Eyes with Suspicious Appearance of the Optic Disc and Normal Intraocular Pressure: Using Clinical and Epidemiological Characteristics to Differentiate Those with and without Glaucoma

Among all glaucoma suspects, eyes with optic nerve head features suspicious or suggestive of early glaucoma are probably those that offer the greatest challenge for clinicians. In contrast with the robust longitudinal data published on ocular hypertension, there is no specific management guideline for these patients. Therefore, evaluating eyes with suspicious optic disc appearance and normal intraocular pressure (IOP), we sought to investigate potential differences in clinical and epidemiological characteristics to differentiate those with normaltension glaucoma (NTG) from those with presumed large physiological optic disc cups (pLPC). In this observational case-control study, we consecutively enrolled individuals with pLPC and NTG. All eyes had vertical cup-to-disc ratio (VCDR)>= 0.6 and untreated IOP= 30 months of follow-up with no evidence of glaucomatous neuropathy. Clinical and epidemiological parameters were compared between groups. Eighty-four individuals with pLPC and 40 NTG patients were included. Regarding our main results, NTG patients were significantly older and with a higher prevalence of Japanese descendants (p= 0.38). Significant odds ratios (OR) were found for race (OR = 2.42for Japanese ancestry), age (OR = 1.05), VCDR (OR = 5.03), and disc size (OR = 0.04p <= 0.04). In conclusion, in patients with suspicious optic disc and normal IOP, those with older age, Japanese ancestry, smaller optic discs, and larger VCDR are more likely to have NTG, and therefore, deserve deeper investigation and closer monitoring.Federal University of Sao PauloUniv Fed Sao Paulo, Dept Ophthalmol, Sao Paulo, SP, BrazilHosp Med Olhos, Glaucoma Unit, Osasco, SP, BrazilMayo Clin, Dept Ophthalmol, Jacksonville, FL 32224 USAUniv Fed Sao Paulo, Dept Ophthalmol, Sao Paulo, SP, BrazilWeb of Scienc

Corneal asphericity and spherical aberration after refractive surgery

PURPOSE: To evaluate changes in corneal asphericity (Q) and spherical aberrations after refractive surgery using Scheimpflug imaging.SETTING: University of California, San Diego, Shiley Eye Center, La Jolla, California, USA.DESIGN: Cohort study.METHODS: After wavefront-guided laser in situ keratomileusis, patients within +/- 0.50 diopter of piano and with an uncorrected distance visual acuity of at least 20/20 were evaluated. the Q values and corneal spherical aberration Zernike values were obtained using Scheimpflug imaging preoperatively and 1 to 3 months postoperatively.RESULTS: the study enrolled 177 myopic eyes and 32 hyperopic eyes. the mean Q value was -0.28 +/- 0.11 (SD) and -0.22 +/- 0.15, respectively, preoperatively and +0.35 +/- 0.44 and -0.64 +/- 0.31, respectively, postoperatively. the asphericity change was highly correlated with preoperative spherical equivalent (r(2) = 0.81; P <=.001). the mean corneal spherical aberration was +0.21 +/- 0.08 mu m in myopic eyes and +0.36 +/- 0.11 mu m in hyperopic eyes preoperatively and +0.36 +/- 0.17 mu m and 0.00 +/- 0.29 mu m, respectively, postoperatively. the corneal spherical aberration changes were correlated with the amount of preoperative refractive error (r(2) = 0.34; P<.001). There was a tendency for Q values and spherical aberrations to become more positive after myopic ablation and more negative after hyperopic ablation.CONCLUSIONS: Myopic and hyperopic corrections induced changes in the Q value and spherical aberrations in opposite directions (ie, positive and negative, respectively). the changes depended on the magnitude of the refractive correction.Research to Prevent Blindness, Inc., New York, New York, USACoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Univ Calif San Diego, Shiley Eye Ctr, Dept Ophthalmol, La Jolla, CA 92093 USAUniversidade Federal de São Paulo, São Paulo, BrazilUniv Santo Tomas, Manila, PhilippinesUniversidade Federal de São Paulo, EPM, São Paulo, BrazilCAPES: BEX 1325/09-4Web of Scienc

The disc damage likelihood scale: Diagnostic accuracy and correlations with cup-to-disc ratio, structural tests and standard automated perimetry

Our objective was to compare the diagnostic accuracies of and to determine the correlations between the disc damage likelihood scale (DDLS) and anatomical and functional tests used for glaucoma detection. A total of 54 healthy subjects (54 eyes) and 47 primary open-angle glaucoma patients (47 eyes) were included in this cross-sectional observational study. DDLS scores and cup-to-disc (C/D) ratios were evaluated. Subjects underwent standard automated perimetry (SAP), optic disc and retinal nerve fiber layer (RNFL) imaging with time and spectral-domain optical coherence tomography (TD and SD-OCT), Heidelberg Retina Tomograph (HRT II), and scanning laser polarimetry (GDx-VCC). Areas under the receiver operating characteristic curves (AROCs) for DDLS and diagnostic tests parameters were calculated. DDLS correlations (Spearman's rank) among these parameters were analyzed. Fifty-four eyes were healthy and 47 had glaucoma, including 16 preperimetric glaucoma. DDLS, vertical and horizontal C/D ratios had the largest AROCs (0.92, 0.94 and 0.91, respectively). DDLS diagnostic accuracy was better than the accuracies of HRT II parameters, TD and SD-OCT RNFL thicknesses, and SAP mean deviation (MD) index. There were no significant differences between the accuracies of the DDLS and the C/D ratios, TD-OCT vertical (0.89) and horizontal (0.86) C/D ratios, TD-OCT C/D area ratio (0.89), and GDx-VCC NFI (0.81). DDLS showed significant strong correlations with vertical (r = 0.79) and horizontal (0.74) C/D ratios, and with the parameters vertical C/D ratio and C/D area ratio from HRT II (both 0.77) and TD-OCT (0.75 and 0.72, respectively). DDLS had significant moderate correlations with most of the other structural measurements and SAP MD. The optic disc clinical evaluation with DDLS system and C/D ratio demonstrated excellent accuracy in distinguishing glaucomatous from healthy eyes. DDLS had moderate to strong correlations with most structural and functional parameters. These findings stress the importance of optic disc clinical examination to detect glaucoma in a clinical scenario.CAPES/Ministry of Education of BrazilCNPq/Ministry of Science and Technology of BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Ophthalmol & Visual Sci, Glaucoma Div, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Ophthalmol & Visual Sci, Glaucoma Div, Sao Paulo, SP, BrazilCAPESCNPqWeb of Scienc