Evaluation of optic nerve head parameters and retinal nerve fiber layer thickness in healthy Brazilian population

Orientador: Vital Paulino CostaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Objetivos: 1) Determinar medidas da menor espessura da rima neural a partir da abertura da membrane de Bruch (do inglês, BMO-MRW) e da espessura da camada de fibras nervosas peripapilar (CFNpp), adquiridas e setorizadas em relação ao eixo entre e fóvea e a abertura da membrana de Bruch (FoBMO), em uma população de indivíduos sem doença ocular; 2) Determinar limites de tolerância de assimetria de medidas de BMO-MRW e de espessura da CFNpp nessa mesma população; 3) Avaliar reprodutibilidades das medidas de BMO-MRW e da CFNpp. Métodos: Realizamos três estudos observacionais com o tomógrafo de coerência óptica Spectralis; 1) No estudo 1, 260 participantes foram divididos em três grupos: Descendentes Africanos (DAs, n=78), Descendentes Europeus (DEs=103) e Descendentes Mistos (DMs=79). Comparamos medidas de BMO-MRW e da CFNpp, entre os grupos, com análise de covariância, após ajuste para idade e área de BMO. Modelos de regressão linear avaliaram a associação entre co-variáveis e os parâmetros; 2) No estudo 2, calculamos percentis das assimetrias globais e setoriais de BMO-MRW e CFNpp, entre olhos de um mesmo indivíduo. O efeito de co-variáveis na assimetria foi avaliado com regressão linear; 3) No estudo 3, reprodutibilidades intra e inter- observador foram estimadas pelo cálculo do desvio padrão (do inglês, SW, within-subject standard deviation) e do coefeciente de variação (COV). Resultados: 1) Não encontramos diferenças setoriais significativas das medidas de BMO-MRW e CFNpp entre grupos raciais, exceto no setor superonasal, onde ambos os parâmetros foram mais finos em DEs (P=0,04 e P<0,001, respectivamente). CFNpp foi mais fina em DEs no setor inferonasal (P=0,009). Encontramos redução de BMO-MRW e CFNpp com a idade, porém, DAs apresentaram redução da CFNpp mais significativa (-0,32 µm/ano) que DEs e DMs (-0,10 µm/ano; P=0,01 e -0,08 µm/ano; P=0,02, respectivamente); 2) Limites de tolerância do intervalo de confiança de 95% para assimetria das medidas globais de BMO-MRW e CFNpp foram de 49 µm e 9 µm, respectivamente. A assimetria de BMO-MRW e da CFNpp estavam correlacionadas com a assimetria da área de BMO (ß= -33,87 µm/mm2, R2=0,06, P<0,001 e ß= 6.13 µm/mm2, R2=0,09, p<0.001, respectivamente); 3) Os COVs (%) para medidas globais de BMO-MRW em individuos saudáveis e em pacientes com glaucoma foram 0,87/1,34 e 1,28/3,13 para análises intra e inter-observador, respectivamente, e para medidas da CFNpp foram de 1,50/2,10 e 2,04/2,87. Os SWs para medidas globais de BMO-MRW em indivíduos saudáveis e com glaucoma foram 2,88/2,54 e 4,17/4,82 para análises intra e inter-observador, respectivamente, e para medidas da CFNpp foram de 1,55/1,40 e 2,27/1,86. Conclusões: 1) Apesar das diferenças significativas de medidas setoriais de BMO-MRW e CFNpp, entre os grupos, essas diferenças foram pequenas comparadas à variação normal de cada raça. Afinamento da CFNpp com a idade foi significativamente maior em DAs, o que deve ser melhor investigado; 2) Diferenças globais de BMO-MRW e CFNpp, entre olhos de um mesmo indivíduo, excedendo 49 e 9 µm, respectivamente, podem indicar assimetrias estatisticamente anormais 3) As medidas de BMO-MRW apresentaram excelentes reprodutibilidades, comparáveis às da CFNpp, parâmetro amplamente utilizado na pratica clínicaAbstract: Objectives: 1) To determine Bruch¿s membrane opening (BMO)- minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer thickness (RNFLT) measurements, relative to its eye specific angle between the fovea and BMO (FoBMO), in healthy individuals; 2) To determine tolerance limits in BMO-MRW and RNFLT asymmetry in healthy individuals; 3) To investigate the reproducibilities of BMO-MRW and RNFLT measurements. Methods: We conducted three observational studies with Spectralis OCT imaging; 1) In the first study, 260 participants were divided in three groups: African Descents (AD, n=78), European Descents (ED, n=103) and Mixed Descents (MD, n= 79). Analysis of covariance was conducted to evaluate mean differences in RNFLT and BMO-MRW among the three racial groups, adjusting for age and BMO area. We used multivariable linear regression models with interaction terms to evaluate if the effects of co-variables on BMO-MRW or RNFLT varied by racial group; 2) In the second study, global and sectorial interocular BMO-MRW and RNFLT differences between paired eyes and their percentile distributions were calculated. The effect of covariables on the parameters¿ asymmetry was evaluated with linear regression analysis; 3) In the third study, intra- and inter-observer reproducibilities were estimated by within-subject standard deviation (SW) and coefficient of variation (COV). Results: 1) We found no significant differences in either BMO-MRW or RNFLT in most sectors, among racial groups, except in the superonasal sector, in which both BMO-MRW and RNFLT were thinner in ED (P=0.04, P<0.001, respectively). RNFLT was also thinner in ED in the inferonasal sector (P=0.009). In all races, global BMO-MRW and RNFLT decreased with age. However, AD subjects had higher rates of global RNFLT decay with age (-0.32 µm/year) compared to ED and MD subjects (-0.10 µm/year and -0.08 µm/year, respectively; P=0.01and P=0.02, respectively); 2) In the second study, we found that the 95th CI limits for interocular BMO-MRW and RNFLT global differences were 49 µm and 9 µm, respectively. BMO-MRW and RNFLT asymmetries were correlated with BMO area asymmetry (ß= -33.87 µm/mm2, R2=0.06, P<0.001 and ß= 6.13 µm/mm2, R2=0.09, p<0.001, respectively); 3) Global BMO-MRW COVs (%) in healthy/glaucoma subjects were 0.87/1.34 and 1.28/3.13 for intra- and interobserver analyses, respectively, and the corresponding global RNFLT figures were 1.50/2.10 and 2.04/2.87. The global BMO-MRW SW in healthy/glaucoma subjects were 2.88/2.54 and 4.17/4.82 for intra- and inter-observer analyses, respectively, and the corresponding figures for global RNFLT were 1.55/1.40 and 2.27/1.86. Conclusions: 1) While we found no significant differences in global BMO-MRW and RNFLT among the three races, these differences were small compared to the normal variations within each race. Age-related thinning of the RNFLT was significantly higher in the AD subgroup, which warrants further study; 2) Global BMO-MRW and RNFLT interocular differences exceeding 49 and 9 µm, respectively, are indicative of statistically abnormal asymmetry; 3) Intra- and inter-observer reproducibilities of BMO-MRW were excellent and comparable to those of RNFLT measurements, which are routinely used in clinical practiceDoutoradoOftalmologiaDoutora em Ciências02-P-4565/2018CAPE

Effects of Misalignments in the Retinal Nerve Fiber Layer Thickness Measurements with Spectral Domain Optical Coherence Tomography

Purpose. To investigate misalignments (MAs) on retinal nerve fiber layer thickness (RNFLT) measurements obtained with Cirrus© SD-OCT. Methods. This was a retrospective, observational, cross-sectional study. Twenty-seven healthy and 29 glaucomatous eyes of 56 individuals with one normal exam and another showing MA were included. MAs were defined as an improper alignment of vertical vessels in the en face image. MAs were classified in complete MA (CMA) and partial MA (PMA), according to their site: 1 (superior, outside the measurement ring (MR)), 2 (superior, within MR), 3 (inferior, within MR), and 4 (inferior, outside MR). We compared RNFLT measurements of aligned versus misaligned exams in all 4 sectors, in the superior area (sectors 1 + 2), inferior area (sectors 3 + 4), and within the measurement ring (sectors 2 + 3). Results. RNFLT measurements at 12 clock-hour of eyes with MAs in the superior area (sectors 1 + 2) were significantly lower than those obtained in the same eyes without MAs P=0.043. No significant difference was found in other areas (sectors 1 + 2 + 3 + 4, sectors 3 + 4, and sectors 2 + 3). Conclusion. SD-OCT scans with superior MAs may present lower superior RNFLT measurements compared to aligned exams

Impact of Personalized Mail and Telephone Interventions to Improve Follow-up to Vision Care in Patients with Diabetes: Results from Two Randomized Prospective Trials

The purpose of this project was to evaluate the effectiveness of personalized mail and telephone interventions to improve follow-up to vision care in patients with diabetes. The project was divided in two parts. In the first study, 521 patients with diabetes who were due for a follow-up dilated fundus examination (DFE) were randomly assigned to receive 1) a single-mailed reminder form letter (usual care), or 2) a reminder letter plus an educational brochure, followed by a telephone call to schedule a DFE. In the second study, patients with diabetes were randomly assigned to receive 1) a single-mailed reminder letter (usual care), or 2) a personalized reminder letter plus an educational brochure or, 3) usual reminder letter plus a telephone call to schedule the DFE. Barriers to care utilization were also captured. The primary outcome was completion of a DFE within 3 months of suggested return date (timely appointment). Overall, all intervention groups were similar regarding demographic characteristics with a majority being female and African American. A combination of personalized mail and telephone communications and telephone communications alone were more effective in improving DFE adherence than a strategy based solely on standard mailed reminders. However, including an educational brochure did not enhance the effectiveness of the telephone-based intervention. Most commonly reported barriers to scheduling a DFE included busy schedule and issues with health insurance. In summary, a low cost telephone-based intervention significantly improves DFE adherence in an urban primary eye care setting. Presentation: 17 minute

Bruch's Membrane Opening Minimum Rim Width In Healthy Brazilian Subjects

5712841Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology (ARVO)MAY 01-05, 2016Seattle, W

Correlation and agreement between the diurnal tension curve, the water-drinking test and the postural-change test in glaucoma patients

sem informação567Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology (ARVO)sem informaçã

Bruch's membrane opening minimum rim width and retinal nerve fiber layer thickness in a Brazilian population of healthy subjects.

OBJECTIVE:To determine Bruch's membrane opening (BMO) minimum rim width (MRW) and peripapillary retinal nerve fiber layer thickness (RNFLT) measurements, acquired with optical coherence tomography (OCT) in healthy Brazilian individuals self-reported as African Descent (AD), European Descent (ED) and Mixed Descent (MD). METHODS:260 healthy individuals (78 AD, 103 ED and 79 MD) were included in this cross-sectional study conducted at the Clinics Hospital of the University of Campinas. We obtained optic nerve head (24 radial B scans) and peripapillary retinal nerve fiber layer (3.5-mm circle scan) images in one randomly selected eye of each subject. RESULTS:After adjustment for BMO area and age, there were no significant differences in mean global MRW (P = 0.63) or RNFLT (P = 0.07) among the three groups. Regionally, there were no significant differences in either MRW or RNFLT in most sectors, except in the superonasal sector, in which both MRW and RNFLT were thinner among ED (P = 0.04, P<0.001, respectively). RNFLT was also thinner in ED in the inferonasal sector (P = 0.009). In all races, global MRW decreased and global RNFLT increased with BMO area. AD subjects had higher rates of global RNFLT decay with age (-0.32 μm/year) compared to ED and MD subjects (-0.10 μm/year and -0.08 μm/year, respectively; P = 0.01 and P = 0.02, respectively). CONCLUSIONS AND RELEVANCE:While we found no significant differences in global MRW and RNFLT among the three races, age-related thinning of the RNFLT was significantly higher in the AD subgroup, which warrants further study

Long-term outcomes in patients initially responsive to selective laser trabeculoplasty

AIM:To determine the long-term effects of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) and the number of medications used up to 5y following treatment in glaucoma patients receiving maximally tolerated medical therapy (MTMT).METHODS:The Wills Eye Hospital Glaucoma Research Center retrospectively reviewed the charts of glaucoma patients who underwent SLT after receiving MTMT. Eyes that did not achieve their target pressure within 3mo following SLT were excluded from the study. Changes in mean IOP and number of glaucoma medications used were analyzed at 1, 3, and 5y following SLT.RESULTS:Seventy-five eyes of 67 patients were included in the study. Fifteen eyes that received SLT failed to achieve their target pressure within 3mo and were excluded from the study. The average follow-up time was 37.4mo (±14.4). Mean IOP was significantly reduced 1y after treatment (P=0.005). It was also reduced 3, 5y after treatment without reaching statistical significance (P=0.20 and P=0.072, respectively). There was a significant decrease in mean number of medications used 1, 3, 5y after treatment (P&lt;0.001, P&lt;0.001, and P=0.039, respectively). In the span of 5y, 2 eyes (2.7%) underwent repeat SLT, 7 eyes (9.3%) underwent glaucoma surgery and an additional 3 eyes (4.0%) underwent both.CONCLUSION:SLT significantly reduced the number of glaucoma medications used 5y following treatment in glaucoma patients receiving MTMT. SLT may delay operating-room surgery