The Structure-function Relationships between Two Different Optical Coherence Tomography in Patients with High Myopic Glaucoma

Purpose@#To evaluate the structure-function relationships between swept-source optical coherence tomography (SS-OCT) and spectral-domain optical coherence tomography (SD-OCT) in glaucoma patients with high myopia. @*Methods@#Forty-three eyes with high-myopia (axial length over 28 mm) and 30 with emmetropia (axial length 21 to 24 mm) of patients with preperimetric glaucoma and primary open-angle glaucoma were retrospectively enrolled. Visual field (VF) sensitivity and mean deviation were evaluated via standard automated perimetry. Peripapillary retinal nerve fiber layer (RNFL) thickness was measured using SD-OCT and SS-OCT. The topographic relationships between structure and function were investigated. @*Results@#In the high myopia group, the average (p 0.05). The emmetropic group exhibited a significant correlation between the average RNFL thickness, and the MS and VF mean deviation (MD) using SS-OCT (both p ≤ 0.001). The average RNFL thickness correlated significantly with the MD using SD-OCT (p = 0.036). In emmetropia patients, the superotemporal, inferotemporal, superonasal, and inferonasal RNFL thicknesses correlated with the corresponding VF sensitivities using both SS-OCT and SD-OCT (all p < 0.05). @*Conclusions@#SS-OCT assessed structure-function relationships more accurately than did SD-OCT in glaucoma patients with high myopia.

Profiles and Clinical Characteristics of Newly Diagnosed Glaucoma in Urban Korea: A Multicenter Study

Purpose@#To explore the clinical characteristics and profiles of newly diagnosed glaucoma subtypes in urban Korea. @*Methods@#All newly diagnosed glaucoma patients enrolled in the participating ophthalmology outpatient clinics were in-cluded. A review of medical history including family history of glaucoma was conducted. The patients underwent complete ophthalmologic examinations including visual field test. The diagnosis of glaucoma was based on the International Society of Geographical and Epidemiological Ophthalmology criteria developed by glaucoma specialists. @*Results@#A total of 198,671 patients visited the participating ophthalmology outpatient clinics during the study period (from January 1, 2001 to June 30, 2016), of which 5,530 (2.8%) were diagnosed with glaucoma. The mean age of the newly diag-nosed glaucoma patients was 52.0 ± 17.3 years (range, 6 to 89) and 2,830 patients were male (51.2%). The mean untreated in-traocular pressure and vertical cup-to-disc ratio of the optic nerve head of newly diagnosed glaucoma eyes were 22.1 ± 10.6 mmHg and 0.66 ± 0.22, respectively. The most frequently observed subtypes of glaucoma were: normal tension glaucoma (33.0%) primary open-angle glaucoma (28.4%), ocular hypertension (11.1%), chronic angle-closure glaucoma (6.8%), neovas-cular glaucoma (5.2%), glaucoma associated with inflammation (3.8%), acute angle-closure glaucoma (3.3%), and glaucoma associated with aphakia or pseudophakia (2.2%). @*Conclusions@#Normal tension glaucoma was the most frequently observed glaucoma subtype in urban ophthalmology outpa-tient clinics in Korea.

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.

The Structure-function Relationships between Two Different Optical Coherence Tomography in Patients with High Myopic Glaucoma

Purpose@#To evaluate the structure-function relationships between swept-source optical coherence tomography (SS-OCT) and spectral-domain optical coherence tomography (SD-OCT) in glaucoma patients with high myopia. @*Methods@#Forty-three eyes with high-myopia (axial length over 28 mm) and 30 with emmetropia (axial length 21 to 24 mm) of patients with preperimetric glaucoma and primary open-angle glaucoma were retrospectively enrolled. Visual field (VF) sensitivity and mean deviation were evaluated via standard automated perimetry. Peripapillary retinal nerve fiber layer (RNFL) thickness was measured using SD-OCT and SS-OCT. The topographic relationships between structure and function were investigated. @*Results@#In the high myopia group, the average (p 0.05). The emmetropic group exhibited a significant correlation between the average RNFL thickness, and the MS and VF mean deviation (MD) using SS-OCT (both p ≤ 0.001). The average RNFL thickness correlated significantly with the MD using SD-OCT (p = 0.036). In emmetropia patients, the superotemporal, inferotemporal, superonasal, and inferonasal RNFL thicknesses correlated with the corresponding VF sensitivities using both SS-OCT and SD-OCT (all p < 0.05). @*Conclusions@#SS-OCT assessed structure-function relationships more accurately than did SD-OCT in glaucoma patients with high myopia.

Associations between Retinal Nerve Fiber Layer Defect and Systemic Indices According to the KNHNES 2010–2012

PURPOSE: To investigate the associations between retinal nerve fiber layer (RNFL) defects and systemic factors in the Korean population. METHODS: Based on data from the 5th Korean National Health and Nutritional Examination Survey (2010–2012), 2,999 non-glaucomatous patients and 424 glaucoma patients were included. We compared body mass index (BMI), blood pressure, and blood test values according to the presence and location of RNFL defects in the groups and analyzed whether these defects were associated with various underlying diseases. RESULTS: In the non-glaucomatous group, RNFL defects were significantly and linearly related with BMI (p = 0.035), systolic blood pressure (p < 0.001), diastolic blood pressure (p = 0.018), fasting blood glucose (p < 0.001), HbA1c (p < 0.001), serum ferritin (p = 0.008), and RNFL defects were also significantly associated with diabetes mellitus (p = 0.001), hypertension (p < 0.001), dyslipidemia (p = 0.003), a history of myocardial infarction or angina (p = 0.037), and migraines (p = 0.004). In the glaucoma group, patients who had superior RNFL defects had a significantly lower systolic blood pressure (p = 0.034) than patients who had inferior RNFL defects. The other systemic indices did not differ significantly between these two subgroups. Superior RNFL defects were significantly associated with diabetes mellitus (p = 0.047) and a history of cerebrovascular accident (p = 0.031). CONCLUSIONS: RNFL defects in both the non-glaucomatous and glaucoma groups were associated with systemic factors. We could identify that the possibility of RNFL defects can be deduced from these systemic abnormalities and active treatment is needed in abnormal systemic condition.

Effects of Early Postoperative Intraocular Pressure after Ahmed Glaucoma Valve Implantation on Long-term Surgical Outcomes

PURPOSE: To evaluate the long-term effects of early postoperative intraocular pressure (IOP) after Ahmed glaucoma valve (AGV) implantation on long-term surgical outcomes. METHODS: This retrospective, non-randomized study included 100 eyes of 100 patients who underwent AGV surgery. We divided the enrolled patients into four groups according to the presence of transient hypotony within the first postoperative week or the presence of a hypertensive phase during the first three postoperative months. Postoperative IOP, the number of glaucoma medications, and cumulative success rate were compared among the groups. RESULTS: There was significantly better IOP control and a better success rate in the non-hypertensive phase group 2 years postoperatively. However, no significant difference was found in the IOP or success rate at 2 years postoperatively between the transient hypotony and non-hypotony groups. Further subgroup analysis showed that the non-hypotony, non-hypertensive phase group had a significantly higher success rate (100%) at 2 years postoperatively. CONCLUSIONS: We can predict the long-term prognosis after AGV implantation by considering the early postoperative IOP state and the presence of a hypertensive phase.

Features of the Lamina Cribrosa and the Autonomic Nervous System in Glaucoma Patients with Disc Hemorrhages

PURPOSE: To assess the effects of structural changes in the lamina cribrosa (LC) and the status of the autonomic nervous system on disc hemorrhages (DHs). METHODS: A retrospective study was performed on 68 eyes of 68 patients with primary open-angle glaucoma and optic DHs. We divided the patients into two groups using optical coherence tomography according to the presence of LC defects, and then compared both groups. We also analyzed autonomic nervous system function using the heart rate variability test, and compared the two groups. RESULTS: Eyes with LC defects had significantly longer axial lengths than those without defects (p = 0.029), and the DH was located more proximally (p < 0.001). A significantly larger proportion of eyes without LC defects had configurational optic disc changes such as optic disc rim notching, focal rim thinning, or generalized thinning (p = 0.001). On heart rate variability testing, the group without LC defects had a significantly higher “low frequency/high frequency ratio” than the group with defects (p = 0.008). CONCLUSIONS: There was a difference in the clinical features of DH between eyes with and without LC defects. Eyes with LC defects were more myopic and the proximal part of the DH tended to be on the disc cup or characterized by peripapillary atrophy. These results suggest that the DH developed due to a mechanical cause in eyes with LC defects. Patients without LC defects had a more dysregulated autonomic nervous system. The DH location was related to disc rim notching and neural rim losses, which implies ischemia as the pathogenic mechanism involved in the development of DH in eyes without LC defects. Therefore, more careful observations of the LC would facilitate a better understanding of the specific pathogenic mechanisms underlying DH.

The Correlations between Recurrent Disc Hemorrhage and Sympathetic Variability, and the Disc Morphology

PURPOSE: To evaluate the correlations of sympathetic variability and recurrent disc hemorrhage, and the morphology of the optic disc. METHODS: This study included 41 eyes of 41 patients who had at least one disc hemorrhage (DH), who were diagnosed with open-angle glaucoma or suspected glaucoma. All eyes had a DH at presentation and were followed-up for at least 3 years. Eyes were classified by the morphology of the optic disc into the focal rim thinning, concentric cupping, or myopic disc groups. The variability of the sympathetic nervous system was defined by the Standard deviation of all node to node intervals (SDNN) as very low frequency, low frequency (LF), or high frequency, which was the standard parameter of heart rate variabilities. RESULTS: There were 14 (34.14%) eyes with a single DH, and the remaining eyes with a recurrent DH. Single DH patients tended to have a myopic disc (p < 0.001) and, especially in the lower 50% of the SDNN group, the recurrent DH group had a lower SDNN (p = 0.046), and a higher LF (p = 0.002). CONCLUSIONS: DH recurred when patients had morphological glaucomatous changes, especially focal rim thinning. Differences of the sympathetic variability had a strong correlation with the recurrent DH.

Comparison of the Variability of Standard Automated Perimetry between Preperimetric Glaucoma Patients and Normal Controls

PURPOSE: To compare the variability of standard automated perimetry (SAP) between patients with preperimetric glaucoma (PPG) and normal controls. METHODS: This study included 67 eyes, classified into the following groups: 30 eyes, normal controls; and 37 eyes, PPG. All subjects were examined with 24-2 Humphrey static perimetry. The visual field was divided into superonasal, superotemporal, inferonasal, and inferotemporal sectors. The variability of SAP was obtained using the standard deviation of sensitivity points at each location. We compared the variability of SAP between the normal controls and PPG patients. RESULTS: The variability of SAP was higher in the PPG group compared with the normal control group (p < 0.001). There was also a significant correlation between the variability of SAP and intraocular pressure fluctuations and retinal nerve fiber layer thickness (both p < 0.05). The variability of SAP in the PPG group was higher (p < 0.05) in all areas except the inferotemporal sector compared with the normal control group. CONCLUSIONS: The variability of the SAP increased in PPG patients compared with normal controls, even when the visual field test results were normal.

The Effectiveness of Visual Field C10-2 in the Early Detection of Glaucoma with Parafoveal Scotoma

PURPOSE: To identify the correspondence between the central sensitivity of several visual field (VF) tests and ganglion cell inner plexiform layer (GC-IPL) thickness in early glaucoma patients with parafoveal scotoma. METHODS: Fifty-seven eyes from 57 patients with glaucomatous optic neuropathy and parafoveal scotoma were analyzed using the standard automated perimetry (SAP) C10-2 test, the SAP C24-2 test, and the frequency doubling technology perimetry (FDT) C24-2 test. The correlation between the VF central sensitivity and the GC-IPL thickness from macular scans via optical coherence tomography was analyzed. RESULTS: The central sensitivity was 27.51 ± 5.43 dB, 27.39 ± 5.05 dB, and 22.09 ± 5.08 dB for SAP C24-2, SAP C10-2, and FDT C24-2, respectively. Mean GC-IPL thickness was 70.2 ± 8.5 µm. Using regression analysis, the value of log R² between the logarithmic central sensitivity and GC-IPL thickness was 0.498, and the linear R2 between the antilogarithmic central sensitivity and GC-IPL thickness in SAP C10-2 was 0.486, and both were statistically significant (p < 0.05). This relationship was stronger in early glaucoma patients compared to late glaucoma patients using SAP C10-2. CONCLUSIONS: The structure-function relationship between GC-IPL thickness and central sensitivity was better with SAP C10-2, especially in early glaucoma patients, compared to other VF modalities.

Detecting the Progression of Normal Tension Glaucoma: A Comparison of Perimetry, Optic Coherence Tomography, and Heidelberg Retinal Tomography

PURPOSE: We compared the abilities of Stratus optical coherence tomography (OCT), Heidelberg retinal tomography (HRT) and standard automated perimetry (SAP) to detect the progression of normal tension glaucoma (NTG) in patients whose eyes displayed localized retinal nerve fiber layer (RNFL) defect enlargements. METHODS: One hundred four NTG patients were selected who met the selection criteria: a localized RNFL defect visible on red-free fundus photography, a minimum of five years of follow-up, and a minimum of five reliable SAP, Stratus OCT and HRT tests. Tests which detected progression at any visit during the 5-year follow-up were identified, and patients were further classified according to the state of the glaucoma using the mean deviation (MD) of SAP. For each test, the overall rates of change were calculated for parameters that differed significantly between patients with and without NTG progression. RESULTS: Forty-seven (45%) out of 104 eyes displayed progression that could be detected by red-free fundus photography. Progression was detected in 27 (57%) eyes using SAP, 19 (40%) eyes using OCT, and 17 (36%) eyes using HRT. In early NTG, SAP detected progression in 44% of eyes, and this increased to 70% in advanced NTG. In contrast, OCT and HRT detected progression in 50 and 7% of eyes during early NTG, but only 30 and 0% of eyes in advanced NTG, respectively. Among several parameters, the rates of change that differed significantly between patients with and without progression were the MD of SAP (p = 0.013), and the inferior RNFL thickness (p = 0.041) and average RNFL thickness (p = 0.032) determined by OCT. CONCLUSIONS: SAP had a higher detection rate of NTG progression than other tests, especially in patients with advanced glaucoma, when we defined progression as the enlargement of a localized RNFL defect. The rates of change of the MD of SAP, inferior RNFL thickness, and average RNFL thickness differed between NTG patients with and without progression.

Changes in the Retinal Nerve Fiber Layer after Intravitreal Injections of Bevacizumab in Glaucoma Patients

PURPOSE: To examine retinal nerve fiber layer (RNFL) changes after intravitreal injection of bevacizumab in patients with or without underlying glaucoma. METHODS: A total of 104 eyes of 104 patients with retinal disease undergoing intravitreal injection of bevacizumab were prospectively investigated. Bevacizumab injections (1.25/0.05 mg/mL) were performed using a standardized technique. In the patient who had pretreatment with intraocular pressure (IOP)-lowering medication, 1 drop of brimonidine was instilled 30 minutes before the injection. Before and after the intravitreal injections, the patients were monitored for IOP and evaluated with optical coherence tomography using Stratus at least 3 months after the injection. RESULTS: Thirty minutes after injection, 6.4% of patients had an IOP over 30 mm Hg in the non-pretreatment group while no patient had an IOP over 30 mm Hg in the pretreatment group. In eyes with only retinal diseases, the RNFL thickness did not change significantly after the injection regardless of pretreatment, whereas in eyes with underlying glaucomatous damage and no pretreatment, significant decrease in RNFL thickness was observed at the superior (p = 0.036) and temporal (p = 0.048) sectors of the optic nerve head without pretreatment. CONCLUSIONS: Intravitreal injection of bevacizumab did not typically cause significant changes in RNFL thickness; however, in eyes with underlying glaucoma without pretreatment, a significant decrease in RNFL thickness was observed in the superior and temporal sectors of the optic nerve head. Therefore, applying IOP-lowering pretreatment medication before intravitreal injection of bevacizumab is required for protection of RNFL in glaucoma patients.

Changes in the Retinal Nerve Fiber Layer after Intravitreal Injections of Bevacizumab in Glaucoma Patients

PURPOSE: To examine retinal nerve fiber layer (RNFL) changes after intravitreal injection of bevacizumab in patients with or without underlying glaucoma. METHODS: A total of 104 eyes of 104 patients with retinal disease undergoing intravitreal injection of bevacizumab were prospectively investigated. Bevacizumab injections (1.25/0.05 mg/mL) were performed using a standardized technique. In the patient who had pretreatment with intraocular pressure (IOP)-lowering medication, 1 drop of brimonidine was instilled 30 minutes before the injection. Before and after the intravitreal injections, the patients were monitored for IOP and evaluated with optical coherence tomography using Stratus at least 3 months after the injection. RESULTS: Thirty minutes after injection, 6.4% of patients had an IOP over 30 mm Hg in the non-pretreatment group while no patient had an IOP over 30 mm Hg in the pretreatment group. In eyes with only retinal diseases, the RNFL thickness did not change significantly after the injection regardless of pretreatment, whereas in eyes with underlying glaucomatous damage and no pretreatment, significant decrease in RNFL thickness was observed at the superior (p = 0.036) and temporal (p = 0.048) sectors of the optic nerve head without pretreatment. CONCLUSIONS: Intravitreal injection of bevacizumab did not typically cause significant changes in RNFL thickness; however, in eyes with underlying glaucoma without pretreatment, a significant decrease in RNFL thickness was observed in the superior and temporal sectors of the optic nerve head. Therefore, applying IOP-lowering pretreatment medication before intravitreal injection of bevacizumab is required for protection of RNFL in glaucoma patients.

Diurnal Fluctuation of Ocular Perfusion Pressure in the Fellow Eyes of Branch Retinal Vein Occlusion

PURPOSE: To investigate diurnal change in blood pressure (BP), intraocular pressure (IOP), and ocular perfusion pressure (OPP) in patients with unilateral branch retinal vein occlusion (BRVO) and compare the results with healthy controls. METHODS: We conducted a prospective case-control study which included 50 patients with unilateral BRVO and 50 age-matched volunteers as controls. Each participant underwent a comprehensive ophthalmic examination including optical coherence tomography (OCT). BP and IOP were evaluated 4 times daily at 8 AM, 10 AM, 2 PM and 6 PM. The mean and fluctuation of BP, IOP, mean arterial pressure (MAP), mean OPP (MOPP), and diastolic OPP (DOPP) were compared between fellow eyes of BRVO patients and normal control eyes. RESULTS: The average retinal nerve fiber layer (RNFL) thickness was significantly reduced in the fellow eyes of BRVO patients compared to control eyes (p < 0.001). Mean IOP and IOP fluctuation did not differ, but BP fluctuation (systolic BP fluctuation, p = 0.045; diastolic BP fluctuation, p = 0.037) and MAP fluctuation (p = 0.011) were greater in the fellow eyes of BRVO patients compared to normal eyes. The mean MOPP and DOPP did not differ between groups, however, the fluctuation of MOPP (p < 0.001) and DOPP (p < 0.001) were significantly increased in the fellow eyes of BRVO patients. The mean and fluctuation of BP, MAP, MOPP and DOPP were associated with reduced average RNFL thickness in the fellow eyes of BRVO patients. CONCLUSIONS: These results suggest the fellow eyes of unilateral BRVO patients may be at risk of developing glaucomatous damage.

Clinical Manifestation of Juvenile Idiopathic Arthritis Associated Uveitis in Korea

PURPOSE: To investigate the incidence and clinical characteristics of juvenile idiopathic arthritis (JIA)-associated uveitis in Korea and to identify the risk factors for developing uveitis and poor visual outcome. METHODS: We performed a retrospective chart review of 149 patients who were diagnosed as JIA between January 2001 and December 2012. Patients were classified based on the International League of Associations for Rheumatology (ILAR) criteria and the incidence and clinical course of uveitis according to each subtype was investigated. We also evaluated the risk factors for poor prognostic outcomes. RESULTS: The present study included 79 males and 70 females and the mean age was 7.42 +/- 3.82 years. In 13 patients (8.6%), uveitis manifested evenly among JIA subtypes, including 5 patients with oligoarthritis type, 4 patients with polyarthritis rheumatoid negative type, and 4 patients with systemic type. Anti-nuclear antibody (ANA) was detected more in the uveitic group (46.13%). The characteristics of uveitis were acute (85%), bilateral (85%), and anterior uveitis (92%). Chronic uveitis occurred in only 2 patients who had uveitis at an early age (mean age of 5 years) and had severe anterior chamber reaction at presentation. Poor visual outcome was associated with band keratopathy and posterior synechiae preceded by the chronic uveitis. CONCLUSIONS: JIA-associated uveitis occurred evenly in each subtype. Uveitis was increased in the presence of ANA. Most uveitis showed good visual outcomes but in cases of early uveitis onset and with severe anterior chamber reaction at presentation the risk of chronic uveitis increased resulting in poor visual outcomes.

Neovascular Glaucoma Following Stereotactic Radiosurgery for an Optic Nerve Glioma: A Case Report

A 13-year-old girl with a right intraorbital optic nerve glioma (ONG) was referred to our glaucoma clinic because of uncontrolled intraocular pressure (IOP) in her right eye. The IOP reached as high as 80 mmHg. Several months earlier, she had undergone stereotactic image-guided robotic radiosurgery using the CyberKnife for her ONG; the mass had become smaller after treatment. Her visual acuity was no light perception. Slit lamp examination revealed rubeosis iridis, a swollen pale optic disc, and vitreous hemorrhage. After medical treatment, the IOP decreased to 34 mmHg, and no pain was reported. Although the mass effect of an ONG can cause neovascular glaucoma (NVG), this case shows that stereotactic radiosurgery may also cause NVG, even after reducing the mass of the tumor. Patients who undergo radiosurgery targeting the periocular area should be followed carefully for complications.

Comparison between Heidelberg Retina Tomograph 2 and Heidelberg Retina Tomograph 3 for Glaucoma Detection

PURPOSE: To compare the ability of Heidelberg Retina Tomograph (HRT) 2 and the new version, HRT3, to discriminate between glaucoma and non-glaucoma eyes and to evaluate the most useful parameters for glaucoma detection. METHODS: Fifty-two healthy eyes, 62 glaucoma-suspect eyes, and 172 glaucoma eyes (a total of 286 eyes) were studied retrospectively. The discrimination capabilities of healthy and glaucomatous eyes were compared using areas under the receiver operating characteristics (AROCs) curves. Agreement between classifications was defined by kappa analysis. RESULTS: The stereometric parameters that best discriminated between glaucoma and non-glaucoma eyes were cup shape measure at HRT2 (areas under the ROCs curves (AUC) 0.784) and global probability score (GPS) at HRT3 (AUC 0.718). The stereometric parameters that best discriminated between normal and non-normal eyes were cup shape measure at HRT2 (AUC 0.785) and GPS at HRT3 (AUC 0.696). The sensitivity was 95% at HRT3 and 91% at HRT2, and specificity was 61% at HRT2 and 59% at HRT3. CONCLUSIONS: The glaucoma-discriminating ability of the HRT3 software is similar to that of HRT2; however, HRT3 provided results without the need for subjective operator input.

Interpretation of Frequency Doubling Technology Perimeter in Diagnosis of Glaucoma and Glaucoma Suspect

PURPOSE: To find applicable parameters of the frequency doubling technology perimeter (FDP), which is known to be useful in detecting early visual field loss. METHODS: The subjects were 65 eyes of normal individuals, 58 eyes of glaucoma suspects, and 37 eyes of glaucoma patients. FDP (MD, PSD), SAP (MD, PSD, CPSD), and 5 parameters of OCT were analyzed. The receiver operating characteristic (ROC) curve, sensitivity, and specificity of each parameter were evaluated, and the comparison of FDP parameters by Pearson's chi-square was made between the glaucoma suspect group and the normal group. The same comparison was made among the normal+glaucoma suspect and glaucoma group. RESULTS: In discriminating between the normal and glaucoma suspect groups, the FDP-PSD revealed an AUC of 0.745 (cutoff: 3.17dB), which was significantly larger than that of SAP-PSD with an AUC of 0.660 (cutoff: 1.73dB). In comparing FDP, PSD by Anderson criteria was most reliable with a hit ratio of 0.732. On the other hand, in discriminating among the normal+glaucoma suspect group and glaucoma group, the SAP-PSD showed an AUC 0.971 (cutoff: 2.92dB), much larger than the FDP-PSD with an AUC of 0.863 (cutoff: 3.78dB). In addition, in comparing the parameters of FDP by Pearson chi-square, PSD 1% was the most reliable with a hit ratio of 0.813. CONCLUSIONS: FDP is a valuable screening tool in detecting early visual field loss. PSD by Anderson criteria can be a reliable parameter for the diagnosis of pre-perimetric glaucoma, and PSD 1% can be used in the discrimination of perimetric glaucoma.

Optic Nerve Head Analysis Obtained by Computerized Stereoscopic Optic Disc Photography

PURPOSE: To compare computerized stereoscopic optic disc photography, plane optic disc photography, and OCT in ONH analysis and predictability of glaucomatous field defects. METHODS: A total of 99 eyes of 50 patients were studied from December 2004 to February 2005. Complete ophthalmic examinations were performed which included computerized stereoscopic optic disc photography, plane optic disc photography, OCT, and a visual field test. RESULTS: The three methods analyzed in this study were largely correlated with each other. However, the horizontal cup-disc ratio using OCT differed from the other methods. The most valuable data was vertical CDR estimation using computerized stereoscopic optic disc photography. The sensitivity and specificity of computerized stereoscopic optic disc photography on a glaucomatous field defect using multivariate analysis were 80% and 100%, respectively. The hit ratios of computerized stereoscopic optic disc photography, plane optic disc photography, and OCT were 90.9, 81.6 and 60.7, respectively. CONCLUSIONS: ONH analysis using computerized stereoscopic optic disc photography may be a benefit in the diagnosis and follow-up of glaucoma patients. It is thought that easy accessibility and convenient storage of computerized photography will be useful for the detection of glaucomatous visual field defects.

Expression of Nitric Oxide Synthase Isoforms in a Rat Model of Chronic Glaucoma

PURPOSE: This study investigated the expression of three isoforms of nitric oxide synthase (NOS): neuronal (nNOS), inducible (iNOS), and endothelial (eNOS) in an experimental rat model of chronic glaucoma. The aim was to research the role of nitric oxide (NO) as a neurotoxic molecule in connection with damage to and the degeneration of retinal ganglion cells in glaucoma. METHODS: Retinal tissues were obtained after inducing chronic elevation of intraocular pressure by cauterization of episcleral vessels. We then performed quantification and localization of NOS isoforms through western blot and immuno-fluorescence staining of the tissues. RESULTS: The expression of nNOS and iNOS increased significantly but that of eNOS did not. nNOS expressed in the amacrine and displaced amacrine cell of the normal retinal tissue, as well as in retinal ganglion cells in the experimental group. iNOS that expressed in the microglia of the normal retinal tissue was also expressed in the cell thought to be an astrocyte or Muller cell end-feet in the experimental group. Administration of L-NAME (NG-nitro-L-arginine-methyl-esther), a non-specific NOS inhibitor, tended to reduce retinal ganglion cell loss, but this result was without statistical significance. CONCLUSIONS: These results showed that the cytotoxicity of excessive NO took part in retinal ganglion cell loss in glaucoma, and the expression of nNOS in retinal ganglion cells suggests that it may play an important role in the selective death of the retinal ganglion cell.