Felipe A Medeiros

University of California, San Diego, San Diego, California, United States

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Publications (226)811.34 Total impact

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    ABSTRACT: Glaucoma is a progressive disease due to damage in the optic nerve with associated functional losses. Although the relationship between structural and functional progression in glaucoma is well established, there is disagreement on how this association evolves over time. In addressing this issue, we propose a new class of non-Gaussian linear-mixed models to estimate the correlations among subject-specific effects in multivariate longitudinal studies with a skewed distribution of random effects, to be used in a study of glaucoma. This class provides an efficient estimation of subject-specific effects by modeling the skewed random effects through the log-gamma distribution. It also provides more reliable estimates of the correlations between the random effects. To validate the log-gamma assumption against the usual normality assumption of the random effects, we propose a lack-of-fit test using the profile likelihood function of the shape parameter. We apply this method to data from a prospective observation study, the Diagnostic Innovations in Glaucoma Study, to present a statistically significant association between structural and functional change rates that leads to a better understanding of the progression of glaucoma over time. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.
    Biometrical Journal 06/2015; DOI:10.1002/bimj.201300001 · 1.24 Impact Factor
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    ABSTRACT: Purpose To evaluate the diagnostic ability of macular ganglion cell and inner plexiform layer measurements in glaucoma, obtained using swept source (SS) and spectral domain (SD) optical coherence tomography (OCT) and to compare to circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurements. Methods The study included 106 glaucomatous eyes of 80 subjects and 41 eyes of 22 healthy subjects from the Diagnostic Innovations in Glaucoma Study. Macular ganglion cell and inner plexiform layer (mGCIPL), macular ganglion cell complex (mGCC) and cpRNFL thickness were assessed using SS-OCT and SD-OCT, and area under the receiver operating characteristic curves (AUCs) were calculated to determine ability to differentiate glaucomatous and healthy eyes and between early glaucomatous and healthy eyes.
    PLoS ONE 05/2015; 10(5). DOI:10.1371/journal.pone.0125957 · 3.53 Impact Factor
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    ABSTRACT: Detection of progression and measurement of rates of change is at the core of glaucoma management, and the use of Spectral Domain Optical Coherence Tomography (SD-OCT) has significantly improved our ability to evaluate change in the disease. In this review, we critically assess the existing literature on the use of SD-OCT for detecting glaucoma progression and estimating rates of change. We discuss aspects related to the reproducibility of measurements, their accuracy to detect longitudinal change over time, and the effect of aging on the ability to detect progression. In addition, we discuss recent studies evaluating the use of combined structure and function approaches to improve detection of glaucoma progression.
    The Open Ophthalmology Journal 05/2015; 9(1):78-88. DOI:10.2174/1874364101509010078
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    ABSTRACT: Identification of structural damage to the optic nerve and retinal nerve fiber layer (RNFL) is an essential component of diagnosis and management of glaucoma. The introduction of spectral-domain OCT (SD-OCT) has allowed objective quantification of damage to these structures with unprecedented resolution. In addition, recent attention has been directed towards imaging the macular area for quantifying loss of neural tissue caused by the disease. Many studies have evaluated and compared the diagnostic accuracies of a variety of parameters that can be obtained from imaging these areas of the ocular fundus. In this article, we critically review the existing literature evaluating the diagnostic accuracy of SD-OCT in glaucoma and we discuss issues related to how SD-OCT results should be incorporated into clinical practice.
    The Open Ophthalmology Journal 05/2015; 9(1):68-77. DOI:10.2174/1874364101509010068
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    ABSTRACT: To examine the relationship between Motor Vehicle Collisions (MVCs) in drivers with glaucoma and standard automated perimetry (SAP), Useful Field of View (UFOV), and driving simulator assessment of divided attention. A cross-sectional study of 153 drivers from the Diagnostic Innovations in Glaucoma Study. All subjects had SAP and divided attention was assessed using UFOV and driving simulation using low-, medium-, and high-contrast peripheral stimuli presented during curve negotiation and car following tasks. Self-reported history of MVCs and average mileage driven were recorded. Eighteen of 153 subjects (11.8%) reported a MVC. There was no difference in visual acuity but the MVC group was older, drove fewer miles, and had worse binocular SAP sensitivity, contrast sensitivity, and ability to divide attention (UFOV and driving simulation). Low contrast driving simulator tasks were the best discriminators of MVC (AUC 0.80 for curve negotiation versus 0.69 for binocular SAP and 0.59 for UFOV). Adjusting for confounding factors, longer reaction times to driving simulator divided attention tasks provided additional value compared with SAP and UFOV, with a 1 standard deviation (SD) increase in reaction time (approximately 0.75 s) associated with almost two-fold increased odds of MVC. Reaction times to low contrast divided attention tasks during driving simulation were significantly associated with history of MVC, performing better than conventional perimetric tests and UFOV. The association between conventional tests of visual function and MVCs in drivers with glaucoma is weak, however, tests of divided attention, particularly using driving simulation, may improve risk assessment.
    05/2015; 4(3):5. DOI:10.1167/tvst.4.3.5
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    ABSTRACT: Schizophrenia is a complex mental disorder associated with not only cognitive dysfunctions, such as memory and attention deficits, but also changes in basic sensory processing. Although most studies on schizophrenia have focused on disturbances in higher-order brain functions associated with the prefrontal cortex or frontal cortex, recent investigations have also reported abnormalities in low-level sensory processes, such as the visual system. At very early stages of the disease, schizophrenia patients frequently describe in detail symptoms of a disturbance in various aspects of visual perception that may lead to worse clinical symptoms and decrease in quality of life. Therefore, the aim of this review is to describe the various studies that have explored the visual issues in schizophrenia.
    Current Psychiatry Reports 05/2015; 17(5):569. DOI:10.1007/s11920-015-0569-x · 3.05 Impact Factor
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    ABSTRACT: Glaucoma is a chronic neurodegenerative disease characterized by loss of retinal ganglion cells, resulting in distinctive changes in the optic nerve head (ONH) and retinal nerve fiber layer. Important advances in technology for non-invasive imaging of the eye have been made providing quantitative tools to measure structural changes in ONH topography, a crucial step in diagnosing and monitoring glaucoma. Three dimensional (3D) spectral domain optical coherence tomography (SD-OCT), an optical imaging technique, is now the standard of care for diagnosing and monitoring progression of numerous eye diseases. This paper aims to detect changes in multi-temporal 3D SD-OCT ONH images using a hierarchical fully Bayesian framework and then to differentiate between changes reflecting random variations or true changes due to glaucoma progression. To this end, we propose the use of kernel-based support vector data description (SVDD) classifier. SVDD is a well-known one-class classifier that allows us to map the data into a high-dimensional feature space where a hypersphere encloses most patterns belonging to the target class. The proposed glaucoma progression detection scheme using the whole 3D SD-OCT images detected glaucoma progression in a significant number of cases showing progression by conventional methods (78%), with high specificity in normal and non-progressing eyes (93% and 94% respectively). The use of the dependency measurement in the SVDD framework increased the robustness of the proposed change-detection scheme with comparison to the classical support vector machine and SVDD methods. The validation using clinical data of the proposed approach has shown that the use of only healthy and non-progressing eyes to train the algorithm led to a high diagnostic accuracy for detecting glaucoma progression compared to other methods. Copyright © 2015 Elsevier B.V. All rights reserved.
    Artificial intelligence in medicine 04/2015; 64(2). DOI:10.1016/j.artmed.2015.04.002 · 1.36 Impact Factor
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    ABSTRACT: To evaluate the relationship between rates of change on frequency doubling technology (FDT) perimetry and longitudinal changes in quality of life (QoL) of glaucoma patients. Prospective observational cohort study. One hundred fifty-two subjects (127 glaucoma and 25 healthy) followed for an average of 3.2 ± 1.1 years. All subjects were evaluated with National Eye Institute Visual Function Questionnaire (NEI VFQ-25), FDT and standard automated perimetry (SAP). Glaucoma patients had a median of 3 NEI VFQ-25, 8 FDT and 8 SAP tests during follow up. Mean sensitivities of the integrated binocular visual fields were estimated for FDT and SAP and used to calculate rates of change. A joint longitudinal multivariable mixed model was used to investigate the association between change in binocular mean sensitivities and change in NEI VFQ-25 Rasch-calibrated scores. There was a statistically significant correlation between change in binocular mean sensitivity for FDT and change in NEI VFQ-25 scores during follow-up in the glaucoma group. In multivariable analysis with the confounding factors, each 1dB/year change in binocular FDT mean sensitivity corresponded to a change of 0.8 units per year in the NEI VFQ-25 scores (P = 0.001). For binocular SAP mean sensitivity, each 1 dB/year change was associated with 2.4 units per year change in NEI VFQ-25 scores (P < 0.001). The multivariable model containing baseline and rate of change information from SAP had stronger ability to predict change in NEI VFQ-25 scores compared to the equivalent model for FDT (R(2) of 50% and 30%, respectively; P = 0.001). SAP performed significantly better than FDT in predicting change in NEI VFQ-25 scores in our population, suggesting that it may still be the preferable perimetric technique for predicting risk of disability from the disease. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Ophthalmology 04/2015; 160(1). DOI:10.1016/j.ajo.2015.04.007 · 4.02 Impact Factor
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    ABSTRACT: The lamina cribrosa is the putative site of retinal ganglion cell axonal injury in glaucoma. Although histological studies have provided evidence of structural changes to the lamina cribrosa, even in early stages of glaucoma, until recently, the ability to evaluate the lamina cribrosa in vivo has been limited. Recent advances in optical coherence tomography, including enhanced depth and swept-source imaging, have changed this, providing a means to image the lamina cribrosa. Imaging has identified general and localized configurational changes in the lamina of glaucomatous eyes, including posterior laminar displacement, altered laminar thickness, and focal laminar defects with spatial association with conventional structural and functional losses. In addition, although the temporal relationship between changes to the lamina cribrosa and glaucomatous retinal ganglion cell loss is yet to be elucidated, quantitative measurements of laminar microarchitecture have good reproducibility and offer the potential to serve as biomarkers for glaucoma diagnosis and progression.
    04/2015; DOI:10.1007/s40135-015-0067-7
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    ABSTRACT: To perform a quantitative trait locus (QTL) analysis and evaluate whether a locus between SIX1 and SIX6 is associated with retinal nerve fiber layer (RNFL) thickness in individuals of European descent. Observational, multi-center, cross-sectional study. 231 participants were recruited from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Association of rs10483727 in SIX1-SIX6 with global and sectoral RNFL thickness was performed. Quantitative trait analysis with the additive model of inheritance was analyzed using linear regression. Trend analysis was performed to evaluate the mean global and sectoral RNFL thickness with 3 genotypes of interest (T/T, C/T, C/C). All models were adjusted for age and gender. Direction of association between T allele and RNFL thickness was consistent in the global and different sectoral RNFL regions. Each copy of the T risk allele in rs10483727 was associated with -0.16 μm thinner global RNFL thickness (β=-0.16, 95% CI: -0.28 to -0.03; P=0.01). Similar patterns were found for the sectoral regions, including inferior (P=0.03), inferior-nasal (P=0.017), superior-nasal (P=0.0025), superior (P=0.002) and superior-temporal (P=0.008). The greatest differences were observed in the superior and inferior quadrants, supporting clinical observations for RNFL thinning in glaucoma. Thinner global RNFL was found in subjects with T/T genotypes compared to subjects with C/T and C/C genotypes (P=0.044). Each copy of the T risk allele has an additive effect and was associated with thinner global and sectoral RNFL. Findings from this QTL analysis further support a genetic contribution to glaucoma pathophysiology. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Ophthalmology 04/2015; 160(1). DOI:10.1016/j.ajo.2015.04.001 · 4.02 Impact Factor
  • Journal of glaucoma 04/2015; DOI:10.1097/IJG.0000000000000245 · 2.43 Impact Factor
  • Journal of glaucoma 04/2015; 24(4):334. DOI:10.1097/IJG.0b013e3181c29bae · 2.43 Impact Factor
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    ABSTRACT: To evaluate postural control using a dynamic virtual reality environment and the relationship between postural metrics and history of falls in patients with glaucoma. Cross-sectional study. The study involved 42 patients with glaucoma with repeatable visual field defects on standard automated perimetry (SAP) and 38 control healthy subjects. Patients underwent evaluation of postural stability by a force platform during presentation of static and dynamic visual stimuli on stereoscopic head-mounted goggles. The dynamic visual stimuli presented rotational and translational ecologically valid peripheral background perturbations. Postural stability was also tested in a completely dark field to assess somatosensory and vestibular contributions to postural control. History of falls was evaluated by a standard questionnaire. Torque moments around the center of foot pressure on the force platform were measured, and the standard deviations of the torque moments (STD) were calculated as a measurement of postural stability and reported in Newton meters (Nm). The association with history of falls was investigated using Poisson regression models. Age, gender, body mass index, severity of visual field defect, best-corrected visual acuity, and STD on dark field condition were included as confounding factors. Patients with glaucoma had larger overall STD than controls during both translational (5.12±2.39 Nm vs. 3.85±1.82 Nm, respectively; P = 0.005) and rotational stimuli (5.60±3.82 Nm vs. 3.93±2.07 Nm, respectively; P = 0.022). Postural metrics obtained during dynamic visual stimuli performed better in explaining history of falls compared with those obtained in static and dark field condition. In the multivariable model, STD values in the mediolateral direction during translational stimulus were significantly associated with a history of falls in patients with glaucoma (incidence rate ratio, 1.85; 95% confidence interval, 1.30-2.63; P = 0.001). The study presented and validated a novel paradigm for evaluation of balance control in patients with glaucoma on the basis of the assessment of postural reactivity to dynamic visual stimuli using a virtual reality environment. The newly developed metrics were associated with a history of falls and may help to provide a better understanding of balance control in patients with glaucoma. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
    Ophthalmology 03/2015; 122(6). DOI:10.1016/j.ophtha.2015.02.010 · 6.17 Impact Factor
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    ABSTRACT: To evaluate racial differences in the development of visual field (VF) damage in glaucoma suspects. Prospective, observational cohort study. Six hundred thirty six eyes from 357 glaucoma suspects with normal VF at baseline were included from the multicenter African Descent and Glaucoma Evaluation Study (ADAGES). Racial differences in the development of VF damage were examined using multivariable Cox Proportional Hazard models. Thirty one (25.4%) of 122 African descent participants and 47 (20.0%) of 235 European descent participants developed VF damage (p=0.078). In multivariable analysis, worse baseline VF mean deviation, higher mean arterial pressure during follow up, and a race *mean intraocular pressure (IOP) interaction term were significantly associated with the development of VF damage suggesting that racial differences in the risk of VF damage varied by IOP. At higher mean IOP levels, race was predictive of the development of VF damage even after adjusting for potentially confounding factors. At mean IOPs during follow-up of 22, 24 and 26 mmHg, multivariable hazard ratios (95%CI) for the development of VF damage in African descent compared to European descent subjects were 2.03 (1.15-3.57), 2.71 (1.39-5.29), and 3.61 (1.61-8.08), respectively. However, at lower mean IOP levels (below 22 mmHg) during follow-up, African descent was not predictive of the development of VF damage. In this cohort of glaucoma suspects with similar access to treatment, multivariate analysis revealed that at higher mean IOP during follow-up, individuals of African descent were more likely to develop VF damage than individuals of European descent. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Ophthalmology 01/2015; 159(4). DOI:10.1016/j.ajo.2015.01.011 · 4.02 Impact Factor
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    ABSTRACT: Evaluation of structural optic nerve damage is a fundamental part of diagnosis and management of glaucoma. However, the relationship between structural measurements and disability associated with the disease is not well characterized. Quantification of this relationship may help validate structural measurements as markers directly relevant to quality of life. To evaluate the relationship between rates of retinal nerve fiber layer (RNFL) loss and longitudinal changes in quality of life in glaucoma. Observational cohort study including 260 eyes of 130 patients with glaucoma followed up for a mean (SD) of 3.5 (0.7) years. All patients had repeatable visual field defects on standard automated perimetry (SAP) at baseline. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was performed annually, and spectral-domain optical coherence tomography and SAP were performed at 6-month intervals. A joint model was used to investigate the association between change in NEI VFQ-25 Rasch-calibrated scores and change in RNFL thickness, adjusting for confounding socioeconomic and clinical variables. Association between change in binocular RNFL thickness (RNFL thickness in the better eye at each point) and change in NEI VFQ-25 scores. Progressive binocular RNFL thickness loss was associated with worsening of NEI VFQ-25 scores over time. In a multivariable model adjusting for baseline disease severity and the rate of change in binocular SAP sensitivity, each 1-μm-per-year loss of RNFL thickness was associated with a decrease of 1.3 units (95% CI, 1.02-1.56) per year in NEI VFQ-25 scores (P < .001). After adjusting for the contribution from SAP, 26% (95% CI, 12%-39%) of the variability of change in NEI VFQ-25 scores was associated uniquely with change in binocular RNFL thickness. The P value remained less than .001 after adjusting for potential confounding factors. Progressive binocular RNFL thickness loss was associated with longitudinal loss in quality of life, even after adjustment for progressive visual field loss. These findings suggest that rates of binocular RNFL change are valid markers for the degree of neural loss in glaucoma with significant relationship to glaucoma-associated disability.
    Jama Ophthalmology 01/2015; DOI:10.1001/jamaophthalmol.2014.5319 · 3.83 Impact Factor
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    ABSTRACT: Glaucoma is neurodegenerative disease characterized by distinctive changes in the optic nerve head and visual field. Without treatment, glaucoma can lead to permanent blindness. Therefore, monitoring glaucoma progression is important to detect uncontrolled disease and the possible need for therapy advancement. In this context, three-dimensional (3-D) spectral domain optical coherence tomography (SD-OCT) has been commonly used in the diagnosis and management of glaucoma patients. We present a new framework for detection of glaucoma progression using 3-D SD-OCT images. In contrast to previous works that use the retinal nerve fiber layer thickness measurement provided by commercially available instruments, we consider the whole 3-D volume for change detection. To account for the spatial voxel dependency, we propose the use of the Markov random field (MRF) model as a prior for the change detection map. In order to improve the robustness of the proposed approach, a nonlocal strategy was adopted to define the MRF energy function. To accommodate the presence of false-positive detection, we used a fuzzy logic approach to classify a 3-D SD-OCT image into a "non-progressing" or "progressing" glaucoma class. We compared the diagnostic performance of the proposed framework to the existing methods of progression detection.
    12/2014; 1(3):034504-1-9. DOI:10.1117/1.JMI.1.3.034504
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    ABSTRACT: Purpose To evaluate the diagnostic accuracies of swept source optical coherence tomography (SS-OCT) wide-angle and peripapillary retinal nerve fiber layer (RNFL) thickness measurements for glaucoma detection. Design Cross-sectional case-control study. Methods 144 glaucomatous eyes of 106 subjects and 66 eyes of 42 healthy subjects from the Diagnostic Innovations in Glaucoma Study were enrolled in this study. Glaucoma was defined by the presence of repeatable abnormal standard automated perimetry results and/or progressive glaucomatous optic disc change on masked grading of stereophotographs. Wide-angle and peripapillary RNFL thicknesses were assessed using SS-OCT. Peripapillary RNFL thickness was also evaluated using spectral-domain OCT (SD-OCT). Areas under the receiver operating characteristic (ROC) curves were calculated to evaluate the ability of the different SS-OCT and SD-OCT parameters to discriminate glaucomatous from healthy eyes. Results Mean (± standard deviation) average SS-OCT wide-angle RNFL thickness were 50.5 ± 5.8 μm and 35.0 ± 9.6 μm in healthy and glaucomatous eyes, respectively (P<0.001). Corresponding values for SS-OCT peripapillary RNFL thickness were 103.5 ± 12.3 μm and 72.9 ± 16.5 μm, respectively (P<0.001). Areas under the ROC curves of SS-OCT wide-angle and peripapillary RNFL thickness were 0.88 and 0.89, respectively. SS-OCT performed similarly to average peripapillary RNFL thickness obtained with SD-OCT (area under the ROC curve of 0.90). Conclusion SS-OCT wide-angle and peripapillary RNFL thickness measurements performed well for detecting glaucomatous damage. Diagnostic accuracies of the SS-OCT and SD-OCT RNFL imaging protocols evaluated in this study were similar.
    American Journal of Ophthalmology 10/2014; 159(1). DOI:10.1016/j.ajo.2014.10.019 · 4.02 Impact Factor
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    ABSTRACT: Purpose To evaluate the association between longitudinal changes in quality of life (QoL) and rates of progressive visual field loss in glaucoma. Design Prospective observational cohort study. Participants We recruited 322 eyes of 161 patients with glaucomatous visual field loss from the Diagnostic Innovations Glaucoma Study followed for an average of 3.5±0.7 years. Methods All subjects had National Eye Institute Visual Function Questionnaire (NEI VFQ)-25 performed annually and standard automated perimetry (SAP) at 6-month intervals. Subjects were included if they had a minimum of 2 NEI VFQ-25 and ≥5 SAP during follow-up. Evaluation of rates of visual field change was performed using the mean sensitivity (MS) of the integrated binocular visual field (BVF). Rasch analysis was performed to obtain final scores of disability as measured by the NEI VFQ-25. A joint longitudinal multivariate mixed model was used to investigate the association between change in NEI VFQ-25 Rasch-calibrated scores and change in BVF sensitivity. Potentially confounding socioeconomic and clinical variables also were analyzed. Main Outcome Measures The relationship between change in NEI VFQ-25 Rasch-calibrated scores and change in binocular SAP MS. Results There was a significant correlation between change in the NEI VFQ-25 Rasch scores during follow-up and change in binocular SAP sensitivity. Each 1-dB change in binocular SAP MS per year was associated with a change of 2.9 units per year in the NEI VFQ-25 Rasch scores during the follow-up period (R2 = 26%; P<0.001). Eyes with more severe disease at baseline were also more likely to have a decrease in NEI VFQ-25 scores during follow-up (P<0.001). For subjects with the same amount of change in SAP sensitivity, those with shorter follow-up times had larger changes in NEI VFQ-25 scores (P = 0.005). A multivariable model containing baseline and rate of change in binocular MS had an adjusted R2 of 50% in predicting change in NEI VFQ-25 scores. Conclusions Baseline severity, magnitude, and rates of change in BVF sensitivity were associated with longitudinal changes in QoL of glaucoma patients. Assessment of longitudinal visual field changes may help to identify patients at greater risk for developing disability from the disease.
    Ophthalmology 10/2014; 122(2). DOI:10.1016/j.ophtha.2014.08.014 · 6.17 Impact Factor
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    ABSTRACT: To evaluate choroidal thickness (CT) in healthy and glaucomatous eyes using Swept Source Optical Coherence Tomography (SS-OCT).
    PLoS ONE 10/2014; 9(10):e109683. DOI:10.1371/journal.pone.0109683 · 3.53 Impact Factor
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    ABSTRACT: Purpose: To evaluate whether optic disc hemorrhages are associated with faster rates of estimated retinal ganglion cell (RGC) loss in glaucoma. Methods: A longitudinal observational cohort study of 222 eyes of 122 patients with glaucoma recruited from the Diagnostic Innovations Glaucoma Study (DIGS) followed for an average of 3.74 +/- 0.85 years. All subjects had optical coherence tomography and standard automated perimetry during follow up. Optic disc hemorrhages were detected by masked evaluation of stereophotographs. Rates of change in estimated numbers of RGCs were determined using a previously described method. A random coefficients model was used to investigate the relationship between disc hemorrhages and rates of change in estimated RGC counts over time. Results: 19 eyes of 18 subjects had at least one disc hemorrhage during follow up. At baseline, average estimated RGC counts in eyes with and without disc hemorrhages were 677,994 cells and 682,021 cells, respectively (P = 0.929). Eyes with optic disc hemorrhages during follow-up had significantly faster rates of estimated RGC loss than eyes without disc hemorrhages (22,233 cells/year versus 10,704 cells/year, P = 0.020). The effect of disc hemorrhages on the rates of estimated RGC loss remained significant after adjusting for confounding variables. Conclusion: Eyes with disc hemorrhages showed faster rates of RGC loss compared to eyes without disc hemorrhages. These results provide further evidence that disc hemorrhages should be considered as an indicator of increased risk for faster neural loss in glaucoma.
    PLoS ONE 08/2014; 9(8):e105611. DOI:10.1371/journal.pone.0105611 · 3.53 Impact Factor

Publication Stats

5k Citations
811.34 Total Impact Points

Institutions

  • 2003–2015
    • University of California, San Diego
      • Department of Ophthalmology
      San Diego, California, United States
  • 2002–2013
    • National University (California)
      San Diego, California, United States
  • 2005–2012
    • La Jolla Pharmaceutical
      San Diego, California, United States
    • CSU Mentor
      Long Beach, California, United States
  • 2010–2011
    • Universidade Federal de São Paulo
      San Paulo, São Paulo, Brazil
    • University of Alabama at Birmingham
      • Department of Ophthalmology
      Birmingham, AL, United States
  • 2001–2011
    • University of São Paulo
      • Departamento de Oftalmologia (FM) (São Paulo)
      San Paulo, São Paulo, Brazil
  • 2008
    • University of California, Irvine
      • Department of Ophthalmology
      Irvine, CA, United States
  • 2007
    • University of Melbourne
      Melbourne, Victoria, Australia