Comparison of Vision-related Quality of Life Between Normal Tension Glaucoma and Primary Open-angle Glaucoma.

PRCIS: Although there was little difference in overall vision-related quality of life (VRQOL) between patients with normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG) after controlling for confounding factors, POAG tended to have poorer VRQOL, especially in social functioning and dependency, than NTG. PURPOSE: The fundamental goal of treatment of patients with glaucoma is to preserve their VRQOL. The aim of this study was to compare VRQOL between patients with NTG and those with POAG. MATERIALS AND METHODS: The self-reported National Eye Institute Visual Function Questionnaire (NEI VFQ-25) survey was performed, including clinical, demographic, and socioeconomic data from 506 Korean patients with NTG and 287 with POAG. The mean deviation of the integrated binocular visual field was calculated using the best location method. The NEI VFQ-25 results were evaluated by Rasch analysis to control item difficulty and variation in individual response ability. Propensity score matching was used to control for various confounding factors affecting VRQOL. RESULTS: Although patients with POAG tended to have worse VRQOL than those with NTG, there was no statistically significant between-group difference in ocular pain, near and distance activities, mental health, role difficulties, ability to drive, and the overall composite score. However, the social functioning (P=0.016) and dependency (P=0.026) were significantly poorer in POAG patients. CONCLUSIONS: Overall VRQOL in patients with NTG and POAG was found to be similar. However, social functioning and dependency were significantly worse in those with POAG. These findings are relevant to supporting glaucoma patients.

Long-Term Effectiveness and Safety of Tafluprost, Travoprost, and Latanoprost in Korean Patients with Primary Open-Angle Glaucoma or Normal-Tension Glaucoma: A Multicenter Retrospective Cohort Study (LOTUS Study).

This multicenter retrospective cohort study compared the effectiveness and safety of long-term tafluprost, travoprost, or latanoprost in patients with primary open-angle glaucoma (POAG) or normal-tension glaucoma (NTG). Data were extracted from electronic medical records of 300 patients treated with tafluprost, travoprost, or latanoprost for >6 months. Propensity matching for age and sex was used for effectiveness and safety comparisons. The primary endpoint was visual field (VF) progression via mean deviation (MD) slope. Secondary endpoints were change of MD, intraocular pressure, pattern standard deviation, VF index, and advanced glaucoma intervention study score. Treatment-related adverse events (AEs) were also compared between groups. Overall, 216 POAG or NTG patients were matched into Match Set 1 (72 patients/group), and 177 NTG-only patients in Match Set 2 (59 patients/group) according to: age (mean: 61, 62 years) and sex (male: 53, 56%). There were no statistically significant between-group differences regarding MD slope (p = 0.413, p = 0.374 in Match Sets 1 and 2, respectively). There were no significant between-group differences/tendencies regarding secondary endpoints. No AEs were serious, and there were no significant between-group differences regarding reported AEs. In patients with POAG or NTG, long-term tafluprost, travoprost, or latanoprost showed similar effects. All three prostaglandin analogs had good long-term safety profiles.

Vision-related quality of life according to location of visual field loss in patients with glaucoma.

PURPOSE: To assess influence of the location of visual field (VF) loss on vision-related quality of life (VRQOL) in patients with glaucoma. METHODS: We included 826 patients with primary open-angle glaucoma (POAG) enrolled in the prospectively designed Life Quality of Glaucoma Patients Who Underwent Treatment (LIGHT) study organized by the Korean Glaucoma Society. We divided the integrated binocular visual field (IVF) into four regions and evaluated the associations between Rasch-analysed 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and location of the IVF using univariate and hierarchical multivariable linear regression. RESULTS: Mean deviation (MD) of the IVF at superior centre showed the lowest value among the four regions. Multivariable linear regression analysis revealed significant correlation of the composite score and all subscales of the NEI VFQ-25 except ocular pain and near activities at each of four IVF regions. Mean deviation at superior centre showed significant correlation with composite score (R2  = 0.181), near activities (R2  = 0.175), and social functioning (R2  = 0.166); MD at superior periphery showed highest correlation with role difficulties (R2  = 0.137); MD at inferior centre showed highest correlation with driving (R2  = 0.145); and MD at inferior periphery showed significant correlation with distance activities (R2  = 0.214) and dependency (R2  = 0.119). CONCLUSION: Four different regions of the IVF had a similarly important impact on subscales of the NEI VFQ-25 in glaucoma patients. Preservation of the superior field should be considered as much as that of the inferior field for maintaining a good VRQOL in patients with glaucoma.

Factors influencing vision-related quality of life according to glaucoma severity.

PURPOSE: To identify factors influencing vision-related quality of life (VRQOL) according to glaucoma severity. METHODS: A total of 901 patients with varying stages of glaucoma were recruited from the prospectively designed LIGHT (Life Quality of Glaucoma Patients Who Underwent Treatment) study organized by the Korean Glaucoma Society. Participants completed a basic questionnaire collecting socioeconomic status and clinical information, in addition to the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Subjects were classified by mean deviation (MD) of integrated binocular visual field (IVF) into mild, moderate and severe damage groups. Factors were evaluated for their influence on VRQOL according to glaucoma severity using univariate and multivariable regression models between Rasch-analysed NEI VFQ-25 subscale scores and different variables. RESULTS: The mild, moderate and severe groups contained 720, 111 and 70 patients, respectively; the mean IVF MD in each group was -1.4, -8.5 and -17.9 dB. Significant differences were observed among the three groups with respect to age, IVF MD, visual acuity (VA), education level, income level, number of glaucoma medications prescribed and follow-up period. The most influential factor associated with VRQOL according to glaucoma severity was VA. The VA of the better eye was much more influential on VRQOL than the VA of the worse eye in the moderate and severe defect groups, and the impact of VA on VRQOL was more prominent in advanced glaucoma. CONCLUSIONS: Visual acuity is the most influential factor on VRQOL in patients with glaucoma. Preservation of VA should be strongly prioritized to maintain good VRQOL.

Vision-related Quality of Life in Korean Glaucoma Patients.

PURPOSE OF THE STUDY: The purpose of the study was to evaluate vision-related quality of life in Korean glaucoma patients and to explore the associated factors. METHODS: A total of 907 glaucoma patients were recruited from the prospectively designed LIGHT (Life quality of the glaucoma patient who underwent treatment) study organized by the Korean Glaucoma Society. Basic questionnaire that included items related to socioeconomic status, comorbidity, and lifestyle, and the validated Korean version of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) were collected. The Rasch score, a logit-based interval scale estimate to summarizing the NEI VFQ-25 responses, was calculated. The univariate and multivariable regression models were used to evaluate associations between the Rasch score and variables. RESULTS: The mean patient age was 58.1±14.1 years, visual field mean deviation (VF MD) of the better and worse eyes was -4.92±6.14 and -9.77±8.31 dB, binocular-integrated VF (IVF) MD was -3.55±5.31 dB, respectively. The lower NEI VFQ-25 Rasch score showed a significant association with the presence of other ocular diseases (P=0.020), a high school level of education or less [vs. university (P=0.006), vs. graduate school or higher (P=0.019)], an anxious personality [vs. a moderate personality (P<0.001), vs. a relaxed personality (P<0.001)], the number of glaucoma medications in use (P=0.049), worse eye visual acuity (P<0.001), and IVF MD (P<0.001). CONCLUSIONS: Visual function parameters are important for the vision-related quality of life of Korean glaucoma patients, notably for worse eye visual acuity and IVF MD. However, social factors, self-assessed personality, and treatment-related issues are also substantial predictors of overall life quality.

Comparison of the intraocular pressure-lowering effect and safety of brimonidine/timolol fixed combination and 0.5% timolol in normal-tension glaucoma patients.

PURPOSE: To compare the therapeutic efficacy and safety of brimonidine/timolol fixed-combination (BTFC) and 0.5% timolol ophthalmic solution in normal-tension glaucoma (NTG) patients. METHODS: This was a multi-institution, randomized, active-controlled, open-label, parallel-group study. After a full ophthalmic and glaucoma examination, a total of 110 NTG patients--55 undergoing therapy with BTFC and 55 0.5%, with timolol--participated in this study. Among them, 1 failed to meet the inclusion/exclusion criteria, 10 revoked their consent to participate in the study, 3 had adverse reactions, and 1 had a drug adherence rate of less than 70%. Ultimately, a total of 95 patients--48 in the BTFC group and 47 in the 0.5% timolol group--completed the study. The study visits took place at baseline and at 4 and 12 weeks. Diurnal IOP was measured at 9 a.m., 11 a.m., and 5 p.m. during the baseline visit and the visit at 12 weeks after eye-drop instillation. At each follow-up visit, compliance was assessed. Throughout the study, all adverse events were recorded and monitored by the investigators. RESULTS: The average difference in IOP change measured at 11 a.m. 12 weeks after administration between the two groups was 2.10 ± 2.59 mmHg. The BTFC group had a better IOP-lowering effect at all time points than did the 0.5% timolol group. The ratio of patients whose average IOP had decreased by >20% after 4 and 12 weeks was 50 and 56% in the BTFC group, respectively, whereas it was 29.41 and 23.53% in the 0.5% timolol group, respectively (p = 0.034, <0.001). CONCLUSIONS: BTFC has a superior IOP-lowering effect than 0.5% timolol in NTG patients.

Surgical Outcomes of Additional Ahmed Glaucoma Valve Implantation in Refractory Glaucoma.

PURPOSE: To evaluate the surgical outcomes of the implantation of an additional Ahmed glaucoma valve (AGV) into the eyes of patients with refractory glaucoma following previous AGV implantation. METHODS: This study is a retrospective review of the clinical histories of 23 patients who had undergone a second AGV implantation after a failed initial implantation. Age, sex, prior surgery, glaucoma type, number of medications, intraocular pressure (IOP), visual acuity, and surgical complications were analyzed. Surgical success was defined as IOP maintained below 21 mm Hg, with at least a 20% overall reduction in IOP, regardless of the use of IOP-lowering medications. RESULTS: Following the implantation of a second AGV, the mean IOP decreased from 39.3 to 18.5 mm Hg (52.9% reduction, P<0.001). The mean number of postoperative IOP-lowering medications administered decreased from 2.8 to 1.7 after the second AGV implantation (P<0.001). The cumulative probability of success for the procedure was 87% after 1 year and 52% after 3 years. Three patients (13.0%) experienced bullous keratopathy after the second AGV implantation. None of the patients showed any evidence of diplopia or ocular movement limitation as a result of the presence of 2 AGVs in the same eye. Prior trabeculectomy was found to be a significant risk factor for failure (P=0.027). CONCLUSIONS: A second AGV implantation can be a good choice of surgical treatment when the first AGV has failed to control IOP.

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.

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.

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.

Quantitative analysis of optic disc color.

PURPOSE: To evaluate the reproducibility of ImageJ software in analyzing the color of the optic disc. METHODS: One hundred twelve normal participants (56 males and 56 females) were enrolled in this study. The image of the optic disc was taken using Kowa digital disc photo-graphy, and the gray scales of the nasal rim (NR), brightest cupping center (BCC) and largest inferior retinal vein (IRV) were calculated using histogram in ImageJ. Three different observers calculated the gray scales three separate times. Reproducibility was assessed using the interclass correlation coefficient (ICC). RESULTS: The mean age of the participants was 50.6 years old (range, 11 to 82 years). The mean gray scales of the nasal rim were 91.81, 94.91, and 93.24; those of the brightest cupping center were 174.84, 179.94, and 177.76; and those of the largest inferior retinal vein were 61.85, 53.48, and 56.73 for observers 1, 2, and 3, respectively. Inter-observer reproducibility for NR, BCC and IRV was considered good based upon ICC values of 0.944, 0.860, and 0.789 for observers 1, 2, and 3, respectively. Significant age-related differences between the values of the brightest cupping center were noted, and the gray scale score was decreased in the older participants (p < 0.001). CONCLUSIONS: The gray scale of the brightest cupping center diminished with age. ImageJ can be a useful objective tool with high reproducibility in the analysis of optic disc color.