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Jung DH, Lee SJ. Comparison of retinal nerve fiber layer thickness between monocular and alternating exotropia in patients with intermittent exotropia. Int Ophthalmol 2024; 44:36. [PMID: 38332228 DOI: 10.1007/s10792-024-03021-z] [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: 02/24/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To investigate differences in intraocular structure based on the presence or absence of fixation preference in children with intermittent exotropia (IXT) by comparing the thickness of the retinal nerve fiber layer (RNFL). METHODS From October 2018 to March 2022, RNFL thickness was retrospectively analyzed using spectral domain optical coherence tomography. Participants had uncorrected visual acuity of 20/20, refractive errors close to emmetropia, and no anisometropia. The patients were divided into monocular and alternating exotropia groups through a cover-uncover test. The average and sectoral thickness of the RNFL in both groups were compared. RESULTS The average global thickness and average thickness of each of the six sectors of the RNFL did not significantly differ between dominant and non-dominant eyes in the monocular exotropia group and between right and left eyes in the alternating exotropia group. The thickness did not significantly differ between the monocular exotropia group and the right or left eye of the alternating exotropia group. Interocular differences in RNFL thickness were negative in the monocular exotropia group (dominant eye-non-dominant eye) and positive in the alternating exotropia group (right eye-left eye) for the average, inferonasal, and inferior sectors, exhibiting statistically significant between-group differences (p = 0.019, p = 0.003, p = 0.023, respectively). CONCLUSIONS In children with IXT without obvious refractive error, there was a significant interocular difference in RNFL thickness of the average, inferonasal, and inferior sectors between monocular and alternating exotropia groups. The presence of fixation preference may affect RNFL thickness.
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Affiliation(s)
- Do Hee Jung
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, 875 Haeundae-Ro, Haeundae-Gu, Busan, 48108, Korea
| | - Soo Jung Lee
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, 875 Haeundae-Ro, Haeundae-Gu, Busan, 48108, Korea.
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2
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Komatsu H, Onoguchi G, Silverstein SM, Jerotic S, Sakuma A, Kanahara N, Kakuto Y, Ono T, Yabana T, Nakazawa T, Tomita H. Retina as a potential biomarker in schizophrenia spectrum disorders: a systematic review and meta-analysis of optical coherence tomography and electroretinography. Mol Psychiatry 2024; 29:464-482. [PMID: 38081943 PMCID: PMC11116118 DOI: 10.1038/s41380-023-02340-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Abnormal findings on optical coherence tomography (OCT) and electroretinography (ERG) have been reported in participants with schizophrenia spectrum disorders (SSDs). This study aims to reveal the pooled standard mean difference (SMD) in retinal parameters on OCT and ERG among participants with SSDs and healthy controls and their association with demographic characteristics, clinical symptoms, smoking, diabetes mellitus, and hypertension. METHODS Using PubMed, Scopus, Web of Science, and PSYNDEX, we searched the literature from inception to March 31, 2023, using specific search terms. This study was registered with PROSPERO (CRD4202235795) and conducted according to PRISMA 2020. RESULTS We included 65 studies in the systematic review and 44 in the meta-analysis. Participants with SSDs showed thinning of the peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell layer- inner plexiform cell layer, and retinal thickness in all other segments of the macula. A meta-analysis of studies that excluded SSD participants with diabetes and hypertension showed no change in results, except for pRNFL inferior and nasal thickness. Furthermore, a significant difference was found in the pooled SMD of pRNFL temporal thickness between the left and right eyes. Meta-regression analysis revealed an association between retinal thinning and duration of illness, positive and negative symptoms. In OCT angiography, no differences were found in the foveal avascular zone and superficial layer foveal vessel density between SSD participants and controls. In flash ERG, the meta-analysis showed reduced amplitude of both a- and b-waves under photopic and scotopic conditions in SSD participants. Furthermore, the latency of photopic a-wave was significantly shorter in SSD participants in comparison with HCs. DISCUSSION Considering the prior report of retinal thinning in unaffected first-degree relatives and the results of the meta-analysis, the findings suggest that retinal changes in SSDs have both trait and state aspects. Future longitudinal multimodal retinal imaging studies are needed to clarify the pathophysiological mechanisms of these changes and to clarify their utility in individual patient monitoring efforts.
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Affiliation(s)
- Hiroshi Komatsu
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan.
- Miyagi Psychiatric Center, Natori, Japan.
| | - Goh Onoguchi
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Stefan Jerotic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Atsushi Sakuma
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobuhisa Kanahara
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
- Division of Medical Treatment and Rehabilitation, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Yoshihisa Kakuto
- Miyagi Psychiatric Center, Natori, Japan
- Department of Community Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Takeshi Yabana
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Tomita
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
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Quach J, Sharpe GP, Demirel S, Girkin CA, Mardin CY, Scheuerle AF, Burgoyne CF, Chauhan BC, Vianna JR. Asymmetry of Peripapillary Retinal Blood Vessel and Retinal Nerve Fiber Layer Thickness Between Healthy Right and Left Eyes. Invest Ophthalmol Vis Sci 2023; 64:17. [PMID: 36790798 PMCID: PMC9940773 DOI: 10.1167/iovs.64.2.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Purpose The purpose of this study was to determine if there is asymmetry in retinal blood vessel (RBV) position and thickness between right and left eyes (R-L) and evaluate whether R-L asymmetry in RBV thickness is related to R-L asymmetry of retinal nerve fiber layer thickness (RNFLT). Methods We analyzed peripapillary circle scan optical coherence tomography (OCT) examinations from healthy White subjects to measure RNFLT and RBV thickness and position relative to the fovea to Bruch's membrane opening axis, for all visible RBV. The R-L asymmetries of RNFLT and RBV thickness were computed for each A-scan. Four major vessels (superior temporal artery [STA] and superior temporal vein [STV], inferior temporal artery [ITA], and vein [ITV]) were identified using infrared images. Results We included 219 individuals. The mean (standard deviation) number of RBV measured per eye was 15.0 (SD = 2.2). The position of the STV and STA was more superior in left eyes than in right eyes, by 2.4 degrees and 3.7 degrees, respectively (P < 0.01). There was no region with significant R-L asymmetry in RBV thickness. RNFLT was thicker in right eyes in the temporal superior region and thicker in left eyes in the superior and nasal superior regions, with the asymmetry profile resembling in a "W" shape. This shape was also present in post hoc analyses in two different populations. The R-L asymmetries of RBV and RNFLT at each A-scan were not significantly associated (P = 0.37). Conclusions There is little R-L asymmetry in RBV, and it is not related to RNFLT asymmetry. This study suggests that R-L RNFLT asymmetry is due to factors other than RBV.
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Affiliation(s)
- Jack Quach
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada,Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Glen P. Sharpe
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Christopher A. Girkin
- Department of Ophthalmology, University of Alabama at Birmingham, Alabama, United States
| | | | | | | | - Balwantray C. Chauhan
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jayme R. Vianna
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
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Berenguer-Vidal R, Verdú-Monedero R, Morales-Sánchez J, Sellés-Navarro I, Kovalyk O, Sancho-Gómez JL. Decision Trees for Glaucoma Screening Based on the Asymmetry of the Retinal Nerve Fiber Layer in Optical Coherence Tomography. SENSORS 2022; 22:s22134842. [PMID: 35808338 PMCID: PMC9269200 DOI: 10.3390/s22134842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 12/10/2022]
Abstract
Purpose: The aim of this study was to analyze the relevance of asymmetry features between both eyes of the same patient for glaucoma screening using optical coherence tomography. Methods: Spectral-domain optical coherence tomography was used to estimate the thickness of the peripapillary retinal nerve fiber layer in both eyes of the patients in the study. These measurements were collected in a dataset from healthy and glaucoma patients. Several metrics for asymmetry in the retinal nerve fiber layer thickness between the two eyes were then proposed. These metrics were evaluated using the dataset by performing a statistical analysis to assess their significance as relevant features in the diagnosis of glaucoma. Finally, the usefulness of these asymmetry features was demonstrated by designing supervised machine learning models that can be used for the early diagnosis of glaucoma. Results: Machine learning models were designed and optimized, specifically decision trees, based on the values of proposed asymmetry metrics. The use of these models on the dataset provided good classification of the patients (accuracy 88%, sensitivity 70%, specificity 93% and precision 75%). Conclusions: The obtained machine learning models based on retinal nerve fiber layer asymmetry are simple but effective methods which offer a good trade-off in classification of patients and simplicity. The fast binary classification relies on a few asymmetry values of the retinal nerve fiber layer thickness, allowing their use in the daily clinical practice for glaucoma screening.
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Affiliation(s)
- Rafael Berenguer-Vidal
- Departamento de Ciencias Politécnicas, Universidad Católica de Murcia UCAM, 30107 Guadalupe, Spain;
| | - Rafael Verdú-Monedero
- Departamento de Tecnologías de la Información y Comunicaciones, Universidad Politécnica de Cartagena, 30202 Cartagena, Spain; (J.M.-S.); (O.K.); (J.-L.S.-G.)
- Correspondence:
| | - Juan Morales-Sánchez
- Departamento de Tecnologías de la Información y Comunicaciones, Universidad Politécnica de Cartagena, 30202 Cartagena, Spain; (J.M.-S.); (O.K.); (J.-L.S.-G.)
| | | | - Oleksandr Kovalyk
- Departamento de Tecnologías de la Información y Comunicaciones, Universidad Politécnica de Cartagena, 30202 Cartagena, Spain; (J.M.-S.); (O.K.); (J.-L.S.-G.)
| | - José-Luis Sancho-Gómez
- Departamento de Tecnologías de la Información y Comunicaciones, Universidad Politécnica de Cartagena, 30202 Cartagena, Spain; (J.M.-S.); (O.K.); (J.-L.S.-G.)
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5
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Wu J, Du Y, Lin C, Zhu Y, Chen W, Pan Q, Zhuo Y, Wang N. Retinal nerve fibre layer thickness measured with SD-OCT in a population-based study: the Handan Eye Study. Br J Ophthalmol 2022:bjophthalmol-2021-320618. [PMID: 35383049 PMCID: PMC10359552 DOI: 10.1136/bjophthalmol-2021-320618] [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: 10/18/2021] [Accepted: 03/13/2022] [Indexed: 12/17/2022]
Abstract
PURPOSE To examine the normative profile of retinal nerve fibre layer (RNFL) thickness and ocular parameters based on spectral-domain optical coherence tomography (SD-OCT) and its associations with related parameters among the Chinese population. METHODS This population-based cohort Handan Eye Study (HES) recruited participants aged≥30 years. All subjects underwent a standardised ophthalmic examination. Peripapillary RNFL thickness was obtained using SD-OCT. Mixed linear models were adopted to evaluate the correlation of RNFL thickness with ocular parameters as well as systemic factors. R V.3.6.1 software was used for statistical analysis. RESULTS 3509 subjects (7024 eyes) with the average age of 55.54±10.37 were collected in this analysis. Overall mean RNFL thickness measured was 113.46±10.90 µm, and the thickest quadrant of parapapillary RNFL was the inferior quadrant, followed by the superior quadrant, the nasal quadrant and the temporal quadrant. In the multivariate linear regression model, thinner RNFL thickness was remarkable association with male (p<0.001), older age (p<0.001), increased body mass index (>30, p=0.018), absence of diabetes (p=0.009), history of cataract surgery (p=0.001), higher intraocular pressure (p=0.007), lower spherical equivalent (p<0.001) and increased axial length (p=0.048). CONCLUSIONS In non-glaucoma individuals, this difference of RNFL thickness in Chinese population should be noted in making disease diagnoses. Meanwhile, multiple ocular and systemic factors are closely related to the thickness of RNFL. Our findings further emphasise the need to demonstrate ethnic differences in RNFL thickness and the specificity of associated ocular and systemic factors, as well as to develop better normative databases worldwide. TRIAL REGISTRATION NUMBER HES was registered in Chinese Clinical Trial Registry website, and the registry number was ChiCTR-EOC-17013214.
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Affiliation(s)
- Jian Wu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China.,Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Yifan Du
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Caixia Lin
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Yingting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wei Chen
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Qing Pan
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yehong Zhuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
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6
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Lu J, Zhou H, Shi Y, Choe J, Shen M, Wang L, Chen K, Zhang Q, Feuer WJ, Gregori G, Rosenfeld PJ, Wang RK. Interocular asymmetry of choroidal thickness and vascularity index measurements in normal eyes assessed by swept-source optical coherence tomography. Quant Imaging Med Surg 2022; 12:781-795. [PMID: 34993118 DOI: 10.21037/qims-21-813] [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: 08/16/2021] [Accepted: 08/25/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND To investigate the symmetry of interocular choroidal thickness and vascularity index measurements in normal eyes using swept-source optical coherence tomography (SS-OCT). Cross-sectional and observational study. This study included 244 eyes of 122 normal adults with ages uniformly distributed from 19 to 89 years. METHODS SS-OCT imaging was performed using a scanning pattern of 12×12 mm. Mean choroidal thickness (MCT) and choroidal vascularity index (CVI) measurements in the entire scanning region were obtained using a validated and published automatic method. The correlation and differences (including signed and absolute differences) between bilateral MCT and CVI measurements were analyzed at the following 6 regions: 3 concentric circles centered on the fovea with diameters of 2.5, 5, and 11 mm; the inner rim from 2.5 to 5 mm circle; the outer rim from 5 to 11 mm circle; and the entire 12×12-mm scan region, respectively. Comparison of interocular MCT and CVI measurements. RESULTS MCT measurements in right and left eyes were strongly correlated in all regions [all intraclass correlation (ICC) >0.73], but MCT measurements in right eyes were significantly thicker than in left eyes. CVI measurements in right and left eyes were moderately correlated in all regions (all ICC >0.46), but CVI measurements in right eyes were significantly smaller than that in left eyes in the macular subregions (2.5 mm circle, 5 mm circle, and the inner rim). Neither signed nor absolute interocular differences in MCT were correlated with corresponding CVI interocular differences. CONCLUSIONS Choroidal differences exist between normal fellow eyes in adults in the absence of obvious pathology. This study is useful in assisting clinicians and researchers in distinguishing asymmetric changes that are to be expected in normal eyes versus changes that could be associated with diseases.
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Affiliation(s)
- Jie Lu
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Hao Zhou
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Yingying Shi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - James Choe
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Mengxi Shen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Liang Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kelly Chen
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Qinqin Zhang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - William J Feuer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Philip J Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, WA, USA.,Department of Ophthalmology, University of Washington, Seattle, WA, USA
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Tan SW, Cai GQ, Li QY, Guo Y, Pan YC, Zhang LJ, Ge QM, Shu HY, Zeng XJ, Shao Y. Interhemispheric Functional Connectivity Alterations in Diabetic Optic Neuropathy: A Resting-State Functional Magnetic Resonance Imaging Study. Diabetes Metab Syndr Obes 2021; 14:2077-2086. [PMID: 34007194 PMCID: PMC8123950 DOI: 10.2147/dmso.s303782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/16/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Previous research suggests that diabetic optic neuropathy (DON) can cause marked anatomical and functional variations in the brain, but to date altered functional synchronization between two functional hemispheres remains uncharacterized in DON patients. Voxel mirrored homotopic connectivity (VMHC) is a voxel-based method to evaluate the synchronism between two mirrored hemispheric by determining the functional connectivity between each voxel in one hemisphere and its counterpart. In this study, we aim to assess abnormal changes in interhemispheric functional connectivity in DON patients via the VMHC method. METHODS The study included 28 adult DON patients (12 male, 16 female) and 28 healthy controls (12 male, 16 female) who were closely matched for sex and age. Participants were examined using resting-state functional magnetic resonance imaging. The VMHC method was applied to investigate the abnormal state in bilateral hemispheres in DON patients and the same regions in healthy controls, as well as the receiver operating characteristic (ROC) curves were used to evaluate characteristics. Associations between altered VMHC values in distinct cerebral regions and clinical features were assessed via correlational analysis. RESULTS Markedly lower VMHC values were evident in the right temporal inferior, the left temporal inferior, the right mid-cingulum, the left mid-cingulum, the right supplementary motor region, and the left supplementary motor region in DON patients compared with healthy controls. ROC curve analysis suggested that the application of VMHC is reliable for the diagnosis of DON. CONCLUSION Anomalous interhemispheric functional connectivity in specific brain areas caused by DON may indicate neuropathologic mechanisms of vision loss and blurry vision in patients with DON.
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Affiliation(s)
- Si-Wen Tan
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, People’s Republic of China
- The First Clinical Medical College, Nanchang University, Nanchang, 330006, Jiangxi Province, People’s Republic of China
| | - Guo-Qian Cai
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, People’s Republic of China
| | - Qiu-Yu Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, People’s Republic of China
| | - Yu Guo
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, People’s Republic of China
| | - Yi-Cong Pan
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, People’s Republic of China
| | - Li-Juan Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, People’s Republic of China
| | - Qian-Min Ge
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, People’s Republic of China
| | - Hui-Ye Shu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, People’s Republic of China
| | - Xian-Jun Zeng
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, People’s Republic of China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, People’s Republic of China
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Shen LL, Mangalesh S, McGeehan B, Tai V, Sarin N, El-Dairi MA, Freedman SF, Maguire MG, Toth CA. Birth Weight Is a Significant Predictor of Retinal Nerve Fiber Layer Thickness at 36 Weeks Postmenstrual Age in Preterm Infants. Am J Ophthalmol 2021; 222:41-53. [PMID: 32891695 PMCID: PMC7930155 DOI: 10.1016/j.ajo.2020.08.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To assess retinal nerve fiber layer (RNFL) thickness in preterm infants. DESIGN Prospective observational study. METHODS We imaged 83 awake infants (159 eyes) at 36 ± 1 weeks postmenstrual age (defined as the time elapsed between the first day of the last maternal menstrual period and the time at imaging) using a handheld optical coherence tomography (OCT) system at the bedside. Blinded graders semi-automatically segmented RNFL in the papillomacular bundle (-15 to +15° relative to the fovea-optic nerve axis). We correlated RNFL thickness and 7 characteristics of interest (sex, race, ethnicity, gestational age, birth weight, stage of retinopathy at prematurity, and presence of pre-plus or plus disease) via univariable and multivariable regressions. RESULTS RNFL was 3.4 μm thicker in the right eyes than in the left eyes (P < .001). Among 7 characteristics, birth weight was the only independent predictor of RNFL thickness (P < .001). A 250-g increase in birth weight was associated with 5.2 μm (95% confidence interval: 3.3-7.0) increase in RNFL thickness. Compared with very preterm infants, extremely preterm infants had thinner RNFL (58.0 ± 10.7 μm vs 63.4 ± 10.7 μm, P = .03), but the statistical significance disappeared after adjustment for birth weight (P = .25). RNFL thickness was 11.2 μm thinner in extremely low birth weight infants than in very low birth weight infants (55.5 ± 8.3 μm vs. 66.7 ± 10.2 μm; P < .001). The difference remained statistically significant after adjustment for gestational age. CONCLUSION Birth weight is a significant independent predictor of RNFL thickness near birth, implying that the retinal ganglion cells reserve is affected by intrauterine processes that affect birth weight.
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Affiliation(s)
- Liangbo L Shen
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Shwetha Mangalesh
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brendan McGeehan
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vincent Tai
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Neeru Sarin
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mays A El-Dairi
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sharon F Freedman
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Maureen G Maguire
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cynthia A Toth
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA; Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina, USA.
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9
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Mahmudi T, Kafieh R, Rabbani H, Mehri A, Akhlaghi MR. Evaluation of Asymmetry in Right and Left Eyes of Normal Individuals Using Extracted Features from Optical Coherence Tomography and Fundus Images. JOURNAL OF MEDICAL SIGNALS & SENSORS 2021; 11:12-23. [PMID: 34026586 PMCID: PMC8043121 DOI: 10.4103/jmss.jmss_67_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/14/2020] [Accepted: 03/09/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Asymmetry analysis of retinal layers in right and left eyes can be a valuable tool for early diagnoses of retinal diseases. To determine the limits of the normal interocular asymmetry in retinal layers around macula, thickness measurements are obtained with optical coherence tomography (OCT). METHODS For this purpose, after segmentation of intraretinal layer in threedimensional OCT data and calculating the midmacular point, the TM of each layer is obtained in 9 sectors in concentric circles around the macula. To compare corresponding sectors in the right and left eyes, the TMs of the left and right images are registered by alignment of retinal raphe (i.e. diskfovea axes). Since the retinal raphe of macular OCTs is not calculable due to limited region size, the TMs are registered by first aligning corresponding retinal raphe of fundus images and then registration of the OCTs to aligned fundus images. To analyze the asymmetry in each retinal layer, the mean and standard deviation of thickness in 9 sectors of 11 layers are calculated in 50 normal individuals. RESULTS The results demonstrate that some sectors of retinal layers have signifcant asymmetry with P < 0.05 in normal population. In this base, the tolerance limits for normal individuals are calculated. CONCLUSION This article shows that normal population does not have identical retinal information in both eyes, and without considering this reality, normal asymmetry in information gathered from both eyes might be interpreted as retinal disorders.
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Affiliation(s)
- Tahereh Mahmudi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Medical Image and Signal Processing Research Center, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Raheleh Kafieh
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Rabbani
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Mehri
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Akhlaghi
- Department of Ophthalmology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Baniasadi N, Rauscher FG, Li D, Wang M, Choi EY, Wang H, Peschel T, Wirkner K, Kirsten T, Thiery J, Engel C, Loeffler M, Elze T. Norms of Interocular Circumpapillary Retinal Nerve Fiber Layer Thickness Differences at 768 Retinal Locations. Transl Vis Sci Technol 2020; 9:23. [PMID: 32879779 PMCID: PMC7442876 DOI: 10.1167/tvst.9.9.23] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/26/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose The onset and progression of optic neuropathies like glaucoma often occurs asymmetrically between the two eyes of a patient. Interocular circumpapillary retinal nerve fiber layer thickness (cpRNFLT) differences could detect disease earlier. To apply such differences diagnostically, detailed location specific norms are necessary. Methods Spectral-domain optical coherence tomography cpRNFLT circle scans from the population-based Leipzig Research Centre for Civilization Diseases-Adult study were selected. At each of the 768 radial scanning locations, normative interocular cpRNFLT difference distributions were calculated based on age and interocular radius difference. Results A total of 8966 cpRNFLT scans of healthy eyes (4483 patients; 55% female; age range, 20-79 years) were selected. Global cpRNFLT average was 1.53 µm thicker in right eyes (P < 2.2 × 10-16). On 96% of the 768 locations, left minus right eye differences were significant (P < 0.05), varying between +11.6 µm (superonasal location) and -11.8 µm (nasal location). Increased age and difference in interocular scanning radii were associated with an increased mean and variance of interocular cpRNFLT difference at most retinal locations, apart from the area temporal to the inferior RNF bundle where cpRNFLT becomes more similar between eyes with age. Conclusions We provide pointwise normative distributions of interocular cpRNFLT differences at an unprecedentedly high spatial resolution of 768 A-scans and reveal considerable location specific asymmetries as well as their associations with age and scanning radius differences between eyes. Translational Relevance To facilitate clinical application, we implement these age- and radius-specific norms across all 768 locations in an open-source software to generate patient-specific normative color plots.
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Affiliation(s)
- Neda Baniasadi
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA
| | - Franziska G Rauscher
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics, and Epidemiology, Leipzig University, Leipzig, Germany
| | - Dian Li
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA
| | - Mengyu Wang
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA
| | - Eun Young Choi
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA
| | - Hui Wang
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA
- Institute for Psychology and Behavior, Jilin University of Finance and Economics, Changchun, China
| | - Thomas Peschel
- Institute for Medical Informatics, Statistics, and Epidemiology, Leipzig University, Leipzig, Germany
| | - Kerstin Wirkner
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics, and Epidemiology, Leipzig University, Leipzig, Germany
| | - Toralf Kirsten
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Applied Computer Science and Biosciences, University of Applied Sciences Mittweida, Mittweida, Germany
| | - Joachim Thiery
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Leipzig University, Leipzig, Germany
| | - Christoph Engel
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics, and Epidemiology, Leipzig University, Leipzig, Germany
| | - Markus Loeffler
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics, and Epidemiology, Leipzig University, Leipzig, Germany
| | - Tobias Elze
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA
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11
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What Are We Missing From Asymmetric Relationship Between the Retinal Nerve Fiber Layer Thickness Profiles and Sphenoid Sinus Volume? J Craniofac Surg 2020; 31:e210-e214. [PMID: 31633664 DOI: 10.1097/scs.0000000000005909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE/AIM OF THE STUDY Detailed analysis of retinal structure such as the retinal nerve fiber layer can be performed by spectral-domain optical coherence tomography (OCT). There are no published studies concerning a relationship between retinal nerve fiber layer and human sphenoid sinus volumes. We investigated this relationship. MATERIAL AND METHODS Spectral-domain OCT. The peripapillary retinal nerve fiber layer (RNFL) thickness and sphenoid sinus volume estimation of both sides of sex-matched patients were retrospectively analyzed. RESULTS The mean RNFL thicknesses at the left side (91.8 μm) were significantly smaller than the right side (94.5 μm) (P = 0.040). However, the mean left sinus volume (44.5 cm) is larger than the right side, (34.5 mm) (P < 0.005). Left and right differences of both parameters are statistically significant (P < 0.05). CONCLUSION There is a negative correlation between mean RNFL thicknesses and mean sinus volumes. To our knowledge, this article is the first report demonstrating the asymmetry relationship between RNFL and sphenoid sinus volumes.
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Ly A, Banh J, Luu P, Huang J, Yapp M, Zangerl B. Interocular asymmetry of the superonasal retinal nerve fibre layer thickness and blood vessel diameter in healthy subjects. PLoS One 2019; 14:e0226728. [PMID: 31869361 PMCID: PMC6927597 DOI: 10.1371/journal.pone.0226728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/03/2019] [Indexed: 11/19/2022] Open
Abstract
Background Optical coherence tomography is commonly used to measure the retinal nerve fibre layer thickness in both normal and diseased eyes; however, variation among normal eyes is common and may limit the usefulness of the results. The aim of this study was to explore the interocular asymmetries in retinal nerve fibre layer thickness in a group of normal eyes and to investigate the influence of blood vessel diameter on local retinal nerve fibre layer thickness. Methods In this prospective study, retinal nerve fibre layer thickness and blood vessel diameter across 100 healthy participants were measured using two optical coherence tomography instruments. Individuals were categorised into two groups based on the presence or absence of interocular retinal nerve fibre layer thickness asymmetry beyond the 75th percentile of all participants. Results The superonasal sectoral retinal nerve fibre layer thickness was significantly greater in the left eye compared to the right, across all three sectors. Mean blood vessel diameter showed a corresponding difference in thickness at one of the superonasal sectors. Linear regression showed a positive and moderate correlation between blood vessel diameter and focal retinal nerve fibre layer thickness. This trend persisted across both arteries and veins, but veins showed larger variability between left and right eye in participants with marked superonasal retinal nerve fibre layer asymmetry. Conclusion Retinal nerve fibre layer thickness and blood vessel diameter vary significantly between eyes even in healthy individuals. These asymmetries in a normal population should be taken into consideration when interpreting the retinal nerve fibre layer thickness measurements from optical coherence tomography to assist in distinguishing normal variations from disease.
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Affiliation(s)
- Angelica Ly
- Centre for Eye Health, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Jennifer Banh
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Patricia Luu
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Jessie Huang
- Centre for Eye Health, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Yapp
- Centre for Eye Health, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Barbara Zangerl
- Centre for Eye Health, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- * E-mail:
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13
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Lateral thinking - Interocular symmetry and asymmetry in neurovascular patterning, in health and disease. Prog Retin Eye Res 2017; 59:131-157. [PMID: 28457789 DOI: 10.1016/j.preteyeres.2017.04.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/24/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023]
Abstract
No biological system or structure is likely to be perfectly symmetrical, or have identical right and left forms. This review explores the evidence for eye and visual pathway asymmetry, in health and in disease, and attempts to provide guidance for those studying the structure and function of the visual system, where recognition of symmetry or asymmetry may be essential. The principal question with regards to asymmetry is not 'are the eyes the same?', for some degree of asymmetry is pervasive, but 'when are they importantly different?'. Knowing if right and left eyes are 'importantly different' could have significant consequences for deciding whether right or left eyes are included in an analysis or for examining the association between a phenotype and ocular parameter. The presence of significant asymmetry would also have important implications for the design of normative databases of retinal and optic nerve metrics. In this review, we highlight not only the universal presence of asymmetry, but provide evidence that some elements of the visual system are inherently more asymmetric than others, pointing to the need for improved normative data to explain sources of asymmetry and their impact on determining associations with genetic, environmental or health-related factors and ultimately in clinical practice.
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14
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Measurement of Radial Peripapillary Capillary Density in the Normal Human Retina Using Optical Coherence Tomography Angiography. J Glaucoma 2017; 26:241-246. [DOI: 10.1097/ijg.0000000000000594] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lee SY, Lee EK, Park KH, Kim DM, Jeoung JW. Asymmetry Analysis of Macular Inner Retinal Layers for Glaucoma Diagnosis: Swept-Source Optical Coherence Tomography Study. PLoS One 2016; 11:e0164866. [PMID: 27764166 PMCID: PMC5072638 DOI: 10.1371/journal.pone.0164866] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 10/03/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To report an asymmetry analysis of macular inner retinal layers using swept-source optical coherence tomography (OCT) and to evaluate the utility for glaucoma diagnosis. DESIGN Observational, cross-sectional study. PARTICIPANTS Seventy normal healthy subjects and 62 glaucoma patients. METHODS Three-dimensional scans were acquired from 70 normal subjects and 62 open angle glaucoma patients by swept-source OCT. The thickness of the retinal nerve fiber layer, ganglion cell-inner plexiform layer (GCIPL), ganglion cell complex, and total retina were calculated within a 6.2×6.2 mm macular area divided into a 31×31 grid of 200×200 μm superpixels. For each of the corresponding superpixels, the thickness differences between the subject eyes and contra-lateral eyes and between the upper and lower macula halves of the subject eyes were determined. The negative differences were displayed on a gray-scale asymmetry map. Black superpixels were defined as thickness decreases over the cut-off values. RESULTS The negative inter-ocular and inter-hemisphere differences in GCIPL thickness (mean ± standard deviation) were -2.78 ± 0.97 μm and -3.43 ± 0.71 μm in the normal group and -4.26 ± 2.23 μm and -4.88 ± 1.46 μm in the glaucoma group. The overall extent of the four layers' thickness decrease was larger in the glaucoma group than in the normal group (all Ps<0.05). The numbers of black superpixels on all of the asymmetry maps were larger in the glaucoma group than in the normal group (all Ps<0.05). The area under receiver operating characteristic curves of average negative thickness differences in macular inner layers for glaucoma diagnosis ranged from 0.748 to 0.894. CONCLUSIONS The asymmetry analysis of macular inner retinal layers showed significant differences between the normal and glaucoma groups. The diagnostic performance of the asymmetry analysis was comparable to that of previous methods. These findings suggest that the asymmetry analysis can be a potential ancillary diagnostic tool.
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Affiliation(s)
- Sang-Yoon Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Ophthalmology, Jeju National University Hospital, Jeju-si, South Korea
| | - Eun Kyoung Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
| | - Dong Myung Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
- * E-mail:
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16
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Yang M, Wang W, Xu Q, Tan S, Wei S. Interocular symmetry of the peripapillary choroidal thickness and retinal nerve fibre layer thickness in healthy adults with isometropia. BMC Ophthalmol 2016; 16:182. [PMID: 27756260 PMCID: PMC5069918 DOI: 10.1186/s12886-016-0361-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/11/2016] [Indexed: 11/24/2022] Open
Abstract
Background The aim of this study was to determine the interocular differences in the peripapillary retinal nerve fibre layer (RNFL), peripapillary choroidal thickness (PCT) and subfoveal choroidal thickness (SFCT) in healthy adults with isometropia, using enhanced depth imaging optical coherence tomography (EDI SD-OCT). Methods One hundred healthy Chinese adults with spherical equivalents of ≤ ±3 dioptres and interocular differences of <0.5 dioptres were prospectively enrolled in this study. They underwent RNFL and PCT measurements via EDI SD-OCT, with a 3.4 mm scan circle centred on the optic nerve head. Subfoveal choroidal thickness (SFCT) measurements were also taken with a horizontal line scan centred on the macula. Right and left eyes were compared by a paired t-test, and the interocular differences were calculated. The agreement and correlations of the RNFLs, PCTs and SFCTs between the right and left eyes were analysed. Results Eighty-six subjects (172 eyes) were included in the final analysis, consisting of 44 (51.6 %) males and 42 (48.8 %) females; 55 (63.9 %) had emmetropia and 33 (36.1 %) had ametropia. The RNFL was statistically significantly thicker in the right eyes when compared to the left eyes in the temporal quadrant, and thinner on average in the nasal superior quadrant (p < 0.05). However, the differences in the choroidal thicknesses in all of the quadrants between the right and left eyes were not statistically significant. The tolerance limits of the average RNFL were −21.1 μm and 7.1 μm, and the mean and standard deviation of the interocular difference in the average PCT was −2.2 ± 24.2 μm. The RNFLs and PCTs in all of the locations in the right eyes were significantly correlated with those in the left eyes. However, no significant associations between the age, sex, interocular asymmetry of spherical the equivalent or interocular differences in the RNFL and PCT were detected. Conclusion The PCT did not differ significantly between the right and left eyes, although interocular asymmetry of the RNFL existed in this Chinese population with isometropia.
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Affiliation(s)
- Mo Yang
- Department of Ophthalmology, Chinese PLA General Hospital, Fuxing Road NO.28, Beijing, Haidian District, China.,Department of Ophthalmology, Shanxi Grand Hospital, Taiyuan, China
| | - Wei Wang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
| | - Quangang Xu
- Department of Ophthalmology, Chinese PLA General Hospital, Fuxing Road NO.28, Beijing, Haidian District, China.,Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Shaoying Tan
- Department of Ophthalmology, Chinese PLA General Hospital, Fuxing Road NO.28, Beijing, Haidian District, China
| | - Shihui Wei
- Department of Ophthalmology, Chinese PLA General Hospital, Fuxing Road NO.28, Beijing, Haidian District, China.
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Hashemi H, Khabazkhoob M, Nabovati P, Yekta A, Emamian MH, Fotouhi A. Retinal nerve fibre layer thickness in a general population in Iran. Clin Exp Ophthalmol 2016; 45:261-269. [PMID: 27727492 DOI: 10.1111/ceo.12849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/23/2016] [Accepted: 10/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND To determine retinal nerve fibre layer (RNFL) thickness distribution and its related factors in a general population of 45 to 69 year olds in Iran. DESIGN Population-based cross-sectional study. PARTICIPANTS Of the 5190 participants of phase one of Shahroud Eye Cohort Study, 4737 participated in Phase two (participation rate = 91.3%). METHODS All study participants underwent visual acuity measurement, refraction tests, slit lamp examination and ophthalmoscopic fundus exam. Tests also included imaging with Cirrus HD-OCT 4000 and its RNFL thickness data were used in this study. MAIN OUTCOME MEASURES The overall RNFL thickness and the average RNFL thickness in different quadrants. RESULTS Mean RNFL thickness in the superior, inferior, nasal and temporal quadrants were 92.47 µm [95% confidence interval (CI): 92.14-92.80], 111.22 µm (95% CI: 110.7-111.73), 118.93 µm (95% CI: 118.31-119.55), 74.83 µm (95% CI: 74.07-75.59) and 65.48 µm (95% CI: 65.06-65.90). Multiple linear regression models indicated that RNFL thickness in all quadrants decreased with ageing, was lower in females (coefficient:-0.87 and P = 0.015), decreased by 1.42 µm (P < 0.001) for each millimetre increase in axial length and decreased by 0.41 µm (P = 0.041) for each diopter decrease in spherical equivalent refraction of myopia. CONCLUSION RNFL thickness in the 45 to 69-year-old Iranian population is lower compared to other studies. This difference should be noted in making disease diagnoses, particularly glaucoma. Also, there is a significant relationship between ageing and RNFL thinning in all quadrants. Longer axial length, myopia and male gender are associated with reduced RNFL thickness.
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Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Payam Nabovati
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Abbasali Yekta
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Hassan Emamian
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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18
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Zhou M, Lu B, Zhao J, Wang Q, Zhang P, Sun X. Interocular Symmetry of Macular Ganglion Cell Complex Thickness in Young Chinese Subjects. PLoS One 2016; 11:e0159583. [PMID: 27454283 PMCID: PMC4959728 DOI: 10.1371/journal.pone.0159583] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/04/2016] [Indexed: 11/28/2022] Open
Abstract
Purpose To report interocular differences in macular ganglion cell complex (mGCC) thickness in young Chinese subjects using RTVue-100 optical coherence tomography (OCT). Methods This was an observational, cross-sectional study. The mGCC thickness was measured in 158young Chinese subjects using RTVue-100 OCT. The normal ranges of the interocular differences were determined as falling between the 2.5th and 97.5th percentiles. Right and left eyes were compared using a paired t test. Pearson correlation analysis was performed to assess the relationships between mGCC thickness and other potential factors. The relationships between the interocular difference in the average mGCC thickness and the potential factors were evaluated by univariate and multivariate linear regression analysis. Results The mean interocular difference in the average, superior, and inferior mGCC thickness were 0.19 ± 2.69 μm, 0.22 ±3.14 μm, and 0.25±3.34 μm, respectively, which were not statistically significant. The 2.5th and 97.5th percentiles of interocular difference for mean average mGCC thickness were -4.82μm and 4.38μm, for superior mGCC thickness, -6.67 μm and 7.04 μm, and for inferior mGCC thickness, -6.75 μm and 6.27 μm. There was a strong correlation between the right and left eyes for all the studied parameters, including spherical equivalent (SE) and axial length (AL). Interocular difference in SE (p = 0.007) were independently correlated with the interocular difference in average mGCC thickness. Conclusions There was no significant relative interocular difference in mGCC thickness in young Chinese subjects. Interocular difference exceeding the normal limits should be considered significantly asymmetrical, and suggestive of pathology.
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Affiliation(s)
- Minwen Zhou
- Department of Ophthalmology, Shanghai First People’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
- Shanghai Key Laboratory of Fundus Disease, Shanghai, China
| | - Bing Lu
- Department of Ophthalmology, Shanghai First People’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Jingke Zhao
- Department of Ophthalmology, Shanghai First People’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Qiu Wang
- Department of Ophthalmology, Shanghai First People’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Pengfei Zhang
- Department of Ophthalmology, Shanghai First People’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai First People’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
- Shanghai Key Laboratory of Fundus Disease, Shanghai, China
- * E-mail:
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Facilitating Glaucoma Diagnosis With Intereye Retinal Nerve Fiber Layer Asymmetry Using Spectral-Domain Optical Coherence Tomography. J Glaucoma 2016; 25:167-76. [PMID: 24921896 DOI: 10.1097/ijg.0000000000000080] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To test whether increased intereye retinal nerve fiber layer (RNFL) asymmetry may be indicative of glaucoma. To determine the best statistical methods and intereye RNFL cutoffs for differentiating between normal and glaucoma subjects to better alert clinicians to early glaucomatous damage. METHODS Sixty-six primary open-angle glaucoma (OAG) and 40 age-matched normal subjects had both eyes imaged at the Massachusetts Eye and Ear Infirmary with a commercially available spectral-domain optical coherence tomography (OCT) machine. Statistical methodologies were used to find cutoffs that achieved the best sensitivities and specificities for differentiating OAG from normal subjects. RESULTS Intereye RNFL asymmetry for global average, all quadrants, and all sectors was significantly greater in OAG than normal subjects. Intereye RNFL asymmetry for global average showed the greatest statistical difference (P<0.001) between OAG (23.64 ± 14.90 μm) and normal eyes (3.58 ± 3.96 μm), with 6.60 times greater asymmetry in OAG eyes. The inferior quadrant showed the second greatest difference, with 3.91 times greater asymmetry in OAG eyes. Using a statistically determined cutoff of 6.0 μm as abnormal, intereye RNFL asymmetry for global average achieved a sensitivity of 74.24% and specificity of 90% in differentiating between normal and OAG subjects, achieving a better combination of sensitivity and specificity than intereye RNFL asymmetry of any quadrant or sector. CONCLUSIONS Intereye RNFL asymmetry may be a useful clinical OCT measurement to provide quantitative assessment of early glaucomatous damage. Newly developed algorithms for intereye RNFL asymmetry may improve the ability to detect glaucoma.
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20
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Hwang YH, Song M, Kim YY, Yeom DJ, Lee JH. Interocular symmetry of retinal nerve fibre layer thickness in healthy eyes: a spectral-domain optical coherence tomographic study. Clin Exp Optom 2015; 97:550-4. [PMID: 25331078 DOI: 10.1111/cxo.12218] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 05/19/2014] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study was performed to investigate the interocular symmetry of peripapillary retinal nerve fibre layer (RNFL) thickness, as measured by Cirrus high-definition spectral-domain optical coherence tomography (OCT), in healthy eyes. A wide range of subject ages and refractive errors was examined. METHODS The retinal nerve fibre layer thickness was measured in 1,234 healthy eyes from 617 subjects using OCT. Interocular differences (right eye minus left eye) in global area and quadrant nerve fibre layer thicknesses were measured. The effect of age and refractive error on interocular nerve fibre layer thickness difference was also examined. RESULTS Means (and standard deviations) of subjects' ages and average subject refractive errors were 36.4 ± 19.8 years (range: five to 80 years) and -2.67 ± 2.91 D (range: -14.13 to +5.75 D), respectively. Cutoff limits for normal interocular nerve fibre layer thickness differences (2.5th and 97.5th percentiles of normative data) in the global area and in the superior, nasal, inferior and temporal quadrants were 9.5, 23.0, 15.6, 20.0 and 22.6 μm, respectively. Mean interocular retinal nerve fibre layer thickness differences in global area and in superior, nasal, inferior and temporal quadrants were 0.7 (p < 0.001), -3.9 (p < 0.001), 2.6 (p < 0.001), 1.1 (p = 0.007) and 3.0 (p < 0.001) μm, respectively. Interocular nerve fibre layer thickness differences were not significantly correlated with age or refractive error (average of right and left eyes, both p > 0.05). CONCLUSIONS Significant interocular differences in peripapillary retinal nerve fibre layer thickness exist in healthy eyes, particularly in the superior quadrant. This finding should be considered when comparing retinal nerve fibre layer thickness between right and left eyes.
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Affiliation(s)
- Young Hoon Hwang
- Department of Ophthalmology, Konyang University, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Seoul, Korea
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Macular ganglion cell imaging study: interocular symmetry of ganglion cell-inner plexiform layer thickness in normal healthy eyes. Am J Ophthalmol 2015; 159:315-23.e2. [PMID: 25447118 DOI: 10.1016/j.ajo.2014.10.032] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 10/27/2014] [Accepted: 10/29/2014] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine cutoffs for interocular differences in ganglion cell-inner plexiform layer thickness in normal healthy eyes and to evaluate the diagnostic performance of these values for differentiating between normal subjects and glaucoma patients. DESIGN Observational, cross-sectional study. METHODS Macular and optic disc scanning were performed in 275 normal subjects, 58 glaucoma patients, and 58 normal controls by high-definition optical coherence tomography. The ganglion cell-inner plexiform layer thickness was calculated, and the normal ranges of the interocular differences were determined as 2.5th and 97.5th percentiles. The signed and absolute interocular differences were compared between normal subjects and glaucoma patients. RESULTS The mean ± standard deviation interocular difference in the average ganglion cell-inner plexiform layer thickness thickness was 0.10 ± 2.31 μm, which was not statistically significant (P = .466). The 2.5th and 97.5th percentiles of the interocular difference were -4.10 μm and +5.00 μm, respectively. On multiple regression analysis, the interocular difference in axial length was correlated with the interocular difference in average ganglion cell-inner plexiform layer thickness thickness (β = 2.044, P = .003). The signed and absolute interocular differences in ganglion cell-inner plexiform layer thickness were higher in glaucoma patients than in normal subjects (all P < .001). Sensitivity and specificity of absolute interocular differences ranged from 25.9% to 51.7% and from 93.1% to 100.0%, respectively. CONCLUSIONS Ganglion cell-inner plexiform layer thickness shows significant interocular symmetry in normal subjects. An absolute interocular difference exceeding normal limits may be indicative of glaucoma.
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Qu S, Sun XT, Xu W, Rong A. Analysis of peripapilary retinal nerve fiber layer thickness of healthy Chinese from northwestern Shanghai using Cirrus HD-OCT. Int J Ophthalmol 2014; 7:654-8. [PMID: 25161937 DOI: 10.3980/j.issn.2222-3959.2014.04.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 12/31/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To investigate peripapillary retinal nerve fiber layer (RNFL) thickness of healthy Chinese individuals from northwestern Shanghai using Cirrus HD-OCT (Carl Zeiss Meditec, Inc. Dublin, CA, USA). METHODS The peripapillary RNFL thickness of 720 eyes from 360 healthy Chinese participants were measured using the Optic Disc Cube 200×200 protocol. Each eye was scanned 3 times. Global and each quadrant's RNFL thickness around the optic nerve were compared between genders, and interocular differences were analyzed. The correlation between global RNFL thickness and age were also assessed in this study. RESULTS The mean global, superior, nasal, inferior and temporal RNFL thickness of all the eyes were 96.04±7.40 µm, 118.36±13.52 µm, 67.63±8.60 µm, 125.17±13.48 µm, 72.49±10.70 µm, respectively. When analyzing between genders, the mean nasal RNFL thickness of male and female were 68.29±8.44 µm and 66.97±8.70 µm, with statistically significant difference (P=0.038), while the data of global, superior, inferior and temporal quadrant showed no significant difference (all P>0.05). When analyzing interocular differences, the mean RNFL thickness of all the right eyes and all the left eyes were 116.46±13.17 µm and 120.27±13.61 µm in superior quadrant (P<0.001); 68.74±8.80 µm and 66.52±8.25 µm in nasal quadrant (P<0.001); 73.16±10.95 and 71.83±10.41 in temporal quadrant (P<0.001), all having statistically significant differences. There were no statistically significant interocular differences of global and inferior RNFL thickness (both P>0.05). There was a significantly negative correlation (r=-0.618, P<0.001) between the mean global RNFL thickness and the age. CONCLUSION In healthy Chinese from northwestern Shanghai, there were no significant differences detected interocular difference and between genders in the mean global RNFL thickness. Nevertheless, significant difference existed in the nasal quadrant between genders, and interocular differences existed in the superior, nasal and temporal quadrants. The RNFL thickness appeared to gradually decrease with age.
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Affiliation(s)
- Shen Qu
- Department of Ophthalmology, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai 200065, China
| | - Xiao-Ting Sun
- Department of Ophthalmology, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai 200065, China
| | - Wei Xu
- Department of Ophthalmology, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai 200065, China
| | - Ao Rong
- Department of Ophthalmology, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai 200065, China
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Retinal nerve fiber layer thickness profiles associated with ocular laterality and dominance. Neurosci Lett 2014; 558:197-202. [DOI: 10.1016/j.neulet.2013.10.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 10/09/2013] [Accepted: 10/23/2013] [Indexed: 11/24/2022]
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Altemir I, Oros D, Elía N, Polo V, Larrosa JM, Pueyo V. Retinal asymmetry in children measured with optical coherence tomography. Am J Ophthalmol 2013; 156:1238-1243.e1. [PMID: 24075424 DOI: 10.1016/j.ajo.2013.07.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 07/26/2013] [Accepted: 07/29/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE To determinate the physiological asymmetry of retinal measurements in the pediatric population with Fourier-domain optical coherence tomography (Cirrus HD-OCT). DESIGN Prospective cross-sectional study. METHODS Three hundred and fifty-seven healthy children were recruited. All subjects underwent a comprehensive ophthalmologic examination and an evaluation of the retinal nerve fiber layer (RNFL), optic nerve head, and macula with Cirrus OCT. Differences between right and left eyes were calculated and values were compared by means of a paired t test. Normal ranges of interocular differences were established as the 2.5th and the 97.5th percentiles. The correlations between right and left eyes were assessed by the intraclass correlation coefficients. RESULTS Mean best-corrected visual acuity (logMAR) was -0.01. Differences in the average RNFL between right and left eyes were not statistically significant. The RNFL in the right eyes was thicker in the temporal and nasal quadrants, whereas the left eyes showed thicker RNFL in the superior quadrant. The interocular difference tolerance limits for average RNFL and macular thicknesses were 13.00 μm and 23.20 μm, respectively. There was a strong correlation for all the parameters between the right and the left eyes. CONCLUSIONS The asymmetry of retinal parameters might be more valuable than the absolute values in assessing certain early diseases. The interocular differences in average RNFL and macular thickness of normal individuals should not exceed 13 μm and 23 μm, respectively, if measured with Cirrus HD-OCT.
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Affiliation(s)
- Irene Altemir
- University of Zaragoza, Zaragoza, Spain; Ophthalmology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Kupersmith MJ, Anderson S, Kardon R. Predictive value of 1 month retinal nerve fiber layer thinning for deficits at 6 months after acute optic neuritis. Mult Scler 2013; 19:1743-8. [PMID: 23698127 DOI: 10.1177/1352458513485149] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Retinal nerve fiber layer (RNFL) loss occurs with multiple sclerosis and after optic neuritis. Vision or RNFL changes at presentation of optic neuritis are not predictive of outcome, but vision loss at 1 month correlates with vision deficits at 6 months. We hypothesized that RFNL thinning at 1 month would predict RNFL loss at 6 months. METHODS We prospectively studied the RNFL by optical coherence tomography (OCT) and scanning laser polarimetry (SLP), and determined the threshold field mean deviation, in 25 subjects with acute optic neuritis over a 6-month period. RNFL values, including the amount of thinning at 1-month, were correlated with 6-month outcome. RESULTS Baseline visual performance and RNFL values were similar for eyes grouped by 1 month RNFL thinning. Eyes with 1 month RNFL thinning had greater and significant RNFL thinning at 6 months, for all quadrants by OCT and for the nasal and inferior quadrants by SLP. RNFL thinning by OCT and SLP at 1 month correlated with 6-month OCT (r = 0.58; p = 0.006) and SLP (r = 0.59; p = 0.002) RNFL thinning, respectively. CONCLUSION Early RNFL loss at 1 month was predictive of the RNFL thinning at 6 months, which corroborated the importance of the 1-month time point for predicting the outcome of an optic neuritis attack.
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Affiliation(s)
- Mark J Kupersmith
- Institute of Neurology and Neurosurgery (INN), Roosevelt Hospital, New York, NY, USA
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African descent and glaucoma evaluation study: asymmetry of structural measures in normal participants. J Glaucoma 2011; 22:65-72. [PMID: 21986568 DOI: 10.1097/ijg.0b013e31822e8e51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the study is to determine the degree of intereye asymmetry of optic disc topography and retinal nerve fiber layer (RNFL) thickness in healthy individuals of African descent (AD) and European descent (ED). DESIGN Observational, clinical study. METHODS Five hundred nineteen healthy individuals (AD, n=262, mean age=44.9 years; ED, n=257, mean age=47.1 years) from the African Descent and Glaucoma Evaluation Study and Diagnostic Innovations in Glaucoma Study were tested using Heidelberg retina romograph (HRT), GDx variable corneal compensation (GDx-VCC), and standard, automated perimetry within 6 months of one another. HRT-II measurements included cup area, cup volume, rim area, and rim volume. GDx-VCC measurements included average RNFL thickness. Intereye asymmetry was calculated as the absolute value of the differences in measurements between the right and left eye. RESULTS AD participants showed significantly higher median asymmetry in cup volume and rim volume (P<0.001 and 0.033, respectively) compared with ED participants. The effect of race lost significance after adjustment for mean disc area and disc area asymmetry in multivariable models. Axial length asymmetry was not correlated with increased asymmetry in any of this study's asymmetry parameters. Normal ranges of asymmetry for the HRT-II measurements of cup area (up to 0.39 mm), cup volume (up to 0.15 mm), rim area (up to 0.45 mm), and rim volume (up to 0.22 mm) were derived, as were asymmetry ranges for GDx-VCC-measured average RNFL thickness (up to 6.25 μm). CONCLUSIONS The effect of race was no longer significant after adjustment for mean disc area and disc area asymmetry. Individuals with asymmetries with magnitudes greater than those of the normal ranges could be considered as suspicious for glaucoma.
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Mwanza JC, Durbin MK, Budenz DL. Interocular symmetry in peripapillary retinal nerve fiber layer thickness measured with the Cirrus HD-OCT in healthy eyes. Am J Ophthalmol 2011; 151:514-21.e1. [PMID: 21236402 DOI: 10.1016/j.ajo.2010.09.015] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2010] [Revised: 09/04/2010] [Accepted: 09/13/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the cutoffs for the interocular difference in retinal nerve fiber layer (RNFL) thickness measured with Cirrus HD-OCT (Carl Zeiss Meditec, Inc) in normal eyes. DESIGN Observational, clinical study. METHODS Scans were acquired at 7 academic glaucoma clinics from both eyes of 284 normal subjects using the Optic Disc Cube 200 × 200 protocol. The interocular differences in RNFL thickness were calculated, and normal ranges of interocular differences were determined as the 2.5th and 97.5th percentiles. RESULTS The average RNFL in the right eye was 0.52 μm thicker than in the left eye; the difference was marginally significant (P = .049). The temporal, nasal, and inferior quadrants had significantly thicker RNFL in the right eye, whereas the left eye showed thicker RNFL in the superior quadrant. The 2.5th and 97.5th percentile interocular difference tolerance limits for average RNFL thickness were -7.9 μm and 8.8 μm, respectively. Although the difference in average RNFL thickness correlated with differences in axial length, disc area, cup-to-disc ratio, and vertical cup-to-disc ratio, only differences in axial length (β = -0.21; P < .001) and disc area (β = 0.17; P < .001) were associated with an interocular difference of average RNFL thickness after adjustment for each other. The interocular difference remained stable despite significant decrease in RNFL thickness with aging. CONCLUSIONS An interocular difference in average RNFL thickness exceeding 9 μm when measured with the Cirrus HD-OCT in normal eyes may be considered statistically significant asymmetry and may be indicative of early glaucomatous damage.
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