Comparison of Serum Homocysteine, Vitamin B12, Vitamin B6 and Folate Levels in Different Glaucoma Types

PURPOSE: To compare the levels of serum homocysteine, vitamin B12, vitamin B6 and folate in patients with normal-tension glaucoma, pseudoexfoliation glaucoma and high-tension glaucoma. METHODS: Thirty-two healthy subjects, 35 patients with normal-tension glaucoma, 22 patients with pseudoexfoliation glaucoma and 31 patients with high-tension glaucoma were included in the present study. Fasting venous samples were collected from all the participants. The levels of serum homocysteine, vitamin B12, vitamin B6 and folate were measured. One-way analysis of variance was used for the comparison of homocysteine, vitamin B12, vitamin B6 and folate levels among the 4 groups. RESULTS: The mean homocysteine levels in the pseudoexfoliation glaucoma and high-tension glaucoma group were 17.91 +/- 5.11 and 17.60 +/- 3.89 micromol/l, respectively, which were significantly higher than that of the control group (p = 0.014, p = 0.013, respectively). The mean vitamin B6 levels in the pseudoexfoliation glaucoma and high-tension glaucoma group were 17.67 +/- 14.32 and 17.00 +/- 10.58 nmol/l, respectively, which were significantly lower than that of the control group (p = 0.026, p = 0.008, respectively). CONCLUSIONS: Hyperhomocysteinemia may play a role as a risk factor in the development or progression of pseudoexfoliation glaucoma and high-tension glaucoma.

Comparison of OCT and HRT Findings Among Normal, Normal Tension Glaucoma, and High Tension Glaucoma

PURPOSE: To evaluate the relationship between optic disc and retinal nerve fiber layer (RNFL) measurements obtained with the optical coherence tomography (OCT) and the Heidelberg retina topography (HRT) in normal, normal tension glaucoma (NTG), and high tension glaucoma (HTG). METHODS: Normal, NTG and HTG subjects who met inclusion and exclusion criteria were evaluated retrospectively. One hundred seventy eyes of 170 patients (30 normal, 40 NTG, and 100 HTG) were enrolled. Complete ophthalmologic examination, HRT, OCT, and automated perimetry were evaluated. RESULTS: Disc area, cup area and cup/disc area ratio measured with HRT were significantly different between NTG and HTG (all p0.05). Mean deviation and corrected pattern standard deviation measured by automated perimetry was significantly correlated with mean and inferior RNFL thickness in both NTG and HTG (Pearson's r, p<0.05). Mean RNFL thickness/disc area ratio was significantly larger in HTG than NTG (35.21+/-18.92 vs. 31.30+/-10.91, p=0.004). CONCLUSIONS: These findings suggest that optic disc and RNFL damage pattern in NTG may be different from those of HTG.

Comparison of Retinal Nerve Fiber Layer Measurements between NTG and HTG using GDx-VCC

PURPOSE: To compare quantitative polarimetric measurements in eyes with NTG and HTG using GDx-VCC. Both groups were matched by age and glaucoma stage based on the Humphrey visual field test. METHODS: We retrospectively reviewed the records of 146 patients who underwent Humphrey field analysis (HFA) and GDx-VCC. We compared outcomes of retinal nerve fiber layer (RNFL) parameters among the three groups by ANOVA and between each pair of groups using the Tukey-Kramer Post-Hoc test. We also evaluated the sensitivity and specificity of GDx-VCC in detecting glaucoma in each group. RESULTS: The mean age and HFA mean deviation (MD) were 55.6+/-9.5 years and -0.8+/-1.5 dB in 47 control patients, 59.4+/-9.0 years and -5.77+/-4.38 dB in 49 NTG patients, and 59.4+/-11.7 years and -8.09+/-6.77 dB in 51 HTG patients, respectively. All thickness parameters were lower in HTG patients compared to NTG patients, but there were no significant differences in ratio parameters between age-matched early HTG and NTG patients. The sensitivity of GDx-VCC was significantly higher in both early and total HTG patients compared to the respective groups of NTG patients. CONCLUSIONS: Compared to eyes with NTG, eyes with HTG showed reduced RNFL thickness and ratio parameters when patients were age and visual field matched. GDx-VCC appeared to be more sensitive in detecting RNFL damage in HTG patients.

The Quantitative Evaluation of Optic Ne rve Head of Normal Tension Glaucoma

It is known that optic disc morphology is different between high tension glaucoma[HTG]and normal tension glaucoma[NTG]. We quantitatively evaluated optic nerve head by confocal scanning laser ophthalmoscope [CSLO]to determine if substantial morphological differences between the HTG and the NTG could be identified. 21 patients[21 eyes]in the early NTG and 32 patients[32 eyes]in the early HTG were matched for visual field defect[MD>-10dB].The optic nerve head was evaluated by Heidelberg Retina Tomograph[HRT]and 12parameters provided by HRT were compared between NTG and HTG. The mean age of patients was 56.6 +/-13.6 years in NTG and 48.9 +/-14.7 years in HTG, respectively[p>0.05].Mean MD was -5.4 +/-1.9dB in the NTG, -5.0 +/-2.5dB in the HTG, respectively[p>0.05]. Disc area was slightly lager in the NTG than in the HTG, but the difference did not reach statistical significance[p>0.05].The neuroretinal rim area was significantly larger in the NTG than in the HTG[p<0.05], whereas the mean cup depth was significantly smaller in the NTG than in the HTG[p<0.05].Among the 12 parameters, cup area, rim area, cup volume, mean cup depth, and maximum cup depth in the NTG had significant correlations with CPSD in the visual field index.These findings further support the hypothesis that there may be different mechanisms in the glaucomatous optic nerve damage.