Abstract
Purpose To evaluate clinically activated retinal astrocytes and Müller cells (ARAM) regarding retinal sensitivity and retinal nerve fiber layer (RNFL) thickness in primary open-angle glaucoma (POAG). Methods Central visual field (VF; i.e., retinal sensitivity) was measured with a custom-made macular pattern by microperimetry and correlated with the presence (ARAM+) or absence (ARAM−) of ARAM on red-free fundus photography and with the corresponding RNFL by optical coherence tomography (OCT). Results In the eyes of POAG patients, ARAM+ had overall a significantly lower retinal sensitivity (ARAM+: 7.34 dB, ARAM−: 11.9 dB; p < 0.001) and lower RNFL thickness in the inferior peripapillary quadrants compared to ARAM− (RNFL superior: ARAM+ 74.2 μm, ARAM− 77.5 μm; RNFL temporal: ARAM+ 46.8 μm, ARAM− 53.0 μm, p < 0.001; and RNFL inferior: ARAM+ 63.2 μm, ARAM− 73.1 μm, p < 0.001). Within the same eye, ARAM+ showed a lower retinal sensitivity compared to ARAM− ([ARAM− (11.13 dB)] − [ARAM+ (9.56 dB) = 1.57 dB; p = 0.25). The proportion of ARAM+ per eye correlated strongly with reduced retinal light sensitivity (p = 0.02), corresponding lower peripapillary RNFL thickness (p = 0.02), and lower RNFL temporal quadrant thickness (p < 0.01), but not with greater age (p = 0.45). Conclusion ARAM was more frequently identified in the eyes with a lower retinal sensitivity and peripapillary RNFL thickness and may be a clinical sign in the macula for an advanced stage of POAG.
Highlights
Glaucomatous optic neuropathy (GON) is characterized by typical changes of the optic nerve head (ONH) and corresponding visual field defects [1]
While the ophthalmic examination focuses on changes of the ONH like increased cup-disc ratio, peripapillary atrophy, and disc hemorrhage [3], morphological alterations in the retina due to activation of the glia were described in primary open-angle glaucoma (POAG) patients earlier [4,5,6]
The goal of this study was to quantify the distribution of astrocytes and Müller cells (ARAM) and to correlate them with retinal light sensitivity and the corresponding peripapillary retinal nerve fiber layer (RNFL) thickness by optical coherence tomography (OCT)
Summary
Glaucomatous optic neuropathy (GON) is characterized by typical changes of the optic nerve head (ONH) and corresponding visual field defects [1]. Astrocytes and Müller cells form the macroglia in the retina They both have structural, metabolic, and other supporting functions for neurons; once activated due to ischemic or other neuronal injuries of the retina [7], they show alterations in the morphology and gene expression [8, 9]; a characteristic upregulation of glial fibrillary acid protein (GFAP) was demonstrated in the human glaucomatous retinas [10] by immunohistochemistry. The clinical correlation of activated retinal astrocytes and Müller cells (termed ARAM) in glaucomatous eyes was described earlier [4,5,6, 11]. There is no knowledge about structure-function correlations of ARAM in POAG at present
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