Average Retinal Nerve Fiber Layer Thickness Research Articles

Biological and Methodological Variability in Retinal Nerve Fiber Layer OCT: The Framingham Heart Study

ObjectiveTo explore participant-level biological attributes and scan-level methodological attributes associated with retinal nerve fiber layer (RNFL) thickness variability in a population-based sample of elderly United States adults. DesignCross-sectional analysis using data from the Framingham Heart Study. Participants1,347 eyes from 825 participants with at least one optical coherence tomography (OCT) scan and axial length data were included. MethodsThree or more successive RNFL scans of each eye of each participant were obtained in a single session. Multivariable linear mixed models were employed to explore the associations between average RNFL thickness with participant-level biological attributes (age, gender, race, ethnicity, and axial length) and scan-level attributes (signal strength [SS]) as independent variables in the whole population as well as a sub-sample of adults with no self-reported history of glaucoma. Similar analyses were designed to assess methodological variability with average within-eye standard deviation (SD) for repeated scans as the dependent variable. Main Outcomes1) Biological variability: average RNFL thickness, 2) Methodological variability: average within- participant SD across repeated scans. ResultsAge (β= −0.19 microns/year, [95% CI: −0.29, −0.09]), female gender (β= +1.48 microns vs. male, [95% CI: 0.09,2.86]), axial length (β= −1.24 microns/mm of greater length, [95% CI: −1.80, −0.67]), and SS (β= +1.62 microns/1 unit greater SS, [95% CI: 1.16,2.09]) were significantly associated with RNFL thickness, while race and ethnicity were not (p>0.05). In analyses designed to assess methodological variability, higher RNFL thickness (β= +0.02 per micron increase, [95% CI: 0.01,0.03]), and lower SS (β= +0.19 per 1 unit lower SS, [95% CI: 0.10,0.27]) were significantly associated with greater RNFL variability. In adults with no self-reported history of glaucoma (n of eyes = 1165, n of participants = 712), female gender was not associated with RNFL, while African-American race was associated with thicker RNFL (β= +4.65 microns vs. Whites, [95% CI: 1.28,8.03]). ConclusionsRNFL thickness is lower with older age, male gender, greater axial length, lower signal strength, and Whites (as compared to African-Americans) without self-reported glaucoma. Measurement variability (SD) is higher with greater RNFL thickness and lower SS. Understanding these biological and methodological variations is important to aid in OCT interpretation.

Profile of Lipoprotein Subclasses in Chinese Primary Open-Angle Glaucoma Patients.

To investigate the plasma lipoprotein subclasses in patients with primary open-angle glaucoma (POAG), a total of 20 Chinese POAG patients on intraocular pressure (IOP)-lowering treatment and 20 age-matched control subjects were recruited. Based on the levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), the study subjects were divided into elevated- and normal-level subgroups. The plasma lipoprotein, lipoprotein subclasses, and oxidized LDL (oxLDL) levels were quantitatively measured. The discrimination potential of the lipoproteins was evaluated using the area under the receiver operating characteristic curve (AUC), and their correlation with clinical parameters was also evaluated. Compared to the control subjects with elevated TC and/or LDL-C levels, the levels of TC, LDL-C, non-high-density lipoprotein cholesterol (non-HDL), LDL subclass LDL3 and small dense LDL (sdLDL), and oxLDL were significantly higher in POAG patients with elevated TC and/or LDL-C levels. No differences in any lipoproteins or the subclasses were found between the POAG patients and control subjects with normal TC and LDL-C levels. Moderate-to-good performance of TC, LDL-C, non-HDL, LDL3, sdLDL, and oxLDL was found in discriminating between the POAG patients and control subjects with elevated TC and/or LDL-C levels (AUC: 0.710-0.950). Significant negative correlations between LDL3 and sdLDL with retinal nerve fiber layer (RNFL) thickness in the superior quadrant and between LDL3 and average RNFL thickness were observed in POAG patients with elevated TC and/or LDL-C levels. This study revealed a significant elevation of plasma lipoproteins, especially the LDL subclasses, in POAG patients with elevated TC and/or LDL-C levels, providing insights on monitoring specific lipoproteins in POAG patients with elevated TC and/or LDL-C.

Longitudinal optical coherence tomography indices in idiopathic intracranial hypertension

Idiopathic intracranial hypertension (IIH) may result in optic nerve fiber loss and even atrophy. The timing of the optical coherence tomography (OCT) indices reaching the lowest point (nadir) and the factors that predict the patient's anatomical outcome are not known. We aimed to determine the timing and the factors that affect nadir retinal nerve fiber layer (RNFL) thickness. The medical records of 99 IIH patients who were treated from December 2009 to January 2020 were retrospectively reviewed. The mean RNFL thickness at presentation was 263.5 ± 106.4 µm. The mean time to nadir was 7.9 ± 6.3 months. The average RNFL and ganglion cell complex (GCC) thickness at the nadir were 92.6 ± 14.5 µm (47% showed thinning) and 77.9 ± 27.8 µm (70% showed thinning), respectively. The Frisén disc edema stage and average RNFL thickness at baseline correlated with a longer time to nadir, (r = 0.28 P = 0.003 and r = 0.24, P = 0.012, respectively). The nadir average RNFL thickness and the nadir average GCC thickness (r = 0.32, P = 0.001, r = 0.29, P = 0.002, respectively) correlated with the baseline visual field mean deviation. The final anatomical outcome of IIH episodes in this study resulted in RNFL and GCC thinning. The time to RNFL nadir and its values correlated with IIH severity at presentation.

The Effect of Childhood Obesity on Intraocular Pressure, Corneal Biomechanics, Retinal Nerve Fiber Layer and Central Macular Thickness.

Elevated corneal hysteresis (CH) and resistance factor (CRF) in obese and over-weight children imply weight's effect on corneal biomechanics. Increased Goldmann-correlated intraocular pressure (IOPg) in obese indicates glaucoma risk, emphasizing screening for IOP, retinal changes. To evaluate the effect of obesity on corneal biomechanics, retinal nerve fibre layer (RNFL) and central macular thicness (CMT) in children. In this prospective, cross-sectional, comparative study, 146 eyes of normal-weight, over-weight, and obese children aged between 6 to 17 years were evaluated. The IOPg, corneal compensated IOP (IOPcc), CH, CRF and the average retinal nerve fiber layer (RNFL), average cup-to-disk ratio (c/d), central macular thickness (CMT) were measured by Ocular Response Analyser and Spectral-Domain Optical Coherence Tomography (SD-OCT), respectively. There was no statistically significant difference regarding age, sex, IOPcc, average RNFL thickness, c/d ratio, and CMT among the groups (P≥0.05). The IOPg was significantly higher in obese children compared to normal-weight children, while CH and CRF values were significantly higher in both obese and over-weight children compared to healthy ones (P<0.05). There was a positive correlation between BMI percentile and IOPg, CH, and CRF values. In our study, higher IOPg, corneal hysteresis, and corneal resistance factor values suggest that obese children could be potential candidates for glaucoma. Therefore, it would be appropriate to screen them for IOP and retinal alterations. On the other hand, further investigations with larger sample sizes and longer follow-up periods are needed to eliminate the risk of glaucoma in obese children.

The Relationship between Lumbar Puncture Opening Pressure and Retinal Nerve Fiber Layer Thickness in the Diagnosis of Idiopathic Intracranial Hypertension: Is a Lumbar Puncture Always Necessary?

Idiopathic intracranial hypertension (IIH), is characterized by elevated intracranial pressure (ICP) without an identified cause. Today, lumbar puncture (LP) is the most common method used for diagnosis by measuring cerebrospinal fluid (CSF) pressure to reflect intracranial pressure. This invasive examination has significant disadvantages, such as complications and negative experiences for patients. Therefore, noninvasive methods for ICP measurement are desired. Optical coherence tomography (OCT) is widely used for the diagnosis and follow-up of IIH patients as it reflects papilledema. The aim of this study is to investigate the relationship between CSF pressure and OCT parameters and the ability of OCT in the diagnostic approach. In our study, patients who were followed up with a diagnosis of IIH with complete neuro-ophthalmological examinations, including visual acuity (VA), visual field, and OCT imaging within 24 hours before lumbar puncture, were retrospectively evaluated. CSF pressure, visual acuity LogMAR, mean deviation of visual fields, retinal nerve fiber layer (RNFL) thickness measured by OCT, and treatment protocols were obtained from our hospital data system. A total of 42 eyes of 21 patients were enrolled in the study. A statistically significant positive and moderate correlation was found between CSF pressure values and average RNFL thickness (r=0.507; P=0.001). The same relationship was demonstrated in all 4 quadrants: inferior, superior, nasal, and temporal. Increased peripapillary RNFL thickness in optic nerve head OCT may be correlated with increased ICP in IIH patients. A larger number of patients are needed to better understand the correlation between OCT parameters and CSF pressure in patients with IIH.

Diagnostic utility of point-of-care ultrasound and optical coherence tomography for papilloedema in children: a prospective pilot study

Background/AimsPapilloedema is an important sign of serious neurological disease, but it can be difficult to detect on funduscopy. The purpose of this study was to determine the diagnostic accuracy of...

Comparing Intraocular Pressure, Ocular Blood Flow, and Retinal Nerve Fiber Layer Thickness in Early and Chronic Hypertensives With Normotensives

Purpose To compare blood pressure (BP), intraocular pressure (IOP), ophthalmic artery flow (OAF) velocity, retinal nerve fiber layer (RNFL) thickness, and visual fields in newly diagnosed hypertension (HT) patients (before treatment), chronic HT (on antihypertensive medications >5 years) and normotensives. Methods A prospective, cross-sectional study at a tertiary care centre in India. Three groups of 45 patients each: group 1 - early HT, group 2 - chronic HT, and Group 3 - normotensives, underwent evaluation of BP, IOP by Goldmann applanation tonometry (GAT), OAF velocity by transcranial doppler (TCD), RNFL analysis by spectral-domain optical coherence tomography (SD-OCT), and visual fields. Results The BP was highest in early HT > chronic HT > normotensives (p < 0.001). The IOP of early HT, chronic HT, and normotensives were 15.87 ± 2.19 mmHg, 13.47 ± 1.92 mmHg, and 15.67 ± SD 1.75 mmHg (p < 0.001). The OAF velocity [peak systolic velocity (PSV), end-diastolic velocity (EDV) in cm/sec] was lowest in chronic HT (30.80 ± 7.05, 8.58 ± 1.58) < early HT (35.47 ± 5.34, 10.02 ± 1.74) < normotensives (36.29 ± 4.43, 10.44 ± 2.29), (p < 0.001). The average RNFL thickness was significantly lower in chronic HT (p = 0.022). The PSV, EDV, and MFV showed significant correlation with IOP (r = 0.247, p = 0.004; r = 0.206, p = 0.016; r = 0.266, p = 0.002) and average RNFL thickness (r = 0.309, p= <0.001; r = 0.277, p = 0.001; r = 0.341, p < 0.001) Conclusions Patients with chronic HT demonstrated the lowest retrobulbar flows, IOP and lower RNFL measurements. Lower ocular perfusion may be associated with lower IOP and may be a risk factor for end-organ damage (RNFL) independent of IOP.

OPTICAL COHERENCE TOMOGRAPHY PREDICTS VISUAL RECOVERY OF PATIENTS WITH PITUITARY ADENOMA FOLLOWING SURGERY IN DR KARIADI HOSPITAL,SEMARANG

Introduction and Objective: The characteristics, symptoms, and clinical manifestations of pituitary adenoma in Indonesia have not been widely studied. In 26 patients undergoing pituitary surgery at Dr. Kariadi Hospital, we compared visual acuity pre-operative and post-operative from normal and thin optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) and ganglion cell layer-internal plexiform layer (GCL-IPL).&#x0D; Method: A retrospective study of the medical record from January 2020 to December 2022 was done. 21 of the 26 patients had surgery by the transsphenoidal route and the rest by craniotomy. All patients had macroadenoma (tumor size &gt;1cm) and were histologically confirmed. Visual acuity before and after surgery was evaluated along with the patient’s OCT value.&#x0D; Result: The thinner pre-operative RNFL thickness was associated with worse visual acuity (VA). Patients with normal RNFL had a median VA of 20/200 while those with thin RNFL had to count their fingers (CF). The patients with normal pre-operative RNFL had a significant improvement in median VA after surgery, from 20/200 to 20/32 (p=0.022), whereas the patients with thin RNFL did not improve (CF to CF, p=0.026). The patients with normal pre-operative GCL-IPL had non-significant improvement in median VA after surgery from CF to 20/20 (p=0.505), also the patients with thin GCL-IPL from CF to 20/200 (p=0.151).&#x0D; Conclusion: The visual recovery after pituitary adenoma surgery is likely to be predicted by pre-operative OCT RNFL. Patients with normal RNFL thickness show an increased tendency in visual recovery after surgery.&#x0D; Keywords: Optical coherence tomography , visual acuity, pituitary adenoma

OPTICAL COHERENCE TOMOGRAPHY PREDICTS VISUAL RECOVERY OF PATIENTS WITH PITUITARY ADENOMA FOLLOWING SURGERY IN DR KARIADI HOSPITAL SEMARANG

Abstract&#x0D; Introduction &amp; Objectives : The characteristics, symptoms, and clinical manifestations of pituitary adenoma in Indonesia have not been widely studied. In 26 patients undergoing pituitary surgery at Dr. Kariadi Hospital, we compared visual acuity pre-surgery and post-surgery from normal and thin optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) and ganglion cell layer-internal plexiform layer (GCL-IPL).&#x0D; Methods : A retrospective study from medical record from Januari 2020 to December 2022 was done. 21 of the 26 patients had surgery by the transsphenoidal route and the rest by craniotomy. All patients had macroadenoma (tumor size &gt;1cm) and histologically confirmed. Visual acuity before and after surgery was evaluated along with patient’s OCT value.&#x0D; Results : The thinner pre-surgery RNFL thickness was associated with worse visual acuity (VA). Patients with normal RNFL had a median VA of 20/200 while those with thin RNFL had to count their fingers (CF). The patients with normal pre-surgery RNFL had a significant improvement in median VA after surgery, from 20/200 to 20/32 (p=0.022), whereas the patients with thin RNFL did not improve (CF to CF, p=0.026). The patients with normal pre-surgery GCL-IPL had non-significant improvement in median VA after surgery from CF to 20/20 (p=0.505), also the patients with thin GCL-IPL from CF to 20/200 (p=0.151).&#x0D; Conclusion : Based on this study, the visual recovery after pituitary adenoma surgery is likely to be predicted by pre-surgery OCT RNFL. Patients with normal RNFL thickness show an increase propensity in visual recovery after surgery.

Optic Nerve Head and Retinal Nerve Fiber Layer Analysis in Emmetropic Malay Children.

The study aims to investigate the normal reference values for optic nerve head (ONH) and retinal nerve fiber layer (RNFL) parameters in emmetropic Malay children, utilizing measurements obtained through Cirrus SD-OCT (Carl Zeiss Meditec, Dublin, CA). A cross-sectional study was conducted on 95 Malay children, aged between seven and 17 years, with no ocular abnormalities. It was held at Hospital Universiti Sains Malaysia, Malaysia, from January 2014 to December 2015. All children underwent a full ocular examination, including refraction and calculation of axial length. ONH and retinal nerve fiber layer thickness (RNFLT) parameters were measured using the Cirrus SD-OCT machine. One eye of each subject was selected randomly for study. The associations between the parameters and the effect of age, gender,axial length, and spherical equivalent (SE) on the measurements were statistically validated. Ninety-five children were involved in the study, with 65 females (68.4%) and 30 males (31.6%). The mean age was 10.6 (2.82) years, the mean intraocular pressure (IOP) was 14.8 (2.81) mmHg, the mean SE-refraction was 0.12 (0.28) diopters, and the mean axial length was 23.03 (0.76) mm. The mean disc area, rim area, and cup volume were 2.32 (0.40) mm2, 1.53 (0.33) mm2, and 0.204 (0.16) mm3, respectively. The average cup-to-disc ratio (SD) (CDR) and the vertical CDR were 0.55 (0.13) and 0.50(0.14). Mean (SD) RNFLT was 102.08 (11.08) μm for all patients. There was a strong positive correlation between the average, superior, and inferior RNFLT with the optical disc area. The rim area and the average, superior, inferior, and nasal RNFLT alsoshowed a significant correlation. The inferiorRNFLT was negatively correlated with the average CDR. There was also a major influence of gender on the disc area. There were no major age, axial length, and SE influences on the measurements. This study provided normative information for ONH and RNFLT parameters in emmetropic Malay children. It was observed that emmetropic Malay males exhibited a significantly larger optical disc area. The increase in RNFLT is correlated with a significant increase in disc and rim areas.

Optical coherence tomography detection of retinal neural loss in patients with tuberous sclerosis

PurposeTuberous Sclerosis (TS) is a rare, multisystem genetic disease caused by mutations in the TSC1 and TSC2 genes, leading to abnormalities in cell differentiation and proliferation. This study aimed to evaluate the neural integrity of individuals with TS by using Optical Coherence Tomography (OCT) to examine the peripapillary retinal nerve fiber layer (RNFL) thickness and the macular thickness in patients with TS and to compare with healthy controls.MethodsPeripapillary and macular OCT scans (Optopol Revo NX SD OCT) were performed on 41 eyes from 22 TS patients, divided into two groups based on the presence of retinal hamartomas, and compared to 20 eyes from a control group. The average peripapillary RNFL thickness was measured for each quadrant. The macular total thickness and ganglion cell layer (GCL) + inner plexiform layer (IPL) thickness were measured based on the Early Treatment Diabetic Retinopathy Study (ETDRS) map. All measurements were then compared between the groups and controls.ResultsThe TS group showed significantly reduced RNFL thickness and macular thickness when compared to the control group. Specifically, patients with retinal hamartomas exhibited an even more pronounced thinning of both RNFL and macular thickness.ConclusionsThese findings suggest that TS patients undergo significant changes in retinal neurodevelopment and experience axonal loss. This finding may have significant prognostic utility regarding central nervous system degeneration in TS, particularly among patients with retinal hamartomas. OCT may serve as a valuable tool for assessing axonal structural abnormalities in TS patients.Trial Registration Number: Not applicable.

Peripapillary Optical Coherence Tomography Angiography in Alzheimer's Disease, Mild Cognitive Impairment, and Normal Cognition.

This study aimed to identify peripapillary microvascular changes in Alzheimer's disease (AD) and mild cognitive impairment (MCI). In this prospective study, 66 eyes of 36 subjects with AD, 119 eyes of 63 with MCI, and 513 eyes of 265 controls with normal cognition were enrolled. Peripapillary capillary perfusion density (CPD), capillary flux index (CFI), and retinal nerve fiber layer (RNFL) thickness were determined. Average CPD differed significantly between all three groups (P = 0.001), being significantly greater in AD vs controls (0.446 ± 0.015 vs 0.439 ± 0.017, P = 0.001) and MCI vs controls (0.443 ± 0.020 vs 0.439 ± 0.017, P = 0.007) but not AD vs MCI (P = 0.69). CFI and average RNFL thickness did not significantly differ among groups (all P > 0.05). Peripapillary CPD is increased in eyes with AD or MCI compared to controls despite similar RNFL thickness. [Ophthalmic Surg Lasers Imaging Retina 2024;55:78-84.].

Changes in Neurodegeneration and Visual Prognosis in Branch Retinal Vein Occlusion after Resolution of Macular Edema

This study aimed to examine the thicknesses of the ganglion cell layer (GCL) and peripapillary retinal nerve fiber layer (RNFL) in eyes with resolved macular edema (ME) in branch retinal vein occlusion (BRVO) and determine their relationship with visual acuity (VA). This retrospective observational case–control study included 57 eyes of BRVO patients with resolved ME after treatment. The macular GCL thickness, peripapillary RNFL thickness, and central macular thickness (CMT) measured on swept-source optical coherence tomography scans with the contralateral eyes used as controls were evaluated. The mean CMT was 270.48 ± 32.7 μm; the mean RNFL thickness was 105.46 ± 25.94 μm in BRVO eyes. Although the average RNFL thickness was decreased in BRVO eyes compared to unaffected eyes, there was no significant difference between the groups. However, the temporal and nasal RNFL thicknesses were significantly different between the groups. The mean affected quadrant had a significantly thinner GCL compared to the corresponding opposite unaffected quadrant (p = 0.02). Final VA was significantly correlated with nasal and middle GCL thicknesses in the affected area (r = −0.512, p = 0.003 and r = −0.537, p = 0.001, respectively); no correlation was found between the average RNFL thickness and mean CMT. The peripapillary RNFL and GCL thicknesses of the affected area were reduced in BRVO eyes compared to unaffected eyes. VA significantly correlated with nasal and middle GCL thicknesses in the affected area. Inner retinal damage occurring in patients with ME secondary to BRVO may be related to the visual prognosis.

Retinal Nerve Fiber Layer Thickness in Patients with Schizophrenia and Its Relation with Cognitive Impairment.

Schizophrenia is a chronic severe mental illness with heterogeneous clinical presentation, course, and outcome. Cognitive impairment is one of its core features. Retinal nerve fiber layer (RNFL) imaging using OCT (optical coherence tomography) could provide easy access for in vivo imaging of the retina, rendering it as a "window to the brain." Studies done on schizophrenia have shown RNFL thinning. This study attempts to look into the association between cognitive impairment, disease duration, and RNFL abnormality in patients with schizophrenia using OCT. Patients diagnosed with schizophrenia meeting DSM 5 (Diagnostic and Statistical Manual of Mental Disorders) criteria and who were confirmed to be in remission for at least six months clinically and scoring less than three on PANSS-8 (positive and negative symptom scale-8) remission scale were included. They were administered the Montreal Cognitive Assessment Scale (MoCA) for cognitive assessment. RNFL measures were taken using spectral domain-OCT. Variables were compared using Pearson's correlation test, one-way ANOVA test, and independent t-test as appropriate. A total of 36 patients were studied. MoCA scores and RNFL thickness showed a positive correlation. Patients with schizophrenia had reduced average RNFL thickness and reduced RNFL thickness in superior, inferior, and temporal quadrants. Average RNFL thickness, Superior and inferior quadrant RNFL thickness showed a positive correlation with MoCA scores. No correlation was obtained between macular volume, macular thickness, duration of illness, and MoCA scores. Patients with schizophrenia have reduced average RNFL thickness. Patients with low MoCA scores have RNFL thinning.

AFG3L2 and ACO2-Linked Dominant Optic Atrophy: Genotype–Phenotype Characterization Compared to OPA1 Patients

PurposeHeterozygous mutations in AFG3L2 gene (encoding a mitochondrial protease indirectly reflecting on OPA1 cleavage) and ACO2 gene (encoding the mitochondrial enzyme aconitase) are associated to isolated forms of Dominant Optic Atrophy (DOA). We aimed at describing their neuro-ophthalmological phenotype as compared with classic OPA1-related DOA. DesignCross-sectional study. MethodsThe following neuro-ophthalmological parameters were collected: Log MAR visual acuity (VA), color vision, mean deviation and foveal threshold at visual fields, average and sectorial retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness at optic coherence tomography. ACO2 and AFG3L2 patients were compared with an age- and gender-matched group of OPA1 patients with 1:2 ratio. All eyes were analysed using Clustered Wilcoxon rank sum test using Rosner-Glynn-Lee method. Results44 eyes from 23 ACO2 and 26 eyes from 13 AFG3L2 patients were compared with 143 eyes from 72 OPA1 patients. All cases presented with bilateral temporal-predominant optic atrophy with various degree of visual impairment. Comparison between AFG3L2 and OPA1 failed to reveal any significant difference. ACO2 patients compared to both AFG3L2 and OPA1 presented overall higher values of nasal RNFL thickness (p=0.029, p=0.023), average (p=0.012, p=0.0007) and sectorial GCL thickness. These results were confirmed also comparing separately affected and subclinical patients. ConclusionsClinically, DOA remains a fairly homogeneous entity despite the growing genetic heterogeneity. ACO2 seems associated to an overall better preservation of retinal ganglion cells, probably depending on the different pathogenic mechanism involving mtDNA maintenance, as opposed to AFG3L2, which is involved in OPA1 processing and resulted virtually indistinguishable from classic OPA1-DOA.

Normative retinal nerve fiber layer thickness in a healthy pediatric South Asian cohort: a spectral-domain optical coherence tomography study.

Currently, the normative values for retinal nerve fiber layer (RNFL) thickness in our population have not been widely studied. Our study aimed to assess the peripapillary RNFL thickness (RNFLT) with Optopol Copernicus REVO80® spectral-domain optical coherence tomography (SD-OCT) amongst healthy children and its associations. One hundred eighty-two eyes of 91 consecutive healthy children 3 to 16 years of age with a refractive error ≤ ± 5 D were included after a thorough eye exam including visual acuity, refraction, tonometry, pachymetry, axial length estimation, and slit lamp exam including fundus assessment. RNFLT was measured via Optopol Copernicus REVO80® high resolution SD-OCT by a single experienced observer with 3D disc mode within a circular area of diameter 3.45 mm and the ring further divided into four quadrants: inferior, superior, nasal, and temporal. The mean age was 11.12 ± 3.12 years (range, 3-16). The average RNFLT was 120.13 ± 12.6 μm. The mean superior RNFL was the thickest at 138.21 ± 16.6 μm, next was the mean inferior RNFLT at 137.62 ± 17.2 μm, followed by the nasal 91.61 ± 18.5 μm and then the temporalat 74.58 ± 11.7 μm. No significant differences in RNFLT were noted between the two eyes. The mean RNFLT was significantly higher in males as compared to females, in vertical quadrants and at an average (p < 0.05). No significant relationship was found between the average RNFLT and factors such as age, axial length, corneal thickness, cup-to-disc ratio, intraocular pressure, or refractive error. This study establishes normative values of RNFLT for this subgroup of Pakistani children for the Optopol Copernicus REVO80® SD-OCT device.

Correlation of mild cognitive impairment with the thickness of retinal nerve fiber layer and serum indicators in type 2 diabetic patients.

Cognitive Impairment arising from type 2 diabetes mellitus (T2DM) has garnered significant attention in recent times. However, there are few studies on the identification and diagnosis of markers of cognitive impairment. Notably, alterations in the Retinal Nerve Fiber Layer's (RNFL) thickness can potentially serve as an indicative measure of central nervous system changes. Further investigations have indicated that the decline in cognitive function within T2DM patients is intricately linked to persistent systemic inflammation and the accumulation of advanced glycosylation end products. Comprehensive studies are warranted to unveil these complex associations. This study aims to explore the potential of utilizing the RNFL thickness and serological concentrations of IL-18, irisin, CML, and RAGE as diagnostic indicators for Mild Cognitive Impairment (MCI) among individuals with T2DM. The thickness of RNFL were determined in all patients and controls using optical coherence tomography (OCT). The serum levels of IL-18, irisin, CML and RAGE were detected by ELISA kit. In addition, Cognitive assessment was performed by the Mini-Mental State Examination (MMSE) and the Montreal Cognitive assessment (MoCA). The average RNFL thickness in the right eye were decreased in T2DM and T2DM combined with MCI (T2DM-MCI) patients and were positively correlated with MoCA and MMSE scores. The serum levels of IL-18, CML and RAGE in T2DM and T2DM-MCI increased significantly (p<0.05) and were negative correlated with MoCA and MMSE scores. The level of irisin in T2DM and T2DM-MCI decreased significantly (p<0.05) and were positively correlated with MoCA and MMSE scores. The area under the ROC curve of T2DM-MCI predicted by the average RNFL thickness in the right eye, CML and RAGE were 0.853, 0.874 and 0.815. The diagnostic efficacy of the combination of average RNFL thickness in the right eye, CML, and RAGE for the diagnosis of T2DM-MCI was 0.969. The average RNFL thickness in the right eye, CML and RAGE have possible diagnostic value in T2DM-MCI patients.

Clinical Characteristics and Associated Factors to the Development of Glaucoma in Eyes With Myopic Optic Neuropathy

PurposeTo observe the development of glaucoma in myopic eyes with and without myopic optic neuropathy (MON) and analyze associated factors to the development of typical glaucomatous damage. DesignA prospective, observational, cohort study MethodsA total of 233 myopic eyes with no definite evidence of glaucomatous damage were included in the study. Myopic patients without any retinal nerve fiber layer (RNFL) or visual field (VF) abnormalities were classified as myopic eyes without MON. Myopic patients with decreased RNFL at the superonasal (SN) or nasal area, and with corresponding VF defects either in the temporal or inferotemporal (IT) region, which is different from glaucomatous damage, were classified as myopic eyes with MON. Myopic eyes that developed glaucoma were defined by the presence of glaucomatous VF in the SN region including defects in Bjerrum area, or a new localized RNFL defect in the IT region on red-free photography or RNFL OCT. Disc morphological features and optic nerve head (ONH) parameters of two groups were compared. Hazard ratios for the association between baseline factors and conversion to glaucoma were obtained using Cox regression analysis. ResultsMean follow-up period was 11.66 ± 2.86 years. Myopic eyes with MON had a thinner average peripapillary RNFL thickness (P < 0.001), worse MD of the VF (P = 0.031), a higher percentage of IT VF defects (P < 0.001), smaller torsion degree (P = 0.047), and greater LCD (P = 0.022). Myopic eyes with MON who developed glaucoma had a thinner average peripapillary RNFL thickness (P = 0.009), greater PPA area (P = 0.049), greater LCD (P < 0.001), and thinner LCT (P < 0.001). Thinner baseline temporal RNFL thickness (HR, 0.956; 95% CI, 0.928–0.986; P = 0.004), greater baseline LCD (HR, 1.003; 95% CI, 1.000–1.005; P = 0.022), and greater PPA area (HR, 1.000; 95% CI, 1.000–1.003; P = 0.050) were significantly associated factors with glaucoma development in the Cox regression analysis. ConclusionMyopic eyes with MON have a greater risk to develop glaucoma compared to myopic eyes without MON. Myopic eyes with MON had larger PPA area, greater LCD, and thinner temporal peripapillary RNFL, indicating that accompanying structural weakness due to myopia, especially at the temporal side of the optic nerve head and the peripapillary sclera, increases the risk of glaucoma in myopic eyes with MON.

Assessment of the radial peripapillary capillary plexus and retinal nerve fiber layer thickness in diabetic patients in comparison to normal age-matched individuals

Background Diabetic retinopathy (DR) is a major complication of diabetes, leading to vision impairment and blindness worldwide. As early detection is crucial, our study investigated the potential of radial peripapillary capillary plexus (RPCP) and retinal nerve fiber layer (RNFL) thickness as biomarkers for retinal assessment in diabetic patients. Methods We conducted a cross-sectional study involving 48 participants, categorized into three groups: healthy controls, diabetic patients without DR (No DR), and patients with mild to moderate nonproliferative DR (NPDR). Vascular density (VD) and RNFL thickness were evaluated using optical coherence tomography (OCT), and OCT-Angiography (OCT-A). Results The study showed a significant difference in VD among the three groups. The mean whole image VD% in the control group was 51.28%, while the No DR and NPDR groups had mean percentages of 49.27% and 49.46%, respectively (P=0.015). These differences were also significant for peripapillary VD (P=0.003), superior-hemi VD (P=0.035), and inferior-hemi VD percentage (P=0.002). Conversely, there were no significant differences in RNFL thickness among the groups (P=0.138). In the NPDR group, positive correlations were found between RNFL thickness and VD percentages, including superior-hemi RNFL thickness and superior-hemi VD% (r=0.724, P&lt;0.001), average whole RNFL thickness and whole image VD% (r=0.655, P&lt;0.001), and average whole RNFL thickness and peripapillary VD% (r=0.647, P&lt;0.001). Conclusion This research emphasizes the value of assessment of retinal VD thickness of the radial peripapillary plexus as an early indicator for preclinical diabetic retinal changes in diabetic patients.

Association of WDR36 polymorphisms with primary open-angle glaucoma

Background: Various genes contribute to the pathophysiology of primary open-angle glaucoma (POAG). The WD repeat domain 36 (WDR36) gene may participate in T cell activation and, hence, in the pathogenesis of POAG. We investigated the association of two WDR36 gene single nucleotide polymorphisms (SNPs) with POAG.&#x0D; Methods: This cross-sectional study recruited patients aged &gt;40 years with POAG and investigated the rs10038177 and rs1971050 SNPs of WDR36 using polymerase chain reaction and direct DNA sequencing. All participants underwent comprehensive ocular examination, visual field assessment using the Swedish Interactive Threshold Algorithm standard 24-2 threshold test, and measurement of peripapillary retinal nerve fiber layer thickness (RNFLT) using spectral domain optical coherence tomography.&#x0D; Results: We enrolled 105 patients with a mean (standard deviation) age of 55.41 (8.56) years and a male-to-female ratio of 56 (53.3%) to 49 (46.7%), most of whom had a diagnosis of POAG for 2 to 5 years (60.0%). Most participants had diabetes (90.5%) but not hypertension (88.6%). There was a significant association of rs10038177 (P&lt;0.05), but not rs1971050 (P&gt;0.05), with family history of glaucoma. The association between rs10038177 and intraocular pressure was significant (P&lt;0.05), but that between rs1971050 and intraocular pressure was not (P&gt;0.05). No significant association was observed between mean cup-to-disc ratio and either SNP (both P&gt;0.05). For rs10038177, a significant association was found only with the RNFLT of the superior quadrant (P&lt;0.05), whereas for rs1971050, a significant association was found with the RNFLT of all four quadrants and average RNFLT (all P&lt;0.05). However, pairwise comparisons revealed no significant differences between genotypes (P&gt;0.05 for all pairwise comparisons). The association of rs10038177 with glaucoma severity was insignificant (P&gt;0.05), and most patients with the TC genotype (71.7%) had moderate severity. There was no significant association between rs1971050 and glaucoma severity (P&gt;0.05).&#x0D; Conclusions: We observed genetic links between some, but not all, characteristics of POAG and the rs10038177 and rs1971050 SNPs of WDR36. Follow-up studies on these and other WDR36 SNPs in populations with different genetic backgrounds are necessary to confirm this genetic association.