Average Peripapillary Retinal Nerve Fiber Research Articles

Evaluation of macular and optic nerve head changes by optical coherence tomography angiography in glaucomatous eyes

Background Optical coherence tomography angiography (OCTA) is introduced as a safe, noninvasive, and dye-free technology that provides an assessment of both large vessels and microvasculature of the retina and some parts of the choriocapillaris. Measuring vessel densities using OCTA at both the macula and optic nerve head (ONH) in glaucomatous eyes and comparing them with those of normal eyes will give us an idea about the effect of glaucoma on vessel densities and the role of OCTA in controlling and monitoring glaucoma progression, which remains despite the various medical and surgical treatment options, the second most common reason of blindness worldwide. Aims The current study aimed to assess vessel densities in glaucomatous patients at both the macula and ONH and compare them with vessel densities of normal participants and to assess if OCTA can be useful in the diagnosis and monitoring of the disease. Settings and design Case–control study. Patients and methods The study enrolled 60 patients who were divided into two groups. Group 1 included 30 patients with any type of glaucoma and group 2 included 30 normal participants. OCTA was performed on all of them to assess the macular and ONH vessel densities. Results Glaucomatous patients showed decreased vessel density at the macula and the ONH. The vessel densities at the foveal and all quadrants of parafoveal regions of the macula were decreased when compared with vessel densities of normal participants. Vessel densities at all quadrants of the peripapillary region also decreased when compared with those of normal participants with a strong positive correlation between average peripapillary vessel density and average peripapillary retinal nerve fiber layer thickness. Conclusions Both macular vessel density and ONH vessel density are affected in glaucoma and that may play a role in the diagnosis and follow-up of the disease.

The thickness of the retinal nerve fiber layer, macula, and ganglion cell-inner plexiform layer in people with drug-resistant epilepsy.

Using Optical coherence tomography (OCT), we evaluated the association between peripapillary retinal nerve fiber, macular thickness, macular ganglion cell-inner plexiform layer, and drug resistance. In this cross-sectional study, we recruited people diagnosed with epilepsy and healthy controls. People with epilepsy were further stratified as drug-resistant or non-drug-resistant based on their response to anti-seizure medications. OCT measurements were conducted, and findings in right eye were analyzed. Fifty-one drug-resistant participants, 37 non-drug-resistant, and 45 controls were enrolled. The average peripapillary retinal nerve fiber layer, ganglion cell-inner plexiform layer, and macular thickness were thinner in the epilepsy groups than in controls. The drug-resistant group had significantly lower average ganglion cell-inner plexiform layer thickness (p = 0.004) and a higher proportion of abnormal/borderline GC/IPL thickness (p = 5.40E-04) than the non-drug-resistant group. Nevertheless, no significant differences were seen between the average thickness of peripapillary retinal nerve fiber and macular thickness. The temporal sectors of these three parameters were also significantly thinner in the drug-resistant group than in the non-drug-resistant. In a multivariate regression model, drug resistance was an independent predictor of reduced ganglion cell-inner plexiform thickness (Odds ratios OR = 10.25, 95% CI 2.82 to 37.28). Increased seizure frequency (r = -0.23, p = 0.039) and a higher number of anti-seizure medications ever used (r = -0.27, p = 0.013) were negatively associated with ganglion cell-inner plexiform layer thickness. Individuals with drug-resistant epilepsy had a consistent reduction in average ganglion cell-inner plexiform layer thickness and the temporal sector of peripapillary retinal nerve fiber layer and macular thickness. This suggests that ganglion cell-inner plexiform layer thickness could potentially serve as an indicator of the burden of drug resistance, as it correlated with reduced thickness in individuals having more frequent seizures and greater exposure to ASMs. In our study, we used a special tool called OCT to measure how thick the retina is in people with epilepsy and in healthy control. We found that the retina was consistently thinner in all areas for those with epilepsy compared to healthy control. Particularly, a specific layer called the ganglion cell-inner plexiform layer was a lot thinner in the group that didn't respond to medications, and this thinning was related to how often seizures occurred and how much medications were taken. Also, certain parts of the retina were thinner in the drug-resistant group.

Swelling of Atrophic Optic Discs in Idiopathic Intracranial Hypertension.

Monitoring patients with idiopathic intracranial hypertension (IIH) and optic atrophy may be difficult as papilledema may not be appreciable on ophthalmoscopy. This retrospective chart review evaluated whether papilledema recurrence can be detected in this population using optical coherence tomography (OCT). Serial clinical assessments, ophthalmoscopy, and peripapillary OCT were reviewed in a cohort of patients with IIH and optic atrophy. Atrophy was defined as moderate if average peripapillary retinal nerve fiber layer (pRNFL) thickness was ≤80 μm and severe if average pRNFL thickness was ≤60 μm on at least 2 consecutive high-quality OCT scans. Based on the upper tolerance limit of test-retest variability, mean pRNFL elevation of ≥6 μm with subsequent decrease to baseline thickness was considered papilledema. In a cohort of 165 patients with IIH, 32 eyes of 20 patients and 22 eyes of 12 patients demonstrated moderate and severe optic atrophy, respectively. Over a median follow-up of 198.5 weeks (range, 14.0-428.9), 63.3% (19 of 30) of patients had at least 1 episode of relapse, and 50.0% (15 of 30) had at least 1 episode of papilledema. There was a total of 36 relapse episodes, of which 7 occurred in patients with clinical signs and symptoms but no OCT evidence of relapse, 12 occurred in patients with OCT changes but no clinical signs and symptoms of relapse, and 17 occurred in patients with both clinical and OCT evidence to support relapse. The median percent pRNFL increase in the latter 2 groups was 13.7% (range, 7.5-111.8), and 7 eyes (13.0%) of 5 patients (16.7%) showed thickening greater than 20.0% from baseline. The rate, magnitude, and concordance of pRNFL swelling were similar between moderately vs severely atrophic eyes. Papilledema recurrence can be detected in atrophic optic discs using OCT. All patients with atrophic IIH should be longitudinally monitored with pRNFL measurement. Concurrence of other relapse-suggestive features should prompt further evaluation.

Comparison of the retinal microvasculature between compressive and glaucomatous optic neuropathy.

To compare the patterns of retinal microvasculature change in the peripapillary and macular region between compressive optic neuropathy (CON) and glaucomatous optic neuropathy (GON), and to assess the ability of optical coherence tomography angiography (OCTA) in differentiating the two conditions. This cross-sectional study included 108 participants (108 eyes), 36 with CON, 36 with GON, and 36 healthy controls. The CON and GON eyes were matched by the average peripapillary retinal nerve fiber layer (pRNFL) thickness (1:1). Optical coherence tomography (OCT) and OCTA were performed to compare the structural and vascular change of the peripapillary and macular region between groups. Both CON and GON eyes showed more severe structural and vascular damage than the control eyes. The CON eyes had lower pRNFL thickness than the GON eyes in the temporal and nasal quadrants, and thicker pRNFL thickness in the inferior quadrant. The average GCC thickness did not differ between the two groups. The peripapillary vessel density of the CON group was significantly higher in the inferior sectors than that of the GON group. In the macular region, the CON group had significantly higher vessel density in the whole image, the temporal sector in parafovea region, and the temporal, superior, and inferior sectors in perifovea region. To a similar degree of structural damage, CON had less retinal vascular impairment than GON, especially in the macular region, and the significance of the finding needs further evaluation.

Machine learning based on Optical Coherence Tomography images as a diagnostic tool for Alzheimer's disease.

We mainly evaluate retinal alterations in Alzheimer's disease (AD) patients, investigate the associations between retinal changes with AD biomarkers, and explore an optimal machine learning (ML) model for AD diagnosis based on retinal thickness. A total of 159 AD patients and 299 healthy controls were enrolled. The retinal parameters of each participant were measured using optical coherence tomography (OCT). Additionally, cognitive impairment severity, brain atrophy, and cerebrospinal fluid (CSF) biomarkers were measured in AD patients. AD patients demonstrated a significant decrease in the average, superior, and inferior quadrant peripapillary retinal nerve fiber layer, macular retinal nerve fiber layer, ganglion cell layer (GCL), inner plexiform layer (IPL) thicknesses, as well as total macular volume (TMV) (all p < 0.05). Moreover, TMV was positively associated with Mini-Mental State Examination and Montreal Cognitive Assessment scores, IPL thickness was correlated negatively with the medial temporal lobe atrophy score, and the GCL thickness was positively correlated with CSF Aβ42 /Aβ40 and negatively associated with p-tau level. Based on the significantly decreased OCT variables between both groups, the XGBoost algorithm exhibited the best diagnostic performance for AD, whose four references, including accuracy, area under the curve, f1 score, and recall, ranged from 0.69 to 0.74. Moreover, the macular retinal thickness exhibited an absolute superiority for AD diagnosis compared with other enrolled variables in all ML models. We identified the retinal alterations in AD patients and found that macular thickness and volume were associated with AD severity and biomarkers. Furthermore, we confirmed that OCT combined with ML could serve as a potential diagnostic tool for AD.

Optical coherence tomography evaluation of retinal nerve fiber layer thickness in non-arteritic anterior ischemic optic neuropathy and primary open angle glaucoma: a systematic review and Meta-analysis

AIM: To assess the differences in average and sectoral peripapillary retinal nerve fiber layer (pRNFL) thickness using spectral domain optical coherence tomography (SD-OCT) in patients with non-arteritic anterior ischemic neuropathy (NAION) compared with those with primary open angle glaucoma (POAG). METHODS: A comprehensive literature search of the PubMed, Cochrane Library, and Embase databases were performed prior to October, 2021. Studies that compared the pRNFL thickness in NAION eyes with that in POAG eyes with matched mean deviation of the visual fields were included. The weighted mean difference (WMD) with 95% confidence interval (CI) was used to pool continuous outcomes. RESULTS: Ten cross-sectional studies (11 datasets) comprising a total of 625 eyes (278 NAION eyes, 347 POAG eyes) were included in the qualitative and quantitative analyses. The pooled results demonstrated that the superior pRNFL was significantly thinner in NAION eyes than in POAG eyes (WMD=-6.40, 95%CI: -12.22 to -0.58, P=0.031), whereas the inferior pRNFL was significant thinner in POAG eyes than in NAION eyes (WMD=11.10, 95%CI: 7.06 to 15.14, P≤0.001). No difference was noted concerning the average, nasal, and temporal pRNFL thickness (average: WMD=1.45, 95%CI: -0.75 to 3.66, P=0.196; nasal: WMD= -2.12, 95%CI: -4.43 to 0.19, P=0.072; temporal: WMD= -1.24, 95%CI: -3.96 to 1.47, P=0.370). CONCLUSION: SD-OCT based evaluation of inferior and superior pRNFL thickness can be potentially utilized to differentiate NAION from POAG, and help to understand the different pathophysiological mechanisms between these two diseases. Further longitudinal studies and studies using eight-quadrant or clock-hour classification method are required to validate the obtained findings.

Brain Gray Matter Atrophy and Functional Connectivity Remodeling in Patients With Chronic LHON.

PurposeThe aim of this study was to investigate the brain gray matter volume (GMV) and spontaneous functional connectivity (FC) changes in patients with chronic Leber's hereditary optic neuropathy (LHON), and their relations with clinical measures.MethodsA total of 32 patients with chronic LHON and matched sighted healthy controls (HC) underwent neuro-ophthalmologic examinations and multimodel magnetic resonance imaging (MRI) scans. Voxel-based morphometry (VBM) was used to detect the GMV differences between the LHON and HC. Furthermore, resting-state FC analysis using the VBM-identified clusters as seeds was carried out to detect potential functional reorganization in the LHON. Finally, the associations between the neuroimaging and clinical measures were performed.ResultsThe average peripapillary retinal nerve fiber layer (RNFL) thickness of the chronic LHON was significantly thinner (T = −16.421, p < 0.001), and the mean defect of the visual field was significantly higher (T = 11.28, p < 0.001) than the HC. VBM analysis demonstrated a significantly lower GMV of bilateral calcarine gyri (CGs) in the LHON than in the HC (p < 0.05). Moreover, in comparison with the HC, the LHON had significantly lower FC between the centroid of the identified left CG and ipsilateral superior occipital gyrus (SOG) and higher FC between this cluster and the ipsilateral posterior cingulate gyrus (p < 0.05, corrected). Finally, the GMV of the left CG was negatively correlated with the LHON duration (r = −0.535, p = 0.002), and the FC between the left CG and the ipsilateral posterior cingulate gyrus of the LHON was negatively correlated with the average peripapillary RNFL thickness (r = −0.522, p = 0.003).ConclusionThe atrophied primary visual cortex of the chronic LHON may be caused by transneuronal degeneration following the retinal damage. Moreover, our findings suggest that the functional organization of the atrophied primary visual cortex has been reshaped in the chronic LHON.

Retinal layers and associated clinical factors in schizophrenia spectrum disorders: a systematic review and meta-analysis.

The retina shares structural and functional similarities with the brain. Furthermore, structural changes in the retina have been observed in patients with schizophrenia spectrum disorders (SSDs). This systematic review and meta-analysis investigated retinal abnormalities and their association with clinical factors for SSD. Studies related to retinal layers in SSD patients were retrieved from PubMed, Scopus, Web of Science, Cochrane Controlled Register of Trials, International Clinical Trials Registry Platform, and PSYNDEX databases from inception to March31, 2021. We screened and assessed the eligibility of the identified studies. EZR ver.1.54 and the metafor package in R were used for the meta-analysis and a random-effects or fixed-effects model was used to report standardized mean differences (SMDs). Twenty-three studies (2079 eyes of patients and 1571 eyes of controls) were included in the systematic review and meta-analysis. The average peripapillary retinal nerve fiber layer (pRNFL) thickness, average macular thickness (MT), and macular ganglion cell layer-inner plexiform layer (GCL-IPL) thickness were significantly lower in patients than in controls (n = 14, 6, and 3, respectively; SMD = -0.33, -0.49, and -0.43, respectively). Patients also had significantly reduced macular volume (MV) compared to controls (n = 7; SMD = -0.53). The optic cup volume (OCV) was significantly larger in patients than in controls (n = 3; SMD = 0.28). The meta-regression analysis indicated an association between several clinical factors, such as duration of illness and the effect size of the pRNFL, macular GCL-IPL, MT, and MV. Thinning of the pRNFL, macular GCL-IPL, MT, and MV and enlargement of the OCV in SSD were observed. Retinal abnormalities may be applicable as state/trait markers in SSDs. The accumulated evidence was mainly cross-sectional and requires verification by longitudinal studies to characterize the relationship between OCT findings and clinical factors.

Macular and Peripapillary Retinal Nerve Fiber Thickness in Unilateral Amblyopic Eye

Amblyopia is the most common cause of monocular visual impairment in both children, and young to middle-aged adults, affecting 2%–5% of the general population. The objective of this study was to compare the peripapillary nerve fiber thickness and macular thickness in amblyopic eyes, fellow eyes and normal control eyes using spectral domain optical coherence tomography. This was a cross-sectional observational study conducted at R M Kedia Eye Hospital, Birgunj, Nepal from February 2020 to July 2020. Pediatric patients with unilateral amblyopia (anisometropic amblyopia, strabismic amblyopia or both) among the age group of 6-18 years attending pediatric department of RM Kedia Eye Hospital were enrolled for the study. All patients underwent a full ophthalmological assessment, including visual-acuity testing, anterior segment evaluation with Topcon slit lamp and fundus examination with Volk +90D lenses. All statistical analysis was done in SPSS V. 20. The average peripapillary retinal nerve fiber layer thickness was 120.6 μm (SD=14.6 μm) in the amblyopic eye, 118.1 μm (SD=15.6 μm) in the fellow eye and 113.2 μm (SD=9.4 μm) in the normal eye (p=0.104) respectively. The average macular thickness was 298.6 μm (SD=19.1 μm) in the amblyopic eye, 296.9 μm (SD=11.2 μm) in the fellow eye and 303 μm (SD=12.4 μm) in the normal eye (p=0.260) respectively. In conclusion, our study did not find any significant difference in the peripapillary retinal nerve fiber thickness or macular thickness when compared between amblyopic eyes, fellow eyes, gender and age matched normal eyes.

Retinal Architecture in Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay (ARSACS): Insights into Disease Pathogenesis and Biomarkers.

Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) causes unique retinal abnormalities, which have not been systematically investigated. To deeply phenotype the retina in ARSACS in order to better understand its pathogenesis and identify potential biomarkers. We evaluated 29 patients with ARSACS, 66 with spinocerebellar ataxia (SCA), 38 with autosomal recessive cerebellar ataxia (ATX), 22 with hereditary spastic paraplegia (SPG), 21 cases of papilledema, and 20 healthy controls (total n=196 subjects). Participants underwent visual acuity assessment, intraocular pressure measurement, fundoscopy, and macular and peripapillary optical coherence tomography (OCT). Macular layers thicknesses in ARSACS were compared with those of age-matched healthy controls. Ophthalmologists analyzed the scans for abnormal signs in the different patient groups. Linear regression analysis was conducted to look for associations between retinal changes and age, age at onset, disease duration, and Scale for the Assessment and Rating of Ataxia (SARA) scores in ARSACS. Only patients with ARSACS exhibited peripapillary retinal striations (82%) on fundoscopy, and their OCT scans revealed foveal hypoplasia (100%), sawtooth appearance (89%), papillomacular fold (86%), and macular microcysts (18%). Average peripapillary retinal nerve fiber layer (pRNFL) was thicker in ARSACS than in SCA, ATX, SPG, and controls; a cut-off of 121 μm was 100% accurate in diagnosing ARSACS. All macular layers were thicker in ARSACS when compared to healthy controls. RNFL thickness in the inferior sector of the macula positively correlated with SARA scores. Retinal abnormalities are highly specific for ARSACS, and suggest retinal hyperplasia due to abnormal retinal development. OCT may provide potential biomarkers for future clinical trials. © 2021 International Parkinson and Movement Disorder Society.

Subfoveal choroidal thickness and retinal nerve fiber layer alterations in chronic heart failure patients.

To comparatively evaluate the subfoveal choroidal thickness and the peripapillary retinal nerve fiber layer thickness in patients with chronic heart failure relative to control subjects. A total of 72 chronic heart failure patients and 40 healthy control subjects were enrolled in this study. The patients were categorized into 2 groups: group 1: patients with 30-50% left ventricle ejection fraction and group 2: patients with the corresponding fraction value of <30%. The subfoveal choroidal thickness and the peripapillary retinal nerve fiber layer thickness were measured by spectral domain-optical coherence tomography. The mean subfoveal choroidal thickness was 250.24 ± 68.34 µm in group 1 and 216.72 ± 71.24 µm in group 2, while it was 273.64 ± 77.68 µm in the control group. The differences among the 3 groups were statistically significant. The average peripapillary retinal nerve fiber layer thicknesses were 100.34 ± 8.24, 95.44 ± 6.67, and 102.34 ± 8.24 µm, respectively. No significant differences were noted in the peripapillary retinal nerve fiber layer thicknesses between group 1 and control group, but it was significantly lower in group 2. Our study thus revealed that the subfoveal choroidal thickness was lower in patients belonging to both the chronic heart failure groups in comparison to those in the control group. However, the alteration in the peripapillary retinal nerve fiber layer thickness was noted in only patients with <30% left ventricle ejection fraction. In the clinical practice, reductions in these values are correlated with decreased left ventricle ejection fraction, which may be important for the follow-up of chorioretinal diseases and the evaluation of glaucoma risks in patients with chronic heart failures.

Performance of Topological Perception in the Myopic Population

ABSTRACT Purpose: Discriminating objects’ topological property (TP) is a primitive function of visual representation, which is reported to be associated with magnocellular (M) visual pathway, temporal lobe (TL), and superior colliculus (SC)-pulvinar subcortical pathway. Previous studies have shown that M pathway and TL were affected in high myopia (HM) subjects. The study was accordingly designed to explore whether topological perception performance was abnormal in HM subjects. Methods: 30 mildly myopic, 25 moderately myopic, 35 highly myopic, and 20 emmetropic subjects were enrolled. All participants underwent a comprehensive ophthalmological assessment including automated refraction, intraocular pressure, Humphrey 10–2 standard automated perimetry, ocular fundus photography and swept-source optical coherence tomography. Defined by differences in hole, TP and non-TP discrimination with letters “E”, “S”, “P”, “d” as stimuli in the central and peripheral regions was performed using the MATLAB 2017 software. d-primes extracted from the software were analyzed within each group. The correlation of peripheral TP/non-TP deficit with spherical equivalent (SE), axial length (AL) and average peripapillary retinal nerve fiber layer (RNFL) thickness was performed. Results: The patterns of topological perception performance were similar among the groups. TP discrimination peripherally was significantly better than that centrally in the mild myopia (P < .001), moderate myopia (P < .001), high myopia (P < .001) and emmetropia groups (P = .001). In the peripheral region, TP d-prime scores were significantly better than non-TP d-prime scores (all P < .001). The main and interaction effects of eccentricity and stimulus type were statistically significant(P < .05). There was no statistically significant correlation between peripheral TP/non-TP deficit and SE, AL or average RNFL thickness (P > .05). Conclusions: The current study first showed that patterns of topological perception among the myopic population were similar and not affected by the severity of myopia.

Agreement in retinal nerve fiber layer values and comparison in children using two optical coherence tomography devices

Abstract Objective To assess absolute agreement and differences in peripapillary retinal nerve fiber layer (pRNFL) values according to sex, age, laterality, origin and optical coherence tomography (OCT) type in normal pediatric patients undergoing OCT scans using both Cirrus and Spectralis. Material and methods Prospective, cross-sectional, and comparative study. We used Spectralis OCT and Cirrus OCT to measure optic disc values of both eyes in one hundred pediatric patients (age 5–15 years), with no previous ocular pathology or systemic disease that could affect the eye. Due to the similarity between eyes, only right eyes were considered (n = 100). Results The average peripapillary retinal nerve fiber layer (pRNFL) values were 99.6 μm with Cirrus and 106.7 μm with the Spectralis system. The four quadrants followed the ISNT rule (inferior-superior-nasal-temporal). The average pRNFL measures correlated negatively with the AL (P 0.05) and there were also no statistical differences in the pRNFL according to age or laterality (P > 0.05). All RNFL values were significantly different between both types of OCTs (P Conclusions We suggest that the respective peripapillary RNFL values obtained using these two OCTs should not be considered interchangeable in pediatric patients.

Grado de concordancia y diferencias entre los valores de capa de fibras nerviosas de la retina peripapilar en niños mediante dos tipos de tomografía de coherencia óptica espectral

ObjectiveTo assess absolute agreement and differences in peripapillary retinal nerve fiber layer (pRNFL) values according to sex, age, laterality, origin and optical coherence tomography (OCT) type in normal pediatric patients undergoing OCT scans using both Cirrus and Spectralis. Material and methodsProspective, cross-sectional, and comparative study. We used Spectralis OCT and Cirrus OCT to measure optic disc values of both eyes in one hundred pediatric patients (age 5 to 15years), with no previous ocular pathology or systemic disease that could affect the eye. Due to the similarity between eyes, only right eyes were considered (n=100). ResultsThe average peripapillary retinal nerve fiber layer (pRNFL) values were 99.6μm with Cirrus and 106.7μm with the Spectralis system. The four quadrants followed the ISNT rule (inferior-superior-nasal-temporal). The average pRNFL measures correlated negatively with the AL (P<.01) in both OCTs, and the degree of agreement between OCTs for pRNFL and inferior RNFL was moderate (CCI: 0.67 and 0.61, respectively), and low in the rest of the sectors. The average pRNFL values of both OCTs were higher in women than in men (P>.05) and there were also no statistical differences in the pRNFL according to age or laterality (P>.05). All RNFL values were significantly different between both types of OCTs (P<.05) and average pRNFL values were significantly thicker (P<.05) in Latin American than in European children in both eyes. ConclusionsWe suggest that the respective peripapillary RNFL values obtained using these two OCTs should not be considered interchangeable in pediatric patients.

The correlation between frequency doubling technology matrix mean deviation and peripapillary retinal nerve fiber thickness of newly diagnosed glaucoma patients

Objective: To evaluate the relationship between glaucomatous structural damage assessed by RTVue SD-OCT and functional loss as measured by Frequency Doubling Technology (FDT) perimetry. Materials and methods: One hundred and forty eyes of 70 newly diagnosed glaucomatous patients irrespective of intraocular pressure level were recruited from a private Tertiary Eye hospital in Lagos Nigeria. All the eyes underwent testing with Avanti RTVue XR SD-OCT (Optovue Inc., Fremont CA USA) and Frequency Doubling Technology (FDT) 24-2 threshold (Humphrey Matrix 800, 2011 Carl Zeiss Meditec, Dublin, CA). The relationship between average peripapillary retinal nerve fiber layer (pRNFL) and mean deviation on the FDT Matrix perimetry was evaluated using Pearson’s correlation coefficient regression analysis. Results: A total of 30 males (42.86%) and 40 (57.14%) females with mean age of 56±14 years with a range of 33-77 years. There were 46 (65.71%) patients with Primary Open-Angle Glaucoma (POAG) and 24 (34.29%) with chronic Primary Angle Closure Glaucoma (PACG). The FDT mean deviation was -14.68±10.59 dB and -10.88 ±8.34 dB for the Right eye (RE) and Left eye (LE) respectively. The mean average pRNFL thickness was 82.26±18.56 and 91.37±15.32 for RE and LE respectively. The Mean deviation significantly correlated with the average peripapillary RNFL thickness (Pearson correlation coefficient, r= 0.88, r2 = 0.77, p-value 0.001 for RE and r= 0.851, r2= 0.72, p-value 0.001 for LE). Conclusion: In this cohort of glaucoma patients, at least 70% of average peripapillary retinal nerve layer thinning measured with RTVue SD-OCT was associated with correspondent visual field loss in glaucoma.

Relationship between pattern electroretinogram and optic disc morphology in glaucoma.

PurposeTo evaluate the relationship between pattern electroretinogram (PERG) and optic disc morphology in glaucoma suspect and glaucoma.MethodsEighty-six eyes of glaucoma suspect and 145 eyes of manifest glaucoma subjects were included in this study. Average peripapillary retinal nerve fiber layer (RNFL) thickness was obtained with spectral-domain optical coherence tomography, and optic disc imaging was performed using the Heidelberg Retinal Tomograph (HRT). Visual function was evaluated with perimetry (SITA and frequency doubling technology) and PERG. Scatter plots and correlation coefficients were evaluated between visual function and RNFL thickness or optic disc structure.ResultsScatter plots of PERG and perimetry according to RNFL thickness change showed that PERG started to decrease earlier than did perimetry. The differences between linear and logarithmic R2 were largest for the scatter plot of SITA 24–2 (linear R2 = 0.415; logarithmic R2 = 0.443) and the smallest for P50 amplitude of PERG (linear R2 = 0.136, logarithmic R2 = 0.138). In glaucoma suspect, HRT parameters such as cup shape measure (CSM) and linear cup-disc ratio (CDR) had significant correlations with PERG amplitudes (P = 0.016 for P50 and 0.049 for N95 in CSM, P = 0.012 for P50 in CDR). However, in glaucoma patients, mean RNFL thickness was associated with PERG amplitude (P = 0.011 for P50 and 0.002 for N95).ConclusionsPERG deterioration occurred earlier than did perimetry according to RNFL thickness decrease. PERG amplitudes were significantly correlated with disc morphology in glaucoma suspect. These results suggest that PERG can detect ganglion cell dysfunction before the cells die.

Peripapillary microvasculature in patients with diabetes mellitus: An optical coherence tomography angiography study

To evaluate changes in peripapillary microvascular parameters in diabetes mellitus (DM) patients using optical coherence tomography angiography (OCTA). Seventy-one diabetic patients (40 in the no diabetic retinopathy [DR] group and 31 in the non-proliferative DR [NPDR] group) and 50 control subjects. OCTA (Zeiss HD-OCT 5000 with AngioPlex) 6 × 6 mm scans centered on the optic disc were analyzed. Peripapillary vessel density (VD), perfusion density (PD) in superficial capillary plexus (SCP) were automatically calculated. The average macular ganglion cell-inner plexiform layer (mGC-IPL) and peripapillary retinal nerve fiber layer (pRNFL) thicknesses of the no DR and NPDR groups were significantly thinner than those of the control group. The no DR and NPDR groups showed lower peripapillary VD and PD in SCP compared with the control group. Using univariate regression analyses, the average mGC-IPL thickness, the pRNFL thickness, the no DR group and NPDR group were significant factors that affected the peripapillary VD and PD in SCP. Multivariate regression analyses showed that the grade of DR was a significant factor affecting the peripapillary VD and PD in SCP. OCTA revealed that peripapillary microvascular parameters in the no DR and NPDR groups were lower than those of normal controls. The peripapillary VD and PD in SCP were correlated with the mGC-IPL thickness, the pRNFL thickness, and the no DR and NPDR groups. Changes in peripapillary OCTA parameters may help with understanding the pathophysiology of DM and evaluating a potentially valuable biomarker for patients with subclinical DR.

Longitudinal reproducibility of spectral domain optical coherence tomography in children with physiologic cupping and stable glaucoma

To determine whether Spectralis (Heidelberg, Germany) spectral domain optical coherence tomography (SD-OCT) measurements are reproducible over time in children with physiologic cupping and stable glaucoma. Subjects were identified from a subset of participants in an earlier retrospective study conducted by our group and included children (<18years of age) with physiologic cupping and stable primary congenital glaucoma (PCG) having had at least 2 SD-OCTs over a period of more than 1 between April 2010 and September 2015. Thicknesses of average peripapillary retinal nerve fiber layer (pRNFL) and six individual sectors and volumes of three segmented retinal layers and total retina were measured. Spectralis review software was used for segmentation. Intraclass correlation coefficients (ICC) and coefficient of variation (COV) were calculated. A total of 35 eyes of 35 children were included: 15 eyes had physiologic cupping; 20 eyes, PCG. Mean ages at initial SD-OCT were 11.2±3.3years and 9.7±3.3, respectively; mean intervals between first and last imaging were 2.2±1.1 and 3.0±1.4years, respectively. ICCs across three visits for both groups for average and sectoral pRNFL thicknesses were 0.887-0.997 and for segmented retinal volumes were 0.806-0.993. ICCs for total retinal volume for physiologic cupping and PCG were 0.993 and 0.954, respectively. COVs for average pRNFL thickness were 0.9% and 1.7%, respectively. For all other measurements, COVs ranged from 0.3% to 5.4%. Reproducibility of longitudinal SD-OCT measurements for average pRNFL thickness in children with stable glaucoma over about 2years is comparable to short-term reproducibility (COV) in normal children (1.16%) and normal and glaucoma adults (1.62%-3.4%).

Choroidal Microvascular Dropout in Pseudoexfoliation Glaucoma.

PurposeTo compare the prevalence of choroidal microvasculature dropout (CMvD) in pseudoexfoliation glaucoma (PXG) and disease severity–matched primary open-angle glaucoma (POAG) eyes.MethodsIn a cross-sectional study, 39 eyes with PXG (33 patients) and 39 glaucoma severity–matched POAG eyes (34 patients) underwent visual fields, optical coherence tomography and optical coherence tomography angiography examination. Peripapillary vessel density (VD) was evaluated from the radial peripapillary capillary slab, parafoveal VD was measured on the superficial vascular plexus slab of the macula, and CMvD was evaluated on the choroidal slabs of the optic disc scan.ResultsThe PXG and POAG groups were similar with respect to average mean deviation on visual fields (−12.1 vs. −12.0 decibel, P = 0.96) and average peripapillary retinal nerve fiber layer thickness on optical coherence tomography (71 vs. 74 μ, P = 0.29). Average peripapillary superficial VD (49.7% vs. 51.3%, P = 0.35) and parafoveal VD (44.8% vs. 45.8%, P = 0.33) were similar between the PXG and POAG groups. CMvD was seen in 18 PXG and 31 POAG eyes (46.2% vs. 79.5%, P = 0.002). On multivariate analysis that accounted for the severity of glaucoma, the odds of CMvD was significantly lower in the PXG group when compared with the POAG group (odds ratio: 0.18–0.21, P < 0.01).ConclusionsThe prevalence of CMvD was significantly lower in the PXG eyes when compared with the POAG eyes.

Ophthalmic, systemic, and genetic characteristics of patients with Wolfram syndrome.

To evaluate the ophthalmic, systemic, and genetic characteristics of patients with Wolfram syndrome. In total, 13 patients with suspected or clinically diagnosed Wolfram syndrome underwent ophthalmic and systemic examinations and genetic analyses for Wolfram syndrome between August and October 2018. The mean age of the subjects was 24.2 ± 7.1 years, of which 5 (38.5%) subjects were male and 8 (61.5%) were female. The mean best-corrected visual acuity ranged from counting fingers to 20/40, with a mean of 20/250 (1.10 ± 0.69 logarithm of the minimum angle of resolution). Dyschromatopsia was present in all patients (100%). There was a severe decrease in the average peripapillary retinal nerve fiber layer and macular ganglion cell-inner plexiform layer thicknesses (54.7 ± 6.5 and 51.9 ± 4.8 µm, respectively). Optical coherence tomography angiography showed significantly lower whole-image, inside disk, and peripapillary vessel densities in the patients with Wolfram syndrome than in the healthy controls (p < 0.001 for all). All patients who underwent genetic analyses had mutations in the WFS1 gene. Moreover, two novel mutations, p.Met623Trpfs*2 (c.1867delA) and p.Arg611Profs*9 (c.1832_11847del16) at exon 8, were detected. The frequency of systemic findings was as follows: optic atrophy (100%), diabetes mellitus (92.3%), central diabetes insipidus (38.5%), sensorineural hearing loss (38.5%), and presence of urological (30.8%), psychiatric (30.8%), and neurological (23.1%) diseases. Wolfram syndrome is a rare genetic disorder that can be associated with severe ophthalmic and systemic abnormalities. All patients who present with unexplained optic atrophy should be evaluated for Wolfram syndrome, even if they do not have diabetes mellitus because optic atrophy can sometimes manifest before diabetes mellitus.