Evaluation of Optic Disc Changes in Severe Myopia

Purpose: To evaluate the changes in the optic nerve head in highly myopic subjects by means of confocal laser scanning opthalmoscope. Methods: Using laser scanning and a three- dimensional image analysis system, we studied 114 young (21. 4 +/- 1.4 years), highly myopic subjects with refractive errors greater than -8.0 D and a control group of 29 subjects ( 18.9 +/- 1.2 years) with myopia of -3.0 D or less, Measurements included cycloplegic refraction, corneal curvature, biometric axial length, and morphometric values of the optic disc obtained with a laser scanning disc analyzer. Results: The optic disc area in highly myopic eyes was similar to that in mildly myopic eyes. However, regression analysis revealed that the optic disc area increased with axial length in subjects with severe myopia. The cup/disc ratio, the disc depth, the neuroretinal rim area, and the Lilting of the disc were not significantly different between the severe and mild myopia groups. Conclusions: These findings may be useful in further investigations of myopic progression and of the mechanisms responsible far the development of:myopic complications

Ocular Hypotensive Effect and Safety of Brinzolamide Ophthalmic Solution in Open Angle Glaucoma Patients

Background and Purpose: Brinzolamide is a new topical carbonic anhydrase inhibitor for intraocular pressure (IOP) control. It has high inhibitory activity against human carbonic anhydrase II, which is the key isoenzyme regulating aqueous humor production. We conducted this study to compare the ocular hypotensive effect and safety of 1% brinzolamide versus that of 0.5% timolol twice daily. Methods: In a double-masked design, 50 open angle glaucoma patients who had a baseline IOP between 20 to 30 mm Hg were randomized to receive either 1% brinzolamide ophthalmic solution or 0.5% timolol twice daily. After completing a 2- week pre-study screening period , patients were scheduled to receive 6 weeks of treatment. Visual acuity, IOP, slit-lamp biomicroscopy, corneal thickness, refraction status, blood pressure, heart rate, and treatment-related signs and symptoms were evaluated at follow-up visits. The eye selected for treatment was the one with the higher baseline IOP, or the right eye if the IOPs were the same in both eyes . The fellow eye served as control. Results. 48 patients completed the study, and there were 24 patients in each group. A significant decrease in mean IOP was found after 6 weeks of treatment in both the brinzolamide group (-17.0%) and the timolol group (-19.7%), with no significant between- group difference in the control of IOP. The central corneal thickness of treatment eyes, measured by ultrasound pachometry, had not changed after 6 weeks of brinzolamide treatment. The study medications were generally well tolerated and no serious adverse reactions occurred during the 6-week study period. Conclusion: When used twice a day, topical brinzolamide is as effective as 0.5% timolol in lowering IOP in patients with open angle glaucoma

Migraine and increased risk of developing open angle glaucoma: a population-based cohort study

Abstract Background Migraine is linked to endothelial dysfunction and is considered to be a systemic vasculopathy. Interestingly, systemic vascular diseases also occur in glaucoma patients and are considered to be vascular risk factors. Whether migraine is simply a concomitant condition in glaucoma patients or a risk factor per se for glaucoma remains unknown. Thus, in the present study, we investigated the risk for open angle glaucoma (OAG) in migraineurs using a 10-year follow-up study that employed a nationwide population-based dataset in Taiwan. Methods This retrospective matched-cohort study used data sourced from the Longitudinal Health Insurance Database 2000. We included 17,283 subjects with migraine in the study cohort and randomly selected 69,132 subjects from the database for the comparison group. Each subject in this study was individually traced for a 10-year period to identify those subjects who subsequently received a diagnosis of OAG. The age-adjusted Charlson’s comorbidity index (ACCI) score was utilized to compute the burden of comorbidity in each subject. Multivariate regression analysis was used to assess risk factors for OAG in migraineurs. Cox proportional hazards regression was performed to compare the 10-year risk of OAG between the migraineurs and the comparison cohort. Results Migraineurs had more vascular comorbidities than the comparison cohort. The overall incidence of OAG (per 1000 person-years) was 1.29 and 1.02, respectively, for migraineurs and the comparison cohort during the 10-year follow-up period. Age, hyperlipidemia, and diabetes mellitus were three significant risk factors for OAG in migraineurs. After adjusting for patients’ age and vascular comorbidities, migraineurs were found to have a 1.68-fold (95% confidence interval [CI], 1.20–2.36) greater risk of developing OAG than the comparison cohort, in subjects with an ACCI score of 0. This association became statistically nonsignificant in subjects with ACCI scores of 1–2 or ≥ 3. Conclusion Migraine is associated with a higher risk of OAG for patients with no comorbidity who are aged under 50 years

Association Between High Myopia and Progression of Visual Field Loss in Primary Open-angle Glaucoma

Taiwan has a very high prevalence rate of myopia. We retrospectively studied the influence of myopia on the progression of visual field (VF) loss in primary open-angle glaucoma (POAG) patients. Methods: We studied 515 POAG patients for a minimum follow-up period of 5 years. VF examination was performed with Humphrey perimeter, 30-2 SITA standard program, every 6 months. A point-wise numerical comparison was applied to judge the VF changes. Test points showing more than 1.0 dB of sensitivity loss in mean defect were identified. A location was considered to have progression if it was detected on two consecutive visits. Progression of VF loss was confirmed if three or more test points deteriorated. Multivariate logistic regression was used to evaluate the association between progression of VF loss and various risk factors. Results: There were 262 cases. Progression of VF loss occurred in 57 eyes (21.8%) during the 5-year follow-up period. Logistic regression revealed that the deterioration was associated with older age, higher mean intraocular pressure, larger vertical cup-to-disc ratio, and greater myopic refraction status. The incidence of VF loss progression was 15.1% in the group of eyes with myopia less than −3 D, 10.5% in the group with −3 D to −6 D, 34.4% in the group with −6 D to −9 D, and 38.9% in the group with myopia greater than −9D. Conclusion: POAG patients with myopia greater than −6 D had a greater progression of VF loss