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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: 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: 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
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ABSTRACT: To compare the glaucoma diagnostic capabilities of optic nerve head (ONH) parameters with retinal nerve fiber layer thickness (RNFLT) using Cirrus spectral-domain optical coherence tomography (Carl Zeiss Meditec Inc, Dublin, CA; version 5.0.0.326).
Two hundred twenty-nine glaucomatous patients, 405 preperimetric glaucoma patients, and 109 healthy individuals were imaged by Cirrus optical coherence tomography optic disc cube mode. Correlations were sought between RNFLT and ONH parameters (disc and rim area, average and vertical cup-to-disc ratio, and cup volume). Areas under receiver operating characteristic curves (AUCs) of average RNFLT were compared with those of ONH parameters with respect to discrimination between glaucomatous patients and healthy individuals. Subgroup analysis was performed in early, moderate-to-advanced glaucomatous groups, glaucoma patients with a small disc area and a large disc area.
Rim area showed the strongest correlation with average RNFLT (r=0.663) and the highest AUC (0.871). The overall AUC for discrimination between healthy individuals and glaucomatous patients was higher for average RNFLT than for rim area (0.957 vs. 0.871, P<0.001). In the early and small disc area subgroup, the AUC of average RNFLT was significantly greater than those of all ONH parameters. In moderate-to-advanced glaucomatous groups' patients, the AUCs of average RNFLT and rim area, in large disc area group patients, the AUC of average RNFLT and vertical cup-to-disc ratio, did not differ significantly.
RNFLT was better than any tested ONH parameter when used for glaucoma discrimination, especially in patients with early-stage glaucoma and in glaucomatous patients with small optic discs.
Journal of glaucoma 06/2011; 21(7):498-504. · 1.74 Impact Factor
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ABSTRACT: To investigate the characteristics of visual field (VF) progression in medically treated normal-tension glaucoma (NTG) patients (Koreans) with unstable ocular perfusion pressure (OPP).
One hundred one eyes of 101 NTG patients followed up for more than 4 years (mean follow-up, 6.2 years ± 12.1 months) were included. Modified Anderson criteria (MC) and linear regression analysis (LA) of VF mean deviation (MD) within the central 10° and 10° to 24° area were assessed for determining VF progression in groups with lowest (LMF) and highest (HMF) 24-hour mean OPP [MOPP = 2/3;(mean arterial pressure - IOP)] fluctuation. Kaplan-Meier analyses were used to compare the elapsed time of confirmed VF progression in the two groups. Hazard ratios (HRs) for the association between clinical risk factors including 24-hour MOPP and central VF progression were obtained by using Cox proportional hazards models.
Three of 33 eyes in the LMF progressed, whereas 12 of 34 eyes in the HMF progressed within the central 10° according to the MC; the between-group difference was significant (P = 0.010). By LA within the central 10°, two eyes from the LMF and nine from the HMF groups showed progression (P = 0.025). The HMF showed a greater cumulative probability of central VF progression than the LMF, by both LA and MC (Kaplan-Meier analysis, P = 0.003, 0.015, log-rank test). In multivariate analysis, only 24-hour MOPP fluctuation was significantly associated with central VF progression (P = 0.014).
The 24-hour MOPP fluctuation was the most consistent prognostic factor among various IOP, blood pressure, and clinical factors for central VF glaucomatous progression in our series of NTG eyes.
Investigative ophthalmology & visual science 02/2011; 52(2):737-43. · 3.43 Impact Factor
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ABSTRACT: To evaluate the utility of baseline Stratus optical coherence tomography (OCT; Carl Zeiss Meditec, Dublin, CA) retinal nerve fiber layer (RNFL) normative classification in the prediction of future visual field (VF) loss.
Eighty-eight eyes with suspected glaucoma with abnormal RNFL classification by Stratus OCT were followed up for more than 4 years. VF conversion in three consecutive tests was assessed after baseline Stratus OCT and VF examination. Baseline intraocular pressure, VF global indices, OCT RNFL thickness, and number of abnormal OCT sectors were compared between VF converters (CG) and nonconverters (NCG). Positive and negative predictive values (PPV, NPV) of OCT sectors with abnormal classifications were calculated with respect to VF conversion. Hazard ratios (HRs) of various risk factors, including abnormal OCT classification, with respect to future VF conversion, were determined by use of the Cox proportional hazard model.
Twenty-one (23.9%) eyes showed VF conversion during follow-up. Baseline OCT RNFL thickness was significantly lower and the number of abnormal OCT RNFL sectors significantly greater in CG than in NCG patients (P = 0.022 for both). The PPV and NPV of normative OCT RNFL classification was highest in the inferior quadrant (50%, 87.1%, respectively). Baseline VF mean deviation (MD) and the number of abnormal OCT RNFL sectors were both associated with future VF conversion (HR, 0.788 and 1.290, respectively).
In patients with suspected glaucoma, an abnormal RNFL classification in the inferior area of the optic disc or an elevated number of abnormal RNFL sectors, as determined by Stratus OCT, were both associated with future VF conversion.
Investigative ophthalmology & visual science 01/2011; 52(5):2634-9. · 3.43 Impact Factor
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ABSTRACT: To evaluate the strength and pattern of the relationship between visual field (VF) mean sensitivity (MS), assessed by standard automated perimetry (SAP), and macular ganglion cell complex thickness (GCCT), measured with spectral-domain optical coherence tomography (SD-OCT).
Ninety-seven glaucoma patients were enrolled. GCCT, determined by ganglion cell complex (GCC) scanning, and two peripapillary retinal nerve fiber layer thickness (pRNFLT) measurements, using the NHM4 (RNFL1) and RNFL 3.45 (RNFL2) modes, were recorded. MS was recorded on the decibel (dB) and 1/L scales. The relationship between function (MS) and structure (GCC, pRNFLT) was sought.
The association of MS (in decibels) with GCC global (r = 0.445) and sectoral (superior, r = 0.528; inferior, r = 0.370) thicknesses was not significantly different from that of MS to global (RNFL1, r = 0.505; RNFL2, r = 0.498) and sectoral (RNFL 1 superior, r = 0.559; inferior, r = 0.440; RNFL 2 superior, r = 0.535; inferior, r = 0.443) pRNFLT, on linear regression analysis. The relationship pattern was curvilinear on the dB scale against GCCT and RNFLT. Logarithmic regression of MS (using both the dB and 1/L scales) against GCCT and RNFLT was better than linear regression in describing the pattern of association.
GCCT, determined by SD-OCT, showed correlation to MS of a strength similar to that demonstrated between MS and pRNFLT.
Investigative ophthalmology & visual science 12/2010; 51(12):6401-7. · 3.43 Impact Factor
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ABSTRACT: To characterize the features of peripapillary atrophy (PPA), as imaged by spectral-domain optical coherence tomography (SD-OCT).
SD-OCT imaging of the optic disc was performed on healthy eyes, eyes suspected of having glaucoma, and eyes diagnosed with glaucoma. From the peripheral β-zone, the retinal nerve fiber layer (RNFL), the junction of the inner and outer segments (IS/OS) of the photoreceptor layer, and the Bruch's membrane/retinal pigment epithelium complex layer (BRL) were visualized.
Nineteen consecutive eyes of 10 subjects were imaged. The RNFL was observed in the PPA β-zone of all eyes, and no eye showed an IS/OS complex in the β-zone. The BRL was absent in the β-zone of two eyes. The BRL was incomplete or showed posterior bowing in the β-zone of five eyes.
The common findings in the PPA β-zone were that the RNFL was present, but the photoreceptor layer was absent. Presence of the BRL was variable in the β-zone areas.
Korean Journal of Ophthalmology 12/2010; 24(6):353-9.
