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Lee JS, Bae HW, Kim CY, Lee SY. Systemic Arterial Stiffness and Choroidal Microvascular Insufficiency on the Structural Progression of Normal Tension Glaucoma. Am J Ophthalmol 2024; 268:10-18. [PMID: 38977152 DOI: 10.1016/j.ajo.2024.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE To identify the role of systemic arterial stiffness and choroidal microvascular insufficiency on structural progression of normal-tension glaucoma (NTG). DESIGN Retrospective cohort study. METHODS A total of 107 early NTG eyes of 88 patients, who underwent pulse wave velocity (PWV) measurements and optical coherence tomography (OCT) angiography (OCT-A) at baseline, were categorized depending on the presence of peripapillary choroidal microvasculature dropout (MvD) and PWV. Differences in glaucomatous progression were analyzed. Structural progression rates were determined using the trend-based analysis of Cirrus OCT. RESULTS Thirty-two eyes displayed choroidal MvD (62.7 [95% CI 58.4-67.0] years old, 53.6% males), and 70 eyes did not show any MvD (59.9 (95% CI 57.1-62.6) years old, 53.3% males) at baseline. Patients were followed for 48.4 (95% CI 40.0-56.8) months. When they were further divided based on PWV (high PWV ≥ 1400 cm/sec), those with choroidal MvD and high PWV showed significantly faster thinning in macular ganglion cell-inner plexiform layer (GCIPL; P = .023). In comparison to those with low PWV and no MvD, eyes with high PWV and MvD in the peripapillary area were likely to show fast structural progression (≤-1.2 µm/year) in the macular GCIPL by odds of 6.019 (95% CI 1.619-38.531, P = .025). CONCLUSIONS In NTG eyes, GCIPL thinning was faster when choroidal MvD and high systemic arterial stiffness were present. The simultaneous presence of regional and systemic vascular insufficiency may be associated with rapid glaucoma structural progression in eyes with low baseline intraocular pressure.
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Affiliation(s)
- Jihei Sara Lee
- From the Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine (J.S.L., H.W.B, C.Y.K., S.Y.L.), Seoul, Republic of Korea
| | - Hyoung Won Bae
- From the Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine (J.S.L., H.W.B, C.Y.K., S.Y.L.), Seoul, Republic of Korea
| | - Chan Yun Kim
- From the Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine (J.S.L., H.W.B, C.Y.K., S.Y.L.), Seoul, Republic of Korea
| | - Sang Yeop Lee
- From the Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine (J.S.L., H.W.B, C.Y.K., S.Y.L.), Seoul, Republic of Korea; Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine (S.Y.L.), Yongin-Si, Republic of Korea.
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Van Eijgen J, Melgarejo JD, Van Laeken J, Van der Pluijm C, Matheussen H, Verhaegen M, Van Keer K, Maestre GE, Al-Aswad LA, Vanassche T, Zhang ZY, Stalmans I. The Relevance of Arterial Blood Pressure in the Management of Glaucoma Progression: A Systematic Review. Am J Hypertens 2024; 37:179-198. [PMID: 37995334 PMCID: PMC10906067 DOI: 10.1093/ajh/hpad111] [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: 07/28/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Glaucoma is one of the leading causes of global blindness and is expected to co-occur more frequently with vascular morbidities in the upcoming years, as both are aging-related diseases. Yet, the pathogenesis of glaucoma is not entirely elucidated and the interplay between intraocular pressure, arterial blood pressure (BP) and ocular perfusion pressure is poorly understood. OBJECTIVES This systematic review aims to provide clinicians with the latest literature regarding the management of arterial BP in glaucoma patients. METHODS A systematic search was performed in Medline, Embase, Web of Science and Cochrane Library. Articles written in English assessing the influence of arterial BP and systemic antihypertensive treatment of glaucoma and its management were eligible for inclusion. Additional studies were identified by revising references included in selected articles. RESULTS 80 Articles were included in this systemic review. A bimodal relation between BP and glaucoma progression was found. Both high and low BP increase the risk of glaucoma. Glaucoma progression was, possibly via ocular perfusion pressure variation, strongly associated with nocturnal dipping and high variability in the BP over 24 h. CONCLUSIONS We concluded that systemic BP level associates with glaucomatous damage and provided recommendations for the management and study of arterial BP in glaucoma. Prospective clinical trials are needed to further support these recommendations.
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Affiliation(s)
- Jan Van Eijgen
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Jesus D Melgarejo
- Institute of Neurosciences, School of Medicine, University of Texas Rio Grande Valley, Harlingen, Texas, USA
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Jana Van Laeken
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
| | - Claire Van der Pluijm
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Hanne Matheussen
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Micheline Verhaegen
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Karel Van Keer
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Gladys E Maestre
- Institute of Neurosciences, School of Medicine, University of Texas Rio Grande Valley, Harlingen, Texas, USA
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, Texas, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Lama A Al-Aswad
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, USA
| | - Thomas Vanassche
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Zhen-Yu Zhang
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Ingeborg Stalmans
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
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Bhanvadia SB, Brar MS, Delavar A, Tavakoli K, Saseendrakumar BR, Weinreb RN, Zangwill LM, Baxter SL. Assessing Usability of Smartwatch Digital Health Devices for Home Blood Pressure Monitoring among Glaucoma Patients. INFORMATICS (MDPI) 2022; 9:79. [PMID: 36873830 PMCID: PMC9980658 DOI: 10.3390/informatics9040079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Glaucoma is a leading cause of blindness worldwide. Blood pressure (BP) dysregulation is a known risk factor, and home-based BP monitoring is increasingly used, but the usability of digital health devices to measure BP among glaucoma patients is not well studied. There may be particular usability challenges among this group, given that glaucoma disproportionately affects the elderly and can cause visual impairment. Therefore, the goal of this mixed-methods study was to assess the usability of a smart watch digital health device for home BP monitoring among glaucoma patients. Adult participants were recruited and given a smartwatch blood pressure monitor for at-home use. The eHEALS questionnaire was used to determine baseline digital health literacy. After a week of use, participants assessed the usability of the BP monitor and related mobile app using the Post-study System Usability Questionnaire (PSSUQ) and the System Usability Scale (SUS), standardized instruments to measure usability in health information technology interventions. Variations in scores were evaluated using ANOVA and open-ended responses about participants' experience were analyzed thematically. Overall, usability scores corresponded to the 80th-84th percentile, although older patients endorsed significantly worse usability based on quantitative scores and additionally provided qualitative feedback describing some difficulty using the device. Usability for older patients should be considered in the design of digital health devices for glaucoma given their disproportionate burden of disease and challenges in navigating digital health technologies, although the overall high usability scores for the device demonstrates promise for future clinical applications in glaucoma risk stratification.
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Affiliation(s)
- Sonali B. Bhanvadia
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92093, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093, USA
| | - Manreet S. Brar
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92093, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093, USA
| | - Arash Delavar
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92093, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093, USA
| | - Kiana Tavakoli
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92093, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093, USA
| | - Bharanidharan Radha Saseendrakumar
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92093, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093, USA
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92093, USA
| | - Linda M. Zangwill
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92093, USA
| | - Sally L. Baxter
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92093, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093, USA
- Correspondence: ; Tel.: +1-(858)-246-4604
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Melgarejo JD, Eijgen JV, Maestre GE, Al-Aswad LA, Thijs L, Mena LJ, Lee JH, Terwilliger JD, Petitto M, Chávez CA, Brito M, Calmon G, Silva E, Wei DM, Cutsforth E, Keer KV, Gustavo De Moraes C, Vanassche T, Janssens S, Stalmans I, Verhamme P, Staessen JA, Zhang ZY. Open-Angle Glaucomatous Optic Neuropathy Is Related to Dips Rather Than Increases in the Mean Arterial Pressure Over 24-H. Am J Hypertens 2022; 35:703-714. [PMID: 35218651 PMCID: PMC9340631 DOI: 10.1093/ajh/hpac028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/27/2022] [Accepted: 02/25/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Mean arterial pressure (MAP) drives ocular perfusion. Excessive 24-h MAP variability relates to glaucoma, however, whether this is due to dips or increases in the blood pressure (BP) is undocumented. We investigated the association of open-angle glaucoma (OAG) in relation to the 5 largest MAP dips/increases over 24-h, henceforth called dips/blips. METHODS In the Maracaibo Aging Study (MAS), 93 participants aged ≥40 y (women, 87.1%; mean age, 61.9 y) underwent baseline ophthalmological and 24-h ambulatory BP monitoring assessments. OAG was the presence of optic nerve damage and visual field defects. Statistical methods included logistic regression and the generalized R2 statistic. For replication, 48 OAG cases at the Leuven Glaucoma Clinic were matched with 48 controls recruited from Flemish population. RESULTS In the MAS, 26 participants had OAG. OAG compared to non-OAG participants experienced longer and deeper dips (116.5 vs. 102.7 minutes; to 60.3 vs. 66.6 mm Hg; -21.0 vs. -18.0 mm Hg absolute or 0.79 vs. 0.81 relative dip compared to the preceding reading). The adjusted odds ratios associated with dip measures ranged from 2.25 (95% confidence interval [CI], 1.31-4.85; P = 0.009) to 3.39 (95% CI, 1.36-8.46; P = 0.008). On top of covariables and 24-MAP level/variability, the dip measures increased the model performance (P ≤ 0.025). Blips did not associate with OAG. The case-control study replicated the MAS observations. CONCLUSIONS Dips rather than increases in the 24-h MAP level were associated with increased risk for OAG. An ophthalmological examination combined with 24-h BP monitoring might be precautious steps required in normotensive and hypertensive patients at risk of OAG.
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Affiliation(s)
- Jesus D Melgarejo
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Zulia, Venezuela
| | - Jan V Eijgen
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Department of Neurosciences, Research Group Ophthalmology, University of Leuven, Leuven, Belgium
| | - Gladys E Maestre
- Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Zulia, Venezuela
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, Texas, USA
- Institute for Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Harlingen, Texas, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Lama A Al-Aswad
- Department of Ophthalmology, New York University (NYU) Grossman School of Medicine, NYU Langone Health, New York, New York, USA
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Luis J Mena
- Department of Informatics, Universidad Politécnica de Sinaloa, Mazatlán, Mexico
| | - Joseph H Lee
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, G.H. Sergievsky Center, Columbia University Medical Center, New York, New York, USA
- Departments of Epidemiology and Neurology, Columbia University Medical Center, New York, New York, USA
| | - Joseph D Terwilliger
- Department of Genetics and Development, Columbia University, New York, New York, USA
- Department of Psychiatry, G.H. Sergievsky Center, Columbia University, New York, New York, USA
- Division of Medical Genetics, New York State Psychiatric Institute, New York, New York, USA
- Division of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Michele Petitto
- Glaucoma and Retina Units, Eye Clinic of Maracaibo, Maracaibo, Zulia, Venezuela
| | - Carlos A Chávez
- Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Zulia, Venezuela
| | - Miguel Brito
- Instituto Docente de Especialidades Oftalmológicas (IDEO), Maracaibo, Zulia, Venezuela
| | - Gustavo Calmon
- Laboratory of Ambulatory Recordings, Cardiovascular Institute (IECLUZ), University of Zulia, Maracaibo, Zulia, Venezuela
| | - Egle Silva
- Laboratory of Ambulatory Recordings, Cardiovascular Institute (IECLUZ), University of Zulia, Maracaibo, Zulia, Venezuela
| | - Dong-Mei Wei
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Ella Cutsforth
- Biomedical Science Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Karel V Keer
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Department of Neurosciences, Research Group Ophthalmology, University of Leuven, Leuven, Belgium
| | | | - Thomas Vanassche
- Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Stefan Janssens
- Division of Cardiology, Department of Internal Medicine, University Hospitals UZ Leuven, Leuven, Belgium
| | - Ingeborg Stalmans
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Department of Neurosciences, Research Group Ophthalmology, University of Leuven, Leuven, Belgium
| | - Peter Verhamme
- Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jan A Staessen
- Biomedical Science Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
| | - Zhen-Yu Zhang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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Lee J, Park CK, Park HYL. Determinants of vessel defects in superficial and deep vascular layers in normal-tension glaucoma using optical coherence tomography angiography. Sci Rep 2021; 11:9941. [PMID: 33976332 PMCID: PMC8113603 DOI: 10.1038/s41598-021-89428-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/21/2021] [Indexed: 11/18/2022] Open
Abstract
We investigated the characteristics of localized vessel density defects (VD) either in the deep or superficial vascular layer of normal-tension glaucoma patients using optical coherence tomography angiography (OCTA). In this retrospective, cross-sectional study, 74 eyes with localized retinal nerve fiber layer (RNFL) defect were included. The relationships between the widths of the VD in the superficial and deep layer and ocular factors were evaluated. Eyes with greater deep VD were significantly older (P = 0.023). The IOP measured at OCTA exam was significantly related to the width of the deep VD (P = 0.009). By contrast, average ganglion cell inner plexiform layer thickness (GCIPLT) was substantially related to the width of the superficial VD (P = 0.004). In logistic regression analysis, aging was noticeably associated with wider deep VD, whereas worse mean deviation (MD) had a significant association with wider superficial VD (P = 0.001, P = 0.003, respectively). In sum, while changes of the superficial layer seemed an overall ramification of glaucomatous damages, the deep layer was more likely to be affected by factors related to ocular microcirculation, such as IOPs and older age. Thus, looking into the deep vascular layer using OCTA could identify risk factors related to the disturbance in ocular microcirculation.
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Affiliation(s)
- Jiyun Lee
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
| | - Chan Kee Park
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
| | - Hae-Young Lopilly Park
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea.
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Tan BH, Young A, Bianchi E, Brown L, Tatham AJ. Fluctuation in Blood Pressure and Intraocular Pressure in Normal Tension Glaucoma Using Ambulatory Monitoring. J Glaucoma 2021; 30:304-311. [PMID: 33394843 DOI: 10.1097/ijg.0000000000001768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/25/2020] [Indexed: 11/25/2022]
Abstract
PRCIS Ambulatory blood pressure (BP) and intraocular pressure (IOP) monitoring of patients with normal tension glaucoma (NTG) revealed features of vascular dysregulation including hypertension, blunted nocturnal BP dipping, and morning BP surge. PURPOSE The aim was to examine ambulatory fluctuations in IOP and BP in patients with NTG. METHODS A prospective study of 45 participants with NTG and 10 controls. All participants had a comprehensive ophthalmological examination followed by glaucoma medication washout. Patients using systemic antihypertensives were excluded. IOP and BP were recorded using home monitoring over 48 hours using a self-rebound tonometer and ambulatory blood pressure monitor. BP was recorded every 30 minutes by day and every 60 minutes overnight. IOP was recorded at 09:00, 11:00, 13:00, 16:00, 20:00, and 04:00. RESULTS Participants with NTG had a median mean deviation (MD) of -4.66 dB (interquartile range: -7.16 to -2.81 dB) in the worse eye. Among those with glaucoma, 18 of 45 (40%) had normal nocturnal BP dipping, 24 (53%) blunted dipping and 3 (6.7%) exaggerated dipping. Each 10 mm Hg lower minimum sleeping systolic BP was associated with a 0.9 dB (95% confidence interval: 0.1-1.6 dB) worse MD. Sixteen of 45 participants with glaucoma (35.6%) and 1 of 10 controls (10%) were found to have systemic hypertension on ambulatory blood pressure monitoring and 32 of those with glaucoma (71%) had a surge in morning BP, compared with 5 controls (50%). There was no difference in MD between patients with normal, exaggerated and blunted dipping (P=0.813). CONCLUSIONS Though glaucoma has been associated with exaggerated nocturnal BP dipping, we found a higher proportion of patients had systemic hypertension, blunted nocturnal BP dipping, and a morning BP surge, measures also associated with vascular dysregulation.
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Affiliation(s)
- Boo Hui Tan
- Princess Alexandra Eye Pavilion
- University of Edinburgh, Edinburgh, UK
| | - Alexandra Young
- Princess Alexandra Eye Pavilion
- University of Edinburgh, Edinburgh, UK
| | - Eleonora Bianchi
- Princess Alexandra Eye Pavilion
- University of Edinburgh, Edinburgh, UK
| | - Lyndsay Brown
- Princess Alexandra Eye Pavilion
- University of Edinburgh, Edinburgh, UK
| | - Andrew J Tatham
- Princess Alexandra Eye Pavilion
- University of Edinburgh, Edinburgh, UK
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Shin JW, Jo YH, Song MK, Won HJ, Kook MS. Nocturnal blood pressure dip and parapapillary choroidal microvasculature dropout in normal-tension glaucoma. Sci Rep 2021; 11:206. [PMID: 33420294 PMCID: PMC7794393 DOI: 10.1038/s41598-020-80705-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 12/22/2020] [Indexed: 11/21/2022] Open
Abstract
Choroidal microvasculature dropout (CMvD) implies compromised optic nerve head perfusion in glaucoma patients. However, there are conflicting findings whether office-hour systemic blood pressure (BP) is related to the presence of CMvD. The present study investigated which systemic BP parameters, derived from 24-h ambulatory BP monitoring (ABPM), are associated with CMvD as assessed by optical coherence tomography angiography (OCT-A) in normal-tension glaucoma (NTG). This study included 88 eyes of 88 NTG patients who underwent 24-h ABPM and OCT-A imaging. Various systemic BP parameters associated with the presence of CMvD were evaluated using logistic regression analyses. CMvD was detected in 38 NTG eyes (43.2%). NTG eyes with CMvD had nighttime diastolic BP (DBP) dip of greater magnitude and longer duration than eyes without CMvD. In multivariate logistic regression, worse VF mean deviation (MD) (odds ratio [OR] 0.786; P = 0.001), greater nighttime DBP dip “%” (OR 1.051; P = 0.034), and higher daytime peak IOP (OR 1.459; P = 0.013) were significantly associated with the presence of CMvD. Based on our findings that the eyes with CMvD are closely associated with having nighttime DBP dip, NTG patients with CMvD should be recommended to undergo 24-h ABPM.
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Affiliation(s)
- Joong Won Shin
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, 388-1 Pungnap-2-dong, Songpa-gu, Seoul, 138-736, Korea
| | - Youn Hye Jo
- Department of Ophthalmology, Konkuk University Hospital, Seoul, Korea
| | - Min Kyung Song
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, 388-1 Pungnap-2-dong, Songpa-gu, Seoul, 138-736, Korea
| | - Hun Jae Won
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, 388-1 Pungnap-2-dong, Songpa-gu, Seoul, 138-736, Korea
| | - Michael S Kook
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, 388-1 Pungnap-2-dong, Songpa-gu, Seoul, 138-736, Korea.
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Association of Scleral Deformation Around the Optic Nerve Head With Central Visual Function in Normal-Tension Glaucoma and Myopia. Am J Ophthalmol 2020; 217:287-296. [PMID: 32387433 DOI: 10.1016/j.ajo.2020.04.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the structural characteristics of the posterior sclera around the optic nerve head (ONH) in patients with normal-tension glaucoma (NTG) and myopia with central visual field (VF) defect. DESIGN Cross-sectional study. METHODS Ninety-seven eyes of 97 NTG patients with myopia were included in this study. Swedish interactive thresholding algorithm (SITA) 24-2 and 10-2 were both performed to compare the central VF with peripheral VF. Optic disc torsion, tilt, and peripapillary atrophy area were calculated in 2-dimensional disc photographs. The most posterior point-that is, the deepest point of the eye (DPE)-was identified in 3-dimensional en face optical coherence tomography results and related measurements were calculated using built-in software. RESULTS Forty-two eyes had worse SITA 10-2 mean deviation (MD) than SITA 24-2 MD and they were assigned to the central dominant VF defect group. The central dominant VF defect group had larger disc torsion and ONH tilt angle and shallower disc-DPE depth than the peripheral dominant VF defect group. According to logistic regression analysis, large ONH tilt angle and shallow disc-DPE depth were significant factors associated with central visual function impairment. CONCLUSIONS Subjects with worse central VF than peripheral showed greater peripapillary scleral deformation, such as in torsion and tilt. Their posterior scleral deformation appeared to be closer to the ONH. Scleral deformation around the ONH may be associated with papillomacular bundle and central VF defects.
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10
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Ocular and Systemic Risk Factors of Different Morphologies of Scotoma in Patients with Normal-Tension Glaucoma. J Ophthalmol 2017; 2017:1480746. [PMID: 28815087 PMCID: PMC5549477 DOI: 10.1155/2017/1480746] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/19/2017] [Indexed: 11/18/2022] Open
Abstract
THE AIM The aim of this study was to assess general and ocular profiles of patients with single-localisation changes in visual field. MATERIAL AND METHODS The study group consisted of 215 Caucasian patients with normal-tension glaucoma with scotoma on single localisation or with preperimetric glaucoma. During regular follow-up visits, ophthalmic examination was carried out and medical history was recorded. The results of the visual field were allocated as paracentral scotomas, arcuate scotomas, peripheral defects, or hemispheric defects. Statistical analysis was conducted with Statistica 12, and p < 0.05 was considered statistically significant. RESULTS Risk factors such as notch, disc hemorrhage, general hypertension, migraine, and diabetes were strongly associated with specific visual field defects. Paracentral defect was significantly more frequent for women (p = 0.05) and patients with disc hemorrhage (p < 0.001). Arcuate scotoma occurred frequently in patients without disc hemorrhage (p = 0.046) or migraines (p = 0.048) but was observed in coexistence with general hypertension (p < 0.001). The hemispheric defect corresponded with notch (p = 0.0036) and migraine (p = 0.081). Initial IOP was highest in patients with arcuate scotoma and lowest in patients with preperimetric glaucoma (p = 0.0120). CONCLUSIONS The specific morphology of scotoma in patients with normal-tension glaucoma is connected with definite general and ocular risk factors.
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