Ganglion Cell-inner Plexiform Layer Research Articles

Ganglion Cell-inner Plexiform Layer Thickness Measured by Cirrus High-definition Optical Coherence Tomography Enhances Glaucoma Diagnosis in Patients with Moderate or High Myopia

Objective: To assess the diagnostic ability of Cirrus high-definition optical coherence tomography (HD-OCT) parameters in patients with moderate or high myopia for detecting glaucoma, and to compare the thickness of the macular ganglion cell-inner plexiform layer (GC-IPL) in glaucomatous and normal eyes in both types of myopia.Materials and Methods: This prospective study enrolled moderately (spherical equivalent -3.00 to -6.00 diopters) and highly (spherical equivalent ≤ -6.00 diopters) myopic patients without (controls) and with (study) glaucoma. Cirrus HD-OCT was used to determine the thickness of the peripapillary retinal nerve fiber layer (RNFL) and the GC-IPL. The area under the receiver operating characteristic curve was analyzed to evaluate the glaucoma detection capability of each Cirrus HD-OCT parameter.Results: Seventy eyes (31 moderate myopia, 39 high myopia) were included. The parameters with the best diagnostic ability were minimum GC-IPL, inferior RNFL and average RNFL thickness in moderately myopic eyes, and average RNFL, inferior RNFL and inferotemporal GC-IPL thickness in highly myopic eyes. All parameters were thinner in glaucomatous than in normal eyes in both groups.Conclusion: Although macular GC-IPL thickness demonstrated high ability to detect glaucoma in patients with moderate or high myopia, it should be used in combination with other structural imaging and functional assessments for diagnosing glaucoma.

Ocular sequelae in severe COVID-19 recovered patients of second wave.

Purpose:To evaluate the retinal microvascular changes in patients, recovered from severe COVID-19 during the second wave of the pandemic in North India.Methods:In this observational cross-sectional study, 70 eyes of 35 patients who recovered from severe COVID-19 during the second wave underwent detailed ophthalmic evaluation 4–6 weeks after discharge. Twelve controls were also enrolled, and the difference in the findings between the case and control groups on optical coherence tomography (OCTA) were studied.Result:The ages of study participants ranged from 27 to 60 years with the male:female ratio being 1.05:1. The fundus changes suggestive of ischemia in the form of cotton wool spots and vascular tortuosity were seen in 25 eyes (35.71%). Increased venous tortuosity was the most common finding seen in 23 eyes (32.85%), of which 10 eyes (28.57%) had concurrent hypertensive retinopathy (HTR) changes. There was a significant reduction in the mean vascular density (VD) and perfusion density (PD) for both the superficial capillary plexus (SCP) and deep capillary plexus (DCP) at inner, outer ring, and whole (P < 0.05). Foveal avascular zone was significantly enlarged in both the SCP (P = 0.01) and the DCP (P = 0.03). The mean ganglion cell-inner plexiform layer (GC-IPL) was significantly reduced in comparison to controls (P < 0.001).Conclusion:Severe COVID-19 can result in microvascular changes at the macula in the form of reduction in vascular and perfusion density, which can be evaluated using OCTA. As structural changes precede functional changes, a close watch is recommended in patients showing compromise in retinal microvasculature.

Spectral-domain OCT measurements in obesity: A systematic review and meta-analysis.

BackgroundPrevious studies proposed possible applications of spectral-domain optical coherence tomography (SD-OCT) measurements in prognosticating pathologies observed in overweight/obesity, including ocular, vascular, and neurologic consequences. Therefore, we conducted a systematic review and meta-analysis to investigate the changes in the in SD-OCT measurements of the patients with higher body mass index (BMI) compared to normal weight individuals.Materials and methodsWe conducted a systematic search on PubMed, Scopus, and Embase. The search results underwent two-phase title/abstract and full-text screenings. We then analyzed SD-OCT measurements differences in patients with high BMI and controls, and performed meta-regression, sub-group analysis, quality assessment, and publication bias assessment. The measurements included macular thickness, cup to disc ratio, ganglion cell-inner plexiform layer (GC-IPL) and its sub-sectors, RNFL and peripapillary RNFL (pRNFL) and their sub-layers, and choroidal thickness and its sub-sectors.Results19 studies were included in this meta-analysis accounting for 1813 individuals, 989 cases and 824 controls. There was an overall trend towards decreased thickness in high BMI patients, but only two measurements reached statistical significance: temporal retinal nerve fiber layer (RNFL) (Standardized mean difference (SMD): -0.33, 95% confidence interval (CI): -0.53 to -0.14, p<0.01) and the choroidal region 1.0 mm nasal to fovea (SMD: -0.38, 95% CI: -0.60 to -0.16, p<0.01).ConclusionSome ocular layers are thinner in patients with higher BMI than the controls. These SD-OCT measurements might correlate with adverse events related to increased body weight and have prognostic abilities. As SD-OCT is a robust, rapid and non-invasive tool, future guidelines and studies are needed to evaluate the possibility of their integration into care of the patients with obesity.

Structural and functional differentiation between compressive and glaucomatous optic neuropathy

Clinical diagnoses of slow, progressive, painless visual losses with various degrees of visual field (VF) losses and disc atrophy are often confused between suprasellar compressive optic neuropathy (CON) and open-angle glaucomatous optic neuropathy (GON). We plotted the thickness of the peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL) against the mean deviation (MD) of the VF of 34 eyes of CON at diagnosis, 30 eyes of CON after therapy, 29 eyes of GON, and 60 eyes of healthy controls in a cross-sectional investigation. At diagnosis, a disproportionally early pattern of structural thinning compared with the corresponding VF losses was unique to CON. GON- and CON-specific thinning parameters were generally useful in differentiating GON and CON from moderate to severe MD losses, but early MD losses (0 to − 6 dB) overlapped with GON in a CON-stage specific manner. GON-specific thinning parameters, RNFL in the inferior sector, and inferior to temporal macular GCIPL ratio showed overlap with posttreatment CON in the early MD losses with AUCs of 0.916 (95% CI 0.860–0.971; P < 0.001) and 0.890 (95% CI 0.811–0.968; P < 0.001), respectively. In comparison, CON-specific thinning parameters, superonasal, and inferonasal GCIPL showed overlap with CON at diagnosis for early MD losses. Overall, the nasal-to-temporal macular GCIPL ratio showed good discrimination between CON and GON throughout the MD range, with an AUC of 0.923 (95% CI 0.870–0.976; P < 0.001). Comparing GON with all stages of CON, the cut-point of 0.95 showed the lower nasal-to-temporal GCIPL ratio had a sensitivity of 72% and specificity of 90% for CON. However, the cut-point of 1.10 showed the superior-to-inferior GCIPL ratio had a sensitivity of 60% and specificity of 98% for GON.

Characterization of Macular Structural and Microvascular Changes in Thalamic Infarction Patients: A Swept-Source Optical Coherence Tomography-Angiography Study.

Background: The retina and brain share similar neuronal and microvascular features. We aimed to investigate the retinal thickness and microvasculature in patients with thalamic infarcts compared with control participants. Material and methods: Swept-source optical coherence tomography (SS-OCT) was used to image the macular thickness (retinal nerve fiber layer, RNFL; ganglion cell-inner plexiform layer, GCIP), while OCT angiography was used to image the microvasculature (superficial vascular plexus, SVP; intermediate capillary plexus, ICP; deep capillary plexus, DCP). Inbuilt software was used to measure the macular thickness (µm) and microvascular density (%). Lesion volumes were quantitively assessed based on structural magnetic resonance images. Results: A total of 35 patients with unilateral thalamic infarction and 31 age–sex-matched controls were enrolled. Compared with control participants, thalamic infarction patients showed a significantly thinner thickness of RNFL (p < 0.01) and GCIP (p = 0.02), and a lower density of SVP (p = 0.001) and ICP (p = 0.022). In the group of patients, ipsilateral eyes showed significant reductions in SVP (p = 0.033), RNFL (p = 0.01) and GCIP (p = 0.043). When divided into three groups based on disease duration (<1 month, 1–6 months, and >6 months), no significant differences were found among these groups. After adjusting for confounders, SVP, ICP, DCP, RNFL, and GCIP were significantly correlated with lesion volume in patients. Conclusions: Thalamic infarction patients showed significant macular structure and microvasculature changes. Lesion size was significantly correlated with these alterations. These findings may be useful for further research into the clinical utility of retinal imaging in stroke patients, especially those with damage to the visual pathway.

Association of Inner Retinal Thickness with Prevalent Dementia and Brain Atrophy in a General Older Population: The Hisayama Study.

PurposeTo assess the association of inner retinal thickness with prevalent dementia and regional brain atrophy in a general older population of Japanese.DesignPopulation-based, cross-sectional study.ParticipantsA total of 1078 residents aged 65 years or older who participated in an eye examination, a comprehensive survey of dementia, and brain magnetic resonance imaging scanning in 2017.MethodsThe thicknesses of the inner retinal layers, namely, the ganglion cell-inner plexiform layer (GC-IPL) and retinal nerve fiber layer (RNFL)—were measured by swept-source OCT (SS-OCT). The association of these retinal thicknesses with the risk of the presence of dementia was estimated using restricted cubic splines and logistic regression models. Regional brain volumes were estimated separately by applying 2 different methods: voxel-based morphometry (VBM) and analysis by FreeSurfer software. The associations of GC-IPL and RNFL thickness with each brain regional volume were analyzed using multiple regression analysis.Main Outcome MeasurePrevalent dementia and regional brain atrophy.ResultsAmong the study participants, 61 participants (5.7%) were diagnosed with dementia. The likelihood of the presence of dementia significantly increased with lower GC-IPL thickness after adjusting for potential confounders (odds ratio, 1.62 [95% confidence interval, 1.30–2.01] per 1 standard deviation decrement in the GC-IPL thickness), but no significant association was observed with RNFL thickness. In the VBM analyses with the multivariable adjustment, lower GC-IPL thickness was significantly associated with lower volume of known brain regions related to cognitive functions (i.e., the hippocampus, amygdala, entorhinal area, and parahippocampal gyrus) and visual functions (i.e., the cuneus, lingual gyrus, and thalamus). Meanwhile, the volume of the thalamus significantly decreased with lower RNFL thickness, but none of the brain regions related to cognitive function exhibited a volume change in association with RNFL thickness. The sensitivity analysis using FreeSurfer analysis also showed that lower GC-IPL thickness was significantly associated with lower regional brain volume/intracranial volume of the hippocampus, amygdala, cuneus, lingual gyrus, and thalamus.ConclusionsOur findings suggest that the measurement of GC-IPL thickness by SS-OCT, which is a noninvasive, convenient, and reproducible method, might be useful for identifying high-risk individuals with dementia.

Clinical Evaluations of Macular Structure-Function Concordance With and Without Drasdo Displacement.

PurposeThe purpose of this study was to compare concordance between ganglion cell-inner plexiform layer (GCIPL) data from the Cirrus optical coherence tomographer (OCT) Ganglion Cell Analysis (GCA) and visual fields (VFs), with and without Drasdo displacement.MethodsFrom 296 open-angle glaucoma participants, GCIPL deviation and raw thickness data were extracted over locations per the 10-2 VF test grid, with and without application of Drasdo displacement, with global and eccentricity-dependent sensitivities and specificities calculated for both. With OCT and VF data classified as within or outside normative limits, pattern deviation values were compared using paired t-tests and Spearman correlations. Regression models were applied to pattern deviation values as a function of GCIPL thickness, and differences in model performance with and without displacement were compared using extra sums-of-squares F tests.ResultsThere were small but significant improvements in global specificity without displacement (0.58–0.59 with displacement and 0.61 without displacement), without notable differences in sensitivity (0.77–0.78 with displacement and 0.76–0.78 without displacement). At abnormal VF locations and without displacement, a higher proportion of correct OCT classifications (P = 0.0008) and significant correlation with worsening pattern deviation values were observed (r = 0.50, P = 0.002). Regression models indicated significantly steeper slopes with Drasdo displacement centrally (P = 0.002–0.04).ConclusionsWith GCA deviation maps, small improvements in structure-function concordance were observed without displacement, which are unlikely to be clinically meaningful. Using GCIPL thickness data, significantly better structure-function concordance was observed centrally with Drasdo displacement.Translational RelevanceApplying Drasdo displacement on probability-based reports is unlikely to alter clinical impressions of structure-function concordance, but applying displacement with GCIPL thickness data may improve detection of structure-function concordance.

Effect of Vascular Comorbidity on Visual and Disability Outcomes in a Secondary Progressive Multiple Sclerosis Clinical Trial Cohort.

Vascular comorbidity (VC) is associated with multiple sclerosis (MS) disease progression and visual dysfunction. The longitudinal effect of VC in people with secondary progressive MS (SPMS) is unclear. This study explored the impact of VC on standard clinical, MRI, and visual outcomes in people with SPMS enrolled in a clinical trial. Data were extracted from a 2-year randomized controlled trial (N = 51) testing the supplement lipoic acid in people with SPMS who underwent annual Expanded Disability Status Scales, Timed 25-Foot Walk tests, MRIs, visual acuity testing, and retinal nerve fiber layer (RNFL) and ganglion cell/inner plexiform layer (GCIPL) thicknesses per optical coherence tomography (OCT). Post hoc linear mixed-effects regression analysis compared baseline and annualized outcomes between participants without VC (VC-) and with 1 or more VCs (VC+) (hypertension, dyslipidemia, obesity, diabetes, peripheral or cardiovascular disease, tobacco use). The VC- (n = 19) and VC+ (n = 28) participants were similar in age, sex, and MS disease duration and had comparable MS disability, mobility, and brain atrophy at baseline and throughout the 2-year parent study. The VC+ participants had worse baseline visual acuity than those in the VC- group by 0.13 logMAR (P = .041). No significant differences were detected in RNFL or GCIPL baseline thickness or atrophy between groups. In an SPMS cohort, VC had an inconsistent effect on standard clinical, MRI, and exploratory OCT outcomes, suggesting that the effect of VC may not be evident in smaller cohort studies. Using a more refined definition of VC in future, adequately powered investigations may help effectively elucidate and account for the interaction between vascular risk burden and MS disability.

Diagnostic ability and sectoral structure\u2013function relationship of circumpapillary and macular superficial vessel density in early glaucomatous eyes

This study aimed to evaluate the diagnostic ability and sectoral structure function relationship of circumpapillary vessel density (cpVD) and macular vessel density (mVD) with optical coherence tomography angiography (OCTA) in early glaucomatous (EG) eyes. 224 EG eyes of 167 patients (mean deviation (MD) > − 6 dB) and 70 normal eyes of 70 subjects were enrolled in this retrospective cross-sectional study. All patients underwent OCT and OCTA scanning. Diagnostic abilities were evaluated with area under receiver operating characteristic curves (AUROC). Structure function relationships of superior, inferior and Garway-Heath sectoral values with its corresponding visual field (VF) sensitivity were determined using linear mixed models. AUROCs were 0.798, 0.621, 0.876 and 0.835 for cpVD, mVD, circumpapillary retinal nerve fiber layer thickness (cpRNFLT) and ganglion cell-inner plexiform layer, respectively. AUROC of cpVD was significantly lower than cpRNFLT (P = 0.010) and higher than mVD (P < 0.001). All Garway-Heath sectors of cpVD significantly correlated with its corresponding VF sensitivity except for the nasal sector. MVD also showed significant structure function relationship and the correlations were stronger in the perifoveal region (6 mm annulus) than in the parafoveal region (3 mm annulus). CpVD demonstrated moderate diagnostic ability and both cpVD and mVD demonstrated significant association with VF sensitivity in EG eyes.

Femtosecond Laser-assisted Cataract Surgery in Patients With Prior Glaucoma Surgery.

Femtosecond laser-assisted cataract surgery (FLACS) is a safe procedure in glaucomatous eyes with prior glaucoma surgery, evidenced by stable intraocular pressure (IOP) and medication use, acceptable success rate, disease stability, and low complication rates at 1-year postoperative. The purpose of this study was to assess the 1-year efficacy and safety of FLACS in glaucomatous eyes with prior glaucoma surgery. Retrospective case series of all consecutive glaucomatous eyes with previous glaucoma surgery that underwent FLACS using the Catalys Precision Laser System with or without concomitant glaucoma surgery at a single ophthalmology center, between 2014 and 2020. Efficacy included change in IOP, glaucoma medication use, best-corrected visual acuity, and surgical success at 12 months postoperatively (POM12). Safety included structural and functional measures of disease stability and postoperative adverse events. A total of 57 eyes with an average age of 62.6±8.1 years were included. At POM12, IOP decreased from 14.5±6.6 mmHg to 13.5±3.7 mm Hg (P=0.22) and glaucoma medication use decreased from 2.1±1.5 to 1.8±1.4 with a marginal significance (P=0.089). Best-corrected visual acuity improved significantly in both groups (P<0.001) and surgical success ranged between 74% and 90% according to the study's success criteria. Safety was favorable with disease stability evidenced by lack of deterioration in cup-to-disc ratio, visual field mean deviation, retinal nerve fiber layer thickness, and ganglion cell-inner plexiform layer thickness. One eye with prior history of trabeculectomy experienced transient bleb leak. Other adverse events were minor without sight-threatening sequelae. The results of this study suggest that FLACS with or without concomitant glaucoma surgery could be a safe procedure in glaucomatous eyes-a population for which FLACS has been relatively contraindicated. Nonetheless, in those with preexisting filtering bleb, extra attention should be paid to the bleb area.

Comparison of peripapillary retinal nerve fiber layer and macular thickness in non-diabetic chronic kidney disease and controls.

ObjectiveThis study aimed to compare the peripapillary retinal nerve fiber layer (pRNFL) thickness and macular thickness (MT) between patients with non-diabetic chronic kidney disease (NDCKD) and controls, as well as between different stages of NDCKD. We also evaluated the correlation between pRNFL thickness and MT with duration of NDCKD.MethodsThis was a comparative cross-sectional study. Subjects were divided into NDCKD and control groups. Both pRNFL thickness and MT, including center subfield thickness (CST), average MT as well as average ganglion cell-inner plexiform layer (GC-IPL) were measured using spectral-domain optical coherence tomography. One-way ANCOVA test was used to compare the differences in pRNFL and MT between NDCKD and controls, as well as between the different stages of NDCKD. Spearman rank-order correlation coefficients were employed to determine the effects of NDCKD duration on pRNFL thickness and MT.ResultsA total of 132 subjects were recruited, 66 with NDCKD and 66 controls. There was a statistically significant difference in superior (110.74 ± 23.35 vs 117.36 ± 16.17 μm, p = 0.022), nasal (65.97 ± 12.90 vs 69.35 ± 10.17 μm, p = 0.006), inferior quadrant (117.44 ± 23.98 vs 126.15 ± 14.75 μm, p = 0.006), average pRNFL (90.36 ± 14.93 vs 95.42 ± 9.87 μm, p = 0.005), CST (231.89 ± 26.72 vs 243.30 ± 21.05 μm, p = 0.006), average MT (268.88 ± 20.21 vs 274.92 ± 12.79 μm, p = 0.020) and average GC-IPL (75.48 ± 12.44 vs 81.56 ± 6.48, p = 0.001) values between the NDCKD group and controls. The superior quadrant (p = 0.007), nasal quadrant (p = 0.030), inferior quadrant (p = 0.047), average pRNFL (p = 0.006), average MT (p = 0.001) and average GC-IPL (p = 0.001) differed significantly between different stages of NDCKD. There was no correlation between pRNFL thickness and MT with duration of NDCKD.ConclusionCST, average MT, average GC-IPL thickness, average pRNFL and all quadrants of pRNFL except the temporal quadrant were significantly thinner in NDCKD patients compared to controls. These changes were associated with the severity of CKD, but not its duration.

The retinal nerve fiber layer thickness is useful for the assessment of diabetic retinopathy severity

ObjectiveTo assess the alterations of individual retinal layer thickness at different stages of diabetic retinopathy (DR) and its role in determining DR severity. MethodsIn this study, 51 patients with nonproliferative DR (NPDR) and 57 patients with proliferative DR (PDR) were enrolled. The individual retinal layer thickness was measured according to the image segmentation of the macular scan collected from the optical coherence tomography (OCT) result. Comparative analysis was performed in addition to assessment of the diagnostic performance of the retina layer using receiver-operating-curve (ROC) analysis. Moreover, correlation analysis was conducted to examine the association between HbA1c and retina layer changes. ResultsIn PDR subjects, the retinal nerve fiber layer (RNFL, p < 0.0001), ganglion cell layer (GCL, p < 0.0001), inner plexiform layer (IPL, p = 0.0025), ganglion cell-inner plexiform layer (GC-IPL, p < 0.0001), and ganglion cell complex (GCC = RNFL+GCL+IPL, p < 0.0001) thickness were decreased compared to NPDR subjects. RNFL exhibited a better performance than GCL, GC-IPL, or GCC (AUC for RNFL = 0.76, p < 0.0001) in discriminating DR severity (cut-off of 16.62 μm (84.21% sensitivity and 70.59% specificity). The RNFL, GCL, IPL, GC-IPL, GCC, inner nuclear layer (INL), and total retinal layer (TLR) thickness correlated negatively with HbA1c levels in PDR group. ConclusionMeasurement of retinal degeneration, particularly by evaluating RNFL thinning is potentially useful for early identification of DR progression.

Macular sector-wise decision tree model for the prediction of parafoveal scotoma not detected by 24-2 visual field test.

Development of a macular sector-wise decision tree model (DTM) for the prediction of parafoveal scotoma. This prospective study enrolled 126 patients with early-stage open-angle glaucoma (mean deviation ≥-6 decibels) without the signs of parafoveal scotoma on the 24-2 visual field (VF) test (i.e., any abnormalities at the four innermost points). Based on the central 36 points of the 10-2 pattern deviation plot, patients were classified as being with or without 10-2 parafoveal scotoma. For the discrimination of patients from those without 10-2 parafoveal scotoma, a macular ganglion cell-inner plexiform layer (mGCIPL) sector-wise DTM analysis was performed. Among 126 eyes without 24-2 parafoveal scotoma, 10-2 parafoveal scotoma was detected in 77 (61.1%) eyes. The balanced accuracy of DTM was best in the inferotemporal sector (0.9286; 95% CI, 0.7458-0.9697) and worst in the inferior sector (0.8373; 0.6484-0.9204). DTM revealed that even in the absence of VF abnormalities at the innermost 4 points on the 24-2 test, (1) 10-2 parafoveal scotoma should be strongly suspected when the adjacent 24-2 perifoveal point in the correlated sector is abnormal; (2) if the 24-2 perifoveal point is normal, and if the probability colour codes of the correlated mGCIPL sector are green, the probability of 10-2 parafoveal scotoma is very low. In clinical practice, the evaluation of the 24-2 perifoveal test points along with the probability colour codes of mGCIPL can be a useful decision-support tool in determining whether 10-2 tests are needed for a given patient.

Parafoveal and peripapillary vessel density in pediatric and juvenile craniopharyngioma patients

We assessed the retinal microvascular alterations detected by optical coherence tomography angiography (OCT-A) in pediatric and juvenile craniopharyngioma (CP) patients with chiasmal compression. We included 15 eyes of 15 pediatric or juvenile CP patients and 18 eyes of 18 healthy subjects. The evaluation of vessel density from the superficial retinal capillary plexus (SRCP), the deep retinal capillary plexus, and the radial peripapillary capillary (RPC) segments was obtained by OCT-A. The association between vessel density measures and functional and structural measurements was also analyzed. There were significant reductions in the nasal sector of the SRCP (p < 0.0001) and all sectors of the RPC segment vessel density (nasal, temporal, and superior; p < 0.0001, inferior; p = 0.0015) in CP patients postoperatively compared to the healthy subjects. The peripapillary retinal nerve fiber layer (r = 0.6602, p = 0.0074) and ganglion cell-inner plexiform layer thicknesses (r = 0.7532, p = 0.0030) were associated with RPC segment vessel density. Visual acuity (r = − 0.5517, p = 0.0330) and temporal visual field sensitivity loss (r = 0.5394, p = 0.0465) showed an association with SRCP vessel density. In pediatric and juvenile patients with CP, parafoveal and peripapillary vascular changes following chiasmal compression were observed. The changes in vascular structures were closely related to structural and functional outcomes.

Association of Central Retinal Arteriolar and Venular Equivalents with Brain-aging and Macular Ganglion Cell-inner Plexiform Layer Thickness

ABSTRACT Introduction Neurodegeneration and cognitive decline in aging are growing public health concerns. This study investigates associations between central retinal arteriolar and venular equivalents (CRAE, CRVE) and brain-aging, a sensory and cognitive test composite measure, and macular ganglion cell-inner plexiform layer (mGCIPL) thickness, a biomarker of neurodegeneration. Methods Beaver Dam Offspring Study (BOSS) participants are adult children (baseline (2005–2008) age 21–84 years) of the population-based Epidemiology of Hearing Loss Study participants. Follow-up occurred every 5 years. In 2010–2013, fundus photographs were used to measure retinal vessels. A brain-aging score was constructed by principal component analysis using sensorineural and cognitive data. Associations between incident brain-aging and vessel measures were investigated using logistic regression. Associations between CRAE and CRVE and mGCIPL thickness, measured in 2015–2017, were also investigated. Results Participants (N = 2381; mean age: 53.9 years (SD = 9.8); 54% women) had a mean CRAE and CRVE of 148.8 µm (SD = 14.5) and 221.7 µm (SD = 20.7), respectively. Among those without ocular conditions, wider CRAE was associated with decreased 5-year brain-aging risk (33% per SD CRAE increase). Both vessel measures were independently associated with mGCIPL thickness. The mGCIPL thickness increased by approximately 1.7 µm and 2.0 µm per SD increase in CRAE and CRVE, respectively. Discussion The association of CRAE with incident brain-aging indicates its potential use as a screening tool among those without eye disease. The associations between CRAE and CRVE and mGCIPL thickness indicate narrower vasculature could affect neuronal health. These associations point to potential usefulness of retinal vessel measurements to identify people at higher risk of sensorineural declines and neurodegeneration.

Long-Term Visual Prognosis in Patients With Aquaporin-4-Immunoglobulin G–Positive Neuromyelitis Optica Spectrum Disorder

To identify the factors associated with visual prognosis for functional and structural outcomes of optic neuritis (ON) in patients with aquaporin-4-immunoglobulin (AQP4-IgG)-positive neuromyelitis optica spectrum disorder (NMOSD). We included the eyes that experienced at least 1 episode of ON and were followed for at least 2 years after the first attack of ON in patients with AQP4-IgG-positive NMOSD. We performed a retrospective review of clinical data, including ophthalmological examination and orbital MRI, of 34 eyes of 22 patients. Functional outcomes were measured as final visual acuity, visual field index, and mean deviation and structural outcomes as final retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) thickness. The mean age at onset of the first ON was 42.7 ± 13.7, and all patients were female. The poor visual acuity was significantly associated with the worse final visual acuity and thinner RNFL and GCIPL. Older age also showed a negative correlation with RNFL thickness. The number of attacks was not statistically significant for functional and structural outcomes. The lesion involving the intracanalicular optic nerve to the chiasm on orbital MRI showed worse visual acuity and a thinner GCIPL. Rapid high-dose intravenous methylprednisolone pulse therapy within 3 days was statistically significant, with better visual acuity and more preserved GCIPL thickness. Our results indicate that the severity of ON rather than the number of recurrences might be critical for the visual prognosis of patients with AQP4-IgG-positive NMOSD. Rapid treatment within 3 days may improve visual outcomes, and a younger age at onset may have better visual outcomes.

Macular Blood Flow and Pattern Electroretinogram in Normal Tension Glaucoma.

Purpose: To investigate whether macular vessel density (VD) was associated with the pattern electroretinogram (PERG) in normal tension glaucoma (NTG). Design: Cross-sectional study. Methods: Seventy-six eyes from patients with NTG were included in this study. Macular VD was calculated from the superficial retinal layer, including the retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL), using the built-in software provided with the optical coherence tomography angiography (OCTA) device. Functional parameters were obtained from standard automated perimetry (SAP) and PERG, using a commercial ERG stimulator. Moreover, structural parameters, such as peripapillary RNFL and macular ganglion cell/inner plexiform layer (GCIPL) thickness, were measured using OCT. Results: Patients with higher VD had higher N95 amplitude (p = 0.048). Macular VD was significantly correlated with N95 amplitude, irrespective of disease severity (r = 0.352, p = 0.002 for the total subjects and r = 0.276, p = 0.043 for mild glaucoma). According to regression analyses, N95 amplitude and macular VD were bidirectional significant factors (p = 0.035 and 0.019, respectively). For patients with mild to moderate glaucoma, N95 amplitude and macular VD were also significantly associated bidirectionally, according to regression analyses (p = 0.032 and 0.040, respectively). Conclusions: Macular VD was significantly associated with N95 amplitude from PERG. The correlation was prominent in early glaucoma, in contrast to the other structural or functional parameters. When considering that PERG represents the objective function of the retinal ganglion cell (RGC), macular VD was associated with RGC dysfunction before the functional change became apparent on SAP.

Progressive retinal changes in pediatric multiple sclerosis

Objectives To determine to what extent acute demyelinating episodes versus chronic degenerative phenomena drive retinal neuroaxonal damage in pediatric acquired demyelinating syndromes (ADS).Methods We acquired optical coherence tomography (OCT) data (follow-up range: 2 weeks – 5 years, at variable intervals from presentation) in pediatric participants who had multiple sclerosis (MS), monophasic ADS, or were healthy. Multivariable mixed effects models were used to assess the association of the number of demyelinating episodes (either optic neuritis [ON], or non-ON relapses) with changes in retinal nerve fiber layer (RNFL) or ganglion cell layer-inner plexiform layer (GCIPL) thickness.Results 64 OCT sans from 23 MS, and 33 scans from 12 monophasic ADS participants were compared with 68 scans from 62 healthy participants. The first ON episode had the biggest impact on RNFL or GCIPL thickness in monophasic ADS (RNFL: -7.9 µm, CI=5.5, p = 0.0056; GCIPL: -8.4 µm, CI=4.4, p = 0.0002) and MS (RNFL: -16 µm, CI = 3.7, p < 10−6; GCIPL: -15 µm, CI = 2.6, p < 10−6). Non-ON relapses were also associated with small but significant retinal thickness reductions in MS (RNFL: -2.6 µm/relapse, CI = 1.4, p = 0.0003; GCIPL: -2.8 µm/relapse, CI = 0.89, p < 10−6). MS participants showed progressive GCIPL thinning independent of acute demyelinating episodes (-2.7 µm/year, CI = 1.9, p = 0.0058).Conclusions We showed a prominent impact of early ON episodes on OCT measures of neuroaxonal structure in patients with ADS. We also demonstrated negative effects of non-ON relapses, and the presence of chronic retinal neurodegenerative changes, in youth with MS.

Ganglion cell layer-inner plexiform layer thickness and vision loss in cerebral palsy

Purpose: To determine if measurements of macular ganglion cell layer-inner plexiform layer (GCLIPL) thickness can discriminate between cerebral palsy patients with and without vision loss using spectral domain optical coherence tomography (SDOCT).Study design: Cross-sectional.Materials and methods: Participants with cerebral palsy enrolled in a prospective study of SDOCT were included if they were cooperative for visual acuity (VA) testing and macular SDOCT images were acquired. Manual segmentation of the macular GCLIPL was performed using elliptical annuli with diameters of 4.5 mm. Subjects with VA &lt; 6/9 were defined as having abnormal vision. Mann-Whitney U test was used to evaluate the relationship between vision and macular GCLIPL thickness. Data were analysed using SPSS version 22.0 software.Results: Forty study eyes (normal vision = 17 eyes; abnormal vision = 23 eyes) from 21 participants with spastic cerebral palsy were included. Most subjects were male (61.90%, n = 13) and the median age was 13 years (range from 7 to 29 years). The median visual acuity was 0.1 logMAR for subjects with normal vision and 0.3 logMAR for subjects with abnormal vision. Eyes with normal vision had higher average GCLIPL thickness (mean = 106.3 ± 27.85 μm) compared to eyes with abnormal vision (mean = 96.6 ± 36.47 μm). However, a significant association between GCLIPL thickness and visual impairment could not be established in this study.Conclusion: Our study demonstrated a reduction in macular GCLIPL thickness in cerebral palsy patients with visual impairment but did not fully support its use as surrogate marker of cerebral visual impairment due to study limitations. Future longitudinal studies are advised to elucidate the relationship between macular GCLIPLand cerebral visual impairment.

Effect of oral citicoline therapy on retinal nerve fiber layer and ganglion cell-inner plexiform layer in patients with primary open angle glaucoma

To evaluate the short-term effects of oral citicoline therapy on the retinal nerve fiber layer (RNFL) and the macular ganglion cell-inner plexiform layer (mGCIPL) in patients with primary open angle glaucoma (POAG). Fifty-four eyes of 54 patients with POAG glaucoma included in the study. In addition to a topical hypotensive, 250-mg oral citicoline was administered to 27 patients, while 27 patients were assigned as the control group. RNFL and mGCIPL values were measured using optical coherence tomography (OCT) at 1d before treatment and 3mo after the initiation of treatment. At the third month visit, citicoline treatment was discontinued and drug-free control (wash-out) measurements were obtained at the fourth month in citicoline group. The average RNFL thickness was significantly higher at month 3 than the baseline (P=0.038) in citicoline group. However, this improvement partially regressed after a 1-month wash-out period. No statistically significant changes in RNFL were observed in the superior, nasal, temporal and inferior quadrants at months 3 and 4 (P>0.05). The change in the average and inferior quadrant RNFL thickness in the citicoline group at 3mo was significantly greater than the control group (P=0.006 and P=0.014, respectively). There were no significant differences between the groups according to the change in mGCIPL thickness and the superior, nasal and temporal quadrant RNFL thickness (P>0.05). With oral citicoline treatment, the loss in the average RNFL is prevented in POAG patients in the short-term. Study data show that citicoline may have a significant impact on slowing glaucoma progression, which could have a potential neuroprotective effect.