Analysis of Factors Affecting Corneal Deflection Amplitude in Normal Korean Eyes

Purpose@#To analyze the corneal deflection amplitude (DA), as measured by the Corvis ST tonometer (Oculus), and other ocular parameters that could affect the DA in normal Korean eyes. @*Methods@#A retrospective study was performed on 126 eyes of 126 normal Korean subjects. Intraocular pressure (IOP) was measured with Goldmann tonometry (IOP-G), and the Corvis ST was used to measure the corneal DA, central corneal thickness (CCT) and IOP; the biomechanically corrected IOP-B was measured with non-contact tonometry (IOP-N). Axial length (AxL), anterior chamber depth (ACD), and the mean keratometric value were obtained with the IOL Master instrument (Zeiss). The relationships between DA and other measurements were then evaluated. @*Results@#The DA was positively correlated with AxL (p = 0.002) and ACD (p = 0.010), and negatively correlated with IOP-G (p < 0.001), IOP-N (p < 0.001), IOP-B (p < 0.001), and CCT (p = 0.006). However, when AxL, ACD, CCT, and each type of IOP were analyzed together, AxL (p = 0.016) and IOP-G (p < 0.001) were the parameters most significantly associated with the DA. @*Conclusions@#A longer AxL and greater ACD were associated with a higher DA, while a higher IOP and thicker CCT were associated with a lower DA. DA, one of the biochemical parameters of the cornea, was affected by multiple ocular factors, i.e., AxL and IOP. These factors should therefore be considered when interpreting DA measurements obtained using the Corvis ST.

Metabolic Health, Obesity, and the Risk of Developing Open-Angle Glaucoma: Metabolically Healthy Obese Patients versus Metabolically Unhealthy but Normal Weight Patients

Background@#This study sought to investigate the associations between metabolic health status, obesity, and incidence of primary open-angle glaucoma (POAG). @*Methods@#In this nationwide, population-based, longitudinal prospective cohort study conducted using the Korean National Health Insurance System, we categorized all subjects based on presence and severity of metabolic syndrome and obesity. Insurance claims data were used to identify POAG development. Then, Cox regression was applied to calculate the hazard of developing POAG in people with various components of metabolic syndrome, obesity, or their combination. @*Results@#Of the total 287,553 subjects, 4,970 (1.3%) developed POAG. High fasting glucose, blood pressure, and total cholesterol levels were all associated with increased risk of developing POAG. Regarding obesity level, people with body mass index (BMI) greater than 30 kg/m 2 were more likely to develop POAG than those with normal BMI. Also, people with greater number of metabolic syndrome components showed a greater POAG incidence. People who are metabolically unhealthy and obese (adjusted hazard ratio [HR], 1.574; 95% confidence interval [CI], 1.449 to 1.711) and those who are metabolically unhealthy nonobese (MUNO: adjusted HR, 1.521; 95% CI, 1.405 to 1.645) but not those who are metabolically healthy obese (MHO: adjusted HR, 1.019; 95% CI, 0.907 to 1.144) had an increased hazard of developing POAG compared with metabolically healthy nonobese (MHNO) subjects. @*Conclusion@#Metabolic health status and obesity were significantly associated with increased risk of POAG incidence. MUNO subjects but not MHO subjects showed a higher risk of POAG development than did MHNO subjects, suggesting that metabolic status is more important than obesity in POAG.

Ganglion Cell Analysis in an Optic Tract Syndrome Patient Previously Diagnosed with Glaucoma

PURPOSE: To report the results of ganglion cell analysis in a patient with optic tract syndrome who was previously diagnosed with glaucoma. CASE SUMMARY: A 32-year-old male, who had been diagnosed with glaucoma 12 years ago, but had not visited an ophthalmology clinic since then, came to our clinic for evaluation of his glaucoma. Both eyes showed an increased cup-to-disc ratio and temporal pallor of the disc. Retinal nerve fiber layer (RNFL) optical coherence tomography showed thinning of the superior, inferior, and temporal peripapillary RNFL in both eyes. On ganglion cell analysis (GCA), ganglion cell layer thinning in the nasal region of the right eye and in the temporal region of the left eye was observed. The visual field test showed right incongruous homonymous hemianopsia. After the atrophic change of the left optic tract was confirmed by orbit magnetic resonance imaging, he was diagnosed with left optic tract syndrome. CONCLUSIONS: We report the results of GCA in a case of optic tract syndrome, previously diagnosed as glaucoma. GCA can be useful when diagnosing optic tract syndrome.

Glaucoma pathogenesis and lifestyle modification

Glaucoma is the leading cause of irreversible blindness worldwide. Increased intraocular pressure is the most important risk factor for glaucoma. Lifestyle patterns that can increase intraocular pressure include smoking, caffeine consumption, lifting heavy weights, certain yoga postures, playing wind instruments, using swimming goggles, and certain sleeping positions. Lifestyle patterns that may reduce intraocular pressure include aerobic exercise. Although only limited studies have investigated the relationship between these lifestyle patterns and glaucoma, smoking cessation and aerobic exercise are recommended. For other lifestyle patterns, including caffeine consumption, lifting heavy weights, certain yoga postures, wind instruments, swimming using goggles, and certain sleeping positions, there does not seem to be sufficient evidence to prohibit them, but they should be taken into account in patients with advanced glaucoma.

Blepharoptosis Repair through the Small Orbital Septum Incision and Minimal Dissection Technique in Patients with Coexisting Dermatochalasis

PURPOSE: To describe a modified surgical technique for blepharoptosis repair through a small orbital septum incision and minimal dissection, along with the results obtained in patients with coexisting dermatochalasis. METHODS: A retrospective chart review included 33 patients (52 eyelids) with blepharoptosis coexisting with dermatochalasis, surgically corrected through a small orbital septum incision and minimal dissection after redundant upper lid skin excision, by placing a single fixation suture between the levator aponeurosis and the tarsal plate. Outcome measures included the pre- and postoperative marginal reflex distances (MRD1), eyelid contour, post-operative complications, and need for reoperation. RESULTS: The pre- and postoperative MRD1 averaged 1.1 +/- 0.8 mm and 2.8 +/- 1.1 mm, respectively. Of the 33 patients, 9 patients (9 eyelids) underwent surgery on one eyelid for unilateral blepharoptosis and dermatochalasis (Group I), 5 patients (5 eyelids) underwent a simple skin excision blepharoplasty of the contralateral eyelid (Group II), and 19 patients (38 eyelids) underwent bilateral blepharoptosis and dermatochalasis repair (Group III). Of the 14 eyelids that underwent unilateral ptosis repair (Groups I and II), 12 eyelids (85.7%) showed less than a 1-mm difference from the contralateral eyelid. Of the 38 eyelids that underwent bilateral ptosis repair (Group III), 27 eyelids (71.1%), 5 eyelids (13.1%), and 6 eyelids (15.8%) had excellent, good, and poor outcomes, respectively. Overall, 44 eyelids (84.6%) out of a total of 52 eyelids had successful outcomes; the remaining 8 eyelids demonstrated unsatisfactory eyelid contour was corrected by an additional surgery. CONCLUSIONS: Blepharoptosis repair through a small orbital septum incision and minimal dissection can be considered an efficient technique in patients with ptosis and dermatochalasis.