1
|
Jonas JB, Panda-Jonas S, Xu J, Wei W, Wang YX. Prevalence and associations of parapapillary scleral ridges: the Beijing Eye Study. Br J Ophthalmol 2024:bjo-2024-325205. [PMID: 39326896 DOI: 10.1136/bjo-2024-325205] [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: 01/15/2024] [Accepted: 08/19/2024] [Indexed: 09/28/2024]
Abstract
PURPOSE To explore the prevalence and associated factors of parapapillary scleral ridges (PSRs). METHODS Out of the cohort of the population-based Beijing Eye Study (n=3468 participants), the study included all eyes with an axial length of ≥25 mm and a randomised sample of eyes with an axial length of <25 mm. Using optical coherence tomographic (OCT) images and fundus photographs, we examined the presence and height of PSRs, defined as a ridge-like structure located on the OCT scans in the parapapillary region. RESULTS The study cohort consisted of 366 eyes (314 individuals; mean age: 63.7±9.7 years). PSR prevalence increased from 0% in the non-myopic group to 3.8% (95% CI 0.3%, 7.3%) in moderately myopic group and 29.2% (95% CI 15.7%, 42.5%) in the highly myopic group. All PSRs were located in the temporal parapapillary gamma zone and corresponded to an ophthalmoscopically visible demarcation line running almost parallel to the optic disc border. Higher PRS prevalence correlated with longer axial length (OR 2.98; 95% CI 1.99, 4.46; p<0.001), female sex (OR 6.48; 95% CI 1.56, 27.0; p=0.01) and older age (OR 1.09; 95% CI 1.01, 1.18; p=0.02). Axial length had the strongest influence (beta: 0.48), followed by sex (beta: 0.20) and age (beta: 0.14). If age was dropped from the multivariable model, myopic maculopathy prevalence (OR 10.0; 95% CI 1.41,70.9; p=0.02) and stage (OR 3.57; 95% CI 1.21, 10.6; p=0.02) became significantly correlated with higher PSR prevalence. CONCLUSIONS With a PSR prevalence of >60% in eyes with an axial length of >28 mm, PSRs are a common morphological feature of high myopia, with age and female sex as additional associated factors. PSRs may be due to a biomechanical interplay between the optic nerve and the posterior ocular segment of markedly axially elongated eyes.
Collapse
Affiliation(s)
- Jost B Jonas
- Rothschild Foundation Hospital, Institute Francais de Myopie, Paris, France
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Privatpraxis Prof Jonas und Dr. Panda-Jonas, Heidelberg, Germany
- Beijing Visual Science and Translational Eye Research Institute (BERI), Beijing Tsinghua Changgung Hospital, Tsinghua Medicine, Tsinghua University, Beijing, China
- New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Songhomitra Panda-Jonas
- Rothschild Foundation Hospital, Institute Francais de Myopie, Paris, France
- Privatpraxis Prof Jonas und Dr. Panda-Jonas, Heidelberg, Germany
- Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jie Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Wenbin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| |
Collapse
|
2
|
Kim SH, Kim M, Lee KM. How is eyeball growth associated with optic nerve head shape and glaucoma? The Lamina cribrosa/Bruch's membrane opening offset theory. Exp Eye Res 2024; 245:109975. [PMID: 38906240 DOI: 10.1016/j.exer.2024.109975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 05/04/2024] [Accepted: 06/16/2024] [Indexed: 06/23/2024]
Abstract
The optic nerve head (ONH) is a complex structure wherein the axons of the retinal ganglion cells extrude from the eyeball through three openings: 1) the Bruch's membrane opening (BMO) in the retinal layer, 2) the anterior scleral canal opening in the anterior scleral layer, and 3) the lamina cribrosa (LC). Eyeball expansion during growth induces an offset among openings, since the expansion affects the inner retinal and outer scleral layers differently: the posterior polar retinal structure is preserved by the preferential growth in the equatorial region, whereas no such regional difference is observed in the scleral layer. The various modes and extents of eyeball expansion result in diverse directionality and amount of offset among openings, which causes diverse ONH morphology in adults, especially in myopia. In this review, we summarize the ONH changes that occur during myopic axial elongation. These changes were observed prospectively in our previous studies, wherein LC shift and subsequent offset from the BMO center could be predicted by tracing the central retinal vascular trunk position. This offset induces the formation of γ-zone parapapillary atrophy or externally oblique border tissue. As a presumptive site of glaucomatous damage, the LC/BMO offset may render the LC pores in the opposite direction more vulnerable. To support such speculation, we also summarize the relationship between LC/BMO offset and glaucomatous damage. Indeed, LC/BMO offset is not only the cause of diverse ONH morphology in adults, but is also, potentially, an important clinical marker for assessment of glaucoma.
Collapse
Affiliation(s)
| | - Martha Kim
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea; Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, South Korea.
| |
Collapse
|
3
|
Lee KM, Rhim JH, Ahn HJ, Kim M, Oh S, Park SW, Kim SH. Association between eyeball asymmetry and offset of openings in optic nerve head canal assessed by posterior polar eyeball topography. Sci Rep 2024; 14:9952. [PMID: 38688983 PMCID: PMC11061147 DOI: 10.1038/s41598-024-60716-0] [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: 10/23/2023] [Accepted: 04/26/2024] [Indexed: 05/02/2024] Open
Abstract
We investigated three-dimensional (3D) eyeball protrusion and its association with the offset between the lamina cribrosa (LC) and Bruch's membrane opening (BMO). 3D-MRI scans were taken from 93 subjects (186 eyes). An ellipsoid was fitted along the posterior 2/3 contour of each eyeball. Eyeball asymmetry with focal bulging was determined by the existence of an adjacent outward protrusion/reciprocal inward depression pair, and the angular deviation of the outermost protruded point (OPP) was measured from the nasal side of the fovea-BMO axis. The LC/BMO offset was evaluated by measuring the central retinal vascular trunk (CRVT) location from the BMO center: (1) the angular deviation and (2) the offset index as the ratio between the CRVT-BMO center distance and the BMO radius in the same direction. Seventy-nine eyes (42%) were classified as having eyeball asymmetry, which had a more superior LC/BMO offset (P < 0.001) and a larger offset index (P = 0.002). In those eyes, the angular deviation of the OPP showed a significant correlation with that of the LC/BMO offset (r = -0.724, P < 0.001), as did protrusion depth with the offset index (r = 0.291, P = 0.009). The presence of eyeball asymmetry was associated with superior LC/BMO offset (P = 0.004) and larger offset index (P = 0.009). Superior LC/BMO offset was associated with older age (P < 0.001), shorter axial length (P < 0.001) and inferior location of OPP (P < 0.001). The location and extent of focal bulging were closely associated with those of LC/BMO offset. This indicates that focal bulging during expansion might be associated with diverse directionality of LC/BMO offset.
Collapse
Affiliation(s)
- Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
- Department of Ophthalmology, Seoul National University Boramae Medical Center, 39 Boramae Road, Dongjak-gu, Seoul, 07061, Korea.
| | - Jung Hyo Rhim
- Department of Radiology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyoung Jun Ahn
- Department of Mathematical Modeling, Mind Flow Lab, Seoul, Korea
| | - Martha Kim
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sun-Won Park
- Department of Radiology, Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok Hwan Kim
- Department of Ophthalmology, The One Seoul Eye Clinic, Seoul, Korea
| |
Collapse
|
4
|
Guo Y, Li J, Tian F, Hou R, Liu L, Duan J, Ji A, Wang Y, Guo X, Zheng D, Wang W, Wu L. Parapapillary βBM and γ Zones Played Different Roles in Axial Elongation Among Young Adolescents Using Optical Coherence Tomography. Invest Ophthalmol Vis Sci 2023; 64:34. [PMID: 38133502 PMCID: PMC10746930 DOI: 10.1167/iovs.64.15.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose To evaluate the influencing factors of parapapillary βBM and γ zones incidence in young adolescents and to explore their associations with axial length progression. Methods In this prospective cohort study, 976 seventh-grade students from nine secondary schools in Beijing, China, were enrolled and followed up 1 year later. Parapapillary βBM zone was defined as retinal pigment epithelium loss while Bruch's membrane was present. Parapapillary γ zone was defined as the absence of retinal pigment epithelium and Bruch's membrane. Logistic regression model was used to analyze the influencing factors of βBM and γ zone incidence. A linear mixed model was used to analyze the associations between parapapillary zones and axial elongation. Results Of the 976 participants, 139 (14.2%) had only βBM zone, 398 (40.8%) had only γ zone, and 171 (17.5%) had both. At follow-up, the incidence of βBM zone was 11.5% (76/659), and the incidence of γ zone was 9.7% (39/404). Optic disc tilt, thinner subfoveal choroid, and longer axial length at baseline showed a higher risk of γ zone incidence. The absence of γ zone at baseline showed a faster axial length progression. When the baseline axial length was 25 mm or longer, the βBM zone was also related to the axial elongation. Conclusions The γ zone was associated with axial length progression, and the βBM zone was also associated with the axial length progression when the axial length exceeded 25 mm, which was consistent with the notion that excessive axial length growth not only is the extension of the eyeball but also has its own pathologic changes.
Collapse
Affiliation(s)
- Yin Guo
- Department of Ophthalmology, Beijing Haidian Hospital, Haidian Section of Peking University Third Hospital, Beijing, China
| | - Jiayan Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Feifei Tian
- Daxing District Center for Disease Control and Prevention, Beijing, China
| | - Rui Hou
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Lijuan Liu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jiali Duan
- Beijing Center for Disease Prevention and Control, Beijing, China
| | - Ang Ji
- Department of Ophthalmology, Beijing Haidian Hospital, Haidian Section of Peking University Third Hospital, Beijing, China
| | - Youxin Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Xiuhua Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Deqiang Zheng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Wei Wang
- Centre for Precision Health, Edith Cowan University, Perth, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Lijuan Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| |
Collapse
|
5
|
Qiao Y, Cheng D, Zhu X, Ruan K, Ye Y, Yu J, Zhang Z, Gao W, Wu M, Shen M, Shen L. Characteristics of the Peripapillary Structure and Vasculature in Patients With Myopic Anisometropia. Transl Vis Sci Technol 2023; 12:16. [PMID: 37850949 PMCID: PMC10593134 DOI: 10.1167/tvst.12.10.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 08/23/2023] [Indexed: 10/19/2023] Open
Abstract
Purpose To evaluate the interocular differences of the peripapillary structural and vascular parameters and that of association with axial length (AL) in participants with myopic anisometropia using swept-source optical coherence tomography. Methods This prospective cross-sectional study included 90 eyes of 45 participants. Each participant's eyes were divided into the more and less myopic eye respectively according to spherical equivalent. The β- and γ-parapapillary atrophy (PPA) areas, Bruch's membrane opening distance, border length, and border tissue angle were measured manually. Peripapillary choroidal vascularity index and choroidal thickness (CT) values in superior, nasal, inferior, and temporal were calculated using a custom-built algorithm based on MATLAB. Results The interocular difference in AL and spherical equivalent was 0.62 ± 0.26 mm and -1.50 (-2.13, -1.25) diopters (D), respectively. The interocular difference in spherical equivalent was highly correlated with that of the AL. The β- and γ-PPA areas were significantly greater in more myopic eyes. The mean and inferior peripapillary choroidal vascularity index and all regions of peripapillary CT were significantly lower in the more myopic eyes. The interocular difference in AL was significantly positively correlated with the interocular differences in γ-PPA area and border length and negatively correlated with the interocular differences in temporal choroidal vascularity index and mean, inferior, and temporal peripapillary CT. There was an independent correlation between the interocular differences in AL and the interocular differences in γ-PPA area, inferior, and temporal peripapillary CT. Conclusions Significant differences between both groups were detected in most peripapillary parameters, especially in peripapillary CT. The γ-PPA area, border length, and peripapillary CT were significantly correlated with the elongation of AL. Translational Relevance The current study characterized and analyzed the peripapillary parameters in myopic anisometropia, which helped to monitor myopic progression.
Collapse
Affiliation(s)
- Yilin Qiao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Dan Cheng
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xueying Zhu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Kaiming Ruan
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yufeng Ye
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jiafeng Yu
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Zhengxi Zhang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Weiqian Gao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Minhui Wu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Meixiao Shen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lijun Shen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| |
Collapse
|
6
|
Xu Y, Yang W, Niu L, Wang X, Zhou X, Li M. Myopic Vascular Changes Revealed by Optical Tomography Angiography and Their Association with Myopic Fundus Manifestations. Ophthalmic Res 2023; 66:1266-1277. [PMID: 37751724 PMCID: PMC10614496 DOI: 10.1159/000531877] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/19/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION We aimed to quantify and evaluate fundal vascular changes at different severities of myopia using optical tomography angiography (OCTA) and explore their association with fundus changes captured by ultra-widefield (UWF) fundus cameras. METHODS Seventy-four participants with myopia were enrolled in the study and underwent basic ophthalmic examination, OCTA, and UWF fundus photography. Multiple parameters were obtained using OCTA (flow area, structure thickness, and vessel density) and UWF fundus cameras (tessellation and parapapillary atrophy [PPA]). RESULTS The right eye of 30 participants with low and moderate myopia and 44 participants with high myopia (HM) were included. Patients with HM had a larger flow area of the outer retina (FA-OR) and a smaller thickness of choroid (TC). Axial length was significantly correlated with retinal and choroidal flow area and thickness in the different zones. The PPA area was positively correlated with FA-OR and negatively correlated with TC. Tessellation exhibited different levels of correlation with OCTA parameters regarding the flow area, thickness, and vessel density of the fundal layers, mainly in the inner retina. CONCLUSION FA-OR and TC exhibited sensitive changes in patients with HM and axial elongation; therefore, they could serve as predictive OCTA biomarkers. The PPA and tessellation were connected to the vascular and structural changes revealed by OCTA.
Collapse
Affiliation(s)
- Yijia Xu
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Weiming Yang
- Children’s Hospital of Fudan University, Shanghai, China
| | - Lingling Niu
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Xiaoying Wang
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Meiyan Li
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| |
Collapse
|
7
|
Jonas JB, Jonas RA, Bikbov MM, Wang YX, Panda-Jonas S. Myopia: Histology, clinical features, and potential implications for the etiology of axial elongation. Prog Retin Eye Res 2023; 96:101156. [PMID: 36585290 DOI: 10.1016/j.preteyeres.2022.101156] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/27/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022]
Abstract
Myopic axial elongation is associated with various non-pathological changes. These include a decrease in photoreceptor cell and retinal pigment epithelium (RPE) cell density and retinal layer thickness, mainly in the retro-equatorial to equatorial regions; choroidal and scleral thinning pronounced at the posterior pole and least marked at the ora serrata; and a shift in Bruch's membrane opening (BMO) occurring in moderately myopic eyes and typically in the temporal/inferior direction. The BMO shift leads to an overhang of Bruch's membrane (BM) into the nasal intrapapillary compartment and BM absence in the temporal region (i.e., parapapillary gamma zone), optic disc ovalization due to shortening of the ophthalmoscopically visible horizontal disc diameter, fovea-optic disc distance elongation, reduction in angle kappa, and straightening/stretching of the papillomacular retinal blood vessels and retinal nerve fibers. Highly myopic eyes additionally show an enlargement of all layers of the optic nerve canal, elongation and thinning of the lamina cribrosa, peripapillary scleral flange (i.e., parapapillary delta zone) and peripapillary choroidal border tissue, and development of circular parapapillary beta, gamma, and delta zone. Pathological features of high myopia include development of macular linear RPE defects (lacquer cracks), which widen to round RPE defects (patchy atrophies) with central BM defects, macular neovascularization, myopic macular retinoschisis, and glaucomatous/glaucoma-like and non-glaucomatous optic neuropathy. BM thickness is unrelated to axial length. Including the change in eye shape from a sphere in emmetropia to a prolate (rotational) ellipsoid in myopia, the features may be explained by a primary BM enlargement in the retro-equatorial/equatorial region leading to axial elongation.
Collapse
Affiliation(s)
- Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karis-University, Mannheim, Germany; Institute for Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany.
| | - Rahul A Jonas
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | | | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | | |
Collapse
|
8
|
Saito H, Kambayashi M, Araie M, Murata H, Enomoto N, 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. Deep Optic Nerve Head Structures Associated With Increasing Axial Length in Healthy Myopic Eyes of Moderate Axial Length. Am J Ophthalmol 2023; 249:156-166. [PMID: 36646241 PMCID: PMC10986762 DOI: 10.1016/j.ajo.2023.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/01/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
PURPOSE To elucidate which swept-source optical coherence tomography (OCT)-derived optic nerve head (ONH) parameters are associated with longer axial length (AXL) in healthy myopic eyes. DESIGN Prospective cross-sectional observational study. METHODS Two hundred eleven healthy eyes of 140 participants (96 emmetropic-mild myopic [AXL: 22.2-24.5 mm], 83 moderately myopic [24.5-26.0 mm], and 32 highly myopic [26.0-27.4 mm] eyes) were enrolled. Bruch membrane opening (BMO), anterior scleral canal opening (ASCO) area and ovality, minimum rim width, parameters defining misalignment between the BMO and ASCO planes, OCT-defined region of perineural canal retinal epithelium atrophy and externally oblique choroidal border tissue, circumpapillary retinal nerve fiber layer thickness (cpRNFLT), circumpapillary choroidal thickness (cpChT), lamina cribrosa parameters, and peripapillary scleral (PPS) angle were calculated from BMO-centered radial scans reconstructed from 3D raster scans. Multivariate linear mixed models were used to elucidate ONH parameters that are independently associated with AXL. RESULTS Longer AXL was associated with a greater misalignment between ASCO and BMO planes, larger region of externally oblique choroidal border tissue, thinner cpChT, larger PPS angle, larger ASCO area, and thicker cpRNFLT (all P < .040 after Bonferroni's correction for number of included explanatory variables). CONCLUSIONS A greater misalignment between BMO and ASCO planes, thinner choroid, a more posteriorly bowed PPS, an enlargement of ASCO, and thicker cpRNFLT were each associated with longer AXL. An enhanced understanding of these AXL-associated configurations should provide essential information to improve our ability to detect glaucoma-induced ONH morphology in myopic eyes.
Collapse
Affiliation(s)
- Hitomi Saito
- From the Department of Ophthalmology, Graduate School of Medicine, University of Tokyo (H.S., M.K., M.Ai.), Tokyo, Japan.
| | - Mitsuki Kambayashi
- From the Department of Ophthalmology, Graduate School of Medicine, University of Tokyo (H.S., M.K., M.Ai.), Tokyo, Japan
| | - Makoto Araie
- Kanto Central Hospital of the Mutual Aid Association of Public School Teachers (M.Ar.), Tokyo, Japan
| | - Hiroshi Murata
- Center Hospital of the National Center for Global Health and Medicine (H.M.), Tokyo, Japan
| | - Nobuko Enomoto
- Japan Community Health care Organization Tokyo Shinjuku Medical Center (N.E.), Tokyo, Japan
| | | | - Kazuhisa Sugiyama
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Sciences (K.S., T.H.), Kanazawa, Japan
| | - Tomomi Higashide
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Sciences (K.S., T.H.), Kanazawa, Japan
| | - Atsuya Miki
- Department of Innovative Visual Science, Osaka University Graduate School of Medicine (A.M.), Osaka, Japan; Department of Myopia Control Research, Aichi Medical University Medical School (A.M.), Nagakute, Japan
| | - Aiko Iwase
- Tajimi Iwase Eye Clinic (A.I.), Tajimi, Japan
| | - Goji Tomita
- Department of Ophthalmology, Toho University Ohashi Medical Center (G.T.), Tokyo, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Graduate School of Medicine, Tohoku University (T.N.), Sendai, Japan
| | - Makoto Aihara
- From the Department of Ophthalmology, Graduate School of Medicine, University of Tokyo (H.S., M.K., M.Ai.), Tokyo, Japan
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University (K.O.-M.), Tokyo, Japan
| | - Tae-Woo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital (T.-W.K.), Seongnam, Korea
| | - Christopher Kai Shun Leung
- Department of Ophthalmology, LKS Faculty of Medicine, University of Hong Kong (C.K.S.L.), Hong Kong Special Administrative Region, China
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute (L.M.Z., R.N.W.), and the Viterbi Family Department of Ophthalmology (L.M.Z., R.N.W.), University of California San Diego, La Jolla, California, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute (L.M.Z., R.N.W.), and the Viterbi Family Department of Ophthalmology (L.M.Z., R.N.W.), University of California San Diego, La Jolla, California, USA
| |
Collapse
|
9
|
KhalafAllah MT, Fuchs PA, Nugen F, El Hamdaoui M, Levy A, Redden DT, Samuels BC, Grytz R. Longitudinal Changes of Bruch's Membrane Opening, Anterior Scleral Canal Opening, and Border Tissue in Experimental Juvenile High Myopia. Invest Ophthalmol Vis Sci 2023; 64:2. [PMID: 37010856 PMCID: PMC10080949 DOI: 10.1167/iovs.64.4.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/08/2023] [Indexed: 04/04/2023] Open
Abstract
Purpose To investigate the relative positional changes between the Bruch's membrane opening (BMO) and the anterior scleral canal opening (ASCO), and border tissue configuration changes during experimental high myopia development in juvenile tree shrews. Methods Juvenile tree shrews were assigned randomly to two groups: binocular normal vision (n = 9) and monocular -10 D lens treatment starting at 24 days of visual experience to induce high myopia in one eye while the other eye served as control (n = 12). Refractive and biometric measurements were obtained daily, and 48 radial optical coherence tomography B-scans through the center of the optic nerve head were obtained weekly for 6 weeks. ASCO and BMO were segmented manually after nonlinear distortion correction. Results Lens-treated eyes developed high degree of axial myopia (-9.76 ± 1.19 D), significantly different (P < 0.001) from normal (0.34 ± 0.97 D) and control eyes (0.39 ± 0.88 D). ASCO-BMO centroid offset gradually increased and became significantly larger in the experimental high myopia group compared with normal and control eyes (P < 0.0001) with an inferonasal directional preference. The border tissue showed a significantly higher tendency of change from internally to externally oblique configuration in the experimental high myopic eyes in four sectors: nasal, inferonasal, inferior, and inferotemporal (P < 0.005). Conclusions During experimental high myopia development, progressive relative deformations of ASCO and BMO occur simultaneously with changes in border tissue configuration from internally to externally oblique in sectors that are close to the posterior pole (nasal in tree shrews). These asymmetric changes may contribute to pathologic optic nerve head remodeling and an increased risk of glaucoma later in life.
Collapse
Affiliation(s)
- Mahmoud T. KhalafAllah
- Vision Science Graduate Program, The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Ophthalmology, Menoufia University, Shebin Elkom, Menoufia, Egypt
| | - Preston A. Fuchs
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Fred Nugen
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Mustapha El Hamdaoui
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Alexander Levy
- Department of Biomedical Engineering, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - David T. Redden
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Brian C. Samuels
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Rafael Grytz
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| |
Collapse
|
10
|
Ma Y, Lin Q, Zhao Q, Jin ZB. Prevalence and Characteristics of Myopia in Adult Rhesus Macaques in Southwest China. Transl Vis Sci Technol 2023; 12:21. [PMID: 36947048 PMCID: PMC10050901 DOI: 10.1167/tvst.12.3.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Purpose To investigate the prevalence of myopia in a large cohort of adult rhesus macaques at Yunnan Province in southwest China and describe the characteristics of myopic rhesus macaque eyes. Methods A total of 219 rhesus macaques 14.07 ± 2.72 years old (range, 8-21) were randomly recruited for this study. We performed fundus photography and measurements of cycloplegic refractive error (RE) and axial length (AL) on macaques. Results A total of 429 eyes of 219 macaques were examined. The median RE was -1.25 diopters (D), and the median AL was 18.69 mm. The prevalence of myopia was 62.47%, and one-third of the myopic eyes were highly myopic. The presence of fundus tessellations was higher in myopic eyes than non-myopic eyes (42.54% vs. 6.21%). The cutoff value for the presence of tessellations was -3.52 D for RE and 19.38 mm for AL. In myopic eyes, there were significant differences between grade 1 and grade 3 fundus tessellations on RE (-5.57 ± 2.97 D vs. -8.13 ± 3.51 D) and AL (19.66 ± 0.55 mm vs. 20.60 ± 1.06 mm). Beta-peripapillary atrophy (β-PPA) was found in 48.10% of myopic eyes and 6.83% of non-myopic eyes. The presence of β-PPA is associated with the presence of fundus tessellations, AL, and RE. The presence of β-PPA was higher in grade 3 than grade 1 fundus tessellations (94.4% vs. 76%). Conclusions More than half of adult rhesus macaques in southwest China are myopic, and one-third of the myopic ones are highly myopic. Similar to humans, tessellated fundi and β-PPA are the characteristic signs of myopic rhesus macaques. Adult rhesus macaques are optimal animal models for research on the pathogenesis of myopia. Translational Relevance This study not only provides a reference for the refractive state and AL in myopic rhesus macaques but also indicates that adult rhesus macaques with spontaneous myopia are optimal animal models for research on the pathogenesis of myopia.
Collapse
Affiliation(s)
- Ya Ma
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qiang Lin
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Qi Zhao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zi-Bing Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
11
|
Oh R, Lee KM, Kim M, Oh S, Kim SH. Hemisphere opposite to central retinal vascular trunk deviation is earlier affected by glaucomatous damage in primary angle-closure glaucoma. Acta Ophthalmol 2023; 101:e252-e260. [PMID: 36134905 DOI: 10.1111/aos.15258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/15/2022] [Accepted: 09/03/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of the study was to investigate whether the position of the central retinal vascular trunk (CRVT), as a surrogate for lamina cribrosa (LC) offset, is associated with the dominant hemisphere of visual field defect in primary angle-closure glaucoma (PACG) eyes. METHODS Central retinal vascular trunk deviation was measured from Bruch's membrane opening (BMO) centre, which was delineated by OCT imaging, using the horizontal midline as a reference. The dominant hemisphere developing visual field defect was defined as three connected abnormal points (having a p-value < 5% probability of being normal) appearing in only one hemisphere or each point of the hemisphere having a statistically worse value compared with its mirrored point in the opposite hemisphere on pattern deviation plots. RESULTS One hundred five (80%) of 132 eyes with PACG had dominant hemisphere of visual field defect initially: 70 eyes (67%) in the superior and 35 eyes (33%) in the inferior hemisphere. The CRVT was located superiorly in the dominant superior visual field defect group (p < 0.001). A logistic regression analysis revealed that superior deviation of the CRVT was the only factor associated with dominant superior visual field defect (p < 0.001). Externally oblique border (EOB) presence was associated with larger BMO (p = 0.005) and angular deviation of CRVT (p = 0.002). CONCLUSIONS Central retinal vascular trunk deviation was associated with the dominant hemisphere of visual field defect in PACG eyes. This finding implies that the LC position relative to the BMO centre (LC/BMO offset) may incur structural vulnerability in the optic nerve head of PACG eyes.
Collapse
Affiliation(s)
- Richul Oh
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
| | - Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Martha Kim
- Department of Ophthamology, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Seok Hwan Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, South Korea
| |
Collapse
|
12
|
Anatomic Peculiarities Associated with Axial Elongation of the Myopic Eye. J Clin Med 2023; 12:jcm12041317. [PMID: 36835853 PMCID: PMC9966891 DOI: 10.3390/jcm12041317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/08/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
PURPOSE To describe anatomical peculiarities associated with axial elongation in the human myopic eye. METHODS Reviewing the results of previous histomorphometrical investigations of enucleated human globes, as well as reviewing findings obtained in population-based studies and hospital-based clinical investigations of myopic patients and non-myopic individuals. RESULTS Myopic axial elongation is associated with a change from a mostly spherical eye shape to a prolate ellipsoid form. It is combined with choroidal and scleral thinning, most pronounced at the posterior pole and less pronounced in the fundus midperiphery. In the fundus midperiphery, the retina and density of the retinal pigment epithelium (RPE) and photoreceptors decrease with a longer axial length, while in the macular region, retinal thickness, RPE cell density, and choriocapillaris thickness are not related to axial length. With axial elongation, a parapapillary gamma zone develops, leading to an enlargement of the optic disc-fovea distance and a decrease in angle kappa. Axial elongation is also correlated with an increase in the surface and volume of Bruch's membrane (BM), while BM thickness remains unchanged. Axial elongation causes moderately myopic eyes to show a shift of BM opening to the foveal direction so that the horizontal disc diameter becomes shorter (with a consequent vertical ovalization of the optic disc shape), a temporal gamma zone develops, and the optic nerve exit takes an oblique course. Features of high myopia are an enlargement of the RPE opening (myopic parapapillary beta zone) and BM opening (secondary macrodisc), elongation and thinning of the lamina cribrosa, peripapillary scleral flange (parapapillary delta zone) and peripapillary choroidal border tissue, secondary BM defects in the macular region, myopic maculoschisis, macular neovascularization, and cobblestones in the fundus periphery. CONCLUSIONS These features combined may be explained by a growth in BM in the fundus midperiphery leading to axial elongation.
Collapse
|
13
|
Jonas JB, Zhang Q, Xu L, Wei WB, Jonas RA, Wang YX. Parapapillary gamma zone enlargement in a 10-year follow-up: the Beijing Eye Study 2001-2011. Eye (Lond) 2023; 37:524-530. [PMID: 35194154 PMCID: PMC9905487 DOI: 10.1038/s41433-022-01978-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/31/2022] [Accepted: 02/08/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess prevalence and associated factors of parapapillary gamma zone enlargement (GZE). METHODS Using fundus photographs and optical coherence tomographic images of participants of the population-based Beijing Eye Study, we examined gamma zone changes in a 10-year follow-up. RESULTS The study included 89 highly myopic eyes (61 participants; age: 65.0 ± 9.8 years) and 86 randomly selected non-highly myopic eyes. GZE prevalence was significantly higher in highly myopic eyes than non-highly myopic eyes (75/89; 84%; 95% CI: 77, 92 versus 18/86; 21%; 95% CI:12, 30; p < 0.001). None of the eyes showed a reduction in gamma zone size. Higher prevalence of segmental GZE without enlargement of Bruch's membrane opening (BMO) (mean: 26/175; 14.9%; 95% CI: 9.5, 20.2) was associated with optic disc size reduction (OR: 43.3; 95% CI: 10.9, 172; p < 0.001), disc-fovea distance elongation (OR: 15.4; 95% CI: 3.12, 76.4; p = 0.001) and lower prevalence of high axial myopia (OR: 0.08; 95% CI: 0.01, 0.44; p = 0.001). Higher prevalence of circular GZE (mean: 38/175; 21.7%; 95% CI: 16, 28) was correlated with optic disc enlargement (OR: 4.30; 95% CI: 1.58, 11.7; p = 0.004), and higher prevalence of myopic maculopathy progression (OR: 4.04; 95% CI: 1.60, 10.2; p = 0.003), or alternatively, higher prevalence of high myopia (OR: 4.44; 95% CI: 1.76, 11.2; p = 0.002). Circular GZE or BMO enlargement was associated with lower prevalence of macular BM defect enlargement (p = 0.035). GZE occurred perpendicular to the orientation of myopic lacquer cracks in 12 out of 17 (71%; 95% CI: 46, 95) eyes with lacquer cracks. Segmental GZE occurred in 49 (89%) out of 55 eyes in the same direction as shortening of the disc diameter developed. CONCLUSIONS The observations support the possibility of a posterior myopic axial elongation-associated BMO shift, leading to a segmental GZE in non-highly myopic eyes, followed by a circular GZE in highly myopic eyes. Large gamma zone might be protective against macular Bruch's membrane defects.
Collapse
Affiliation(s)
- Jost B Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
- Privatpraxis Prof Jonas und Dr Panda-Jonas, Heidelberg, Germany
| | - Qi Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Liang Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Wen Bin Wei
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, 100730, Beijing, China
| | - Rahul A Jonas
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.
| |
Collapse
|
14
|
Shang K, Zhuang D, Dai Y. Comparative analysis of OCT-defined parapapillary beta and gamma zones between primary open angle glaucoma and primary angle closure glaucoma. Sci Rep 2022; 12:11070. [PMID: 35773326 PMCID: PMC9246945 DOI: 10.1038/s41598-022-15457-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/23/2022] [Indexed: 11/27/2022] Open
Abstract
The ophthalmoscopic beta zone of parapapillary atrophy has recently been proposed to divide into a gamma zone and a (new) beta zone based on OCT imaging. The present study was undertaken to compare the microstructural characteristics of parapapillary gamma and beta zones and their influencing factors between primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG). Seventy-three PACG patients that had no evidence of an acute attack and 78 POAG patients were enrolled. Patients were matched by propensity scores for age and visual field mean defect (MD) value. The area and angular extent of both zones were measured. In multivariate analysis, a larger beta zone was correlated with older age, severe MD value and longer axial length. A larger gamma zone was correlated with longer axial length. Older age and severe MD value were correlated with the concentric shape of beta zone. Comparing the PACG and POAG groups that adjusted for age and MD value, gamma zone was larger and more prevalent in the POAG group, while beta zone showed no significant difference. Taken separately, MD value was associated with the area and shape of beta zone in the PACG group. Axial length was associated with the temporal shape of beta zone in the POAG group. These data indicated that OCT-defined parapapillary beta and gamma zones exhibited different characteristics in two types of glaucoma. Clinically, the size of parapapillary beta zone may serve as a better indicator of glaucoma severity in eyes with PACG than that in POAG.
Collapse
Affiliation(s)
- Kunte Shang
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, 200031, China
| | - Dongli Zhuang
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, 200031, China
| | - Yi Dai
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Road, Shanghai, 200031, China. .,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, 200031, China.
| |
Collapse
|
15
|
Li Y, Zheng F, Foo LL, Wong QY, Ting D, Hoang QV, Chong R, Ang M, Wong CW. Advances in OCT Imaging in Myopia and Pathologic Myopia. Diagnostics (Basel) 2022; 12:diagnostics12061418. [PMID: 35741230 PMCID: PMC9221645 DOI: 10.3390/diagnostics12061418] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Advances in imaging with optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) technology, including the development of swept source OCT/OCTA, widefield or ultra-widefield systems, have greatly improved the understanding, diagnosis, and treatment of myopia and myopia-related complications. Anterior segment OCT is useful for imaging the anterior segment of myopes, providing the basis for implantable collamer lens optimization, or detecting intraocular lens decentration in high myopic patients. OCT has enhanced imaging of vitreous properties, and measurement of choroidal thickness in myopic eyes. Widefield OCT systems have greatly improved the visualization of peripheral retinal lesions and have enabled the evaluation of wide staphyloma and ocular curvature. Based on OCT imaging, a new classification system and guidelines for the management of myopic traction maculopathy have been proposed; different dome-shaped macula morphologies have been described; and myopia-related abnormalities in the optic nerve and peripapillary region have been demonstrated. OCTA can quantitatively evaluate the retinal microvasculature and choriocapillaris, which is useful for the early detection of myopic choroidal neovascularization and the evaluation of anti-vascular endothelial growth factor therapy in these patients. In addition, the application of artificial intelligence in OCT/OCTA imaging in myopia has achieved promising results.
Collapse
Affiliation(s)
- Yong Li
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Feihui Zheng
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
| | - Li Lian Foo
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Qiu Ying Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
| | - Daniel Ting
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Quan V. Hoang
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Department of Ophthalmology, Columbia University, New York, NY 10027, USA
| | - Rachel Chong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- Correspondence:
| |
Collapse
|
16
|
Cheng D, Ruan K, Wu M, Qiao Y, Gao W, Lian H, Shen M, Bao F, Yang Y, Zhu J, Huang H, Meng X, Shen L, Ye Y. Characteristics of the Optic Nerve Head in Myopic Eyes Using Swept-Source Optical Coherence Tomography. Invest Ophthalmol Vis Sci 2022; 63:20. [PMID: 35731511 PMCID: PMC9233286 DOI: 10.1167/iovs.63.6.20] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose To investigate the characteristics of the optic nerve head (ONH) in myopia using swept-source optical coherence tomography (SS-OCT). Methods Participants were divided into three groups according to the axial length (AL). The optic disc morphology, retinal nerve fiber layer (RNFL) thickness, and radial peripapillary capillary (RPC) vessel density (VD), optic disc tilt, rotation, Bruch's membrane opening distance (BMOD), border length (BL), border tissue angle, focal lamina cribrosa (LC) defects, β- and γ-zone peripapillary atrophy (PPA), microvasculature dropout (MvD), choroidal thickness (CT), and the choroidal vascularity index (CVI) were compared. Linear regression analysis evaluated relationships between spherical equivalent, AL, and ONH parameters. Results One hundred five, 98, and 118 eyes were included in groups 1, 2, and 3, respectively. With AL increasing, the mean, superior and temporal CT, central mean and temporal, pericentral mean, inferior and nasal RPC VD, and temporal CVI decreased, whereas the mean and temporal RNFL thickness, optic disc, RIM and β-PPA area, presence and area of γ-PPA, BMOD and BL increased. Compared to other groups, group 3 depicted a larger cup area, more focal LC defect and total and juxtapapillary MvD; a lower central superior, inferior and nasal, pericentral superior, and temporal RPC VD. Group 1 demonstrated more tilted disc, larger inferior and nasal CT, mean, superior, inferior, and nasal CVI. Conclusions Myopia eyes have larger ONH changes, PPAs, regional RNFL, and MvD, but smaller regional CTs, RPC VD, and CVIs. SS-OCT may be useful in detecting ONH variations during myopia.
Collapse
Affiliation(s)
- Dan Cheng
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Kaiming Ruan
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Minhui Wu
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Yilin Qiao
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Weiqian Gao
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Hengli Lian
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Meixiao Shen
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Fangjun Bao
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Yizeng Yang
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Jun Zhu
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Haiying Huang
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Xianwei Meng
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Lijun Shen
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China.,Department of Ophthalmology, Zhejiang Provincial People's Hospital, Hanghzou, Zhejiang, China
| | - Yufeng Ye
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| |
Collapse
|
17
|
Kim M, Lee KM, Choung HK, Oh S, Kim SH. Change of peripapillary retinal nerve fiber layer and choroidal thickness during 4-year myopic progress: Boramae Myopia Cohort Study Report 4. Br J Ophthalmol 2022:bjophthalmol-2021-320596. [PMID: 35383050 DOI: 10.1136/bjophthalmol-2021-320596] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/18/2022] [Indexed: 11/03/2022]
Abstract
AIMS To investigate the longitudinal changes of peripapillary retinal nerve fibre layer (RNFL) and choroidal thickness during myopic axial elongation. METHODS Peripapillary RNFL and choroidal thickness were prospectively evaluated by spectral-domain optical coherence tomography (SD-OCT) in 46 eyes of 23 myopic children over the course of 4 years. Using serial OCT images acquired based on a fixed scan circle in the glaucoma progression analysis mode, general and sectoral RNFL thicknesses were acquired at the same position and the angular location of the peak was measured. The peripapillary choroidal thickness likewise was measured at eight positions in serial OCT images. RESULTS The mean age at the baseline was 9.6±1.7 years. The mean axial length increased from 24.80±1.28 mm to 25.64±1.35 mm. The global peripapillary RNFL thickness was 98.54±12.06 µm at baseline. The global and sectoral RNFL thicknesses did not change during the 4 years. The angular location of RNFL peaks was also stable and was located in the superotemporal (64.18±10.85°) and inferotemporal (293.98±11.62°) sectors. The global peripapillary choroidal thickness was 145.40±28.67 µm at the baseline. The global and sectoral choroidal thicknesses did not change during the 4 years. CONCLUSIONS The peripapillary RNFL and choroidal thicknesses as well as the locations of the RNFL peaks had been preserved, during the 4-year follow-up on myopic children, when traced and measured from the same location.
Collapse
Affiliation(s)
- Martha Kim
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, the Republic of Korea.,Sensory Organ Research Institute, Dongguk University Ilsan Hospital, Goyang, the Republic of Korea
| | - Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, the Republic of Korea.,Department of Ophthalmology, Seoul National University Boramae Hospital, Seoul, the Republic of Korea
| | - Ho-Kyung Choung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, the Republic of Korea.,Department of Ophthalmology, Seoul National University Boramae Hospital, Seoul, the Republic of Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University Boramae Hospital, Seoul, the Republic of Korea
| | - Seok Hwan Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, the Republic of Korea .,Department of Ophthalmology, Seoul National University Boramae Hospital, Seoul, the Republic of Korea
| |
Collapse
|
18
|
Lin Q, Jia Y, Li T, Wang S, Xu X, Xu Y, Lu L, Yang C, Zou H. Optic disc morphology and peripapillary atrophic changes in diabetic children and adults without diabetic retinopathy or visual impairment. Acta Ophthalmol 2022; 100:e157-e166. [PMID: 33949131 PMCID: PMC9292269 DOI: 10.1111/aos.14885] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/25/2021] [Accepted: 04/04/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate the changes in optic disc morphology and peripapillary atrophy (PPA) in diabetic children and adults without diabetic retinopathy (DR) or visual impairment (VI). METHODS This cross-sectional study included two groups of subjects. One group included 91 children with type 1 diabetes mellitus (T1DM) and 86 healthy children, and the other group included 444 adults with T2DM and 442 healthy controls. The optic disc parameters including major and minor axis lengths, optic disc ovality (ODO), optic disc tilt, optic disc area and β-PPA area were analysed in all subjects. Optic disc rotation and the Bergmeister papilla were analysed only in children. Patients with diabetes and healthy controls were compared in each group of the study population. RESULTS In both groups, patients with diabetes and healthy controls were matched for age, sex and axial length (AL). Among the children, β-PPA area was significantly smaller in those with diabetes (0.29 ± 0.43 mm2 ) than in the healthy controls (0.46 ± 0.58 mm2 , p < 0.05). Multiple linear regression analysis showed that diagnosis of DM was negatively associated with β-PPA area. Longer AL and higher body mass index (BMI) were positively associated with β-PPA area. Among adults, ODO was significantly larger in those with diabetes (1.14 ± 0.09) than in healthy controls (1.12 ± 0.06, p < 0.05). Multiple linear regression analysis showed that the BMI and DM were potential risk factors affecting ODO. CONCLUSION Hyperglycaemia had different effects on the optic disc in children and adults. Unlike in healthy controls, hyperglycaemia had an impact on the peripapillary tissue in children and on optic disc shape in adults before DR and VI development.
Collapse
Affiliation(s)
- Qiurong Lin
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases National Clinical Research Center for Eye Diseases Shanghai Key laboratory of Ocular Fundus Diseases Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Shanghai Eye Diseases Prevention & Treatment Center Shanghai Eye Hospital Shanghai China
| | - Yan Jia
- Department of Ophthalmology Children's Hospital of Fudan University Shanghai China
| | - Tao Li
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases National Clinical Research Center for Eye Diseases Shanghai Key laboratory of Ocular Fundus Diseases Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Shanghai Eye Diseases Prevention & Treatment Center Shanghai Eye Hospital Shanghai China
| | - Shanshan Wang
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases National Clinical Research Center for Eye Diseases Shanghai Key laboratory of Ocular Fundus Diseases Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Shanghai Eye Diseases Prevention & Treatment Center Shanghai Eye Hospital Shanghai China
| | - Xian Xu
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases National Clinical Research Center for Eye Diseases Shanghai Key laboratory of Ocular Fundus Diseases Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Shanghai Eye Diseases Prevention & Treatment Center Shanghai Eye Hospital Shanghai China
| | - Yi Xu
- Shanghai Eye Diseases Prevention & Treatment Center Shanghai Eye Hospital Shanghai China
| | - Lina Lu
- Shanghai Eye Diseases Prevention & Treatment Center Shanghai Eye Hospital Shanghai China
| | - Chenhao Yang
- Department of Ophthalmology Children's Hospital of Fudan University Shanghai China
| | - Haidong Zou
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases National Clinical Research Center for Eye Diseases Shanghai Key laboratory of Ocular Fundus Diseases Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Shanghai Eye Diseases Prevention & Treatment Center Shanghai Eye Hospital Shanghai China
| |
Collapse
|
19
|
Jonas RA, Wei CC, Jonas JB, Wang YX. Decreasing myopic lacquer crack and widening parapapillary gamma zone: case report. BMC Ophthalmol 2021; 21:443. [PMID: 34952568 PMCID: PMC8709951 DOI: 10.1186/s12886-021-02216-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Myopic axial elongation may be due to an equatorial enlargement of Bruch’s membrane (BM), leading to a prolate eye shape and increasing strain with BM and the retinal pigment epithelium (RPE) layer at the posterior pole. The increased BM strain may cause an enlargement of Bruch’s membrane opening (BMO) of the optic nerve head, with the subsequent development and enlargement of parapapillary gamma zone as BM-free parapapillary zone. The increased strain within BM and RPE may also cause lacquer cracks (LCs) as linear breaks in the RPE and / or BM. Studies suggested that a more marked gamma zone enlargement is associated with lower prevalence of LCs or macular BM defects. Here report on the disappearance of a LC during a 10-year follow-up of a highly myopic eye, concurrent with a marked increase in gamma zone. Case presentation A 56-year-old woman showed in her right eye (axial length measured 30.69 mm) a LC, vertically oval optic disc, and parapapillary gamma zone in 2001. When re-examined in 2006, gamma zone had enlarged, while the LC was no longer detectable. In 2011, the LC was not visible neither upon ophthalmoscopy and or upon optical coherence tomography (OCT), while gamma zone had further enlarged. The gamma zone enlargement occurred in a direction perpendicular to the direction of the former LC. Conclusions The observation suggest that a LC can decrease in width, in temporal association with an enlargement of gamma zone. It fits with the notion that an enlargement of the BMO (i.e., enlarging gamma zone) may lead to a relaxation of the BM strain and subsequently to a decrease in the width of the LC.
Collapse
Affiliation(s)
- Rahul A Jonas
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | - Chuan Chuan Wei
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital University of Medical Science, Beijing Ophthalmology and Visual Sciences Key Laboratory, 1 Dongjiaomin Lane, Dongcheng District, Beijing, 100730, China
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Kutzerufer 1, 68167, Mannheim, Germany. .,Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland. .,Privatpraxis Prof Jonas und Dr Panda-Jonas, Heidelberg, Germany.
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital University of Medical Science, Beijing Ophthalmology and Visual Sciences Key Laboratory, 1 Dongjiaomin Lane, Dongcheng District, Beijing, 100730, China.
| |
Collapse
|
20
|
Lee KM, Ahn HJ, Kim M, Oh S, Kim SH. Offset of openings in optic nerve head canal at level of Bruch's membrane, anterior sclera, and lamina cribrosa. Sci Rep 2021; 11:22435. [PMID: 34789748 PMCID: PMC8599705 DOI: 10.1038/s41598-021-01184-8] [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] [Received: 04/02/2021] [Accepted: 09/27/2021] [Indexed: 01/31/2023] Open
Abstract
We compared the central retinal vascular trunk (CRVT) position, as a surrogate of lamina cribrosa (LC) offset, with the anterior scleral opening (ASCO) offset from the Bruch’s membrane opening (BMO). Based on the BMO-centered radial scans, the BMO and ASCO margins were demarcated, and each center was determined as the center of the best-fitted ellipse for each margin. The ASCO/BMO offset was defined as the offset between each center. Angular deviations and the extent of ASCO and CRVT offsets from the BMO center were compared directly. Incomplete demarcation of ASCO was found in 20%, which was associated with a larger BMO area and a larger ASCO offset from the BMO. The angular deviation of ASCO offset was associated with that of CRVT offset and that of the longest externally oblique border. The ASCO offset was smaller than the CRVT offset, and, unlike the CRVT offset, it was rarely deviated to the inferior side. The complete ASCO margin might not be demarcatable when determined on BMO-centered radial scans in the presence of an offset. Also, the ASCO, which reflects only the superficial scleral layer, might not reflect the LC position, because the LC might be shifted further from the ASCO.
Collapse
Affiliation(s)
- Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Boramae Medical Center, 39 Boramae Road, Dongjak-gu, Seoul, 07061, Korea
| | - Hyoung Jun Ahn
- Department of Mathematical Modeling, Mind Flow Lab, Seoul, Korea
| | - Martha Kim
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seok Hwan Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea. .,Department of Ophthalmology, Seoul National University Boramae Medical Center, 39 Boramae Road, Dongjak-gu, Seoul, 07061, Korea.
| |
Collapse
|
21
|
Choung HK, Kim M, Oh S, Lee KM, Kim SH. Central retinal vascular trunk deviation in unilateral normal-tension glaucoma. PLoS One 2021; 16:e0254889. [PMID: 34283884 PMCID: PMC8291707 DOI: 10.1371/journal.pone.0254889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate whether the position of the central retinal vascular trunk (CRVT), as a surrogate of lamina cribrosa (LC) offset, was associated with the presence of glaucoma in normal-tension glaucoma (NTG) patients. Methods The position of the CRVT was measured as the deviation from the center of the Bruch’s membrane opening (BMO), as delineated by spectral-domain optical coherence tomography imaging. The offset index was calculated as the distance of the CRVT from the BMO center relative to that of the BMO margin. The angular deviation of CRVT was measured with the horizontal nasal midline as 0° and the superior location as a positive value. The offset index and angular deviation were compared between glaucoma and fellow control eyes within individuals. Results NTG eyes had higher baseline intraocular pressure (P = 0.001), a larger β-zone parapapillary atrophy area (P = 0.013), and a larger offset index (P<0.001). In a generalized linear mixed-effects model, larger offset index was the only risk factor of NTG diagnosis (OR = 31.625, P<0.001). A generalized estimating equation regression model revealed that the offset index was larger in the NTG eyes than in the control eyes for all ranges of axial length, while it was the smallest for the axial length of 23.4 mm (all P<0.001). Conclusions The offset index was larger in the unilateral NTG eyes, which fact is suggestive of the potential role of LC/BMO offset as a loco-regional susceptibility factor.
Collapse
Affiliation(s)
- Ho-Kyung Choung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Martha Kim
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, Korea
- * E-mail:
| | - Seok Hwan Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, Korea
| |
Collapse
|
22
|
Chen YH, Wei RH, Hui YN. Commentary review on peripapillary morphological characteristics in high myopia eyes with glaucoma: diagnostic challenges and strategies. Int J Ophthalmol 2021; 14:600-605. [PMID: 33875954 DOI: 10.18240/ijo.2021.04.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/30/2020] [Indexed: 12/19/2022] Open
Abstract
The incidences of open angle glaucoma (OAG) and high myopia are increasing concomitantly. Considering the aging population and concurrent rapid increase in the number of individuals with myopia, the risk of visual defects caused by highly myopic OAG is likely to increase dramatically over the next few decades. However, precise screening and diagnosis of OAG is challenging because of the tilt and rotation of the optic disc, as well as extensive β-zone parapapillary atrophy in highly myopic eyes. Recent advances in optical coherence tomography (OCT) and OCT angiography (OCTA) technologies imply that both modalities are promising tools for the detection of highly myopic OAG. Notably, the diagnosis of OAG remains to be determined with the longitudinal changes of functional damages (e.g. visual field defect, visual electrophysiological changes). We herein describe some aspects of microvascular and microstructural pathology in patients with highly myopic OAG and proposes a framework for the development of novel diagnostic and therapeutic strategies.
Collapse
Affiliation(s)
- Yan-Hui Chen
- Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Tianjin 300070, China.,Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Rui-Hua Wei
- Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Tianjin 300070, China.,Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Yan-Nian Hui
- Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an 710023, Shaanxi Province, China
| |
Collapse
|
23
|
Bak E, Lee KM, Kim M, Oh S, Kim SH. Angular Location of Retinal Nerve Fiber Layer Defect: Association With Myopia and Open-Angle Glaucoma. Invest Ophthalmol Vis Sci 2021; 61:13. [PMID: 32902578 PMCID: PMC7488617 DOI: 10.1167/iovs.61.11.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare retinal nerve fiber layer (RNFL) defects' angle measurements determined from the center of the optic disc and Bruch's membrane opening (BMO), as a function of myopia and open-angle glaucoma (OAG) subtypes. Methods In total, 118 patients with OAG were grouped by axial length (AL; high myopia, AL >26 mm; mild to moderate myopia, 24 ≤ AL ≤26 mm; nonmyopia, AL <24 mm) and OAG subtype (normal-tension glaucoma [NTG], high-tension glaucoma [HTG]). The disc and BMO centers were determined by a merged image of red-free fundus photography and spectral-domain optical coherence tomography. The angular location of the RNFL defect close to the fovea (angle α) was measured from the disc center and BMO center, respectively (angle αdisc and angle αBMO). The difference between angle αdisc and αBMO (Δα), as well as the RNFL defect width (angle γ), was evaluated. Results Angle αdisc was smaller in myopic eyes and correlated significantly with AL (P = 0.001), whereas it did not differ among OAG subgroups. Angle αBMO and angle γ were not different in the myopic and OAG subgroups. The Δ α was larger for eyes with higher degree of myopia and had significant correlation with AL (P < 0.001) and was larger in NTG eyes than in HTG eyes (P = 0.023). Conclusions The angular location of the RNFL defect measured from the disc center, but not from the BMO center, was closer to the fovea for glaucomatous eyes with higher values of AL. The present study may facilitate understanding of the characteristic locational pattern of the RNFL defect in myopic glaucomatous eyes.
Collapse
Affiliation(s)
- Eunoo Bak
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Martha Kim
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seok Hwan Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, Korea
| |
Collapse
|
24
|
Park MS, Lee KM, Kim M, Choung HK, Oh S, Kim SH. Longitudinal Changes in Layered Retinal Thickness during Axial Elongation in Healthy Myopic Eyes. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.2.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
25
|
Laíns I, Wang JC, Cui Y, Katz R, Vingopoulos F, Staurenghi G, Vavvas DG, Miller JW, Miller JB. Retinal applications of swept source optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Prog Retin Eye Res 2021; 84:100951. [PMID: 33516833 DOI: 10.1016/j.preteyeres.2021.100951] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 02/08/2023]
Abstract
The advent of optical coherence tomography (OCT) revolutionized both clinical assessment and research of vitreoretinal conditions. Since then, extraordinary advances have been made in this imaging technology, including the relatively recent development of swept-source OCT (SS-OCT). SS-OCT enables a fast scan rate and utilizes a tunable swept laser, thus enabling the incorporation of longer wavelengths than conventional spectral-domain devices. These features enable imaging of larger areas with reduced motion artifact, and a better visualization of the choroidal vasculature, respectively. Building on the principles of OCT, swept-source OCT has also been applied to OCT angiography (SS-OCTA), thus enabling a non-invasive in depth-resolved imaging of the retinal and choroidal microvasculature. Despite their advantages, the widespread use of SS-OCT and SS-OCTA remains relatively limited. In this review, we summarize the technical details, advantages and limitations of SS-OCT and SS-OCTA, with a particular emphasis on their relevance for the study of retinal conditions. Additionally, we comprehensively review relevant studies performed to date to the study of retinal health and disease, and highlight current gaps in knowledge and opportunities to take advantage of swept source technology to improve our current understanding of many medical and surgical chorioretinal conditions. We anticipate that SS-OCT and SS-OCTA will continue to evolve rapidly, contributing to a paradigm shift to more widespread adoption of new imaging technology to clinical practice.
Collapse
Affiliation(s)
- Inês Laíns
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Jay C Wang
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Ying Cui
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA; Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Raviv Katz
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Filippos Vingopoulos
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Italy
| | - Demetrios G Vavvas
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Joan W Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - John B Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA.
| |
Collapse
|
26
|
Wang YX, Panda-Jonas S, Jonas JB. Optic nerve head anatomy in myopia and glaucoma, including parapapillary zones alpha, beta, gamma and delta: Histology and clinical features. Prog Retin Eye Res 2020; 83:100933. [PMID: 33309588 DOI: 10.1016/j.preteyeres.2020.100933] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/22/2020] [Accepted: 11/27/2020] [Indexed: 12/13/2022]
Abstract
The optic nerve head can morphologically be differentiated into the optic disc with the lamina cribrosa as its basis, and the parapapillary region with zones alpha (irregular pigmentation due to irregularities of the retinal pigment epithelium (RPE) and peripheral location), beta zone (complete RPE loss while Bruch's membrane (BM) is present), gamma zone (absence of BM), and delta zone (elongated and thinned peripapillary scleral flange) within gamma zone and located at the peripapillary ring. Alpha zone is present in almost all eyes. Beta zone is associated with glaucoma and may develop due to a IOP rise-dependent parapapillary up-piling of RPE. Gamma zone may develop due to a shift of the non-enlarged BM opening (BMO) in moderate myopia, while in highly myopic eyes, the BMO enlarges and a circular gamma zone and delta zone develop. The ophthalmoscopic shape and size of the optic disc is markedly influenced by a myopic shift of BMO, usually into the temporal direction, leading to a BM overhanging into the intrapapillary compartment at the nasal disc border, a secondary lack of BM in the temporal parapapillary region (leading to gamma zone in non-highly myopic eyes), and an ocular optic nerve canal running obliquely from centrally posteriorly to nasally anteriorly. In highly myopic eyes (cut-off for high myopia at approximately -8 diopters or an axial length of 26.5 mm), the optic disc area enlarges, the lamina cribrosa thus enlarges in area and decreases in thickness, and the BMO increases, leading to a circular gamma zone and delta zone in highly myopic eyes.
Collapse
Affiliation(s)
- Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.
| | - Songhomitra Panda-Jonas
- Institute for Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany
| | - Jost B Jonas
- Institute for Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany; Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karis-University, Mannheim, Germany
| |
Collapse
|
27
|
Shin YI, Lee KM, Kim M, Oh S, Kim SH. Short foveo-disc distance in situs inversus of optic disc. Sci Rep 2020; 10:17740. [PMID: 33082477 PMCID: PMC7576120 DOI: 10.1038/s41598-020-74743-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 10/06/2020] [Indexed: 12/01/2022] Open
Abstract
Situs inversus of optic disc (SIOD) is thought to be a congenital optic disc abnormality that is caused by dysversion of optic nerve insertion. SIOD, however, has many additional features that cannot be explained by abnormal optic-nerve-insertion directionality. In this study, we measured the distance between the fovea and disc in 22 eyes of 15 SIOD patients. For comparison, two control eyes were matched with each SIOD eye by age and axial length. The vertical distance between the temporal vascular arcades also was measured. The foveo-disc distance was shorter in the SIOD eyes than in the control eyes, while the inter-arcade distance did not differ. Further, we measured the circumpapillary retinal nerve fiber layer thickness, which showed nasal crowding of two humps in the SIOD eyes. This nasal crowding disappeared when we shifted the circle scan by the mean difference (465 μm) of the foveal-disc distance between the two groups. Our findings suggest that the optic disc was located closer to the fovea than it would have been normally. Thus, SIOD might reflect incomplete expansion of the posterior pole in the direction of the fovea-disc axis.
Collapse
Affiliation(s)
- Young In Shin
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Martha Kim
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sohee Oh
- Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seok Hwan Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea. .,Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, Korea.
| |
Collapse
|
28
|
Lee KM, Park SW, Kim M, Oh S, Kim SH. Relationship between Three-Dimensional Magnetic Resonance Imaging Eyeball Shape and Optic Nerve Head Morphology. Ophthalmology 2020; 128:532-544. [PMID: 32916169 DOI: 10.1016/j.ophtha.2020.08.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/12/2020] [Accepted: 08/31/2020] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To determine if the 3-dimensional (3D) eyeball shape is associated with the positions of the central retinal vascular trunk (CRVT) and the externally oblique border (EOB) in the optic nerve head (ONH). DESIGN Prospective, cross-sectional study. PARTICIPANTS Fifty-six subjects (112 eyes) with a diagnosis of glaucoma or glaucoma suspect. METHODS The eyeball shape on 3D magnetic resonance imaging (MRI) scans was classified according to the dimension of the longest diameter: axial dimension (prolate sphere), group 1; horizontal dimension (horizontally oblate sphere), group 2; and vertical dimension (vertically oblate sphere), group 3. The deviation of the CRVT, as a surrogate of lamina cribrosa (LC) shift, was measured from the center of the Bruch's membrane opening (BMO) demarcated by OCT imaging, with the horizontal midline as 0° and the superior location as a positive value. The angular location of the longest EOB was also measured. MAIN OUTCOME MEASURE Positions of CRVT and EOB according to the 3D eyeball shape. RESULTS Among 112 eyes, 54 (48%) had a prolate shape (group 1), 23 (21%) had a horizontally oblate shape (group 2), and 35 (31%) had a vertically oblate shape (group 3). The angular deviation of the CRVT differed among the groups: to the nasal side in group 1, to the temporal side in group 2, and along the vertical meridian in group 3. In cases of asymmetric eyeball shape, the CRVT was deviated toward the undergrown side from the overgrown side, regardless of grouping. The angular location of the longest EOB was in the direction opposite to the CRVT position (P < 0.001). A generalized estimating equation analysis revealed that the temporal location of the CRVT was associated with older age (P = 0.001), nasal location of the longest EOB (P < 0.001), and oblate shape of the eyeball (P < 0.001, group 2; P = 0.007, group 3). CONCLUSIONS The position of the CRVT and EOB were associated with the 3D eyeball shape. Considering that infant ONH morphology is highly uniform, various modes of eyeball expansion during growth can result in diverse directionalities of offset between the LC and the BMO in adults.
Collapse
Affiliation(s)
- Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sun-Won Park
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Martha Kim
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seok Hwan Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, Korea.
| |
Collapse
|
29
|
Kim HR, Weinreb RN, Zangwill LM, Suh MH. Characteristics of Focal Gamma Zone Parapapillary Atrophy. Invest Ophthalmol Vis Sci 2020; 61:17. [PMID: 32176268 PMCID: PMC7401693 DOI: 10.1167/iovs.61.3.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to investigate the characteristics of focal γ-zone parapapillary atrophy (focal γPPA) in patients with primary open-angle glaucoma (POAG) using spectral-domain optical coherence tomography (SD-OCT). Methods Three groups of POAG eyes (n = 214) were defined according to the circumferential extent of Bruch's membrane (BM) within the β-zone PPA, as follows: (1) no γPPA (intact BM; n = 81), (2) conventional γPPA (γPPA involving the fovea-BM-opening axis; n = 89), and (3) focal γPPA (γPPA not involving the fovea-BM-opening axis; n = 44). Clinical and ocular characteristics, including age, axial length (AXL), and focal lamina cribrosa (LC) defects were compared among the three groups. Results The focal γPPA group was significantly older (60.6 ± 11.0 years) and had shorter AXL (24.10 ± 1.34 mm) than those of the conventional γPPA group (46.2 ± 13.8 years and 26.53 ± 1.61 mm, respectively; P < 0.001). These values of the focal γPPA group were similar to those of the no γPPA group (23.73 ± 0.97 mm for AXL and 64.0 ± 13.0 years for age). The focal γPPA group had a significantly higher prevalence of focal LC defects than did the other two groups (70.5% [31/44] for the focal γPPA group versus 46.1% [41/89] for the conventional γPPA group versus 37.0% [30/81] for the no γPPA group; P = 0.002). Conclusions Focal γPPA was differentiated from conventional γPPA by older age and shorter AXL. Further, focal γPPA was frequently accompanied by focal LC defects. Longitudinal studies elucidating whether focal LC defects and focal γPPA share common pathogenesis are warranted.
Collapse
|
30
|
Lee KM, Kim M, Oh S, Kim SH. Hemisphere opposite to vascular trunk deviation is earlier affected by glaucomatous damage in myopic high-tension glaucoma. PLoS One 2020; 15:e0233270. [PMID: 32421695 PMCID: PMC7233594 DOI: 10.1371/journal.pone.0233270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 05/02/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate whether the position of the central vascular trunk, as a surrogate of lamina cribrosa (LC) shift, is associated with the initial hemisphere of visual field defect in myopic high-tension glaucoma (HTG) eyes. METHODS The deviation of the central vascular trunk was measured from the center of the Bruch's membrane opening (BMO), which was delineated by OCT imaging. The angular deviation was measured with the horizontal nasal midline as 0° and the superior location as a positive value. The initial hemisphere developing visual field defect was defined as three connected abnormal points (having a P value with less than 0.5% probability of being normal) appearing in only one hemisphere in pattern deviation plots. If those points were observed in both hemispheres initially, the eye was classified as bi-hemispheric visual field defect. RESULTS Initially, 36 eyes (44%) had superior visual field defects, 27 (33%) inferior visual field defects, and 18 (22%) bi-hemispheric visual field defects. After a mean follow-up of 5 years, the number of bi-hemispheric visual field defects had increased to 34 (42%). A logistic regression analysis revealed that inferior deviation of vascular trunk was the only factor associated with initial inferior visual field defect (P = 0.001), while initial bi-hemispheric visual field defects were associated with worse mean deviation at initial visits (P<0.001). A conditional inference tree analysis showed that both the angular deviation (P<0.001) and initial mean deviation (P = 0.025) determined the initial hemispheres developing visual field defect. CONCLUSIONS Although both hemispheres were involved as glaucoma progression, the axons on the side counter to the vascular trunk deviation were damaged earlier in HTG. This finding implies the LC shift could add additional stress to axons exposed to high intraocular pressure.
Collapse
Affiliation(s)
- Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Martha Kim
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seok Hwan Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, Korea
| |
Collapse
|
31
|
Parapapillary atrophy and changes in the optic nerve head and posterior pole in high myopia. Sci Rep 2020; 10:4607. [PMID: 32165727 PMCID: PMC7067880 DOI: 10.1038/s41598-020-61485-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/27/2020] [Indexed: 12/15/2022] Open
Abstract
We investigated the relationship between microstructure of β-parapapillary atrophy (β-PPA) and morphologic features of optic nerve head (ONH) and posterior pole in highly myopic eyes. Eighty-nine highly myopic eyes were included in this study. Bruch’s membrane opening (BMO) area, lamina cribrosa (LC) thickness, anterior laminar depth, peripapillary and subfoveal choroidal thickness (CT), macular Bruch’s membrane (BM) length, and width of β-PPA with and without Bruch’s membrane (PPA+BM and PPA−BM) were evaluated. The mean age and axial length of the included subjects were 26.88 ± 2.44 years and 27.03 ± 0.88 mm, respectively. The width of PPA−BM was larger with increasing BMO area (P = 0.001), whereas the BMO area was not associated with the width of PPA+BM. The large PPA+BM was significantly related to a thinner LC (P = 0.003), deeper anterior lamina surface (P < 0.001), longer macular BM length (P = 0.008), and thinner temporal peripapillary CT (P = 0.034). We found that the morphologic features of the ONH and posterior pole in highly myopic eyes were different based on the microstructure of β-PPA. Whether these features are linked to the development of glaucoma in myopic eyes should be investigated in future studies.
Collapse
|
32
|
Piao H, Guo Y, Ha JY, Sung MS, Park SW. Association of macular thickness with parapapillary atrophy in myopic eyes. BMC Ophthalmol 2020; 20:93. [PMID: 32143676 PMCID: PMC7060613 DOI: 10.1186/s12886-020-01362-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/28/2020] [Indexed: 12/31/2022] Open
Abstract
Background To investigate whether macular structure could be affected by axial elongation and to determine the association between macular intraretinal thickness and the microstructure of β-zone parapapillary atrophy (PPA) in myopic eyes. Methods The study recruited 113 healthy myopic subjects (113 eyes). Images of the macula, subfoveal choroid, and optic nerve head were acquired using spectral-domain optical coherence tomography (SD-OCT). An automatic segmentation algorithm was used to segment the macular images into 7 intraretinal layers. PPA widths with and without Bruch’s membrane (PPA+BM and PPA-BM, respectively) were evaluated. Linear regression analysis was performed to evaluate the association between macular intraretinal thickness and axial length and the microstructure of PPA. Results An increase in axial length was associated with a decrease in whole macular thickness of the peripheral region and an increase in whole macular thickness of the central region. Thickness alterations of the macular intraretinal layers were most apparent in the peripheral region. A significant correlation was found between PPA-BM width and macular intraretinal layer thickness, whereas no significant correlation was found between PPA+BM width and macular intraretinal layer thickness. Moreover, both PPA+BM and PPA-BM widths significantly correlated with subfoveal choroidal thickness. Conclusions Macular intraretinal layer thickness may be affected by PPA-BM width. These findings indicate that the microstructure of PPA should be considered when evaluating the macula in patient with myopia and glaucoma.
Collapse
Affiliation(s)
- Helong Piao
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea.,Department of Ophthalmology, Yanbian University Hospital, Yanji, Jilin, China
| | - Yue Guo
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea.,Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jun Young Ha
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Mi Sun Sung
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Sang Woo Park
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea.
| |
Collapse
|
33
|
Shon K, Hye Jo Y, Won Shin J, Kwon J, Jeong D, Kook MS. Nasalization of Central Retinal Vessel Trunk Predicts Rapid Progression of Central Visual Field in Open-Angle Glaucoma. Sci Rep 2020; 10:3789. [PMID: 32123195 PMCID: PMC7052215 DOI: 10.1038/s41598-020-60355-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 02/06/2020] [Indexed: 11/13/2022] Open
Abstract
Central visual field (CVF) loss is important in maintaining vision-related quality of life in eyes with open-angle glaucoma (OAG). The present study investigated whether nasalized location of central retinal vessel trunk (CRVT) at baseline is associated with rapid rate of CVF loss in early-stage OAG eyes. This study included 76 OAG eyes with high nasalization CRVT [HNL] group and 75 OAG eyes with low nasalization CRVT [LNL] group matched for glaucoma severity at baseline that showed progressive visual field (VF) loss. The rates of mean threshold changes at various regions were compared in the two groups using a linear mixed model. Clinical variables associated with rapid rate of CVF progression were also identified using a linear mixed model. The rate of CVF loss in the central 10° was significantly higher in the HNL group than that in the LNL group (-0.452 dB/year vs. -0.291 dB/year, P < 0.001). The average and inferior hemi-macular ganglion cell inner plexiform layer (GCIPL) progression rates were significantly faster in the HNL group than in the LNL group (P < 0.05). Nasalized location of CRVT was an independent predictor of a more rapid VF loss in the central 10° region (P < 0.05).
Collapse
Affiliation(s)
- Kilhwan Shon
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Youn Hye Jo
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Joong Won Shin
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Junki Kwon
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Daun Jeong
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Michael S Kook
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea.
| |
Collapse
|
34
|
Lee KM, Kim M, Kim SH. Case report: what gives the myopic tilted disc an oval appearance? BMC Ophthalmol 2020; 20:20. [PMID: 31918696 PMCID: PMC6953138 DOI: 10.1186/s12886-020-1305-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/31/2019] [Indexed: 12/31/2022] Open
Abstract
Background Myopic tilted disc, observed as an oval disc, has been alleged to be a funduscopic en-face manifestation of excessive optic nerve head (ONH) sloping or tilting. Here, we report the case of a myopic child showing a developing oval disc in fundus photos during axial elongation, but without progressive tilting in spectral-domain optical coherence tomography (SD-OCT) images. Case presentation By merging B-scan SD-OCT images of the ONH and macula, the curvature of the posterior pole, including both the fovea and ONH, was reconstructed and compared before and after 2 years of axial elongation. Despite the marked increase of disc ovality, the posterior polar curvature was rarely changed. The preponderance of optic disc change was induced by the shift of the temporal disc margin in the nasal direction. This shifting alone imitated an increase of tilt angle but one that was still far smaller than the required degree of tilt for ONH-tilt-based disc ovality. To clarify, we calculated the required extent of axial elongation to obtain a substantial degree of ONH tilt when considering the adjacency of the fovea and the ONH. Without a focal increase of posterior polar curvature, which is to say posterior staphyloma, such change is not possible until the axial length increases extraordinarily. Conclusion The most prominent change in the development of myopic tilted disc, which change gives it an oval appearance and imitates a tilt when measured, is actually not a tilt but rather a shift of the temporal disc margin.
Collapse
Affiliation(s)
- Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Martha Kim
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Seok Hwan Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, South Korea.
| |
Collapse
|
35
|
Kim M, Kim SY, Lee KM, Oh S, Kim SH. Position of Central Vascular Trunk and Shape of Optic Nerve Head in Newborns. Invest Ophthalmol Vis Sci 2019; 60:3381-3387. [PMID: 31387114 DOI: 10.1167/iovs.19-27363] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the baseline position of the central vascular trunk (CVT) and the characteristics of the optic nerve head (ONH) in newborns. Methods CVT position was evaluated based on fundus images obtained from newborns who had undergone eye-screening examinations. It was then graded according to the optic disc area as follows: grade 1, within central 4%; grade 2, within central 9%; grade 3, within central 16%; grade 4, within central 25%; grade 5, outside central 25% of optic disc area. The direction of the CVT position was determined in cases of grade 2 or more as superior, inferior, nasal, and temporal, relative to the optic disc center. The ovality index and the vertical cup-to-disc ratio were determined as well. Results In 1000 fundus images from 1000 newborns, 87.1% showed grade 1 (95% confidence interval 84.7-88.8), and 10.7% showed grade 2. The most common CVT direction was central (87.1%, grade 1), followed by nasal (11.0%) and inferior (1.2%). The ovality index was 1.28 ± 0.09 (range, 1.01-1.61). The ONH shape was vertically oval and highly uniform. The average vertical cup-to-disc ratio was 0.29 ± 0.13 (range, 0.00-0.67). Conclusions The CVT of newborns was located in the central area of the ONH in most cases. The shape of the optic disc was vertically oval, and very similar among the newborns. Considering the high variability of ONH morphology and the diverse location of the CVT in adults, our result suggests that the shape of the ONH and the CVT position might change during eyeball growth.
Collapse
Affiliation(s)
- Martha Kim
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - So Young Kim
- Department of Ophthalmology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Boramae Hospital, Seoul, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University Boramae Hospital, Seoul, Korea
| | - Seok Hwan Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Boramae Hospital, Seoul, Korea
| |
Collapse
|
36
|
Morphological features of parapapillary beta zone and gamma zone in chronic primary angle-closure glaucoma. Eye (Lond) 2019; 33:1378-1386. [PMID: 31406353 DOI: 10.1038/s41433-019-0541-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/11/2019] [Accepted: 04/27/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate the morphological features of parapapillary beta zone and gamma zone and their associated factors in eyes with chronic primary angle-closure glaucoma (CACG). METHODS The observational cross-sectional study included 65 CACG eyes and 65 non-myopic control eyes. On enhanced depth imaging of optical coherent tomography images, the area of parapapillary beta zone and gamma zone, and the peripapillary choroidal thickness at 6 sectors were measured. The optic disc ovality index and Bruch's membrane opening (BMO) shape were further calculated. RESULTS Beta zone was present in 103 (79.2%) eyes and gamma zone in 29 (22.3%) eyes. Compared to control eyes, CACG was associated with larger parapapillary beta zone, female gender, and older age (P < 0.01). No significant difference was observed in axial length and peripapillary choroidal thickness between both groups (P > 0.05). In multivariate analysis, beta zone area was positively associated with older age and higher prevalence of CACG (P < 0.01), while a larger gamma zone area was associated with a smaller disc ovality index and a higher BMO ovality ratio (P < 0.01). The peripapillary choroidal thickness at six sectors was decreased with older age (P < 0.01). CONCLUSIONS In mainly non-myopic subjects with or without CACG, larger parapapillary beta zone was correlated with older age and presence of glaucoma, while a larger parapapillary gamma zone was correlated with disc ovality but not with glaucoma. Parapapillary beta zone and gamma zone may play different roles in physiological and glaucomatous changes around optic nerve head.
Collapse
|