Jeffrey M Liebmann

Publications (193)565.45 Total impact

• Article: Predicting Progression in Glaucoma Suspects with Longitudinal Estimates of Retinal Ganglion Cell Counts.

  Daniel Meira-Freitas, Renato Lisboa, Andrew Tatham, Linda M Zangwill, Robert N Weinreb, Christopher A Girkin, Jeffrey M Liebmann, Felipe A Medeiros
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  ABSTRACT: PURPOSE: To evaluate the ability of baseline and longitudinal estimates of retinal ganglion cell (RGC) counts in predicting progression in eyes suspected of having glaucoma. METHODS: The study included 288 glaucoma suspect eyes of 288 patients followed for an average of 3.8 ± 1.0 years. Participants had normal standard automated perimetry (SAP) at baseline. Retinal nerve fiber layer thickness assessment was performed with optical coherence tomography (OCT). Progression was defined as development of repeatable abnormal SAP or glaucomatous progressive optic disc changes. Estimates of RGC counts were obtained by combining data from SAP and OCT according to previously described method. Joint longitudinal survival models were used to evaluate the ability of baseline and rates of change in estimated RGC counts for predicting progression over time, adjusting for confounding variables. RESULTS: Forty-eight eyes (17%) showed progression during follow-up. The mean rate of change in estimated RGC counts was -18,987 cells/year in progressors versus -8,808 cells/year for nonprogressors (P<0.001). Baseline RGC counts and slopes of RGC loss were significantly predictive of progression, with HRs of 1.56 per 100,000 cells lower (95% CI: 1.18 - 2.08; P=0.002) and 2.68 per 10,000 cells/year faster loss (95% CI: 1.22 - 5.90; P=0.014), respectively. The longitudinal model including estimates of RGC counts performed significantly better than models including only structural or functional indexes separately. CONCLUSION: Baseline and longitudinal estimates of RGC counts may be helpful in predicting progression and performed significantly better than conventional approaches for risk stratification of glaucoma suspects.
  Investigative ophthalmology & visual science 05/2013; · 3.43 Impact Factor
• Article: The relationship between cup to disc ratio and estimated number of retinal ganglion cells.

  Andrew J Tatham, Robert N Weinreb, Linda M Zangwill, Jeffrey M Liebmann, Christopher A Girkin, Felipe A Medeiros
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  ABSTRACT: PURPOSE: To investigate the relationship between cup to disc ratio (CDR) and estimates of retinal ganglion cell (RGC) number. METHODS: This cross-sectional study included 156 healthy eyes, 53 glaucoma suspects and 127 eyes with glaucoma. All eyes had SAP, Cirrus SD-OCT and stereoscopic optic disc photography within 6 months. CDR was determined from stereoscopic photographs by two or more masked graders. The number of RGCs in each eye was estimated using a published model that combines estimates of RGC number from SAP sensitivity thresholds and SD-OCT retinal nerve fiber layer measurements. RESULTS: The mean estimated RGC count was 1,063,809 in healthy eyes, 828,522 in glaucoma suspects, 774,200 in early, 468,568 in moderate, and 218,471 in advanced glaucoma. Healthy eyes had a mean vertical CDR of 0.45±0.15 versus 0.80±0.16 in glaucomatous eyes. There was good correlation between stereophotographic vertical CDR and Cirrus vertical CDR (R2=0.825; P<0.001). The relationship between estimated RGCs and vertical CDR was best represented using a 3rd degree polynomial regression model, including age and optic disc area, which accounted for 83.3% of the variation in estimated RGC counts. The non-linear relationship between RGC estimates and CDRs indicated that eyes with a large CDR would require loss of large RGC numbers for a small increase in CDR. CONCLUSIONS: The relationship between estimated RGC counts and CDR suggests that assessment of change in CDR is an insensitive method for evaluation of progressive neural losses in glaucoma. Even relatively small changes in CDR may be associated with large losses of RGCs, especially in eyes with large CDRs.
  Investigative ophthalmology & visual science 04/2013; · 3.43 Impact Factor
• Article: Structure and Clinical Significance of Central Optic Disc Pits.

  Shehzad Qayum, Timothy Sullivan, Sung Chul Park, Kunal Merchant, Rudrani Banik, Jeffrey M Liebmann, Robert Ritch
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  ABSTRACT: OBJECTIVE: To assess the structure of central optic disc pits (ODPs) using enhanced-depth imaging optical coherence tomography (EDI OCT) and to ascertain their clinical significance. DESIGN: Prospective, cross-sectional study. PARTICIPANTS: Patients with an ophthalmoscopically visible central ODP in either eye, irrespective of accompanying ocular disease, were enrolled from the neuro-ophthalmology and glaucoma referral practices. Each subject with a central ODP was matched with 2 healthy subjects with normal-appearing optic disc within 5 years of age. METHODS: Each participant received a complete ophthalmologic examination including standard automated perimetry, retinal nerve fiber layer (RNFL) thickness measurement by OCT, and serial horizontal and vertical cross-sectional EDI OCT of the optic nerve head. MAIN OUTCOME MEASURES: Structure of the lamina cribrosa (LC) in relation to the central ODP in EDI OCT images. RESULTS: Eighteen eyes (13 subjects) with a central ODP and 52 healthy eyes (26 controls) were included. Four eyes (2 subjects) with a central ODP were otherwise normal with intact macula, neuroretinal rim, RNFL, and visual field. Fourteen eyes (11 subjects) with a central ODP had glaucoma with glaucomatous neuroretinal rim thinning, RNFL loss, and corresponding visual field defect. No eye had associated maculopathy. On EDI OCT, the central ODP corresponded with a full-thickness defect in the LC center with no serous retinal detachment or herniation of neural tissue through the LC defect. Central ODPs were separated from (type 1) or merged with (type 2) the LC opening for the central retinal vascular trunk. In control eyes, no LC defect was detected. CONCLUSIONS: Central ODPs are full-thickness LC defects unassociated with maculopathy and different from glaucomatous acquired pits of the optic nerve, which represent focal laminar defect adjacent to the disc edge. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.
  Ophthalmology 03/2013; · 5.45 Impact Factor
• Article: Enhanced Depth Imaging Optical Coherence Tomography of Optic Nerve Head Drusen.

  Kunal Y Merchant, Daniel Su, Sung Chul Park, Shehzad Qayum, Rudrani Banik, Jeffrey M Liebmann, Robert Ritch
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  ABSTRACT: OBJECTIVE: To assess the value of enhanced depth imaging optical coherence tomography (EDI OCT) in diagnosing and evaluating optic nerve head drusen (ONHD) compared with conventional diagnostic methods. DESIGN: Prospective, comparative, cross-sectional study. PARTICIPANTS: Thirty-four patients with clinically visible or suspected ONHD in either eye based on dilated optic disc examination or optic disc stereophotography and without ocular comorbidity. METHODS: Spectral-domain OCT of the optic nerve head in both conventional (non-EDI) and EDI modes, ultrasound B-scan, and standard automated perimetry were performed on both eyes of all participants. MAIN OUTCOME MEASURES: Detection and findings of ONHD between EDI OCT and conventional diagnostic methods. RESULTS: Sixty-eight eyes were clinically classified into 3 groups: 32 eyes with definite ONHD, 25 eyes with suspected ONHD, and 11 normal-appearing fellow eyes. In the definite ONHD group, EDI OCT, non-EDI OCT, and ultrasound B-scan were positive for ONHD in all eyes and visual field (VF) was abnormal in 24 eyes. In the suspected ONHD group, EDI OCT, non-EDI OCT, ultrasound B-scan, and VF were positive in 17, 14, 7, and 3 eyes, respectively; 8 eyes had no evidence of ONHD in any of the tests. In normal-appearing fellow eyes, EDI OCT, non-EDI OCT, ultrasound B-scan, and VF were positive in 3, 1, 1, and 0 eyes, respectively; 4 eyes had no evidence of ONHD in any of the tests. Enhanced depth imaging OCT had a significantly higher ONHD detection rate than ultrasound B-scan in all eyes (52/68 eyes vs. 40/68 eyes; P<0.001), in eyes with clinically suspected ONHD or normal-appearing fellow eyes (20/36 eyes vs. 8/36 eyes; P<0.001), and in eyes with clinically suspected ONHD (17/25 eyes vs. 7/25 eyes; P = 0.002). Enhanced depth imaging OCT-detected ONHD appeared as signal-poor regions surrounded by short, hyper-reflective bands or isolated/clustered hyper-reflective bands without a signal-poor core. In non-EDI OCT, posterior surfaces of the ONHD and deep-seated hyper-reflective bands were invisible or less clear than in EDI OCT. CONCLUSIONS: Enhanced depth imaging OCT detects lesions likely representing ONHD more often and better assesses their shape and structure than conventional tests. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
  Ophthalmology 03/2013; · 5.45 Impact Factor
• Article: Sensitivity and Specificity of Short Duration Transient Visual Evoked Potentials (SD-tVEP) in Discriminating Normal from Glaucomatous Eyes.

  Cinthi Pillai, Robert Ritch, Peter Derr, Alberto Gonzalez, Laurie Kopko Cox, John Siegfried, Jeffrey M Liebmann, Celso Tello
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  ABSTRACT: PURPOSE: To evaluate the ability of the short duration transient VEP (SD-tVEP) to discriminate between healthy eyes and eyes with early to advanced glaucomatous visual field loss. METHODS: We tested 30 eyes of 30 healthy controls and 45 eyes of 35 glaucoma patients. Normal eyes had 20/30 or better visual acuity and normal 24-2 SITA Standard visual fields. Glaucoma was staged as mild (mean deviation, MD>-6.0 dB), moderate (MD -6.0 to -12.0 dB), and severe (MD<-12.0 dB). There were 15 eyes in each group. SD-tVEPs were recorded using the Diopsys NOVA-LX System (Diopsys, Inc., Pine Brook, NJ). Each eye was stimulated with a low (Lc) and high (Hc) Michelson contrast checkerboard pattern. Each test resulted in an Lc and an Hc SD-tVEP response. Each response was evaluated for overall waveform quality, P100 latency and amplitude difference of the P100 and N75. The sensitivity, specificity, negative predictor value (NPV) and positive predictor value (PPV) was calculated. RESULTS: Lc latency showed the highest accuracy for discrimination using receiver operator characteristic curves for high and low contrast parameters. The analysis for all subjects resulted in a 91.1% sensitivity, 93.3% specificity, 95.3% PPV of 95.3%, and an 87.5% NPV. Evaluating the mean Lc latency of the mild, moderate and severe glaucoma patients against controls showed discrimination consistent with the glaucoma severity. CONCLUSIONS: Short-duration transient VEP objectively identified decreased visual function and discriminated between healthy and glaucomatous eyes and showed good differentiation between healthy eyes and those with early visual field loss. VEP may be useful for early diagnosis of glaucoma.
  Investigative ophthalmology & visual science 03/2013; · 3.43 Impact Factor
• Article: The Rate of Structural Change: The Confocal Scanning Laser Ophthalmoscopy Ancillary Study to the Ocular Hypertension Treatment Study.

  Linda M Zangwill, Sonia Jain, Keri Dirkes, Feng He, Felipe A Medeiros, Gary L Trick, James D Brandt, George A Cioffi, Anne L Coleman, Jeffrey M Liebmann, Jody R Piltz-Seymour, Mae O Gordon, Michael A Kass, Robert N Weinreb
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  ABSTRACT: PURPOSE: To compare rates of topographic change in ocular hypertensive eyes in which primary open-angle glaucoma (POAG) does or does not develop, and to identify factors that influence the rate of change. DESIGN: Longitudinal, randomized clinical trial. METHODS: Four hundred forty-one participants (832 eyes) in the Confocal Scanning Laser Ophthalmoscopy Ancillary Study to the Ocular Hypertension Treatment Study were included. POAG was defined as repeatable visual field, photography-based optic disc changes, or both. The rate of topographic change in the 52 participants (66 eyes) who developed POAG was compared with that of participants who did not develop POAG using multivariable mixed effects models. RESULTS: In both univariate and multivariate analyses, the rate of rim area loss was significantly faster in eyes in which POAG developed than in eyes in which it did not (univariate mean, -0.0131 mm(2)/year and -0.0026 mm(2)/year, respectively). The significantly faster rate of rim area loss in black persons found in the univariate analysis did not remain significant when baseline disc area was included in the model. In multivariate analyses, the rate of rim area loss and other topographic parameters also was significantly faster in eyes with worse baseline visual field pattern standard deviation and higher intraocular pressure during follow-up. Moreover, a significant rate of rim area loss was detected in eyes in which POAG did not develop (P < .0001). The rate of rim area loss in eyes with an optic disc POAG endpoint was significantly faster than in those with a visual field POAG endpoint. CONCLUSIONS: The rate of rim area loss is approximately 5 times faster in eyes in which POAG developed compared with eyes in which it did not. These results suggest that measuring the rate of structural change can provide important information for the clinical management of ocular hypertensive patients. Additional follow-up is needed to determine whether the statistically significant change in the eyes in which POAG did not develop represents normal aging or glaucomatous change not detected by conventional methods.
  American journal of ophthalmology 03/2013; · 3.83 Impact Factor
• Article: Association Between Rates of Binocular Visual Field Loss and Vision-Related Quality of Life in Patients With Glaucoma.

  Renato Lisboa, Yeoun Sook Chun, Linda M Zangwill, Robert N Weinreb, Peter N Rosen, Jeffrey M Liebmann, Christopher A Girkin, Felipe A Medeiros
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  ABSTRACT: IMPORTANCE It is reasonable to hypothesize that for 2 patients with similar degrees of integrated binocular visual field (BVF) loss, the patient with a history of faster disease progression will report worse vision-related quality of life (VRQOL) than the patient with slowly progressing damage. However, to our knowledge, this hypothesis has not been investigated in the literature. OBJECTIVE To evaluate the association between binocular rates of visual field change and VRQOL in patients with glaucoma. DESIGN Observational cohort study. SETTING Patients were recruited from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. PARTICIPANTS The study included 796 eyes of 398 patients with diagnosed or suspected glaucoma followed up from October 1, 1998, until January 31, 2012, for a mean (SD) of 7.3 (2.0) years. MAIN OUTCOME MEASURES The VRQOL was evaluated using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) at the last follow-up visit. The NEI VFQ-25 was completed for all patients during the period extending from December 1, 2009, through January 31, 2012. Integrated BVFs were calculated from the monocular fields of each patient. Linear regression of mean deviation values was used to evaluate rates of BVF change during the follow-up period. Logistic regression models were used to investigate the association between abnormal VRQOL and rates of BVF change, while adjusting for potentially confounding socioeconomic and demographic variables. RESULTS Thirty-two patients (8.0%) had abnormal VRQOL as determined by the results of the NEI VFQ-25. Patients with abnormal VRQOL had significantly faster rates of BVF change than those with normal VRQOL (-0.18 vs -0.06 dB/y; P < .001). Rates of BVF change were significantly associated with abnormality in VRQOL (odds ratio = 1.31 per 0.1 dB/y faster; P = .04), after adjustment for confounding variables. CONCLUSIONS AND RELEVANCE Patients with faster rates of BVF change were at higher risk of reporting abnormal VRQOL. Assessment of rates of BVF change may provide useful information in determining risk of functional impairment in glaucoma.
  JAMA ophthalmology. 02/2013;
• Article: Focal Lamina Cribrosa Defects Associated With Glaucomatous Rim Thinning and Acquired Pits.

  Jae Young You, Sung Chul Park, Daniel Su, Christopher C Teng, Jeffrey M Liebmann, Robert Ritch
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  ABSTRACT: IMPORTANCE Considering the potential clinical importance of focal lamina cribrosa (LC) defects as a characteristic structural feature in glaucoma and a risk factor for glaucomatous visual field progression, it may be helpful to know the structure of focal LC defects and the spatial relationship between them and glaucomatous optic disc changes such as neuroretinal rim thinning/notching and acquired pits of the optic nerve (APON). OBJECTIVE To investigate structural and spatial relationships between focal LC defects and glaucomatous neuroretinal rim thinning/notching and APON. DESIGN In a cross-sectional analysis of data from an ongoing, prospective, longitudinal study, serial enhanced-depth imaging (EDI) optical coherence tomographic (OCT) images of the optic nerve head were obtained from patients with glaucoma and reviewed for focal LC defects (laminar holes or disinsertions). Anterior laminar insertion points and edges of laminar holes or disinsertions were marked in EDI-OCT images, reconstructed 3-dimensionally, and superimposed on optic disc photographs. SETTING A glaucoma referral practice. PARTICIPANTS Two hundred thirty-nine eyes (120 patients) were examined. Fifty-four eyes were excluded because of an incomplete horizontal or vertical set of serial EDI-OCT images or poor-quality EDI-OCT images owing to media opacity, irregular tear film, or poor patient cooperation. Among the remaining 185 eyes, 40 (from 31 patients) had laminar holes or disinsertions and were included for analysis. MAIN OUTCOME MEASURES Presence, extent, and location of laminar holes or disinsertions. RESULTS Among 185 eyes, 11 laminar holes and 36 laminar disinsertions were found in 40 eyes. Superimposed images of the 3-dimensionally reconstructed focal LC defects and disc photographs showed that the outline of the LC defect corresponded almost precisely to that of clinical APON for 6 laminar holes and that the LC defect was much larger than and enclosed APON for 10 laminar disinsertions. The remaining 5 laminar holes and 26 laminar disinsertions corresponded to focal neuroretinal rim loss, with no evidence of APON in disc photographs. CONCLUSIONS AND RELEVANCE Focal LC defects (laminar holes or disinsertions) are associated with neuroretinal rim loss and APON. The extent of LC defects can be visualized more effectively on EDI-OCT images than by clinical examination.
  JAMA ophthalmology. 01/2013;
• Article: Optic disc progression and rates of visual field change in treated glaucoma.

  Carlos G De Moraes, Jeffrey M Liebmann, Sung C Park, Christopher C Teng, Julia Nemiroff, Celso Tello, Robert Ritch
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  ABSTRACT: Purpose: To investigate the relationship between optic disc progression and rates of visual field (VF) change in patients with treated glaucoma. Methods: Glaucoma patients with repeatable VF loss, ≥8 SITA-Standard 24-2 VF tests and good quality optic disc stereophotographs evaluated over a 10-year period were included. Optic disc photographs were reviewed for signs of glaucoma progression (neuroretinal rim change, widening of retinal nerve fibre layer defect, disc haemorrhage and enlargement of beta-zone parapapillary atrophy) by two glaucoma specialists masked to their temporal sequence. Disagreements were adjudicated by a third grader. VF progression was evaluated using automated pointwise linear regression (PLR) and defined as at least two adjacent test points progressing >1.0 dB/year at p < 0.01. VF progression outcomes were compared with photograph review results. Results: Three-hundred and eighty nine eyes (389 patients; mean age 64.9 ± 13.0 years; mean baseline MD, -7.1 ± 5.1 dB) were included. Most patients had primary open angle glaucoma (54%). Eighty-two eyes (21%) had confirmed optic disc progression and 115 eyes (29%) met the VF PLR criteria. Eyes with documented optic disc progression had more rapid rates of VF change (-0.66 ± 0.7 versus -0.36 ± 0.7 dB/year, p < 0.01) and met the VF PLR endpoint more often (univariate OR = 1.85, p = 0.02; multivariate OR = 1.78, p = 0.03) than eyes without optic disc progression. There was moderate spatial consistency between the location of the optic disc progression and the hemifield with more rapid progression (81%, kappa = 0.40). Conclusions: Treated glaucomatous eyes with documented optic disc progression are at increased risk of diminished visual function over time and may require more aggressive therapy to prevent future vision loss. Among the indicators of structural progression, disc haemorrhage was the single most significant predictor for VF deterioration.
  Acta ophthalmologica 01/2013; · 2.44 Impact Factor
• Article: Series Length used during Trend Analysis Affects Sensitivity to Changes in Progression Rate in the Ocular Hypertension Treatment Study (OHTS).

  Stuart K Gardiner, Shaban Demirel, Carlos Gustavo De Moraes, Jeffrey M Liebmann, George A Cioffi, Robert Ritch, Mae O Gordon, Michael A Kass
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  ABSTRACT: PURPOSE: TREND ANALYSIS TECHNIQUES TO DETECT GLAUCOMATOUS PROGRESSION TYPICALLY ASSUME A CONSTANT RATE OF CHANGE. THIS STUDY USES DATA FROM THE OCULAR HYPERTENSION TREATMENT STUDY TO ASSESS WHETHER THIS ASSUMPTION DECREASES SENSITIVITY TO CHANGES IN PROGRESSION RATE, BY INCLUDING EARLIER PERIODS OF STABILITY. METHODS: Series of visual fields (mean 24 per eye) completed at 6-month intervals from participants initially randomized to observation were split into subseries before and after the initiation of treatment (the "split-point"). The Mean Deviation Rate of change (MDR) was derived using these entire subseries, and using only the W tests nearest the split-point, for different window lengths of W tests. A generalized estimating equation model was used to detect changes in MDR occurring at the split-point. RESULTS: Using shortened subseries with W=7 tests, the MDR slowed by 0.142dB/yr upon initiation of treatment (p<0.001), and the proportion of eyes showing "rapid deterioration" (MDR<-0.5dB/yr with p<5%) decreased from 11.8% to 6.5% (p<0.001). Using the entire sequence, no significant change in MDR was detected (p=0.796), and there was no change in the proportion of eyes progressing (p=0.084). Window lengths 6≤W≤9 produced similar benefits. CONCLUSIONS: Event analysis revealed a beneficial treatment effect in this dataset. This effect was not detected by linear trend analysis applied to entire series, but was detected when using shorter subseries of length between six and nine fields. Using linear trend analysis on the entire field sequence may not be optimal for detecting and monitoring progression. Non-linear analyses may be needed for long series of fields.
  Investigative ophthalmology & visual science 01/2013; · 3.43 Impact Factor
• Article: Author response: the coefficient of determination: what determines a useful r2 statistic?

  Carlos Gustavo De Moraes, Jeffrey M Liebmann, Robert Ritch, David S Greenfield, Mitra Sehi, Yun S Chung
  Investigative ophthalmology & visual science 01/2013; 54(1):37-8. · 3.43 Impact Factor
• Article: Retinal Ganglion Cell Count Estimates Associated with Early Development of Visual Field Defects in Glaucoma.

  Felipe A Medeiros, Renato Lisboa, Robert N Weinreb, Jeffrey M Liebmann, Christopher Girkin, Linda M Zangwill
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  ABSTRACT: PURPOSE: To estimate retinal ganglion cell (RGC) losses associated with the earliest development of visual field defects in glaucoma. DESIGN: Observational cohort study. PARTICIPANTS: The study group included 53 eyes of 53 patients with suspected glaucoma who were followed as part of the Diagnostic Innovations in Glaucoma (DIGS) study. These eyes had normal standard automated perimetry (SAP) visual fields at baseline and developed repeatable (3 consecutive) abnormal test results during a median follow-up of 6.7 years. An age-matched control group of 124 eyes of 124 healthy subjects recruited from the general population was included. METHODS: Estimates of RGC counts were obtained using a previously published model that combines estimates of RGC numbers from SAP sensitivity thresholds and retinal nerve fiber layer (RNFL) thickness measurements with spectral domain optical coherence tomography (SD-OCT). For eyes converting to glaucoma, estimates of RGC counts were obtained at the time (within ±3 months) of the first abnormal visual field, representing the time of earliest detection of visual field losses. MAIN OUTCOME MEASURES: Estimates of RGC counts in eyes converting to glaucoma versus healthy eyes. RESULTS: The average RGC count estimate in the eyes with early visual field defects was 652057±115829 cells, which was significantly lower than the average of 910 584±142 412 cells found in healthy eyes (P < 0.001). Compared with the average number of RGCs in the healthy group, glaucomatous eyes had an average RGC loss of 28.4%, ranging from 6% to 57%, at the time of the earliest visual field defect on SAP. Retinal ganglion cell counts performed significantly better than the SD-OCT average RNFL thickness parameter in discriminating glaucomatous from healthy eyes with receiver operating characteristic curve areas of 0.95±0.02 and 0.88±0.03, respectively (P = 0.001). CONCLUSIONS: Glaucomatous eyes with the earliest detectable visual field loss on automated perimetry may already show substantial loss of RGCs. Empirical estimates of RGC counts combining structural and functional tests agreed closely with previous histologic reports on the number of RGCs associated with early visual fields defects on SAP. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
  Ophthalmology 12/2012; · 5.45 Impact Factor
• Source

  Available from: Tiago Santos Prata

  Dataset: SD-tVEP Prata et al

  Tiago Santos Prata, Verônica C Lima, Carlos Gustavo V De Moraes, Valerie Trubnik, Peter Derr, Jeffrey M Liebmann, Robert Ritch, Celso Tello
• Article: Progression Pattern of Initial Parafoveal Scotomas in Glaucoma.

  Daniel Su, Sung Chul Park, Joseph L Simonson, Jeffrey M Liebmann, Robert Ritch
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  ABSTRACT: OBJECTIVE: To characterize the progression pattern of initial parafoveal scotomas (IPFSs) using cross-sectional and longitudinal 10-2 visual field (VF) data. DESIGN: Retrospective, observational study. PARTICIPANTS: Glaucoma patients with an IPFS in either hemifield based on 2 reliable 24-2 Swedish interactive threshold algorithm standard VFs (≥3 adjacent points with P<0.05 within the central 10° of fixation, 1 point or more with P<0.01 lying at the innermost paracentral points, and no scotoma outside the central 10°) and at least 2 10-2 VFs (first and last VFs 1 year or more apart). METHODS: To simulate a cohort with an extended follow-up, eyes with an IPFS were divided into subgroups based on the severity of glaucoma using their 10-2 VF pattern standard deviation (PSD). Cross-sectional data were used to create an average pattern deviation map that was generated by averaging pattern deviation map values of 10-2 VF point-by-point within each subgroup. Longitudinal data (eyes with 5 or more 10-2 VFs) was used to perform pointwise linear regression analysis of pattern deviation values. Patterns of IPFS progression were identified from these cross-sectional and longitudinal assessments. MAIN OUTCOME MEASURES: Average pattern deviation maps (cross-sectional) and maps of progression rates (longitudinal) in different disease severity subgroups. RESULTS: Eighty eyes (80 patients) and 40 eyes (40 patients) with an IPFS were included for cross-sectional and longitudinal analyses, respectively. The mean age ± standard deviation, 24-2 VF mean deviation, and 24-2 VF PSD for all eyes were 63±10 years, -3.27±2.18 dB, and 5.46±2.40 dB, respectively. Based on maps generated in both cross-sectional and longitudinal analyses, IPFS in the superior hemifield had an arcuate pattern initially that later deepened approximately 3° to 5° above fixation. The scotoma then elongated toward the physiologic blind spot and spread toward the nasal periphery, sparing the area corresponding to the papillomacular bundle. The IPFS in the inferior hemifield had a similar pattern, but was slightly farther from fixation. CONCLUSIONS: Superior and inferior IPFS have a similar characteristic pattern of progression, although the latter tend to be farther from fixation. Understanding these patterns should help in the management of such patients and in improving VF testing algorithms. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
  Ophthalmology 11/2012; · 5.45 Impact Factor
• Article: Exfoliation syndrome in Nigeria.

  Olusola O Olawoye, Adeyinka O Ashaye, Christopher C Teng, Jeffrey M Liebmann, Robert Ritch, Benedict G Ajayi
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  ABSTRACT: The purpose of this study was to estimate the prevalence of exfoliation syndrome (XFS) and its association with ocular disease in patients attending the eye clinic of the University College Hospital (UCH) in Ibadan, Nigeria. A total of 448 consecutive new patients, aged 30-90 years who presented to the eye clinic of UCH between December 2009 and November 2010 were evaluated. Each patient had a complete ophthalmic examination. Patients with exfoliative material on the anterior lens surface and/or pupillary margin in either or both eyes were considered to have XFS. Means, standard deviation, and 95% confidence intervals were calculated. All the patients examined were from the southern part of Nigeria. Majority (94.2%) were of the Yoruba tribe from southwestern Nigeria, while 5.8% were from southeastern Nigeria. The mean age of the study cohort was 58.5 ± 13.8, 54.8% were males, 12 (2.7%) had XFS. All patients with XFS were of the Yoruba tribe, with a mean age 65.6 ± 5.6 years. There was a male predilection (66.7%). All eyes with XFS had lenticular opacities. XFS was bilateral in eight patients (66.7%) of whom seven patients (87.5%) had glaucoma and lenticular opacities bilaterally. This is the first report of the existence of XFS in Nigeria. Larger studies are necessary in this population to further investigate the disease.
  Middle East African journal of ophthalmology 10/2012; 19(4):402-5.
• Source

  Available from: Robert Ritch

  Article: Glaucomatous damage of the macula.

  Donald C Hood, Ali S Raza, Carlos Gustavo V de Moraes, Jeffrey M Liebmann, Robert Ritch
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  ABSTRACT: There is a growing body of evidence that early glaucomatous damage involves the macula. The anatomical basis of this damage can be studied using frequency domain optical coherence tomography (fdOCT), by which the local thickness of the retinal nerve fiber layer (RNFL) and local retinal ganglion cell plus inner plexiform (RGC+) layer can be measured. Based upon averaged fdOCT results from healthy controls and patients, we show that: 1. For healthy controls, the average RGC+ layer thickness closely matches human histological data; 2. For glaucoma patients and suspects, the average RGC+ layer shows greater glaucomatous thinning in the inferior retina (superior visual field (VF)); and 3. The central test points of the 6° VF grid (24-2 test pattern) miss the region of greatest RGC+ thinning. Based upon fdOCT results from individual patients, we have learned that: 1. Local RGC+ loss is associated with local VF sensitivity loss as long as the displacement of RGCs from the foveal center is taken into consideration; and 2. Macular damage is typically arcuate in nature and often associated with local RNFL thinning in a narrow region of the disc, which we call the macular vulnerability zone (MVZ). According to our schematic model of macular damage, most of the inferior region of the macula projects to the MVZ, which is located largely in the inferior quadrant of the disc, a region that is particularly susceptible to glaucomatous damage. A small (cecocentral) region of the inferior macula, and all of the superior macula (inferior VF), project to the temporal quadrant, a region that is less susceptible to damage. The overall message is clear; clinicians need to be aware that glaucomatous damage to the macula is common, can occur early in the disease, and can be missed and/or underestimated with standard VF tests that use a 6° grid, such as the 24-2 VF test.
  Progress in Retinal and Eye Research 09/2012; · 9.45 Impact Factor
• Article: Rate of Visual Field Progression in Eyes With Optic Disc Hemorrhages in the Ocular Hypertension Treatment Study.

  Carlos Gustavo De Moraes, Shaban Demirel, Stuart K Gardiner, Jeffrey M Liebmann, George A Cioffi, Robert Ritch, Mae O Gordon, Michael A Kass
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  ABSTRACT: OBJECTIVE To compare rates of visual field (VF) change in ocular hypertensive eyes with and without optic disc hemorrhage (DH). METHODS Ocular Hypertension Treatment Study subjects (minimum 10 reliable VF tests, followed up ≥5 years) were included. Trend analyses of VF sequences over time of DH and non-DH eyes were assessed by regression of mean deviation (MDR) and pointwise linear regression (PLR). The main outcome measures were rates of VF change in DH and non-DH eyes. RESULTS Two thousand six hundred seven eyes (1378 participants) were included. The mean (SD) number of VF tests per eye was 23.7 (4.9) spanning a mean (SD) of 12.2 (2.0) years. At least 1 DH was detected in 187 eyes (7.2%), of which 52 eyes had recurrent DH. Mean deviation rate of change was significantly worse in DH compared with non-DH eyes (mean [SD], -0.17 [0.27] vs -0.07 [0.19] dB/y; P < .01). Significant PLR progression occurred more frequently in eyes with DH (odds ratio, 3.6; P < .01), which increased when 2 or more DHs were present (odds ratio, 4.2; P = .01). Eyes initially randomized to treatment were less likely to have a DH during follow-up. CONCLUSIONS Eyes with DH had more rapid VF deterioration when assessed by global (MDR) or local (PLR) trend analysis than eyes without DH. Eyes with recurrent DH had similar rates of global VF change (MDR) when compared with eyes with a single DH but reached criteria for rapid PLR change more often. Intraocular pressure reduction in ocular hypertension reduces the risk of developing a DH. Ocular hypertensive eyes with DH should be monitored closely and may need more aggressive therapy. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00000125.
  Archives of ophthalmology 08/2012; · 3.86 Impact Factor
• Article: Estimating the rate of retinal ganglion cell loss in glaucoma.

  Felipe A Medeiros, Linda M Zangwill, Douglas R Anderson, Jeffrey M Liebmann, Christopher A Girkin, Ronald S Harwerth, Marie-Josée Fredette, Robert N Weinreb
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  ABSTRACT: To present and evaluate a new method of estimating rates of retinal ganglion cell (RGC) loss in glaucoma by combining structural and functional measurements. Observational cohort study. The study included 213 eyes of 213 glaucoma patients followed up for an average of 4.5 ± 0.8 years with standard automated perimetry visual fields and optical coherence tomography. A control group of 33 eyes of 33 glaucoma patients underwent repeated tests over a short period to test the specificity of the method. An additional group of 52 eyes from 52 healthy subjects followed up for an average of 4.0 ± 0.7 years was used to estimate age-related losses of RGCs. Estimates of RGC counts were obtained from standard automated perimetry and optical coherence tomography, and a weighted average was used to obtain a final estimate of the number of RGCs for each eye. The rate of RGC loss was calculated for each eye using linear regression. Progression was defined by a statistically significant slope faster than the age-expected loss of RGCs. From the 213 eyes, 47 (22.1%) showed rates of RGC loss that were faster than the age-expected decline. A larger proportion of glaucomatous eyes showed progression based on rates of RGC loss rather than based on isolated parameters from standard automated perimetry (8.5%) or optical coherence tomography (14.6%; P < .01), while maintaining similar specificities in the stable group. The rate of RGC loss estimated from combining structure and function performed better than either isolated structural or functional measures for detecting progressive glaucomatous damage.
  American journal of ophthalmology 07/2012; 154(5):814-824.e1. · 3.83 Impact Factor
• Article: Risk Factors for Visual Field Progression in the Low-pressure Glaucoma Treatment Study.

  Carlos Gustavo De Moraes, Jeffrey M Liebmann, David S Greenfield, Stuart K Gardiner, Robert Ritch, Theodore Krupin
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  ABSTRACT: To investigate risk factors associated with visual field progression in the Low-pressure Glaucoma Treatment Study, a prospective trial designed to compare the effects of the alpha2-adrenergic agonist brimonidine tartrate 0.2% to the beta-adrenergic antagonist timolol maleate 0.5% on visual function in low-pressure glaucoma. Prospective cohort study. Low-pressure Glaucoma Treatment Study patients with ≥5 visual field tests during follow-up were included. Progression was determined using pointwise linear regression analysis, defined as the same 3 or more visual field locations with a slope more negative than -1.0 dB/year at P < 5%, on 3 consecutive tests. Ocular and systemic risk factors were analyzed using Cox proportional hazards model and further tested for independence in a multivariate model. A total of 253 eyes of 127 subjects (mean age, 64.7 ± 10.9 years; mean follow-up, 40.6 ± 12 months) were analyzed. Eyes randomized to timolol progressed faster than those randomized to brimonidine (mean rates of progression, -0.38 ± 0.9 vs 0.02 ± 0.7 dB/y, P < .01). In the final multivariate model adjusting for all tested covariates, older age (hazard ratio [HR] = 1.41/decade older, 95% confidence interval [CI] = 1.05 to 1.90, P = .022), use of systemic antihypertensives (HR = 2.53, 95% CI = 1.32 to 4.87, P = .005), and mean ocular perfusion pressure (HR = 1.21/mm Hg lower, 95% CI = 1.12 to 1.31, P < .001) were associated with progression whereas randomization to brimonidine revealed a protective effect (HR = 0.26, 95% CI = 0.12 to 0.55, P < .001). While randomization to brimonidine 0.2% was protective compared to timolol 0.5%, lower mean ocular perfusion pressure increased the risk for reaching a progression outcome in the Low-pressure Glaucoma Treatment Study. This suggests that the beneficial effect of randomization to the brimonidine arm was independent of possible differences in ocular perfusion pressures between the 2 treatment arms. The current results and large number of drop-outs in the brimonidine 0.2% arm suggest that more research is necessary before altering clinical practice paradigms.
  American journal of ophthalmology 07/2012; 154(4):702-11. · 3.83 Impact Factor
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  Available from: Christopher Bowd

  Article: Progression of Patterns (POP): A Machine Classifier Algorithm to Identify Glaucoma Progression in Visual Fields.

  Michael H Goldbaum, Intae Lee, Giljin Jang, Madhusudhanan Balasubramanian, Pamela A Sample, Robert N Weinreb, Jeffrey M Liebmann, Christopher A Girkin, Douglas R Anderson, Linda M Zangwill, Marie-Josee Fredette, Tzyy-Ping Jung, Felipe A Medeiros, Christopher Bowd
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  ABSTRACT: Purpose. We evaluated Progression of Patterns (POP) for its ability to identify progression of glaucomatous visual field (VF) defects. Methods. POP uses variational Bayesian independent component mixture model (VIM), a machine learning classifier (MLC) developed previously. VIM separated Swedish Interactive Thresholding Algorithm (SITA) VFs from a set of 2,085 normal and glaucomatous eyes into nine axes (VF patterns): seven glaucomatous. Stable glaucoma was simulated in a second set of 55 patient eyes with five VFs each, collected within four weeks. A third set of 628 eyes with 4,186 VFs (mean ± SD of 6.7 ± 1.7 VFs over 4.0 ± 1.4 years) was tested for progression. Tested eyes were placed into suspect and glaucoma categories at baseline, based on VFs and disk stereoscopic photographs; a subset of eyes had stereophotographic evidence of progressive glaucomatous optic neuropathy (PGON). Each sequence of fields was projected along seven VIM glaucoma axes. Linear regression (LR) slopes generated from projections onto each axis yielded a degree of confidence (DOC) that there was progression. At 95% specificity, progression cutoffs were established for POP, visual field index (VFI), and mean deviation (MD). Guided progression analysis (GPA) was also compared. Results. POP identified a statistically similar number of eyes (P > 0.05) as progressing compared with VFI, MD, and GPA in suspects (3.8%, 2.7%, 5.6%, and 2.9%, respectively), and more eyes than GPA (P = 0.01) in glaucoma (16.0%, 15.3%, 12.0%, and 7.3%, respectively), and more eyes than GPA (P = 0.05) in PGON eyes (26.3%, 23.7%, 27.6%, and 14.5%, respectively). Conclusions. POP, with its display of DOC of progression and its identification of progressing VF defect pattern, adds to the information available to the clinician for detecting VF progression.
  Investigative ophthalmology & visual science 07/2012; 53(10):6557-67. · 3.43 Impact Factor