A Path Analysis of Effects of Patients' Underlying Conditions, Treatment Satisfaction, and Adherence on Quality of Life Among Korea Glaucoma Patients.

PRéCIS:: This observed patient-specific features and treatment-driven conditions that were significantly associated with the impairment of health-related quality of life (HRQOL) among glaucoma patients. The results suggest that more systematic strategies should be implemented to improve an HRQOL. PURPOSE: To determine factors contributing to an HRQOL and assess total, direct and indirect, effects that may exist between the determinants using path analysis. MATERIALS AND METHODS: Data were derived from previous Korea glaucoma outcomes research. A total of 847 glaucoma outpatients with ≤2 years of eye-drop use were included in the present study. Including factors and their hypothetical pathways to an HRQOL were based on the literature review and consultation with specialists. Age, sex, comorbidities, and education levels were included as underlying conditions and treatment patterns were defined by the number of daily instillations of prescribed eye-drops. Treatment satisfaction and adherence were estimated using a Treatment Satisfaction Questionnaire for Medication, which assessed side-effects, effectiveness, convenience, global satisfaction, and pill count. An HRQOL was assessed by EQ-5D and EQ-visual analogue scale (EQ-VAS). RESULTS: In EQ-5D analysis, male individuals showed total effects (ß=0.102, P=0.0026), including both direct (ß=0.076, P=0.0095) and indirect effects (ß=0.0253, P=0.0020), which were mediated by treatment satisfaction in the side effects and global satisfaction categories. Higher education (ß=0.197, P=0.0020) and satisfaction in the side effect (ß=0.095, P=0.0076) and global satisfaction (ß=0.075, P=0.0414) categories were found to have direct effects on EQ-5D. For EQ-VAS, higher education levels had significant total effects (ß=0.153, P=0.0020) accounting for direct effects (ß=0.131, P=0.0030) and indirect effects (ß=0.0223, P=0.0531) through global satisfaction. In addition, male individuals had indirect effects (ß=0.274, P=0.0165), which was indirectly mediated by satisfaction in the global satisfaction category. Comorbidity (ß=-0.096, P=0.0090) and satisfaction in the effectiveness (ß=0.094, P=0.0302), convenience (ß=0.076, P=0.0390), and global satisfaction (ß =0.144, P=0.0020) categories showed indirect effect on EQ-VAS. CONCLUSION: Higher education and better treatment satisfaction had positive effects on HRQOL both in direct and indirect ways whereas comorbidities indirectly showed negative associations with HRQOL.

Periodically Patterned Au-TiO2 Heterostructures for Photoelectrochemical Sensor.

Periodically patterned Au nanorods in TiO2 nanocavities (Au NRs@TiO2) were fabricated via magnetron sputtering followed by a thermal dewetting process. This innovative Au NRs@TiO2 heterostructure was used as a plasmonic sensing platform for photoelectrochemical detection of glucose and lactose. This Au NRs@TiO2 patterned heterostructure possesses superior sensing properties to other Au nanoparticle-based sensors because (i) localized surface plasmon resonance (LSPR) generated at Au/TiO2 interfaces enhanced sensitivity of glucose (lactose) amperometric detection; (ii) periodic Au nanocrystals in TiO2 nanocavities accelerated charge separation and transfer rate, especially under monochromatic blue light irradiation; (iii) discrete planar architectures comprising Au NRs immobilized on TiO2 substrates significantly improved stability and reusability of the sensors. A low detection limit of 1 µM (10 µM) and a high sensitivity of 812 µA mM-1 cm-2 (270 µA mM-1 cm-2) were achieved on the Au NRs@TiO2 heterostructures for glucose (lactose) detection without the addition of enzymes. Good selectivity and superb stability over more than 8 weeks was also demonstrated using these Au NRs@TiO2 heterostructures for glucose (lactose) detection. Additionally, this cost-efficient technique can be easily extended to other photoelectrochemical sensing systems when considering the combination of sensing and visible or infrared light source enhancement.

Treatment patterns and medication adherence of patients with glaucoma in South Korea.

BACKGROUND/AIMS: This study aimed to investigate treatment patterns and medication adherence of glaucoma. It also identified key factors associated with non-adherence. METHODS: It was a cross-sectional, observational study. Patients who use eye-drops for ≤2 years were recruited at 15 eye clinics from March to November 2013. Data were collected through self-administered questionnaires and medical chart review. Medication adherence was evaluated using patients' self-report on pill count and defined as patients' administering drug for ≥80% of prescribed days. Medication adherence rate was calculated by dividing actual number of administration from total prescribed number of administration for 7 days. Patients whose self-reported prescription was different from total daily doses of physicians' prescription were considered as non-adherent. RESULTS: A total of 1050 patients included, and medication adherence rate was evaluated in 1046 patients whose verification of adherence was available. Of the total, 27.4% were non-adherent, and the medication adherence rates of the total, the adherent, and the non-adherent were 90.6±17.8%, 96.8±5.5% and 56.6±24.7%, respectively. The most commonly used medication was prostaglandin (PGA) alone and the second was combination of two-class (ß-blocker and carbonic anhydrase inhibitor (CAI)) and three-class combination of PGA, ß-blocker and CAI followed. In multivariate analysis, the risk of non-adherence was 1.466 times greater in males than in females (95% CI 1.106 to 1.943) and 1.328-fold greater as the daily number of administration was increased (95% CI 1.186 to 1.487). CONCLUSION: Approximately, one-third of the patients were non-adherent, and males and increased daily number of administration were associated with non-adherence. It highlights that more systematic treatment strategies should be considered for better medication adherence, leading to effective glaucoma management.

Enhanced Photoelectrocatalytic Reduction of Oxygen Using Au@TiO2 Plasmonic Film.

Novel Au@TiO2 plasmonic films were fabricated by individually placing Au nanoparticles into TiO2 nanocavity arrays through a sputtering and dewetting process. These discrete Au nanoparticles in TiO2 nanocavities showed strong visible-light absorption due to the plasmonic resonance. Photoelectrochemical studies demonstrated that the developed Au@TiO2 plasmonic films exhibited significantly enhanced catalytic activities toward oxygen reduction reactions with an onset potential of 0.92 V (vs reversible hydrogen electrode), electron transfer number of 3.94, and limiting current density of 5.2 mA cm-2. A superior ORR activity of 310 mA mg-1 is achieved using low Au loading mass. The isolated Au nanoparticle size remarkably affected the catalytic activities of Au@TiO2, and TiO2 coated with 5 nm Au (Au5@TiO2) exhibited the best catalytic function to reduce oxygen. The plasmon-enhanced reductive activity is attributed to the surface plasmonic resonance of isolated Au nanoparticles in TiO2 nanocavities and suppressed electron recombination. This work provides comprehensive understanding of a novel plasmonic system using isolated noble metals into nanostructured semiconductor films as a potential alternative catalyst for oxygen reduction reaction.

Bimatoprost 0.01 % for previously treated patients with open-angle glaucoma or ocular hypertension in the Korean clinical setting.

PURPOSE: To evaluate the occurrence of hyperemia with, and efficacy of, bimatoprost 0.01 % for patients in Korea previously treated for open-angle glaucoma (OAG; including normal tension glaucoma) or ocular hypertension (OHT). METHODS: In this multicenter, observational study (Asia Pacific Patterns from Early Access of Lumigan 0.01 % in Korea; APPEAL Korea), patients with unachieved target intraocular pressure (IOP) despite previous treatment received bimatoprost 0.01 % daily for 12 weeks. The primary endpoint was incidence of hyperemia and its severity, graded using the standard 5-point photographic scale and grouped as "none to mild" and "moderate to severe". Hyperemia shifts were reported. IOP and adverse events (AEs) were recorded. RESULTS: Of 800 patients (intent-to-treat/safety population), 248 were switched from previous treatment to bimatoprost 0.01 % monotherapy. Hyperemia shifts from baseline at weeks 6 and 12 were unchanged (84.8, 89.8 %), improved (4.4, 4.8 %), or worsened (10.8, 5.4 %), respectively. The shift was significant at week 6 (P < 0.0001). Hyperemia did not worsen significantly in patients previously receiving a prostaglandin analog or prostamide (PGA/PSD). Baseline mean IOP ± SD was 17.0 ± 5.7 mmHg, decreasing to 14.6 ± 3.8 mmHg (P < 0.0001) after 6 weeks, and to 14.7 ± 3.6 mmHg (P < 0.0001) after 12 weeks. Patients switched from PGA or PSD (excluding bimatoprost 0.03 %) to bimatoprost 0.01 % experienced significant IOP reductions from baseline. Treatment-related ocular AEs were reported by 37 patients, the most common being hyperemia (7.3 %). CONCLUSIONS: This subanalysis of the APPEAL Korea study supports use of bimatoprost 0.01 % for previously treated patients with OAG (including normal tension glaucoma) or OHT who did not reach target IOP or were intolerant of previous treatment.

Characteristics of eyes with inner retinal cleavage.

PURPOSE: Inner retinal cleavage can be misdiagnosed as a glaucomatous retinal nerve fiber layer (RNFL) defect. This study was performed to characterize eyes with inner retinal cleavage. METHODS: Inner retinal cleavage is defined as the appearance of a dark spindle-shaped space between the nerve fibers. Patients who presented at our institution with inner retinal cleavage were enrolled in the study. All participants were evaluated by fundus examination, visual field testing with standard automated perimetry, and optical coherence tomography (OCT) imaging. RESULTS: A total of 15 eyes of 11 subjects with inner retinal cleavage were included in the study. The median age of the subjects was 57 years (age range, 30-67 years). In each case, inner retinal cleavage was located adjacent to retinal blood vessels. Tissue bridging the cleavage area was observed in ten eyes. Six eyes had epiretinal membranes (ERMs), two eyes had glaucoma, and one eye had ERM in addition to glaucoma. Six eyes with inner retinal cleavage without combined ocular abnormalities had highly myopic refractive error (-6.50 to -8.50 diopters). Cross-sectional OCT images of the areas of inner retinal cleavage demonstrated defects with irregular margins and empty spaces in the inner layers of the retina. During the follow-up period, no eye showed changes in inner retinal layer cleavage or visual field sensitivity. CONCLUSIONS: Inner retinal cleavage was found in eyes with high myopia or ERMs. Inner retinal cleavage was associated with structural changes distinct from those associated with glaucomatous RNFL defects.

Bimatoprost 0.01% in treatment-naïve patients with open-angle glaucoma or ocular hypertension: an observational study in the Korean clinical setting.

BACKGROUND: This study evaluates the efficacy and tolerability (ie, occurrence and severity of hyperemia) of bimatoprost 0.01% in treatment-naïve patients with open-angle glaucoma (OAG) or ocular hypertension in the Korean clinical setting. METHODS: In this multicenter, open-label, observational study, treatment-naïve patients with OAG, including patients with normal-tension glaucoma (NTG, defined as IOP ≤21 mm Hg), or ocular hypertension received bimatoprost 0.01% once daily. Hyperemia was assessed at baseline and weeks 6 and 12, graded by a masked evaluator using a photonumeric scale (0, +0.5, +1, +2, +3), and grouped as (0 to +1) and (+2 to +3). Shifts between groupings were reported as no change, improved ([+2 to +3] to [0 to +1]), or worsened ([0 to +1] to [+2 to +3]). Other adverse events were monitored. Mean IOP changes from baseline at weeks 6 and 12 were reported. Supplemental analyses were conducted for IOPs >21 versus ≤21 mm Hg. RESULTS: Of 295 treatment-naïve patients included in the intent-to-treat/safety population, 73 (24.7%) had baseline IOP >21 mm Hg (mean, 25.7 ± 5.0 mm Hg) and 222 (75.3%) had baseline IOP ≤21 mm Hg (mean, 16.3 ± 3.0 mm Hg); 96.3% had hyperemia graded none (36.3%) to mild (17.3%). At week 12, hyperemia was graded none to mild in 83.7% (n = 220). Worsening occurred in 12.3% of patients by week 6 and 12.7% by week 12. Small improvements occurred in 0.8% and 0.5% of patients at weeks 6 and 12, respectively. Hyperemia scores were generally low and the majority of patients had no change in severity during the study. Mean IOP at weeks 6 and 12 was reduced to 16.4 ± 4.0 mm Hg (-34.5%; P < 0.0001) and 16.7 ± 3.9 mm Hg (-32.0%; P < 0.001) in the baseline-IOP >21 mm Hg group versus 13.3 ± 2.6 mm Hg (-17.8%; P < 0.001) and 13.7 ± 2.8 mm Hg (-15.9%; P < 0.001) in the baseline-IOP ≤21 mm Hg group, respectively. CONCLUSIONS: In treatment-naïve patients, bimatoprost 0.01% induced low shifts in worsening of hyperemia and significant reductions in IOP, regardless of baseline IOP. CLINICAL TRIAL REGISTRATION NUMBER: NCT01594970.

Changes in retinal nerve fiber layer thickness after optic disc hemorrhage in glaucomatous eyes.

PURPOSE: The aim of this study was to investigate the changes in longitudinal retinal nerve fiber layer thickness (RNFLT) as determined by spectral-domain optical coherence tomography (OCT) after optic disc hemorrhage (DH) in glaucomatous eyes. METHODS: A total of 65 eyes with unilateral DH and 65 contralateral eyes without DH were subjected to RNFLT measurements by using OCT at the time of DH detection and at 1 year (12±2 mo) and 2 years (24±2 mo) later. For the definition of event-based significant RNFLT changes (a change beyond the upper limit of the 95% confidence interval of test-retest variability), 50 eyes with stable glaucoma without DH that had undergone OCT examinations 3 times with a 1-year interval were also enrolled. Clock-hour sector RNFLT in the eyes with DH and clock-hour sector RNFLT at equivalent locations in the contralateral eyes without DH were analyzed to assess localized and spatially compatible RNFLT changes associated with DH. RESULTS: Of the eyes with DH, 38.5% showed decrease in RNFLT and 6.2% showed increase in RNFLT 1 year after DH detection, whereas 58.5% showed decrease in RNFLT and no eye showed increase in RNFLT 2 years after DH detection. Significant decreases in RNFLT in the eyes with DH were associated with the presence of recurrent DH and greater baseline RNFLT (P<0.05). Of the contralateral eyes without DH, 4.6% and 15.4% showed decrease in RNFLT 1 and 2 years after DH detection, respectively. CONCLUSIONS: In the glaucomatous eyes, DH was associated with progressive decrease in RNFLT as determined by OCT, especially in the eyes with recurrent DH and greater baseline RNFLT.

Macular ganglion cell analysis for early detection of glaucoma.

PURPOSE: To investigate the ability of Cirrus high-definition optical coherence tomography (Cirrus HD-OCT; Carl Zeiss Meditec, Dublin, CA) macular ganglion cell analysis (GCA) sector, deviation, and thickness maps to detect early glaucoma. DESIGN: Cross-sectional study. PARTICIPANTS: We enrolled 131 eyes with early glaucoma (mean deviation >-6.0 dB) and 132 age- and refractive error-matched healthy eyes. METHODS: Macular GCA maps were obtained using Cirrus HD-OCT. The location, angular distance, and width of circumpapillary retinal nerve fiber layer (RNFL) defects were investigated by using red-free fundus photographs. The presence of a structural abnormality in the GCA map was defined as (1) yellow/red color codes in the sector map, (2) yellow/red pixels (>10) in the deviation map, and (3) blue areas in the thickness map. MAIN OUTCOME MEASURES: The prevalence of and factors associated with the presence or absence of abnormal GCA findings were assessed. RESULTS: Among the 131 glaucomatous eyes, 105 (80.2%), 115 (87.8%), and 104 (79.4%) showed structural abnormalities in the GCA sector, deviation, and thickness maps, respectively. The absence of abnormal findings in the GCA maps of glaucomatous eyes was associated with the presence of RNFL defects in the superior hemisphere, a greater angular distance between the fovea and the RNFL defect, a narrower width of the RNFL defect, less severe visual field defects, or an isolated peripheral nasal step (outside 10 degrees of fixation) (P<0.05). A greater angular distance of the RNFL defect remained significant in multivariate analyses (P<0.05). Among the 132 healthy eyes, 28 (21.2%), 37 (28.0%), and 20 (15.2%) had abnormal findings in the GCA sector, deviation, and thickness maps, respectively. The presence of abnormal GCA findings in healthy eyes was associated with a higher degree of myopic refractive error (P<0.05). CONCLUSIONS: Cirrus HD-OCT GCA maps showed a good ability to detect early glaucoma. However, GCA maps did not show abnormal findings in glaucomatous eyes when the angular distance between fovea and RNFL defect was great. These findings should be considered when diagnosing early glaucoma using GCA maps.

Agreement of retinal nerve fiber layer defect location between red-free fundus photography and cirrus HD-OCT maps.

PURPOSE: To investigate the agreement of angular locations of retinal nerve fiber layer (RNFL) defect margins in glaucomatous eyes by using red-free fundus photographs and Cirrus high-definition optical coherence tomography (OCT) RNFL deviation and thickness maps. METHODS: We examined 380 RNFL defects that showed clear margins in red-free fundus photographs. The OCT deviation and thickness maps were overlaid on the corresponding red-free fundus photographs. A reference line was drawn between the disc center and the macular center. Lines were also drawn between the optic disc center and the point where the RNFL defect margins crossed the OCT scan circle. The angle between the reference and defect-margin lines defined the angular location of the defect margin. Angular locations of proximal (nearest to the reference) and distal (farthest from the reference) RNFL defect margins on OCT deviation and thickness maps were compared to the locations on red-free fundus photographs. RESULTS: The angular locations of proximal and distal RNFL defect margins on OCT thickness maps showed good agreement with red-free fundus photographs. However, OCT deviation maps showed greater angular locations for both proximal and distal RNFL defect margins compared with red-free fundus photographs, especially in eyes with higher myopia (p < 0.05). CONCLUSIONS: Red-free fundus photographs and OCT thickness maps showed good agreement for the RNFL defect margin identification. However, this was not the case for deviation maps, especially in myopic eyes. This finding should be considered when evaluating RNFL defects using OCT maps.

Effect of peripapillary retinoschisis on retinal nerve fibre layer thickness measurement in glaucomatous eyes.

BACKGROUND/AIMS: To investigate the effect of peripapillary retinoschisis on the peripapillary retinal nerve fibre layer (RNFL) thickness measurement by using optical coherence tomography (OCT) in glaucomatous eyes. METHODS: We included 19 glaucomatous eyes of 19 subjects with peripapillary retinoschisis defined as the splitting of the peripapillary RNFL with schisis cavities (retinoschisis group) and 38 age-matched, refractive error-matched and visual field mean deviation-matched glaucomatous eyes from 38 subjects without peripapillary retinoschisis (control group) that had undergone RNFL thickness measurements by using OCT. RNFL thickness was compared between the two groups. For the retinoschisis group, the RNFL thicknesses prior to peripapillary retinoschisis formation, at the time of peripapillary retinoschisis, and after peripapillary retinoschisis resolution were compared. RESULTS: The average RNFL was greater in the eyes in the retinoschisis group (median, 81.6 µm) than in those in the control group (median, 69.7 µm, p=0.009). In the retinoschisis group, the average RNFL thickness at the time of peripapillary retinoschisis was greater than that prior to peripapillary retinoschisis formation (p=0.013) or after peripapillary retinoschisis resolution (p=0.001). The RNFL thickness was not different prior to peripapillary retinoschisis formation and after peripapillary retinoschisis resolution (p>0.05). CONCLUSIONS: Transient increase in RNFL thickness as determined by OCT was observed in glaucomatous eyes with peripapillary retinoschisis. Caution is warranted when interpreting the RNFL thickness measurement in eyes with peripapillary retinoschisis.

Lithium chloride inhibits TGF-ß1-induced myofibroblast transdifferentiation via PI3K/Akt pathway in cultured fibroblasts from Tenon's capsule of the human eye.

Excess scarring of the conjunctiva after glaucoma filtration surgery is a major cause of failure. Transforming growth factor (TGF)-ß is critically involved in post-operative scarring. Lithium inhibits TGF-ß-induced gene protein expression in corneal fibroblasts and inhibits TGF-ß-induced epithelial mesenchymal transition. Here, we investigated the effects of LiCl on TGF-ß1-mediated signaling pathways and on myofibroblast transdifferentiation of human Tenon's capsule fibroblasts (HTFs). LiCl treatment reduced expression of TGF-ß1-induced α-SMA expression in HTFs. LiCl also decreased Akt phosphorylation induced by TGF-ß1. TGF-ß1-induced α-SMA expression was significantly decreased by LY294002 and Akt siRNA indicating that these changes are mediated by the PI3K/Akt pathway. Thus, LiCl induces the suppression of transdifferentiation stimulated by TGF-ß1 by the regulation of PI3K/Akt signaling in HTFs.

Comparison of the outcome of silicone Ahmed glaucoma valve implantation with a surface area between 96 and 184 mm² in adult eyes.

PURPOSE: To compare the success rates, complications, and visual outcomes between silicone Ahmed glaucoma valve (AGV) implantation with 96 mm(2) (FP8) or 184 mm(2) (FP7) surface areas. METHODS: This study is a retrospective review of the records from 132 adult patients (134 eyes) that underwent silicone AGV implant surgery. Among them, the outcomes of 24 eyes from 24 patients with refractory glaucoma who underwent FP8 AGV implantation were compared with 76 eyes from 76 patients who underwent FP7 AGV implantation. Preoperative and postoperative data, including intraocular pressure (IOP), visual acuity, number of medications, and complications were compared between the 2 groups. RESULTS: There were no significant differences in baseline characteristics between the 2 groups (p > 0.05). The postoperative visual acuity of the patients in the FP8 group was better than that of the patients in the FP7 group in some early postoperative periods (p < 0.05); however, after 10 postoperative months, visual acuity was not significantly different through the 3-year follow-up period (p > 0.05). Postoperative IOP was not significantly different between the 2 groups (p > 0.05) except for IOP on postoperative day 1 (11.42 mmHg for the FP7 group and 7.42 mmHg for the FP8 group; p = 0.031). There was no statistical difference in success rates, final IOP, number of medications, or complication rates between the 2 groups (p > 0.05). CONCLUSIONS: The FP7 and FP8 AGV implants showed no difference in terms of vision preservation, IOP reduction, and number of glaucoma medications required.

Ability of cirrus high-definition spectral-domain optical coherence tomography clock-hour, deviation, and thickness maps in detecting photographic retinal nerve fiber layer abnormalities.

PURPOSE: To investigate the ability of clock-hour, deviation, and thickness maps of Cirrus high-definition spectral-domain optical coherence tomography (HD-OCT) in detecting retinal nerve fiber layer (RNFL) defects identified in red-free fundus photographs in eyes with early glaucoma (mean deviation >-6.0 dB). DESIGN: Cross-sectional study. PARTICIPANTS: Two hundred ninety-five eyes with glaucomatous RNFL defects with clear margins observed in red-free fundus photographs and 200 age-, sex-, and refractive error-matched healthy eyes were enrolled. METHODS: The width and location of RNFL defects were evaluated by using the red-free fundus photograph. When a RNFL defect detected by red-free fundus photograph did not present as (1) yellow/red codes in the clock-hour map, (2) yellow/red pixels in the deviation map, or (3) blue/black areas in the thickness map, the event was classified as a misidentification of a photographic RNFL defect by Cirrus HD-OCT. In healthy eyes, the presence of false-positive RNFL color codes of Cirrus HD-OCT maps was investigated. MAIN OUTCOME MEASURES: The prevalence of and factors associated with the (1) misidentification of photographic RNFL defects by Cirrus HD-OCT in eyes with glaucoma and (2) false-positive RNFL color codes of Cirrus HD-OCT maps in healthy eyes were assessed. RESULTS: Among the 295 red-free fundus photographic RNFL defects from 295 eyes with glaucoma, 83 (28.1%), 27 (9.2%), and 0 (0%) defects were misidentified in the clock-hour, deviation, and thickness maps of Cirrus HD-OCT, respectively. Fifty-six defects (19.0%) were misidentified only in the clock-hour map and 27 (9.2%) in both the clock-hour and deviation maps. The misidentification of photographic RNFL defects by Cirrus HD-OCT was associated with a narrower width and a temporal location of RNFL defects (P<0.05). Among the 200 healthy eyes, 25 (12.5%), 30 (15.0%), and 12 (6.0%) eyes had false-positive RNFL color codes in clock-hour, deviation, and thickness maps of Cirrus HD-OCT, respectively. CONCLUSIONS: Among the clock-hour, deviation, and thickness maps obtained with Cirrus HD-OCT, the thickness map showed the best diagnostic ability in detecting photographic RNFL defects. The RNFL thickness map may be a useful tool for the detection of RNFL defects in eyes with early glaucoma.

Detection of glaucomatous progression by spectral-domain optical coherence tomography.

PURPOSE: To compare the rate of change of circumpapillary retinal nerve fiber layer (cRNFL) thickness, macular volume and thickness, and optic nerve head (ONH) parameters assessed using spectral-domain optical coherence tomography (SD-OCT) between eyes with progressing and nonprogressing glaucoma. DESIGN: Longitudinal, observational study. PARTICIPANTS: Two hundred seventy-nine eyes from 162 glaucoma patients followed for an average of 2.2 years. METHODS: Eyes were classified as progressors and nonprogressors according to assessment of optic disc and RNFL photographs and visual field progression analysis. Linear mixed effects models were used to evaluate the overall rate of change of cRNFL thickness, macular volume and thickness, and ONH parameters after adjustment for age, spherical equivalent, signal strength, and baseline SD-OCT measurements. MAIN OUTCOME MEASURES: The rate of change of cRNFL thickness, macular volume, and thickness and ONH parameters. RESULTS: Sixty-three eyes (22.6%) from 52 subjects were identified as progressors. Average, inferior quadrant, and 6- and 7-o'clock sector cRNFL thickness decreased faster in progressors than in nonprogressors (-1.26 vs -0.94, -2.47 vs -1.75, -3.60 vs -2.52, and -2.77 vs -1.51 µm/year, respectively; all P<0.05). The ONH rim area decreased faster, and average and vertical cup-to-disc ratio increased faster in progressors than in nonprogressors (-0.016 vs -0.006 mm(2)/year, and 0.004 vs 0.002 and 0.006 vs 0.004 per year, respectively; all P<0.05). Macular cube volume and the thickness of temporal outer and inferior inner macular sectors decreased faster in progressors than in nonprogressors (-0.068 vs -0.048 mm(3)/year, and -2.27 vs -1.67 and -2.51 vs -1.73 µm/year, respectively; all P<0.05). CONCLUSIONS: Serial measurement of parameters in all 3 areas (cRNFL, macula, and ONH) by SD-OCT may permit identification of progression in glaucomatous eyes. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Errors in neuroretinal rim measurement by Cirrus high-definition optical coherence tomography in myopic eyes.

BACKGROUND/AIMS: To investigate the prevalence of, and factors associated with, errors in neuroretinal rim measurement by Cirrus high-definition (HD) spectral-domain optical coherence tomography (OCT) in myopic eyes. METHODS: Neuroretinal rim thicknesses of 255 myopic eyes were measured by Cirrus HD-OCT. The prevalence of, and factors associated with, optic disc margin detection error and cup margin detection error were assessed by analysing 72 cross-sectional optic nerve head (ONH) images obtained at 5° intervals for each eye. RESULTS: Among the 255 eyes, 45 (17.6%) had neuroretinal rim measurement errors; 29 (11.4%) had optic disc margin detection errors at the temporal (16 eyes), superior (11 eyes), and inferior (2 eyes) quadrants; 19 (7.5%) showed cup margin detection errors at the nasal (17 eyes) and temporal (2 eyes) quadrants; and 3 (1.2%) had both disc and cup margin detection errors. Errors in detection of temporal optic disc margin were associated with presence of parapapillary atrophy (PPA), higher myopia, and greater axial length (AL) (p<0.001). Cup margin detection errors were associated with vitreous opacities attached to the ONH surface or acute cup slope angles (p<0.001). CONCLUSIONS: Errors in neuroretinal rim measurement by Cirrus HD-OCT were found in myopic eyes, especially in eyes with PPA, higher myopia, greater AL, vitreous opacity or acute cup slope angle. These findings should be considered when interpreting neuroretinal rim thickness measured by Cirrus HD-OCT.

Central corneal thickness in a Korean population: the Namil Study.

PURPOSE: We investigated the distribution of central corneal thickness (CCT), and its association with age, sex, intraocular pressure (IOP), anterior chamber depth (ACD), axial length (AL), and the presence of systemic hypertension and diabetes in a Korean population. METHODS: Our study is a population-based glaucoma prevalence study of residents aged ≥40 years in Namil-meon area, located in central South Korea. All subjects underwent a complete ophthalmic examination that included CCT measurement with an ultrasonic pachymeter, ACD and AL measurements by optical biometry, and Goldmann applanation tonometry. The right eye of all subjects was analyzed. RESULTS: The mean (SD) CCT of the 1259 right eyes was 530.9 (31.5) µm. In univariate analysis, a thicker CCT was associated with a higher IOP (P < 0.001), a longer AL (P = 0.003), and a younger age (P < 0.001). ACD was not correlated significantly with CCT (P = 0.087). Men had a 5.7 µm higher CCT than women (age adjusted, P = 0.001). Subjects with hypertension had a 4.1 µm lower CCT than those without hypertension (age, sex-adjusted, P = 0.027), and the presence of diabetes was not associated significantly with CCT (age, sex-adjusted, P = 0.892). In multivariate analysis, a higher CCT was associated with a higher IOP (P < 0.001), younger age (P = 0.001), male sex (P = 0.005), and the absence of hypertension (P = 0.018). CONCLUSIONS: The mean CCT of a Korean population was 530.9 µm. CCT was associated with IOP, age, sex, and hypertension.

Optic nerve head, retinal nerve fiber layer, and macular thickness measurements in young patients with retinitis pigmentosa.

PURPOSE: To evaluate optic nerve head (ONH) parameters, peripapillary retinal nerve fiber layer (RNFL) thickness, and macular thickness by using Cirrus HD spectral-domain optical coherence tomography (OCT) in young patients with retinitis pigmentosa (RP). METHODS: ONH parameters, RNFL thickness, and macular thickness were measured and compared between 36 eyes from 36 young RP patients (RP group; mean age, 23.08 years) and 70 eyes from 70 healthy young subjects (control group; mean age, 22.66 years) using Cirrus HD-OCT. The effects of the presence of optic disc pallor and the severity of visual field (VF) defects on OCT parameters were also evaluated. RESULTS: The RP group had a greater rim area, smaller cup-to-disc ratio, smaller cup volume, thicker RNFL, and thinner macula than the control group (p ≤ 0.024). ONH parameters were not affected by the presence of optic disc pallor (p ≥ 0.239). Eyes with more severe VF defects (mean deviation ≤ -13.88 dB) had thinner average macular areas than eyes with less severe VF defects (mean deviation ≥ -13.88 dB; p = 0.002). Meanwhile, the ONH parameters and average peripapillary RNFL thickness were not significantly different between the two groups (p ≥ 0.275). CONCLUSIONS: Young eyes with RP exhibited different OCT parameters compared to healthy eyes. Among the various OCT parameters, only macular thickness was associated with disease severity. These findings should be considered when evaluating young RP patients.

Detection of glaucoma progression by assessment of segmented macular thickness data obtained using spectral domain optical coherence tomography.

PURPOSE: We evaluated the clinical use of segmented macular layer thickness measurement in terms of glaucoma diagnosis and the ability to detect progression, and to compare such outcomes to those by circumpapillary retinal nerve fiber layer (cRNFLT) and total macular thickness (TMT) measurements. METHODS: The study included 141 glaucomatous and 61 healthy eyes. All glaucomatous eyes were subjected to at least four spectral domain optical coherence tomography (SD-OCT) examinations (mean follow-up, 2.13 years). Segmented macular layers were the macular nerve fiber layer (NFL), ganglion cell and inner plexiform layer (GCA), and outer retinal layer (ORL; from outer plexiform layer to retinal pigment epithelium). Areas under receiver operating characteristic curves (AUCs) discriminating healthy from glaucomatous eyes were determined in baseline measurements. The sensitivity and specificity of these parameters in terms of glaucoma progression detection were determined, with reference to assessment of optic disc/retinal nerve fiber layer (RNFL) photographs/visual field (VF) deterioration as standard(s). RESULTS: GCA afforded the best diagnostic performance among three macular layers. The AUC of the GCA thickness (GCAT) was less than that of cRNFLT (0.869 vs. 0.953, P = 0.018), but superior to that of TMT (0.790, P = 0.05). Of the eyes, 38 showed progression during follow-up by standard METHODS: The sensitivities of TMT, GCAT, and cRNFLT values in terms of detection of progression were 14%, 8%, and 5%, respectively. CONCLUSIONS: Although baseline cRNFL measurement was optimal in terms of glaucoma diagnosis, the GCAT and TMT showed similar levels of sensitivity in progression detection.

Transduction of PTEN proteins using the tat domain modulates TGF-ß1-mediated signaling pathways and transdifferentiation in subconjunctival fibroblasts.

PURPOSE: This study investigated the effects of the tumor suppressor protein PTEN (phosphatase and tensin homolog) on transforming growth factor (TGF)-ß1-mediated signaling pathways and the transdifferentiation of human subconjunctival fibroblasts (SCFs) after the transduction of this protein containing a transactivator of transcription (Tat) domain. METHODS: The Tat-PTEN expression vector was constructed to express the Tat domain of HIV-1 fused to PTEN. After transduction of the fusion protein and TGF-ß1 stimulation, the dose-dependent effect of the transduced Tat-PTEN fusion protein on Akt phosphorylation and the stability of the Tat-PTEN fusion protein in SCF cells were evaluated by Western blot analysis. The effect of the Tat-PTEN fusion protein on the TGF-ß1-stimulated expression of α-SMA and fibronectin was also evaluated by Western blot analysis and immunocytochemistry. RESULTS: To increase the efficiency of enzyme activity and to successfully deliver this protein to cells, the authors used a PTEN fusion protein that contained the transduction domain of the Tat protein from HIV-1. By Western blot analysis, the transduced Tat-PTEN fusion protein was found to modulate TGF-ß1 signaling in SCF cells and result in the suppression of Akt phosphorylation. Furthermore, the transduction of the Tat-PTEN fusion protein was found to suppress the TGF-ß1-stimulated expression of α-SMA and fibronectin by Western blot analysis and immunocytochemical staining, and the effects of the transduced fusion protein could be controlled in a dose-dependent manner. CONCLUSIONS: The Tat-PTEN fusion proteins were successfully transduced into the SCF cells and induced the suppression of transdifferentiation and fibrosis through the regulation of TGF-ß-mediated signaling. The ability of the Tat-PTEN fusion protein to regulate cell survival could potentially be applied to protein therapy to counteract postoperative scarring in glaucoma surgery.