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Rocha JAG, Franco CGVDS, Magacho L, Paranhos A, Kanadani FN, Gracitelli CPB, Prata TS. Automated Optic Nerve Head Hemoglobin Measurements versus General Ophthalmologists Evaluation to Differentiate Glaucomatous from Large Physiological Cupping: A Diagnostic Performance Comparative Study. Clin Ophthalmol 2024; 18:2073-2081. [PMID: 39051025 PMCID: PMC11268564 DOI: 10.2147/opth.s466349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/11/2024] [Indexed: 07/27/2024] Open
Abstract
Purpose The aim of this study is to compare the diagnostic performance in differentiating patients with glaucoma from those with presumed large physiological optic disc cupping (LPC), using optic nerve head hemoglobin levels (ONH Hb), as a screening method, versus the evaluation of general ophthalmologists. Patients and Methods Twenty general ophthalmologists evaluated PowerPoint images of 40 patients with glaucoma and 40 presenting LPC. Presentation of patient's exams were distributed as follows: Group 1 (GI): color retinography (CR), Group 2 (GII): CR + visual field (VF), Group 3 (GIII): CR + optical coherence tomography (OCT), Group 4 (GIV): CR + VF + OCT. The Laguna ONhE software was used to estimate ONH Hb based on CR. Main outcomes were the comparison of sensitivity and accuracy between general ophthalmologists' evaluation and the glaucoma discriminant function (GDF) index from Laguna ONhE and also the agreement between examiners (Kappa statistics). Results Laguna ONhE GDF index demonstrated higher sensitivity values (GI- 90%; GII-90%; GIII-100%; GIV-100%) comparing to all groups (GI-59%; GII-86.5%; GIII-86.5%; GIV-68.5%). In GI, in which it was observed the worst accuracy result (64.8%), we found 75% for GDF. In GII, the accuracy was 81.3% and we found 55% for GDF. The highest agreement was in GII (Kappa=0.63; 95% CI=0.53-0.72), and the lowest in GI (Kappa=0.30; 95% CI=0.20-0.39). Conclusion Laguna ONhE software, a low-cost and non-invasive method, showed good sensitivity and great utility as a screening method in differentiating patients with glaucoma from those with LPC, compared with evaluation of general ophthalmologists.
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Affiliation(s)
- Janaina Andrade Guimarães Rocha
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
- Department of Glaucoma, Glaucoma Institute, Belo Horizonte, Minas Gerais, Brazil
| | | | - Leopoldo Magacho
- Department of Ophthalmology, Federal University of Goiás, Goiânia, Goiás, Brazil
- Department of Glaucoma, Excellence in Ophthalmology, Goiânia, Goiás, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Fábio Nishimura Kanadani
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
- Department of Glaucoma, Glaucoma Institute, Belo Horizonte, Minas Gerais, Brazil
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA
| | - Carolina Pelegrini Barbosa Gracitelli
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
- Department of Glaucoma, Vera Cruz Oftalmologia, Campinas, São Paulo, Brazil
| | - Tiago Santos Prata
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
- Department of Glaucoma, Glaucoma Institute, Belo Horizonte, Minas Gerais, Brazil
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA
- Glaucoma Unit, Opty Group Brazil, São Paulo, São Paulo, Brazil
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Glidai Y, Lucy KA, Schuman JS, Alexopoulos P, Wang B, Wu M, Liu M, Vande Geest JP, Kollech HG, Lee T, Ishikawa H, Wollstein G. Microstructural Deformations Within the Depth of the Lamina Cribrosa in Response to Acute In Vivo Intraocular Pressure Modulation. Invest Ophthalmol Vis Sci 2022; 63:25. [PMID: 35604666 PMCID: PMC9150833 DOI: 10.1167/iovs.63.5.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose The lamina cribrosa (LC) is a leading target for initial glaucomatous damage. We investigated the in vivo microstructural deformation within the LC volume in response to acute IOP modulation while maintaining fixed intracranial pressure (ICP). Methods In vivo optic nerve head (ONH) spectral-domain optical coherence tomography (OCT) scans (Leica, Chicago, IL, USA) were obtained from eight eyes of healthy adult rhesus macaques (7 animals; ages = 7.9-14.4 years) in different IOP settings and fixed ICP (8-12 mm Hg). IOP and ICP were controlled by cannulation of the anterior chamber and the lateral ventricle of the brain, respectively, connected to a gravity-controlled reservoir. ONH images were acquired at baseline IOP, 30 mm Hg (H1-IOP), and 40 to 50 mm Hg (H2-IOP). Scans were registered in 3D, and LC microstructure measurements were obtained from shared regions and depths. Results Only half of the eyes exhibited LC beam-to-pore ratio (BPR) and microstructure deformations. The maximal BPR change location within the LC volume varied between eyes. BPR deformer eyes had a significantly higher baseline connective tissue volume fraction (CTVF) and lower pore aspect ratio (P = 0.03 and P = 0.04, respectively) compared to BPR non-deformer. In all eyes, the magnitude of BPR changes in the anterior surface was significantly different (either larger or smaller) from the maximal change within the LC (H1-IOP: P = 0.02 and H2-IOP: P = 0.004). Conclusions The LC deforms unevenly throughout its depth in response to IOP modulation at fixed ICP. Therefore, analysis of merely the anterior LC surface microstructure will not fully capture the microstructure deformations within the LC. BPR deformer eyes have higher CTVF than BPR non-deformer eyes.
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Affiliation(s)
- Yoav Glidai
- Department of Ophthalmology, NYU Langone Health, New York, New York, United States
| | - Katie A. Lucy
- Department of Ophthalmology, NYU Langone Health, New York, New York, United States
| | - Joel S. Schuman
- Department of Ophthalmology, NYU Langone Health, New York, New York, United States,Department of Biomedical Engineering, NYU Tandon School of Engineering, New York, New York, United States,Center for Neural Science, NYU, New York, New York, United States
| | | | - Bo Wang
- UPMC Eye Center, Eye and Ear Institute, Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Mengfei Wu
- Department of Ophthalmology, NYU Langone Health, New York, New York, United States,Division of Biostatistics, Departments of Population Health and Environmental Medicine, NYU Langone Health, New York, New York, United States
| | - Mengling Liu
- Department of Ophthalmology, NYU Langone Health, New York, New York, United States,Division of Biostatistics, Departments of Population Health and Environmental Medicine, NYU Langone Health, New York, New York, United States
| | - Jonathan P. Vande Geest
- UPMC Eye Center, Eye and Ear Institute, Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Hirut G. Kollech
- Computational Modeling and Simulation Program, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - TingFang Lee
- Department of Ophthalmology, NYU Langone Health, New York, New York, United States,Division of Biostatistics, Departments of Population Health and Environmental Medicine, NYU Langone Health, New York, New York, United States
| | - Hiroshi Ishikawa
- Department of Ophthalmology, NYU Langone Health, New York, New York, United States
| | - Gadi Wollstein
- Department of Ophthalmology, NYU Langone Health, New York, New York, United States,Center for Neural Science, NYU, New York, New York, United States
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Agapito Tito CV, Silvatti J, de Almeida INF, Taniguchi EV, Prata TS, Paranhos A, Kayser C. Structural abnormalities associated with glaucoma using swept-source optical coherence tomography in patients with systemic sclerosis. Int Ophthalmol 2021; 42:1369-1380. [PMID: 34822051 DOI: 10.1007/s10792-021-02124-1] [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: 01/13/2021] [Accepted: 11/12/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Vasospasm represents an early event in systemic sclerosis (SSc). Ocular vasospasm may induce optic nerve head (ONH) damage and has been involved in the pathogenesis of glaucoma, especially normal-tension glaucoma (NTG). We aimed to investigate the presence of structural abnormalities associated with NTG using swept-source optical coherence tomography (SS-OCT) and to correlate the OCT parameters with clinical, capillaroscopy and digital blood flow measures in patients with SSc. METHODS In this cross-sectional study, 40 patients with SSc and 23 age-matched controls were included. The following parameters were measured using SS-OCT: mean and sectoral retinal nerve fibre layer (RNFL) thickness, macular ganglion cell layer complex (GCC) thickness and ONH morphology. Nailfold capillaroscopy (NFC) and digital blood flow measurements using laser Doppler imaging (LDI) were performed in all subjects. RESULTS Patients with SSc showed a thinner temporal RNFL than the controls (69.23 ± 11.74 versus 83.35 ± 20.19 µm, p = 0.001). The other parameters were similar between the two groups. In SSc patients, there was an inverse correlation between the disease duration and the average, superior and inferior RNFL thickness and the GCC thickness and between Raynaud's phenomenon duration and the average RNFL and GCC thickness (p < 0.05). NFC and LDI measurements did not show correlations with OCT parameters. CONCLUSION A thinner temporal RNFL and the correlation between Raynaud's phenomenon and disease duration and structural abnormalities on OCT suggest the presence of early ganglion cell damage in patients with SSc. Although mild, these findings indicate the need to monitor ocular abnormalities in SSc.
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Affiliation(s)
- Cecilia Victoria Agapito Tito
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu 740, 3° andar, São Paulo, SP, 04023-062, Brazil
| | - Juliana Silvatti
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu 740, 3° andar, São Paulo, SP, 04023-062, Brazil
| | - Izabela N F de Almeida
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Elise V Taniguchi
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tiago S Prata
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Cristiane Kayser
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu 740, 3° andar, São Paulo, SP, 04023-062, Brazil.
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Optic Nerve Head Hemoglobin Levels in Glaucoma: A Structural and Functional Correlation Study. J Ophthalmol 2021; 2021:9916102. [PMID: 34659827 PMCID: PMC8516580 DOI: 10.1155/2021/9916102] [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: 04/03/2021] [Revised: 06/25/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate structural and functional correlations in glaucoma patients using optic nerve head hemoglobin (ONH Hb) measurements as determined by automated colorimetric analysis of conventional retinography. Methods We prospectively enrolled healthy participants and glaucomatous patients with a wide range of disease stages. All participants underwent visual field (VF) testing (standard automated perimetry, SAP), color fundus imaging (mydriatic retinography), and peripapillary retinal nerve fiber layer (pRNFL) assessment through spectral-domain optical coherence tomography (SD-OCT). Software Laguna ONhE was used to estimate the amount of ONH Hb and to determine the glaucoma discriminant function (GDF) index. Scatter plots were constructed, and regression analysis was used to investigate the correlations between GDF, average pRNFL thickness, and VF mean deviation (VFMD) index values. A secondary analysis was performed to compare each parameter between three different glaucoma groups divided according to VFMD values (mild, >−6 dB; moderate, −6 to −12 dB; and advanced, <−12 dB). Results One hundred ninety-six eyes from 123 participants (69 with glaucoma and 54 controls) were enrolled. Overall, all parameters evaluated differed significantly between glaucomatous and control eyes (p ≤ 0.001). The comparison of each parameter according to groups of disease stages revealed significant differences between controls and each of the glaucomatous groups (p < 0.001). More pronounced changes in GDF values were observed in early disease stages. We found significant nonlinear correlations between GDF and VFMD values (R2 = 0.295, p < 0.001) and between pRNFL thickness and VFMD (R2 = 0.598, p < 0.001). A linear correlation was found between GDF and pRNFL thickness values (R2 = 0.195, p < 0.001). Conclusion Our results showed significant associations between ONH Hb values and both structural and functional damage in glaucoma obtained by SD-OCT and SAP, respectively. The nonlinear correlation we found and the GDF behavior along different disease stages suggest that ONH Hb levels' reduction may precede visual function changes in early glaucoma stages.
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Elucidation of the role of the lamina cribrosa in glaucoma using optical coherence tomography. Surv Ophthalmol 2021; 67:197-216. [PMID: 33548238 DOI: 10.1016/j.survophthal.2021.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 01/07/2023]
Abstract
Glaucoma is a chronic and progressive optic neuropathy characterized by the death of retinal ganglion cells and corresponding visual field loss. Despite the growing number of studies on the subject, the pathogenesis of the disease remains unclear. Notwithstanding, several studies have shown that the lamina cribrosa (LC) is considered an anatomic site of glaucomatous optic nerve injury, thus having a key role in the pathophysiology of glaucoma development and progression. Different morphological alterations of the LC have been described in vivo in glaucomatous eyes after the evolution of optical coherence tomography (OCT) devices. The most relevant findings were the reduction of laminar thickness, the presence of localized defects, and the posterior LC displacement. These new laminar parameters documented through OCT are not only promising as possible additional tools for glaucoma diagnosis and monitoring, but also as predictors of disease progression. In spite of the advance of technology, however, proper evaluation of the LC is not yet viable in all eyes. We describe OCT-identified LC changes related to the development and progression of glaucoma and provide future directions based on a critical data analysis, focusing on its clinical relevance and applicability.
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Nazareth T, Rocha J, Scoralick ALB, Dias DT, Gracitelli CPB, Kanadani FN, Prata TS. <p>Retinal Sensitivity Thresholds Obtained Through Easyfield and Humphrey Perimeters in Eyes with Glaucoma: A Cross-Sectional Comparative Study</p>. Clin Ophthalmol 2020; 14:4201-4207. [PMID: 33299296 PMCID: PMC7719433 DOI: 10.2147/opth.s280692] [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: 09/14/2020] [Accepted: 11/10/2020] [Indexed: 11/24/2022] Open
Abstract
Objective To compare global retinal sensitivity thresholds obtained through the Easyfield perimeter (EF) and Humphrey visual field analyzer (HFA). Design Observational cross-sectional study. Participants Glaucomatous patients and glaucoma suspects enrolled between October 2018 and April 2019. Materials and Methods All participants underwent EF (SPARK Precision) and HFA perimetry (SITA-Standard). After inclusion, demographic and ocular data were collected, including measurements of retinal nerve fiber layer (RNFL) thickness obtained from spectral-domain optical coherence tomography (SD-OCT). Global indices (mean deviation, MD; pattern standard deviation, PSD) values were compared between perimeters, and their correlation and agreement were evaluated. We used regression analysis to investigate structure-functional correlations between SD-OCT measurements and MD index of each perimeter. Results We investigated 111 eyes from 69 patients. Mean MD (mean difference=1.49dB) and PSD values (mean difference=0.42dB) from the HFA were significantly larger than those from the EF perimeter (p<0.001). There were significant linear correlations between EF-MD and HFA-MD (r=0.56), and EF-PSD and HFA-PSD (r=0.38; p<0.001). We found significant non-linear associations between average RNFL thickness and MD values derived from both EF (R2=0.41) and HFA (R2=0.17) perimeters (p≤0.012). A difference <2dB between EF-MD and HFA-MD was found in 53% of the eyes, while 71% of them had a difference <1dB between EF-PSD and HFA-PSD. Conclusion While we found a moderate correlation and a small mean sensitivity difference between test results, EF’s correlation with structural measurements was at least comparable to that of the HFA. Our findings suggest that although these tests should not be used interchangeably, EF SPARK Precision could be used as an alternative for functional assessment in eyes with mild glaucoma.
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Affiliation(s)
- Thaissa Nazareth
- Glaucoma Service, Instituto de Olhos Ciências Médicas, Belo Horizonte, Brazil
| | - Janaina Rocha
- Glaucoma Service, Instituto de Olhos Ciências Médicas, Belo Horizonte, Brazil
- Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
| | | | - Diego T Dias
- Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
| | | | - Fabio N Kanadani
- Glaucoma Service, Instituto de Olhos Ciências Médicas, Belo Horizonte, Brazil
- Ophthalmology Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Tiago S Prata
- Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
- Ophthalmology Department, Mayo Clinic, Jacksonville, Florida, USA
- Correspondence: Tiago S Prata Ophthalmology Department, Federal University of São Paulo, Rua Dr João Lourenço, 713; Vila Nova Conceição, São PauloCEP: 04508-031, BrazilTel +55 11 43019481Fax +55 11 3683-0404 Email
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Lopes FSS, Matsubara I, Almeida I, Gracitelli CPB, Dorairaj SK, Vessani RM, Paranhos A, Prata TS. Using Enhanced Depth Imaging Optical Coherence Tomography-Derived Parameters to Discriminate between Eyes with and without Glaucoma: A Cross-Sectional Comparative Study. Ophthalmic Res 2020; 64:108-115. [PMID: 32454499 DOI: 10.1159/000508952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 05/20/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION New technologies have been developed in order to decrease interpersonal influence and subjectivity during the glaucoma diagnosis process. Enhanced depth imaging spectral-domain OCT (EDI OCT) has turned up as a favorable tool for deep optic nerve head (ONH) structures assessment. OBJECTIVE A prospective cross-sectional study was conducted to compare the diagnostic performance of different EDI OCT-derived parameters to discriminate between eyes with and without glaucoma. MATERIAL AND METHODS The following ONH parameters were measured: lamina cribrosa (LC) thickness and area; prelaminar neural tissue (PLNT) thickness and area; average Bruch's membrane opening - minimum rim width (BMO-MRW), superior BMO-MRW, and inferior BMO-MRW. Peripapillary retinal nerve fiber layer (pRNFL) thickness was also obtained. RESULTS Seventy-three participants were included. There were no significant differences between AUCs for average BMO-MRW (0.995), PLNT area (0.968), and average pRNFL thickness (0.975; p ≥ 0.089). However, AUCs for each of these 3 parameters were significantly larger than LC area AUC (0.701; p ≤ 0.001). Sensitivities at 80% specificity were: PLNT area = 92.3%, average BMO-MRW = 97.4%, and average pRNFL thickness = 94.9%. CONCLUSIONS Comparing the diagnostic performance of different EDI OCT ONH parameters to discriminate between eyes with and without glaucoma, we found better results for neural tissue-based indexes (BMO-MRW and PLNT area) compared to laminar parameters. In this specific population, these neural tissue-based parameters (including PLNT area, which was investigated by the first time in the present study) had a diagnostic performance comparable to that of the conventional pRNFL thickness protocol.
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Affiliation(s)
- Flavio Siqueira Santos Lopes
- Glaucoma Service, Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil, .,Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil,
| | - Igor Matsubara
- Glaucoma Service, Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil
| | - Izabela Almeida
- Glaucoma Service, Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil
| | | | - Syril K Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, USA
| | - Roberto Murad Vessani
- Glaucoma Service, Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Augusto Paranhos
- Glaucoma Service, Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Tiago Santos Prata
- Glaucoma Service, Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil.,Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, USA
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Colicchio D, Terenzi LAO, Rocha JAG, Sousa AKS, Almeida ED, Moreno PA, Leite MT, Paranhos A, Kanadani FN, Prata TS. Comparison of Fundus Biomicroscopy Examination of the Optic Nerve Head with and without Mydriasis. Ophthalmic Res 2019; 63:8-12. [PMID: 31454807 DOI: 10.1159/000500980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/15/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Notwithstanding the significant advances in automated imaging techniques in the past 2 decades, subjective evaluation of the optic disc still remains an important part of glaucoma propaedeutic. In places with limited resources and a high demand for ophthalmic care, anatomical evaluation of glaucoma cases often relies solely on slit-lamp-based fundus biomicroscopic examination, which is frequently performed without mydriasis. OBJECTIVE The aim of this study was to compare metrics related to fundus biomicroscopy examination of the optic nerve head and peripapillary retinal nerve fiber layer (pRNFL) with and without mydriasis. MATERIAL AND METHODS Healthy individuals, patients with early glaucoma, and glaucoma suspects were prospectively enrolled. Patients were examined before and after mydriasis by three glaucoma specialists, who estimated patients' vertical cup-to-disc ratio (CDR) and evaluated the presence of glaucomatous signs: laminar dot sign, disc hemorrhage, disc saucering, disc notching, peripapillary atrophy, localized pRNFL defect, and loss of the ISNT pattern. Main outcome measures were the intra-observer comparison, the inter-observer agreement, and the abilities to identify glaucomatous signs before and after mydriasis. RESULTS Thirty patients (60 eyes) were enrolled (mean age, 62.3 ± 11.6 years). Considering the evaluation of the three examiners, the mean vertical CDR increased from 0.41 to 0.44 (p = 0.02), and the median of the coefficient of variation of the measures was reduced from 0.24 to 0.11 (p = 0.01) after mydriasis. Regarding the inter-observer agreement evaluation, the kappa coefficient values ranged from 0.64 to 0.72 before mydriasis and from 0.71 to 0.77 after mydriasis. Dot sign and disc notching were better identified through fundoscopic examination with mydriasis compared to the nonmydriatic examination (p < 0.01). CONCLUSION Our results suggest that fundus biomicroscopy should be performed with mydriasis whenever possible, as it yells a better intra- and inter-observer agreement and improves the detection of glaucomatous signs. Moreover, examiners seem to underestimate CDR values without mydriasis. Further investigation is warranted to validate these findings by general ophthalmologists and in different populations.
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Affiliation(s)
- Daniel Colicchio
- Glaucoma Service, Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
| | - Larissa A O Terenzi
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil.,Department of Ophthalmology, Instituto de Olhos Ciências Médicas, Belo Horizonte, Brazil
| | - Janaina A G Rocha
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil.,Department of Ophthalmology, Instituto de Olhos Ciências Médicas, Belo Horizonte, Brazil
| | - Aline K S Sousa
- Glaucoma Service, Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
| | - Eglailson D Almeida
- Glaucoma Service, Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
| | - Pilar A Moreno
- Glaucoma Service, Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
| | - Mauro T Leite
- Glaucoma Service, Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
| | - Augusto Paranhos
- Glaucoma Service, Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
| | - Fábio N Kanadani
- Department of Ophthalmology, Instituto de Olhos Ciências Médicas, Belo Horizonte, Brazil.,Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, USA
| | - Tiago Santos Prata
- Glaucoma Service, Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil, .,Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil, .,Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, USA,
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Igarashi N, Honjo M, Asano S, Takagi K, Aihara M. Optic disc cupping characteristics of normal pressure hydrocephalus patients with normal-tension glaucoma. Sci Rep 2019; 9:3108. [PMID: 30816215 PMCID: PMC6395590 DOI: 10.1038/s41598-019-39526-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/21/2019] [Indexed: 12/21/2022] Open
Abstract
We examined the potential association of idiopathic normal pressure hydrocephalus (iNPH) with the generation of normal-tension glaucoma (NTG), to explore possible relationships between intracranial pressure (ICP) and the presence of glaucoma, and to compare disc morphology of NTG patients with or without iNPH. We investigated 20 iNPH patients, examined the prevalence of glaucoma, and compared the optic discs of NTG patients with iNPH (n = 11) and age-matched NTG patients without iNPH (n = 16). All data were collected prior to the treatment of iNPH, to eliminate the possibility that the treatment may have contributed to the progression of NTG. The diagnoses of NTG were made using visual field data, intraocular pressure measurements, fundoscopy, and optical coherence tomography (OCT). Using OCT, the optic nerve disc depth was also measured. The ICP was higher in the iNPH with NTG compared to iNPH without NTG (p = 0.0425), and the cupping depths of the discs of NTG patients with iNPH were significantly shallower compared with those of NTG patients without iNPH (p = 0.0097). Based on the difference in cupping depth, NTG patients with iNPH may have a different morphology from typical glaucoma patients, which could in turn reflect a different pathogenesis compared to NTG patients without iNPH.
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Affiliation(s)
- Nozomi Igarashi
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Megumi Honjo
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shotaro Asano
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoshi Takagi
- Department of Normal Tension Hydrocephalus, Kashiwa Tanaka Hospital, Chiba, Japan
| | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Lopes FS, Matsubara I, Almeida I, Dorairaj SK, Vessani RM, Paranhos A, Prata TS. Structure-function relationships in glaucoma using enhanced depth imaging optical coherence tomography-derived parameters: a cross-sectional observational study. BMC Ophthalmol 2019; 19:52. [PMID: 30770751 PMCID: PMC6377769 DOI: 10.1186/s12886-019-1054-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 01/29/2019] [Indexed: 12/14/2022] Open
Abstract
Background To investigate structural and functional correlations in glaucoma patients using enhanced depth imaging spectral-domain optical coherence tomography (EDI OCT)-derived parameters. Methods We prospectively enrolled healthy participants and glaucomatous patients with a wide range of disease stages. All participants underwent visual field (VF) testing (SITA - Standard 24–2; Carl Zeiss Meditec, Dublin, CA) and EDI OCT imaging (Spectralis; Heidelberg Engineering Co., Heidelberg, Germany). The following optic nerve head parameters were measured on serial vertical EDI OCT B-scans by two experienced examiners masked to patients clinical data: lamina cribrosa (LC) thickness and area, prelaminar neural tissue thickness and area, anterior LC depth, Bruch’s membrane opening (BMO) and average, superior, and inferior BMO-minimum rim width (BMO-MRW). Only good quality images were considered, and whenever both eyes were eligible, one was randomly selected for analysis. Scatter plots were constructed to investigate correlations between each anatomic parameter and patient’s VF status (based on VF index [VFI] values). Results A total of 73 eyes of 73 patients were included. All EDI OCT parameters evaluated differed significantly between glaucomatous and control eyes (P ≤ 0.045). A secondary analysis, in which glaucomatous patients were divided according to VF mean deviation index values into 3 groups (mild [G1; > − 6 dB], moderate [G2; − 6 to − 12 dB] and advanced [G3; <− 12 dB] glaucoma), revealed that average BMO-MRW was the EDI OCT parameter that presented more significant differences between the different stages of glaucoma. Significant structure-function correlations were found between VFI values and prelaminar neural tissue area (R2 = 0.20, P = 0.017), average BMO-MRW (R2 = 0.35, P ≤ 0.001), superior BMO-MRW (R2 = 0.21, P = 0.012), and inferior BMO-MRW (R2 = 0.27, P = 0.002). No significant correlations were found for LC area and anterior LC depth (P ≥ 0.452). Conclusions Evaluating the distribution pattern and structure-function correlations of different laminar and prelaminar EDI OCT-derived parameters in glaucomatous patients, we found better results for neural tissue-based indexes (compared to LC-derived parameters). The diagnostic utility of each parameter deserves further investigations. Electronic supplementary material The online version of this article (10.1186/s12886-019-1054-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Flavio S Lopes
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, 04021-001, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, R. Salém Bechara, 281, Centro, Osasco, 06018-180, Brazil
| | - Igor Matsubara
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, 04021-001, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, R. Salém Bechara, 281, Centro, Osasco, 06018-180, Brazil
| | - Izabela Almeida
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, 04021-001, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, R. Salém Bechara, 281, Centro, Osasco, 06018-180, Brazil
| | - Syril K Dorairaj
- Department of Ophthalmology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
| | - Roberto M Vessani
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, 04021-001, Brazil
| | - Augusto Paranhos
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, 04021-001, Brazil
| | - Tiago S Prata
- Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, 04021-001, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, R. Salém Bechara, 281, Centro, Osasco, 06018-180, Brazil.,Department of Ophthalmology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
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Akkaya S, Küçük B, Doğan HK, Can E. Evaluation of the lamina cribrosa in patients with diabetes mellitus using enhanced depth imaging spectral-domain optical coherence tomography. Diab Vasc Dis Res 2018; 15:442-448. [PMID: 29895175 DOI: 10.1177/1479164118782091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To compare the lamina cribrosa thickness and anterior lamina cribrosa depth between patients with and without diabetes mellitus and to investigate the effect of metabolic control and duration of diabetes mellitus on lamina cribrosa thickness and anterior lamina cribrosa depth using enhanced depth imaging spectral-domain optical coherence tomography. METHODS A total of 70 patients were enrolled in this cross-sectional study and were divided into the diabetes and control groups. Intraocular pressure, circumpapillary retinal nerve fibre layer thickness, anterior lamina cribrosa depth and lamina cribrosa thickness were compared between the groups. RESULTS In the control group, the mean intraocular pressure was 14.6 ± 3.1 (mean ± standard deviation) mmHg, mean circumpapillary retinal nerve fibre layer thickness was 105.41 ± 5.86 μm, mean anterior lamina cribrosa depth was 420.3 ± 90.2 μm and mean lamina cribrosa thickness was 248.5 ± 5.4 μm. In the diabetes group, the mean intraocular pressure was 13.9 ± 2.2 mmHg, mean circumpapillary retinal nerve fibre layer thickness was 101.37 ± 10.97 μm, mean anterior lamina cribrosa depth was 351.4 ± 58.6 μm and mean lamina cribrosa thickness was 271.6 ± 33.9 μm. Lamina cribrosa thickness was significantly higher ( p < 0.001) and anterior lamina cribrosa depth was significantly lower ( p = 0.003) in the diabetes group. There was no statistical difference between the groups with regard to age, spherical equivalent, axial length, circumpapillary retinal nerve fibre layer thickness and intraocular pressure ( p = 0.69, 0.26, 0.47, 0.06 and 0.46, respectively). Lamina cribrosa thickness and anterior lamina cribrosa depth were not significantly correlated with duration of diabetes mellitus (lamina cribrosa thickness: r = -0.078, p = 0.643; anterior lamina cribrosa depth: r = -0.062, p = 0.710) or HbA1c levels (lamina cribrosa thickness: r = -0.078, p = 0.596; anterior lamina cribrosa depth: r = -0.228, p = 0.169). CONCLUSION The results of this study showed that the optical coherence tomography measurement of lamina cribrosa revealed thicker and more anteriorly positioned lamina cribrosa for patients with diabetes mellitus compared with those for healthy controls.
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Affiliation(s)
- Serkan Akkaya
- 1 Department of Ophthalmology, Kayseri Egitim ve Arastirma Hastanesi, Kayseri, Turkey
| | - Bekir Küçük
- 2 Department of Ophthalmology, Bozok Universitesi Tip Fakultesi, Yozgat, Turkey
| | - Hatice Karaköse Doğan
- 3 Department of Endocrinology and Metabolic Disorders, Kayseri Egitim ve Arastirma Hastanesi, Kayseri, Turkey
| | - Ertuğrul Can
- 4 Department of Ophthalmology, Ondokuz Mayis Universitesi Tip Fakultesi, Samsun, Turkey
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