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ABSTRACT: To evaluate the clinical characteristics of newly diagnosed glaucomatous subjects who had a history of refractive corneal ablation surgery (RCAS).
Sixty-eight glaucomatous subjects who had a history of RCAS and 68 age- and visual field (VF) mean deviation-matched glaucomatous subjects with no history of RCAS were included. Intraocular pressure (IOP), central corneal thickness (CCT), VF, and retinal nerve fiber layer thickness determined by optical coherence tomography were assessed. Parameters were compared between patients with and without a history of RCAS. Between-eye comparisons in the same participant (more advanced vs. less-advanced eye, in terms of glaucoma severity) were performed in the RCAS group.
With similar levels of glaucoma severity, those with a history of RCAS showed significantly lower baseline IOP and a thinner CCT than the eyes of individuals without a RCAS history (13.6 vs. 18.7 mmHg, 490.5 vs. 551.7 µm, all p < 0.001). However, the extent of IOP reduction after anti-glaucoma medication did not significantly differ between the two groups (17% vs. 24.3%, p = 0.144). In the between-eye comparisons of individual participants in the RCAS group, the more advanced eyes were more myopic than the less-advanced eyes (-1.84 vs. -0.58 diopter, p = 0.003).
Eyes with a history of RCAS showed a similar level of IOP reduction as eyes without such a history after anti-glaucoma medication. Our finding that the more advanced eyes were more myopic than the less-advanced eyes in the same participant may suggest an association between glaucoma severity and myopic regression.
Korean Journal of Ophthalmology 04/2013; 27(2):103-8.
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ABSTRACT: A 50-year-old woman, who had undergone extensive removal of conjunctiva on the right eye for cosmetic purposes at a local clinic 8 months prior to presentation, was referred for uncontrolled intraocular pressure (IOP) elevation (up to 38 mmHg) despite maximal medical treatment. The superior and inferior conjunctival and episcleral vessels were severely engorged and the nasal and temporal bulbar conjunctival areas were covered with an avascular epithelium. Gonioscopic examination revealed an open angle with Schlemm's canal filled with blood to 360 degrees in the right eye. Brain and orbital magnetic resonance imaging and angiography results were normal. With the maximum tolerable anti-glaucoma medications, the IOP gradually decreased to 25 mmHg over 4 months of treatment. Extensive removal of conjunctiva and Tenon's capsule, leaving bare sclera, may lead to an elevation of the episcleral venous pressure because intrascleral and episcleral veins may no longer drain properly due to a lack of connection to Tenon's capsule and the conjunctival vasculature. This rare case suggests one possible mechanism of secondary glaucoma following ocular surgery.
Korean Journal of Ophthalmology 04/2013; 27(2):141-4.
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ABSTRACT: PURPOSE: To compare the rate of change of circumpapillary retinal nerve fiber layer (cRNFL) thickness, macular volume and thickness, and optic nerve head (ONH) parameters assessed using spectral-domain optical coherence tomography (SD-OCT) between eyes with progressing and nonprogressing glaucoma. DESIGN: Longitudinal, observational study. PARTICIPANTS: Two hundred seventy-nine eyes from 162 glaucoma patients followed for an average of 2.2 years. METHODS: Eyes were classified as progressors and nonprogressors according to assessment of optic disc and RNFL photographs and visual field progression analysis. Linear mixed effects models were used to evaluate the overall rate of change of cRNFL thickness, macular volume and thickness, and ONH parameters after adjustment for age, spherical equivalent, signal strength, and baseline SD-OCT measurements. MAIN OUTCOME MEASURES: The rate of change of cRNFL thickness, macular volume, and thickness and ONH parameters. RESULTS: Sixty-three eyes (22.6%) from 52 subjects were identified as progressors. Average, inferior quadrant, and 6- and 7-o'clock sector cRNFL thickness decreased faster in progressors than in nonprogressors (-1.26 vs -0.94, -2.47 vs -1.75, -3.60 vs -2.52, and -2.77 vs -1.51 μm/year, respectively; all P<0.05). The ONH rim area decreased faster, and average and vertical cup-to-disc ratio increased faster in progressors than in nonprogressors (-0.016 vs -0.006 mm2/year, and 0.004 vs 0.002 and 0.006 vs 0.004 per year, respectively; all P<0.05). Macular cube volume and the thickness of temporal outer and inferior inner macular sectors decreased faster in progressors than in nonprogressors (-0.068 vs -0.048 mm3/year, and -2.27 vs -1.67 and -2.51 vs -1.73 μm/year, respectively; all P<0.05). CONCLUSIONS: Serial measurement of parameters in all 3 areas (cRNFL, macula, and ONH) by SD-OCT may permit identification of progression in glaucomatous eyes. 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
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ABSTRACT: ABSTRACT Purpose: To evaluate the performance of Cirrus spectral domain optical coherence tomography (SD-OCT)-guided progression analysis (GPA) software to detect progression of retinal nerve fiber layer (RNFL) thinning in glaucoma patients. Materials and methods: This retrospective cohort study included 272 eyes of 154 glaucoma patients. Median follow-up time was 2.2 years, during which time data from at least four good-quality OCT examinations were collected. Glaucomatous eyes were classified as either early or advanced group according to visual field (VF) severity. Reference standard of glaucoma progression was defined by expert assessment of optic disc/RNFL photographs or VF GPA data, or visual field index (VFI) linear regression analysis. Sensitivity and specificity of OCT GPA, and agreement between OCT GPA findings and each reference standard strategy were estimated. Results: Fifty-three eyes (19.5%) showed progression by at least one of the reference standard strategies, while OCT GPA detected progression in 36 eyes (13.2%). When expert assessment of optic disc/RNFL photographs and/or VF analysis was used as the reference standard, the sensitivity and specificity of OCT GPA employed to detect glaucoma progression were 20.8% and 88.6%. Agreement between OCT GPA and either optic disc/RNFL photographic evaluation or VF analysis was poor (κ = 0.12 and 0.03, respectively). RNFL photographic assessment in early stage glaucoma showed best agreement with OCT GPA in terms of progression detection. Discussion: The Cirrus OCT GPA detected a considerable number of eyes exhibiting glaucoma progression. OCT GPA may be useful for progression detection in earlier stage of glaucoma to complement other reference standard strategies.
Current eye research 03/2013; 38(3):386-95. · 1.51 Impact Factor
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ABSTRACT: PURPOSE: To assess the reproducibility of circumpapillary retinal nerve fiber layer thickness (cRNFLT) and total macular thickness (TMT) parameters using Cirrus spectral domain optical coherence tomography (SD-OCT) and to apply this information to investigate its ability to detect cases where visual field (VF) progression was noted on event-based analysis in the eyes with early glaucomatous VF loss. METHODS: Intraclass correlation coefficient (ICC), coefficient of variation (COV), and intersession test-retest variability were calculated from control group. The sensitivity and specificity of SD-OCT for the identification of progressive VF defects were tested on progressive and stable patients. RESULTS: All ICCs from cRNFLT and TMT measurements ranged from 94.8% to 99.0%. While average cRNFLT showed the lowest intersession COV (2.57%), the nasal-outer and superior-inner TMT sectors showed the lowest COV (0.96%). The sensitivities of Cirrus SD-OCT cRNFLT measurements ranged from 37.8% to 48.9%, while that of TMT measurement was 73.3% when tested at the 95% confidence interval (CI). The sensitivity for detecting progressive VF changes in the central 10 degree area improved to 84.8% with TMT measurement, while it remained unchanged with cRNFLT measurements. The agreement on progression detection between cRNFLT and TMT sector measurements was poor (κ= 0.072 for overall, and 0.102 for the central 10 degree area at 95% CI, respectively). CONCLUSION: Intersession measurements of both cRNFLT and TMT parameters with Cirrus SD-OCT showed excellent reproducibility. TMT parameters using Cirrus SD-OCT may be better than cRNFLT measurements in terms of detecting progressive VF loss. This sensitivity derived from TMT measurements increased when progressive VF loss occurred in the central 10 degree area.
Investigative ophthalmology & visual science 02/2013; · 3.43 Impact Factor
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ABSTRACT: Optical coherence tomography (OCT) is an interferometry-based imaging modality that generates high-resolution cross-sectional images of the retina. Circumpapillary retinal nerve fibre layer (cpRNFL) and optic disc assessments are the mainstay of glaucomatous structural measurements. However, because these measurements are not always available or precise, it would be useful to have another reliable indicator. The macula has been suggested as an alternative scanning location for glaucoma diagnosis. Using time-domain (TD) OCT, macular measurements have been shown to provide good glaucoma diagnostic capabilities. Performance of cpRNFL measurement was generally superior to macular assessment. However, macular measurement showed better glaucoma diagnostic performance and progression detection capability in some specific cases, which suggests that these two measurements may be combined to produce a better diagnostic strategy. With the adoption of spectral-domain OCT, which allows a higher image resolution than TD-OCT, segmentation of inner macular layers becomes possible. The role of macular measurements for detection of glaucoma progression is still under investigation. Improvement of image quality would allow better visualisation, development of various scanning modes would optimise macular measurements, and further refining of the analytical algorithm would provide more accurate segmentation. With these achievements, macular measurement can be an important surrogate for glaucomatous structural assessment.
The British journal of ophthalmology 09/2012; · 2.92 Impact Factor
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ABSTRACT: To investigate the prevalence of, and factors associated with, errors in neuroretinal rim measurement by Cirrus high-definition (HD) spectral-domain optical coherence tomography (OCT) in myopic eyes.
Neuroretinal rim thicknesses of 255 myopic eyes were measured by Cirrus HD-OCT. The prevalence of, and factors associated with, optic disc margin detection error and cup margin detection error were assessed by analysing 72 cross-sectional optic nerve head (ONH) images obtained at 5° intervals for each eye.
Among the 255 eyes, 45 (17.6%) had neuroretinal rim measurement errors; 29 (11.4%) had optic disc margin detection errors at the temporal (16 eyes), superior (11 eyes), and inferior (2 eyes) quadrants; 19 (7.5%) showed cup margin detection errors at the nasal (17 eyes) and temporal (2 eyes) quadrants; and 3 (1.2%) had both disc and cup margin detection errors. Errors in detection of temporal optic disc margin were associated with presence of parapapillary atrophy (PPA), higher myopia, and greater axial length (AL) (p<0.001). Cup margin detection errors were associated with vitreous opacities attached to the ONH surface or acute cup slope angles (p<0.001).
Errors in neuroretinal rim measurement by Cirrus HD-OCT were found in myopic eyes, especially in eyes with PPA, higher myopia, greater AL, vitreous opacity or acute cup slope angle. These findings should be considered when interpreting neuroretinal rim thickness measured by Cirrus HD-OCT.
The British journal of ophthalmology 08/2012; 96(11):1386-90. · 2.92 Impact Factor
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ABSTRACT: To evaluate optic nerve head (ONH) parameters, peripapillary retinal nerve fiber layer (RNFL) thickness, and macular thickness by using Cirrus HD spectral-domain optical coherence tomography (OCT) in young patients with retinitis pigmentosa (RP).
ONH parameters, RNFL thickness, and macular thickness were measured and compared between 36 eyes from 36 young RP patients (RP group; mean age, 23.08 years) and 70 eyes from 70 healthy young subjects (control group; mean age, 22.66 years) using Cirrus HD-OCT. The effects of the presence of optic disc pallor and the severity of visual field (VF) defects on OCT parameters were also evaluated.
The RP group had a greater rim area, smaller cup-to-disc ratio, smaller cup volume, thicker RNFL, and thinner macula than the control group (p ≤ 0.024). ONH parameters were not affected by the presence of optic disc pallor (p ≥ 0.239). Eyes with more severe VF defects (mean deviation ≤ -13.88 dB) had thinner average macular areas than eyes with less severe VF defects (mean deviation ≥ -13.88 dB; p = 0.002). Meanwhile, the ONH parameters and average peripapillary RNFL thickness were not significantly different between the two groups (p ≥ 0.275).
Young eyes with RP exhibited different OCT parameters compared to healthy eyes. Among the various OCT parameters, only macular thickness was associated with disease severity. These findings should be considered when evaluating young RP patients.
Current eye research 06/2012; 37(10):914-20. · 1.51 Impact Factor
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ABSTRACT: We attempted to understand better the relationship between the macular visual field (VF) mean sensitivity (MS) assessed by standard automated perimetry (SAP) and the ganglion cell complex thickness (GCCT), and macular peripapillary retinal nerve fiber layer thickness (mpRNFLT) assessed by spectral domain optical coherence tomography (SD-OCT, RTVue-100) in open-angle glaucoma (OAG) patients.
We enrolled in the study 217 OAG patients with baseline intraocular pressure (IOP) in the statistically normal range. GCCT and mpRNFLT measurements, using the ganglion cell complex (GCC) and the optic nerve head (ONH) modes of RTVue-100 OCT, were obtained for analysis. Macular VF sensitivity was recorded in the dB and 1/L scales. The relationship of the function (MS) and structure (GCCT, mpRNFLT) was sought globally and in two VF sectors (superior and inferior).
The relationship of the macular VF sensitivity (dB) to the GCC, and mpRNFL global (R(2) = 0.111, 0.127) and sectoral (superior R(2) = 0.358, 0.171; inferior R(2) = 0.227, 0.263) thicknesses were statistically significant (all P < 0.05). The relationship of the macular VF sensitivity to the GCCT differed significantly from that of the macular VF sensitivity to the mpRNFL in the superior VF sector (R(2) = 0.358 vs. 0.171, P < 0.05).
GCCT determined by SD-OCT (RTVue-100) showed a statistically significant structure-function association with macular VF, and the strength of the association was greater than that of the mpRNFL with macular VF in the superior central VF area.
Investigative ophthalmology & visual science 06/2012; 53(8):5044-51. · 3.43 Impact Factor
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ABSTRACT: To evaluate the glaucoma progression in patients with a history of refractive corneal surgery (RCS).
A total of 313 eyes of 313 glaucoma patients (RCS group, 34 eyes; non-RCS group, 279 eyes) with a mean follow-up period of 2.7 years were included. Glaucoma progression was determined either by experts' stereoscopic optic disc/retinal nerve fiber layer (RNFL) photographs or by serial visual field (VF) data. Uni- and multivariate Cox's proportional hazards models were used to determine associations between potential risk factors including a history of RCS and glaucoma progression.
Among 313 eyes, 87 (27.8%) eyes showed progression either by optic disc/RNFL photographs or VF assessment during the follow-up period. Ten (29.4%) of eyes in the RCS group and 77 (27.6%) of eyes in the non-RCS group showed glaucoma progression; however, prevalence of progression did not differ between the two groups (P = 0.482). Among all participants, baseline age and VF pattern standard deviation (PSD; hazard ratios of 1.013 and 1.119; P = 0.026 and P < 0.001, respectively) were significant risk factors for progression. In both the RCS and the non-RCS group, only VF PSD was a significant risk factor for progression according to multivariate Cox proportional hazards (1.193, 1.099, P < 0.001, P < 0.001, respectively).
Baseline VF PSD and age substantially affected glaucoma progression in all study participants, although their RCS history was not a significant risk factor for glaucoma progression.
Investigative ophthalmology & visual science 06/2012; 53(8):4485-9. · 3.43 Impact Factor
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ABSTRACT: The aim of this study was to investigate factors associated with the signal strengths (SS, image quality scores) of optic disc and macular images obtained using Cirrus spectral domain optical coherence tomography (OCT).
Ninety-two glaucomatous eyes were imaged using the Cirrus OCT macular and optic disc cube modes after pupil dilation. The influences of patient age, spherical equivalent, cataract presence, and cataract and glaucoma severity (visual field mean deviation), on the SS of images obtained using the two cube modes were compared between patients whose images showed high SS (SS ≥7) and low SS (SS <7).
The signal strength was significantly higher in images obtained using the macular cube compared to the optic disc cube mode (7.8 ± 1.3 vs. 6.9 ± 1.1, respectively; p = 0.001). Age and visual acuity of patients differed significantly between the high- and low-SS groups when data acquired using the optic disc (p = 0.027 and 0.012, respectively) and macular cube modes (p = 0.046 and 0.014, respectively) were analyzed. When the optic disc cube mode was employed, the extent of cataracts was significantly related to SS, whereas when the macular cube mode was used, none of the factors analyzed was significantly associated with SS.
Age, visual acuity, and the extent of cataracts were significantly associated with images of higher SS when the Cirrus OCT optic disc cube mode was employed.
Korean Journal of Ophthalmology 06/2012; 26(3):169-73.
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ABSTRACT: To evaluate the use of scanning laser polarimetry (SLP, GDx VCC) to measure the retinal nerve fiber layer (RNFL) thickness in order to evaluate the progression of glaucoma.
Test-retest measurement variability was determined in 47 glaucomatous eyes. One eye each from 152 glaucomatous patients with at least 4 years of follow-up was enrolled. Visual field (VF) loss progression was determined by both event analysis (EA, Humphrey guided progression analysis) and trend analysis (TA, linear regression analysis of the visual field index). SLP progression was defined as a reduction of RNFL exceeding the predetermined repeatability coefficient in three consecutive exams, as compared to the baseline measure (EA). The slope of RNFL thickness change over time was determined by linear regression analysis (TA).
Twenty-two eyes (14.5%) progressed according to the VF EA, 16 (10.5%) by VF TA, 37 (24.3%) by SLP EA and 19 (12.5%) by SLP TA. Agreement between VF and SLP progression was poor in both EA and TA (VF EA vs. SLP EA, k = 0.110; VF TA vs. SLP TA, k = 0.129). The mean (±standard deviation) progression rate of RNFL thickness as measured by SLP TA did not significantly differ between VF EA progressors and non-progressors (-0.224 ± 0.148 µm/yr vs. -0.218 ± 0.151 µm/yr, p = 0.874). SLP TA and EA showed similar levels of sensitivity when VF progression was considered as the reference standard.
RNFL thickness as measurement by SLP was shown to be capable of detecting glaucoma progression. Both EA and TA of SLP showed poor agreement with VF outcomes in detecting glaucoma progression.
Korean Journal of Ophthalmology 06/2012; 26(3):174-81.
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ABSTRACT: We evaluated the clinical use of segmented macular layer thickness measurement in terms of glaucoma diagnosis and the ability to detect progression, and to compare such outcomes to those by circumpapillary retinal nerve fiber layer (cRNFLT) and total macular thickness (TMT) measurements.
The study included 141 glaucomatous and 61 healthy eyes. All glaucomatous eyes were subjected to at least four spectral domain optical coherence tomography (SD-OCT) examinations (mean follow-up, 2.13 years). Segmented macular layers were the macular nerve fiber layer (NFL), ganglion cell and inner plexiform layer (GCA), and outer retinal layer (ORL; from outer plexiform layer to retinal pigment epithelium). Areas under receiver operating characteristic curves (AUCs) discriminating healthy from glaucomatous eyes were determined in baseline measurements. The sensitivity and specificity of these parameters in terms of glaucoma progression detection were determined, with reference to assessment of optic disc/retinal nerve fiber layer (RNFL) photographs/visual field (VF) deterioration as standard(s).
GCA afforded the best diagnostic performance among three macular layers. The AUC of the GCA thickness (GCAT) was less than that of cRNFLT (0.869 vs. 0.953, P = 0.018), but superior to that of TMT (0.790, P = 0.05). Of the eyes, 38 showed progression during follow-up by standard
The sensitivities of TMT, GCAT, and cRNFLT values in terms of detection of progression were 14%, 8%, and 5%, respectively.
Although baseline cRNFL measurement was optimal in terms of glaucoma diagnosis, the GCAT and TMT showed similar levels of sensitivity in progression detection.
Investigative ophthalmology & visual science 05/2012; 53(7):3817-26. · 3.43 Impact Factor
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ABSTRACT: To investigate whether asymmetry in hemifield macular thickness can serve as an early indicator of glaucomatous structural damage using spectral domain optical coherence tomography.
Five zones in the macular thickness map were defined. Each zone included reciprocal areas in the superior and inferior hemifield. Differences in average retinal thickness (DRT) between corresponding regional pairs were measured in each of the five zones in 50 healthy eyes. An abnormality was defined as the DRT value lying outside the 95% confidence intervals. An eye was considered to yield an "abnormal macular hemifield test" (MHT) if abnormality was evident in any zone. The sensitivity and specificity for glaucoma detection of MHT and average circumpapillary retinal nerve fiber layer (cRNFL) classification were determined.
A total of 114 healthy, 103 glaucoma-suspect, and 74 glaucomatous eyes were included. Overall, 5.8%, 36.9%, 88.4%, and 77.4% of the eyes of the healthy, glaucoma-suspect (GS), early glaucoma (EG), and advanced glaucoma (AG) groups yielded abnormal MHT results, respectively. In EG eyes, the sensitivity of an abnormal MHT result was significantly greater than that of abnormal average cRNFL classification (P=0.008). In the GS and AG groups, the sensitivity did not significantly differ between an abnormal MHT result and an average cRNFL classification (P=0.880, 0.180). Compared with sectoral cRNFL thickness measurements, MHT showed a similar level of diagnostic performance. Specificity was not different between an abnormal MHT result and an average cRNFL classification (P=0.687).
Evaluation of asymmetry in hemifield macular thickness may serve as an assessment tool in the early diagnosis of glaucoma.
Investigative ophthalmology & visual science 03/2012; 53(3):1139-44. · 3.43 Impact Factor
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ABSTRACT: To evaluate serial changes in anterior segment (AS) parameters in terms of variation in pupil diameter (PD) using AS optical coherence tomography (OCT) in eyes with primary angle closure or primary angle closure glaucoma (PCG), age-matched open-angle (AO) eyes, and young open-angle (YO) eyes.
Forty-four PCG (mean ± SD; 62.2 ± 7.5 years), 36 AO (62.0 ± 12.3 years), and 58 YO eyes (29.1 ± 7.0 years) were imaged under four standardized lighting conditions (3.25, 100.8, 426, and 1420 cd/m(2)). PD, anterior chamber depth (ACD), iris cross-sectional area (IA), iris thicknesses at 750 and 1500 μm from the scleral spur (IT750, IT1500), iris curvature (IC), lens vault (LV), and anterior chamber area (ACA), were calculated. The slope of the change in each AS parameter in terms of variation in PD was determined by a linear mixed-effect model.
The mean ACD was significantly shallower (P < 0.001), the IC higher (P < 0.001), the IT750 greater (P = 0.026), the ACA smaller (P < 0.001), the LV greater (P < 0.001), and the IA wider (P = 0.019) in PCG eyes compared with AO eyes. However, the mean slope of no parameter differed significantly between PCG and AO eyes. The mean slopes of IC, IT1500, and IA differed between AO and YO eyes.
Older eyes showed significantly different dynamic AS parameter responses in terms of change in PD compared with younger eyes. Thus, the authors suggest that changes in the dynamic features of AS parameters with age may contribute to angle closure development, in addition to any predisposing anatomic condition.
Investigative ophthalmology & visual science 02/2012; 53(2):693-7. · 3.43 Impact Factor
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ABSTRACT: We evaluated and compared visual field index (VFI) and mean deviation (MD) capacity in detecting glaucoma progression at different stages.
Participants were classified as having early-, moderate-, or advanced-stage glaucoma. Trend-based approaches (TA) using linear regression analysis of the VFI and MD (VFI TA, MD TA) over patient age were performed. The rate was determined by both approaches at different stages of glaucoma.
We analyzed 173 eyes of 173 participants (mean follow-up 6.2 years). Glaucoma progressed in 24 eyes (13.9%) as determined by VFI TA and in 21 eyes (12.1%) as determined by MD TA. Agreement between VFI TA and MD TA was moderate to good (κ = 0.617). The rate was -0.29 ± 2.31 dB per year as determined by MD TA and 1.25 ± 4.79% per year as determined by VFI TA. Progression rate according to glaucoma severity was not significantly different among subgroups when assessed by both trend-based approaches.
VFI TA and MD TA performed similarly in measuring different stages of glaucoma progression. However, VFI TA and MD TA did not have agree perfectly in glaucoma progression detection. As glaucomatous changes can be general or localized, we suggest that changes in the MD and VFI should be considered when monitoring glaucoma progression through all stages.
Japanese Journal of Ophthalmology 12/2011; 56(2):128-33. · 0.92 Impact Factor
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ABSTRACT: To evaluate the progression rate of macular and circumpapillary retinal nerve fiber layer (RNFL) thickness in advanced glaucomatous eyes using spectral domain optical coherence tomography (Cirrus HD-OCT, Carl Zeiss Meditec, Dublin, CA).
Longitudinal, observational study.
A total of 98 eyes of 98 patients with advanced glaucoma (visual field [VF] mean deviation [MD] <-10 dB) with a mean follow-up time of 2.2 years.
Three glaucoma experts independently reviewed optic disc and RNFL photographs and classified patients into 3 groups: progressed, stable, and undetermined (criterion 1). Patients in the undetermined group could not be evaluated because of advanced optic disc cupping. The eyes were also classified into 2 groups, progressed and stable, by serial VF data (criterion 2).
Progression rates as determined by linear regression analysis against patient age using serial macular and RNFL thickness parameters were compared among different groups.
By criterion 1, 25 eyes (25.5%) were classified as stable, 13 eyes (13.3%) were classified as progressed, and 60 eyes (61.2%) were classified as undetermined. By criterion 2, 86 eyes (87.8%) were classified as stable, and 12 eyes (12.2%) were classified as progressed. By criterion 1, the mean progression rate of average macular thickness was significantly higher in the progressed group than in the stable and undetermined groups (-4.74±4.40, -0.53±1.44, and -2.72±4.75 μm/year, respectively; P = 0.01). The undetermined group showed a higher progression rate than the stable group (P = 0.045). However, the progression rate of average RNFL thickness did not differ significantly among the 3 groups (-1.19±2.62, -0.33±1.29, and -1.21±2.75 μm/year, respectively; P = 0.34). By criterion 2, the mean progression rate of average RNFL thickness did not differ significantly between the stable and progressed groups (-0.90±2.42 and -2.08±2.85 μm/year; P = 0.459). However, the progression rate as revealed by average macular thickness was significantly different between the 2 groups (-2.22±4.33 and -5.12±2.40 μm/year, respectively; P = 0.039).
Exploration of changes over time in macular thickness may improve detection of progression in patients with advanced glaucoma.
Ophthalmology 12/2011; 119(2):308-13. · 5.45 Impact Factor
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ABSTRACT: To investigate thickness of the macular ganglion cell complex (mGCC) and circumpapillary retinal nerve fiber layer (cRNFL) in retinal segments without visual field (VF) loss in glaucomatous eyes in which localized VF defects were confined to a single hemifield, using spectral-domain optical coherence tomography (SD-OCT).
Seventy-one Asian glaucomatous patients and 64 normal subjects underwent mGCC and cRNFL imaging employing RTVue-100 SD-OCT. We compared both thickness parameters in retinal segments without VF defects with those in segments in which such defects were evident, and in matched segments of normal controls. Linear regression analysis was used to investigate the relationship between mGCC and cRNFL thickness parameters of segments with or without VF defects, and glaucoma status based on Humphrey field analyzer (HFA) indices.
Mean mGCC thickness in the hemiretinae of glaucomatous eyes without VF defects was 87.2 ± 9.3 μm, significantly lower than in matched control hemiretinae (96.2 ± 5.0 μm; p < 0.001), but significantly higher than in glaucomatous hemiretinae with VF defects (76.4 ± 9.9 μm; p < 0.001). A similar trend was also noted with mean cRNFL thickness. There were significant associations between both thickness parameters in glaucomatous hemiretinae with or without VF loss and degree of VF damage at initial presentation.
Perimetrically normal hemifields of glaucomatous eyes had significantly lower mGCC and cRNFL thicknesses than did the corresponding retinal regions of healthy eyes. SD-OCT may be a useful ancillary diagnostic tool for evaluation of early macular and circumpapillary structural changes in glaucomatous eyes with localized VF defects.
Albrecht von Graæes Archiv für Ophthalmologie 12/2011; 250(4):595-602. · 2.17 Impact Factor
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ABSTRACT: To explore factors affecting the glaucoma diagnostic capability of macular thickness and circumpapillary retinal nerve fiber layer (cRNFL) thickness as determined by spectral domain-optical coherence tomography.
Area under the curve (AUC) of the receiver operating characteristics (ROC) discriminating healthy from glaucomatous eyes was determined using 10 macular thickness and 16 cRNFL thickness parameters. Glaucomatous eyes were categorized into two groups using four criteria according to whether cRNFL thickness or macular thickness measurement was better for glaucoma detection (cRNFL better group [RBG], macula better group [MBG], respectively). The clinical characteristics were compared between RBG and MBG. ROC regression analysis was conducted to identify variables affecting diagnostic capability using either macular thickness or cRNFL thickness measurements.
Four hundred twenty-four glaucomatous patients and 297 healthy subjects were analyzed. Of all cRNFL parameters, average thickness showed the largest AUC (0.958). Of macular parameters, the inferior outer sector showed the largest AUC (0.880). More eyes were placed into the RBG than the MBG, making use of all four criteria (90 vs. 24, 143 vs. 46, 76 vs. 18, and 103 vs. 36, respectively). RBG patients had a smaller optic disc area than did MBG patients in 3 of the 4 criteria. Signal strength affected the diagnostic performance of cRNFL thickness measurement (P = 0.043), whereas that of macular thickness was not affected by any covariate analyzed.
Overall, cRNFL thickness measurements were generally superior to those of macular thickness when used to diagnose glaucoma. Macular thickness parameters were of greater value in eyes with larger optic discs.
Investigative ophthalmology & visual science 09/2011; 52(11):8094-101. · 3.43 Impact Factor
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ABSTRACT: PURPOSE: To evaluate the clinical outcome of a modified anterior chamber tube shunt to an encircling band (ACTSEB) procedure in eyes with uncontrolled intraocular pressure (IOP) after scleral encircling band (EB) implantation for treatment of retinal detachment. METHODS: Eight eyes of 7 consecutive patients were analyzed. Silicone tube (external/internal diameter, 0.64/0.30 mm) with 3 to 4 side ports around the distal portion was prepared. Temporary partial ligation of the tube was performed. The fibrous capsule around the EB was incised and the distal portion of each tube was placed under the EB and anchored to the sclera. The proximal part of the tube was inserted into the anterior chamber. IOP, use of antiglaucoma medication, and complications were recorded for 1 year after surgery. Success was defined as an IOP of 8 to 21 mm Hg and no requirement for an additional procedure; complete success was defined as control of IOP without use of antiglaucoma medication; and qualified success as control of IOP with the use of medication. RESULTS: Mean preoperative IOP was 40.1 mm Hg under maximum tolerated medical therapy. Mean IOP was 10.6 mm Hg at 1 day and 16.9 mm Hg at 1 year after surgery. Antiglaucoma medication was used in 3 eyes during follow-up. Tube exposure was detected in 1 eye at 10 months after surgery. The complete success rate was 50% (4 eyes) and the qualified success rate 37.5% (3 eyes). CONCLUSION: Our modification of the ACTSEB procedure resulted in good clinical outcomes, with favorable control of IOP and a low rate of complications.
Journal of glaucoma 06/2011; · 1.74 Impact Factor
