Faculty Bibliography
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63
Risk Factors for Optic Disc Hemorrhage in the Low-pressure Glaucoma Treatment Study
PURPOSE: To investigate risk factors for disc hemorrhage detection in the Low-pressure Glaucoma Treatment Study. DESIGN: Cohort of a randomized, double-masked, multicenter clinical trial. METHODS: Low-pressure Glaucoma Treatment Study patients with at least 16 months of follow-up were included. Exclusion criteria included untreated intraocular pressure (IOP) >21 mm Hg, visual field mean deviation worse than -16 decibels, or contraindications to study medications. Patients were randomized to topical treatment with timolol 0.5% or brimonidine 0.2%. Stereophotographs were independently reviewed by two masked graders searching for disc hemorrhages. The main outcomes investigated were the detection of disc hemorrhage at any time during follow-up and their recurrence. Ocular and systemic risk factors for disc hemorrhage detection were analyzed using Cox proportional hazards model and further tested for independence in a multivariate model. RESULTS: 253 eyes of 127 subjects (mean age, 64.7+/-10.9 years; women, 58%; European ancestry, 71%) followed for an average (+/-SD) of 40.6+/-12 months were included. In the multivariable analysis, history of migraine (hazard ratio, HR =5.737, P =0.012), narrower neuroretinal rim width at baseline (HR =2.91, P =0.048), use of systemic beta-blockers (HR =5.585, P =0.036), low mean systolic blood pressure (HR =1.06, P =0.02), and low mean arterial ocular perfusion pressure during follow-up (HR =1.172, P =0.007) were significant and independent risk factors for disc hemorrhage detection. Treatment randomization was not associated with either the occurrence or recurrence of disc hemorrhages. CONCLUSIONS: In this cohort of Low-pressure Glaucoma Treatment Study patients, migraine, baseline narrower neuroretinal rim width, low systolic blood pressure and mean arterial ocular perfusion pressure, and use of systemic beta-blockers were risk factors for disc hemorrhage detection. Randomization assignment did not influence the frequency of disc hemorrhage detection.
PMID: 24513094
ISSN: 0002-9394
CID: 829762
Clinical optic disc findings associated with focal lamina cribrosa defects in glaucoma [Meeting Abstract]
Purpose To investigate the clinical optic disc findings associated with focal lamina cribrosa defects (FLCD) in glaucoma. Methods Serial enhanced depth imaging optical coherence tomography (EDI OCT) B-scans (interval between scans, ~30 mum) of the optic nerve head were obtained from glaucoma patients at various disease stages. EDI OCT scans were reviewed for presence/absence of focal LC defects (laminar holes or disinsertions) by a masked observer. The best quality stereo disc photo taken within 6 months from EDI OCT was selected for each eye by another masked observer. The disc photos were reviewed by another a third masked observer for presence/absence of a notch with remaining neuroretinal rim tissue, a notch with no remaining rim tissue, diffuse rim thinning, bayoneting of circumlinear vessel, beta-zone parapapillary atrophy (PPA), and acquired pit of the optic nerve (APON). Strength of association with the EDI OCT finding (presence/absence of FLCD) was calculated for each of the 6 clinical optic disc findings using Cramer's V test. Disc findings significantly associated with FLCD in Cramer's V test were entered into a multivariable logistic regression model. Disc hemorrhage was not included in the study because it would not be meaningful to include a transient finding such as disc hemorrhage in a cross-sectional analysis of irreversible findings. Results 186 eyes of 186 glaucoma patients (mean age, 68+/-18 years) were included for analysis. A notch with no remaining rim tissue, diffuse rim thinning and APON were significantly correlated with FLCD (all p<0.02), but a notch with remaining rim tissue, beta-zone PPA and bayoneting of circumlinear vessels were not (all p>0.10) (Table 1). In the multivariable logistic regression model, a notch with no remaining rim tissue (p=0.001, odds ratio [OR]=3.47) and APON (p=0.004, OR=10.31) were significantly associated with FLCD. The association between diffuse rim thinning and FLCD was marginally significant (p=0.052 OR=2.26). Conclusions A notch with no remaining rim tissue was associated with FLCD, whereas a notch with remaining rim tissue was not. The association between APON and FLCD, previously reported by our group, was confirmed. These clinical optic disc features may be helpful in predicting the presence of FLCD and deciding EDI OCT-guided evaluation of the LC
EMBASE:616116898
ISSN: 0146-0404
CID: 2565642
Factors associated with anterior chamber volume and iris volume in pigment dispersion syndrome [Meeting Abstract]
Purpose Purpose To investigate clinical factors associated with anterior chamber volume (ACV) and iris volume (IV) in eyes with pigment dispersion syndrome (PDS) with and without ocular hypertension or glaucoma (PG) using swept-source optical coherence tomography (SSOCT). Methods In this cross-sectional study, each participant underwent SS-OCT (Casia SS-1000 OCT; Tomey, Inc., Nagoya, Japan) to obtain 128 volumetric high-resolution radial B-scans centered on the pupil center and a complete ophthalmologic examination including standard automated perimetry (SAP) and spectral-domain OCT retinal nerve fiber layer thickness (RNFLT). Trace lines of the anterior chamber and iris contour were reviewed by a glaucoma specialist and corrected if necessary. ACV and IV were analyzed using the SSOCT's built-in software. ACV and IV were correlated with the following demographic and clinical factors using a multivariate model: age, phakic refractive error, untreated intraocular pressure (IOP), central cornea thickness (CCT), SAP mean deviation (MD) and RNFLT. Results 20 eyes (10 patients; 4 women; mean age, 43+/-12 years), including 7 PDS eyes and 13 PG eyes, were included. Mean refractive error, central corneal thickness, and SAP mean deviation were -2.56+/-2.34D, 556.8+/-27.3mum, and -2.44+/-3.24dB, respectively (Table 1). Mean ACV was 239+/-29 mm3 (range, 194-297) and mean iris volume was 44+/-5 mm3 (range, 37 -54). Greater ACV was associated with higher IOP (p=0.03) and associated with worse SAP MD (p=0.04) and lower CCT (p=0.04). IV was not related to these factors (all p>0.05). Conclusions Greater ACV appears to be greater with higher IOP and worse visual field status in PDS and PG eyes. Greater ACV may be related to more frequent or wider iridozonular contact and enhanced pigment liberation
EMBASE:616117781
ISSN: 0146-0404
CID: 2565572
Volumetric assessment of the cornea, anterior chamber and iris using swept-source optical coherence topography in pigment dispersion syndrome and normal eyes [Meeting Abstract]
Purpose: To compare cornea, anterior chamber and iris volumes between normal and pigment dispersion syndrome (PDS) eyes using swept-source optical coherence tomography (SS-OCT). Methods: Volumetric radial scans of the cornea, anterior chamber and iris were performed using SS-OCT (Casia SS-1000; Tomey, Nagoya, Japan) in ambient light. Total, superior, inferior, nasal, and temporal quadrant volumes (mm3) were calculated for the cornea, anterior chamber, and iris in normal and pigment dispersion syndrome eyes, using the built-in software. Results: 20 PDS eyes (10 patients; mean age, 42.6+/-11.7 years) and 16 normal eyes (11 patients; mean age, 38.4+/-12.0 years) were included. Compared to normal eyes, PDS eyes had greater total cornea volume (147.7+/-10.1 vs 133.5+/-11.3, p <0.01) and greater total anterior chamber volume (239.5+/-28.9 vs 179.3+/-35.1, p<0.01). There was no difference in total iris volume (44.4+/-4.7 vs 45.1+/-4.5, p=0.67) between the two groups. In PDS eyes, the superior quadrant cornea volume (34.0) (mm3) was less than the nasal (36.7), temporal (37.5) and inferior (39.5) quadrant volumes (p<0.01); but there was no difference in the anterior chamber volume (p=0.5) and iris volume (p=0.06) between the four quadrants. In normal eyes, the superior quadrant cornea volume (29.6) (mm3) was less than the nasal (33.9), temporal (35.3) and inferior (35.2) quadrant volumes (p<0.01); the superior quadrant anterior chamber volume (41.5) was also less than the nasal (42.8), temporal (46.8), and inferior (48.2) quadrant volumes, (p=0.04); and the superior iris volume (11.7) was greater than the nasal (10.8), temporal (11.2) and inferior (11.4) quadrant volumes (p=0.05). Conclusions: Cornea and anterior chamber volumes are greater in PDS eyes compared to normal eyes. Differences in anterior chamber and iris volume may become less pronounced in PDS. Imaging the cornea, anterior chamber and iris using SS-OCT may be beneficial to help better understand the pathophysiology of PDS
EMBASE:616122117
ISSN: 0146-0404
CID: 2565252
Early glaucoma involves both deep local, and shallow widespread, retinal nerve fiber damage of the macular region
PURPOSE: To better understand the nature of early glaucomatous damage of the macula by comparing the results from 10-2 visual fields, optical coherence tomography (OCT) macular cube scans, and OCT circumpapillary circle scans. METHODS: One eye of each of 66 glaucoma patients or suspects, with a mean deviation (MD) on the 24-2 visual field (VF) test of better than -6 decibels (dB), was prospectively tested with 10-2 VFs and OCT macular cube and circumpapillary circle scans. Thickness and probability maps of the retinal ganglion cell plus inner plexiform (RGC+) layers were generated. A hemifield was considered abnormal if both the macular RGC+ and the 10-2 probability plots were abnormal (cluster criteria). The thickness plots of the circumpapillary retinal nerve fiber layer (RNFL) were analyzed in the context of a model that predicted the region of the disc associated with macular damage. RESULTS: Twenty-seven hemifields (20 eyes) had abnormal 10-2 and RGC+ probability plots: 7 in upper VF/inferior retina, 6 in lower VF/superior retina, and 7 in both hemifields. Both shallow widespread and deep local thinning of the circumpapillary RNFL were observed. The local defects were more common and closer to fixation in the upper VF/inferior retina as predicted. CONCLUSIONS: A model of glaucomatous damage of the macula predicted the location of both the widespread and local defects in the temporal and inferior disc quadrants. Optical coherence tomography scans of the circumpapillary RNFL and the macular RGC+ layer can aid in the identification of these defects and help in the interpretation of 24-2 and 10-2 VF tests.
PMCID:3912939
PMID: 24370831
ISSN: 0146-0404
CID: 819022
Classification of retinal ganglion cell defects seen on frequency-domain OCT in the macula of patients with glaucoma [Meeting Abstract]
Purpose To classify patterns of retinal ganglion cell (RGC) defects in glaucoma patients as seen on frequency-domain optical coherence tomography (fdOCT) volume macular scans and to compare these patterns to associated visual fields (VF). Methods One eye of 35 glaucoma patients or suspects (inclusion criteria: 24-2 MD of -6 or better) was prospectively tested with fdOCT and 10-2 VFs. The combined RGC and inner plexiform layers (RGC+) of the OCT scans were segmented using a computer-assisted manual segmentation technique.[1,2] RGC+ probability plots [3] (divided into an 8 by 8 grid) were generated. First, a scan was considered abnormal if at least 3 contiguous abnormal squares (at 5%, 2%, 2%) respecting the horizontal midline were present. This criterion yielded 24 abnormal OCT hemifields, similar to the number (26) of abnormal 10-2 VFs yielded by the typical 5%, 5%, 1% criterion. The 24 abnormal OCT hemifields were classified as arcuate-like, widespread, or "other." "Other" included temporal and non-continuous defects. RGC+ thinning plots were obtained by averaging the RGC+ thickness by classification and subtracting the average control thickness.[4] For each OCT group, the means of the associated 10-2 total deviation values were acquired. Results 24 (34%) of the 70 OCT hemifields were abnormal. Of these, 10 (14%) were arcuate-like, 8 (11%) widespread, and 6 (9%) "other." Fig. 1 (field view) shows the average OCT thinning plots for the inferior retinal hemifield and Fig. 2 the averaged associated VFs. For OCTs classified as normal (Fig. 1A), the mean 10-2 VF appeared normal (Fig. 2A). OCTs classified as arcuate exhibited greater thickness loss in the nasal retina (Fig. 1B) and the mean 10-2 VF appeared arcuate (Fig. 2B). For OCTs classified as widespread (Fig. 1C), the mean 10-2 VF also appeared widespread (Fig. 2C). Finally, there was no clear correspondence between OCT (Fig. 1D) and VF (Fig. 2D) for the "other" class, although the sample size was small. Conclusions The pattern of RGC defects on OCT could be classified into 4 groups. Except for the "other" category, the average 10-2 VF closely resembled the pattern of OCT RGC+ thinning.(Table Presented)
EMBASE:628584443
ISSN: 1552-5783
CID: 4001532
Lamina cribrosa position and age [Meeting Abstract]
Purpose To assess age-dependent changes in the lamina cribrosa (LC) position within the optic nerve head in normal eyes. Methods Serial horizontal enhanced depth imaging optical coherence tomography (EDI OCT) B-scans of the optic nerve head were obtained from one eye of normal subjects. Interval between EDI OCT Bscans was ~30 mum. After delineating the anterior LC surface, mean and maximum LC depths (reference plane, Bruch's membrane edges) were measured in 11 equally spaced horizontal Bscans, excluding the LC insertion area under Bruch's membrane and the scleral rim (Fig A and B). Using the horizontal midline EDI OCT B-scan, the lateral LC displacement from the Bruch's membrane opening was measured as an angle (theta Fig C). Mean and maximum LC depths were compared between three age groups (20-39, 40-59, and 60-79 years). Results The 86 normal subjects (mean age, 44+/-18 years) included 44 subjects aged 20-39, 21 aged 40-59, and 21 aged 60-79 years. Both mean and maximum LC depths were similar between the three age groups in all 11 scans, before (all p>0.51; Fig D) and after (all p>0.55) controlling for the angle of lateral LC displacement (theta) and intraocular pressure. The average value of all 11 mean LC depths was 360+/-72 (range, 239 to 530) mum, 369+/-76 (range, 274 to 524) mum, and 354+/-72 (range, 237 to 499) mum in the 20-39, 40-59, and 60-79 years, respectively (p=0.78). The mean and maximum LC depths did not correlate with age either before (all p>0.43; Fig E) or after (all p>0.54) controlling for the angle of lateral LC displacement (theta) and intraocular pressure. Conclusions The central and mid-peripheral LC position within the optic nerve head does not change significantly with age under normal conditions. Changes in the LC position appear to be associated with pathologic processes
EMBASE:628585026
ISSN: 1552-5783
CID: 4001522
Outcomes of trabeculectomy with 5-Fluorouracil at a nigerian tertiary hospital
PURPOSE: To report the outcomes of trabeculectomy with adjunctive 5-Fluorouracil (5- FU) at a Nigerian tertiary hospital. METHODS: In this prospective study, all patients with glaucoma undergoing trabeculectomy with 5-FU at the University College Hospital, Ibadan, Nigeria, from June 2009 to May2010 were enrolled. Each patient had a complete ophthalmic evaluation. Intraocular pressure (IOP), visual acuity (VA) and complications post-trabeculectomy were assessed at one year. Success of the procedure was de fi ned as complete when no additional medications were required to achieve an IOP of
PMCID:3740464
PMID: 23943687
ISSN: 2008-322x
CID: 985992
Optic disc progression and rates of visual field change in treated glaucoma
Purpose: To investigate the relationship between optic disc progression and rates of visual field (VF) change in patients with treated glaucoma. Methods: Glaucoma patients with repeatable VF loss, >/=8 SITA-Standard 24-2 VF tests and good quality optic disc stereophotographs evaluated over a 10-year period were included. Optic disc photographs were reviewed for signs of glaucoma progression (neuroretinal rim change, widening of retinal nerve fibre layer defect, disc haemorrhage and enlargement of beta-zone parapapillary atrophy) by two glaucoma specialists masked to their temporal sequence. Disagreements were adjudicated by a third grader. VF progression was evaluated using automated pointwise linear regression (PLR) and defined as at least two adjacent test points progressing >1.0 dB/year at p < 0.01. VF progression outcomes were compared with photograph review results. Results: Three-hundred and eighty nine eyes (389 patients; mean age 64.9 +/- 13.0 years; mean baseline MD, -7.1 +/- 5.1 dB) were included. Most patients had primary open angle glaucoma (54%). Eighty-two eyes (21%) had confirmed optic disc progression and 115 eyes (29%) met the VF PLR criteria. Eyes with documented optic disc progression had more rapid rates of VF change (-0.66 +/- 0.7 versus -0.36 +/- 0.7 dB/year, p < 0.01) and met the VF PLR endpoint more often (univariate OR = 1.85, p = 0.02; multivariate OR = 1.78, p = 0.03) than eyes without optic disc progression. There was moderate spatial consistency between the location of the optic disc progression and the hemifield with more rapid progression (81%, kappa = 0.40). Conclusions: Treated glaucomatous eyes with documented optic disc progression are at increased risk of diminished visual function over time and may require more aggressive therapy to prevent future vision loss. Among the indicators of structural progression, disc haemorrhage was the single most significant predictor for VF deterioration.
PMID: 23356423
ISSN: 1755-375x
CID: 223212
Focal lamina cribrosa defects associated with glaucomatous rim thinning and acquired pits
IMPORTANCE Considering the potential clinical importance of focal lamina cribrosa (LC) defects as a characteristic structural feature in glaucoma and a risk factor for glaucomatous visual field progression, it may be helpful to know the structure of focal LC defects and the spatial relationship between them and glaucomatous optic disc changes such as neuroretinal rim thinning/notching and acquired pits of the optic nerve (APON). OBJECTIVE To investigate structural and spatial relationships between focal LC defects and glaucomatous neuroretinal rim thinning/notching and APON. DESIGN In a cross-sectional analysis of data from an ongoing, prospective, longitudinal study, serial enhanced-depth imaging (EDI) optical coherence tomographic (OCT) images of the optic nerve head were obtained from patients with glaucoma and reviewed for focal LC defects (laminar holes or disinsertions). Anterior laminar insertion points and edges of laminar holes or disinsertions were marked in EDI-OCT images, reconstructed 3-dimensionally, and superimposed on optic disc photographs. SETTING A glaucoma referral practice. PARTICIPANTS Two hundred thirty-nine eyes (120 patients) were examined. Fifty-four eyes were excluded because of an incomplete horizontal or vertical set of serial EDI-OCT images or poor-quality EDI-OCT images owing to media opacity, irregular tear film, or poor patient cooperation. Among the remaining 185 eyes, 40 (from 31 patients) had laminar holes or disinsertions and were included for analysis. MAIN OUTCOME MEASURES Presence, extent, and location of laminar holes or disinsertions. RESULTS Among 185 eyes, 11 laminar holes and 36 laminar disinsertions were found in 40 eyes. Superimposed images of the 3-dimensionally reconstructed focal LC defects and disc photographs showed that the outline of the LC defect corresponded almost precisely to that of clinical APON for 6 laminar holes and that the LC defect was much larger than and enclosed APON for 10 laminar disinsertions. The remaining 5 laminar holes and 26 laminar disinsertions corresponded to focal neuroretinal rim loss, with no evidence of APON in disc photographs. CONCLUSIONS AND RELEVANCE Focal LC defects (laminar holes or disinsertions) are associated with neuroretinal rim loss and APON. The extent of LC defects can be visualized more effectively on EDI-OCT images than by clinical examination.
PMID: 23370812
ISSN: 2168-6165
CID: 287872
