The Pattern of Retinal Nerve Fiber Layer and Macular Ganglion Cell-Inner Plexiform Layer Thickness Changes in Glaucoma

Background/Aims. To investigate the patterns of retinal ganglion cell damage at different stages of glaucoma, using the circumpapillary retinal nerve fiber layer (RNFL) and macula ganglion cell-inner plexiform layer (GCIPL) thicknesses. Methods. In 296 eyes of 296 glaucoma patients and 55 eyes of 55 healthy controls, the correlations of mean deviation (MD) with the superior and inferior quadrant RNFL/GCIPL thickness (defined as the average of three superior and inferior sectors, resp.) were analyzed. Results. In early to moderate glaucoma, most of the RNFL/GCIPL thicknesses had significant positive correlations with the MD. In advanced glaucoma, the superior GCIPL thickness showed the highest correlation with MD (r=0.495), followed by the superior RNFL (r=0.452) (all; P<0.05). The correlation coefficient of the inferior RNFL thickness with MD (r<0.471) was significantly stronger in early to moderate glaucoma compared to that in advanced glaucoma (r=0.192; P<0.001). In contrast, the correlations of the superior GCIPL thickness with MD (r=0.452) in advanced glaucoma was significantly stronger compared to that in early to moderate glaucoma (r=0.159; P<0.001). Conclusions. The most preserved region in advanced glaucoma appears to be the superior macular GCIPL, whereas the most vulnerable region for initial glaucoma is the inferior RNFL around the optic disc

The Impact of Superficial Vessel Density on Glaucoma Progression according to the Stage of Glaucoma

Purpose: To investigate the clinical significance of vessel density (VD) on visual field (VF) progression regarding the severity of glaucoma. Methods: A total of 130 eyes were recruited in this retrospective and longitudinal study. Superficial and deep VDs in circumpapillary and macular regions were measured via ImageJ. The rate of VF progression was defined as the mean deviation (MD) slope (dB/year). Linear regression was used to verify factors affecting deterioration of VF. The eyes with lower superficial VD were further analyzed. Results: Fifty patients with early glaucoma (EG) (MD &gt; −6 dB) and 52 patients with moderate-to-advanced glaucoma (MAG) (MD ≤ −6 dB) were included. A faster progression rate was found in MAG (p = 0.049). Superficial VD was noticeably related to the VF progression rate in total eyes and in MAG (Both Ps ≤ 0.007, respectively). With patients in the lower half of the superficial VD, the VD was significantly associated with the rate of progression (B, 0.049, p = 0.021). This association was independent of the baseline MD and OCT parameters. Conclusion: Decreased superficial VD might conversely affect the progression of glaucoma even in MAG, which suggests superficial VD could be used as a potential marker to foresee the disease progression even in progressed eyes

Segmented inner plexiform layer thickness as a potential biomarker to evaluate open-angle glaucoma: Dendritic degeneration of retinal ganglion cell.

To evaluate the changes of retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), and ganglion cell-inner plexiform layer (GCIPL) thicknesses and compare structure-function relationships of 4 retinal layers using spectral-domain optical coherence tomography (SD-OCT) in macular region of glaucoma patients.In cross-sectional study, a total of 85 eyes with pre-perimetric to advanced glaucoma and 26 normal controls were enrolled. The glaucomatous eyes were subdivided into three groups according to the severity of visual field defect: a preperimetric glaucoma group, an early glaucoma group, and a moderate to advanced glaucoma group. RNFL, GCL, IPL, and GCIPL thicknesses were measured at the level of the macula by the Spectralis (Heidelberg Engineering, Heidelberg, Germany) SD-OCT with automated segmentation software. For functional evaluation, corresponding mean sensitivity (MS) values were measured using 24-2 standard automated perimetry (SAP).RNFL, GCL, IPL, and GCIPL thicknesses were significantly different among 4 groups (P < .001). Macular structure losses were positively correlated with the MS values of the 24-2 SAP for RNFL, GCL, IPL, and GCIPL (R = 0.553, 0.636, 0.648 and 0.646, respectively, P < .001). In regression analysis, IPL and GCIPL thicknesses showed stronger association with the corresponding MS values of 24-2 SAP compared with RNFL and GCL thicknesses (R2 = 0.420, P < .001 for IPL; R2 = 0.417, P< .001 for GCIPL thickness).Segmented IPL thickness was significantly associated with the degree of glaucoma. Segmental analysis of the inner retinal layer including the IPL in macular region may provide valuable information for evaluating glaucoma

Central Visual Field Progression in Normal-Tension Glaucoma Patients With Autonomic Dysfunction

PURPOSE. To investigate the characteristics of visual field (VF) progression in normal-tension glaucoma (NTG) patients with autonomic dysfunction. METHODS. Forty-eight NTG eyes with more than seven VF tests during at least 5 years of followup were analyzed retrospectively. All participants were referred to rheumatology, where they were subjected to heart-rate variability assessment. Patients were classified into the lowest and highest heart-rate variability groups according to the SD value of the qualified normal-tonormal intervals of the heart-rate-variability assessment. The VF was divided into central and peripheral regions and further classified into superior and inferior regions. Groups in the lowest and highest heart-rate variability groups were compared in terms of rates of change in the mean thresholds of each designated region by using a linear mixed model. Potential clinical factors associated with central VF progression were also investigated. RESULTS. The baseline VF showed similar stages of glaucoma damage between the lowest and highest heart-rate variability groups. The mean global rate of VF changes was similar between the two groups. Only the rate of VF changes in the central and superior central regions were significantly different between the lowest heart-rate variability group (À1.16 dB/year in the central region and À1.48 dB/year in the superior central region) and highest heart-rate variability group (À0.52 dB/year in the central region and À0.64 dB/year in the superior central region). Baseline VF pattern SD (b ¼ À1.160, P ¼ 0.008), migraine (b ¼ 1.380, P ¼ 0.040), orthostatic hypotension (b ¼ 1.146, P ¼ 0.023), and lower heart-rate variability (b ¼ À1.516, P ¼ 0.010) were significantly associated with central VF progression. CONCLUSIONS. NTG patients with lower heart-rate variability, which reflects autonomic dysfunction with sympathetic predominance, presented faster rate of central VF progression than patients with higher heart-rate variability. Intraocular pressure-independent risk factors, such as migraine, orthostatic hypotension, and autonomic dysfunction, were related to central VF progression

Macular Ganglion Cell Analysis Determined by Cirrus HD Optical Coherence Tomography for Early Detecting Chiasmal Compression

<div><p>Purpose</p><p>To evaluate the performance of macular ganglion cell-inner plexiform layer (mGCIPL) measurement with Cirrus high-definition (HD) optical coherence tomography (OCT) for early detection of optic chiasmal compression.</p><p>Methods</p><p>Forty-six eyes of 46 patients with optic chiasmal compression caused by a pituitary adenoma (PA group), 31 eyes of 31 patients with normal tension glaucoma (NTG group), and 32 eyes of 32 normal participants (control group) were enrolled. The PA group was subdivided into two subgroups, which comprised patients with temporal visual field (VF) defects (perimetric PA group, 34 eyes) and without VF defect (preperimetric PA group, 12 eyes). The mGCIPL thickness and circumpapillary retinal nerve fiber layer (cpRNFL) thickness were measured using Cirrus HD-OCT. We calculated the number of patients who had an abnormal GCA sector map, defined as at least one yellow or red sector.</p><p>Results</p><p>Eyes in the perimetric PA group had significantly decreased mGCIPL thickness in all sectors. Eyes in the preperimetric PA group had significantly thinner mGCIPL in the superior, superonasal, inferonasal, and inferior sectors than eyes in control group, but no changes in cpRNFL parameters were observed. The mGCIPL thickness in inferonasal area showed the greatest AUC value (0.965), followed by the superonasal area (0.958) for discriminating preperimetric PA group from the control group. A higher reduction rate of mGCIPL thickness was noted in the nasal sector compared to other sectors, which was irrespective of temporal visual field defects. The mGCIPL thickness maps showed superonasal (P = 0.003) and inferonasal thinning in the PA group (P = 0.003), while inferotemporal thinning was revealed in the NTG group (P = 0.001).</p><p>Conclusions</p><p>Macular GCIPL thickness parameters obtained with the Cirrus HD-OCT were useful in early detection of chiasmal compression and differentiating from NTG by characteristic nasal mGCIPL thinning.</p></div

The effect of parental factors in children with large cup-to-disc ratios.

To investigate large cup-to-disc ratios (CDR) in children and to determine the relationship between parental CDR and clinical characteristics associated with glaucoma.Two hundred thirty six children aged 6 to 12 years with CDR ≥ 0.6 were enrolled in this study. Subjects were classified into two groups based on parental CDR: disc suspect children with disc suspect (CDR ≥0.6) parents and disc suspect children without disc suspect parents. Ocular variables were compared between the two groups.Of the 236 disc suspect children, 100 (42.4%) had at least one disc suspect parent. Intraocular pressure (IOP) was higher in disc suspect children with disc suspect parents (16.52±2.66 mmHg) than in disc suspect children without disc suspect parents (14.38±2.30 mmHg, p = 0.023). In the group with disc suspect parents, vertical CDR significantly correlated with IOP (R = -0.325, p = 0.001), average retinal nerve fiber layer (RNFL) thickness (R = -0.319, p = 0.001), rim area (R = -0.740, p = 0.001), and cup volume (R = 0.499, p = 0.001). However, spherical equivalent (R = 0.333, p = 0.001), AL (R = -0.223, p = 0.009), and disc area (R = 0.325, p = 0.001) significantly correlated with vertical CDR in disc suspect children without disc suspect parents, in contrast to those with disc suspect parents. Larger vertical CDR was associated with the presence of disc suspect parents (p = 0.001), larger disc area (p = 0.001), thinner rim area (p = 0.001), larger average CDR (p = 0.001), and larger cup volume (p = 0.021).Family history of large CDR was a significant factor associated with large vertical CDR in children. In children with disc suspect parents, there were significant correlations between IOP and average RNFL thickness and vertical CDR

Posterior scleral deformations around optic disc are associated with visual field damage in open-angle glaucoma patients with myopia.

PurposeTo identify important variables associated with visual field (VF) defects in open-angle glaucoma (OAG) with myopia.Materials and methodsA total of 105 OAG with myopia were enrolled in this cross-sectional study. The disc tilt ratio, disc torsion degree, disc-foveal angle, and area of peripapillary atrophy (PPA) were measured from red-free fundus photographs. Patients underwent Swept-source optical coherence tomography to measure peripapillary retinal nerve fiber layer (RNFL), subfoveal choroidal, and sufoveal scleral thicknesses. Functional evaluation was performed using 24-2 standard automated perimetry. For statistical analyses, logistic regression, artificial neural networks (ANN), and hierarchical cluster analysis were performed.ResultsLogistic regression demonstrated peripapillary RNFL thickness as a significant variable for the presence of VF defects, otherwise ANN identified PPA area, peripapillary RNFL thickness, disc-foveal angle, and disc torsion degree as significant clinical variables in OAG with myopia. Two clusters were made after a hierarchical cluster analysis. Cluster 2 showed significantly worse VF damage than cluster 1 (MD = -5.20±5.25 dB for cluster 2 and -1.84±3.02 dB for cluster 1, P ConclusionsGenerally peripapillary RNFL thickness is considered as an important variable associated with visual field defects in glaucoma patients. ANN identified parameters associated with posterior scleral deformations around optic disc induced by myopic change including PPA area, disc torsion degree, and disc-foveal angle as significant clinical variables for visual field damage in OAG with myopia