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Jiravarnsirikul A, Yang H, Jeoung JW, Hong SW, Rezapour J, Gardiner S, Fortune B, Girard MJA, Nicolela M, Zangwill LM, Chauhan BC, Burgoyne CF. OCT Optic Nerve Head Morphology in Myopia IV: Neural Canal Scleral Flange Remodeling in Highly Myopic Eyes. Am J Ophthalmol 2024; 261:141-164. [PMID: 38311154 PMCID: PMC11031338 DOI: 10.1016/j.ajo.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To compare the prevalence, location and magnitude of optic nerve head (ONH) OCT-detected, exposed neural canal (ENC), externally oblique choroidal border tissue (EOCBT) and exposed scleral flange (ESF) regions in 122 highly myopic (Hi-Myo) versus 362 nonhighly myopic healthy (Non-Hi-Myo-Healthy) eyes. DESIGN Cross-sectional study. METHODS After OCT radial B-scan, ONH imaging, Bruch's membrane opening (BMO), the anterior scleral canal opening (ASCO), and the scleral flange opening (SFO) were manually segmented in each B-scan and projected to BMO reference plane. The direction and magnitude of BMO/ASCO offset and BMO/SFO offset as well as the location and magnitude of ENC, EOCBT and ESF regions, perineural canal (pNC) retinal nerve fiber layer thickness (RNFLT) and pNC choroidal thickness (CT) were calculated within 30° sectors relative to the Foveal-BMO (FoBMO) axis. Hi-ESF eyes were defined to be those with an ESF region ≥100 µms in at least 1 sector. RESULTS Hi-Myo eyes more frequently demonstrated Hi-ESF regions (87/122) than Non-Hi-myo-Healthy eyes (73/362) and contained significantly larger ENC, EOCBT, and ESF regions (P < .001) which were greatest in magnitude and prevalence within the inferior-temporal FoBMO sectors where Hi-Myo pNC-RNFLT and pNCCT were thinnest. BMO/ASCO offset and the BMO/SFO offset were both significantly increased (P < .001) in the Hi-Myo eyes, with the latter demonstrating a greater increase. CONCLUSIONS ENC region tissue remodeling that includes the scleral flange is enhanced in Hi-Myo compared to Non-Hi-Myo-Healthy eyes. Longitudinal studies are necessary to determine whether the presence of an ENC region influences ONH susceptibility to aging and/or glaucoma.
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Affiliation(s)
- Anuwat Jiravarnsirikul
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory (A.J., H.Y., C.F.B.), Legacy Research Institute, Portland, Oregon, USA; Department of Ophthalmology (A.J.), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Hongli Yang
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory (A.J., H.Y., C.F.B.), Legacy Research Institute, Portland, Oregon, USA
| | - Jin Wook Jeoung
- Department of Ophthalmology (J.W.J.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | | | - Jasmin Rezapour
- Viterbi Family Department of Ophthalmology (J.R., L.Z.), Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, California, USA; Department of Ophthalmology (J.R.), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stuart Gardiner
- Devers Eye Institute, Discoveries in Sight Research Laboratories (S.G., B.F.), Legacy Research Institute, Portland, Oregon, USA
| | - Brad Fortune
- Devers Eye Institute, Discoveries in Sight Research Laboratories (S.G., B.F.), Legacy Research Institute, Portland, Oregon, USA
| | - Michaël J A Girard
- Department of Biomedical Engineering (M.J.A.G.), Ophthalmic Engineering & Innovation Laboratory, National University of Singapore, Singapore, Singapore
| | - Marcelo Nicolela
- Ophthalmology and Visual Sciences (M.N., B.C.C.), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Linda M Zangwill
- Viterbi Family Department of Ophthalmology (J.R., L.Z.), Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, California, USA
| | - Balwantray C Chauhan
- Ophthalmology and Visual Sciences (M.N., B.C.C.), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Claude F Burgoyne
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory (A.J., H.Y., C.F.B.), Legacy Research Institute, Portland, Oregon, USA.
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Hong S, Yang H, Gardiner SK, Luo H, Sharpe GP, Caprioli J, Demirel S, Girkin CA, Mardin CY, Quigley HA, Scheuerle AF, Fortune B, Jiravarnsirikul A, Zangalli C, Chauhan BC, Burgoyne CF. Optical Coherence Tomographic Optic Nerve Head Morphology in Myopia III: The Exposed Neural Canal Region in Healthy Eyes-Implications for High Myopia. Am J Ophthalmol 2024; 258:55-75. [PMID: 37673378 PMCID: PMC10841091 DOI: 10.1016/j.ajo.2023.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/04/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE To determine the prevalence and magnitude of optical coherence tomography (OCT) exposed neural canal (ENC), externally oblique choroidal border tissue (EOCBT), and exposed scleral flange (ESF) regions in 362 non-highly myopic (spherical equivalent -6.00 to 5.75 diopters) eyes of 362 healthy subjects. DESIGN Cross-sectional study. METHODS After OCT optic nerve head (ONH) imaging, Bruch membrane opening (BMO), the anterior scleral canal opening (ASCO), and the scleral flange opening (SFO) were manually segmented. BMO, ASCO, and SFO points were projected to the BMO reference plane. The direction and magnitude of BMO/ASCO offset as well as the magnitude of ENC, EOCBT, and ESF was calculated within 30° sectors relative to the foveal-BMO axis. Hi-ESF eyes demonstrated an ESF ≥100 µm in at least 1 sector. Sectoral peri-neural canal choroidal thickness (pNC-CT) was measured and correlations between the magnitude of sectoral ESF and proportional pNC-CT were assessed. RESULTS Seventy-three Hi-ESF (20.2%) and 289 non-Hi-ESF eyes (79.8%) were identified. BMO/ASCO offset as well as ENC, EOCBT, and ESF prevalence and magnitude were greatest inferior temporally where the pNC-CT was thinnest. Among Hi-ESF eyes, the magnitude of each ENC region correlated with the BMO/ASCO offset magnitude, and the sectors with the longest ESF correlated with the sectors with proportionally thinnest pNC-CT. CONCLUSIONS ONH BMO/ASCO offset, either as a cause or result of ONH neural canal remodeling, corresponds with the sectoral location of maximum ESF and minimum pNC-CT in non-highly myopic eyes. Longitudinal studies to characterize the development and clinical implications of ENC Hi-ESF regions in non-highly myopic and highly myopic eyes are indicated.
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Affiliation(s)
- Seungwoo Hong
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute (S.H., H.Y., H.L., A.J., C.F.B.), Portland, Oregon, USA; Yebon Eye Clinic (S.H.), Seoul, Korea
| | - Hongli Yang
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute (S.H., H.Y., H.L., A.J., C.F.B.), Portland, Oregon, USA
| | - Stuart K Gardiner
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute (S.K.G., S.D., B.F.), Portland, Oregon, USA
| | - Haomin Luo
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute (S.H., H.Y., H.L., A.J., C.F.B.), Portland, Oregon, USA; Department of Ophthalmology, Hunan Provincial People's Hospital, Hunan Normal University (H.L.), Changsha, Hunan Province, China
| | - Glen P Sharpe
- Ophthalmology and Visual Sciences, Dalhousie University (G.P.S., B.C.C.), Halifax, Nova Scotia, Canada
| | - Joseph Caprioli
- Jules Stein Eye Institute, David Geffen School of Medicine at UCLA (J.C.), Los Angeles, California, USA
| | - Shaban Demirel
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute (S.K.G., S.D., B.F.), Portland, Oregon, USA
| | - Christopher A Girkin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham (C.A.G.), Birmingham, Alabama, USA
| | - Christian Y Mardin
- Department of Ophthalmology, University of Erlangen (C.Y.M.), Erlangen, Germany
| | - Harry A Quigley
- Wilmer Eye Institute, Johns Hopkins University (H.A.Q.), Baltimore, Maryland, USA
| | | | - Brad Fortune
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute (S.K.G., S.D., B.F.), Portland, Oregon, USA
| | - Anuwat Jiravarnsirikul
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute (S.H., H.Y., H.L., A.J., C.F.B.), Portland, Oregon, USA; Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University (A.J.), Bangkok, Thailand
| | - Camila Zangalli
- Department of Glaucoma, Hospital de Olhos Niteroi (C.Z.), Rio de Janeiro, Brazil
| | - Balwantray C Chauhan
- Ophthalmology and Visual Sciences, Dalhousie University (G.P.S., B.C.C.), Halifax, Nova Scotia, Canada
| | - Claude F Burgoyne
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute (S.H., H.Y., H.L., A.J., C.F.B.), Portland, Oregon, USA.
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Grissom N, Gardiner SK, Rees JP, Sanchez FG, Mansberger SL, Cunningham ET, Burgoyne CF, Rice K, Belter C, Kinast RM. Patients with Low Vision Struggle with Placing Eye Drops and Benefit from an Eye Drop Aid. Ophthalmol Glaucoma 2023; 6:501-508. [PMID: 37084868 DOI: 10.1016/j.ogla.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE To evaluate eye drop self-administration in a low-vision patient population and test whether a nose-pivoted drop delivery device (NPDD, GentleDrop) can improve eye drop delivery in these patients. DESIGN Repeated-measures case series. PARTICIPANTS Thirty subjects (58 eyes) with low vision, defined as best-corrected visual acuity worse than 20/60 or visual field worse than 20° in the better-seeing eye. METHODS We video-recorded subjects while self-administering eye drops using their own traditional delivery at baseline, after a standardized teaching, and with an NPDD. Two masked graders independently reviewed each drop delivery. Primary success was defined as the drop reaching the eye without the bottle touching the eye or eyelids. Subjects rated ease-of-use (1-10 scale, 10 = easiest) after each drop delivery and completed a satisfaction survey, which included asking whether subjects could place drops independently (1-5 scale, 5 = most independent). MAIN OUTCOME MEASURES Logistic-transformed generalized estimating equation regression to compare technique satisfaction, ease-of-use, independence, no contact, and success. RESULTS Primary success was observed in 30 (52%) of 58 eyes at baseline and increased to 44 eyes (76%) with an NPDD (P = 0.013). Bottle tip contact occurred in 23 (40%) of 58 eyes at baseline and 8 eyes (14%) with an NPDD (P = 0.004). Mean ease-of-use scores were 6.7 ± 3.1 at baseline and 8.3 ± 1.8 (P < 0.001) with an NPDD. Likewise, the NPDD improved success, bottle tip contact, and ease-of-use compared with post-teaching traditional delivery (P < 0.01). Twenty-two (73%) of 30 subjects preferred the NPDD to traditional delivery. Twenty-nine (97%) thought the NPDD was comfortable to use, and all would recommend the device. A subgroup analysis was performed on 16 subjects that self-reported difficulty instilling drops at baseline. The NPDD showed similar results, and it increased confidence in placing drops independently (4.6 ± 0.9) compared with baseline (2.7 ± 1.6, P < 0.001). Fifteen (94%) subjects in this subgroup preferred the NPDD. CONCLUSIONS Low-vision subjects struggled to self-administer eye drops. An NPDD can improve bottle tip contact, ease-of-use, satisfaction, and independence. Eye care providers could consider screening low-vision patients about difficulty with eye drop self-administration and recommending eye drop aids. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
| | - Stuart K Gardiner
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Jack P Rees
- Legacy Devers Eye Institute, Portland, Oregon
| | - Facundo G Sanchez
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Steven L Mansberger
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Emmett T Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California; The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California; The Francis I. The Proctor Foundation, UCSF School of Medicine, San Francisco, California
| | - Claude F Burgoyne
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Karen Rice
- Legacy Devers Eye Institute, Portland, Oregon
| | | | - Robert M Kinast
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon.
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Burgoyne CF, Wang YX, Jeoung JW, Hong S, Gardiner S, Reynaud J, Fortune B, Girard MJA, Sharpe G, Nicolela M, Chauhan BC, Yang H. OCT Optic Nerve Head Morphology in Myopia II: Peri-Neural Canal Scleral Bowing and Choroidal Thickness in High Myopia-An American Ophthalmological Society Thesis. Am J Ophthalmol 2023; 252:225-252. [PMID: 36906092 PMCID: PMC10492898 DOI: 10.1016/j.ajo.2023.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/16/2023] [Accepted: 03/01/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE To use optical coherence tomography (OCT) to characterize optic nerve head (ONH) peri-neural canal (pNC) scleral bowing (pNC-SB) and pNC choroidal thickness (pNC-CT) in 69 highly myopic and 138 healthy, age-matched, control eyes. DESIGN Cross-sectional, case control study. METHODS Within ONH radial B-scans, Bruch membrane (BM), BM opening (BMO), anterior scleral canal opening (ASCO), and pNC scleral surface were segmented. BMO and ASCO planes and centroids were determined. pNC-SB was characterized within 30° foveal-BMO (FoBMO) sectors by 2 parameters: pNC-SB-scleral slope (pNC-SB-SS), measured within 3 pNC segments (0-300, 300-700, and 700-1000 μm from the ASCO centroid); and pNC-SB-ASCO depth relative to a pNC scleral reference plane (pNC-SB-ASCOD). pNC-CT was calculated as the minimum distance between the scleral surface and BM at 3 pNC locations (300, 700, and 1100 μm from the ASCO). RESULTS pNC-SB increased and pNC-CT decreased with axial length (P < .0133; P < .0001) and age (P < .0211; P < .0004) among all study eyes. pNC-SB was increased (P < .001) and pNC-CT was decreased (P < .0279) in the highly myopic compared to control eyes, and these differences were greatest in the inferior quadrant sectors (P < .0002). Sectoral pNC-SB was not related to sectoral pNC-CT in control eyes, but was inversely related to sectoral pNC-CT (P < .0001) in the highly myopic eyes. CONCLUSIONS Our data suggest that pNC-SB is increased and pNC-CT is decreased in highly myopic eyes and that these phenomena are greatest in the inferior sectors. They support the hypothesis that sectors of maximum pNC-SB may predict sectors of greatest susceptibility to aging and glaucoma in future longitudinal studies of highly myopic eyes. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Claude F Burgoyne
- From the Devers Eye Institute Optic Nerve Head Research Laboratory (C.F., J.R., H.Y.), Legacy Research Institute, Portland, Oregon, USA; Devers Eye Institute Discoveries in Sight Research Laboratories (C.F.B., S.G., J.R., B.F., H.Y.), Legacy Research Institute, Portland, Oregon, USA.
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology (Y.X.W.), Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing, China
| | - Jin Wook Jeoung
- Department of Ophthalmology (J.W.J.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | | | - Stuart Gardiner
- Devers Eye Institute Discoveries in Sight Research Laboratories (C.F.B., S.G., J.R., B.F., H.Y.), Legacy Research Institute, Portland, Oregon, USA
| | - Juan Reynaud
- Devers Eye Institute Discoveries in Sight Research Laboratories (C.F.B., S.G., J.R., B.F., H.Y.), Legacy Research Institute, Portland, Oregon, USA
| | - Brad Fortune
- Devers Eye Institute Discoveries in Sight Research Laboratories (C.F.B., S.G., J.R., B.F., H.Y.), Legacy Research Institute, Portland, Oregon, USA
| | - Michaël J A Girard
- Ophthalmic Engineering & Innovation Laboratory (M.J.A.G.), Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Glen Sharpe
- Department of Ophthalmology and Visual Sciences (G.S., M.N., B.C.C.), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marcelo Nicolela
- Department of Ophthalmology and Visual Sciences (G.S., M.N., B.C.C.), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Balwantray C Chauhan
- Department of Ophthalmology and Visual Sciences (G.S., M.N., B.C.C.), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hongli Yang
- Devers Eye Institute Discoveries in Sight Research Laboratories (C.F.B., S.G., J.R., B.F., H.Y.), Legacy Research Institute, Portland, Oregon, USA
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Goyal V, Read AT, Ritch MD, Hannon BG, Rodriguez GS, Brown DM, Feola AJ, Hedberg-Buenz A, Cull GA, Reynaud J, Garvin MK, Anderson MG, Burgoyne CF, Ethier CR. AxoNet 2.0: A Deep Learning-Based Tool for Morphometric Analysis of Retinal Ganglion Cell Axons. Transl Vis Sci Technol 2023; 12:9. [PMID: 36917117 PMCID: PMC10020950 DOI: 10.1167/tvst.12.3.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 01/30/2023] [Indexed: 03/16/2023] Open
Abstract
Purpose Assessment of glaucomatous damage in animal models is facilitated by rapid and accurate quantification of retinal ganglion cell (RGC) axonal loss and morphologic change. However, manual assessment is extremely time- and labor-intensive. Here, we developed AxoNet 2.0, an automated deep learning (DL) tool that (i) counts normal-appearing RGC axons and (ii) quantifies their morphometry from light micrographs. Methods A DL algorithm was trained to segment the axoplasm and myelin sheath of normal-appearing axons using manually-annotated rat optic nerve (ON) cross-sectional micrographs. Performance was quantified by various metrics (e.g., soft-Dice coefficient between predicted and ground-truth segmentations). We also quantified axon counts, axon density, and axon size distributions between hypertensive and control eyes and compared to literature reports. Results AxoNet 2.0 performed very well when compared to manual annotations of rat ON (R2 = 0.92 for automated vs. manual counts, soft-Dice coefficient = 0.81 ± 0.02, mean absolute percentage error in axonal morphometric outcomes < 15%). AxoNet 2.0 also showed promise for generalization, performing well on other animal models (R2 = 0.97 between automated versus manual counts for mice and 0.98 for non-human primates). As expected, the algorithm detected decreased in axon density in hypertensive rat eyes (P ≪ 0.001) with preferential loss of large axons (P < 0.001). Conclusions AxoNet 2.0 provides a fast and nonsubjective tool to quantify both RGC axon counts and morphological features, thus assisting with assessing axonal damage in animal models of glaucomatous optic neuropathy. Translational Relevance This deep learning approach will increase rigor of basic science studies designed to investigate RGC axon protection and regeneration.
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Affiliation(s)
- Vidisha Goyal
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - A. Thomas Read
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Matthew D. Ritch
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Bailey G. Hannon
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Gabriela Sanchez Rodriguez
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Dillon M. Brown
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Andrew J. Feola
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Decatur, GA, USA
- Department of Ophthalmology, Emory University, Atlanta, GA, USA
| | - Adam Hedberg-Buenz
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, USA
- Iowa City VA Health Care System and Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, USA
| | - Grant A. Cull
- Devers Eye Institute, Legacy Research Institute, Portland, OR, USA
| | - Juan Reynaud
- Devers Eye Institute, Legacy Research Institute, Portland, OR, USA
| | - Mona K. Garvin
- Devers Eye Institute, Legacy Research Institute, Portland, OR, USA
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA
| | - Michael G. Anderson
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, USA
- Iowa City VA Health Care System and Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, USA
| | | | - C. Ross Ethier
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
- Department of Ophthalmology, Emory University, Atlanta, GA, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Hong BY, Fortune B, Kinast RM, Burgoyne CF, Rees JP, Mansberger SL. Optic nerve cavitations in glaucoma suspect and glaucoma patients. Am J Ophthalmol Case Rep 2022; 28:101733. [PMCID: PMC9636442 DOI: 10.1016/j.ajoc.2022.101733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose Glaucoma is associated with structural changes of the optic nerve head such as deformation, lamina cribosa defects, prelaminar schisis, and peripapillary retinal schisis. We describe optic nerve cavitations that were detected by routine spectral domain optical coherence tomography (OCT). Observations OCT imaging showed cavitations in 5 eyes of 4 patients with an initial diagnosis of glaucoma or glaucoma suspect. The cavitations were seen as hyporeflective spaces that are sharply delineated from surrounding tissue. They were centered inferonasally, anterior to the lamina cribosa, and at least partially within the Bruch's membrane opening (BMO). They extended from 3 to 6 clock hours. Conclusion AND IMPORTANCE: We describe a new OCT finding in patients with a diagnosis of glaucoma and glaucoma suspect. While previous reports describe cavitations in the choroid in patients with pathological myopia, our patients had minimal refractive error and the cavitations were located within the optic nerve. We will examine these patients over time to determine the impact of this finding on longitudinal changes in structure and function.
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Affiliation(s)
| | | | | | | | | | - Steven L. Mansberger
- Corresponding author. Legacy Devers Eye Institute. 1040 N.W. 22nd Ave., Suite 200, Portland, OR, 97210, USA.
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Chaudhary P, Stowell C, Reynaud J, Gardiner SK, Yang H, Williams G, Williams I, Marsh-Armstrong N, Burgoyne CF. Optic Nerve Head Myelin-Related Protein, GFAP, and Iba1 Alterations in Non-Human Primates With Early to Moderate Experimental Glaucoma. Invest Ophthalmol Vis Sci 2022; 63:9. [PMID: 36239974 PMCID: PMC9586137 DOI: 10.1167/iovs.63.11.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose The purpose of this study was to test if optic nerve head (ONH) myelin basic protein (MBP), 2′,3′-cyclic nucleotide 3′-phosphodiesterase (CNPase), glial fibrillary acidic protein (GFAP), and ionized calcium binding adaptor molecule 1 (Iba1) proteins are altered in non-human primate (NHP) early/moderate experimental glaucoma (EG). Methods Following paraformaldehyde perfusion, control and EG eye ONH tissues from four NHPs were paraffin embedded and serially (5 µm) vertically sectioned. Anti-MBP, CNPase, GFAP, Iba1, and nuclear dye-stained sections were imaged using sub-saturating light intensities. Whole-section images were segmented creating anatomically consistent laminar (L) and retrolaminar (RL) regions/sub-regions. EG versus control eye intensity/pixel-cluster density data within L and two RL regions (RL1 [1-250 µm]/RL2 [251-500 µm] from L) were compared using random effects models within the statistical program “R.” Results EG eye retinal nerve fiber loss ranged from 0% to 20%. EG eyes’ MBP and CNPase intensity were decreased within the RL1 (MBP = 31.4%, P < 0.001; CNPase =62.3%, P < 0.001) and RL2 (MBP = 19.6%, P < 0.001; CNPase = 56.1%, P = 0.0004) regions. EG eye GFAP intensity was decreased in the L (41.6%, P < 0.001) and RL regions (26.7% for RL1, and 28.4% for RL2, both P < 0.001). Iba1+ and NucBlue pixel-cluster density were increased in the laminar (28.2%, P = 0.03 and 16.6%, P = 0.008) and both RL regions (RL1 = 37.3%, P = 0.01 and 23.7%, P = 0.0002; RL2 = 53.7%, P = 0.002 and 33.2%, P < 0.001). Conclusions Retrolaminar myelin disruption occurs early in NHP EG and may be accompanied by laminar and retrolaminar decreases in astrocyte process labeling and increases in microglial/ macrophage density. The mechanistic and therapeutic implications of these findings warrant further study.
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Affiliation(s)
- Priya Chaudhary
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States.,Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Cheri Stowell
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States.,Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Juan Reynaud
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States.,Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Stuart K Gardiner
- Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Hongli Yang
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States.,Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Galen Williams
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States.,Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Imee Williams
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States.,Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | | | - Claude F Burgoyne
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States.,Discoveries in Sight, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
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9
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Schwaner SA, Perry RN, Kight AM, Winder E, Yang H, Morrison JC, Burgoyne CF, Ross Ethier C. Individual-Specific Modeling of Rat Optic Nerve Head Biomechanics in Glaucoma. J Biomech Eng 2021; 143:1091616. [PMID: 33210142 DOI: 10.1115/1.4049157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Indexed: 02/04/2023]
Abstract
Glaucoma is the second leading cause of blindness worldwide and is characterized by the death of retinal ganglion cells (RGCs), the cells that send vision information to the brain. Their axons exit the eye at the optic nerve head (ONH), the main site of damage in glaucoma. The importance of biomechanics in glaucoma is indicated by the fact that elevated intraocular pressure (IOP) is a causative risk factor for the disease. However, exactly how biomechanical insult leads to RGC death is not understood. Although rat models are widely used to study glaucoma, their ONH biomechanics have not been characterized in depth. Therefore, we aimed to do so through finite element (FE) modeling. Utilizing our previously described method, we constructed and analyzed ONH models with individual-specific geometry in which the sclera was modeled as a matrix reinforced with collagen fibers. We developed eight sets of scleral material parameters based on results from our previous inverse FE study and used them to simulate the effects of elevated IOP in eight model variants of each of seven rat ONHs. Within the optic nerve, highest strains were seen inferiorly, a pattern that was consistent across model geometries and model variants. In addition, changing the collagen fiber direction to be circumferential within the peripapillary sclera resulted in more pronounced decreases in strain than changing scleral stiffness. The results from this study can be used to interpret data from rat glaucoma studies to learn more about how biomechanics affects RGC pathogenesis in glaucoma.
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Affiliation(s)
- Stephen A Schwaner
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332
| | - Robert N Perry
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22904
| | - Alison M Kight
- Department of Bioengineering, Stanford University, Stanford, CA 94305
| | - Emily Winder
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA 30332
| | - Hongli Yang
- Optic Nerve Head Research Laboratory, Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Health System, Portland, OR 97210
| | - John C Morrison
- The Kenneth C. Swan Ocular Neurobiology Laboratory, Casey Eye Institute, Oregon Health and Science University, Portland, OR 97239
| | - Claude F Burgoyne
- Optic Nerve Head Research Laboratory, Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Health System, Portland, OR 97210
| | - C Ross Ethier
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA 30332
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10
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Lowry EA, Mansberger SL, Gardiner SK, Yang H, Sanchez F, Reynaud J, Demirel S, Burgoyne CF, Fortune B. Association of Optic Nerve Head Prelaminar Schisis With Glaucoma. Am J Ophthalmol 2021; 223:246-258. [PMID: 33166501 DOI: 10.1016/j.ajo.2020.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/24/2020] [Accepted: 10/27/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To compare the frequency of observing optic nerve head (ONH) prelaminar schisis by optical coherence tomography (OCT) in glaucoma and glaucoma suspect (GL/S) eyes vs healthy control (HC) eyes and to assess its association with other markers of glaucoma severity. METHODS This cross-sectional study included 298 eyes of 150 GL/S patients and 88 eyes of 44 HCs. OCT scans were obtained, including 24 radial B-scans, each composed of 768 A-lines spanning 15°, centered on the ONH. Two reviewers masked to all other clinical, demographic, and ocular information independently graded the OCT scans for the presence of ONH prelaminar schisis on a 4-point scale of 0 (none) to 3 (severe). The probability of ONH schisis was compared between groups and against demographic and ocular factors, including structural and functional measures of glaucoma severity. RESULTS The frequency and severity of ONH prelaminar schisis were greater in GL/S than in HC (P = .009). Among the GL/S group, 165 eyes (55.4%) had no visible schisis (Grade 0), 71 (23.8%) had Grade 1, 46 (15.4%) had Grade 2 and 16 (5.4%) had Grade 3 schisis. Among HC eyes, 59 (67.0%) had Grade 0, 24 (27.3%) had Grade 1, 5 (5.7%) had Grade 2, none had Grade 3. ONH schisis was more common in eyes with thinner MRW and a deeper cup. CONCLUSIONS ONH prelaminar schisis may be a sign of glaucomatous deformation and reflect ongoing pathophysiological damage. ONH prelaminar schisis can impact OCT image segmentation and diagnostic parameters, resulting in substantial overestimation of the true rim tissue thickness and underestimation of cup depth.
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11
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Sanchez FG, Mansberger SL, Kung Y, Gardiner SK, Burgoyne CF, Cunningham ET, Rees JP, Jones EP, Kinast RM. Novel Eye Drop Delivery Aid Improves Outcomes and Satisfaction. Ophthalmol Glaucoma 2021; 4:440-446. [PMID: 33444854 DOI: 10.1016/j.ogla.2021.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/29/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare a nose-pivoted drop delivery device (NPDD) with traditional eye drop delivery in glaucoma subjects. DESIGN Repeated-measures case series. PARTICIPANTS Fifty glaucoma subjects (100 eyes) who reported difficulty self-administering eye drops. METHODS We compared eye drop delivery using a NPDD against traditional delivery techniques at baseline (baseline traditional) and after standardized teaching (post-teaching traditional). Subjects used a 1-to-10 scale (10 being easiest) to rate the ease of delivery with each technique and completed a satisfaction survey. Two graders used digital video to independently review eye drop delivery and recorded: (1) accurate placement: the eye drop reached the ocular surface; (2) no contact: no bottle tip contact against the ocular or periocular surface; and (3)number of eye drops dispensed. We defined primary success as accurate placement and no contact; secondary success as primary success with only 1 drop dispensed. MAIN OUTCOME MEASURES We used logistic-transformed generalized estimating equation (GEE) regression to compare technique satisfaction, accuracy, no contact, and primary and secondary success. Number of drops dispensed was compared using a Cox model. RESULTS Forty-seven of 50 subjects (94%) preferred the NPDD over traditional eye drop delivery. The mean score for ease of use was higher for the NPDD (8.9 ± 1.1) than baseline traditional (6.7 ± 2.1; P < 0.001) and post-teaching traditional (7.0 ± 2.0; P < 0.001). Forty-nine of 50 (98%) subjects thought the NPDD was comfortable to use and would recommend the device. The eye drop reached the ocular surface in a similar percentage of subjects (>90%) with each method. The bottle tip contacted fewer eyes with the NPDD (10 eyes) than baseline traditional (33 eyes; P < 0.001) and post-teaching traditional (25 eyes; P = 0.009). The number of drops dispensed was lower with the NPDD (1.7 ± 1.2) than baseline traditional (2.2 ± 1.6; P = 0.017) and post-teaching traditional (2.4 ± 1.8; P = 0.006). The NPDD increased primary and secondary success of eye drop delivery (86% and 54%, respectively) compared to baseline traditional (66% [P = 0.001] and 28% [P < 0.001]) and post-teaching traditional (70% [P = 0.005] and 40% [P = 0.018]). CONCLUSIONS Eye drop users preferred the NPDD over traditional eye drop delivery. The NPDD improved eye drop delivery success, reduced bottle tip contact, and decreased the number of eye drops wasted.
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Affiliation(s)
- Facundo G Sanchez
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Steven L Mansberger
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | | | - Stuart K Gardiner
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Claude F Burgoyne
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Emmett T Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California; Department of Ophthalmology, Stanford University School of Medicine, Stanford, California; The Francis I. Proctor Foundation, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Jack P Rees
- Legacy Devers Eye Institute, Portland, Oregon
| | | | - Robert M Kinast
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon.
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12
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Jeoung JW, Yang H, Gardiner S, Wang YX, Hong S, Fortune B, Girard MJ, Hardin C, Wei P, Nicolela M, Vianna JR, Chauhan BC, Burgoyne CF. Optical Coherence Tomography Optic Nerve Head Morphology in Myopia I: Implications of Anterior Scleral Canal Opening Versus Bruch Membrane Opening Offset. Am J Ophthalmol 2020; 218:105-119. [PMID: 32445702 DOI: 10.1016/j.ajo.2020.05.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To measure the magnitude and direction of anterior scleral canal opening (ASCO) offset relative to the Bruch membrane opening (BMO) (ASCO/BMO offset) to characterize neural canal obliqueness and minimum cross-sectional area (NCMCA) in 69 highly myopic and 138 healthy, age-matched, control eyes. DESIGN Cross-sectional study. METHODS Using optical coherence tomography (OCT) scans of the optic nerve head (ONH), BMO and ASCO were manually segmented and their centroids and size and shape were calculated. ASCO/BMO offset magnitude and direction were measured after projecting the ASCO/BMO centroid vector onto the BMO plane. Neural canal axis obliqueness was defined as the angle between the ASCO/BMO centroid vector and the vector perpendicular to the BMO plane. NCMCA was defined by projecting BMO and ASCO points onto a plane perpendicular to the neural canal axis and measuring their overlapping area. RESULTS ASCO/BMO offset magnitude was greater (highly myopic eyes 264.3 ± 131.1 μm; healthy control subjects 89.0 ± 55.8 μm, P < .001, t test) and ASCO centroid was most frequently nasal relative to BMO centroid (94.2% of eyes) in the highly myopic eyes. BMO and ASCO areas were significantly larger (P < .001, t test), NCMCA was significantly smaller (P < .001), and all 3 were significantly more elliptical (P ≤ .001) in myopic eyes. Neural canal obliqueness was greater in myopic (65.17° ± 14.03°) compared with control eyes (40.91° ± 16.22°; P < .001, t test). CONCLUSIONS Our data suggest that increased temporal displacement of BMO relative to the ASCO, increased BMO and ASCO area, decreased NCMCA, and increased neural canal obliqueness are characteristic components of ONH morphology in highly myopic eyes.
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13
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Wang YX, Yang H, Luo H, Hong SW, Gardiner SK, Jeoung JW, Hardin C, Sharpe GP, Nouri-Mahdavi K, Caprioli J, Demirel S, Girkin CA, Liebmann JM, Mardin CY, Quigley HA, Scheuerle AF, Fortune B, Chauhan BC, Burgoyne CF. Peripapillary Scleral Bowing Increases with Age and Is Inversely Associated with Peripapillary Choroidal Thickness in Healthy Eyes. Am J Ophthalmol 2020; 217:91-103. [PMID: 32298653 DOI: 10.1016/j.ajo.2020.03.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To use optical coherence tomography (OCT) to 3-dimensionally characterize the optic nerve head (ONH) in peripapillary scleral bowing in non-highly myopic healthy eyes. DESIGN Cross-sectional, multicenter study. METHODS A total of 362 non-highly myopic (+6 diopters [D] > spherical equivalent > -6D) eyes of 362 healthy subjects from 20-90 years old underwent OCT ONH radial B-scan imaging. Bruch's membrane (BM), BM opening (BMO), anterior scleral canal opening (ASCO), and the peripapillary scleral surface were segmented. BMO and ASCO planes were fit, and their centroids, major axes, ovality, areas and offsets were determined. Peripapillary scleral bowing was characterized by 2 parameters: peripapillary scleral slope (ppSS) of 3 anterior peripapillary scleral segments (0-300, 300-700, and 700-1,000 μm from the ASCO centroid); and ASCO depth relative to a peripapillary scleral reference plane (ASCOD-ppScleral). Peripapillary choroidal thickness (ppCT) was calculated relative to the ASCO as the minimum distance between the anterior scleral surface and BM. RESULTS Both ppSS and ASCOD-ppScleral ranged from slightly inward through profoundly outward in direction. Both parameters increased with age and were independently associated with decreased ppCT. CONCLUSIONS In non-highly myopic healthy eyes, outward peripapillary scleral bowing achieved substantial levels, was markedly increased with age, and was independently associated with decreased peripapillary choroidal thickness. These findings provide a normative foundation for characterizing this anatomy in cases of high myopia and glaucoma and in eyes with optic disc tilt, torsion, and peripapillary atrophy.
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14
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Chauhan BC, Vianna JR, Burgoyne CF. Reply. Ophthalmology 2020; 127:e83. [PMID: 32828207 DOI: 10.1016/j.ophtha.2020.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- 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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15
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Ritch MD, Hannon BG, Read AT, Feola AJ, Cull GA, Reynaud J, Morrison JC, Burgoyne CF, Pardue MT, Ethier CR. AxoNet: A deep learning-based tool to count retinal ganglion cell axons. Sci Rep 2020; 10:8034. [PMID: 32415269 PMCID: PMC7228952 DOI: 10.1038/s41598-020-64898-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/21/2020] [Indexed: 11/15/2022] Open
Abstract
In this work, we develop a robust, extensible tool to automatically and accurately count retinal ganglion cell axons in optic nerve (ON) tissue images from various animal models of glaucoma. We adapted deep learning to regress pixelwise axon count density estimates, which were then integrated over the image area to determine axon counts. The tool, termed AxoNet, was trained and evaluated using a dataset containing images of ON regions randomly selected from whole cross sections of both control and damaged rat ONs and manually annotated for axon count and location. This rat-trained network was then applied to a separate dataset of non-human primate (NHP) ON images. AxoNet was compared to two existing automated axon counting tools, AxonMaster and AxonJ, using both datasets. AxoNet outperformed the existing tools on both the rat and NHP ON datasets as judged by mean absolute error, R2 values when regressing automated vs. manual counts, and Bland-Altman analysis. AxoNet does not rely on hand-crafted image features for axon recognition and is robust to variations in the extent of ON tissue damage, image quality, and species of mammal. Therefore, AxoNet is not species-specific and can be extended to quantify additional ON characteristics in glaucoma and potentially other neurodegenerative diseases.
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Affiliation(s)
- Matthew D Ritch
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, United States
| | - Bailey G Hannon
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States
| | - A Thomas Read
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, United States
| | - Andrew J Feola
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, United States
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Atlanta, Georgia, United States
| | - Grant A Cull
- Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Juan Reynaud
- Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - John C Morrison
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States
| | - Claude F Burgoyne
- Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Machelle T Pardue
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, United States
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Atlanta, Georgia, United States
| | - C Ross Ethier
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, United States.
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States.
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16
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Yang H, Luo H, Hardin C, Wang Y, Jeoung JW, Albert C, Vianna JR, Sharpe GP, Reynaud J, Demirel S, Mansberger SL, Fortune B, Nicolela M, Gardiner SK, Chauhan BC, Burgoyne CF. Optical Coherence Tomography Structural Abnormality Detection in Glaucoma Using Topographically Correspondent Rim and Retinal Nerve Fiber Layer Criteria. Am J Ophthalmol 2020; 213:203-216. [PMID: 31899204 PMCID: PMC7214190 DOI: 10.1016/j.ajo.2019.12.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/05/2019] [Accepted: 12/18/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE This study evaluated the ability of topographically correspondent (TC) minimum rim width (MRW) and peripapillary retinal nerve fiber layer thickness (pRNFLT) criteria to detect optical coherence tomography (OCT) structural abnormality in glaucoma (GL) and glaucoma suspect (GLS) eyes. DESIGN Retrospective cross-sectional study. METHODS A total of 196 GL eyes, 150 GLS eyes, and 303 heathy eyes underwent pRNFL and 24 radial optic nerve head OCT imaging and manual correction of the internal limiting membrane, Bruch's membrane opening (BMO), and outer pRNFL segmentations. MRW and pRNFLT were quantified in 6 Garway-Heath or 12 30-degree (clock-hour) sectors. OCT abnormality for each parameter was defined to be less than the 5th percentile of the healthy eye distribution. OCT abnormality for individual eyes was defined using global, sectoral, and combined parameter criteria that achieved ≥95% specificity in the healthy eyes. TC combination criteria required the sectoral location of MRW and pRNFLT abnormality to be topographically aligned and included comMR (a previously reported TC combination consisting of MRW and pRNFLT parameter: [MRW + pRNFLT × (average MRW healthy eyes/average pRNFLT healthy eyes) MRW]. RESULTS TC sectoral criteria (1 Garway-Heath MRW + corresponding Garway-Heath RNFLT), (one 30-degree MRW + any 1 corresponding or adjacent 30-degree pRNFLT), 30-degree and Garway-Heath comMR-TI and global comMR were the best performing criteria, demonstrating (96%-99% specificity), 86%-91% sensitivity for GL, 80%-84% sensitivity for early GL (MD ≥ -4.0 dB) and 93%-96% sensitivity for moderate-to-advanced GL (MD < -4.0 dB). CONCLUSIONS Clinically intuitive TC MRW and pRNFLT combination criteria identified the sectoral location of OCT abnormality in GL eyes with high diagnostic precision.
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Affiliation(s)
- Hongli Yang
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Haomin Luo
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Department of Ophthalmology, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Christy Hardin
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Yaxing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Capital Medical University, Beijing, China
| | - Jin Wook Jeoung
- Department of Ophthalmology, Medical College, the Catholic University of Korea, Seoul, South Korea
| | - Cindy Albert
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Jayme R Vianna
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Glen P Sharpe
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Juan Reynaud
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Shaban Demirel
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Steven L Mansberger
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Brad Fortune
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Marcelo Nicolela
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stuart K Gardiner
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Balwantray C Chauhan
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Claude F Burgoyne
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA.
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17
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Hong S, Yang H, Gardiner SK, Luo H, Hardin C, Sharpe GP, Caprioli J, Demirel S, Girkin CA, Liebmann JM, Mardin CY, Quigley HA, Scheuerle AF, Fortune B, Chauhan BC, Burgoyne CF. OCT-Detected Optic Nerve Head Neural Canal Direction, Obliqueness, and Minimum Cross-Sectional Area in Healthy Eyes. Am J Ophthalmol 2019; 208:185-205. [PMID: 31095953 DOI: 10.1016/j.ajo.2019.05.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE To assess anterior scleral canal opening (ASCO) offset relative to Bruch's membrane opening (BMO) (ASCO/BMO offset) so as to determine neural canal direction, obliqueness, and minimum cross-sectional area (NCMCA) in 362 healthy eyes. DESIGN Cross-sectional study. METHODS After optical coherence tomography optic nerve head and retinal nerve fiber layer thickness (RNFLT) imaging, BMO and ASCO were manually segmented. Planes, centroids, size, and shape were calculated. Neural canal direction was defined by projecting the neural canal axis vector (connecting BMO and ASCO centroids) onto the BMO plane. Neural canal obliqueness was defined by the angle between the neural canal axis and the BMO plane perpendicular vector. NCMCA was defined by projecting BMO and ASCO points onto a neural canal axis perpendicular plane and measuring the area of overlap. The angular distance between superior and inferior peak RNFLT was measured, and correlations between RFNLT, BMO, ASCO, ASCO/BMO offset, and NCMCA were assessed. RESULTS Mean (SD) NCMCA was significantly smaller than either the BMO or ASCO area (1.33 (0.42), 1.82 (0.38), 2.22 (0.43) mm2, respectively), and most closely correlated to RNFLT (P < .001, R2 = 0.158). Neural canal direction was most commonly superior-nasal (55%). Mean neural canal obliqueness was 39.4° (17.3°). The angular distance between superior and inferior peak RNFLT correlated to neural canal direction (P ≤ .008, R2 = 0.093). CONCLUSIONS ASCO/BMO offset underlies neural canal direction, obliqueness, and NCMCA. RNFLT is more strongly correlated to NCMCA than to BMO or ASCO, and its peripapillary distribution is influenced by neural canal direction.
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Affiliation(s)
- Seungwoo Hong
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, USA; Department of Ophthalmology, Medical College, the Catholic University of Korea, Seoul, Korea
| | - Hongli Yang
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, USA
| | - Stuart K Gardiner
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, USA
| | - Haomin Luo
- Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha, Hunan Province, P.R. China; Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, USA
| | - Christy Hardin
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, USA
| | - Glen P Sharpe
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada
| | - Joseph Caprioli
- Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Shaban Demirel
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, USA
| | - Christopher A Girkin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey M Liebmann
- Einhorn Clinical Research Center, Moise and Chella Safra Advanced Ocular Imaging Laboratory, New York Eye and Ear Infirmary of Mount Sinai Health System, New York, USA
| | | | - Harry A Quigley
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Brad Fortune
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, USA
| | | | - Claude F Burgoyne
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, USA.
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18
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Schwaner SA, Kight AM, Perry RN, Pazos M, Yang H, Johnson EC, Morrison JC, Burgoyne CF, Ross Ethier C. A Methodology for Individual-Specific Modeling of Rat Optic Nerve Head Biomechanics in Glaucoma. J Biomech Eng 2019; 140:2679249. [PMID: 30003249 DOI: 10.1115/1.4039998] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Indexed: 12/20/2022]
Abstract
Glaucoma is the leading cause of irreversible blindness and involves the death of retinal ganglion cells (RGCs). Although biomechanics likely contributes to axonal injury within the optic nerve head (ONH), leading to RGC death, the pathways by which this occurs are not well understood. While rat models of glaucoma are well-suited for mechanistic studies, the anatomy of the rat ONH is different from the human, and the resulting differences in biomechanics have not been characterized. The aim of this study is to describe a methodology for building individual-specific finite element (FE) models of rat ONHs. This method was used to build three rat ONH FE models and compute the biomechanical environment within these ONHs. Initial results show that rat ONH strains are larger and more asymmetric than those seen in human ONH modeling studies. This method provides a framework for building additional models of normotensive and glaucomatous rat ONHs. Comparing model strain patterns with patterns of cellular response seen in studies using rat glaucoma models will help us to learn more about the link between biomechanics and glaucomatous cell death, which in turn may drive the development of novel therapies for glaucoma.
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Affiliation(s)
- Stephen A Schwaner
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, 315 Ferst Drive, 2306 IBB, Atlanta, GA 30332 e-mail:
| | - Alison M Kight
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA 30332 e-mail:
| | - Robert N Perry
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA 30332 e-mail:
| | - Marta Pazos
- Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona, Barcelona 08036, Spain e-mail:
| | - Hongli Yang
- Optic Nerve Head Research Laboratory, Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Health System, Portland, OR 97210 e-mail:
| | - Elaine C Johnson
- The Kenneth C. Swan Ocular Neurobiology Laboratory, Casey Eye Institute, Oregon Health and Science University, Portland, OR 97239 e-mail:
| | - John C Morrison
- The Kenneth C. Swan Ocular Neurobiology Laboratory, Casey Eye Institute, Oregon Health and Science University, Portland, OR 97239 e-mail:
| | - Claude F Burgoyne
- Optic Nerve Head Research Laboratory, Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Health System, Portland, OR 97210 e-mail:
| | - C Ross Ethier
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA 30332 e-mail:
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19
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Fazio MA, Girard MJA, Lee W, Morris JS, Burgoyne CF, Downs JC. The Relationship Between Scleral Strain Change and Differential Cumulative Intraocular Pressure Exposure in the Nonhuman Primate Chronic Ocular Hypertension Model. Invest Ophthalmol Vis Sci 2019; 60:4141-4150. [PMID: 31598625 PMCID: PMC6785842 DOI: 10.1167/iovs.19-27060] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/17/2019] [Indexed: 01/15/2023] Open
Abstract
Purpose To determine the relationship between peripapillary scleral strain change and cumulative differential IOP exposure in nonhuman primates (NHPs) with unilateral chronic ocular hypertension. Methods Posterior scleral shells from 6 bilaterally normal and 10 unilateral chronic ocular hypertension NHPs were pressurized from 5 to 45 mm Hg, and the resulting full-field, three-dimensional, scleral surface deformations were acquired using laser speckle interferometry. Scleral tensile strain (local tissue deformation) was calculated by analytical differentiation of the displacement field; zero strain was assumed at 5 mm Hg. Maximum principal strain was used to represent the scleral strain, and strains were averaged over a 15°-wide (∼3.6-mm) circumpapillary region adjacent to the ONH. The relative difference in mean strain was calculated between fellow eyes and compared with the differential cumulative IOP exposure within NHPs during the study period. The relationship between the relative difference in scleral strain and the differential cumulative IOP exposure in fellow eyes was assessed using an F test and quadratic regression model. Results Relative differential scleral tensile strain was significantly associated with differential cumulative IOP exposure in contralateral eyes in the chronic ocular hypertension NHPs, with the bilaterally normal NHPs showing no significant strain difference between fellow eyes. The sclera in the chronic ocular hypertension eyes was more compliant than in their fellow eyes at low levels of differential cumulative IOP exposure, but stiffer at larger differential IOPs (P < 0.0001). Conclusions These cross-sectional findings suggest that longitudinal IOP-induced changes in scleral mechanical behavior are dependent on the magnitude of differential cumulative IOP exposure.
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Affiliation(s)
- Massimo A. Fazio
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Michael J. A. Girard
- In Vivo Biomechanics Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Wonyul Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Jeffrey S. Morris
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Claude F. Burgoyne
- Optic Nerve Head Biomechanics Laboratory, Devers Eye Institute, Portland, Oregon, United States
| | - J. Crawford Downs
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama, United States
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20
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Yang H, Luo H, Gardiner SK, Hardin C, Sharpe GP, Caprioli J, Demirel S, Girkin CA, Liebmann JM, Mardin CY, Quigley HA, Scheuerle AF, Fortune B, Chauhan BC, Burgoyne CF. Factors Influencing Optical Coherence Tomography Peripapillary Choroidal Thickness: A Multicenter Study. Invest Ophthalmol Vis Sci 2019; 60:795-806. [PMID: 30811523 PMCID: PMC6392476 DOI: 10.1167/iovs.18-25407] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To quantify peripapillary choroidal thickness (PCT) and the factors that influence it in healthy participants who represent the racial and ethnic composition of the U.S. population. Methods A total of 362 healthy participants underwent optical coherence tomography (OCT) enhanced depth imaging of the optic nerve head with a 24 radial B-scan pattern aligned to the fovea to Bruch's membrane opening axis. Bruch's membrane, anterior scleral canal opening (ASCO), and the anterior scleral surface were manually segmented. PCT was measured at 100, 300, 500, 700, 900, and 1100 μm from the ASCO globally and within 12 clock-hour sectors. The effects of age, axial length, intraocular pressure, ethnicity, sex, sector, and ASCO area on PCT were assessed by ANOVA and univariable and multivariable regressions. Results Globally, PCT was thicker further from the ASCO border and thinner with older age, longer axial length, larger ASCO area, European descent, and female sex. Among these effectors, age and axial length explained the greatest proportion of variance. The rate of age-related decline increased further from the ASCO border. Sectorally, the inferior-temporal sectors were thinnest (10.7%-20.0% thinner than the thickest sector) and demonstrated a higher rate of age-related loss (from 15.6% to 20.7% faster) at each ASCO distance. Conclusions In healthy eyes, PCT was thinnest in the inferior temporal sectors and thinner PCT was associated with older age, European descent, longer axial length, larger ASCO area, and female sex. Among these associations, age had the strongest influence, and its effect was greatest within the inferior temporal sectors.
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Affiliation(s)
- Hongli Yang
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States
| | - Haomin Luo
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States.,Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Stuart K Gardiner
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
| | - Christy Hardin
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States
| | - Glen P Sharpe
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joseph Caprioli
- Jules Stein Eye Institute, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California, United States
| | - Shaban Demirel
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
| | - Christopher A Girkin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Jeffrey M Liebmann
- Einhorn Clinical Research Center, Moise and Chella Safra Advanced Ocular Imaging Laboratory, New York Eye and Ear Infirmary of Mount Sinai Health System, New York, United States
| | | | - Harry A Quigley
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States
| | | | - Brad Fortune
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
| | - Balwantray C Chauhan
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Claude F Burgoyne
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States
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21
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Hong SW, Koenigsman H, Yang H, Ren R, Reynaud J, Kinast RM, Mansberger SL, Fortune B, Demirel S, Gardiner SK, Burgoyne CF. Glaucoma Specialist Detection of Optical Coherence Tomography Suspicious Rim Tissue in Glaucoma and Glaucoma Suspect Eyes. Am J Ophthalmol 2019; 199:28-43. [PMID: 30414397 DOI: 10.1016/j.ajo.2018.10.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/19/2018] [Accepted: 10/26/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess glaucoma specialists' detection of optic nerve head (ONH) rim tissue that is thin by optical coherence tomography (OCT) criteria. DESIGN Reliability analysis. METHODS Five clinicians marked the disc margin (DM) and rim margin (RM) on stereophotographs of 151 glaucoma or glaucoma suspect eyes obtained within 3 months of OCT imaging. The photo and OCT infrared image for each eye were co-localized and regionalized into 12 sectors relative to the axis between the Bruch membrane opening (BMO) centroid and the fovea. For each clinician, the distance from BMO centroid to their DM (DM radius) and RM (RM radius) was used to generate sectoral rim width (RW) (DM radius-RM radius) and cup-to-disc ratio (CDR) (RM radius/DM radius) estimates. OCT minimum rim width (MRW) was determined by sector. Among all eyes, for each OCT MRW suspicious sector (<5% of OCT normative database), we determined each clinician's detection (clinician CDR ≥ 0.7). RESULTS Clinicians most commonly failed to detect OCT suspicious rim tissue in the nasal sectors. Among 502 sectors with suspicious OCT MRW, all 5 clinicians rated CDR ≥ 0.7 in only 29.5% and all 5 clinicians rated CDR < 0.7 in 21%. OCT suspicious rim thickness was most common (32% of eyes) in the nasal and inferior sectors. MRW vs clinician RW discordance was greatest nasally, while BMO vs clinician DM discordance was greatest temporally. CONCLUSIONS Clinicians most commonly failed to detect OCT suspicious rim thickness nasally where suspicious rim tissues were also most common.
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22
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Luo H, Yang H, Gardiner SK, Hardin C, Sharpe GP, Caprioli J, Demirel S, Girkin CA, Liebmann JM, Mardin CY, Quigley HA, Scheuerle AF, Fortune B, Chauhan BC, Burgoyne CF. Factors Influencing Central Lamina Cribrosa Depth: A Multicenter Study. Invest Ophthalmol Vis Sci 2019; 59:2357-2370. [PMID: 29847642 PMCID: PMC5939685 DOI: 10.1167/iovs.17-23456] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose To quantify the influence of ocular and demographic factors on central laminar depth (LD) in healthy participants. Methods A total of 362 normal subjects underwent optical coherence tomography (OCT) enhanced depth imaging of the optic nerve head (ONH) with a 24 radial B-scan pattern aligned to the fovea–to–Bruch's membrane opening (BMO) axis. BMO, anterior lamina, anterior scleral canal opening (ASCO), Bruch's membrane (BM), and the peripapillary scleral surface were manually segmented. The extent of laminar segmentation was quantified within 72 ASCO subsectors. Central LD was quantified relative to four reference planes: BMO, ASCO, BM, and scleral. The effects of age, sex, ethnicity, IOP, BMO area, ASCO area, and axial length on LD were assessed. Results Laminar visibility was most consistent within the central ASCO (median 89%, range, 69%–95%). LDBMO and LDBM were significantly shallower in eyes with greater age, BMO area, and axial length and in females. LDASCO was shallower in eyes with greater ASCO area and axial length and in European and Hispanic descent compared to African descent eyes. LDSclera behaved similarly, but was not associated with axial length. BMO and ASCO area were not different between African descent and European descent eyes. Conclusions Central LD was deeper in African descent eyes and influenced least by age, axial length, and sex, but more by ASCO area, when measured relative to the ASCO and sclera. However, the magnitude of these effects for all four reference planes was small, and their clinical importance in the detection of glaucoma and its progression remains to be determined.
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Affiliation(s)
- Haomin Luo
- Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha, Hunan Province, P.R. China.,Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States
| | - Hongli Yang
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States
| | - Stuart K Gardiner
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
| | - Christy Hardin
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States
| | - Glen P Sharpe
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joseph Caprioli
- Jules Stein Eye Institute, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, United States
| | - Shaban Demirel
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
| | - Christopher A Girkin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Jeffrey M Liebmann
- Einhorn Clinical Research Center, Moise and Chella Safra Advanced Ocular Imaging Laboratory, New York Eye and Ear Infirmary of Mount Sinai Health System, New York, New York, United States
| | | | - Harry A Quigley
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States
| | | | - Brad Fortune
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
| | - Balwantray C Chauhan
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Claude F Burgoyne
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States
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23
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Hong SW, Koenigsman H, Ren R, Yang H, Gardiner SK, Reynaud J, Kinast RM, Mansberger SL, Fortune B, Demirel S, Burgoyne CF. Glaucoma Specialist Optic Disc Margin, Rim Margin, and Rim Width Discordance in Glaucoma and Glaucoma Suspect Eyes. Am J Ophthalmol 2018; 192:65-76. [PMID: 29750947 DOI: 10.1016/j.ajo.2018.04.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/20/2018] [Accepted: 04/20/2018] [Indexed: 01/21/2023]
Abstract
PURPOSE To quantify the variability of 5 glaucoma specialists' optic disc margin (DM), rim margin (RM), and rim width (RW) estimates. DESIGN Inter-observer reliability analysis. METHODS Clinicians viewed stereo-photographs from 214 subjects with glaucoma or ocular hypertension and digitally marked the DM and RM. For each photograph, the centroid of each clinician's DM was calculated, and an averaged DMcentroid was determined. The axis between the DMcentroid and the fovea was used to establish 12 30-degree sectors. Measurements from the DMcentroid to each clinician's DM (DMradius) and RM (RMradius) were used to generate a RW (DMradius-RMradius) and cup-to-disc ratio (CDR) (RMradius/DMradius) by sector. Parameter means, standard deviations, and coefficient of variations (COVs) were calculated across all clinicians for each eye. Parameter means for each clinician, and intraclass correlation coefficients (ICC), were calculated across all eyes by sector. RESULTS Among all eyes, the median COV by sector ranged from 3% to 5% for DMradius, 20% to 25% for RMradius, and 26% to 30% for RW. Sectoral ICCs for CDR ranged from 0.566 to 0.668. Sectors suspicious for rim thinning by 1 clinician were frequently overlooked by others. Among 1724 sectors in which at least 1 clinician was suspicious for rim thinning (CDR ≥ 0.7), all 5 clinicians' CDRs were ≥ 0.7 in only 499 (29%), and 2 of the 5 clinicians failed to detect rim thinning (CDR < 0.7) in 442 (26%). CONCLUSION In this study, glaucoma specialist RM, DM, and RW discordance was frequent and substantial, even in sectors that were suspicious for rim thinning.
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Affiliation(s)
- Seung Woo Hong
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Department of Ophthalmology, Medical College, Catholic University of Korea, Seoul, South Korea
| | - Helen Koenigsman
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Ruojin Ren
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Hongli Yang
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Stuart K Gardiner
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Juan Reynaud
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Robert M Kinast
- Devers Eye Institute Glaucoma Service, Portland, Oregon, USA
| | - Steven L Mansberger
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Devers Eye Institute Glaucoma Service, Portland, Oregon, USA
| | - Brad Fortune
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Shaban Demirel
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Claude F Burgoyne
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Devers Eye Institute Glaucoma Service, Portland, Oregon, USA.
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24
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Torres LA, Vianna JR, Jarrar F, Sharpe GP, Araie M, Caprioli J, Demirel S, Girkin CA, Hangai M, Iwase A, Liebmann JM, Mardin CY, Nakazawa T, Quigley HA, Scheuerle AF, Sugiyama K, Tanihara H, Tomita G, Yanagi Y, Burgoyne CF, Chauhan BC. Protruded retinal layers within the optic nerve head neuroretinal rim. Acta Ophthalmol 2018; 96:e493-e502. [PMID: 30105788 DOI: 10.1111/aos.13657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 11/06/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE To determine the frequency with which retinal tissues other than the nerve fibre layer, hereafter referred to as protruded retinal layers (PRL), are a component of optical coherence tomography (OCT) neuroretinal rim measurements. METHODS Ninety healthy (30 White, Black and Japanese, respectively) subjects were included in the study. A radial scan pattern (24 B-scans centred on Bruch's membrane opening [BMO]) was used. For each of the 48 minimum rim width (MRW) measurement points, we determined whether PRL were present, absent or indeterminate. When present, the proportion of PRL within the MRW was quantified. RESULTS Protruded retinal layers were present in 503 (11.6%), absent in 3805 (88.1%) and indeterminate in 12 (0.3%) measurement points. Overall, 69 (76.6%) subjects had ≥1 points with PRL, with White subjects having the highest frequency and Japanese the lowest (29 [97%] and 18 [60%], respectively; p < 0.01). PRL were present in one-third of points in the temporal sector, but ≤5% in other sectors. When present, the median PRL thickness was 53.0 (interquartile range [IQR]: 33.0 to 78.5) μm, representing 20.6 (IQR: 13.0 to 28.5)% of MRW. Globally, the median PRL thickness comprised 1.3 (IQR: 0.2 to 3.5)% of the MRW; however, in the temporal sector, it exceeded 30% of MRW in some subjects. CONCLUSIONS Protruded retinal layers are a component of MRW measurements in most normal subjects, occurring in almost 12% of all measurement points analysed. There were racial variations in the presence of PRL and a significantly higher frequency of PRL in the temporal sector.
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Affiliation(s)
- Lucas A. Torres
- Department of Ophthalmology and Visual Sciences; Dalhousie University; Halifax Nova Scotia Canada
| | - Jayme R. Vianna
- Department of Ophthalmology and Visual Sciences; Dalhousie University; Halifax Nova Scotia Canada
| | - Faisal Jarrar
- Department of Ophthalmology and Visual Sciences; Dalhousie University; Halifax Nova Scotia Canada
| | - Glen P. Sharpe
- Department of Ophthalmology and Visual Sciences; Dalhousie University; Halifax Nova Scotia Canada
| | - Makoto Araie
- Kanto Central Hospital of the Mutual Aid Association of Public School Teachers; Tokyo Japan
| | - Joseph Caprioli
- Department of Ophthalmology; Jules Stein Eye Institute; University of California Los Angeles; Los Angeles California USA
| | - Shaban Demirel
- Devers Eye Institute; Legacy Research Institute; Portland Oregon USA
| | - Christopher A. Girkin
- Department of Ophthalmology; University of Alabama at Birmingham; Birmingham Alabama USA
| | - Masanori Hangai
- Department of Ophthalmology; Saitama Medical School; Moro Japan
| | | | - Jeffrey M. Liebmann
- New York Eye and Ear Infirmary; New York University School of Medicine; New York New York USA
| | | | - Toru Nakazawa
- Department of Ophthalmology; Tohoku University Graduate School of Medicine; Tohoku Japan
| | - Harry A. Quigley
- Wilmer Ophthalmological Institute; Johns Hopkins University; Baltimore Maryland USA
| | | | - Kazuhisa Sugiyama
- Department of Ophthalmology and Visual Science; Kanazawa University Graduate School of Medical Science; Kanazawa Japan
| | - Hidenobu Tanihara
- Department of Ophthalmology; Faculty of Life Sciences; Kumamoto University; Kumamoto Japan
| | - Goji Tomita
- Department of Ophthalmology; Toho University Ohashi Medical Center; Tokyo Japan
| | - Yasuo Yanagi
- Department of Ophthalmology; The University of Tokyo Graduate School of Medicine; Tokyo Japan
| | | | - Balwantray C. Chauhan
- Department of Ophthalmology and Visual Sciences; Dalhousie University; Halifax Nova Scotia Canada
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Yang H, Reynaud J, Lockwood H, Williams G, Hardin C, Reyes L, Gardiner SK, Burgoyne CF. 3D Histomorphometric Reconstruction and Quantification of the Optic Nerve Head Connective Tissues. Methods Mol Biol 2018; 1695:207-267. [PMID: 29190029 DOI: 10.1007/978-1-4939-7407-8_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Accurately characterizing the 3D geometry of the optic nerve head neural and connective tissues has been the goal of a large and important body of scientific work. In the present report, we summarize our methods for the high-resolution, digital, 3D histomorphometric reconstruction of the optic nerve head tissues, including their visualization, parameterization, and quantification. In addition, we present our methods for between-eye comparisons of this anatomy, and their use to determine animal-specific and experiment-wide experimental glaucoma versus Control eye differences in the unilateral, monkey experimental glaucoma model. Finally, we demonstrate its application to finite element modeling, 3D optic nerve head reconstruction of other species, and 3D optic nerve head reconstructions using other imaging modalities.
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Affiliation(s)
- Hongli Yang
- Optic Nerve Head Research Laboratory, Legacy Research Institute, Devers Eye Institute, 1225 NE 2nd Ave., Portland, OR, 97232, USA
- Discoveries in Sight Research Laboratories, Legacy Research Institute, Devers Eye Institute, Portland, OR, USA
| | - Juan Reynaud
- Optic Nerve Head Research Laboratory, Legacy Research Institute, Devers Eye Institute, 1225 NE 2nd Ave., Portland, OR, 97232, USA
- Discoveries in Sight Research Laboratories, Legacy Research Institute, Devers Eye Institute, Portland, OR, USA
| | - Howard Lockwood
- Optic Nerve Head Research Laboratory, Legacy Research Institute, Devers Eye Institute, 1225 NE 2nd Ave., Portland, OR, 97232, USA
- Discoveries in Sight Research Laboratories, Legacy Research Institute, Devers Eye Institute, Portland, OR, USA
| | - Galen Williams
- Optic Nerve Head Research Laboratory, Legacy Research Institute, Devers Eye Institute, 1225 NE 2nd Ave., Portland, OR, 97232, USA
- Discoveries in Sight Research Laboratories, Legacy Research Institute, Devers Eye Institute, Portland, OR, USA
| | - Christy Hardin
- Optic Nerve Head Research Laboratory, Legacy Research Institute, Devers Eye Institute, 1225 NE 2nd Ave., Portland, OR, 97232, USA
- Discoveries in Sight Research Laboratories, Legacy Research Institute, Devers Eye Institute, Portland, OR, USA
| | - Luke Reyes
- Optic Nerve Head Research Laboratory, Legacy Research Institute, Devers Eye Institute, 1225 NE 2nd Ave., Portland, OR, 97232, USA
- Discoveries in Sight Research Laboratories, Legacy Research Institute, Devers Eye Institute, Portland, OR, USA
| | - Stuart K Gardiner
- Discoveries in Sight Research Laboratories, Legacy Research Institute, Devers Eye Institute, Portland, OR, USA
| | - Claude F Burgoyne
- Optic Nerve Head Research Laboratory, Legacy Research Institute, Devers Eye Institute, 1225 NE 2nd Ave., Portland, OR, 97232, USA.
- Discoveries in Sight Research Laboratories, Legacy Research Institute, Devers Eye Institute, Portland, OR, USA.
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Govetto A, Bhavsar KV, Virgili G, Gerber MJ, Freund KB, Curcio CA, Burgoyne CF, Hubschman JP, Sarraf D. Tractional Abnormalities of the Central Foveal Bouquet in Epiretinal Membranes: Clinical Spectrum and Pathophysiological Perspectives. Am J Ophthalmol 2017; 184:167-180. [PMID: 29106913 DOI: 10.1016/j.ajo.2017.10.011] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 10/16/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the tractional alterations of the central bouquet (CB) in idiopathic epiretinal membranes (ERMs). DESIGN Retrospective, consecutive, observational case series. METHODS ERMs were classified according to a 4-stage grading system. The CB was defined as a circular area of approximately 100 μm composed of densely packed cones (and Müller cells) in the central fovea. Tractional abnormalities of the CB were identified with spectral-domain optical coherence tomography. Ex vivo histopathologic analysis was performed. RESULTS In this study 263 eyes with ERMs were included. Mean follow-up was 21.2 ± 16.7 months. At baseline, tractional abnormalities of the CB were diagnosed in 58 out of 263 eyes (22%) and divided into 3 categories: cotton ball sign (defined as a fuzzy hyperreflective area between the ellipsoid zone and the interdigitation zone in the central fovea), foveolar detachment, and acquired vitelliform lesion. The presence of ectopic inner foveal layers was negatively correlated with the presence of CB tractional abnormalities (P = .002). Visual acuity was highest in association with the cotton ball sign and lowest in the acquired vitelliform lesion group. Sequential morphologic progression was identified in 7 eyes. Ex vivo histopathologic analysis illustrated characteristic staining patterns supporting a potential mechanism of traction by Müller cells in the CB. CONCLUSIONS The cotton ball sign, foveolar detachment, and acquired vitelliform lesion may comprise a continuum in the same clinical spectrum and may represent subsequent stages of CB abnormalities. Foveal Müller cells may play an integral role in the transmission of mechanical forces to the central foveal cones.
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Araie M, Iwase A, Sugiyama K, Nakazawa T, Tomita G, Hangai M, Yanagi Y, Murata H, Tanihara H, Burgoyne CF, Chauhan BC. Determinants and Characteristics of Bruch's Membrane Opening and Bruch's Membrane Opening-Minimum Rim Width in a Normal Japanese Population. Invest Ophthalmol Vis Sci 2017; 58:4106-4113. [PMID: 28828482 PMCID: PMC6108307 DOI: 10.1167/iovs.17-22057] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To identify determinants of Bruch's membrane opening (BMO), and BMO-minimum rim width (BMO-MRW) and circumpapillary retinal nerve fiber layer thickness (RNFLT) centered on BMO center and characterize these parameters in a normal Japanese population. Methods Spectral-domain optical coherence tomography images of optic nerve head and circumpapillary and macular retina were obtained in 258 eyes of 258 normal Japanese with mean (standard deviation) age of 51.7 (18.2) years. BMO area, BMO-MRW, RNFLT (measured with a 3.5-mm-diameter circle scan) were all acquired and analyzed relative to the eye-specific fovea to BMO (FoBMO) axis. One randomly selected eye of each subject was analyzed. Multiple regression analysis was used to identify determinants to the parameters. Results BMO area, global BMO-MRW, RNFLT, and FoBMO angle averaged 2.06 (0.45) mm2, 305.5 (50.0) μm, 101.8 (9.6) μm, and -7.8° (3.8°), respectively. There was a modest correlation between global BMO-MRW and RNFLT (r = 0.337; P < 0.001), while the sectorwise correlations were highest in the superior-temporal sector (r = 0.500; P < 0.001) and lowest in the nasal sector (r = 0.117; P = 0.063). Global BMO-MRW and RNFLT declined with age at -1.04 μm/y (P < 0.001) and -0.12 μm/y (P = 0.001), and the former correlated negatively (P = 0.001) and the latter positively (P < 0.001) with BMO area after adjustment for other factors (R2 = 0.191 and 0.272, respectively). BMO area correlated positively with axial length (P = 0.023) and negatively with age (P < 0.001) (R2 = 0.157). Conclusions BMO-MRW and RNFLT declined with age with a difference between them in their relationship to BMO area. BMO area positively correlated with axial length and negatively with age.
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Affiliation(s)
- Makoto Araie
- Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan
| | | | - Kazuhisa Sugiyama
- Department of Ophthalmology and Visual Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Goji Tomita
- Department of Ophthalmology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Masanori Hangai
- Department of Ophthalmology, Saitama Medical School, Moro, Japan
| | - Yasuo Yanagi
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hidenobu Tanihara
- Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | | | - Balwantray C Chauhan
- Department of Ophthalmology and Visual Science, Dalhousie University, Halifax, Nova Scotia, Canada
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Girkin CA, Fazio MA, Yang H, Reynaud J, Burgoyne CF, Smith B, Wang L, Downs JC. Variation in the Three-Dimensional Histomorphometry of the Normal Human Optic Nerve Head With Age and Race: Lamina Cribrosa and Peripapillary Scleral Thickness and Position. Invest Ophthalmol Vis Sci 2017; 58:3759-3769. [PMID: 28738420 PMCID: PMC5525554 DOI: 10.1167/iovs.17-21842] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Purpose This study quantified the thickness and depth of the lamina cribrosa (LC) and peripapillary scleral thickness in high-resolution three-dimensional (3D) fluorescent reconstructions of the optic nerve head (ONH) in eyes from donors of African (AD) and European descent (ED). Methods A total of 64 eyes (45 ED, 19 AD) from 51 normal donors were obtained within 6 hours of death and fixed at 10 mm Hg of pressure. The optic nerve head was trephined from the globe and digitally reconstructed at 1.5 × 1.5 × 1.5 μm voxel resolution with an automated episcopic fluorescence technique. The load-bearing ONH connective tissue surfaces were manually delineated in 3D using custom software. Results The lamina cribrosa and peripapillary sclera were significantly thinner in AD eyes adjusting for age and sex (LC was 24 ± 11 μm thinner; P = 0.0350; scleral was 56 ± 22 μm thinner; P = 0.0097). The lamina cribrosa was significantly thinner in females (23 ± 11 μm thinner; P = 0.0425). Age was not significantly associated with any morphologic parameter in the ED group. However, increasing age was associated with an increase in scleral thickness (1.3 μm/year, P = 0.0499) and an increase in LC depth (2.3 μm/year, P = 0.0035) in the AD group. The sclera was thickest in the superior and temporal regions while the LC was thinnest superiorly. Conclusions Substantial sectorial and racial differences in LC and scleral morphology were observed, as well as increasing LC depth and scleral thickness with age in the AD group. Results suggest greater age-related remodeling of the load-bearing ONH connective tissues in eyes from AD individuals that could explain, in part, the greater predilection to glaucomatous injury seen in aged AD populations.
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Affiliation(s)
- Christopher A Girkin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Massimo A Fazio
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States 2Department of Biomedical Engineering, School of Engineering, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Hongli Yang
- Devers Eye Institute, Legacy Health System, Portland, Oregon, United States
| | - Juan Reynaud
- Devers Eye Institute, Legacy Health System, Portland, Oregon, United States
| | - Claude F Burgoyne
- Devers Eye Institute, Legacy Health System, Portland, Oregon, United States
| | - Brandon Smith
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Lan Wang
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - J Crawford Downs
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
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Yang H, Reynaud J, Lockwood H, Williams G, Hardin C, Reyes L, Stowell C, Gardiner SK, Burgoyne CF. The connective tissue phenotype of glaucomatous cupping in the monkey eye - Clinical and research implications. Prog Retin Eye Res 2017; 59:1-52. [PMID: 28300644 PMCID: PMC5603293 DOI: 10.1016/j.preteyeres.2017.03.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/14/2017] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
Abstract
In a series of previous publications we have proposed a framework for conceptualizing the optic nerve head (ONH) as a biomechanical structure. That framework proposes important roles for intraocular pressure (IOP), IOP-related stress and strain, cerebrospinal fluid pressure (CSFp), systemic and ocular determinants of blood flow, inflammation, auto-immunity, genetics, and other non-IOP related risk factors in the physiology of ONH aging and the pathophysiology of glaucomatous damage to the ONH. The present report summarizes 20 years of technique development and study results pertinent to the characterization of ONH connective tissue deformation and remodeling in the unilateral monkey experimental glaucoma (EG) model. In it we propose that the defining pathophysiology of a glaucomatous optic neuropathy involves deformation, remodeling, and mechanical failure of the ONH connective tissues. We view this as an active process, driven by astrocyte, microglial, fibroblast and oligodendrocyte mechanobiology. These cells, and the connective tissue phenomena they propagate, have primary and secondary effects on retinal ganglion cell (RGC) axon, laminar beam and retrolaminar capillary homeostasis that may initially be "protective" but eventually lead to RGC axonal injury, repair and/or cell death. The primary goal of this report is to summarize our 3D histomorphometric and optical coherence tomography (OCT)-based evidence for the early onset and progression of ONH connective tissue deformation and remodeling in monkey EG. A second goal is to explain the importance of including ONH connective tissue processes in characterizing the phenotype of a glaucomatous optic neuropathy in all species. A third goal is to summarize our current efforts to move from ONH morphology to the cell biology of connective tissue remodeling and axonal insult early in the disease. A final goal is to facilitate the translation of our findings and ideas into neuroprotective interventions that target these ONH phenomena for therapeutic effect.
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Affiliation(s)
- Hongli Yang
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Juan Reynaud
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Howard Lockwood
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Galen Williams
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Christy Hardin
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Luke Reyes
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Cheri Stowell
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Stuart K Gardiner
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Claude F Burgoyne
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States.
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Ivers KM, Yang H, Gardiner SK, Qin L, Reyes L, Fortune B, Burgoyne CF. In Vivo Detection of Laminar and Peripapillary Scleral Hypercompliance in Early Monkey Experimental Glaucoma. Invest Ophthalmol Vis Sci 2017; 57:OCT388-403. [PMID: 27409498 PMCID: PMC4968772 DOI: 10.1167/iovs.15-18666] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare optical coherence tomography (OCT) detected, optic nerve head (ONH) compliance within control and experimental glaucoma (EG) eyes of 15 monkeys at EG onset. Methods Intraocular pressure (IOP) was chronically elevated in one eye of each animal using a laser. Experimental glaucoma onset was identified using confocal scanning laser tomography (CSLT). Optical coherence tomography ONH imaging (40 radial B-scans) was performed at 10 mm Hg before and after laser. At EG onset, OCT scans were obtained at IOP 10 and 30 mm Hg. Optical coherence tomography landmarks within the IOP 10/30 images were delineated to quantify IOP 10/30 differences (compliance) for anterior lamina cribrosa surface depth (ALCSD) relative to Bruch's membrane opening (BMO) (ALCSD-BMO), ALCSD relative to peripheral BM (ALCSD-BM), and BMO depth relative to peripheral BM (BMOD-BM). A linear mixed effects model assessed for acute IOP elevation effects, control versus EG eye effects, and their interaction Results Effects of IOP elevation were greater in EG versus control eyes for ALCSD-BMO (−46 ± 45 vs. −8 ± 13 μm, P = 0.0042) and ALCSD-BM (−92 ± 64 vs. −42 ± 22 μm, P = 0.0075). Experimental glaucoma eye-specific ALCSD-BMO and ALCSD-BM compliance exceeded the range of control eye compliance in 9 and 8 of the 15 EG eyes, respectively. Post-laser peak IOP (R2 = 0.798, P < 0.0001) and post-laser mean IOP (R2 = 0.634, P < 0.0004) most strongly correlated to EG versus control eye differences in ALCSD-BMO compliance. Conclusions Laminar (ALCSD-BMO) and peripapillary scleral (ALCSD-BM) hypercompliance are present in most monkey eyes at the onset of EG.
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Affiliation(s)
- Kevin M Ivers
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States 2Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Hongli Yang
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States 2Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Stuart K Gardiner
- Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Lirong Qin
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Luke Reyes
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Brad Fortune
- Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Claude F Burgoyne
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States 2Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
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Fortune B, Hardin C, Reynaud J, Cull G, Yang H, Wang L, Burgoyne CF. Comparing Optic Nerve Head Rim Width, Rim Area, and Peripapillary Retinal Nerve Fiber Layer Thickness to Axon Count in Experimental Glaucoma. Invest Ophthalmol Vis Sci 2017; 57:OCT404-12. [PMID: 27409499 PMCID: PMC4968911 DOI: 10.1167/iovs.15-18667] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We compare spectral-domain optical coherence tomography (SDOCT) measurements of minimum rim width (MRW), minimum rim area (MRA), and peripapillary retinal nerve fiber layer thickness (RNFLT) to complete orbital optic nerve axon counts in nonhuman primates (NHP) with unilateral experimental glaucoma (EG). Methods Biweekly SDOCT measurements of MRW, MRA, and RNFLT were acquired under manometric IOP control (10 mm Hg) in 51 NHP during baseline (mean ± SD, 5.0 ± 1.6 sessions) and after laser photocoagulation was applied to the trabecular meshwork of one eye to induce chronic IOP elevation. At the study endpoint (predefined for each NHP), 100% axon counts were obtained from each optic nerve. Results For SDOCT parameters at baseline, the correlation between the two eyes of each animal was strongest for RNFLT (R = 0.97) and MRW (R = 0.97), but lower for MRA (R = 0.85). At the final time point, average values in EG eyes relative to control eyes were: −22% for RNFLT, −38% for MRW, −36% for MRA, and −36% for optic nerve axons. The correlation with axon counts was strongest for RNFLT (R = 0.81), compared to MRW (R = 0.72, P = 0.001) or MRA (R = 0.70, P = 0.001). Diagnostic sensitivity was 75% for RNFLT, 90% for MRW, and 88% for MRA; all had 100% specificity. Conclusions Peripapillary RNFLT was correlated more closely with total orbital optic nerve axon count than were the ONH parameters MRW or MRA. This is likely because glaucomatous deformation (beyond axon loss alone) has a greater influence on the ONH parameters MRW and MRA than on RNFLT.
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Ing E, Ivers KM, Yang H, Gardiner SK, Reynaud J, Cull G, Wang L, Burgoyne CF. Cupping in the Monkey Optic Nerve Transection Model Consists of Prelaminar Tissue Thinning in the Absence of Posterior Laminar Deformation. Invest Ophthalmol Vis Sci 2017; 57:2914–2927. [PMID: 27168368 PMCID: PMC5399930 DOI: 10.1167/iovs.15-18975] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To use optical coherence tomography (OCT) to test the hypothesis that optic nerve head (ONH) “cupping” in the monkey optic nerve transection (ONT) model does not include posterior laminar deformation. Methods Five monkeys (aged 5.5–7.8 years) underwent ONH and retinal nerve fiber layer (RNFL) OCT imaging five times at baseline and biweekly following unilateral ONT until euthanization at ∼40% RNFL loss. Retinal nerve fiber layer thickness (RNFLT) and minimum rim width (MRW) were calculated from each pre- and post-ONT imaging session. The anterior lamina cribrosa surface (ALCS) was delineated within baseline and pre-euthanasia data sets. Significant ONT versus control eye pre-euthanasia change in prelaminar tissue thickness (PLTT), MRW, RNFLT, and ALCS depth (ALCSD) was determined using a linear mixed-effects model. Eye-specific change in each parameter exceeded the 95% confidence interval constructed from baseline measurements. Results Animals were euthanized 49 to 51 days post ONT. Overall ONT eye change from baseline was significant for MRW (−26.2%, P = 0.0011), RNFLT (−43.8%, P < 0.0001), PLTT (−23.8%, P = 0.0013), and ALCSD (−20.8%, P = 0.033). All five ONT eyes demonstrated significant eye-specific decreases in MRW (−23.7% to −31.8%) and RNFLT (−39.6% to −49.7%). Four ONT eyes showed significant PLTT thinning (−23.0% to −28.2%). The ALCS was anteriorly displaced in three of the ONT eyes (−25.7% to −39.2%). No ONT eye demonstrated posterior laminar displacement. Conclusions Seven weeks following surgical ONT in the monkey eye, ONH cupping involves prelaminar and rim tissue thinning without posterior deformation of the lamina cribrosa.
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Affiliation(s)
- Eliesa Ing
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Kevin M Ivers
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States 2Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Hongli Yang
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States 2Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Stuart K Gardiner
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Juan Reynaud
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States 2Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Grant Cull
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Lin Wang
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Claude F Burgoyne
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States 2Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
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Reynaud J, Lockwood H, Gardiner SK, Williams G, Yang H, Burgoyne CF. Lamina Cribrosa Microarchitecture in Monkey Early Experimental Glaucoma: Global Change. Invest Ophthalmol Vis Sci 2017; 57:3451-69. [PMID: 27362781 PMCID: PMC4961064 DOI: 10.1167/iovs.16-19474] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to characterize experimental glaucoma (EG) versus control eye differences in lamina cribrosa (LC), beam diameter (BD), pore diameter (PD), connective tissue volume fraction (CTVF), connective tissue volume (CTV), and LC volume (LV) in monkey early EG. Methods Optic nerve heads (ONHs) of 14 unilateral EG and 6 bilateral normal (BN) monkeys underwent three-dimensional reconstruction and LC beam segmentation. Each beam and pore voxel was assigned a diameter based on the largest sphere that contained it before transformation to a common cylinder with inner, middle, and outer layers. Full-thickness and layer averages for BD, PD, CTVF, CTV, and LV were calculated for each ONH. Beam diameter and PD distributions for each ONH were fit to a gamma distribution and summarized by scale and shape parameters. Experimental glaucoma and depth effects were assessed for each parameter by linear mixed-effects (LME) modeling. Animal-specific EG versus control eye differences that exceeded the maximum intereye difference among the six BN animals were considered significant. Results Overall EG eye mean PD was 12.8% larger (28.2 ± 5.6 vs. 25.0 ± 3.3 μm), CTV was 26.5% larger (100.06 ± 47.98 vs. 79.12 ± 28.35 × 106 μm3), and LV was 40% larger (229.29 ± 98.19 vs. 163.63 ± 39.87 × 106 μm3) than control eyes (P ≤ 0.05, LME). Experimental glaucoma effects were significantly different by layer for PD (P = 0.0097) and CTVF (P < 0.0001). Pore diameter expanded consistently across all PDs. Experimental glaucoma eye-specific parameter change was variable in magnitude and direction. Conclusions Pore diameter, CTV, and LV increase in monkey early EG; however, EG eye-specific change is variable and includes both increases and decreases in BD and CTVF.
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Affiliation(s)
- Juan Reynaud
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States 2Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Howard Lockwood
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States 2Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Stuart K Gardiner
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Galen Williams
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States 2Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Hongli Yang
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States 2Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Claude F Burgoyne
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States 2Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
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Fortune B, Reynaud J, Hardin C, Wang L, Sigal IA, Burgoyne CF. Experimental Glaucoma Causes Optic Nerve Head Neural Rim Tissue Compression: A Potentially Important Mechanism of Axon Injury. Invest Ophthalmol Vis Sci 2017; 57:4403-11. [PMID: 27564522 PMCID: PMC5016000 DOI: 10.1167/iovs.16-20000] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose We tested the hypothesis that experimental glaucoma (EG) results in greater thinning of the optic nerve head (ONH) neural rim tissue than the peripapillary retinal nerve fiber layer (RNFL) tissue. Methods Longitudinal spectral-domain optical coherence tomography (SDOCT) imaging of the ONH and peripapillary RNFL was performed every other week under manometric IOP control (10 mm Hg) in 51 nonhuman primates (NHP) during baseline and after induction of unilateral EG. The ONH parameter minimum rim area (MRA) was derived from 80 radial B-scans centered on the ONH; RNFL cross-sectional area (RNFLA) from a peripapillary circular B-scan with 12° diameter. Results In control eyes, MRA was 1.00 ± 0.19 mm2 at baseline and 1.00 ± 0.19 mm2 at the final session (P = 0.77), while RNFLA was 0.95 ± 0.09 and 0.95 ± 0.10 mm2, respectively (P = 0.96). In EG eyes, MRA decreased from 1.00 ± 0.19 mm2 at baseline to 0.63 ± 0.21 mm2 at the final session (P < 0.0001), while RNFLA decreased from 0.95 ± 0.09 to 0.74 ± 0.19 mm2, respectively (P < 0.0001). Thus, MRA decreased by 36.4 ± 20.6% in EG eyes, significantly more than the decrease in RNFLA (21.7 ± 19.4%, P < 0.0001). Other significant changes in EG eyes included increased Bruch's membrane opening (BMO) nonplanarity (P < 0.05), decreased BMO aspect ratio (P < 0.0001), and decreased MRA angle (P < 0.001). Bruch's membrane opening area did not change from baseline in either control or EG eyes (P = 0.27, P = 0.15, respectively). Conclusions Optic nerve head neural rim tissue thinning exceeded peripapillary RNFL thinning in NHP EG. These results support the hypothesis that axon bundles are compressed transversely within the ONH rim along with glaucomatous deformation of connective tissues.
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Affiliation(s)
- Brad Fortune
- Discoveries in Sight Research Laboratories Devers Eye Institute and Legacy Research Institute, Legacy Health, Portland, Oregon, United States
| | - Juan Reynaud
- Discoveries in Sight Research Laboratories Devers Eye Institute and Legacy Research Institute, Legacy Health, Portland, Oregon, United States
| | - Christy Hardin
- Discoveries in Sight Research Laboratories Devers Eye Institute and Legacy Research Institute, Legacy Health, Portland, Oregon, United States
| | - Lin Wang
- Discoveries in Sight Research Laboratories Devers Eye Institute and Legacy Research Institute, Legacy Health, Portland, Oregon, United States
| | - Ian A Sigal
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Claude F Burgoyne
- Discoveries in Sight Research Laboratories Devers Eye Institute and Legacy Research Institute, Legacy Health, Portland, Oregon, United States
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Stowell C, Burgoyne CF, Tamm ER, Ethier CR. Biomechanical aspects of axonal damage in glaucoma: A brief review. Exp Eye Res 2017; 157:13-19. [PMID: 28223180 DOI: 10.1016/j.exer.2017.02.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 02/13/2017] [Indexed: 02/06/2023]
Abstract
The biomechanical environment within the optic nerve head (ONH) is complex and is likely directly involved in the loss of retinal ganglion cells (RGCs) in glaucoma. Unfortunately, our understanding of this process is poor. Here we describe factors that influence ONH biomechanics, including ONH connective tissue microarchitecture and anatomy; intraocular pressure (IOP); and cerebrospinal fluid pressure (CSFp). We note that connective tissue factors can vary significantly from one individual to the next, as well as regionally within an eye, and that the understanding of ONH biomechanics is hindered by anatomical differences between small-animal models of glaucoma (rats and mice) and humans. Other challenges of using animal models of glaucoma to study the role of biomechanics include the complexity of assessing the degree of glaucomatous progression; and inadequate tools for monitoring and consistently elevating IOP in animal models. We conclude with a consideration of important open research questions/challenges in this area, including: (i) Creating a systems biology description of the ONH; (ii) addressing the role of astrocyte connective tissue remodeling and reactivity in glaucoma; (iii) providing a better characterization of ONH astrocytes and non-astrocytic constituent cells; (iv) better understanding the role of ONH astrocyte phagocytosis, proliferation and death; (v) collecting gene expression and phenotype data on a larger, more coordinated scale; and (vi) developing an implantable IOP sensor.
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Affiliation(s)
- Cheri Stowell
- Optic Nerve Head Research Laboratory, Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Health System, Portland, Oregon, USA
| | - Claude F Burgoyne
- Optic Nerve Head Research Laboratory, Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Health System, Portland, Oregon, USA
| | - Ernst R Tamm
- Institute of Human Anatomy and Embryology, University of Regensburg, Regensburg, Germany
| | - C Ross Ethier
- Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA, USA.
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Wilsey LJ, Reynaud J, Cull G, Burgoyne CF, Fortune B. Macular Structure and Function in Nonhuman Primate Experimental Glaucoma. Invest Ophthalmol Vis Sci 2016; 57:1892-900. [PMID: 27082305 PMCID: PMC4849889 DOI: 10.1167/iovs.15-18119] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate structure and function of macular retinal layers in nonhuman primate (NHP) experimental glaucoma (EG). Methods Twenty-one NHP had longitudinal imaging of macular structure by SDOCT, 16 also had recordings of function by multifocal ERG. The average thickness over 15° was derived for seven individual SDOCT layers: macular nerve fiber layer (m-NFL), retinal ganglion cell layer (RGCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer+inner segments combined (ONL+IS), and outer segments (OS). Peripapillary RNFL thickness (ppRNFLT) was measured from a single circular B-scan with 12° diameter. Responses to a slow-sequence multifocal ERG (mfERG) stimulus (7F) were filtered (at 75 Hz) into low- and high-frequency components (LFC, HFC). Results At final follow-up, significant structural loss occurred only in EG eyes and only for ppRNFLT (−29 ± 23%), m-NFL (−17 ± 16%), RGCL (−22 ± 15%), and IPL (−19 ± 14%); though there was also a small increase in OPL (+6 ± 7%) and ONL+IS (4 ± 4%) and a similar tendency for INL. Macular structural loss was correlated with ppRNFLT only for the NFL, RGCL and IPL (R = 0.95, 0.93 and 0.95, respectively, P < 0.0001). Significant functional loss occurred only for HFC and N2 in EG eyes. Significant longitudinal structure–function correlations (P < 0.01) were observed only in EG eyes and only for mfERG HFC and N2: HFC was correlated with ppRNFLT (R = 0.69), macular NFL (R = 0.67), RGCL (R = 0.74), and IPL (R = 0.72); N2 was correlated with RGCL (R = 0.54) and IPL (R = 0.48). High-frequency components amplitude change was inversely correlated with outer retinal thickness change (= −0.66). Conclusions Macular structural and functional losses are correlated and specific to ganglion cells over a wide range of EG severity. Outer retinal changes are likely due to inner retinal loss.
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Told R, Wang L, Cull G, Thompson SJ, Burgoyne CF, Aschinger GC, Schmetterer L, Werkmeister RM. Total Retinal Blood Flow in a Nonhuman Primate Optic Nerve Transection Model Using Dual-Beam Bidirectional Doppler FD-OCT and Microsphere Method. Invest Ophthalmol Vis Sci 2016; 57:1432-40. [PMID: 27031838 DOI: 10.1167/iovs.16-19140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We validated noninvasive Doppler-optical coherence tomography (OCT) blood flow measurements against the terminal microsphere method in a surgical induced optic nerve transection nonhuman primate model. METHODS In 6 nonhuman primates, total retinal blood flow (TRBF) was measured with a custom-built dual-beam bidirectional Doppler Fourier Domain (FD)-OCT. Peripapillary retinal nerve fiber layer thickness (RNFLT) was measured by Spectralis spectral-domain (SD)-OCT. Measurements were performed every 10 to 15 days before and after unilateral optic nerve transection (ONT) until RNFLT was reduced by more than 40% from baseline. Before the animals were killed, TRBF was measured using the microsphere technique. RESULTS A significant correlation between all arterial and venous Doppler OCT TRBF measurements was found in ONT and contralateral control eyes (both P < 0.01, n = 6). The Bland-Altman analysis showed a bias of 0.57 in the ONT group and 0.02 in the contralateral control group. Also, excellent agreement was observed between Doppler OCT and microsphere measurements (P < 0.01, r = 0.976, bias = 0.54). After ONT, TRBF and RNFLT decreased by -51% ± 42% and -44% ± 2% (n = 5), respectively. In the contralateral control eyes, TRBF and RNFLT were unchanged. CONCLUSIONS Very good accordance was found between TRBF measurements, obtained with dual-beam bidirectional Doppler FD-OCT and the microsphere method. It also was possible to monitor changes over time in TRBF after ONT with Doppler OCT. These findings highlight the accuracy and potential of noninvasive Doppler OCT to provide valuable information for detecting early changes in ocular disease in future.
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Affiliation(s)
- Reinhard Told
- Center for Medical Physics and Biomedical Engineering Medical University of Vienna, Vienna, Austria 2Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Lin Wang
- Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Grant Cull
- Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Simon J Thompson
- Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Claude F Burgoyne
- Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Gerold C Aschinger
- Center for Medical Physics and Biomedical Engineering Medical University of Vienna, Vienna, Austria 3Institute of Applied Physics, Vienna University of Technology, Vienna, Austria
| | - Leopold Schmetterer
- Center for Medical Physics and Biomedical Engineering Medical University of Vienna, Vienna, Austria 4Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - René M Werkmeister
- Center for Medical Physics and Biomedical Engineering Medical University of Vienna, Vienna, Austria
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Yang H, Ren R, Lockwood H, Williams G, Libertiaux V, Downs C, Gardiner SK, Burgoyne CF. The Connective Tissue Components of Optic Nerve Head Cupping in Monkey Experimental Glaucoma Part 1: Global Change. Invest Ophthalmol Vis Sci 2016; 56:7661-78. [PMID: 26641545 DOI: 10.1167/iovs.15-17624] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To characterize optic nerve head (ONH) connective tissue change within 21 monkey experimental glaucoma (EG) eyes, so as to identify its principal components. METHODS Animals were imaged three to five times at baseline then every 2 weeks following chronic unilateral IOP elevation, and euthanized early through end-stage confocal scanning laser tomographic change. Optic nerve heads were serial-sectioned, three-dimensionally (3D) reconstructed, delineated, and quantified. Overall EG versus control eye differences were assessed by general estimating equations (GEE). Significant, animal-specific, EG eye change was required to exceed the maximum physiologic intereye differences in six healthy animals. RESULTS Overall EG eye change was significant (P < 0.0026) and animal-specific EG eye change most frequent, for five phenomena (number of EG eyes and range of animal-specific change): posterior laminar deformation (21, -29 to -437 μm), laminar thickening (11, 20-73 μm) and thinning (3, -23 to -31 μm), scleral canal expansion (17, 20-139 μm), outward anterior (16, -16 to -124 μm) and posterior (17, -22 to -279 μm) laminar insertion migration, and peripapillary scleral bowing (11, 21-77 μm). Experimental glaucoma versus control eye laminar thickness differences were bimodal in behavior, being thickened in most EG eyes demonstrating the least deformation and less thickened or thinned in most EG eyes demonstrating the greatest deformation. CONCLUSIONS Our postmortem studies retrospectively identify five connective tissue components of ONH "cupping" in monkey EG which serve as targets for longitudinally staging and phenotyping ONH connective tissue alteration within all forms of monkey and human optic neuropathy.
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Affiliation(s)
- Hongli Yang
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States 2Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
| | - Ruojin Ren
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States 2Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
| | - Howard Lockwood
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States 2Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
| | - Galen Williams
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States 2Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
| | - Vincent Libertiaux
- Department of Ophthalmology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - Crawford Downs
- Department of Ophthalmology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - Stuart K Gardiner
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
| | - Claude F Burgoyne
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, United States 2Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, United States
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Cull G, Told R, Burgoyne CF, Thompson S, Fortune B, Wang L. Compromised Optic Nerve Blood Flow and Autoregulation Secondary to Neural Degeneration. Invest Ophthalmol Vis Sci 2016; 56:7286-92. [PMID: 26551332 DOI: 10.1167/iovs.15-17879] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To test the hypothesis that optic nerve head (ONH) blood flow (BF) and autoregulation compromise are consequences of optic nerve degeneration induced by surgical optic nerve transection (ONT). METHODS In both eyes of five nonhuman primates, peripapillary retinal nerve fiber layer thickness (RNFLT) was measured by spectral-domain optical coherence tomography. Optic nerve head BF and dynamic autoregulation responses to a rapid manometric IOP increase (from 10-40 mm Hg) were measured by Laser Speckle Flowgraphy. The measurements were conducted every 10 to 15 days before and after unilateral ONT. Post-ONT measurements were repeated until RNFLT in the ONT eye was reduced by more than 40% of baseline value. RESULTS After ONT, RNFLT, and ONH BF progressively declined over time (P < 0.0001 and P = 0.02, respectively). Longitudinal changes between the two were highly correlated (P < 0.0001). When data was grouped by test session, the first significant decreases for RNFLT and BF were found 13 ± 0.8 and 24 ± 3.2 days post ONT, respectively (P < 0.05, both). At the final time point (55 ± 0.5 days post ONT), RNFLT, and BF were reduced by 44% ± 2.0% and 38 ± 5.0% from baseline, respectively. Dynamic autoregulation analysis showed marginal increased response time in post-ONT eyes (P = 0.05). Control eyes showed no longitudinal changes for any parameter. CONCLUSIONS The close association between RNFLT loss and ONH BF decrease following optic nerve degeneration demonstrated a clear cause and effect relationship. Increased BF response time appears to be a sign of dynamic autoregulation dysfunction in this ONT model.
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Affiliation(s)
- Grant Cull
- Devers Eye Institute Legacy Research Institute, Portland, Oregon, United States
| | - Reinhard Told
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Claude F Burgoyne
- Devers Eye Institute Legacy Research Institute, Portland, Oregon, United States
| | - Simon Thompson
- Devers Eye Institute Legacy Research Institute, Portland, Oregon, United States
| | - Brad Fortune
- Devers Eye Institute Legacy Research Institute, Portland, Oregon, United States
| | - Lin Wang
- Devers Eye Institute Legacy Research Institute, Portland, Oregon, United States
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Gardiner SK, Boey PY, Yang H, Fortune B, Burgoyne CF, Demirel S. Structural Measurements for Monitoring Change in Glaucoma: Comparing Retinal Nerve Fiber Layer Thickness With Minimum Rim Width and Area. Invest Ophthalmol Vis Sci 2016; 56:6886-91. [PMID: 26501416 DOI: 10.1167/iovs.15-16701] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Minimum rim width (MRW) and area (MRA) have been introduced as anatomically defensible measures of neuroretinal rim tissue observable using spectral-domain optical coherence tomography (SDOCT). They have been reported to change earlier than retinal nerve fiber layer thickness (RNFLT) in glaucoma. This study sought to determine which is better to distinguish subsequent change from variability, using the previously described longitudinal signal-to-noise ratio (LSNR). METHODS Data from 157 eyes of 157 participants with high-risk ocular hypertension or non-end-stage glaucoma (mean deviation [MD] from -22 to +3 dB) were used. Participants were tested approximately every 6 months for at least six visits. For each eye, MRW, MRA, and RNFLT were regressed linearly against time. Longitudinal signal-to-noise ratio for each eye was defined as the rate of change over time (signal) divided by the standard deviation of residuals from this trend (noise). These were compared between parameters using a Wilcoxon signed rank test. RESULTS The median LSNRs were -0.58y⁻¹ for RNFLT (bootstrapped 95% confidence interval -0.69 to -0.48y⁻¹); -0.44y⁻¹ (-0.59 to -0.32y⁻¹) for MRW; and -0.23y⁻¹ (-0.32 to -0.08y⁻¹) for MRA. Longitudinal signal-to-noise ratios were significantly more negative for RNFLT than for MRW (P = 0.025) or for MRA (P < 0.001). CONCLUSIONS Retinal nerve fiber layer thickness measured by SDOCT had a better LSNR than MRW or MRA. Although MRW and MRA may be more sensitive for early detection of glaucomatous damage, these data suggest that RNFLT may be preferable for monitoring change.
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Affiliation(s)
| | | | - Hongli Yang
- Devers Eye Institute Legacy Health, Portland, Oregon, United States
| | - Brad Fortune
- Devers Eye Institute Legacy Health, Portland, Oregon, United States
| | | | - Shaban Demirel
- Devers Eye Institute Legacy Health, Portland, Oregon, United States
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Pazos M, Yang H, Gardiner SK, Cepurna WO, Johnson EC, Morrison JC, Burgoyne CF. Expansions of the neurovascular scleral canal and contained optic nerve occur early in the hypertonic saline rat experimental glaucoma model. Exp Eye Res 2015; 145:173-186. [PMID: 26500195 DOI: 10.1016/j.exer.2015.10.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/14/2015] [Accepted: 10/16/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To characterize early optic nerve head (ONH) structural change in rat experimental glaucoma (EG). METHODS Unilateral intraocular pressure (IOP) elevation was induced in Brown Norway rats by hypertonic saline injection into the episcleral veins and animals were sacrificed 4 weeks later by perfusion fixation. Optic nerve cross-sections were graded from 1 (normal) to 5 (extensive injury) by 5 masked observers. ONHs with peripapillary retina and sclera were embedded, serial sectioned, 3-D reconstructed, delineated, and quantified. Overall and animal-specific EG versus Control eye ONH parameter differences were assessed globally and regionally by linear mixed effect models with significance criteria adjusted for multiple comparisons. RESULTS Expansions of the optic nerve and surrounding anterior scleral canal opening achieved statistical significance overall (p < 0.0022), and in 7 of 8 EG eyes (p < 0.005). In at least 5 EG eyes, significant expansions (p < 0.005) in Bruch's membrane opening (BMO) (range 3-10%), the anterior and posterior scleral canal openings (8-21% and 5-21%, respectively), and the optic nerve at the anterior and posterior scleral canal openings (11-30% and 8-41%, respectively) were detected. Optic nerve expansion was greatest within the superior and inferior quadrants. Optic nerve expansion at the posterior scleral canal opening was significantly correlated to optic nerve damage (R = 0.768, p = 0.042). CONCLUSION In the rat ONH, the optic nerve and surrounding BMO and neurovascular scleral canal expand early in their response to chronic experimental IOP elevation. These findings provide phenotypic landmarks and imaging targets for detecting the development of experimental glaucomatous optic neuropathy in the rat eye.
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Affiliation(s)
- Marta Pazos
- Hospital de l'Esperança, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hongli Yang
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, USA
| | - Stuart K Gardiner
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, USA
| | - William O Cepurna
- Kenneth C. Swan Ocular Neurobiology Laboratory, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Elaine C Johnson
- Kenneth C. Swan Ocular Neurobiology Laboratory, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - John C Morrison
- Kenneth C. Swan Ocular Neurobiology Laboratory, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Claude F Burgoyne
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, USA.
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Fortune B, Cull G, Reynaud J, Wang L, Burgoyne CF. Relating Retinal Ganglion Cell Function and Retinal Nerve Fiber Layer (RNFL) Retardance to Progressive Loss of RNFL Thickness and Optic Nerve Axons in Experimental Glaucoma. Invest Ophthalmol Vis Sci 2015; 56:3936-44. [PMID: 26087359 DOI: 10.1167/iovs.15-16548] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To relate changes in retinal function and retinal nerve fiber layer (RNFL) retardance to loss of RNFL thickness and optic nerve axon counts in a nonhuman primate (NHP) model of experimental glaucoma (EG). METHODS Bilateral longitudinal measurements of peripapillary RNFL thickness (spectral-domain optical coherence tomography, SDOCT; Spectralis), retardance (GDxVCC), and multifocal electroretinography (mfERG; VERIS) were performed in 39 NHP at baseline (BL; median, 5 recordings; range, 3-10) and weekly after induction of unilateral EG by laser photocoagulation of the trabecular meshwork. Multifocal ERG responses were high-pass filtered (>75 Hz) to measure high- and low-frequency component (HFC and LFC) amplitudes, including LFC features N1, P1, and N2. High-frequency component amplitudes are known to specifically reflect retinal ganglion cell (RGC) function. Complete (100%) axon counts of orbital optic nerves were obtained in 31/39 NHP. RESULTS Postlaser follow-up was 10.4 ± 7.9 months; mean and peak IOP were 18 ± 5 and 41 ± 11 mm Hg in EG eyes, 11 ± 2 and 18 ± 6 mm Hg in control (CTL) eyes. At the final available time point, RNFL thickness had decreased from BL by 14 ± 14%, retardance by 20 ± 11%, and the mfERG HFC by 30 ± 17% (P < 0.0001 each). Longitudinal changes in retardance and HFC were linearly related to RNFL thickness change (R2 = 0.51, P < 0.0001 and R2 = 0.22, P = 0.002, respectively); LFC N2 was weakly related but N1 or P2 (N1: R2 = 0.07, P = 0.11; P1: R2 = 0.04, P = 0.24; N2: R2 = 0.13, P = 0.02). At zero change from BL for RNFL thickness (Y-intercept), retardance was reduced by 11% (95% confidence interval [CI]: -15.3% to -6.8%) and HFC by 21.5% (95% CI: -28.7% to -14.3%). Relative loss of RNFL thickness, retardance, and HFC (EG:CTL) were each related to axon loss (R2 = 0.66, P < 0.0001; R2 = 0.42, P < 0.0001; R2 = 0.42, P < 0.0001, respectively), but only retardance and HFC were significantly reduced at zero relative axon loss (Y-intercept; retardance: -9.4%, 95% CI: -15.5% to -3.4%; HFC: -10.9%, 95% CI: -18.6% to -3.2%; RNFL thickness: +1.8%, 95% CI: -4.9% to +5.4%). CONCLUSIONS Retinal nerve fiber layer retardance and RGC function exhibit progressive loss from baseline before any loss of RNFL thickness or orbital optic nerve axons occurs in NHP EG. These in vivo measures might serve as potential biomarkers of early-stage glaucomatous damage preceding axon loss and RGC death.
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Chauhan BC, Danthurebandara VM, Sharpe GP, Demirel S, Girkin CA, Mardin CY, Scheuerle AF, Burgoyne CF. Bruch's Membrane Opening Minimum Rim Width and Retinal Nerve Fiber Layer Thickness in a Normal White Population: A Multicenter Study. Ophthalmology 2015. [PMID: 26198806 DOI: 10.1016/j.ophtha.2015.06.001] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Conventional optic disc margin-based neuroretinal rim measurements lack a solid anatomic and geometrical basis. An optical coherence tomography (OCT) index, Bruch's membrane opening minimum rim width (BMO-MRW), addresses these deficiencies and has higher diagnostic accuracy for glaucoma. We characterized BMO-MRW and peripapillary retinal nerve fiber layer thickness (RNFLT) in a normal population. DESIGN Multicenter cross-sectional study. PARTICIPANTS Normal white subjects. METHODS An approximately equal number of subjects in each decade group (20-90 years of age) was enrolled in 5 centers. Subjects had normal ocular and visual field examination results. We obtained OCT images of the optic nerve head (24 radial scans) and peripapillary retina (1 circular scan). The angle between the fovea and BMO center (FoBMO angle), relative to the horizontal axis of the image frame, was first determined and all scans were acquired and analyzed relative to this eye-specific FoBMO axis. Variation in BMO-MRW and RNFLT was analyzed with respect to age, sector, and BMO shape. MAIN OUTCOME MEASURES Age-related decline and between-subject variability in BMO-MRW and RNFLT. RESULTS There were 246 eyes of 246 subjects with a median age of 52.9 years (range, 19.8-87.3 years). The median FoBMO angle was -6.7° (range, 2.5° to -17.5°). The BMO was predominantly vertically oval with a median area of 1.74 mm(2) (range, 1.05-3.40 mm(2)). Neither FoBMO angle nor BMO area was associated with age or axial length. Both global mean BMO-MRW and RNFLT declined with age at a rate of -1.34 μm/year and -0.21 μm/year, equivalent to 4.0% and 2.1% loss per decade of life, respectively. Sectorially, the most rapid decrease occurred inferiorly and the least temporally; however, the age association was always stronger with BMO-MRW than with RNFLT. There was a modest relationship between mean global BMO-MRW and RNFLT (r = 0.35), whereas sectorially the relationship ranged from moderate (r = 0.45, inferotemporal) to nonexistent (r = 0.01, temporal). CONCLUSIONS There was significant age-related loss of BMO-MRW in healthy subjects and notable differences between BMO-MRW and RNFLT in their relationship with age and between each other. Adjusting BMO-MRW and RNFLT for age and sector is important in ensuring optimal diagnostics for glaucoma.
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Affiliation(s)
- Balwantray C Chauhan
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada.
| | | | - Glen P Sharpe
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada
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Lockwood H, Reynaud J, Gardiner S, Grimm J, Libertiaux V, Downs JC, Yang H, Burgoyne CF. Lamina cribrosa microarchitecture in normal monkey eyes part 1: methods and initial results. Invest Ophthalmol Vis Sci 2015; 56:1618-37. [PMID: 25650423 DOI: 10.1167/iovs.14-15967] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To introduce quantitative postmortem lamina cribrosa (LC) microarchitecture (LMA) assessment and characterize beam diameter (BD), pore diameter (PD), and connective tissue volume fraction (CTVF) in 21 normal monkey eyes. METHODS Optic nerve heads (ONHs) underwent digital three-dimensional (3D) reconstruction and LC beam segmentation. Each beam and pore voxel was assigned a diameter based on the largest sphere that contained it before transformation to one of twelve 30° sectors in a common cylinder. Mean BD, PD, and CTVF within 12 central and 12 peripheral subsectors and within inner, middle, and outer LC depths were assessed for sector, subsector, and depth effects by analysis of variance using general estimating equations. Eye-specific LMA discordance (the pattern of lowest connective tissue density) was plotted for each parameter. RESULTS The ranges of mean BD, PD, and CTVF were 14.0 to 23.1 μm, 20.0 to 35.6 μm, and 0.247 to 0.638, respectively. Sector, subsector, and depth effects were significant (P < 0.01) for all parameters except subsector on CTVF. Beam diameter and CTVF were smaller and PD was larger within the superior-temporal (ST) and inferior-temporal (IT) sectors (P < 0.05). These differences were enhanced within the central versus peripheral subsectors. Beam diameter and CTVF were larger and PD was smaller (P < 0.05) within the middle LC layer. Lamina cribrosa microarchitecture discordance most commonly occurred within the ST and IT sectors, varied by eye, and generally diminished as CTVF increased. CONCLUSIONS Our data support previous characterizations of diminished connective tissue density within the ST and IT ONH regions. The clinical importance of eye-specific LMA discordance warrants further study.
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Affiliation(s)
- Howard Lockwood
- Optic Nerve Head Research Laboratory, Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Health, Portland, Oregon, United States Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| | - Juan Reynaud
- Optic Nerve Head Research Laboratory, Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Health, Portland, Oregon, United States Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| | - Stuart Gardiner
- Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| | - Jonathan Grimm
- Ocular Biomechanics Laboratory, Department of Ophthalmology, UPMC Eye Center, Ophthalmology and Visual Science Research Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Vincent Libertiaux
- Department of Ophthalmology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - J Crawford Downs
- Department of Ophthalmology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - Hongli Yang
- Optic Nerve Head Research Laboratory, Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Health, Portland, Oregon, United States Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| | - Claude F Burgoyne
- Optic Nerve Head Research Laboratory, Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Health, Portland, Oregon, United States Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Health, Portland, Oregon, United States
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Abbott CJ, Choe TE, Burgoyne CF, Cull G, Wang L, Fortune B. Comparison of retinal nerve fiber layer thickness in vivo and axonal transport after chronic intraocular pressure elevation in young versus older rats. PLoS One 2014; 9:e114546. [PMID: 25501362 PMCID: PMC4263742 DOI: 10.1371/journal.pone.0114546] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 11/11/2014] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To compare in young and old rats longitudinal measurements of retinal nerve fiber layer thickness (RNFLT) and axonal transport 3-weeks after chronic IOP elevation. METHOD IOP was elevated unilaterally in 2- and 9.5-month-old Brown-Norway rats by intracameral injections of magnetic microbeads. RNFLT was measured by spectral domain optical coherence tomography. Anterograde axonal transport was assessed from confocal scanning laser ophthalmolscopy of superior colliculi (SC) after bilateral intravitreal injections of cholera toxin-B-488. Optic nerve sections were graded for damage. RESULTS Mean IOP was elevated in both groups (young 37, old 38 mmHg, p = 0.95). RNFL in young rats exhibited 10% thickening at 1-week (50.9±8.1 µm, p<0.05) vs. baseline (46.4±2.4 µm), then 7% thinning at 2-weeks (43.0±7.2 µm, p>0.05) and 3-weeks (43.5±4.4 µm, p>0.05), representing 20% loss of dynamic range. RNFLT in old rats showed no significant change at 1-week (44.9±4.1 µm) vs. baseline (49.2±5.3 µm), but progression to 22% thinning at 2-weeks (38.0±3.7 µm, p<0.01) and 3-weeks (40.0±6.6 µm, p<0.05), representing 59% loss of dynamic range. Relative SC fluorescence intensity was reduced in both groups (p<0.001), representing 77-80% loss of dynamic range and a severe transport deficit. Optic nerves showed 75-95% damage (p<0.001). There was greater RNFL thinning in old rats (p<0.05), despite equivalent IOP insult, transport deficit and nerve damage between age groups (all p>0.05). CONCLUSION Chronic IOP elevation resulted in severely disrupted axonal transport and optic nerve axon damage in all rats, associated with mild RNFL loss in young rats but a moderate RNFL loss in old rats despite the similar IOP insult. Hence, the glaucomatous injury response within the RNFL depends on age.
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Affiliation(s)
- Carla J. Abbott
- Discoveries in Sight Research Laboratories, Devers Eye Institute and Legacy Research Institute, Legacy Health, Portland, Oregon, United States of America
| | - Tiffany E. Choe
- Discoveries in Sight Research Laboratories, Devers Eye Institute and Legacy Research Institute, Legacy Health, Portland, Oregon, United States of America
| | - Claude F. Burgoyne
- Discoveries in Sight Research Laboratories, Devers Eye Institute and Legacy Research Institute, Legacy Health, Portland, Oregon, United States of America
| | - Grant Cull
- Discoveries in Sight Research Laboratories, Devers Eye Institute and Legacy Research Institute, Legacy Health, Portland, Oregon, United States of America
| | - Lin Wang
- Discoveries in Sight Research Laboratories, Devers Eye Institute and Legacy Research Institute, Legacy Health, Portland, Oregon, United States of America
| | - Brad Fortune
- Discoveries in Sight Research Laboratories, Devers Eye Institute and Legacy Research Institute, Legacy Health, Portland, Oregon, United States of America
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Yang H, He L, Gardiner SK, Reynaud J, Williams G, Hardin C, Strouthidis NG, Downs JC, Fortune B, Burgoyne CF. Age-related differences in longitudinal structural change by spectral-domain optical coherence tomography in early experimental glaucoma. Invest Ophthalmol Vis Sci 2014; 55:6409-20. [PMID: 25190652 DOI: 10.1167/iovs.14-14156] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To characterize age-related differences in the magnitude of spectral-domain optical coherence tomography (SD-OCT) structural change in early experimental glaucoma (EG). METHODS Both eyes from four young (1.4-2.6 years) and four old (18.6-21.9 years) rhesus monkeys were imaged at least three times at baseline, and then every 2 weeks after laser-induced, chronic, unilateral IOP elevation until the onset of EG (confocal scanning laser tomographic surface change confirmed twice). Two to 20 weeks after EG onset, animals were euthanized and optic nerve axon counts for all eyes were performed. Masked operators delineated retinal and ONH landmarks in 40 radial B-scans from each eye and imaging session to quantify change from baseline in five SD-OCT neural and connective tissue parameters. The effects of EG, age, and EG × age interactions on the magnitude, rate (magnitude per postlaser time), and IOP responsiveness (magnitude per cumulative IOP insult) of postlaser parameter change were individually assessed using general estimating equation models. RESULTS Presac SD-OCT RNFLT and minimum rim width change and postmortem axon loss was not significantly different in old compared with young EG eyes. The rate of change and IOP responsiveness of the parameters anterior lamina cribrosa surface depth relative to Bruch's membrane opening (BMO) and BMO depth relative to peripheral Bruch's membrane were significantly lower (P < 0.05) in the old compared with the young EG eyes. CONCLUSIONS At similar postlaser times, levels of cumulative IOP insult and axonal damage, SD-OCT-detected ONH connective tissue structural change is greater in young compared with old monkey EG eyes.
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Affiliation(s)
- Hongli Yang
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Health, Portland, Oregon, United States Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| | - Lin He
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Health, Portland, Oregon, United States Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| | - Stuart K Gardiner
- Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| | - Juan Reynaud
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Health, Portland, Oregon, United States Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| | - Galen Williams
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Health, Portland, Oregon, United States Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| | - Christy Hardin
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Health, Portland, Oregon, United States Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| | - Nicholas G Strouthidis
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
| | - J Crawford Downs
- Ocular Biomechanics and Biotransport Program, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - Brad Fortune
- Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| | - Claude F Burgoyne
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Health, Portland, Oregon, United States Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Health, Portland, Oregon, United States
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Fortune B, Reynaud J, Cull G, Burgoyne CF, Wang L. The Effect of Age on Optic Nerve Axon Counts, SDOCT Scan Quality, and Peripapillary Retinal Nerve Fiber Layer Thickness Measurements in Rhesus Monkeys. Transl Vis Sci Technol 2014; 3:2. [PMID: 24932430 DOI: 10.1167/tvst.3.3.2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 04/01/2014] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate the effect of age on optic nerve axon counts, spectral-domain optical coherence tomography (SDOCT) scan quality, and peripapillary retinal nerve fiber layer thickness (RNFLT) measurements in healthy monkey eyes. METHODS In total, 83 healthy rhesus monkeys were included in this study (age range: 1.2-26.7 years). Peripapillary RNFLT was measured by SDOCT. An automated algorithm was used to count 100% of the axons and measure their cross-sectional area in postmortem optic nerve tissue samples (N = 46). Simulation experiments were done to determine the effects of optical changes on measurements of RNFLT. An objective, fully-automated method was used to measure the diameter of the major blood vessel profiles within each SDOCT B-scan. RESULTS Peripapillary RNFLT was negatively correlated with age in cross-sectional analysis (P < 0.01). The best-fitting linear model was RNFLT(μm) = -0.40 × age(years) + 104.5 μm (R2 = 0.1, P < 0.01). Age had very little influence on optic nerve axon count; the result of the best-fit linear model was axon count = -1364 × Age(years) + 1,210,284 (R2 < 0.01, P = 0.74). Older eyes lost the smallest diameter axons and/or axons had an increased diameter in the optic nerve of older animals. There was an inverse correlation between age and SDOCT scan quality (R = -0.65, P < 0.0001). Simulation experiments revealed that approximately 17% of the apparent cross-sectional rate of RNFLT loss is due to reduced scan quality associated with optical changes of the aging eye. Another 12% was due to thinning of the major blood vessels. CONCLUSIONS RNFLT declines by 4 μm per decade in healthy rhesus monkey eyes. This rate is approximately three times faster than loss of optic nerve axons. Approximately one-half of this difference is explained by optical degradation of the aging eye reducing SDOCT scan quality and thinning of the major blood vessels. TRANSLATIONAL RELEVANCE Current models used to predict retinal ganglion cell losses should be reconsidered.
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Affiliation(s)
- Brad Fortune
- Discoveries in Sight Research Laboratories, Devers Eye Institute, and Legacy Research Institute, Legacy Health, Portland, OR
| | - Juan Reynaud
- Discoveries in Sight Research Laboratories, Devers Eye Institute, and Legacy Research Institute, Legacy Health, Portland, OR
| | - Grant Cull
- Discoveries in Sight Research Laboratories, Devers Eye Institute, and Legacy Research Institute, Legacy Health, Portland, OR
| | - Claude F Burgoyne
- Discoveries in Sight Research Laboratories, Devers Eye Institute, and Legacy Research Institute, Legacy Health, Portland, OR
| | - Lin Wang
- Discoveries in Sight Research Laboratories, Devers Eye Institute, and Legacy Research Institute, Legacy Health, Portland, OR
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Wang L, Cull G, Burgoyne CF, Thompson S, Fortune B. Longitudinal alterations in the dynamic autoregulation of optic nerve head blood flow revealed in experimental glaucoma. Invest Ophthalmol Vis Sci 2014; 55:3509-16. [PMID: 24812551 DOI: 10.1167/iovs.14-14020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To use a novel dynamic autoregulation analysis (dAR) to test the hypothesis that the optic nerve head (ONH) blood flow (BF) autoregulation is disrupted during early stages of experimental glaucoma (EG) in nonhuman primates. METHODS Retinal nerve fiber layer thickness (RNFLT, assessed by optical coherence tomography) and ONH BF (assessed by laser speckle imaging technique) were measured biweekly before and after unilateral laser treatment to the trabecular meshwork. Each nonhuman primate was followed until reaching either an early stage of damage (RNFLT loss < 20%, n = 6) or moderate to advanced stages of damage (RNFLT loss > 20%, n = 9). At each test, dAR was assessed by characterizing ONH BF changes during the first minute of rapid manometrical intraocular pressure (IOP) elevation from 10 to 40 mm Hg. The dAR analysis extracted the following parameters: baseline BF, average BF 10 seconds before IOP elevation; BFΔmax, maximum BF change from baseline BF; Tr, time from baseline BF to the BFΔmax; Kr, average descending BF rate. RESULTS Mean postlaser IOP was 20.2 ± 5.9 and 12.3 ± 2.6 mm Hg in EG and control eyes, respectively (P < 0.0001). Compared with prelaser values, baseline BF was higher in early EG, but lower in moderate to advanced EG (P = 0.01). Tr was increased and Kr was reduced in both stages (P < 0.01). BFΔmax was smaller in the early EG (P = 0.05) and remained low in the moderate to advanced EG (P = 0.15). No changes in the parameters were observed in control eyes. CONCLUSIONS Chronic IOP elevation causes ONH autoregulation dysfunction in the early stage of EG, characterized by a disrupted BF response and delayed Tr, revealed by dAR analysis.
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Affiliation(s)
- Lin Wang
- Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Grant Cull
- Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Claude F Burgoyne
- Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Simon Thompson
- Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Brad Fortune
- Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
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He L, Ren R, Yang H, Hardin C, Reyes L, Reynaud J, Gardiner SK, Fortune B, Demirel S, Burgoyne CF. Anatomic vs. acquired image frame discordance in spectral domain optical coherence tomography minimum rim measurements. PLoS One 2014; 9:e92225. [PMID: 24643069 PMCID: PMC3958478 DOI: 10.1371/journal.pone.0092225] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 02/20/2014] [Indexed: 11/19/2022] Open
Abstract
Purpose To quantify the effects of using the fovea to Bruch's membrane opening (FoBMO) axis as the nasal-temporal midline for 30° sectoral (clock-hour) spectral domain optical coherence tomography (SDOCT) optic nerve head (ONH) minimum rim width (MRW) and area (MRA) calculations. Methods The internal limiting membrane and BMO were delineated within 24 radial ONH B-scans in 222 eyes of 222 participants with ocular hypertension and glaucoma. For each eye the fovea was marked within the infrared reflectance image, the FoBMO angle (θ) relative to the acquired image frame (AIF) horizontal was calculated, the ONH was divided into 30°sectors using a FoBMO or AIF nasal/temporal axis, and SDOCT MRW and MRA were quantified within each FoBMO vs. AIF sector. For each sector, focal rim loss was calculated as the MRW and MRA gradients (i.e. the difference between the value for that sector and the one clockwise to it divided by 30°). Sectoral FoBMO vs. AIF discordance was calculated as the difference between the FoBMO and AIF values for each sector. Generalized estimating equations were used to predict the eyes and sectors of maximum FoBMO vs. AIF discordance. Results The mean FoBMO angle was −6.6±4.2° (range: −17° to +7°). FoBMO vs. AIF discordance in sectoral mean MRW and MRA was significant for 7 of 12 and 6 of 12 sectors, respectively (p<0.05, Wilcoxon test, Bonferroni correction). Eye-specific, FoBMO vs. AIF sectoral discordance was predicted by sectoral rim gradient (p<0.001) and FoBMO angle (p<0.001) and achieved maximum values of 83% for MRW and 101% for MRA. Conclusions Using the FoBMO axis as the nasal-temporal axis to regionalize the ONH rather than a line parallel to the AIF horizontal axis significantly influences clock-hour SDOCT rim values. This effect is greatest in eyes with large FoBMO angles and sectors with focal rim loss.
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Affiliation(s)
- Lin He
- Optic Nerve Head Research Laboratory, Legacy Health, Portland, Oregon, United States of America
| | - Ruojin Ren
- Optic Nerve Head Research Laboratory, Legacy Health, Portland, Oregon, United States of America
| | - Hongli Yang
- Optic Nerve Head Research Laboratory, Legacy Health, Portland, Oregon, United States of America
- Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Health, Portland, Oregon, United States of America
| | - Christy Hardin
- Optic Nerve Head Research Laboratory, Legacy Health, Portland, Oregon, United States of America
| | - Luke Reyes
- Optic Nerve Head Research Laboratory, Legacy Health, Portland, Oregon, United States of America
| | - Juan Reynaud
- Optic Nerve Head Research Laboratory, Legacy Health, Portland, Oregon, United States of America
- Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Health, Portland, Oregon, United States of America
| | - Stuart K. Gardiner
- Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Health, Portland, Oregon, United States of America
| | - Brad Fortune
- Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Health, Portland, Oregon, United States of America
| | - Shaban Demirel
- Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Health, Portland, Oregon, United States of America
| | - Claude F. Burgoyne
- Optic Nerve Head Research Laboratory, Legacy Health, Portland, Oregon, United States of America
- Discoveries in Sight Research Laboratories of the Devers Eye Institute, Legacy Health, Portland, Oregon, United States of America
- * E-mail:
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Ren R, Yang H, Gardiner SK, Fortune B, Hardin C, Demirel S, Burgoyne CF. Anterior lamina cribrosa surface depth, age, and visual field sensitivity in the Portland Progression Project. Invest Ophthalmol Vis Sci 2014; 55:1531-9. [PMID: 24474264 DOI: 10.1167/iovs.13-13382] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess the effect of age on spectral-domain optical coherence tomography (SDOCT)-detected lamina cribrosa depth while controlling for visual field (VF) status and retinal nerve fiber layer thickness (RNFLT) in 221 high-risk ocular hypertension and glaucoma patients enrolled in the Portland Progression Project. METHODS In this cross-sectional study, each participant underwent 870-nm SDOCT to obtain high-resolution radial B-scans centered on the optic nerve head (ONH) and a standardized ophthalmologic examination, including automated perimetry, on the same day. For each ONH, an anterior lamina cribrosa surface depth (ALCSD) parameter was generated as the average perpendicular distance from each anterior lamina cribrosa surface point relative to Bruch's membrane opening (BMO) reference plane within all 24 delineated B-scans. The relative effects of age, age-corrected VF status (mean deviation [MD]), and RNFLT on ALCSD were analyzed. RESULTS The mean age ± SD of participants was 64 ± 11 years (range, 33-90 years). The relationship between ALCSD and MD was age-dependent. ALCSD = 407.68 - 67.13 × MD - 0.08 × Age + 0.89 × MD × Age (MD, P = 0.001; MD × Age, P = 0.004). The relationship between ALCSD and RNFLT may also be age-dependent but did not achieve significance (interaction term, P = 0.067). ALCSD increased with worse VF status in younger eyes but not in older eyes. In older eyes, the anterior lamina was shallower than in younger eyes for the same VF status and RNFLT. CONCLUSIONS These data are consistent with the concept that structure/structure and structure/function relationships change with age.
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Affiliation(s)
- Ruojin Ren
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon
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