Cup-disc Ratio Research Articles

Effect of body position on the pathogenesis of asymmetric primary open angle glaucoma.

To explore the pathogenesis of asymmetric primary open angle glaucoma (POAG) in both eyes by comparing the intraocular pressure (IOP) of patients who sleep in different positions and to investigate the relationship between IOP variations and sleep positions. One hundred and thirty-one patients with asymmetric POAG and forty-six healthy volunteers were enrolled. All participants completed a questionnaire that provided information about their sleep laterality. The cup disc ratio (C/D) and visual field defect established binocular asymmetry. The IOP of both eyes was measured using iCare parameters after the patients were asked to change body position. The "worse" and "better" eyes were identified according to the diagnosis, whereas the "dependent" and "independent" eyes were defined according to the lateral position. No significant difference in sleep laterality was observed between healthy people and patients with POAG (F=3.195, P=0.362). Among the enrolled patients, the IOP of the dependent eye was always greater than that of the independent eye in the lateral position (P<0.05). In the patients with binocular asymmetric POAG, the questionnaire clearly showed that 85.7% of left side preferences were found their left eyes to be the worse eyes and the right eyes of 71.4% patients with a right side preference were the more serious. When the asymmetric C/D ratio was greater than or equal to 0.2, the worse eye of patients with POAG and a preferred sleeping position was the dependent eye (χ2 =16.762, P=0.001). A higher IOP was measured in the dependent eye in the lateral position. The long-term tendency to choose a lateral sleeping position might lead the dependent eye to manifest more severe symptoms than the independent eye. Thus, the lateral sleeping position might be one cause of asymmetric POAG.

Correlation Between VEP Latency, CDR and PSD On Standard Automated Perimetry In Newly Diagnosed POAG Cases

Aim and Objective:- The current study was conducted to find out the correlation between Pattern reversal VEP (visual evoked potential) parameters, standard automated perimeter parameters and cup disc ratio (CDR) in newly diagnosed cases of POAG (primary open angle glaucoma).

Optic nerve head recovery following the iop-lowering surgery in the eye with early juvenile glaucoma-nine years follow up

Introduction. Congenital uveal ectropion (CEU) is a rare, non-progressive condition often accompanied with eyelid ptosis, anterior insertion of the iris, disgenesis of the iridocorneal angle and glaucoma. Case report. We present a case of a seven-year-old girl with a congential unilateral uveal ectropion and a secondary glaucoma which had daily variations from 13 up to 50 mm Hg. The patient had no other abnormalities of the iris or underlying systemic diseases. Introduced local anti-glaucomatous therapy initially normalized intraocular pressure (IOP), but failed to provide long term normalisation. Trabeculectomy normalized the IOP which resulted in the reduction of the cup/disc ratio and restitution of neuroretinal rim. The rim area increased to 1.716 mm2 (0.958 mm2 preoperative) rim volume, was 0.666 mm3 (0.195 mm3 preoperative) while cupdisc (C/D) ratio decreased to 0.330 (0.626 preoperative) as well as linear C/D=0.574 (0.791 preoperative). Neuroretinal rim (NR) was preoperatively preserved in the Ti segment, damaged in T, Ts, N, Ns segments, and borderline in the Ni segment. Postoperatively, neuroretinal rim was preserved in all segments. Conclusion. In the presented case trabeculectomy induced recovery of the nerve tissue of the optic nerve head which was confirmed by Haidelberg Retina Tomograph II (HRT II). The treatment results have been maintained during the follow-up period of nine years without topical or systemic antiglaucomatous therapy. Although CEU is a non-progressive and benign eye disease, associated glaucoma can cause severe optic nerve damage if not detected early and treated properly. As can be seen in the presented case, an adequate treatment can prevent and even reverse optic disc neuropathy.

The relationship between vertical cup–disc ratio and body mass index in a population of adult Saudi females

Purpose: The vertical cup–disc (C/D) ratio is useful clinically in optic-disc assessment in glaucoma suspects and diagnosing glaucomas and is thought to also be influenced by many ocular and systemic factors. The body mass index (BMI) is said to be an important parameter which influences vertical C/D ratio and different studies have shown different correlation between these two variables. The aim of the study was to assess the relationship of vertical C/D ratio with BMI in a population of Saudi adult females. Methods: One hundred and one female participants in the age group 18 to 40 years were included in a cross-sectional study after obtaining information regarding demographic data, ocular/systemic diseases, and surgeries by an oral interview. The BMI was calculated as ratio of body weight divided by the square of the body height. C/D ratio was recorded with direct ophthalmoscopic examination and examination with 90-D (Volk) lens. Analysis of variance was used to examine the BMI on vertical C/D ratio. A P-value <0.05 was considered to be statistically significant with confidence interval of 95%. Results: The mean BMI was 22.7 (±4.49) and the mean C/D ratio was 0.22 (±0.14). No significant relationship between increasing vertical C/D ratio and BMI P-value 0.154 was found. Conclusion: This study, conducted as a pilot study to investigate the relationship between C/D ratio and BMI in a young female Saudi population, found no significant relationship between vertical C/D ratio and BMI. This relationship is important as it helps to rule out effect of BMI on C/D ratio parameters in this population.

Evaluation of the optic nerve head and peripapillary retinal nerve fiber layer thickness in patients receiving Electro-Convulsive Therapy

Background: Electroconvulsive therapy (ECT) is a method commonly used in the treatment of psychiatric disorders. As ocular side effects from OCT are less studied and discussed, the aim of this study was to evaluate the profile of the peripapillary retinal nerve fiber layer thickness in patients receiving ECT.&#x0D; Method: This study was performed on 30 patients who had indication for ECT. After recording demographic data, retinal nerve fiber layer thickness was measured by using spectral domain optical coherence tomography (Heidelberg Engineering, Heidelberg, Germany) of optic nerve head and peripapillary retinal nerve fiber layer.&#x0D; Results: Our results showed that for most of the studied variables, the normal range was observed in less than 85% of patients receiving ECT. Variables which were outside the normal range were: cup disk (C/D) ratio (right and left eyes were 50% and 46.7%, respectively), vertical C/D ratio (right and left eyes were 53.3% and 46.7%, respectively), and cup volume (right and left eyes were 53.3% and 33.3%, respectively).&#x0D; Conclusion: This study showed that a high percentage of patients receiving ECT had changes in the optic nerve head while intra-ocular pressure in these patients was normal. It is warranted for examiners to pay attention to diagnosis of normal tension glaucoma in patients receiving ECT.

Role of trabeculectomy in advanced glaucoma: Whether we stand to consider it a bane or a boon today?

To elucidate the role of trabeculectomy in advanced glaucoma. Only patients with primary open-angle glaucoma were selected. All patients who had cup-disc ratio of 0.9 or a near-total cupping were given a trial of aggressive maximum medical therapy for IOP control for at least 4weeks. Target IOP was defined as≤12mmHg. Patients who showed progression were included in the study. A total of 10 patients were selected. Trabeculectomy was performed using limbal-based conjunctival flap. Patients were followed up for a period of 2years for visual acuity, intraocular pressure, visual fields, slit-lamp biomicroscopy and bleb morphology. Mean preoperative intraocular pressure on five drugs was 21.7±3.8mmHg (range 18-27mmHg) on maximum medical therapy. Mean post-operative intraocular pressure was 11±1.78mmHg (range 9-13mmHg) and 11±1.92mmHg (range 9-14mmHg) at 1 month and 6months post-operatively, respectively. Post-operatively, the visual acuity remained stable in 17 patients. It dropped by 1 Snellen line in 2 patients and 2 Snellen lines in 1 patient, respectively, over a period of 6months and later improved to 6/6P following cataract surgery. There was no defined visual field progression in any of the 20 patients. Besides being a cost-effective alternative to medical management, trabeculectomy not only provides a better IOP control but also has a high safety profile when performed by an experienced surgeon.

Weightlifters - Need to Be Cautious Especially Having Pigment Dispersion Syndrome or Pigmentary Glaucoma

Weightlifter developed sudden diminution of vision after exercise with visual acuity in right eye (RE) HM and in left eye (LE) CF 1foot, Intraocular pressure (IOP) with Goldmann applanation tonometer (GAT) in both eyes were 34 mmHg with antiglaucoma medications. Slit lamp examination of both eyes showed edematous cornea, concave configuration of iris, semi dilated pupil, sluggishly reacting to light and pigment on corneal endothelium &amp; on clear lens in RE, LE lens was clear. Gonioscopy showed open angle with increased pigmentation. Fundus examination showed cup disc ratio 0.8 in RE &amp; 0.85 in LE. Anterior segment optical coherence tomography (ASOCT) confirmed concave configuration of iris. Patient was treated with antiglaucoma medications &amp; peripheral iridotomy done with Nd: YAG in BE which decreased concave configuration of iris. Visual acuity improved to 6/6 in RE &amp; 6/9 in LE. BE IOP with GAT 14 mmHg, Humphery visual field (HVF) 10-2 showed advanced field defects, Central corneal thickness 598µ, OCT showed retinal nerve fibre layer thickness in RE 75µ &amp; 64µ in LE. Planned for trabeculectomy with MMC subsequently in BE. Conclusion: Weightlifters can need to remain cautious especially having Pigment dispersion syndrome or pigmentary glaucoma &amp; should undergo regular ophthalmic checkup

Comparison of the Variation in Stereoscopic Vertical Cup Disc Ratio Examination with 90 D lens vs. Cirrus HD-OCT

Aim: To compare the variation in stereoscopic vertical cup disc ratio examination with 90 D lens Vs. Cirrus HDOCT. Material and Methods: This is a retrospective study of all cases in which Cirrus HD-OCT was done for glaucomatous disc evaluation in the month of January 2016 and examined by single experienced glaucoma specialist. It includes 94 eyes of 49 patients (4 patients were one eyed). Difference of vertical cup disc ratio between 90 D and Cirrus HD-OCT was noted, values less than 0.1 were considered as comparable while the values more than or equal to 0.1 were considered as non-comparable. Results: Age of the patients was 44.26 ± 17.89 years (mean ± SD). Out of 49 patients, 65.31% (32) were males and 34.69% (17) were females. Vertical Cup disc ratio was comparable in 92.55% (87) and found to be noncomparable in 7.45% (7) of eyes with Cirrus HD-OCT. Conclusion: Stereoscopic vertical cup disc ratio examination with 90 D lens was found to be comparable with Cirrus HD-OCT in majority of the cases.

Lupus Nephritis with Visual Field Defect Secondary to Hypertensive Retinopathy: A Case Report

A 23-year-old lady presented with both eye progressive painless blurring of vision for two weeks in 2011. Prior to that she had malar rash, hair loss, photosensitivity and bilateral leg swelling. Ocular examination showed that visual acuity on the right was 6/60 and on the left was 6/24. Both optic disc were swollen with extensive peripapillary cotton wool spot (CWS), flame shape haemorrhages, dilated and tortuous vessels with macular oedema. Systemic examination revealed blood pressure of 176/111 mmHg, malar rash and alopecia. Diagnosis of grade 4 hypertensive retinopathy secondary to SLE was made. The diagnosis was confirmed by positive ANA/ dsDNA, low C3/ C4 and renal biopsy showed lupus nephritis. She was treated with oral prednisolone, hydroxychloroquine and cyclosporin A. Throughout the monitoring for hydroxychloroquine toxicity, vision over both eyes were 6/9, but serial visual fields showed non-progressive left superior and inferior scotoma while right eye showed inferior scotoma. The intraocular pressure was normal with pink optic disc and cup disc ratio of 0.3. Optical coherence tomography (OCT) showed temporal and nasal retinal nerve fiber layer thinning bilaterally. However, macula OCT, fundus fluorescein angiography and autofluorescence were normal. The visual field defect was concluded secondary to CWS indicating microinfarction of the retinal nerve fiber secondary to previous hypertensive retinopathy. Non-progressive visual field defects may occur after the appearance of CWS in hypertensive retinopathy and it should not be overlooked when diagnosing glaucoma or hydroxychloroquine toxicity.

Prediction of Visual Field Progression in Patients with Primary Open-Angle Glaucoma, Mainly Including Normal Tension Glaucoma

An objective method to predict individual visual field progression will contribute to realise personalised medication. The purpose of this study was to establish a predictive formula for glaucomatous visual field progression in patients with Primary open-angle glaucoma, mainly including normal tension glaucoma. This study was a large-scale, longitudinal and retrospective study including 498 eyes of 312 patients visiting from June 2009 to May 2015. In this analysis, 191 eyes of 191 patients meeting all eligible criteria were used. A predictive formula to calculate the rate of glaucomatous visual field progression (mean deviation slope) was obtained through multivariate linear regression analysis by adopting “Angle of Retinal Nerve Fibre Layer Defect” at the baseline, “Vertical Cup-Disc ratio” at the baseline, “Presence or absence of Disc Haemorrhage” during the follow-up period, and “Mean IOP change (%)” during the follow-up period as predictors. Coefficient of determination of the formula was 0.20. The discriminative ability of the formula was evaluated as moderate performance using receiver operating characteristic analysis, and the area under the curve was approximately 0.75 at all cut-off values. Internal validity was confirmed by bootstrapping. The predictive formula established by this type of approach might be useful for personalised medication.

Cataract surgery outcome in patients with non-glaucomatous pseudoexfoliation.

Aim. To study the outcome of cataract surgery in eyes with pseudoexfoliation without signs of glaucoma. Methods. This prospective study was done over nine months on patients with pseudoexfoliation undergoing small incision cataract surgery. Only patients with normal intraocular pressure (Central Corneal Thickness Corrected), normal cup disc ratio and open angles were included. Patients on anti-glaucoma medication were excluded. Patients underwent surgery performed by a single senior surgeon. Intraoperative and postoperative day (POD) 1 findings were noted. Results. The mean age of the patients was 61.60 years +/ - 10.21 years. Males were 46% (n=16). Right eye was operated upon in 60% of the cases (n=21). The mean pupil dilation was 5.1 mm +/ - 1.47 mm. The postoperative day 1 visual acuity of the patients was logMar 1.02 +/- 0.64 and the mean POD 1 intraocular pressure was noted to be 26.23 mmHg +/ - 11.40 mmHg. Five cases had a zonular dialysis intraoperatively due to weak zonules. 11 cases had high anterior chamber reaction of 2+ or more. Four cases had unavoidable sphincter tears and two cases had iridodialysis superiorly during nucleus delivery. Conclusions. Intraoperative complications should be anticipated in patients with pseudoexfoliation even without glaucomatous changes due to poor pupillary dilation and zonular weakness. First postoperative day visual acuity in pseudoexfoliation patients undergoing cataract surgery was found to be low due to severe anterior chamber inflammation causing elevated intraocular pressure and corneal edema. Abbreviations. POD = Postoperative day, PEX = Pseudoexfoliation syndrome, LOXL 1 = Lysyl oxidase-like 1, IOP = Intraocular pressure, AC = Anterior chamber, IOL = Intraocular lens.

Karakteristik glaukoma juvenil pasca trabekulektomi di RSUP Sanglah Denpasar Januari 2014 – Desember 2015

      Juvenile Glaucoma is a kind of primary open angle glaucoma with increase of intraocular pressure and usually found in patients with age 4 until 35 years old. A billateral chronic optic neuropathy in juvenile glaucoma very possible to cause blindness. Trabeculectomy are recomended as a succesful surgery treatment in juvenile glaucoma. This research is a descriptive. Data were collected retrospectively based on the medical records of patients who underwent trabeculectomy in Sanglah Hospital period January 1, 2014 through December 31, 2015. Data on the characteristics of the subjects analyzed descriptively, shown as frequency, percentage, mean and standard deviation. Improvement of visual acuity and intraocular pressure were analyzed by repeated measurement ANOVA. A total number of 20 eyes of 14 patient were included in this study. The majority of patients were male (57.1%), a mean of age 20.21 ± 9.34, almost all located in the city of Denpasar, the majority type of work is student (64%), and a mean of Cup-disc ratio 0.79 ± 0.16. There is no difference between the average visual acuity at different measurement time (p=0,374). There is a difference between the mean intraocular pressure in the different measurement time (p=0,000). There is no improvement of visual acuity and there is a improvement of intraocular pressure after the trabeculectomy in patients with juvenile glaucoma.Â

PRIMARY CONGENITAL GLAUCOMA;

Objectives: To determine the outcome of trabeculotomy in patients presentingwith primary congenital glaucoma at a tertiary care hospital in Pakistan. Design: It wasa descriptive case series. Place and Duration of Study: This study was conducted at theDepartment of Ophthalmology, Allied Hospital Faisalabad over 3 years from January 2014to December 2016. Material and Methods: 45 consecutive children presenting with primarycongenital glaucoma were included after written informed consent. These children underwenttrabeculotomy. Outcome variable was frequency of successful treatment which was definedas persistent intraocular pressure below 20 mmHg without medication for at least six monthsand reduction or stabilization of cupping of the optic disc. A predesigned proforma was usedto record patient’s demographic details along with outcome variables. Results: The mean ageof the patients was 17.47±5.77 months. There were 28 (62.2%) male and 17 (37.8%) femalechildren with a male to female ratio of 1.6:1. It was bilateral in 37 (82.2%) patients. There wassignificant improvement in the mean intraocular pressure (12.69±2.12 vs. 25.09±4.52 mmHg;p&lt;0.00001), horizontal corneal diameter (11.96±1.49 vs. 14.87±2.03mm; p&lt;0.00001),axial length (20.16±2.51 vs. 20.69±2.37mm; p=0.0002) and cup-disc ratio (0.30±0.15 vs.0.51±0.19; p&lt;0.00001) from baseline at 6 months follow-up after trabeculotomy. Treatmentwas successful in 39 (86.7%) patients. There was no significant difference in the frequencyof successful treatment across age and gender groups. Conclusion: Trabeculotomy is aneasy to perform procedure with high success rate of 86.7% in children with primary congenitalglaucoma. The complications observed in the present series were related to surgical skill andtechnique and were successfully managed.

English

Objectives: To determine the outcome of trabeculotomy in patients presentingwith primary congenital glaucoma at a tertiary care hospital in Pakistan. Design: It wasa descriptive case series. Place and Duration of Study: This study was conducted at theDepartment of Ophthalmology, Allied Hospital Faisalabad over 3 years from January 2014to December 2016. Material and Methods: 45 consecutive children presenting with primarycongenital glaucoma were included after written informed consent. These children underwenttrabeculotomy. Outcome variable was frequency of successful treatment which was definedas persistent intraocular pressure below 20 mmHg without medication for at least six monthsand reduction or stabilization of cupping of the optic disc. A predesigned proforma was usedto record patient’s demographic details along with outcome variables. Results: The mean ageof the patients was 17.47±5.77 months. There were 28 (62.2%) male and 17 (37.8%) femalechildren with a male to female ratio of 1.6:1. It was bilateral in 37 (82.2%) patients. There wassignificant improvement in the mean intraocular pressure (12.69±2.12 vs. 25.09±4.52 mmHg;p&lt;0.00001), horizontal corneal diameter (11.96±1.49 vs. 14.87±2.03mm; p&lt;0.00001),axial length (20.16±2.51 vs. 20.69±2.37mm; p=0.0002) and cup-disc ratio (0.30±0.15 vs.0.51±0.19; p&lt;0.00001) from baseline at 6 months follow-up after trabeculotomy. Treatmentwas successful in 39 (86.7%) patients. There was no significant difference in the frequencyof successful treatment across age and gender groups. Conclusion: Trabeculotomy is aneasy to perform procedure with high success rate of 86.7% in children with primary congenitalglaucoma. The complications observed in the present series were related to surgical skill andtechnique and were successfully managed.

Preliminary Study of the Differences in Optic Nerve Head Hemoglobin Measures Between Patients With and Without Childhood Glaucoma.

To evaluate the effectiveness of quantifying color changes in the optic nerve head in retinal photographs of patients with childhood glaucoma. In this observational study, three photographs of the optic nerve head were obtained in 28 patients with childhood glaucoma and 28 age- and sex-matched healthy participants (the childhood glaucoma and control groups, respectively). The Laguna Optic Nerve Head Hemoglobin (ONhE) software (Insoft SL, Tenerife, Spain) was used to determine hemoglobin levels in the optic nerve head. The following parameters were quantified: the hemoglobin levels in the optic nerve head across the whole disc, in 24 sectors (the optic nerve head divided by two concentric rings and eight 45-degree radial sectors), and in the vertical disc diameter (sectors 8 and 20), and the estimated cup-disc ratio and Glaucoma Discriminant Function, which combines the slope of the hemoglobin amount with the mean vertical disc diameter. Patient ages ranged from 9 to 14 years (median: 11 years) in the childhood glaucoma group, and 7 to 13 years (median: 9 years) in the control group (P < .061). Eyes in the childhood glaucoma group showed a significantly higher cup-disc ratio compared to eyes in the control group (0.6 ± 0.2 vs 0.5 ± 0.1, respectively; P < .0001). In the childhood glaucoma group, the Glaucoma Discriminant Function was found to be significantly lower than in the control group (-6.5 ± 31.1 vs 9.4 ± 17.1, respectively; P < .0001). There were no significant differences in the hemoglobin levels in the optic nerve head across the whole disc between eyes in the childhood glaucoma and control groups (58.2% ± 10.9% vs 58.5% ± 6.7%, respectively; P = .847). The Laguna ONhE software showed good reproducibility in measuring percentages of hemoglobin levels in both groups. The Laguna ONhE software is useful for patients with childhood glaucoma. However, hemoglobin levels in the optic nerve head across the whole disc may have normal values. This method had good reliability and is easy to implement in routine clinical practice. [J Pediatr Ophthalmol Strabismus. 2017;54(6):387-394.].

Correlation between Central Corneal Thickness, Intraocular Pressure, Optic Disc Size and Cup-Disc Ratio in Normal Population

Correlation between Central Corneal Thickness, Intraocular Pressure, Optic Disc Size and Cup-Disc Ratio in Normal Population

Visual Evoked Potentials in Primary Open Angle Glaucoma.

Background and Aims Visual evoked potentials (VEPs) assess the integrity of the visual pathways from the optic nerve to the occipital cortex. Optic disc cupping and visual field loss have been associated with prolongation of latency of VEP in primary open angle glaucoma (POAG). Methods Pattern reversal and flash VEP tests were done in consenting 20 primary open angle glaucoma eyes and 40 normal control eyes. Results In POAG cases, the refractive error [3.51 ± 1.88 versus 1.88 ± 1.11, D, p = 0.001], cup-disc ratio in percent [66.00 ± 16.98 versus 28.50 ± 5.80, p = 0.001], intraocular pressure [19.55 ± 2.08 versus 11.65 ± 1.64, mmHg, p = 0.001], and automated visual field pattern standard deviation [4.13 ± 6.96 versus 1.64 ± 0.45, dB, p = 0.001] were significantly more than in control. The visual acuity [0.41 ± 0.29 versus 1.00 ± 0.00, p = 0.001], foveal visual sensitivity [25.92 ± 6.88 versus 33.48 ± 1.75, dB, p = 0.001], and automated visual field mean deviation [−9.63 ± 10.58 versus 0.07 ± 1.54, dB, p = 0.001] were significantly less in cases than in control. Among VEP variables, pattern reversal latency N145 [149.00 ± 15.75 versus 137.52 ± 15.20, ms, p = 0.011], flash amplitude N75 [2.18 ± .57 versus 1.47 ± .38, μV, p = 0.001], and flash amplitude N145 [1.99 ± .39 versus 1.43 ± .38, μV, p = 0.001] were increased in cases. The pattern reversal amplitude N75 [1.97 ± .35 versus 2.47 ± .58, μV, p = 0.001], amplitude P100 [3.09 ± .46 versus 6.07 ± 1.44, μV, p = 0.001], and amplitude N145 [2.21 ± .58 versus 4.45 ± 1.99, μV, p = 0.001] were decreased in cases. Conclusions POAG caused glaucomatous damage to optic pathway.

Optic disc hemorrhages in glaucoma and common clinical features.

To analyze optic nerve head stereophotographs for the presence of optic disc hemorrhages, and to describe bleeding patterns and patient characteristics. Retrospective, cross-sectional study. 1113 optic nerve stereophotograph pairs of 562 consecutive patients. Stereophotographs were systematically reviewed for the presence of a disc hemorrhage with careful documentation of optic nerve head features. All charts of patients with hemorrhage were subsequently studied for demographic information and clinical data. Disc hemorrhages were observed in 7.1% of patients with optic disc photography. Most patients had open-angle glaucoma (57.5%) with focal ischemic phenotype of the optic disc (66.7%). The mean vertical and horizontal cup-disc ratios were 0.82 ± 0.14 and 0.76 ± 0.14, respectively. The β-zone peripapillary atrophy was observed in 48.9% of patients. The most common location was the inferotemporal region of the disc (60.8%), and most were flame or splinter shaped (70.6%). Disc hemorrhages were found either superficial to or within the retinal nerve fibre layer (72.5%), and in association with a notch (64.4%). The average intraocular pressure was 17.3 ± 4.9 mm Hg, and most hemorrhages were associated with early visual field defects (42.5%). Optic disc hemorrhages in patients with glaucoma were most frequently observed inferiorly in association with a notch. Most eyes with a disc hemorrhage had an intraocular pressure within normal range and had either early or no visual field loss. These findings highlight the importance of careful examination of the optic nerve head to look for the presence of a disc hemorrhage as an important biomarker of glaucoma damage.

Pattern of referrals by Optometrists in Nigeria in relation to glaucoma and diabetic retinopathy

Referrals from primary care practitioners such as optometrists to other health care providers is critical to the health care delivery system of any society. This study explores the pattern of referrals of Nigerian optometrists with respect to glaucoma and diabetic retinopathy. A cross-sectional survey using a 28-item questionnaire was administered to optometrists attending the 37th annual general meeting of the Nigerian Optometric Association. Of the 58 respondents, 51 (87.9%) of the respondents based their diagnosis of glaucoma on the triad of raised intra-ocular pressure (IOP), cup-disc (C/D) ratio and characteristic visual field defect while the remaining seven (12.1%) based their diagnosis of glaucoma on raised IOP and C/D ratio. Fifty-four (93.1%) requested for a fasting blood glucose test (FBG) from patients who presented with ocular signs indicative of diabetes or diabetic retinopathy. When diabetic retinopathy was observed in a patient, 16 (27.6%) responded to refer the patient to an ophthalmologist while eight (13.8%) agree to refer the patient to a medical personnel/physician. Forty-four (75.9%) of the respondents reportedly performs visual field test (VFT) while 14 (24.1%) do not perform VFT. A total of 31 (53.4%) of the respondents reported that they will initiate treatment for a glaucoma patient before referring the patient to an ophthalmologist while 10 (17.2%) will refer glaucoma patient outright to an ophthalmologist. With respect to the stage of diabetic retinopathy that will warrant a referral, 42 (72.4%) of the respondents refer the patient at any stage when the diagnosis is made while 5 (8.6%) will only refer the patient if there is no improvement in the condition presumably after follow-up care. More female respondents were likely to refer glaucoma patients (OR = 1.556, 95% CI = 0.488 – 4.963) and diabetic retinopathy (OR = 3.682, 95% CI = 0.357 – 37.922) to ophthalmologists. Majority of Nigerian optometrists refer glaucoma and diabetic retinopathy patients to ophthalmologists; though more than half of the respondents will initiate treatment for glaucoma before referral.Journal of Medical and Biomedical Sciences (2016) 5(3), 36-44Keywords: Optometry, Ophthalmology, referral, Nigeria, glaucoma

Haplotype reference consortium panel: Practical implications of imputations with large reference panels.

Recently, the Haplotype Reference Consortium (HRC) released a large imputation panel that allows more accurate imputation of genetic variants. In this study, we compared a set of directly assayed common and rare variants from an exome array to imputed genotypes, that is, 1000 genomes project (1000GP) and HRC. We showed that imputation using the HRC panel improved the concordance between assayed and imputed genotypes at common, and especially, low-frequency variants. Furthermore, we performed a genome-wide association meta-analysis of vertical cup-disc ratio, a highly heritable endophenotype of glaucoma, in four cohorts using 1000GP and HRC imputations. We compared the results of the meta-analysis using 1000GP to the meta-analysis results using HRC. Overall, we found that using HRC imputation significantly improved P values (P=3.07×10-61 ), particularly for suggestive variants. Both meta-analyses were performed in the same sample size, yet we found eight genome-wide significant loci in the HRC-based meta-analysis versus seven genome-wide significant loci in the 1000GP-based meta-analysis. This study provides supporting evidence of the new avenues for gene discovery and fine mapping that the HRC imputation panel offers.