Robert Ritch

New York Eye and Ear Infirmary · Department of Ophthalmology

Objective: To investigate any relationships between exfoliation syndrome or exfoliation glaucoma and age-related macular degeneration utilizing the Utah population database. Design: This was a retrospective, case–control cohort study. Subjects, Participants, and/or Controls: We identified 3405 patients diagnosed with exfoliation syndrome (XFS) or e...

This prospective study aimed to compare vascular parameters (endothelin-1 [ET-1] blood levels, laser Doppler imaging [LDI] of distal phalanxes, and nailfold capillaroscopy) between open-angle glaucoma patients with low- and high-tension optic disc hemorrhages (LTDH and HTDH, respectively). The 33 enrolled patients (mean age, 62.3 ± 13 years) were c...

Purpose: A pilot study of electronic medical records (EMR) in Utah was undertaken to investigate exfoliation syndrome and exfoliation glaucoma (XFS/XFG) in abdominal aortic aneurysm (AAA) patients. In a subsequent retrospective cohort study of Utah XFS/XFG patients and population controls, the risk of AAA was examined. Methods: EMR of a statewid...

Several studies have suggested a possible relationship between exfoliation syndrome (XFS) and abdominal aortic aneurysm (AAA). A systematic literature review was undertaken to investigate this potential association. The systematic literature review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Anal...

Background: Prior data suggest an association between non-melanoma skin cancer, i.e., basal and squamous cell cancers most often located in areas of sun exposure, and pseudoexfoliation syndrome. This study aimed to evaluate the association between these conditions and UV exposure through a detailed questionnaire in a large and robust Utah populatio...

Purpose: To compare vascular parameters, assessed by endothelin-1 (ET-1) blood levels, Laser Doppler Imaging (LDI) of distal phalanx, and nailfold capillaroscopy (NC), between open-angle glaucoma (OAG) patients with low (LTDH) and high-tension optic disc hemorrhages (HTDH). Methods: In this prospective study, patients were classified as LTDH if pre...

This work aims at determining the ability of a deep learning (DL) algorithm to measure retinal nerve fiber layer (RNFL) thickness from optical coherence tomography (OCT) scans in anterior ischemic optic neuropathy (NAION) and demyelinating optic neuritis (ON). The training/validation dataset included 750 RNFL OCT B-scans. Performance of our algorit...

This work aims at determining the ability of a deep learning (DL) algorithm to measure retinal nerve fiber layer (RNFL) thickness from optical coherence tomography (OCT) scans in anterior ischemic optic neuropathy (NAION) and demyelinating optic neuritis (ON). The training/validation dataset included 750 RNFL OCT B-scans. Performance of our algorit...

Back ground/aims To determine whether parapapillary choroidal microvasculature (PPCMv) density, measured by optical coherence tomography angiography, differed between acute primary angle-closure (APAC), primary open-angle glaucoma (POAG) and controls. Methods This is a prospective, cross-sectional, observational study. Data from 149 eyes from two...

Objective We assessed the relation between UV-associated dermatological carcinomas (basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)) and exfoliation syndrome with or without glaucoma (XFS/XFG). Design Case-control study. Subjects, participants, and controls:321 participants with XFS/XFG, primary open angle glaucoma (POAG), and control...

Precis: Two novel, quantitative metrics, and one traditional metric, were able to distinguish between many, but not all healthy and glaucomatous eyes in the bottom 5th percentile of global circumpapillary retinal nerve fiber layer (cpRNFL) thickness. Purpose: To test the hypothesis that objective OCT measures can distinguish between a healthy co...

Objective: Individuals with elevated systolic blood pressure (BP) or low diastolic BP, whether or not on antihypertensive treatment, may be at higher risk for developing glaucoma. We aimed to investigate BP levels in relation to glaucoma risk in a large cohort of postmenopausal women. Methods: Prospective follow-up of 101,447 postmenopausal wome...

Purpose: To identify genetic variants associated with pigment dispersion syndrome (PDS) and pigmentary glaucoma (PG) in unrelated patients and to further understand the genetic and potentially causal relationships between PDS and associated risk factors. Design: A 2-stage genome-wide association meta-analysis with replication and subsequent in s...

Objective To investigate the presence of flavoprotein fluorescence (FPF) at the optic nerve head (ONH) rim as a marker of mitochondrial dysfunction in primary open-angle glaucoma (POAG) and control eyes. Design Retrospective cross-sectional study, with patients recruited from the New York Eye and Ear Infirmary of Mount Sinai. Subjects, Participan...

The purpose of the Utah Project on Exfoliation Syndrome (UPEXS) is to identify associations between exfoliation syndrome (XFS) and other diseases that share the commonality of abnormalities in elastin and Lysyl Oxidase-Like 1 gene regulation. The UPEXS is unique because it uses the Utah Population Database, which is linked to the Utah genealogy, th...

Purpose Exfoliation syndrome, a systemic disorder with ocular manifestations, is associated with lysyl oxidase-like gene variants. Along with transforming growth factor beta-1, lysyl oxidase-like 1 is a key enzyme in stabilizing extracellular matrix and remodelling collagen/elastin. Given the role that transforming growth factor beta-1, lysyl oxida...

Prcis: Patients with low-tension optic disc hemorrhages are more frequently women, have NTG diagnosis and greater visual field loss. Symptoms of vascular dysregulation and Asian race also seem to be more prevalent in this clinical subtype. Purpose: Optic disc hemorrhage (DH) is an important glaucoma risk factor, and occurs in a wide intraocular...

Objective: Individuals with elevated systolic blood pressure (BP) or low diastolic BP, whether or not on antihypertensive treatment, may be at higher risk for developing glaucoma. We aimed to investigate BP levels in relation to risk of incident glaucoma in a large cohort of elderly women. Methods: Prospective follow-up of 101,447 postmenopausal wo...

Purpose Common LOXL1 protein-altering variants are significant genetic risk factors for exfoliation syndrome (XFS) and the related secondary glaucoma (XFG). A rare LOXL1 missense allele has been associated with protective effects in a Japanese cohort, suggesting that other rare alleles may also exhibit protective effects. The goal of this study was...

The increasing prevalence of myopia and high myopia has important public health implications because of the concomitant increase in visual disability. This chapter focuses on glaucoma among the many myopia-associated pathologic conditions. Myopia increases the risk of open-angle glaucoma independently of other risk factors including intraocular pre...

Background Glaucoma is a leading cause of visual disability and blindness. Release of iris pigment within the eye, pigment dispersion syndrome (PDS), can lead to one type of glaucoma known as pigmentary glaucoma. PDS has a genetic component, however, the genes involved with this condition are largely unknown. We sought to discover genes that cause...

Objective To compare the effectiveness and safety of the MicroShunt versus trabeculectomy in patients with primary open-angle glaucoma (POAG). Design One-year results from a 2-year, prospective, randomized, multicenter, non-inferiority study (NCT01881425) conducted in the USA and Europe. Participants Eligible patients were aged 40–85 years with i...

Purpose: To compare the variability and ability to detect visual field progression of 24-2, central 12 locations of the 24-2 and 10-2 visual field (VF) tests in eyes with abnormal VFs. Design: Retrospective, multisite cohort. Participants: A total of 52,806 24-2 and 11,966 10-2 VF tests from 7,307 eyes from the Glaucoma Research Network databa...

Primary open-angle glaucoma (POAG), is a heritable common cause of blindness world-wide. To identify risk loci, we conduct a large multi-ethnic meta-analysis of genome-wide association studies on a total of 34,179 cases and 349,321 controls, identifying 44 previously unreported risk loci and confirming 83 loci that were previously known. The majori...

Glaucoma is a chronic and progressive optic neuropathy characterized by the death of retinal ganglion cells and corresponding visual field loss. Despite the growing number of studies on the subject, the pathogenesis of the disease remains unclear. Notwithstanding, several studies have shown that the lamina cribrosa (LC) is considered an anatomic si...

Purpose: To compare peripapillary perfused capillary density (PCD) on optical coherence tomography angiography among resolved acute angle-closure (AAC), primary open-angle glaucoma (POAG), and control eyes. Design: Prospective, cross-sectional, observational study. Methods: All patients with resolved AAC or POAG of varying severity and control...

Purpose To determine whether parapapillary choroidal microvasculature (PPCMv) density as measured by optical coherence tomography angiography (OCT-A) differs between pseudoexfoliation syndrome (PXS) and pseudoexfoliation glaucoma (PXG). Design Cross-sectional study Methods One hundred ninety-two eyes of 120 subjects from two academic referral ins...

Purpose: To assess the effects of local defects, segmentation errors, and improper image alignment on the performance of the commonly used optical coherence tomography (OCT) measure of progression, that is the change in global (average) circumpapillary retinal nerve fiber layer (cpRNFL) thickness (ΔG). Methods: One hundred fifty eyes suspected o...

Precis: The region of glaucomatous progression, seen on optical coherence tomography (OCT) images of the circumpapillary retinal nerve fiber layer (cRNFL), increases in width and depth in all eyes, but shows a variety of different patterns of loss across eyes. Purpose: The purpose of this study was to examine the patterns of cRNFL loss secondary...

Purpose: Exfoliation syndrome (XFS), the most common recognizable cause of open-angle glaucoma worldwide, is a systemic disorder with genetic predisposition due to variations in lysyl oxidase-like 1 (LOXL1) function, leading to altered elastin matrices in ocular and systemic tissues. Obstructive sleep apnea (OSA) is a highly prevalent disorder als...

Background/Aims: Optic disc hemorrhage (DH) is an important glaucoma risk factor, and occurs in a wide intraocular pressure (IOP) range. We sought to characterize distinct clinical subtypes of patients with high- (HTDH) and low-tension DHs (LTDH). Methods: In this cross-sectional study, treated glaucomatous patients with DHs from two Glaucoma Servi...

Assessment of the vasculature within the optic nerve, peripapillary superficial retina, macula, and peripapillary choroid can be determined in glaucoma using optical coherence tomography angiography (OCTA). Decreased perfusion within the pre-laminar layer of the optic nerve has been correlated with glaucoma severity. The peripapillary superficial r...

Precis: It is generally assumed that optical coherence tomography (OCT) cannot be used to diagnose glaucomatous optic neuropathy (GON) in high myopes. However, this study presents evidence that there is sufficient information in OCT scans to allow for accurate diagnosis of GON in most eyes with high myopia. Purpose: The purpose of this study was...

PRéCIS:: Bruch's membrane opening-minimum rim width and circumpapillary retinal nerve fiber layer thickness measures may be improved by comparing probability levels and accounting for blood vessel locations. Purpose: To understand the differences between two optical coherence tomography (OCT) measures of glaucomatous damage: the Bruch's membrane...

Glaucoma is a neurodegenerative eye disease that results in retinal ganglion cell loss and ultimately loss of vision. Elevated intraocular pressure (IOP) is the most common known risk factor for retinal ganglion cell damage and visual field loss, and the only modifiable risk factor proven to reduce the development and progression of glaucoma. This...

Purpose To describe the development of a new algorithm for detecting changes in 10-2 visual field (VF) tests using event-based analysis and to test its validity in a second, independent glaucoma cohort. Design Prospective cohort study. Methods Patients with established open-angle glaucoma from the Macular Assessment and Progression Study (MAPS, d...

Purpose The origin of blood in glaucoma-related disc hemorrhages (DH) remains unknown. A prior clinic-based study of primary open-angle glaucoma (POAG)-related DH showed that they had grayscale pixel intensities more similar to blood from retinal macroaneurysms and adjacent retinal arterioles than to blood from retinal vein occlusions or adjacent r...

Purpose: To determine whether parapapillary choroidal microvasculature (PPCMv) density as measured by optical coherence tomography angiography differs between nonarteritic anterior ischemic optic neuropathy (NAION) and primary open angle glaucoma (POAG). Methods: Thirty-seven eyes with chronic NAION, 34 unaffected fellow eyes with NAION, 47 mode...

Precis: In a cohort study of 120,307 participants with 25+ years of follow-up, a history of non-melanoma skin cancer was associated with a 40% higher exfoliation glaucoma risk. Purpose: To evaluate the relationship between non-melanoma skin cancer (a marker of ultraviolet radiation exposure) and exfoliation glaucoma (XFG). Methods: We performe...

Purpose: To quantify the central visual field (VF) loss patterns in glaucoma using artificial intelligence. Design: Retrospective study. Participants: VFs of 8712 patients with 13 951 Humphrey 10-2 test results from 13 951 eyes for cross-sectional analyses, and 824 patients with at least 5 reliable 10-2 test results at 6-month intervals or mor...

Background: Ganglion cell inner plexiform (GCIP) layer thinning following acute optic neuritis (ON) is well-known. However, the onset of changes in the outer retinal layers needs further study. In this study, we determine longitudinal changes in retinal layer thickness in ON. Methods: Thirty ON patients underwent optical coherence tomography (OC...

Objective: To determine the relationship between optic disc hemorrhage (DH) and corneal hysteresis (CH). Methods: Consecutive patients with prior or current photographic evidence of unilateral DH who had undergone CH measurement with the Ocular Response Analyzer (ORA; Reichert, Buffalo, NY) were enrolled. Eyes with a history of corneal disease,...

Purpose To understand the added value of Bruch’s membrane opening-minimum rim width (BMO-MRW) measurements to conventional circumpapillary retinal nerve fibre layer (cpRNFL) thickness measurements on optical coherence tomography (OCT) imaging for discriminating between perimetric glaucoma and healthy eyes, evaluated through a qualitative evaluation...

Exfoliation syndrome (XFS), also known as pseudoexfoliation syndrome, is a systemic disorder that is usually recognized by characteristic findings in the anterior segment of the eye. This paper discusses the ocular and systemic risk factors that cause XFS to progress to exfoliation glaucoma (XFG)

Purpose: To assess the relationship between the rate of glaucomatous visual field (VF) worsening and baseline age and baseline visual field mean deviation (MD). Design: Retrospective, multisite cohort. Participants: A total of 84,711 reliable SITA 24-2 VF tests from 8167 eyes from 5644 patients with ≥6 visual field tests, ≥5 years of follow up...

Purpose: To compare macular vasculature in patients with primary open-angle glaucoma (POAG) POAG and atrophic non-arteritic anterior ischemic optic neuropathy (NAION). Design: Prospective, cross-sectional study METHODS: Thirty seven eyes with moderate and advanced POAG, 19 eyes with atrophic NAION, and 40 eyes of normal subjects were imaged usin...

Importance Genetic variants associated with primary open-angle glaucoma (POAG) are known to influence disease risk. However, the clinical effect of associated variants individually or in aggregate is not known. Genetic risk scores (GRS) examine the cumulative genetic load by combining individual genetic variants into a single measure, which is assu...

Importance: Systemic blood flow alterations have been described using video nailfold capillaroscopy (NFC) in high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) variants of primary open-angle glaucoma (POAG). To date, no previous studies have explored alterations in nailfold capillary blood flow in exfoliation glaucoma (XFG). Objective:...

Purpose: The purpose of this study was to explore macula vessel density and foveal avascular zone (FAZ) parameters in exfoliation glaucoma (XFG) compared to primary open-angle glaucoma (POAG) using optical coherence tomography angiography (OCTA). Methods: This was a cross-sectional observational study. Twenty-six XFG and 28 POAG patients with co...

Purpose Pseudoexfoliation (PEX) syndrome is an age-related systemic disease with ocular manifestations. The development of animal models is critical in order to elucidate the cause of the disease and to test potential treatment regimens. The purpose of this study is to report phenotypes found in mouse eyes injected with Adenovirus coding Wnt5a. Som...

Time course of Adenovirus-mediated gene expression after intracameral injection. Adenovirus (GFP/Wnt5a co-expression) was injected into the anterior chamber. The same eye was imaged by the fluorescence stereomicroscope at different time point. Three days after the injection, GFP-positive started showing up mainly in the trabecular meshwork region,...

Wnt5a expression in the cornea after adenovirus intracameral injection. AdGFP and AdWnt5a virus were injected into the anterior chamber of mouse eye. Two weeks and two months after injection, the eyes were collected and subjected to anti-Wnt5a immunostaining. Two weeks after injection, no positive signal can be found in AdGFP-injected eye (A). Stro...

Trabecular meshwork cells and corneal endothelial cells were the target cell of Adenovirus-mediated gene expression. Six days after the Adenovirus (GFP/Wnt5a co-expression) injection, live image was taken by fluorescent stereomicroscope using Z-stack scanning. GFP-positive cells can be found all over the cornea. Cornea in the pupil region should al...

PRéCIS:: The 24-hour ocular dimensional profile recorded by a contact lens sensor was affected by intraocular pressure lowering interventions. Among different treatments, incisional surgery had the most significant effect. Purpose: We investigated the effect of different intraocular pressure (IOP)-lowering interventions on contact lens sensor (CL...

Purpose: To examine the frequency of paravascular defects (PDs) and macular epiretinal membranes (ERMs) in eyes categorized as having mild glaucoma or glaucoma suspect using en-face slab analysis of optical coherence tomography (OCT) scans. Materials and methods: Fifty-seven glaucomatous eyes, 44 low-risk suspect eyes, and 101 healthy control ey...

Importance Mutations in the myocilin (MYOC) gene are the most common molecularly defined cause of primary open-angle glaucoma that typically occurs in patients with high intraocular pressures (IOP). One MYOC mutation, p.Gln368Ter, has been associated with as many as 1.6% of primary open-angle glaucoma cases that had a mean maximum recorded IOP of 3...

Purpose: To examine the utility of optical coherence tomography (OCT) for studying eyes with advanced glaucoma [i.e., eyes with a 24-2 visual field (VF) mean deviation (MD) worse than -15 dB], we tested the hypothesis that if these eyes had a 10-2 total deviation (TD) map with points better than -8 dB, then the topographically corresponding region...

Purpose: The purpose of this study is to evaluate differences in optical coherence tomography angiography (OCT-A) findings between patients with papilledema and pseudopapilledema. Methods: In this prospective, comparative study, 41 eyes of 21 subjects with papilledema, 27 eyes of 15 subjects with pseudopapilledema, and 44 eyes of 44 healthy norm...

Purpose: Glaucoma, a leading cause of blindness worldwide, often remains undetected until irreversible vision loss has occurred. Treatments focus on lowering intraocular pressure (IOP), the only modifiable and readily measurable risk factor. However, IOP can vary and does not always predict disease progression. MicroRNAs (miRNAs) are promising bio...

Exfoliation syndrome (XFS) is an age-related disease defined by the deposition of aggregated fibrous material (XFM) in the peri-cellular space. Principal morbidity occurs in the eye, where XFM accumulates on the anterior ocular tissues. GWAS have found that certain genetic variants of lysyl oxidase-like 1 (LOXL1), a matrix cross-linking enzyme that...

The first description of exfoliation syndrome (XFS) was presented by John Gustaf Lindberg in his doctoral thesis 100 years ago. The syndrome is an age-related disorder in which abnormal fibrillar extracellular material is produced and accumulates in several ocular tissues. Once thought to be peculiar to Scandinavia, XFS is found in almost every rac...

Importance Macular function is important for daily activities but is underestimated when tested with 24-2 visual fields, which are often used to classify glaucoma severity. Objective To test the hypothesis that current glaucoma staging systems underestimate glaucoma severity by not detecting macular damage. Design, Setting, and Participants This...

Purpose Exfoliation syndrome (XFS) is associated with genetic variants of lysyl oxidase–like 1 (LOXL1), a key enzyme in the stabilization of extracellular matrix (ECM) and elastin, and in connective tissue repair. Because patients with chronic obstructive pulmonary disease (COPD) have increased and altered elastin degradation, an association betwee...

Purpose: To find genetic contributions to glaucoma in African Americans. Design: Cross-sectional, case-control study. Participants: One thousand eight hundred seventy-five primary open-angle glaucoma (POAG) patients and 1709 controls, self-identified as being of African descent (AD), from the African Descent and Glaucoma Evaluation Study (ADAG...

Importance Exfoliation syndrome (XFS) is a systemic connective tissue disease, and abnormal connective tissue metabolism is implicated in inguinal hernias (IH). Associating XFS with comorbid conditions may illuminate their underlying pathophysiology and affect clinical screening and treatment. Exfoliation syndrome involves altered systemic extracel...

Purpose: To compare the effects of laser iridotomy (LI) and pilocarpine on iridocorneal angle and anterior chamber structure in anatomically narrow angles (ANA). Materials and methods: Temporal LI was performed 90 minutes after 2% pilocarpine administration in patients with occludable ANA. Swept-source optical coherence tomography B-scans of the...

Purpose: We conducted a secondary analysis of a randomized, placebo-controlled trial to test if hormone therapy (HT) altered the risk of open-angle glaucoma (OAG), and if the risk reduction varied by race. Design: Secondary analysis of randomized controlled trial data Methods: We linked Medicare claims data to 25,535 women in the Women's Health...

Importance Argon laser peripheral iridoplasty (ALPI) could be effective in widening residual angle closure following laser peripheral iridotomy (LPI). Background We investigated changes in angle parameters following ALPI and its safety profile in this study. Design Retrospective, observational case series. Participants The records from a single...

Purpose: In a myopic population, we investigated the occurrence of circumpapillary retinal nerve fiber layer (RNFL) segmentation errors that required manual correction in optical coherence tomography (OCT) and its effect on glaucoma diagnostic capability of OCT. Materials and methods: Myopic subjects (spherical equivalent refractive error <-3 di...

Purpose The purpose of this study was to determine whether a qualitative approach toward evaluating optical coherence tomography (OCT) imaging improves the ability to detect glaucomatous damage compared to a conventional metric of global circumpapillary retinal nerve fiber layer (cpRNFL) thickness. Methods A total of 394 healthy eyes and 272 glauc...

Purpose: Glaucomatous eyes with disc hemorrhage (DH) have a greater risk of paracentral visual field (VF) loss. However, not every DH eye presents with parafoveal scotoma (PFS), and contributing factors are still to be determined. In the present study, we investigated clinical and ocular factors associated with the presence of PFS in glaucomatous...

Purpose Our purpose was to compare the effectiveness of detecting progressive retinal nerve fiber layer (RNFL) thickness changes using widefield scans compared to circumpapillary circle scans derived from optic disc volume scans when using a manual region-of-interest (ROI) approach. Methods In a prospective observational study, a total of 125 eyes...