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ABSTRACT: Purpose: This study was aimed at reporting the outcomes of trabeculectomy in primary juvenile open angle glaucoma (JOAG). Design: This study was a retrospective noncomparative case series. Materials and Methods: We included 60 eyes of 41 JOAG patients who underwent primary trabeculectomy without mitomycin-C (MMC) between 1995 and 2007. The primary outcome was success, defined as complete, if intraocular pressure (IOP) was >5 and ≤21 mmHg without medications or qualified if IOP was >5 and ≤21 mmHg with or without antiglaucoma medications. Secondary outcome measures were mean and percentage IOP reduction, complications, and risk factors for the failure of trabeculectomy. Results: The mean (±standard deviation) age at presentation was 24.1 ± 6.8 years (range, 12-35). Mean follow-up was 67 ± 41 months (range, 12-156). At 1 year, the probability of complete success was 92% (n = 56, 95% CI: 81-96%), at 3 years it was 89% (n = 47, 95% CI: 78-95%), and at the end of 5 years, it was 80% (n = 34, 95% CI: 65-89%). The probability of qualified success was 100% (n = 60) at 1 year, 98% (n = 51, 95% CI: 87-100%) at 3 years, and 96% (n = 36, 95% CI: 84-99%) at the end of 5 years. The mean IOP reduced from 35 ± 10 to 13 ± 2.5 mmHg (P < 0.001) after trabeculectomy. There was no serious postoperative complication. Young age was the only significant risk factor associated with the failure (odds ratio = 0.89, P = 0.03). Conclusion: Primary trabeculectomy without MMC has good success rates in JOAG.
Indian Journal of Ophthalmology 04/2013; · 1.02 Impact Factor
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ABSTRACT: Purpose: To compare the safety and efficacy of trabeculectomy with Ologen implant vs. trabeculectomy with Mitomycin C (MMC). Materials and Methods: In a prospective, randomized, pilot study, 39 eyes of 33 subjects with medically uncontrolled primary glaucoma, aged 18 years or above underwent trabeculectomy either with MMC (20 eyes) or with Ologen implant (19 eyes). The primary outcome measure was cumulative success probability, defined as complete if the intraocular pressure (IOP) was > 5 and ≤ 21 mm Hg without anti-glaucoma medications or additional surgery and qualified if an IOP was > 5 and ≤ 21 mm Hg with or without anti-glaucoma medications. Results: Mean (± standard deviation) follow-up in Ologen group was 19.1 ± 8.1 months, and in MMC group was 18.0 ± 8.4 months. Mean IOP reduction at 6 months was significantly lower (P = 0.01) in the MMC group (11.9 ± 2.9 mm Hg) as compared to Ologen group (14.6 ± 2.7 mm Hg). However, at 12 months (P = 0.81) and 24 months (P = 0.32), the mean IOP was similar between the 2 groups. Complete success probability at the end of 6 months in Ologen group was 100% (95% confidence interval: 59.1 - 99.0) was similar (P = 0.53) to that in MMC group (93.8%, 95% CI: 63.2 - 99.1). The incidences of early post-operative complications were similar in the 2 groups, except hyphema, which was significantly more in Ologen group (P = 0.02). Conclusion: In this pilot study, the success of trabeculectomy and complications were similar in both Ologen and MMC groups at the end of 6 months.
Indian Journal of Ophthalmology 04/2013; · 1.02 Impact Factor
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ABSTRACT: PURPOSE:: To evaluate the (i) effects of biological (age and axial length) and instrument-related [typical scan score (TSS) and corneal birefringence] parameters on the retinal nerve fiber layer (RNFL) measurements and (ii) repeatability of RNFL measurements with the enhanced corneal compensation (ECC) protocol of scanning laser polarimetry (SLP) in healthy subjects. METHODS:: In a cross-sectional study, 140 eyes of 73 healthy subjects underwent RNFL imaging with the ECC protocol of SLP. Linear mixed modeling methods were used to evaluate the effects of age, axial length, TSS, and corneal birefringence on RNFL measurements. One randomly selected eye of 48 subjects from the cohort underwent 3 serial scans during the same session to determine the repeatability. RESULTS:: Age significantly influenced all RNFL measurements. RNFL measurements decreased by 1 µm for every decade increase in age. TSS affected the overall average RNFL measurement (β=-0.62, P=0.003), whereas residual anterior segment retardance affected the superior quadrant measurement (β=1.14, P=0.01). Axial length and corneal birefringence measurements did not influence RNFL measurements. Repeatability, as assessed by the coefficient of variation, ranged between 1.7% for the overall average RNFL measurement and 11.4% for th nerve fiber indicator. CONCLUSIONS:: Age significantly affected all RNFL measurements with the ECC protocol of SLP, whereas TSS and residual anterior segment retardance affected the overall average and the superior average RNFL measurements, respectively. Axial length and corneal birefringence measurements did not influence any RNFL measurements. RNFL measurements had good intrasession repeatability. These results are important while evaluating the change in structural measurements over time in glaucoma patients.
Journal of glaucoma 02/2013; · 1.74 Impact Factor
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ABSTRACT: PURPOSE: To report treatment outcomes in malignant glaucoma. DESIGN: Retrospective case series. PARTICIPANTS: Twenty-eight eyes of 26 patients who were treated for malignant glaucoma between 1991 and 2009. METHODS: Malignant glaucoma was diagnosed based on the presence of a shallow or flat central and peripheral anterior chamber in the presence of patent iridotomy, with intraocular pressure (IOP) of 22 mmHg or more after any intraocular surgery. The treatment algorithm included antiglaucoma medications and cycloplegics as first-line methods; the second-line therapy in pseudophakic eyes was laser hyaloidotomy, followed by vitrectomy-hyaloidotomy-iridectomy (VHI) or transscleral cyclophotocoagulation (TSCPC). MAIN OUTCOME MEASURES: Resolution was defined as deepening of the central anterior chamber and IOP of 21 mmHg or less (on 2 successive follow-ups at least 1 week apart) with or without topical antiglaucoma medications in the absence of systemic antiglaucoma medications. RESULTS: At the diagnosis of malignant glaucoma, 5 eyes were phakic and 23 were pseudophakic. The preceding surgeries were trabeculectomy (11 eyes), cataract surgery (10 eyes), and combined cataract and glaucoma surgery (7 eyes). Mean IOP decreased from 34±8.3 mmHg at presentation to 14.3±5.2 mmHg at the last visit (P<0.001). Resolution of malignant glaucoma was seen in 27 eyes (27/28; 96%), 17 eyes resolved with 1 intervention, and 10 eyes required repeat procedures. Of the 27 eyes whose disease resolved, this result was achieved in 4 eyes with medical treatment, in 7 pseudophakic eyes with laser hyaloidotomy, in 4 eyes with VHI, and in 12 eyes with TSCPC. The median duration of follow-up was 192 days (interquartile range, 35-425 days). There was no difference in the visual acuity at presentation and at the final visit in 14 eyes. Eight eyes gained 2 lines or more and 6 eyes lost 2 lines or more of visual acuity. CONCLUSIONS: Malignant glaucoma can be managed successfully by appropriate and timely interventions. Medical treatment was beneficial in phakic eyes, laser hyaloidotomy was beneficial in pseudophakic eyes, and vitrectomy and TSCPC were beneficial in refractory cases. A stepladder approach to treatment was successful (96%) in this series. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Ophthalmology 01/2013; · 5.45 Impact Factor
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ABSTRACT: Purpose: To present a selected case series of plateau iris syndrome (PIS) that attempts to highlight the varied outcomes. Methods: Retrospective review of three selected cases of plateau iris. Results: Case 1 with 23 years follow-up highlights the benign nature of the disease with no disc and field changes. Case 2 represents the progressive form of the disease. Case 3 demonstrates the better efficacy of pilocarpine in comparison to other anti-glaucoma medications in the treatment of plateau iris. Conclusion: The understanding of the varied clinical course of plateau iris syndrome, as demonstrated by the above cases, might aid in therapeutic decision making.
Seminars in ophthalmology 01/2013; 28(1):28-31.
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ABSTRACT: Purpose: To evaluate the long-term outcomes of laser peripheral iridotomy (LPI) in primary angle closure disease. Methods: We retrospectively reviewed the medical records of all Indian subjects of primary angle closure (PAC) and primary angle closure glaucoma (PACG) who underwent LPI between 2003 and 2004. Subjects requiring additional treatment in the form of antiglaucoma medications or trabeculectomy during the follow-up were identified. Baseline factors predicting the need for additional treatment following LPI in primary angle closure disease (PAC+PACG) were analyzed. Results: 84 eyes (PAC:PACG = 16:68) of 47 subjects had undergone LPI during the study period. Over a mean follow-up of 50 ± 22.7 months, 68 eyes (PAC:PACG = 9:59) required additional treatment, of which 26 eyes (PAC:PACG=2:24) subsequently underwent trabeculectomy. Over the initial 20 months of follow-up after LPI, the cumulative probability of requiring no additional treatment was similar between PAC [63.6% (95% CI: 29.7-84.5)] and PACG eyes [64.0% (95% CI: 44.5-78.3)]. Subsequently, the cumulative probability of requiring no additional treatment in PACG eyes dropped to 24.8% (9.7-43.5) at 4 years and 9.9% (1.8-26.7) at 7 years. Presenting IOP (p = 0.01) and highest recorded IOP before LPI (p = 0.03) were the most significant predictors of the need for additional treatment after LPI. Extent of synechial angle closure (p = 0.04) and the cup to disc ratio (p = 0.05) significantly predicted the need for trabeculectomy subsequently in PACG eyes. Conclusions: The majority of angle closure eyes required additional treatment after LPI. Eyes with a higher presenting IOP were more likely to require additional treatment and those with a greater amount of synechial angle closure and larger cup disc ratio at presentation were more likely to require surgery over the follow-up.
Seminars in ophthalmology 01/2013; 28(1):4-8.
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ABSTRACT: PURPOSE: To evaluate the magnitude of VFI change attributable to change in the estimation algorithm from pattern deviation probability plot (PDPP) to total deviation probability plot (TDPP) when the mean deviation (MD) crosses -20 decibel (dB). Methods: In a retrospective study, 37 stable glaucoma eyes in which, MD of the VFs crossed -20 dB were identified. For each eye, a pair of VFs was selected so that one VF of the pair had a MD better than but close to -20 dB and the other had a MD worse than but again close to -20 dB. The change in VFI in the VF pairs and its associations with the number of points in probability plots with normal threshold sensitivities were evaluated. Similar pairs of VFs from 28 stable glaucoma eyes where the MD crossed -10 dB were chosen as controls. RESULTS: The change in VFI in VF pairs when the MD crossed -20 dB, ranged from 3% to 33% (median: 15%) while the same when MD crossed -10 dB ranged from 1 to 8% (median: 4%). Difference in the number of points with normal threshold sensitivities in PDPP when MD was better than -20 dB compared to those in TDPP when MD crossed -20 dB significantly influenced the VFI change (R2=0.65). Considering the eccentricity of these points further explained the VFI change (R2=0.81). Conclusion: The decrease in VFI when MD crosses -20 dB can be highly variable. This has to be considered while using VFI in clinical and research settings.
Investigative ophthalmology & visual science 12/2012; · 3.43 Impact Factor
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ABSTRACT: PURPOSE:: To report the clinical features, management, and treatment outcomes of glaucoma in microspherophakia. METHODS:: Medical records of 159 eyes of 80 subjects with microspherophakia were reviewed. The clinical features at presentation, presence of glaucoma, methods of treatment, and their outcomes were noted. Glaucoma was diagnosed based on intraocular pressure (IOP)≥22 mm Hg on 2 different occasions and/or glaucomatous optic disc damage. Angle closure was defined as occludable angles >270 degrees with or without presence of peripheral anterior synechiae. RESULTS:: Glaucoma was diagnosed in 81 eyes (51%). The mean age of subjects was 20±13 years, mean refractive error was -13.5±5.5, the mean IOP was 27.7±11.1 mm Hg. IOP≥22 mm Hg was present in 84% of eyes, disc damage in 59% of the eyes, 75% eyes had angle closure, and 25% had open angle on gonioscopy. Subluxation of crystalline lens was seen in 53 eyes and 14 eyes had dislocation of the lens; systemic associations were present in 21 subjects (3 Marfan syndrome, 18 Weill-Marchesani syndrome). Nine eyes out of 51 and 2 out of 16 eyes responded to medical treatment and laser iridotomy, respectively. Of the 48 eyes that required surgical intervention, 24 eyes underwent trabeculectomy. Complete success probability of trabeculectomy was 86% [95% confidence interval (CI), 63%-95%] at 6 months, 77% (95% CI, 53%-90%) at 1 year, which was maintained till 7 years, and reduced to 61% (95%CI, 26%-84%) at 8 years. Nearly 20% of eyes at presentation and 30% of the eyes at last follow-up were blind due to glaucoma. CONCLUSIONS:: More than half of the eyes with microspherophakia in this series presented with glaucoma; angle closure was the predominant form of glaucoma. Blindness due to glaucoma in microspherophakia was 20% to 30%.
Journal of glaucoma 10/2012; · 1.74 Impact Factor
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ABSTRACT: Purpose: To study the normal corneal birefringence measurements using scanning laser polarimetry (SLP) and to evaluate the effects of age, gender and corneal thickness on these measurements.
Methods: In an observational, cross-sectional study, 140 eyes of 73 normal subjects of Indian origin (age range: 19-68 years, 37 men and 36 women) underwent corneal birefringence measurements with SLP. Measures of corneal birefringence obtained were corneal polarization axis (CPA) and corneal polarization magnitude (CPM). Distribution of CPA and CPM were investigated. Linear mixed modeling methods were used to evaluate the effects of age, gender and corneal thickness on the corneal birefringence measurements.
Results: CPA (median 3o nasally downwards, range 42o nasally upwards to 23o nasally downwards) and CPM (mean 96 nm, range 57 to 140) showed wide variability. There was a significant (P<0.001) correlation between the fellow eyes both for CPA (coefficient of determination, R2 = 0.57) and CPM (R2 = 0.72). CPA and CPM were significantly (R2 = 0.12, p<0.001) associated with each other. CPA and CPM were not associated with age, gender or central corneal thickness (p>0.05 for all associations).
Conclusion: Corneal birefringence measurements in normal subjects of Indian origin showed wide variability. CPA and CPM were dependent on each other but were not dependent on the age and gender of the subject or the corneal thickness.
Eye 07/2012; · 1.85 Impact Factor
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ABSTRACT: To evaluate the efficacy and safety of the toric Implantable Collamer Lens phakic intraocular lens (pIOL) in the management of myopic astigmatism in Indian eyes.
Tertiary eyecare center, South India.
Retrospective interventional case series.
The study included consecutive patients with myopic astigmatism with a minimum follow-up of 1 year. Safety, efficacy, predictability, and adverse events were assessed preoperatively and 12 months postoperatively.
The study enrolled 110 eyes (65 patients). The mean corrected distance visual acuity was 0.23 logMAR ± 0.23 (SD) preoperatively and 0.18 ± 0.18 logMAR 12 months postoperatively (P<.001). The mean refractive cylinder decreased from 2.3 ± 1.1 diopters (D) to 0.4 ± 0.6 D, respectively (P<.001). Postoperatively, the uncorrected distance visual acuity improved to 20/20 in 15 eyes (13.6%) and 20/40 or better in 72 eyes (65.4%). Fourteen eyes (12.7%) gained 2 or more lines of corrected distance visual acuity, 21 eyes (19.1%) gained 1 line, 61 eyes (55.5%) had no change, and 1 eye (0.9%) lost 2 lines. Predictability within ±0.50 D of cylinder was achieved in 77 eyes (70 %) and within ±1.00 D in 97 eyes (88.2%). Twelve months postoperatively, the safety index was 0.75 and the efficacy index was 1.04. Endothelial cell loss at the end of 12 months was 10.3%. Clinically significant cataract developed in 1 eye (0.9%).
Implantation of posterior chamber toric pIOLs to correct myopic astigmatism was effective, safe, and predictable.
Journal of cataract and refractive surgery 07/2012; 38(9):1583-9. · 2.75 Impact Factor
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ABSTRACT: PURPOSE:: To evaluate the relationship between intraocular pressure (IOP) and the rate of visual field (VF) progression in treated glaucoma. METHODS:: In a clinic-based, retrospective study, data of consecutive primary open-angle and angle-closure glaucoma patients with ≥5 VFs between 1989 and 2008 were analyzed. The Guided Progression Analysis software, which provides the rate of change of Visual Field Index per year, was used to assess the rate of progression (ROP). IOP measurements during the VF examination visits were extracted, and mean, peak, and fluctuation (SD) of IOP during the follow-up were calculated. Relationships between IOP parameters and ROP were analyzed using regression models. Other risk factors evaluated were age, sex, type of glaucoma, presence of hypertension and diabetes, severity of VF loss at presentation, glaucoma surgery during follow-up, number of antiglaucoma medications, and follow-up duration. RESULTS:: During the study period, 296 eyes of 213 glaucoma patients had undergone ≥5 VFs. IOP fluctuation was the only IOP parameter significantly associated with ROP (β=-0.37, P=0.02). Evaluated in a multivariate model with other risk factors, the severity of VF damage at presentation (β=0.08, P=0.002) and IOP fluctuation (β=-0.35, P=0.02) remained significantly associated with ROP. Greater IOP fluctuation was seen in eyes undergoing glaucoma surgery and eyes requiring more antiglaucoma medications during follow-up. CONCLUSIONS:: Long-term IOP fluctuation was the most important IOP parameter associated with increased ROP of glaucomatous VF loss. This association is likely due to the confounding effect of enhanced therapy in eyes suspected to be progressing.
Journal of glaucoma 05/2012; · 1.74 Impact Factor
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ABSTRACT: To evaluate the influence of a control group on the diagnostic accuracy of spectral-domain optical coherence tomography (SD-OCT) in early glaucoma.
In a diagnostic, case-control study, 119 eyes of 60 normal subjects with no findings suspicious for glaucoma (control cohort 1); 76 eyes of 41 subjects referred by general ophthalmologists as glaucoma suspects based on optic disc morphology, but found by glaucoma experts to be normal but with physiological variations in their optic nerves (control cohort 2); and 65 eyes of 46 early-glaucoma patients (cases) underwent imaging of the optic nerve head (ONH), retinal nerve fiber layer (RNFL), and ganglion cell complex (GCC) by SD-OCT.
Areas under the receiver operating characteristic curves (AUC) of ONH parameters discriminating glaucomatous eyes from normal eyes of control cohort 2 were significantly lesser (P < 0.001) than those discriminating glaucomatous eyes from normal eyes of control cohort 1. AUCs of RNFL parameters discriminating glaucomatous eyes from normal eyes of control cohorts 2 and 1 were comparable. Although the AUCs of GCC thickness parameters were comparable, AUCs of GCC focal and global loss volume in control cohort 2 (0.684 and 0.671. respectively) were significantly less (P < 0.05) than in control cohort 1 (0.881 and 0.841, respectively).
The effectiveness of most SD-OCT parameters in detecting glaucoma significantly decreased when evaluated against a clinically relevant control group with suspicious-looking optic nerves compared with that against a control group consisting of normal subjects with no findings suspicious for glaucoma.
Investigative ophthalmology & visual science 02/2012; 53(2):1058-65. · 3.43 Impact Factor
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American journal of ophthalmology 11/2011; 152(5):877; author reply 877-8. · 3.83 Impact Factor
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ABSTRACT: PURPOSE:: To determine the effect of cataract on the Visual Field Index (VFI) in glaucoma patients. METHODS:: Reliable visual fields (VFs) of 53 patients (53 eyes) with primary glaucoma who underwent phacoemulsification either alone or combined with trabeculectomy were analyzed before and after surgery. All patients had VFs within a period of 15 months before and after surgery. VFI, mean deviation (MD), and pattern standard deviation (PSD) before surgery were compared with those after surgery. RESULTS:: Median (25th and 75th percentiles) MD after cataract surgery [-10.52 dB (range, -19.25 to -4.86 dB)] was significantly better (P=0.003) than that before surgery [-11.74 dB (range, -20.61 to -7.15 dB)]. Median PSD after surgery [4.76 dB (range, 2.48 to 9.83)] was worse (P=0.01) than that before surgery [3.50 dB (range, 1.93 to 8.20 dB)] when eyes with MD better than -20 dB were considered (41 eyes). VFI after surgery [80% (range, 44% to 94%)] was similar (P=0.92) to that before surgery [77% (range, 37% to 92%)]. MD improved while VFI remained unchanged in both nuclear sclerotic (n=41) and posterior subcapsular cataracts (n=12). CONCLUSIONS:: MD and PSD were significantly affected, whereas VFI was not affected by cataract. VFI may be a more robust measure of VF damage than MD or PSD in glaucomatous eyes with coexisting cataracts.
Journal of glaucoma 09/2011; · 1.74 Impact Factor
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Ophthalmology 05/2011; 118(5):1010; author reply 1010. · 5.45 Impact Factor
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ABSTRACT: To evaluate the relationship between severity of visual field (VF) loss at presentation and rate of VF progression in glaucoma.
Clinic-based, retrospective study.
We included 512 eyes of 310 primary glaucoma patients.
We analyzed the VFs of all subjects of primary glaucoma who had >5 VFs between 1989 and 2008. Based on the mean deviation (MD), we classified the VF loss as mild (MD > -6 dB), moderate (MD ≤ -6 to ≥ -12 dB) or severe (MD < -12 dB). Guided Progression Analysis software which gives the rate of progression (ROP) of Visual Field Index per year was used to assess the ROP.
Relationship between severity of VF loss at presentation and ROP.
The median duration of follow-up was 6.8 years. The ROP increased (worsened) by 0.02% per year for every dB worsening of MD (P = 0.02) and for every year of increasing age (P = 0.001). Association between MD and ROP showed a significant positive relationship in mild (β = 0.18; P = 0.001) and a significant negative relationship in severe (β = -0.16; P<0.001) VF loss category. Association between MD and ROP was not significant in the moderate VF loss category (β = -0.05; P = 0.61).
In early stages of glaucoma, the ROP worsened as the severity increased, but, in later stages of the disease, ROP became smaller as the severity increased. There is a need for better methods to detect progression in eyes with severe glaucomatous damage.
Ophthalmology 02/2011; 118(2):249-53. · 5.45 Impact Factor
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ABSTRACT: Evidence-based medicine is an evolving new paradigm. With the advent of numerous new diagnostic techniques and therapeutic interventions, one needs to critically evaluate and validate them by appropriate methods before adopting them into day-to-day patient care. The concepts involved in the evaluation of diagnostic tests and therapy are discussed. For delivering the highest level of clinical care, evidence alone is not sufficient. Integrating individual clinical experience and patients′ perspectives with the best available external evidence is essential.
Indian Journal of Ophthalmology. 01/2011;
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ABSTRACT: Evidence-based medicine is an evolving new paradigm. With the advent of numerous new diagnostic techniques and therapeutic interventions, one needs to critically evaluate and validate them by appropriate methods before adopting them into day-to-day patient care. The concepts involved in the evaluation of diagnostic tests and therapy are discussed. For delivering the highest level of clinical care, evidence alone is not sufficient. Integrating individual clinical experience and patients' perspectives with the best available external evidence is essential.
Indian Journal of Ophthalmology 01/2011; 59 Suppl:S5-10. · 1.02 Impact Factor
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ABSTRACT: To compare the surgical outcomes of single site phacotrabeculectomy without mitomycin C (MMC) in primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG).
We retrospectively reviewed the records of all patients with a diagnosis of PACG and POAG, who underwent single site phacotrabeculectomy without MMC between January 2001 and December 2005 and had a minimum follow-up of 12 months. The primary outcome measure was cumulative success probability, defined as complete [intraocular pressure (IOP) ≤21 mm Hg without antiglaucoma medications or additional surgery] and qualified (IOP <21 mm Hg with medications). Secondary outcome measures were reduction of IOP, the number of antiglaucoma medications at last follow-up, and complication rates.
Seventy-one eyes of 63 PACG patients (mean age 61.2 y) and 72 eyes of 57 POAG patients (mean age 64.0 y) were analyzed. Mean duration of follow-up was 38.7 and 41.7 months in the PACG and POAG groups, respectively. Complete success in PACG (72.1%) was more than the POAG group (56.1%), but the difference was not statistically significant (P=0.06). Qualified success in the PACG and POAG group was 87.4% and 92.8%, respectively (P=0.43). IOP reduction was greater (P=0.03) in the PACG group and PACG group required fewer antiglaucoma medications postoperatively (P=0.03) for IOP control.
Survival probability of single site phacotrabeculectomy without MMC was not significantly different between the PACG and POAG groups. IOP reduction was greater and the need for antiglaucoma medications after surgery was lesser in the PACG group.
Journal of glaucoma 01/2011; 20(1):57-62. · 1.74 Impact Factor
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ABSTRACT: To evaluate the effects of signal strength, age, sex, optic disc size, and axial length on the normal optic nerve head (ONH), retinal nerve fiber layer (RNFL), and macular measurements with spectral domain optical coherence tomography (SD-OCT).
In an observational, cross-sectional study, 119 eyes of 60 normal subjects of Indian origin underwent ONH, RNFL, and macular imaging with SD-OCT during the same visit. Linear mixed-modeling methods were used to evaluate the effects of signal strength, age, sex, optic disc area, and axial length on ONH, RNFL, and macular measurements.
ONH rim measurements increased and cup measurements decreased with increasing signal strengths. For a 10-unit increase in signal strength, total rim area increased by a mean of 0.1 mm(2). ONH measurements also increased with increasing optic disc size. Rim measurements decreased and cup measurements increased with increasing axial length. None of the predictors influenced RNFL measurements. Macular inner retinal thickness decreased by a mean of 1.7 μm and macular full retinal thickness decreased by an average of 3.4 μm for every decade's increase in age. Sex did not influence any of the measurements.
Signal strength, optic disc size, and axial length had a significant effect on ONH measurements, whereas age had a significant effect on macular measurements. None of the predictors evaluated influenced the RNFL measurements. These predictors should be considered when evaluating change in the structural measurements in glaucoma over time.
Investigative ophthalmology & visual science 11/2010; 52(2):1103-10. · 3.43 Impact Factor
