Investigation of intraocular pressure fluctuation as a risk factor of glaucoma progression

Purpose: Since the role of short- and long-term intraocular pressure (IOP) fluctuation as a predictor of glaucoma progression is still controversial, the purpose of this study was to investigate the role of IOP fluctuation in a non-selected patient cohort. Materials and methods: Two-hundred and forty eyes of 120 glaucoma patients (51% female) with a mean age of 64.5 years were included. Inclusion criteria were at least a visual field (VF) and a 48-hour diurnal phasing of IOP including nocturnal measurement. Glaucoma Progression was defined as – if available – confirmed progression of reproducible VF defects in at least three VF examinations or increase of cup area on optic nerve imaging (Heidelberg Retina Tomograph [HRT]) with at least two images after baseline. If results were stable or less than previously mentioned VF or HRT examinations were available, it was classified as “no progression”. Results: Glaucoma progression was seen in seven of 240 eyes in the VF analysis and ten of 240 eyes on HRT. Of all 240 eyes, 92 and 41 eyes fulfilled the criteria to be included for progression evaluation on VF and HRT analysis, respectively. Mean time to progression ± standard error was 3.6±0.2 years on VF and 4.5±0.3 years on HRT. Univariate and multivariate Cox regression analyses revealed short-term IOP fluctuation (P,0.0001) and maximum IOP (P,0.001) as risk factors for glaucoma progression on VF. There was no significant influence of demographic characteristics, ocular or general health on glaucoma progression. Conclusion: Short-term IOP fluctuation was associated with the progression of glaucoma in this non-selected cohort of glaucoma patients receiving phasing of IOP. Keywords: glaucoma progression, short-term IOP fluctuation, long-term IOP fluctuation, glaucoma imaging, visual fiel

Development of technology for hot drape forming and nozzles for torus sections Final report, Jun. 1963 - Dec. 1965

Hot drape forming and heat treatment of aluminum base alloy toroidal shell segment

Investigation of intraocular pressure fluctuation as a risk factor of glaucoma progression

Purpose: Since the role of short- and long-term intraocular pressure (IOP) fluctuation as a predictor of glaucoma progression is still controversial, the purpose of this study was to investigate the role of IOP fluctuation in a non-selected patient cohort. Materials and methods: Two-hundred and forty eyes of 120 glaucoma patients (51% female) with a mean age of 64.5 years were included. Inclusion criteria were at least a visual field (VF) and a 48-hour diurnal phasing of IOP including nocturnal measurement. Glaucoma Progression was defined as – if available – confirmed progression of reproducible VF defects in at least three VF examinations or increase of cup area on optic nerve imaging (Heidelberg Retina Tomograph [HRT]) with at least two images after baseline. If results were stable or less than previously mentioned VF or HRT examinations were available, it was classified as “no progression”. Results: Glaucoma progression was seen in seven of 240 eyes in the VF analysis and ten of 240 eyes on HRT. Of all 240 eyes, 92 and 41 eyes fulfilled the criteria to be included for progression evaluation on VF and HRT analysis, respectively. Mean time to progression ± standard error was 3.6±0.2 years on VF and 4.5±0.3 years on HRT. Univariate and multivariate Cox regression analyses revealed short-term IOP fluctuation (P,0.0001) and maximum IOP (P,0.001) as risk factors for glaucoma progression on VF. There was no significant influence of demographic characteristics, ocular or general health on glaucoma progression. Conclusion: Short-term IOP fluctuation was associated with the progression of glaucoma in this non-selected cohort of glaucoma patients receiving phasing of IOP. Keywords: glaucoma progression, short-term IOP fluctuation, long-term IOP fluctuation, glaucoma imaging, visual fiel

Retinal and optic nerve degeneration in α-mannosidosis

α-mannosidosis is a rare, autosomal-recessive, lysosomal storage disease caused by a deficient activity of α-mannosidase. Typical symptoms include intellectual, motor and hearing impairment, facial coarsening, and musculoskeletal abnormalities. Ocular pathologies reported previously were mainly opacities of the cornea and lens, strabismus, and ocular motility disorders. However, retinal and optic nerve degeneration have been rarely described

The Effect of Induced Intraocular Stray Light on Recognition Thresholds for Pseudo-High-Pass Filtered Letters

PURPOSE: The Moorfields Acuity Chart (MAC)—comprising pseudo-high-pass filtered “vanishing optotype” (VO) letters—is more sensitive to functional visual loss in age-related macular degeneration (AMD) compared to conventional letter charts. It is currently unknown the degree to which MAC acuity is affected by optical factors such as cataract. This is important to know when determining whether an individual's vision loss owes more to neural or optical factors. Here we estimate recognition acuity for VOs and conventional letters with simulated lens aging, achieved using different levels of induced intraocular light scatter. METHODS: Recognition thresholds were determined for two experienced and one naive participant with conventional and VO letters. Stimuli were presented either foveally or at 10 degrees in the horizontal temporal retina, under varying degrees of intraocular light scatter induced by white resin opacity-containing filters (WOFs grades 1 to 5). RESULTS: Foveal acuity only became significantly different from baseline (no filter) for WOF grade 5 with conventional letters and WOF grades 4 and 5 with VOs. In the periphery, no statistical difference was found for any stray-light level for both conventional and VOs. CONCLUSIONS: Recognition acuity measured with conventional and VOs is robust to the effects of simulated lens opacification, and thus its higher sensitivity to neural damage should not simultaneously be confounded by such optical factors. TRANSLATIONAL RELEVANCE: The MAC may be better able to differentiate between neural and optical deficits of visual performance, making it more suitable for the assessment of patients with AMD, who may display both types of functional visual loss

Relationship between psychophysical measures of retinal ganglion cell density and in vivo measures of cone density in glaucoma

Purpose: Considerable between-individual variation in retinal ganglion cell (RGC) density exists in healthy individuals, making identification of change from normal to glaucoma difficult. In ascertaining local cone-to-RGC density ratios in healthy individuals, we wished to investigate the usefulness of objective cone density estimates as a surrogate of baseline RGC density in glaucoma patients, and thus a more efficient way of identifying early changes. Design: Exploratory cohort study. Participants: Twenty glaucoma patients (60% women) with a median age of 54 years and mean deviation (MD) in the visual field of –5 dB and 20 healthy controls (70% women) with a median age of 57 years and a mean MD of 0 dB were included. Methods: Glaucoma patients and healthy participants underwent in vivo cone imaging at 4 locations of 8.8° eccentricity with a modified Heidelberg Retina Angiograph HRA2 (scan angle, 3°). Cones were counted using an automated program. Retinal ganglion cell density was estimated at the same test locations from peripheral grating resolution acuity thresholds. Main Outcome Measures: Retinal cone density, estimated RGC density, and cone-to-RGC ratios in glaucoma patients and healthy controls. Results: Median cone-to-RGC density was 3.51:1 (interquartile range [IQR], 2.59:1–6.81:1) in glaucoma patients compared with 2.35:1 (IQR, 1.83:1–2.82:1) in healthy participants. Retinal ganglion cell density was 33% lower in glaucoma patients than in healthy participants; however, cone density was very similar in glaucoma patients (7248 cells/mm2) and healthy controls (7242 cells/mm2). The area under the receiver operator characteristic curve was 0.79 (95% confidence interval [CI], 0.71–0.86) for both RGC density and cone-to-RGC ratio and 0.49 (95% CI, 0.39–0.58) for cone density. Conclusions: Local measurements of cone density do not differ significantly from normal in glaucoma patients despite large differences in RGC density. There was no statistically significant association between RGC density and cone density in the normal participants, and the range of cone-to-RGC density ratios was relatively large in healthy controls. These findings suggest that estimates of baseline RGC density from cone density are unlikely to be precise and offer little advantage over determination of RGC alone in the identification of early glaucomatous change

Ageing changes in retinal outer nuclear layer thickness and cone photoreceptor density using adaptive optics-free imaging

Purpose: To investigate age-related changes of the outer nuclear layer (ONL) thickness and cone density, and their associations in healthy participants using a modified, narrow scan-angle Heidelberg Retina Angiograph (HRA2). Methods: Retinal cones were imaged outside the fovea at 8.8° eccentricity and cone density was compared to ONL thickness measurements obtained by Spectral-Domain Optical Coherence Tomography (SD-OCT) at the same locations. Fifty-six eyes of 56 healthy participants with a median age (interquartile range, IQR) of 37 years (29–55) were included. Results: Median (IQR) cone count was 7,472 (7,188, 7,746) cones/mm2 and median (IQR) ONL thickness was 56 (52, 60) µm for healthy participants. Both cone density and ONL thickness were negatively associated with age: cone density, R2 = 0.16 (F(1,54) = 10.41, P = 0.002); ONL thickness, R2 = 0.12 (F(1,54) = 7.41, P = 0.009). No significant association was seen between cone density and ONL thickness (R2 = 0.03; F(1,54) = 1.66, P = 0.20). Conclusion: Cone density was lower, and ONL thinner, in older compared to younger participants, therefore, image-based structural measures should be compared to age-related data. However, cone density and ONL thickness were not strongly associated, indicating that determinants of ONL thickness measurements other than cone density measurements, and including measurement error, have a major influence

Umsetzung eines digitalen Semesters Augenheilkunde während der COVID-19-Pandemie

Hintergrund Die erste Welle der COVID-19-Pandemie stellte Lehrende und Studierende vor große Herausforderungen, da die studentische Lehre trotz Einschränkung des Präsenzunterrichts stattzufinden hatte. Für Präsenzunterricht und Veranstaltungen mit Patientenkontakt mussten kurzfristig zwischen Mitte März und Beginn des Semesters im April Alternativen gestaltet werden. Ziel der Arbeit Beschreibung von Konzept und Umsetzung der studentischen Lehre an der Augenklinik der Universitätsmedizin Mainz in kompletter digitaler Form im Sommersemester 2020. Konzeptvorstellung Vorlesung, Untersuchungskurs und Praktikum der Augenheilkunde finden an der Universitätsmedizin Mainz im 5. und 6. Semester im Studiengang Humanmedizin statt. Grundlage der Neukonzeption war der bisherige Kursaufbau. Das umgesetzte Konzept umfasste Vorlesungen als Videopodcasts, Untersuchungsvideos, Online-Untersuchungskonferenzen, leitsymptomorientierte interaktive Patientenfälle, Operationsvideos, Anamnesevideos von Patienten und die Gestaltung eines „Live-Patientenzimmers“, in dem Patientenfälle inklusive Live-Übertragung des Spaltlampenbefundes und der Fundoskopie präsentiert wurden. Die Evaluation durch Studierende zeigte eine sehr gute Annahme des Konzeptes. Diskussion Es gelang innerhalb eines Zeitrahmens von 4 Wochen eine vollständige Überarbeitung und Digitalisierung des Kurses Augenheilkunde. Der größte Anteil der Neugestaltung beinhaltete die mediale Produktion von Untersuchungsvideos, interaktiven Patientenfällen und Videopodcasts der Vorlesungen. Diese digitalen Lehrkonzepte können auch in den nächsten Semestern nach Wiederaufnahme des Präsenzunterrichts genutzt werden und die Präsenzlehre in der Augenheilkunde unterstützen.Background The first wave of the COVID-19 pandemic posed great challenges for teachers and students, as teaching had to take place despite the restriction of classroom teaching. For attendance lessons and events with patient contact alternatives had to be arranged at short notice between mid-March and the beginning of the semester in mid-April. Objective Description of the concept and implementation in the student teaching at the Department of Ophthalmology of the University Medical Center Mainz in complete digital form in spring 2020. Presentation of concept Lectures, examination course and practical training in ophthalmology take place in the 5th and 6th semester of the study of human medicine. The basis of the new concept were the former course curricula. Implemented concepts included a complete revision and implementation of lectures as video podcasts, examination videos, online examination conferences, interactive patient cases, narrated videos of surgery, anamnesis videos of patients and the design of the virtual patient room, a live online practice with presentation and examination of patients including transmission of the slit-lamp image to reproduce anterior and posterior segment examination. An evaluation showed a very positive reception of the new concept by students. Discussion Within a tight timeframe of 4 weeks a complete revision of the ophthalmology course was achieved. The implementation was time-consuming, with the largest share in the media production of examination videos, interactive patient cases and video podcasts of the lectures. We consider a reduction of classroom teaching for parts of the learning objectives that can be represented by such videos to be possibly useful. An independent digital appropriation of such content may enable a more productive learning environment in face-to-face teaching