using optical coherence tomography and 30-2 full-threshold standard automated perimetry (SAP). At varying endpoints, animals were euthanized followed by perfusion fixation, and 1-mm retinal punches were obtained from 34 corresponding SAP locations. RGCs were immunolabeled with an antibody against an RNA-binding protein (RBPMS) marker and imaged using confocal microscopy. RGC counts from each location were then related to visual sensitivities for each stimulus size, after accounting for ocular magnification. Results At the endpoint, the circumpapillary retinal nerve fiber layer thickness for experimental glaucoma eyes ranged from 47 to 113 µm. RGC density in control eyes was greatest for the 4.24° sample (18,024 ± 6869 cells/mm2) and decreased with eccentricity. Visual sensitivity at each tested location followed that predicted by spatial summation, with the critical area increasing with eccentricity (slope = 0.0036, R2 = 0.44). The relationship between RGC counts and visual sensitivity was described using a two-line fit, where the intercept of the first segment and hinge points were dependent on eccentricity. Conclusions In NHPs, SAP visual thresholds are related to the underlying RGCs. The resulting spatial summation based structure-function model can be used to estimate RGC content from any standard white-on-white stimulus size.
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Affiliation(s)
| | | | - Nimesh B Patel
- University of Houston College of Optometry, Houston, Texas, United States
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Chua J, Wong D, Yow AP, Tan B, Liu X, Ismail MB, Chin CWL, Lamoureux E, Husain R, Schmetterer L. Segregation of neuronal and vascular retinal damage in patients with hypertension and diabetes. Ann N Y Acad Sci 2024; 1531:49-59. [PMID: 38084081 DOI: 10.1111/nyas.15089] [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] [Indexed: 01/19/2024]
Abstract
This study aimed to examine the impact of diabetes and hypertension on retinal nerve fiber layer (RNFL) thickness components. Optical coherence tomography (OCT) measurements do not consider blood vessel contribution, which this study addressed. We hypothesized that diabetes and/or hypertension would lead to thinner RNFL versus controls due to the vascular component. OCT angiography was used to measure the RNFL in 121 controls, 50 diabetes patients, 371 hypertension patients, and 177 diabetes patients with hypertension. A novel technique separated the RNFL thickness into original (vascular component) and corrected (no vascular component) measurements. Diabetes-only (98 ± 1.7 µm; p = 0.002) and diabetes with hypertension (99 ± 0.8 µm; p = 0.001) patients had thinner original RNFL versus controls (102 ± 0.8 µm). No difference was seen between hypertension-only patients (101 ± 0.5 µm; p = 0.083) and controls. After removing the blood vessel component, diabetes/hypertension groups had thinner corrected RNFL versus controls (p = 0.024). Discrepancies in diabetes/hypertension patients were due to thicker retinal blood vessels within the RNFL thickness (p = 0.002). Our findings suggest that diabetes and/or hypertension independently contribute to neurodegenerative thinning of the RNFL, even in the absence of retinopathy. The differentiation of neuronal and vascular components in RNFL thickness measurements provided by the novel technique highlights the importance of considering vascular changes in individuals with these conditions.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Ai Ping Yow
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore
- Institute for Digital Molecular Analytics and Science (IDMxS), Singapore, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore
| | - Xinyu Liu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
| | - Munirah Binte Ismail
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore
| | - Calvin Woon Loong Chin
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Rahat Husain
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
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Shi L, Mohammadi M, Mohammadzadeh V, Su E, Weiss RE, Caprioli J, Nouri-Mahdavi K. Comparing Rates of Change in Moderate to Advanced Glaucoma: Retinal Nerve Fiber Layer Versus Bruch Membrane Opening-Minimum Rim Width. Am J Ophthalmol 2023; 253:181-188. [PMID: 37150336 PMCID: PMC10859221 DOI: 10.1016/j.ajo.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/17/2023] [Accepted: 05/01/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE To compare rates of change (RoC) of peripapillary retinal nerve fiber layer (RNFL) and Bruch membrane opening-based minimum rim width (BMO-MRW) thickness in moderate-to-advanced glaucoma. DESIGN Prospective cohort study. METHODS Longitudinal optical coherence tomography (OCT) optic nerve head volume scans of 113 eyes of 113 glaucoma patients with moderate-to-advanced or central damage were exported. This study estimated and compared global and sectoral RoC with linear mixed effects models and simple linear regression (SLR) of RNFL and BMO-MRW thickness. Permutation analyses were used to test significance of RoC in the SLR model. It also compared longitudinal signal-to-noise ratios (LSNR) defined as RoC divided by residual standard deviation (SD) between the two groups. RESULTS Mean (SD) follow-up and median (IQR) OCT scan sessions were 5.2 (1.3) years and 10 (8-11), respectively. Baseline average (SD) visual field mean deviation was -9.2 (5.8) dB. Based on SLR, a higher proportion of significant negative RNFL RoC was observed compared to BMO-MRW in the inferotemporal (35% vs 20%; P = .015) and inferonasal (42% vs 17%; P < .001) sectors. Permutation analyses also demonstrated a higher proportion of worsening RNFL RoC than BMO-MRW in the inferotemporal (P = .026) and inferonasal (P < .001) sectors along with overall lower positive RoC. Longitudinal signal-to-noise ratios for RNFL were significantly more negative than for BMO-MRW globally, and in the inferotemporal, inferonasal, and superonasal sectors (P ≤ .01). CONCLUSIONS Longitudinal RNFL OCT measurements are more likely to detect structural change and demonstrate better LSNR compared with BMO-MRW in eyes with central or moderate-to-advanced glaucoma damage at baseline.
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Affiliation(s)
- Lynn Shi
- From Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA (L.S, M.M, V.M, J.C, K.N-M)
| | - Massood Mohammadi
- From Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA (L.S, M.M, V.M, J.C, K.N-M)
| | - Vahid Mohammadzadeh
- From Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA (L.S, M.M, V.M, J.C, K.N-M)
| | - Erica Su
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA (E.S, R.E.W)
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA (E.S, R.E.W)
| | - Joseph Caprioli
- From Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA (L.S, M.M, V.M, J.C, K.N-M)
| | - Kouros Nouri-Mahdavi
- From Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA (L.S, M.M, V.M, J.C, K.N-M).
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Uchehara B, Kwee LC, Regan J, Chatterjee R, Eckstrand J, Swope S, Gold G, Schaack T, Douglas P, Mettu P, Haddad F, Shore S, Hernandez A, Mahaffey KW, Pagidipati N, Shah SH. Accelerated Epigenetic Aging Is Associated With Multiple Cardiometabolic, Hematologic, and Renal Abnormalities: A Project Baseline Health Substudy. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2023; 16:216-223. [PMID: 37039013 PMCID: PMC10330131 DOI: 10.1161/circgen.122.003772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 01/30/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Epigenetic clocks estimate chronologic age using methylation levels at specific loci. We tested the hypothesis that accelerated epigenetic aging is associated with abnormal values in a range of clinical, imaging, and laboratory characteristics. METHODS The Project Baseline Health Study recruited 2502 participants, including 1661 with epigenetic age estimates from the Horvath pan-tissue clock. We classified individuals with extreme values as having epigenetic age acceleration (EAA) or epigenetic age deceleration. A subset of participants with longitudinal methylation profiling was categorized as accelerated versus nonaccelerated. Using principal components analysis, we created phenoclusters using 122 phenotypic variables and compared individuals with EAA versus epigenetic age deceleration, and at one year of follow-up, using logistic regression models adjusted for sex (false discovery rate [Q] <0.10); in secondary exploratory analyses, we tested individual clinical variables. RESULTS The EAA (n=188) and epigenetic age deceleration (n=195) groups were identified as having EAA estimates ≥5 years or ≤-5 years, respectively. In primary analyses, individuals with EAA had higher values for phenoclusters summarizing lung function and lipids, and lower values for a phenocluster representing physical function. In secondary analyses of individual variables, neutrophils, body mass index, and waist circumference were significantly higher in individuals with EAA (Q<0.10). No phenoclusters were significantly different between participants with accelerated (n=148) versus nonaccelerated (n=112) longitudinal aging. CONCLUSIONS We report multiple cardiometabolic, hematologic, and physical function features characterizing individuals with EAA. These highlight factors that may mediate the adverse effects of aging and identify potential targets for study of mitigation of these effects. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03154346.
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Affiliation(s)
| | | | - Jessica Regan
- Division of General Internal Medicine, Dept of Medicine
| | | | | | - Sue Swope
- Stanford Center for Clinical Research, Dept of Medicine, Stanford University School of Medicine, Stanford
| | - Gary Gold
- Stanford Center for Clinical Research, Dept of Medicine, Stanford University School of Medicine, Stanford
| | - Terry Schaack
- California Health & Longevity Institute, Westlake Village
| | | | - Prithu Mettu
- Division of Retinal Ophthalmology, Dept of Ophthalmology
| | - Francois Haddad
- Stanford Center for Clinical Research, Dept of Medicine, Stanford University School of Medicine, Stanford
| | | | - Adrian Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Kenneth W. Mahaffey
- Stanford Center for Clinical Research, Dept of Medicine, Stanford University School of Medicine, Stanford
| | | | - Svati H. Shah
- Duke Molecular Physiology Institute, Duke University
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Patel NB, Carter-Dawson L, Frishman LJ. Neuroretinal Rim Response to Transient Intraocular Pressure Challenge Predicts the Extent of Retinal Ganglion Cell Loss in Experimental Glaucoma. Invest Ophthalmol Vis Sci 2023; 64:30. [PMID: 37256608 PMCID: PMC10233313 DOI: 10.1167/iovs.64.5.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/12/2023] [Indexed: 06/01/2023] Open
Abstract
Purpose To determine if the optic nerve head (ONH) response to transient elevated intraocular pressure (IOP) can predict the extent of neural loss in the nonhuman primate experimental glaucoma model. Methods The anterior chamber pressure of 21 healthy animals (5.4 ± 1.2 years, 8 female) was adjusted to 25 mm Hg for two hours followed by 10 mm Hg for an additional two hours. For the duration of IOP challenge the ONH was imaged using radial optical coherence tomography (OCT) scans at five-minute intervals. Afterward, a randomized sample of 14 of these subjects had unilateral experimental glaucoma induced and were monitored with OCT imaging, tonometry, and ocular biometry at two-week intervals. Results With pressure challenge, the maximum decrease in ONH minimum rim width (MRW) was 40 ± 10.5 µm at 25 mm Hg and was correlated with the precannulation MRW, Bruch's membrane opening (BMO) position, and the anterior lamina cribrosa surface position (P = 0.01). The maximum return of MRW at 10 mm Hg was 16.1 ± 5.0 µm and was not associated with any precannulation ONH feature (P = 0.24). However, healthy eyes with greater thickness return at 10 mm Hg had greater loss of MRW and retinal nerve fiber layer (RNFL) at a cumulative IOP of 1000 mm Hg · days after induction of experimental glaucoma. In addition, MRW and RNFL thinning was correlated with an increase in axial length (P < 0.01). Conclusion This study's findings suggest that the ONH's response to transient changes in IOP are associated with features of the ONH and surrounding tissues. The neural rim properties at baseline and the extent of axial elongation are associated with the severity of glaucomatous loss in the nonhuman primate model.
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Affiliation(s)
- Nimesh B Patel
- University of Houston College of Optometry, Houston, Texas, United States
| | | | - Laura J Frishman
- University of Houston College of Optometry, Houston, Texas, United States
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Mathews B, Le PH, Budenz DL, Mwanza JC. Agreement of Diagnostic Classification Between Structural Parameters in Pre-Perimetric and Early Perimetric Glaucoma. J Glaucoma 2023; 32:301-306. [PMID: 36477025 DOI: 10.1097/ijg.0000000000002157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022]
Abstract
PRCIS In both pre-perimetric and early perimetric glaucoma, the diagnostic agreements between optic disk, retinal nerve fiber layer, and ganglion cell-inner plexiform layer parameters based on Cirrus HD-OCT normative database classification were mostly fair, suggesting that abnormal classification in 1 anatomic area may suffice for the diagnosis of glaucoma in early stages. PURPOSE To evaluate the agreement of normative database diagnostic classification between optic disk, retinal nerve fiber layer (RNFL), and ganglion cell-inner plexiform layer (GCIPL) in patients with early glaucoma. METHODS Retrospective cross-sectional study involving 66 eyes (66 patients) with pre-perimetric and 97 eyes (97 patients) with early perimetric glaucoma. Normative database diagnostic classifications were retrieved from Cirrus HD-OCT scans of 1 eye per participant. An eye was considered abnormal if any of the optic disk, RNFL, or GCIPL was abnormal (yellow or red color-coded classification). For combined parameters, the eye had to be flagged as abnormal by both classifications, regardless of the parameters that were abnormal (global or sectorial). The agreement was assessed with Cohen's Kappa statistics. RESULTS The agreement between RNFL and GCIPL was fair in both pre-perimetric (κ=0.25) and perimetric glaucoma (κ=0.21). Agreements between RNFL or GCIPL and optic nerve head parameters (rim area and vertical cup-to-disk ratio; VCDR) were inconclusive due to insufficient data ( P >0.05). Combining GCIPL and rim area agreed fairly with RNFL both in pre-perimetric (κ=0.21) and perimetric glaucoma (κ=0.33). The best classification agreement (moderate) was achieved with the comparison of RNFL-rim area versus VCDR (κ=0.48 in pre-perimetric, 0.45 in perimetric glaucoma). There were no significant differences between pre-perimetric and perimetric glaucoma coefficients of classification agreement. CONCLUSIONS The normative database diagnostic agreements between optic disk, RNFL, and GCIPL were mostly fair in both pre-perimetric and early perimetric glaucoma. Clinicians should not wait for multiple structures to show abnormality on OCT to diagnose early glaucoma.
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Affiliation(s)
- Basil Mathews
- Department of Ophthalmology, Kittner Eye Center, University of North Carolina, NC
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Quach J, Sharpe GP, Demirel S, Girkin CA, Mardin CY, Scheuerle AF, Burgoyne CF, Chauhan BC, Vianna JR. Asymmetry of Peripapillary Retinal Blood Vessel and Retinal Nerve Fiber Layer Thickness Between Healthy Right and Left Eyes. Invest Ophthalmol Vis Sci 2023; 64:17. [PMID: 36790798 PMCID: PMC9940773 DOI: 10.1167/iovs.64.2.17] [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] [Indexed: 02/16/2023] Open
Abstract
Purpose The purpose of this study was to determine if there is asymmetry in retinal blood vessel (RBV) position and thickness between right and left eyes (R-L) and evaluate whether R-L asymmetry in RBV thickness is related to R-L asymmetry of retinal nerve fiber layer thickness (RNFLT). Methods We analyzed peripapillary circle scan optical coherence tomography (OCT) examinations from healthy White subjects to measure RNFLT and RBV thickness and position relative to the fovea to Bruch's membrane opening axis, for all visible RBV. The R-L asymmetries of RNFLT and RBV thickness were computed for each A-scan. Four major vessels (superior temporal artery [STA] and superior temporal vein [STV], inferior temporal artery [ITA], and vein [ITV]) were identified using infrared images. Results We included 219 individuals. The mean (standard deviation) number of RBV measured per eye was 15.0 (SD = 2.2). The position of the STV and STA was more superior in left eyes than in right eyes, by 2.4 degrees and 3.7 degrees, respectively (P < 0.01). There was no region with significant R-L asymmetry in RBV thickness. RNFLT was thicker in right eyes in the temporal superior region and thicker in left eyes in the superior and nasal superior regions, with the asymmetry profile resembling in a "W" shape. This shape was also present in post hoc analyses in two different populations. The R-L asymmetries of RBV and RNFLT at each A-scan were not significantly associated (P = 0.37). Conclusions There is little R-L asymmetry in RBV, and it is not related to RNFLT asymmetry. This study suggests that R-L RNFLT asymmetry is due to factors other than RBV.
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Affiliation(s)
- Jack Quach
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada,Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Glen P. Sharpe
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Christopher A. Girkin
- Department of Ophthalmology, University of Alabama at Birmingham, Alabama, United States
| | | | | | | | - Balwantray C. Chauhan
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jayme R. Vianna
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
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Gardiner SK, Kinast RM, Chen TC, Strouthidis NG, De Moraes CG, Nouri-Mahdavi K, Myers JS, Jeoung JW, Lind JT, Rhodes LA, Budenz DL, Mansberger SL. Clinicians' Use of Quantitative Information When Assessing the Rate of Structural Progression in Glaucoma. Ophthalmol Glaucoma 2022; 5:507-515. [PMID: 35144008 PMCID: PMC9357231 DOI: 10.1016/j.ogla.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/18/2022] [Accepted: 02/01/2022] [Indexed: 05/29/2023]
Abstract
PURPOSE OCT scans contain large amounts of information, but clinicians often rely on reported layer thicknesses when assessing the rate of glaucomatous progression. We sought to determine which of these quantifications most closely relate to the subjective assessment of glaucoma experts who had all the diagnostic information available. DESIGN Prospective cohort study. PARTICIPANTS Eleven glaucoma specialists independently scored the rate of structural progression from a series of 5 biannual clinical OCT printouts. METHODS A total of 100 glaucoma or glaucoma suspect eyes of 51 participants were included; 20 were scored twice to assess repeatability. Scores ranged from 1 (improvement) to 7 (very rapid progression). Generalized estimating equation linear models were used to predict the mean clinician score from the rates of change of retinal nerve fiber layer thickness (RNFLT) or minimum rim width (MRW) globally or in the most rapidly thinning of the 6 sectors. MAIN OUTCOME MEASURES The correlation between the objective rates of change and the average of the 11 clinicians' scores. RESULTS Average RNFLT within the series of study eyes was 79.3 μm (range, 41.4-126.6). Some 95% of individual clinician scores varied by ≤ 1 point when repeated. The mean clinician score was more strongly correlated with the rate of change of RNFLT in the most rapidly changing sector in %/year (pseudo-R2 = 0.657) than the rate of global RNFLT (0.372). The rate of MRW in the most rapidly changing sector had pseudo-R2 = 0.149. CONCLUSIONS The rate of change of RNFLT in the most rapidly changing sector predicted experts' assessment of the rate of structural progression better than global rates or MRW. Sectoral rates may be a useful addition to current clinical printouts.
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Affiliation(s)
| | | | - Teresa C Chen
- Harvard Medical School, Massachusetts Eye & Ear, Boston, Massachusetts
| | - Nicholas G Strouthidis
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom; Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, NSW, Australia
| | | | - Kouros Nouri-Mahdavi
- Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | | | - Jin Wook Jeoung
- Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - John T Lind
- Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Donald L Budenz
- Department of Ophthalmology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
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Srinivasan VV, Das S, Patel N. Widefield OCT Imaging for Quantifying Inner Retinal Thickness in the Nonhuman Primate. Transl Vis Sci Technol 2022; 11:12. [PMID: 35972432 PMCID: PMC9396678 DOI: 10.1167/tvst.11.8.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine the agreement and repeatability of inner retinal thickness measures from widefield imaging compared to standard scans in healthy nonhuman primates. Methods Optical coherence tomography (OCT) scans were acquired from 30 healthy rhesus monkeys, with 11 animals scanned at multiple visits. The scan protocol included 20° × 20° raster scans centered on the macula and optic nerve head (ONH), a 12° diameter circular scan centered on the ONH, and a 55 × 45° widefield raster scan. Each scan was segmented using custom neural network–based algorithms. Bland–Altman analysis were used for comparing average circumpapillary retinal nerve fiber layer (RNFL) thickness and ganglion cell inner plexiform layer (GCIPL) thickness for a 16° diameter region. Comparisons were also made for similar 1° × 1° superpixels from the raster scans. Results Average circumpapillary RNFL thickness from the circular scan was 114.2 ± 5.8 µm, and 113.2 ± 7.3 µm for an interpolated scan path from widefield imaging (bias = −1.03 µm, 95% limits of agreement [LOA] −8.6 to 6.5 µm). GCIPL thickness from standard raster scans was 72.7 ± 4.3 µm, and 73.7 ± 3.7 µm from widefield images (bias = 1.0 µm, 95% LOA −2.4 to 4.4 µm). Repeatability for both RNFL and GCIPL standard analysis was less than 5.2 µm. For 1° × 1° superpixels, the 95% limits of agreement were between −13.9 µm and 13.7 µm for RNFL thickness and −2.5 µm and 2.5 µm for GCIPL thickness. Conclusions Inner retinal thickness measures from widefield imaging have good repeatability and are comparable to those measured using standard scans. Translational Relevance Monitoring retinal ganglion cell loss in the non-human primate experimental glaucoma model could be enhanced using widefield imaging.
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Affiliation(s)
| | - Siddarth Das
- University of Houston College of Optometry, Houston, TX, USA
| | - Nimesh Patel
- University of Houston College of Optometry, Houston, TX, USA
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11
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Kim YW, Sharpe GP, Hutchison DM, Rafuse PE, Shuba LM, Nicolela MT, Vianna JR, Chauhan BC. Impact of Glaucoma Severity on Rates of Neuroretinal Rim, Retinal Nerve Fiber Layer, and Macular Ganglion Cell Layer Thickness Change. Am J Ophthalmol 2022; 239:115-121. [PMID: 35122748 DOI: 10.1016/j.ajo.2022.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/09/2021] [Accepted: 01/20/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the impact of glaucoma severity on rates of change of minimum rim width (MRW), peripapillary retinal nerve fiber layer (RNFL), and macular ganglion cell layer (GCL) thickness. DESIGN Prospective, cohort study. METHODS Glaucoma patients and healthy subjects had optical coherence tomography scans at 6-month intervals. Individual rates of change for MRW, RNFL, and GCL thickness were estimated with ordinary least-squares regression. Linear mixed-effect models were used to estimate the rate of change of each parameter and evaluate the impact of glaucoma severity (expressed by visual field mean deviation, MD) and age on these rates. RESULTS A total of 132 glaucoma patients and 57 healthy subjects were followed for a median of 4.3 years and 3.7 years, respectively. Healthy subjects had a statistically significant deterioration in MRW (-1.66 µm/year), RNFL (-0.46 µm/year), and GCL thickness (-0.22 µm/year). While glaucoma patients had a faster rate of change in each parameter compared with healthy subjects, only GCL thickness showed a statistically significant group difference (mean difference: -0.17 µm/year; P = .03). Older baseline age was associated with faster GCL thickness change (-0.07 µm/year; P = .03), but not other parameters. Baseline MD had no impact on the subsequent rates of change in any of the parameters. CONCLUSIONS The rates of MRW, RNFL, and GCL thickness change were not significantly influenced by glaucoma severity at baseline; however, GCL thickness was able to statistically contrast the rate of change between healthy subjects and glaucoma patients throughout the disease spectrum.
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Affiliation(s)
- Yong Woo Kim
- From the Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health, Halifax, Canada
| | - Glen P Sharpe
- From the Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health, Halifax, Canada
| | - Donna M Hutchison
- From the Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health, Halifax, Canada
| | - Paul E Rafuse
- From the Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health, Halifax, Canada
| | - Lesya M Shuba
- From the Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health, Halifax, Canada
| | - Marcelo T Nicolela
- From the Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health, Halifax, Canada
| | - Jayme R Vianna
- From the Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health, Halifax, Canada
| | - Balwantray C Chauhan
- From the Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health, Halifax, Canada.
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12
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Unsuspected Central Vision Decrease from Macular Ganglion Cell Loss after Posterior Segment Surgery. Retina 2022; 42:867-876. [PMID: 35030145 DOI: 10.1097/iae.0000000000003408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe a novel post-surgical complication of circumscribed macula ganglion cell loss as an apparent cause of unsuspected vision loss following posterior segment surgery. METHODS Patients were seen in referral and were evaluated with comprehensive examination to include optical coherence tomography (OCT) and microperimetry. RESULTS All 8 patients had a sudden central vision loss following vitrectomy and many patients suspected the central loss was present even before the eye patch was removed on the first postoperative day. Of the 8, 1 had a vitrectomy with no membrane peeling while the remaining 7 had membrane peeling. The mean post-operative visual acuity was 20/200. The mean ganglion cell layer (GCL) volume was 0.69 µm3 in the involved eye and 1.035 µm3 in the fellow eye (P<.001). The global retinal nerve fiber layer (RNFL) thicknesses in the involved and fellow eyes were 81.3 and 90 µm respectively (P = .08). The outer retinal architecture was unremarkable in the involved eyes and did not appear to explain the poor acuity. The GCL volume loss was not necessarily associated with RNFL thicknesses that were in the abnormal range or in optic nerve pallor. Microperimetry showed severe depression of the threshold sensitivities. CONCLUSION Severe loss of the macular ganglion cells may occur after vitrectomy and is associated with central vision loss. The diagnosis is made by having a high index of suspicion when examining OCT B-scan images and by evaluating GCL volumes. The frequency of this occurrence is currently unknown.
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13
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Musial G, Adhikari S, Mirhajianmoghadam H, Queener HM, Schill AW, Patel NB, Porter J. Longitudinal In Vivo Changes in Radial Peripapillary Capillaries and Optic Nerve Head Structure in Non-Human Primates With Early Experimental Glaucoma. Invest Ophthalmol Vis Sci 2022; 63:10. [PMID: 34994770 PMCID: PMC8742514 DOI: 10.1167/iovs.63.1.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose There is conflicting evidence regarding whether a loss of radial peripapillary capillaries (RPCs) precedes neuronal loss in glaucoma. We examined the time course of in vivo changes in RPCs, optic nerve head (ONH) structure, and retinal nerve fiber layer thickness (RNFLT) in experimental glaucoma (EG). Methods Spectral domain optical coherence tomography images were acquired before and approximately every two weeks after inducing unilateral EG in nine rhesus monkeys to quantify mean anterior lamina cribrosa surface depth (ALCSD), minimum rim width (MRW), and RNFLT. Perfused RPC density was measured from adaptive optics scanning laser ophthalmoscope images acquired on the temporal half of the ONH. The time of first significant change was quantified as when values fell and remained outside of the 95% confidence interval established from control eyes. Results Mean ALCSD and/or MRW were the first parameters to change in eight EG eyes. RPC density changed first in the ninth. At their first points of change, mean ALCSD posteriorly deformed by 100.2 ± 101.2 µm, MRW thinned by 82.3 ± 65.9 µm, RNFLT decreased by 25 ± 14 µm, and RPC density decreased by 4.5 ± 2.1%. RPC density decreased before RNFL thinning in 5 EG eyes. RNFLT decreased before RPC density decreased in two EG eyes, whereas two EG eyes had simultaneous changes. Conclusions In most EG eyes, RPC density decreased before (or simultaneous with) a change in RNFLT, suggesting that vascular factors may play a role in axonal loss in some eyes in early glaucoma.
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Affiliation(s)
- Gwen Musial
- University of Houston, Houston, Texas, United States
| | | | | | | | | | | | - Jason Porter
- University of Houston, Houston, Texas, United States
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Kolačko Š, Predović J, Kokot A, Bosnar D, Brzović-Šarić V, Šarić B, Balog S, Milanovic K, Ivastinovic D. Do Gender, Age, Body Mass and Height Influence Eye Biometrical Properties in Young Adults? A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111719. [PMID: 34770229 PMCID: PMC8582935 DOI: 10.3390/ijerph182111719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/03/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Do gender, age, body mass and height influence eye biometrical properties in young adults? METHODS A total of 155 eyes (92 female, 63 male) of healthy subjects between the ages of 18 and 39 years were included in the study. The subjects' gender and age were recorded, and their body mass, height and biometrical properties of the eyes were measured. RESULTS The male subjects had significantly thicker and flatter corneas and lower minimal rim-to-disk ratios than the female subjects did. In both genders, age showed strong, negative correlations with anterior chamber depth and pupil diameter and a positive correlation with lens thickness. We also found significant, negative correlations between body height and mass with keratometry measurements, negative correlations between body height and optic disk rim area and rim volume, and positive correlations between body mass and axial length in both genders. CONCLUSIONS Biometric eye parameters differ among people. In addition to age and gender, which are usually taken into consideration when interpreting ocular biometry findings, we strongly suggest that body height and mass should be also routinely considered when interpreting eye biometry data, as these factors have an impact on ocular biometry.
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Affiliation(s)
- Štefanija Kolačko
- University Hospital “Sveti Duh”, 10000 Zagreb, Croatia; (Š.K.); (D.B.); (V.B.-Š.); (B.Š.)
- Department of Nursing and Palliative Medicine, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Jurica Predović
- University Hospital “Sveti Duh”, 10000 Zagreb, Croatia; (Š.K.); (D.B.); (V.B.-Š.); (B.Š.)
- Department of Ophthalmology and Optometry, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Ophthalmology and Optometry, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Correspondence: (J.P.); (A.K.)
| | - Antonio Kokot
- Department of Ophthalmology and Optometry, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Anatomy and Neuroscience, Faculty of medicine, University of Josip Juraj Strossmayer, 31000 Osijek, Croatia; (S.B.); (K.M.)
- Correspondence: (J.P.); (A.K.)
| | - Damir Bosnar
- University Hospital “Sveti Duh”, 10000 Zagreb, Croatia; (Š.K.); (D.B.); (V.B.-Š.); (B.Š.)
- Department of Ophthalmology and Optometry, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Ophthalmology and Optometry, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Vlatka Brzović-Šarić
- University Hospital “Sveti Duh”, 10000 Zagreb, Croatia; (Š.K.); (D.B.); (V.B.-Š.); (B.Š.)
| | - Borna Šarić
- University Hospital “Sveti Duh”, 10000 Zagreb, Croatia; (Š.K.); (D.B.); (V.B.-Š.); (B.Š.)
| | - Slaven Balog
- Department of Anatomy and Neuroscience, Faculty of medicine, University of Josip Juraj Strossmayer, 31000 Osijek, Croatia; (S.B.); (K.M.)
- Dr. Balog Ophthalmology Clinic, 31000 Osijek, Croatia
| | - Kristina Milanovic
- Department of Anatomy and Neuroscience, Faculty of medicine, University of Josip Juraj Strossmayer, 31000 Osijek, Croatia; (S.B.); (K.M.)
| | - Domagoj Ivastinovic
- Department of Ophthalmology, Medical University of Graz, 8036 Graz, Austria;
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15
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Lin KH, Tran T, Kim S, Park S, Stout JT, Chen R, Rogers J, Yiu G, Thomasy S, Moshiri A. Advanced Retinal Imaging and Ocular Parameters of the Rhesus Macaque Eye. Transl Vis Sci Technol 2021; 10:7. [PMID: 34111251 PMCID: PMC8107642 DOI: 10.1167/tvst.10.6.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine the range of normal ocular biometry and perform advanced retinal imaging and functional assessment of the rhesus macaque eye. Methods We performed ocular phenotyping on rhesus macaques at the California National Primate Research Center. This process consisted of anterior and posterior segment eye examination by ophthalmologists, advanced retinal imaging, and functional retinal electrophysiology. Results Full eye examinations were performed on 142 animals, consisting of pupillary light reflex, tonometry, external examination and photography, anterior slit lamp examination, and posterior segment examination by indirect ophthalmoscopy. Ages of the rhesus macaques ranged from 0.7 to 29 years (mean, 16.4 ± 7.5 years). Anterior segment measurements such as intraocular pressure (n = 142), corneal thickness (n = 84), lens thickness (n = 114), and axial length (n = 114) were acquired. Advanced retinal imaging in the form of fundus photography (n = 78), optical coherence tomography (n = 60), and quantitative autofluorescence (n = 44) was obtained. Electroretinography (n = 75) was used to assay retinal function. Quantitative analyses of the macular structure, retinal layer segmentation, and rod and cone photoreceptor electrical responses are reported. Quantitative assessments were made and variations between sexes were analyzed to compare with established sex changes in human eyes. Conclusions The rhesus macaque has an ocular structure and function very similar to that of the human eye. In particular macular structure and retinal function is very similar to humans, making this species particularly useful for the study of macular biology and development of therapies for cone photoreceptor disorders. Translational Relevance Rhesus macaques are an ideal model for future vision science studies of human eye diseases.
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Affiliation(s)
- Kira H Lin
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - Tu Tran
- Department of Ophthalmology & Vision Science, School of Medicine, University of California-Davis, Sacramento, CA, USA
| | - Soohyun Kim
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - Sangwan Park
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - J Timothy Stout
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA
| | - Rui Chen
- Human Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.,Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey Rogers
- Human Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Glenn Yiu
- Department of Ophthalmology & Vision Science, School of Medicine, University of California-Davis, Sacramento, CA, USA
| | - Sara Thomasy
- Department of Ophthalmology & Vision Science, School of Medicine, University of California-Davis, Sacramento, CA, USA.,Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - Ala Moshiri
- Department of Ophthalmology & Vision Science, School of Medicine, University of California-Davis, Sacramento, CA, USA
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16
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Antwi-Boasiako K, Carter-Dawson L, Harwerth R, Gondo M, Patel N. The Relationship Between Macula Retinal Ganglion Cell Density and Visual Function in the Nonhuman Primate. Invest Ophthalmol Vis Sci 2021; 62:5. [PMID: 33393971 PMCID: PMC7794274 DOI: 10.1167/iovs.62.1.5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose Loss of ganglion cell inner plexiform layer (GCIPL) and visual sensitivity in the macula region are known to occur at all stages of glaucoma. While both are dependent on the underlying retinal ganglion cells (RGCs), the relationship between structure and function is modest. We hypothesize that the imprecise relationship is due to a lack of direct correspondence between in vivo measures and RGC counts, as well as the relatively large stimulus size used by standard perimetry, which exceeds spatial summation. Methods The relationship between optical coherence tomography (OCT)–derived GCIPL thickness and corresponding inner cell density from retinal flat mounts was determined for four nonhuman primates with varying stages of neuropathy. Normative data for 10-2 threshold using Goldman size I to V stimuli were established for 10 animals, 4 of which were then followed longitudinally with OCT and perimetry. The relationship between GCIPL volume, which incorporated stimulus size after removal of residual thickness, and differential light sensitivity was determined for both experimental glaucoma and healthy eyes. Results Peak inner retinal cell density was 63,052 ± 9238 cells/mm2 in the healthy eye. Cell density was related to both GCIPL thickness and eccentricity (R2 = 0.74, P < .01). For all 10-2 eccentricities, size III stimuli were greater than the critical area (P < 0.01). Based on the structural and histologic relationship, the critical area corresponds to approximately 156 RGCs. Conclusions The relationship between cell density and GCIPL thickness is dependent on retinal eccentricity. For 10-2 perimetry, perimetric loss, especially at earlier stages of neuropathy, may best be detected using size II or smaller stimuli.
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Affiliation(s)
| | | | - Ronald Harwerth
- College of Optometry, University of Houston, Houston, Texas, United States
| | - Margaret Gondo
- College of Optometry, University of Houston, Houston, Texas, United States
| | - Nimesh Patel
- College of Optometry, University of Houston, Houston, Texas, United States
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17
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Yow AP, Tan B, Chua J, Husain R, Schmetterer L, Wong D. Segregation of neuronal-vascular components in a retinal nerve fiber layer for thickness measurement using OCT and OCT angiography. BIOMEDICAL OPTICS EXPRESS 2021; 12:3228-3240. [PMID: 34221656 PMCID: PMC8221930 DOI: 10.1364/boe.420507] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/18/2021] [Accepted: 04/13/2021] [Indexed: 05/02/2023]
Abstract
Assessment of the circumpapillary retinal nerve fiber layer (RNFL) provides crucial knowledge on the status of the optic nerve. Current circumpapillary RNFL measurements consider only thickness, but an accurate evaluation should also consider blood vessel contribution. Previous studies considered the presence of major vessels in RNFL thickness measurements from optical coherence tomography (OCT). However, such quantitative measurements do not account for smaller vessels, which could also affect circumpapillary RNFL measurements. We present an approach to automatically segregate the neuronal and vascular components in circumpapillary RNFL by combining vascular information from OCT angiography (OCTA) and structural data from OCT. Automated segmentation of the circumpapillary RNFL using a state-of-the-art deep learning network is first performed and followed by the lateral and depth-resolved localization of the vascular component by vertically projecting the vessels along the circular scan from OCTA vessels map onto the segmented RNFL. Using this proposed approach, we compare the correlations of circumpapillary RNFL thicknesses with age at different levels of vessel exclusion (exclusion of major vessels only vs both major- and micro-vessels) and also evaluate the thickness variability in 75 healthy eyes. Our results show that the ratio of major- and micro-vessels to circumpapillary RNFL achieved a stronger correlation with aging (r = 0.478, P < .001) than the ratio with only major vessels to circumpapillary RNFL (r = 0.027, P = .820). Exclusion of blood vessels from circumpapillary RNFL thickness using OCTA imaging provides a better measure of the neuronal components and could potentially improve the diagnostic performance for disease detection.
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Affiliation(s)
- Ai Ping Yow
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
| | - Bingyao Tan
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
| | - Jacqueline Chua
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Rahat Husain
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Leopold Schmetterer
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Damon Wong
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
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18
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Pardon LP, Cheng H, Chettry P, Patel NB. Optic Nerve Head Morphological Changes Over 12 Hours in Seated and Head-Down Tilt Postures. Invest Ophthalmol Vis Sci 2021; 61:21. [PMID: 33186468 PMCID: PMC7671873 DOI: 10.1167/iovs.61.13.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose The purpose of this study was to determine changes in optic nerve head (ONH) morphology in seated and 6° head-down tilt (HDT) postures over a 12-hour period. Methods Thirty eyes of 30 healthy human subjects (15 females) were included. Composite radial and circular optical coherence tomography (OCT) scans centered on the ONH, intraocular pressure (IOP), and optic nerve sheath diameter (ONSD) were acquired every two hours from 7 a.m. to 7 p.m. for both seated (n = 30) and HDT (n = 10) sessions. Global minimum rim width (BMO-MRW), total retinal thickness (TRT), retinal nerve fiber layer thickness (RNFLT), and Bruch's membrane opening (BMO) height were quantified. Results BMO-MRW decreased an average of 9.55 ± 8.03 µm (P < 0.01) over 12 hours in a seated position (range, -26.64 to +3.36 µm), and thinning was greater in females (-13.56 vs. -5.55 µm, P = 0.004). Modest decreases in TRT from the BMO to 500 µm (P < 0.04) and RNFLT for the 2.7, 3.5, and 4.2 mm circular scans (P < 0.02) were also observed. BMO-MRW thinning was not related to changes in IOP or ONSD (P = 0.34). In HDT, IOP and ONSD increased, BMO height moved anteriorly, and BMO-MRW thinning did not occur (P > 0.1). Conclusions The neuroretinal rim thins throughout the day in healthy individuals, and this change cannot be explained by changes in IOP or ONSD during the same time period. A HDT posture blunts the neuroretinal rim thinning observed in a seated position, suggesting a role of the translaminar pressure difference.
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Affiliation(s)
- Laura P Pardon
- University of Houston, College of Optometry, Houston, Texas, United States
| | - Han Cheng
- University of Houston, College of Optometry, Houston, Texas, United States
| | - Pratik Chettry
- University of Houston, College of Optometry, Houston, Texas, United States
| | - Nimesh B Patel
- University of Houston, College of Optometry, Houston, Texas, United States
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19
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Fortune B. Optical coherence tomography evaluation of the optic nerve head neuro‐retinal rim in glaucoma. Clin Exp Optom 2021; 102:286-290. [DOI: 10.1111/cxo.12833] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/09/2018] [Indexed: 12/30/2022] Open
Affiliation(s)
- Brad Fortune
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Health, Portland, Oregon, USA,
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20
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Abstract
Supplemental Digital Content is available in the text. Precis: In open-angle glaucoma, when neuroretinal rim tissue measured by volumetric optical coherence tomography (OCT) scans is below a third of the normal value, visual field (VF) damage becomes detectable. Purpose: To determine the amount of neuroretinal rim tissue thickness below which VF damage becomes detectable. Methods: In a retrospective cross-sectional study, 1 eye per subject (of 57 healthy and 100 open-angle glaucoma patients) at an academic institution had eye examinations, VF testing, spectral-domain OCT retinal nerve fiber layer (RNFL) thickness measurements, and optic nerve volumetric scans. Using custom algorithms, the minimum distance band (MDB) neuroretinal rim thickness was calculated from optic nerve scans. “Broken-stick” regression was performed for estimating both the MDB and RNFL thickness tipping-point thresholds, below which were associated with initial VF defects in the decibel scale. The slopes for the structure-function relationship above and below the thresholds were computed. Smoothing curves of the MDB and RNFL thickness covariates were evaluated to examine the consistency of the independently identified tipping-point pairs. Results: Plots of VF total deviation against MDB thickness revealed plateaus of VF total deviation unrelated to MDB thickness. Below the thresholds, VF total deviation decreased with MDB thickness, with the associated slopes significantly greater than those above the thresholds (P<0.014). Below 31% of global MDB thickness, and 36.8% and 43.6% of superior and inferior MDB thickness, VF damage becomes detectable. The MDB and RNFL tipping points were in good accordance with the correlation of the MDB and RNFL thickness covariates. Conclusions: When neuroretinal rim tissue, characterized by MDB thickness in OCT, is below a third of the normal value, VF damage in the decibel scale becomes detectable.
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Chiou CA, Wang M, Taniguchi EV, Nascimento E Silva R, Khoroshilov A, Li D, Wang H, Greenstein SH, Brauner SC, Turalba AV, Pasquale LR, Shen LQ. Characterization of Prelaminar Wedge-Shaped Defects in Primary Open-Angle Glaucoma. Curr Eye Res 2020; 46:895-902. [PMID: 33054505 DOI: 10.1080/02713683.2020.1836229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine the clinical relevance of prelaminar wedge defects (PLWDs) detected by swept-source optical coherence tomography (SS-OCT) in primary open-angle glaucoma (POAG). MATERIALS AND METHODS In this retrospective case-control study, PLWDs were defined as triangular-shaped defects at the surface of the optic nerve prelaminar tissue, not adjacent to blood vessels, present on cross-sectional SS-OCT scans. Two observers masked to diagnosis independently reviewed scans to detect PLWDs and lamina cribrosa defects. History of disc hemorrhage, occurring within 2 years prior to imaging, was obtained from chart review. One eye per subject was randomly selected. Two-sided t-tests, analysis of variance with Bonferroni correction, and multivariable logistic regression analysis were performed to explore demographic and clinical features associated with PLWDs. RESULTS 40 POAG and 23 control eyes were included. PLWDS were found in 27.5% of POAG (n = 11) and 4.3% of controls (n = 1, p = .04). Eyes with repeat SS-OCT imaging (7 POAG and 0 controls) had persistent PLWDs. More POAG eyes with PLWDs had a history of disc hemorrhage (45.5%) than POAG eyes without PLWDs (3.4%, p = .004). On multivariable analysis, compared to POAG without PLWDs, POAG with PLWDs had increased odds of observed disc hemorrhage (OR = 21.6, 95% CI, 2.2-589.0, p = .02) after adjusting for age, gender, visual field mean deviation and maximum intraocular pressure (IOP). POAG with PLWDs had more lamina cribrosa defects (45.5%) than POAG without PLWDs (3.4%, p = .01) but did not differ significantly from controls (8.7%, p = .07). Compared to all patients without PLWDs, patients with PLWDs had increased odds of having lamina cribrosa defects (OR = 44.8; 95% CI, 6.3-703.6, p < .001) after adjusting for age, gender, and maximum IOP. CONCLUSIONS PLWDs were more frequently found in POAG than control eyes and were associated with a history of disc hemorrhage and lamina cribrosa defects. PLWDs may be a useful imaging biomarker of glaucomatous damage.
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Affiliation(s)
- Carolina A Chiou
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Mengyu Wang
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
| | - Elise V Taniguchi
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Anna Khoroshilov
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Dian Li
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
| | - Haobing Wang
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | | | - Stacey C Brauner
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Angela V Turalba
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Ophthalmology and Visual Services, Atrius Health, Boston, Massachusetts, USA
| | - Louis R Pasquale
- Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lucy Q Shen
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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22
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Abstract
PURPOSE To assess the validity of and compare applanation and rebound tonometry readings of intraocular pressure in alert normal chicks from ages 3 to 45 days. METHODS Intraocular pressures (IOPs) were measured weekly in awake White Leghorn chicks, from ages 3-45 days (n = 22-30 per age group), with both applanation Tono-Pen and rebound TonoLab tonometers. Three repeated measurements on individual eyes were used to derive variance data for both instruments at each age. Calibration curves were also derived for each instrument and each age, weekly from ages 10-45 days (n = 3-4 per age group), from in situ manometry data collected over IOP settings of 0 to 100 mmHg in 5 mmHg steps in cannulated eyes. RESULTS The TonoLab showed less within measurement variability, but more variability with age, than the Tono-Pen. The coefficient of variation ranged from 3.8-8.3% for the TonoLab, compared to 11.0-19.7% for the Tono-Pen across all ages. For the youngest, 3 day-old chicks, mean IOPs recorded with the Tono-Pen and TonoLab were not significantly different (17.0 ± 5.6 and 15.2 ± 3.7 mmHg, respectively, P = .27). However, with increasing age, IOP readings significantly increased for the TonoLab (P < .001), whereas Tono-Pen readings did not. Compared to manometry settings, the Tono-Pen tended to underestimate IOPs while the TonoLab overestimated IOPs over the range 20-60 mmHg, saturating thereafter; there were also age-dependent differences for the TonoLab. CONCLUSIONS Both the Tono-Pen and TonoLab gave IOP readings that differed from manometry settings in normal young chicks over some or all of the ages tested. These results reinforce the importance of calibrating clinical tonometers in animal studies involving IOP as a key variable.
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Affiliation(s)
- Lisa A Ostrin
- College of Optometry, University of Houston , Houston, Texas, USA
| | - Christine F Wildsoet
- School of Optometry and Vision Science Program, University of California Berkeley , Berkeley, California, USA
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23
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Jnawali A, Mirhajianmoghadam H, Musial G, Porter J, Ostrin LA. The optic nerve head, lamina cribrosa, and nerve fiber layer in non-myopic and myopic children. Exp Eye Res 2020; 195:108041. [PMID: 32353426 PMCID: PMC7282968 DOI: 10.1016/j.exer.2020.108041] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/18/2022]
Abstract
The purpose of this study was to evaluate the optic nerve head, lamina cribrosa, retina, and choroid in school age children using spectral domain optical coherence tomography (SD-OCT) and to assess these structural parameters in relation to age, axial length, and refractive error. Healthy children, ages 11.15 ± 2.62 years (range 6-15 years, n = 53), underwent cycloplegic autorefraction, biometry, and SD-OCT imaging in both eyes. Images were analyzed using custom written programs in MATLAB, after adjustment for lateral magnification. Peripapillary retinal nerve fiber layer (RNFL) thickness, retinal and choroidal thicknesses, Bruch's membrane opening (BMO) area, minimum rim width (MRW), and anterior lamina cribrosa surface depth (ALCSD) were determined and analyzed with age, axial length, and refraction. Results show that axial length increased and refractive error became more myopic with increasing age (R2 = 0.25, β = 0.18, P < 0.0001 and R2 = 0.27, β = -0.37, P < 0.0001, respectively). Minimum foveal thickness and central 1 mm retinal thickness increased with increasing age (R2 = 0.15, β = 2.38, P < 0.01 and R2 = 0.11, β = 3.16, P < 0.05, respectively). Age-adjusted raw values for peripapillary RNFL thickness decreased with increasing axial length (R2 = 0.11, β = -3.18, P < 0.05); however, this relationship was not present when image magnification was corrected (R2 = 0.07, β = 2.72, P = 0.09). BMO area increased with myopic refractive error (R2 = 0.16, β = -0.10, P < 0.01). Age-adjusted vertical cup-to-disc ratio decreased with increasing axial length and myopic refractive error (R2 = 0.12, β = -0.05, P < 0.05 and R2 = 0.11, β = 0.03, P = 0.05, respectively). Mean MRW, mean ALCSD, and peripapillary choroidal thickness were not associated with age, axial length, or refraction. Mean MRW was significantly thinner in eyes with deeper ALCS (R2 = 0.41, β = -0.83, P < 0.0001). These findings provide normal values for retinal and optic nerve head parameters in school age children, and also suggest that ocular remodeling occurs in some structures in school age children with normal eye growth and during early stages of myopia development.
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Affiliation(s)
- Ashutosh Jnawali
- University of Houston College of Optometry, 4901 Calhoun, Houston, TX, 77004, USA
| | | | - Gwen Musial
- University of Houston Department of Biomedical Engineering, 4800 Calhoun, Houston, TX, 77204, USA
| | - Jason Porter
- University of Houston College of Optometry, 4901 Calhoun, Houston, TX, 77004, USA
| | - Lisa A Ostrin
- University of Houston College of Optometry, 4901 Calhoun, Houston, TX, 77004, USA.
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24
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Custom Optical Coherence Tomography Parameters for Distinguishing Papilledema from Pseudopapilledema. Optom Vis Sci 2020; 96:599-608. [PMID: 31318797 DOI: 10.1097/opx.0000000000001408] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
SIGNIFICANCE Causes of papilledema can be life-threatening; however, distinguishing papilledema from pseudopapilledema is often challenging. The conventional optical coherence tomography (OCT) scan for assessing the optic nerve often fails to detect mild papilledema. Our study suggests that parameters derived from volumetric OCT scans can provide additional useful information for detecting papilledema. PURPOSE Optical coherence tomography analysis of the optic nerve commonly measures retinal nerve fiber layer thickness (RNFLT) along a 1.73-mm-radius scan path. This conventional scan, however, often fails to detect mild papilledema. The purpose of this study was to evaluate additional OCT-derived measures of the optic nerve head (ONH) and peripapillary retina for differentiating papilledema (all grades and mild) from pseudopapilledema. METHODS Cirrus OCT ONH volume scans were acquired from 21 papilledema (15 mild papilledema), 27 pseudopapilledema, and 42 control subjects. Raw scan data were exported, and total retinal thickness within Bruch's membrane opening (BMO) plus RNFLT and total retinal thickness at the following eccentricities were calculated using custom algorithms: BMO to 250, 250 to 500, 500 to 1000, and 1000 to 1500 μm. Minimum rim width was calculated, and BMO height was measured from a 4-mm Bruch's membrane reference plane centered on the BMO. RESULTS Retinal nerve fiber layer thickness from BMO to 250 μm, minimum rim width, and BMO height had significantly greater areas under the receiver operating characteristic curve than did conventional RNFLT for differentiating mild papilledema from pseudopapilledema (P < .0001) and greater sensitivities at 95% specificity. Using cutoff values at 95% specificity, custom parameters detected 10 mild papilledema patients, and conventional RNFLT detected only 1. Bruch's membrane opening heights above the reference plane were observed in papilledema only, although many papilledema cases had a neutral or negative BMO height. CONCLUSIONS Using OCT volumetric data, additional parameters describing peripapillary tissue thickness, neuroretinal rim thickness, and ONH position can be calculated and provide valuable measures for differentiating mild papilledema from pseudopapilledema.
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25
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Pardon LP, Harwerth RS, Patel NB. Neuroretinal rim response to transient changes in intraocular pressure in healthy non-human primate eyes. Exp Eye Res 2020; 193:107978. [PMID: 32081667 DOI: 10.1016/j.exer.2020.107978] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/26/2020] [Accepted: 02/14/2020] [Indexed: 12/19/2022]
Abstract
Optic nerve head (ONH) neuroretinal rim thickness, quantified as minimum rim width (BMO-MRW), is a sensitive measure for assessing early glaucomatous disease. The BMO-MRW is sensitive to transient fluctuations in intraocular pressure (IOP), but the time course over which BMO-MRW decreases and recovers with changes in IOP remains unknown. The goal of this study was to investigate the dynamics of BMO-MRW changes over 2-h periods of mild or moderate IOP elevation, and subsequent recovery, in healthy non-human primate eyes. Eight non-human primates were included in the study. For each animal, in two different sessions separated by at least 2 weeks, the anterior chamber IOP of one eye was maintained at either 25 mmHg or 40 mmHg for 2 h and, subsequently, at 10 mmHg for 2 h. For the duration of anterior chamber cannulation, optical coherence tomography (OCT) radial scans centered on the ONH were acquired every 5 min and used to quantify BMO-MRW. An exponential decay or rise to maximum function was used to determine the extent and rate of structural change. Additionally, Bruch's membrane opening (BMO) area, BMO height/displacement, and BMO-referenced anterior lamina cribrosa surface depth (BMO-ALCSD) were computed from radial scans. A circular scan was used to quantify retinal nerve fiber layer thickness (RNFLT) and circumpapillary choroid thickness. The primary results demonstrated that the BMO-MRW changed over an extended duration, while BMO displacement was rapid and remained stable with sustained IOP. The mean maximum predicted BMO-MRW thinning following 2 h of IOP elevation was significantly related to pressure (34.2 ± 13.8 μm for an IOP of 25 mmHg vs 40.5 ± 12.6 μm for 40 mmHg, p = 0.03). The half-life for BMO-MRW thinning was 21.9 ± 9.2 min for 25 mmHg and 20.9 ± 4.2 min for 40 mmHg, not significantly different between IOP levels (p = 0.76). Subsequently, after 2 h of IOP at 10 mmHg, all animals exhibited partial recovery of BMO-MRW with similar degrees of persistent residual thinning for the two IOP levels (21.5 ± 13.7 vs 21.0 ± 12.3 μm, p = 0.88). Similar to BMO-MRW, choroid thickness exhibited gradual thinning with IOP elevation and residual thinning following IOP reduction. However, there was no significant change in BMO area or BMO-ALCSD in either experimental session. The RNFLT gradually decreased over the duration of IOP elevation, with continued decreases following IOP reduction for the 40 mmHg session, resulting in total changes from baseline of -2.24 ± 0.81 and -2.45 ± 1.21 μm for 25 and 40 mmHg, respectively (p < 0.001). The sum of the results demonstrate that the ONH neural tissue is sensitive to changes in IOP, the effects of which are gradual over an extended time course and different for increased vs. decreased pressure. Understanding the duration over which IOP influences BMO-MRW has important implications for studies investigating the effects of IOP on the ONH. Additionally, individual variability in ONH response to IOP may improve our understanding of the risk and progression of disease.
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Affiliation(s)
- Laura P Pardon
- University of Houston, College of Optometry, 4901 Calhoun Road, Houston, TX, 77204-2020, USA.
| | - Ronald S Harwerth
- University of Houston, College of Optometry, 4901 Calhoun Road, Houston, TX, 77204-2020, USA
| | - Nimesh B Patel
- University of Houston, College of Optometry, 4901 Calhoun Road, Houston, TX, 77204-2020, USA
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26
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Lee EJ, Han JC, Park DY, Kee C. A neuroglia-based interpretation of glaucomatous neuroretinal rim thinning in the optic nerve head. Prog Retin Eye Res 2020; 77:100840. [PMID: 31982595 DOI: 10.1016/j.preteyeres.2020.100840] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/02/2020] [Accepted: 01/13/2020] [Indexed: 12/14/2022]
Abstract
Neuroretinal rim thinning (NRR) is a characteristic glaucomatous optic disc change. However, the precise mechanism of the rim thinning has not been completely elucidated. This review focuses on the structural role of the glioarchitecture in the formation of the glaucomatous NRR thinning. The NRR is a glia-framed structure, with honeycomb geometry and mechanically reinforced astrocyte processes along the transverse plane. When neural damage selectively involves the neuron and spares the glia, the gross structure of the tissue is preserved. The disorganization and loss of the glioarchitecture are the two hallmarks of optic nerve head (ONH) remodeling in glaucoma that leads to the thinning of NRR tissue upon axonal loss. This is in contrast to most non-glaucomatous optic neuropathies with optic disc pallor where hypertrophy of the glioarchitecture is associated with the seemingly absent optic disc cupping. Arteritic anterior ischemic optic neuropathy is an exception where pan-necrosis of ONH tissue leads to NRR thinning. Milder ischemia indicates selective neuronal loss that spares glia in non-arteritic anterior ischemic optic neuropathy. The biological reason is the heterogeneous glial response determined by the site, type, and severity of the injury. The neuroglial interpretation explains how the cellular changes underlie the clinical findings. Updated understandings on glial responses illustrate the mechanical, microenvironmental, and microglial modulation of activated astrocytes in glaucoma. Findings relevant to the possible mechanism of the astrocyte death in advanced glaucoma are also emerging. Ultimately, a better understanding of glaucomatous glial response may lead to glia-targeting neuroprotection in the future.
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Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Do Young Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea.
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27
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Differential Effects of Aging in the Macular Retinal Layers, Neuroretinal Rim, and Peripapillary Retinal Nerve Fiber Layer. Ophthalmology 2019; 127:177-185. [PMID: 31668716 DOI: 10.1016/j.ophtha.2019.09.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/21/2019] [Accepted: 09/17/2019] [Indexed: 11/22/2022] Open
Abstract
PURPOSE We determined the differential aging effects of the inner 6 layers of the macula in contrast to the minimum neuroretinal rim width (MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness. DESIGN Cross-sectional, multicenter study. PARTICIPANTS An approximately equal number of white subjects with a normal ocular and visual field examination in each decade group from 20 to 90 years. METHODS OCT of the macula, optic nerve head, and peripapillary retina. MAIN OUTCOME MEASURES Sectoral measurements of the inner 6 layers of the macula; age-related decline of each of these layers; strength of the associations with age of the macular parameters, MRW, and peripapillary RNFL thickness; and association between ganglion cell layer (GCL) thickness and MRW and peripapillary RNFL thickness. RESULTS The study sample comprised 1 eye of 246 subjects with a median (range) age of 52.9 (19.8-87.3) years. Of the 6 layers, there was a statistically significant decline with age of only the GCL, inner plexiform layer, and inner nuclear layer thickness with rates of -0.11 μm/year, -0.07 μm/year, and -0.03 μm/year, respectively. These rates corresponded to 2.82%, 2.10%, and 0.78% loss per decade, respectively, and were generally uniform across sectors. The rate of loss of MRW and peripapillary RNFL thickness was -1.22 μm/year and -0.20 μm/year, corresponding to 3.75% and 2.03% loss per decade. However, the association of GCL thickness change with age (R2 = 0.28) was approximately twice that of MRW and RNFL thickness (R2 = 0.14 for each). CONCLUSIONS In concordance with histopathologic studies showing age-related loss of retinal ganglion cell axons, we showed a significant decline in GCL thickness, as well as MRW and peripapillary RNFL thickness. The stronger relationship between aging and GCL thickness compared with the rim or peripapillary RNFL may indicate that GCL thickness could be better suited to measure progression of structural glaucomatous loss.
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28
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Yan ZC, Yang XJ, Chen HR, Deng SF, Zhu YT, Zhuo YH. Effects of chronic elevated intraocular pressure on parameters of optical coherence tomography in rhesus monkeys. Int J Ophthalmol 2019; 12:542-548. [PMID: 31024804 DOI: 10.18240/ijo.2019.04.03] [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: 06/10/2018] [Accepted: 10/09/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To determine the progression of parameters from optical coherence tomography (OCT) in chronic elevated intraocular pressure (IOP) monkeys. METHODS A chronic elevated IOP model of rhesus monkeys was induced by laser photocoagulation. Representative OCT parameters, including the average and four-quadrant retinal nerve fiber layer (RNFL) thickness, and parameters from optic nerve head (ONH) analysis were collected before and after laser treatments biweekly for up to 28wk. The performance of each parameter for early progression detection was analyzed. The progressive trends toward elevated IOP were analyzed using a linear mixed-effects model. RESULTS There were 10 successfully maintained high IOP eyes in 7 monkeys. The follow-up time was 24±5.37wk. With cumulative IOP elevation, the cup area, rim area and C/D area ratio were statistically significantly changed as early as 2wk after elevated IOP induction (P<0.05). The quadrant RNFL thickness changed at 6wk after high IOP induction, and the superior and inferior RNFL thicknesses exhibited more obvious reductions than other quadrants. The average RNFL thickness was the last one to show a significant decrease at 8wk. CONCLUSION The parameters of ONH are most sensitive to elevated IOP in a primate glaucomatous model. These findings suggest that we should focus on those parameters instead of RNFL thickness in patients with elevated IOP, as they might present with earlier glaucomatous changes.
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Affiliation(s)
- Zhi-Chao Yan
- Department of Ophthalmology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong Province, China.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Xue-Jiao Yang
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Hong-Rui Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Shui-Feng Deng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Ying-Ting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Ye-Hong Zhuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
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29
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Comparison of Spectralis and Cirrus spectral domain optical coherence tomography for the objective morphometric assessment of the neuroretinal rim width. Graefes Arch Clin Exp Ophthalmol 2019; 257:1265-1275. [DOI: 10.1007/s00417-019-04299-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/04/2019] [Accepted: 03/15/2019] [Indexed: 12/14/2022] Open
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30
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Bruch's membrane opening minimum rim width and retinal nerve fiber layer thickness in a Brazilian population of healthy subjects. PLoS One 2018; 13:e0206887. [PMID: 30562371 PMCID: PMC6298691 DOI: 10.1371/journal.pone.0206887] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 10/23/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To determine Bruch’s membrane opening (BMO) minimum rim width (MRW) and peripapillary retinal nerve fiber layer thickness (RNFLT) measurements, acquired with optical coherence tomography (OCT) in healthy Brazilian individuals self-reported as African Descent (AD), European Descent (ED) and Mixed Descent (MD). Methods 260 healthy individuals (78 AD, 103 ED and 79 MD) were included in this cross-sectional study conducted at the Clinics Hospital of the University of Campinas. We obtained optic nerve head (24 radial B scans) and peripapillary retinal nerve fiber layer (3.5-mm circle scan) images in one randomly selected eye of each subject. Results After adjustment for BMO area and age, there were no significant differences in mean global MRW (P = 0.63) or RNFLT (P = 0.07) among the three groups. Regionally, there were no significant differences in either MRW or RNFLT in most sectors, except in the superonasal sector, in which both MRW and RNFLT were thinner among ED (P = 0.04, P<0.001, respectively). RNFLT was also thinner in ED in the inferonasal sector (P = 0.009). In all races, global MRW decreased and global RNFLT increased with BMO area. AD subjects had higher rates of global RNFLT decay with age (-0.32 μm/year) compared to ED and MD subjects (-0.10 μm/year and -0.08 μm/year, respectively; P = 0.01 and P = 0.02, respectively). Conclusions and relevance While we found no significant differences in global MRW and RNFLT among the three races, age-related thinning of the RNFLT was significantly higher in the AD subgroup, which warrants further study.
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31
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Torres LA, Vianna JR, Jarrar F, Sharpe GP, Araie M, Caprioli J, Demirel S, Girkin CA, Hangai M, Iwase A, Liebmann JM, Mardin CY, Nakazawa T, Quigley HA, Scheuerle AF, Sugiyama K, Tanihara H, Tomita G, Yanagi Y, Burgoyne CF, Chauhan BC. Protruded retinal layers within the optic nerve head neuroretinal rim. Acta Ophthalmol 2018; 96:e493-e502. [PMID: 30105788 DOI: 10.1111/aos.13657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 11/06/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE To determine the frequency with which retinal tissues other than the nerve fibre layer, hereafter referred to as protruded retinal layers (PRL), are a component of optical coherence tomography (OCT) neuroretinal rim measurements. METHODS Ninety healthy (30 White, Black and Japanese, respectively) subjects were included in the study. A radial scan pattern (24 B-scans centred on Bruch's membrane opening [BMO]) was used. For each of the 48 minimum rim width (MRW) measurement points, we determined whether PRL were present, absent or indeterminate. When present, the proportion of PRL within the MRW was quantified. RESULTS Protruded retinal layers were present in 503 (11.6%), absent in 3805 (88.1%) and indeterminate in 12 (0.3%) measurement points. Overall, 69 (76.6%) subjects had ≥1 points with PRL, with White subjects having the highest frequency and Japanese the lowest (29 [97%] and 18 [60%], respectively; p < 0.01). PRL were present in one-third of points in the temporal sector, but ≤5% in other sectors. When present, the median PRL thickness was 53.0 (interquartile range [IQR]: 33.0 to 78.5) μm, representing 20.6 (IQR: 13.0 to 28.5)% of MRW. Globally, the median PRL thickness comprised 1.3 (IQR: 0.2 to 3.5)% of the MRW; however, in the temporal sector, it exceeded 30% of MRW in some subjects. CONCLUSIONS Protruded retinal layers are a component of MRW measurements in most normal subjects, occurring in almost 12% of all measurement points analysed. There were racial variations in the presence of PRL and a significantly higher frequency of PRL in the temporal sector.
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Affiliation(s)
- Lucas A. Torres
- Department of Ophthalmology and Visual Sciences; Dalhousie University; Halifax Nova Scotia Canada
| | - Jayme R. Vianna
- Department of Ophthalmology and Visual Sciences; Dalhousie University; Halifax Nova Scotia Canada
| | - Faisal Jarrar
- Department of Ophthalmology and Visual Sciences; Dalhousie University; Halifax Nova Scotia Canada
| | - Glen P. Sharpe
- Department of Ophthalmology and Visual Sciences; Dalhousie University; Halifax Nova Scotia Canada
| | - Makoto Araie
- Kanto Central Hospital of the Mutual Aid Association of Public School Teachers; Tokyo Japan
| | - Joseph Caprioli
- Department of Ophthalmology; Jules Stein Eye Institute; University of California Los Angeles; Los Angeles California USA
| | - Shaban Demirel
- Devers Eye Institute; Legacy Research Institute; Portland Oregon USA
| | - Christopher A. Girkin
- Department of Ophthalmology; University of Alabama at Birmingham; Birmingham Alabama USA
| | - Masanori Hangai
- Department of Ophthalmology; Saitama Medical School; Moro Japan
| | | | - Jeffrey M. Liebmann
- New York Eye and Ear Infirmary; New York University School of Medicine; New York New York USA
| | | | - Toru Nakazawa
- Department of Ophthalmology; Tohoku University Graduate School of Medicine; Tohoku Japan
| | - Harry A. Quigley
- Wilmer Ophthalmological Institute; Johns Hopkins University; Baltimore Maryland USA
| | | | - Kazuhisa Sugiyama
- Department of Ophthalmology and Visual Science; Kanazawa University Graduate School of Medical Science; Kanazawa Japan
| | - Hidenobu Tanihara
- Department of Ophthalmology; Faculty of Life Sciences; Kumamoto University; Kumamoto Japan
| | - Goji Tomita
- Department of Ophthalmology; Toho University Ohashi Medical Center; Tokyo Japan
| | - Yasuo Yanagi
- Department of Ophthalmology; The University of Tokyo Graduate School of Medicine; Tokyo Japan
| | | | - Balwantray C. Chauhan
- Department of Ophthalmology and Visual Sciences; Dalhousie University; Halifax Nova Scotia Canada
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Patel N, McAllister F, Pardon L, Harwerth R. The effects of graded intraocular pressure challenge on the optic nerve head. Exp Eye Res 2018; 169:79-90. [PMID: 29409880 PMCID: PMC5878999 DOI: 10.1016/j.exer.2018.01.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 01/27/2018] [Accepted: 01/30/2018] [Indexed: 12/21/2022]
Abstract
Intraocular pressure (IOP) is an important risk factor for glaucoma, and the response of the ONH and surrounding tissues to elevated IOP are often investigated to better understand pathophysiology. In vivo structure including that of the optic nerve head (ONH) and surrounding tissue of the eye are often assessed using optical coherence tomography (OCT). With advances in OCT technology, both large vessels and capillaries can be imaged non-invasively (OCT Angiography). Because a significant portion of retinal thickness is comprised of vasculature, the purpose of the current study was to investigate OCT structural and vascular changes in healthy non-human primate eyes with systematic graded increases and decreases in IOP. Six healthy animals with no previous experimental intervention were used. The pressure in the anterior chamber was adjusted from 10 mmHg to 60 mmHg and back to 10 mmHg in 10 mmHg steps every 10 min. Using optical coherence tomography (OCT), retinal nerve fiber layer (RNFL) thickness, minimum rim width (MRW), Bruch's membrane opening (BMO) size and relative height, anterior lamina cribrosa surface (ALCS) depth, choroidal thickness, and angiography (OCTA) were quantified. With IOP challenge there were significant changes in all morphological measures quantified (p < 0.01) other than BMO size (p = 0.30) and RNFL thickness (p = 0.29). Specifically, the position of the BMO was sensitive to both an increase and decease in IOP. The inner retinal capillary density gradually decreased with increasing IOP, reaching statistical significance when pressure exceeded 50 mmHg, but returned when IOP was reduced. The average choroidal thickness around the ONH decreased for elliptical annuli 500-1000 μm and 1000-1500 μm, from the BMO, with increasing IOP (p < 0.01). For the 1000-1500 μm annulus, choroid thickness did not return to baseline with IOP reduction. Similarly, the MRW decreased with increase in IOP, but with pressure reduction did not return, and at the final 10 mmHg time point was thinner than at baseline (p < 0.01). The results from this experiment illustrate differences in ONH neural rim tissue, RNFL and vessel density changes with acute IOP challenge. Overall, vessel collapse could not completely account for changes in RNFL or ONH MRW thickness. The study supports the hypothesis neural rim compression may be an important part of IOP-induced damage.
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Affiliation(s)
- Nimesh Patel
- University of Houston, College of Optometry, 4901 Calhoun Road, Houston, TX 77204, USA.
| | - Faith McAllister
- University of Houston, College of Optometry, 4901 Calhoun Road, Houston, TX 77204, USA
| | - Laura Pardon
- University of Houston, College of Optometry, 4901 Calhoun Road, Houston, TX 77204, USA
| | - Ronald Harwerth
- University of Houston, College of Optometry, 4901 Calhoun Road, Houston, TX 77204, USA
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Taniguchi EV, Paschalis EI, Li D, Nouri-Mahdavi K, Brauner SC, Greenstein SH, Turalba AV, Wiggs JL, Pasquale LR, Shen LQ. Thin minimal rim width at Bruch's membrane opening is associated with glaucomatous paracentral visual field loss. Clin Ophthalmol 2017; 11:2157-2167. [PMID: 29263644 PMCID: PMC5726361 DOI: 10.2147/opth.s149300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare optic nerve head (ONH) measurements in glaucomatous eyes with paracentral visual field (VF) loss to eyes with peripheral VF loss and controls. Methods Open-angle glaucoma (OAG) patients with early paracentral VF loss or isolated peripheral VF loss as well as control subjects underwent ONH imaging with swept-source optical coherence tomography (OCT) and retinal nerve fiber layer (RNFL) imaging with spectral-domain OCT. Minimum rim width at Bruch's membrane opening (BMO-MRW), lamina cribrosa depth (LCD), and RNFL thickness were compared among the glaucoma and control groups with one-way analysis of variance, Kruskal-Wallis test, and multiple regression analysis. Results Twenty-nine eyes from 29 OAG patients (15 early paracentral and 14 isolated peripheral VF loss) and 20 eyes of 20 control subjects were included. The early paracentral and isolated peripheral VF loss groups had similar VF mean deviation (MD) (-5.3±2.7 dB and -3.7±3.0 dB, p=0.15, respectively). Global BMO-MRW was lower in OAG eyes than in controls (193.8±40.0 vs 322.7±62.2 μm, p<0.001), but similar between eyes with early paracentral VF loss and those with isolated peripheral VF loss (187.6±43.4 vs 200.6±36.3 μm; p>0.99). In contrast, the minimal BMO-MRW was lower in eyes with early paracentral loss (69.0±33.6 μm) than in eyes with isolated peripheral loss (107.7±40.2 μm; p=0.03) or control eyes (200.1±40.8 μm; p<0.001). Average and thinnest RNFL thickness did not differ between OAG groups (p=0.61 and 0.19, respectively). Horizontal and vertical LCD did not differ among the OAG groups and controls (p=0.80 and 0.82, respectively). Multivariable linear regression analysis among OAG cases confirmed the association between lower minimal BMO-MRW and early paracentral VF loss (β=-38.3 μm; 95% confidence interval, -69.8 to -6.8 μm; p=0.02) after adjusting for age, gender, MD, and disc size. Conclusion Thin minimal BMO-MRW may represent a new structural biomarker associated with early glaucomatous paracentral VF loss.
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Affiliation(s)
- Elise V Taniguchi
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA.,Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear - Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Eleftherios I Paschalis
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA.,Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear - Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA
| | - Dejiao Li
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA.,Department of Ophthalmology, Beijing China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Kouros Nouri-Mahdavi
- Department of Ophthalmology, David Geffen School of Medicine and Stein Eye Institute, Los Angeles, CA, USA
| | - Stacey C Brauner
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA
| | - Scott H Greenstein
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA
| | - Angela V Turalba
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA
| | - Janey L Wiggs
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA
| | - Louis R Pasquale
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lucy Q Shen
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA
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Amini N, Daneshvar R, Sharifipour F, Romero P, Henry S, Caprioli J, Nouri-Mahdavi K. Structure-Function Relationships in Perimetric Glaucoma: Comparison of Minimum-Rim Width and Retinal Nerve Fiber Layer Parameters. Invest Ophthalmol Vis Sci 2017; 58:4623-4631. [PMID: 28898356 PMCID: PMC5596793 DOI: 10.1167/iovs.17-21936] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To test the hypotheses that: (1) structure–function (SF) relationships between visual fields (VF) and Bruch's membrane opening-based minimum rim width (BMO-MRW) measurements are superior to those for peripapillary retinal nerve fiber layer (pRNFL) in perimetric glaucoma; (2) BMO-MRW measurements may extend the utility of structural measurement across the range of glaucoma severity; and (3) to estimate the influence of Bruch's membrane opening (BMO) size on BMO-MRW measurements. Methods One hundred eight perimetric glaucoma eyes (68 patients) with good quality spectral-domain optical coherence tomography images of the optic disc and pRNFL, and reliable VF within 6 months were recruited. Relationship of global and sectoral BMO-MRW and pRNFL thickness with corresponding VF parameters and the influence of normalizing BMO-MRW (on BMO circumference, nBMO-MRW) on SF relationships were investigated. Broken-stick models were used to compare the point at which pRNFL and BMO-MRW parameters reached their measurement floor. Results The median (interquartile range) of VF mean deviation was −5.9 (−12.6 to −3.6) dB. Spearman correlation coefficients between pRNFL, BMO-MRW, and nBMO-MRW measures and corresponding VF cluster average deviations ranged between 0.55 to 0.80, 0.35 to 0.66, and 0.38 to 0.65, respectively. Bruch's membrane opening–MRW parameters demonstrated weaker SF relationships compared with pRNFL globally and in temporal, temporal-superior, and nasal-inferior sectors (P < 0.03). Normalization of BMO-MRW did not significantly influence SF relationships. Conclusions Structure–function relationships were somewhat weaker with BMO-MRW parameters compared with pRNFL in eyes with perimetric glaucoma. Bruch's membrane opening–MRW normalization did not significantly change SF relationships in this group of eyes with mild departures from average BMO size.
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Affiliation(s)
- Navid Amini
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
| | - Ramin Daneshvar
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States.,Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farideh Sharifipour
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States.,Department of Ophthalmology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Pablo Romero
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States.,Department of Ophthalmology, University of Chile, Santiago, Chile
| | - Sharon Henry
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
| | - Joseph Caprioli
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
| | - Kouros Nouri-Mahdavi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
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Li D, Li T, Paschalis EI, Wang H, Taniguchi EV, Choo ZN, Shoji MK, Greenstein SH, Brauner SC, Turalba AV, Pasquale LR, Shen LQ. Optic Nerve Head Characteristics in Chronic Angle Closure Glaucoma Detected by Swept-Source OCT. Curr Eye Res 2017; 42:1450-1457. [DOI: 10.1080/02713683.2017.1341535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Dejiao Li
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Taibo Li
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Eleftherios I. Paschalis
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear, Schepens Eye Research Institute, Boston, MA, USA
| | - Haobing Wang
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Elise V. Taniguchi
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Zi-Ning Choo
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Marissa K. Shoji
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Scott H. Greenstein
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Stacey C. Brauner
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Angela V. Turalba
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Louis R. Pasquale
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Lucy Q. Shen
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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36
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Yang H, Reynaud J, Lockwood H, Williams G, Hardin C, Reyes L, Stowell C, Gardiner SK, Burgoyne CF. The connective tissue phenotype of glaucomatous cupping in the monkey eye - Clinical and research implications. Prog Retin Eye Res 2017; 59:1-52. [PMID: 28300644 PMCID: PMC5603293 DOI: 10.1016/j.preteyeres.2017.03.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/14/2017] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
Abstract
In a series of previous publications we have proposed a framework for conceptualizing the optic nerve head (ONH) as a biomechanical structure. That framework proposes important roles for intraocular pressure (IOP), IOP-related stress and strain, cerebrospinal fluid pressure (CSFp), systemic and ocular determinants of blood flow, inflammation, auto-immunity, genetics, and other non-IOP related risk factors in the physiology of ONH aging and the pathophysiology of glaucomatous damage to the ONH. The present report summarizes 20 years of technique development and study results pertinent to the characterization of ONH connective tissue deformation and remodeling in the unilateral monkey experimental glaucoma (EG) model. In it we propose that the defining pathophysiology of a glaucomatous optic neuropathy involves deformation, remodeling, and mechanical failure of the ONH connective tissues. We view this as an active process, driven by astrocyte, microglial, fibroblast and oligodendrocyte mechanobiology. These cells, and the connective tissue phenomena they propagate, have primary and secondary effects on retinal ganglion cell (RGC) axon, laminar beam and retrolaminar capillary homeostasis that may initially be "protective" but eventually lead to RGC axonal injury, repair and/or cell death. The primary goal of this report is to summarize our 3D histomorphometric and optical coherence tomography (OCT)-based evidence for the early onset and progression of ONH connective tissue deformation and remodeling in monkey EG. A second goal is to explain the importance of including ONH connective tissue processes in characterizing the phenotype of a glaucomatous optic neuropathy in all species. A third goal is to summarize our current efforts to move from ONH morphology to the cell biology of connective tissue remodeling and axonal insult early in the disease. A final goal is to facilitate the translation of our findings and ideas into neuroprotective interventions that target these ONH phenomena for therapeutic effect.
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Affiliation(s)
- Hongli Yang
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Juan Reynaud
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Howard Lockwood
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Galen Williams
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Christy Hardin
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Luke Reyes
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Cheri Stowell
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Stuart K Gardiner
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Claude F Burgoyne
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States.
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37
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Fortune B, Hardin C, Reynaud J, Cull G, Yang H, Wang L, Burgoyne CF. Comparing Optic Nerve Head Rim Width, Rim Area, and Peripapillary Retinal Nerve Fiber Layer Thickness to Axon Count in Experimental Glaucoma. Invest Ophthalmol Vis Sci 2017; 57:OCT404-12. [PMID: 27409499 PMCID: PMC4968911 DOI: 10.1167/iovs.15-18667] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We compare spectral-domain optical coherence tomography (SDOCT) measurements of minimum rim width (MRW), minimum rim area (MRA), and peripapillary retinal nerve fiber layer thickness (RNFLT) to complete orbital optic nerve axon counts in nonhuman primates (NHP) with unilateral experimental glaucoma (EG). Methods Biweekly SDOCT measurements of MRW, MRA, and RNFLT were acquired under manometric IOP control (10 mm Hg) in 51 NHP during baseline (mean ± SD, 5.0 ± 1.6 sessions) and after laser photocoagulation was applied to the trabecular meshwork of one eye to induce chronic IOP elevation. At the study endpoint (predefined for each NHP), 100% axon counts were obtained from each optic nerve. Results For SDOCT parameters at baseline, the correlation between the two eyes of each animal was strongest for RNFLT (R = 0.97) and MRW (R = 0.97), but lower for MRA (R = 0.85). At the final time point, average values in EG eyes relative to control eyes were: −22% for RNFLT, −38% for MRW, −36% for MRA, and −36% for optic nerve axons. The correlation with axon counts was strongest for RNFLT (R = 0.81), compared to MRW (R = 0.72, P = 0.001) or MRA (R = 0.70, P = 0.001). Diagnostic sensitivity was 75% for RNFLT, 90% for MRW, and 88% for MRA; all had 100% specificity. Conclusions Peripapillary RNFLT was correlated more closely with total orbital optic nerve axon count than were the ONH parameters MRW or MRA. This is likely because glaucomatous deformation (beyond axon loss alone) has a greater influence on the ONH parameters MRW and MRA than on RNFLT.
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Smith CA, Vianna JR, Chauhan BC. Assessing retinal ganglion cell damage. Eye (Lond) 2017; 31:209-217. [PMID: 28085141 PMCID: PMC5306472 DOI: 10.1038/eye.2016.295] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 11/21/2016] [Indexed: 11/09/2022] Open
Abstract
Retinal ganglion cell (RGC) loss is the hallmark of optic neuropathies, including glaucoma, where damage to RGC axons occurs at the level of the optic nerve head. In experimental glaucoma, damage is assessed at the axon level (in the retinal nerve fibre layer and optic nerve head) or at the soma level (in the retina). In clinical glaucoma where measurements are generally limited to non-invasive techniques, structural measurements of the retinal nerve fibre layer and optic nerve head, or functional measurements with perimetry provide surrogate estimates of RGC integrity. These surrogate measurements, while clinically useful, are several levels removed from estimating actual RGC loss. Advances in imaging, labelling techniques, and transgenic medicine are making enormous strides in experimental glaucoma, providing knowledge on the pathophysiology of glaucoma, its progression and testing new therapeutic avenues. Advances are also being made in functional imaging of RGCs. Future efforts will now be directed towards translating these advances to clinical care.
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Affiliation(s)
- C A Smith
- Department of Physiology and Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada
- Retina and Optic Nerve Research Laboratory, Dalhousie University, Halifax, Nova Scotia, Canada
| | - J R Vianna
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - B C Chauhan
- Department of Physiology and Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada
- Retina and Optic Nerve Research Laboratory, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
Optical coherence tomography is an imaging technique using low coherence light sources to produce high-resolution cross-sectional images. This article reviews pertinent anatomy and various pathologies causing optic atrophy (eg, compressive, infiltrating, demyelinating) versus optic nerve swelling (from increased intracranial pressure known as papilledema or other optic nerve intrinsic pathologies). On optical coherence tomography, optic atrophy is often associated with reduced average retinal nerve fiber layer thickness, whereas optic nerve swelling is usually associated with increased average retinal nerve fiber layer thickness.
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40
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Gardiner SK, Boey PY, Yang H, Fortune B, Burgoyne CF, Demirel S. Structural Measurements for Monitoring Change in Glaucoma: Comparing Retinal Nerve Fiber Layer Thickness With Minimum Rim Width and Area. Invest Ophthalmol Vis Sci 2016; 56:6886-91. [PMID: 26501416 DOI: 10.1167/iovs.15-16701] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Minimum rim width (MRW) and area (MRA) have been introduced as anatomically defensible measures of neuroretinal rim tissue observable using spectral-domain optical coherence tomography (SDOCT). They have been reported to change earlier than retinal nerve fiber layer thickness (RNFLT) in glaucoma. This study sought to determine which is better to distinguish subsequent change from variability, using the previously described longitudinal signal-to-noise ratio (LSNR). METHODS Data from 157 eyes of 157 participants with high-risk ocular hypertension or non-end-stage glaucoma (mean deviation [MD] from -22 to +3 dB) were used. Participants were tested approximately every 6 months for at least six visits. For each eye, MRW, MRA, and RNFLT were regressed linearly against time. Longitudinal signal-to-noise ratio for each eye was defined as the rate of change over time (signal) divided by the standard deviation of residuals from this trend (noise). These were compared between parameters using a Wilcoxon signed rank test. RESULTS The median LSNRs were -0.58y⁻¹ for RNFLT (bootstrapped 95% confidence interval -0.69 to -0.48y⁻¹); -0.44y⁻¹ (-0.59 to -0.32y⁻¹) for MRW; and -0.23y⁻¹ (-0.32 to -0.08y⁻¹) for MRA. Longitudinal signal-to-noise ratios were significantly more negative for RNFLT than for MRW (P = 0.025) or for MRA (P < 0.001). CONCLUSIONS Retinal nerve fiber layer thickness measured by SDOCT had a better LSNR than MRW or MRA. Although MRW and MRA may be more sensitive for early detection of glaucomatous damage, these data suggest that RNFLT may be preferable for monitoring change.
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Affiliation(s)
| | | | - Hongli Yang
- Devers Eye Institute Legacy Health, Portland, Oregon, United States
| | - Brad Fortune
- Devers Eye Institute Legacy Health, Portland, Oregon, United States
| | | | - Shaban Demirel
- Devers Eye Institute Legacy Health, Portland, Oregon, United States
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41
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Ivers KM, Sredar N, Patel NB, Rajagopalan L, Queener HM, Twa MD, Harwerth RS, Porter J. In Vivo Changes in Lamina Cribrosa Microarchitecture and Optic Nerve Head Structure in Early Experimental Glaucoma. PLoS One 2015; 10:e0134223. [PMID: 26230993 PMCID: PMC4521723 DOI: 10.1371/journal.pone.0134223] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 07/07/2015] [Indexed: 11/18/2022] Open
Abstract
The lamina cribrosa likely plays an important role in retinal ganglion cell axon injury in glaucoma. We sought to (1) better understand optic nerve head (ONH) structure and anterior lamina cribrosa surface (ALCS) microarchitecture between fellow eyes of living, normal non-human primates and (2) characterize the time-course of in vivo structural changes in the ONH, ALCS microarchitecture, and retinal nerve fiber layer thickness (RNFLT) in non-human primate eyes with early experimental glaucoma (EG). Spectral domain optical coherence tomography (SDOCT) images of the ONH were acquired cross-sectionally in six bilaterally normal rhesus monkeys, and before and approximately every two weeks after inducing unilateral EG in seven rhesus monkeys. ONH parameters and RNFLT were quantified from segmented SDOCT images. Mean ALCS pore area, elongation and nearest neighbor distance (NND) were quantified globally, in sectors and regionally from adaptive optics scanning laser ophthalmoscope images. In bilaterally normal monkeys, ONH parameters were similar between fellow eyes with few inter-eye differences in ALCS pore parameters. In EG monkeys, an increase in mean ALCS Depth (ALCSD) was the first structural change measured in 6 of 7 EG eyes. A decrease in mean minimum rim width (MRW) simultaneously accompanied this early change in 4 of 6 EG eyes and was the first structural change in the 7th EG eye. Mean ALCS pore parameters were among the first or second changes measured in 4 EG eyes. Mean ALCS pore area and NND increased in superotemporal and temporal sectors and in central and peripheral regions at the first time-point of change in ALCS pore geometry. RNFLT and/or mean ALCS radius of curvature were typically the last parameters to initially change. Survival analyses found mean ALCSD was the only parameter to significantly show an initial change prior to the first measured loss in RNFLT across EG eyes.
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Affiliation(s)
- Kevin M. Ivers
- College of Optometry, University of Houston, Houston, Texas, United States of America
| | - Nripun Sredar
- Department of Computer Science, University of Houston, Houston, Texas, United States of America
| | - Nimesh B. Patel
- College of Optometry, University of Houston, Houston, Texas, United States of America
| | - Lakshmi Rajagopalan
- College of Optometry, University of Houston, Houston, Texas, United States of America
| | - Hope M. Queener
- College of Optometry, University of Houston, Houston, Texas, United States of America
| | - Michael D. Twa
- School of Optometry, University of Alabama, Birmingham, Birmingham, Alabama, United States of America
| | - Ronald S. Harwerth
- College of Optometry, University of Houston, Houston, Texas, United States of America
| | - Jason Porter
- College of Optometry, University of Houston, Houston, Texas, United States of America
- * E-mail:
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42
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The non-human primate experimental glaucoma model. Exp Eye Res 2015; 141:57-73. [PMID: 26070984 DOI: 10.1016/j.exer.2015.06.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/03/2015] [Accepted: 06/06/2015] [Indexed: 01/05/2023]
Abstract
The purpose of this report is to summarize the current strengths and weaknesses of the non-human primate (NHP) experimental glaucoma (EG) model through sections devoted to its history, methods, important findings, alternative optic neuropathy models and future directions. NHP EG has become well established for studying human glaucoma in part because the NHP optic nerve head (ONH) shares a close anatomic association with the human ONH and because it provides the only means of systematically studying the very earliest visual system responses to chronic intraocular pressure (IOP) elevation, i.e. the conversion from ocular hypertension to glaucomatous damage. However, NHPs are impractical for studies that require large animal numbers, demonstrate spontaneous glaucoma only rarely, do not currently provide a model of the neuropathy at normal levels of IOP, and cannot easily be genetically manipulated, except through tissue-specific, viral vectors. The goal of this summary is to direct NHP EG and non-NHP EG investigators to the previous, current and future accomplishment of clinically relevant knowledge in this model.
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Fortune B. In vivo imaging methods to assess glaucomatous optic neuropathy. Exp Eye Res 2015; 141:139-53. [PMID: 26048475 DOI: 10.1016/j.exer.2015.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 05/13/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
The goal of this review is to summarize the most common imaging methods currently applied for in vivo assessment of ocular structure in animal models of experimental glaucoma with an emphasis on translational relevance to clinical studies of the human disease. The most common techniques in current use include optical coherence tomography and scanning laser ophthalmoscopy. In reviewing the application of these and other imaging modalities to study glaucomatous optic neuropathy, this article is organized into three major sections: 1) imaging the optic nerve head, 2) imaging the retinal nerve fiber layer and 3) imaging retinal ganglion cell soma and dendrites. The article concludes with a brief section on possible future directions.
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Affiliation(s)
- Brad Fortune
- Discoveries in Sight Research Laboratories, Devers Eye Institute and Legacy Research Institute, Legacy Health, 1225 NE Second Avenue, Portland, OR 97232, USA.
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Belghith A, Bowd C, Medeiros FA, Balasubramanian M, Weinreb RN, Zangwill LM. Learning from healthy and stable eyes: A new approach for detection of glaucomatous progression. Artif Intell Med 2015; 64:105-15. [PMID: 25940856 DOI: 10.1016/j.artmed.2015.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED Glaucoma is a chronic neurodegenerative disease characterized by loss of retinal ganglion cells, resulting in distinctive changes in the optic nerve head (ONH) and retinal nerve fiber layer. Important advances in technology for non-invasive imaging of the eye have been made providing quantitative tools to measure structural changes in ONH topography, a crucial step in diagnosing and monitoring glaucoma. Three dimensional (3D) spectral domain optical coherence tomography (SD-OCT), an optical imaging technique, is now the standard of care for diagnosing and monitoring progression of numerous eye diseases. METHOD This paper aims to detect changes in multi-temporal 3D SD-OCT ONH images using a hierarchical fully Bayesian framework and then to differentiate between changes reflecting random variations or true changes due to glaucoma progression. To this end, we propose the use of kernel-based support vector data description (SVDD) classifier. SVDD is a well-known one-class classifier that allows us to map the data into a high-dimensional feature space where a hypersphere encloses most patterns belonging to the target class. RESULTS The proposed glaucoma progression detection scheme using the whole 3D SD-OCT images detected glaucoma progression in a significant number of cases showing progression by conventional methods (78%), with high specificity in normal and non-progressing eyes (93% and 94% respectively). CONCLUSION The use of the dependency measurement in the SVDD framework increased the robustness of the proposed change-detection scheme with comparison to the classical support vector machine and SVDD methods. The validation using clinical data of the proposed approach has shown that the use of only healthy and non-progressing eyes to train the algorithm led to a high diagnostic accuracy for detecting glaucoma progression compared to other methods.
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Affiliation(s)
- Akram Belghith
- University of California San Diego, Hamilton Glaucoma Center, 9500 Gilman Drive, La Jolla, CA 92093-0946, United States.
| | - Christopher Bowd
- University of California San Diego, Hamilton Glaucoma Center, 9500 Gilman Drive, La Jolla, CA 92093-0946, United States.
| | - Felipe A Medeiros
- University of California San Diego, Hamilton Glaucoma Center, 9500 Gilman Drive, La Jolla, CA 92093-0946, United States.
| | - Madhusudhanan Balasubramanian
- University of Memphis, Department of Electrical and Computer Engineering, 3815 Central Avenue, Memphis, TN 38152, United States.
| | - Robert N Weinreb
- University of California San Diego, Hamilton Glaucoma Center, 9500 Gilman Drive, La Jolla, CA 92093-0946, United States.
| | - Linda M Zangwill
- University of California San Diego, Hamilton Glaucoma Center, 9500 Gilman Drive, La Jolla, CA 92093-0946, United States.
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Belghith A, Bowd C, Medeiros FA, Balasubramanian M, Weinreb RN, Zangwill LM. Glaucoma progression detection using nonlocal Markov random field prior. J Med Imaging (Bellingham) 2014; 1:034504. [PMID: 26158069 PMCID: PMC4478777 DOI: 10.1117/1.jmi.1.3.034504] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/20/2014] [Indexed: 11/14/2022] Open
Abstract
Glaucoma is neurodegenerative disease characterized by distinctive changes in the optic nerve head and visual field. Without treatment, glaucoma can lead to permanent blindness. Therefore, monitoring glaucoma progression is important to detect uncontrolled disease and the possible need for therapy advancement. In this context, three-dimensional (3-D) spectral domain optical coherence tomography (SD-OCT) has been commonly used in the diagnosis and management of glaucoma patients. We present a new framework for detection of glaucoma progression using 3-D SD-OCT images. In contrast to previous works that use the retinal nerve fiber layer thickness measurement provided by commercially available instruments, we consider the whole 3-D volume for change detection. To account for the spatial voxel dependency, we propose the use of the Markov random field (MRF) model as a prior for the change detection map. In order to improve the robustness of the proposed approach, a nonlocal strategy was adopted to define the MRF energy function. To accommodate the presence of false-positive detection, we used a fuzzy logic approach to classify a 3-D SD-OCT image into a "non-progressing" or "progressing" glaucoma class. We compared the diagnostic performance of the proposed framework to the existing methods of progression detection.
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Affiliation(s)
- Akram Belghith
- University of California San Diego, Hamilton Glaucoma Center, 9500 Gilman Drive, La Jolla, California 92093-0946, United States
| | - Christopher Bowd
- University of California San Diego, Hamilton Glaucoma Center, 9500 Gilman Drive, La Jolla, California 92093-0946, United States
| | - Felipe A. Medeiros
- University of California San Diego, Hamilton Glaucoma Center, 9500 Gilman Drive, La Jolla, California 92093-0946, United States
| | - Madhusudhanan Balasubramanian
- University of Memphis, Department of Electrical and Computer Engineering, 3815 Central Avenue, Memphis, Tennessee 38152 United States
- University of Memphis, Department of Biomedical Engineering, 920 Madison Avenue, Memphis, Tennessee 38103 United States
- University of Tennessee Health Science Center, Department of Biomedical Engineering, 920 Madison Avenue, Memphis, Tennessee 38103 United States
| | - Robert N. Weinreb
- University of California San Diego, Hamilton Glaucoma Center, 9500 Gilman Drive, La Jolla, California 92093-0946, United States
| | - Linda M. Zangwill
- University of California San Diego, Hamilton Glaucoma Center, 9500 Gilman Drive, La Jolla, California 92093-0946, United States
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