High-tension Glaucoma Patients Research Articles

Continuous intraocular pressure variations following positional transitions in normal subjects and open angle glaucoma patients using a contact lens sensor system.

To evaluate the efficacy of a novel contact lens sensor system (CLS) in detecting continuous intraocular pressure (IOP) variations following positional transitions, and to explore these IOP variation patterns among normal subjects, untreated glaucoma patients, and untreated ocular hypertension (OHT) subjects. This prospective comparative study included 20 normal subjects, 14 high tension glaucoma (HTG) patients, 16 normal tension glaucoma (NTG) patients, and 14 OHT subjects. Participants wore the CLS for continuous IOP monitoring while undergoing sequential body position changes: from sitting to supine to a 10° head-down tilt (HDT), with each position maintained for ten minutes. Continuous IOP parameters, including mean, peak, and fluctuation (peak minus valley) in each position, as well as increment (peak minus starting value), interval (time to arrive peak), and velocity (increment divided by interval) after two position transitions, were compared among different positions and groups, respectively. Normal subjects, HTG and NTG patients exhibited higher CLS IOP mean and peak in supine/HDT positions compared to sitting (P < 0.05), but the mean or peak in HDT did not significantly differ from that in supine (P > 0.2). In OHT, all IOP parameters showed no significant difference among various positions (P > 0.1), except for velocity. Comparisons among groups revealed that during the transition from sitting to supine, HTG demonstrated higher IOP increment than other three groups and higher velocity than normal subjects (P < 0.05). NTG patients exhibited no significant differences in IOP increment, interval and velocity, compared to normal subjects (P > 0.05). The CLS proved effective in continuously recording IOP responses following positional changes in normal and glaucomatous eyes. Transitioning from sitting to supine resulted in increased IOP among normal subjects, HTG and NTG patients, but not in OHT. Compared to normal subjects, this IOP increase was more pronounced and rapid in HTG, but comparable in NTG. WHAT IS KNOWN : Positional transitions can induce IOP variations, which differ among normal subjects and glaucoma patients, and potentially relate to glaucomatous neuropathy. However, prior findings are constrained by the discontinuity of traditional tonometry. This study utilized a novel contact lens sensor system (CLS) to continuously monitor IOP during positional transitions in normal subjects and untreated glaucoma/OHT subjects. Continuous IOP outcomes revealed that normal subjects, HTG patients, and NTG patients exhibited an increase in IOP when transitioning from sitting to supine, whereas OHT did not. Compared to normal subjects, this increase in IOP was more pronounced and rapid in HTG patients, but similar in NTG.

The Impact of Intraocular Pressure Changes on Corneal Biomechanics in Primary Open-angle Glaucoma

PurposeTo investigate the relationship between intraocular pressure (IOP) changes and corneal biomechanical properties, determine the quantitative relationship between IOP changes and corneal biomechanical properties in patients with glaucoma and observe the differences among different types of glaucoma when the effects of high-level IOP were excluded. DesignProspective clinical cohort study. MethodsSetting: Institutional. Patients: Treatment-naive patients with primary open-angle glaucoma or ocular hypertension (OHT) were included. Observation Procedures: IOP was measured using a Goldmann applanation tonometer. Corneal biomechanics were evaluated using a corneal indentation device and corneal visualization Scheimpflug technology. Medication therapy was used for IOP reduction. Repeated measurements were taken at the baseline visit and each week thereafter within a month. Paired t tests were used to compare IOP and corneal biomechanical metrics before and after IOP-lowering therapy. One-way analysis of variance was employed to investigate potential differences across groups, with a Bonferroni post hoc correction administered for multiple intergroup comparisons. Main Outcome Measures: Corneal biomechanical parameters following IOP changes. ResultsEighty-one participants (mean age, 41.63 ± 17.33 years) were included in this study. The cohort comprised 20 patients with normal-tension glaucoma (NTG), 47 with high-tension glaucoma (HTG), and 14 with OHT. The baseline corneal stiffness (88.58±18.30 N/m) and corneal modulus (0.71±0.16 MPa) were greater than the post-IOP reduction values (67.15±9.24 N/m and 0.54±0.08 MPa, respectively; P<0.001). The relationships between changes in IOP and changes in corneal biomechanical parameters were Δ corneal stiffness=2.06*ΔIOP+6.47 (P<0.001) and Δ corneal modulus=0.017*ΔIOP+0.051 (P<0.001). After IOP reduction, the mean corneal stiffness at the 4th week in the NTG group was significantly lower (60.97±6.36 N/m) than that in the HTG (67.25±9.01 N/m) and OHT (75.62±6.52 N/m, P < 0.001) groups. Additionally, the stiffness of HTG patients was lower than that of OHT patients (P = 0.003). ConclusionsChanges in IOP have an impact on corneal biomechanical parameters. Decreases in corneal stiffness and modulus were observed after IOP reduction. When the effect of high-level IOP was excluded, corneal biomechanics varied according to the type of glaucoma. The HTG corneas were softer than the OHT corneas, and the NTG corneas were even softer.

Elevated Intraocular Pressure Moderated Brain Morphometry in High-tension Glaucoma: aStructural MRI Study.

High-tension glaucoma (HTG) is one of the most common forms of primary open angle glaucoma. The purpose of this study was to assess in HTG brain, whether the elevated intraocular pressure (IOP) had an effect on the brain morphological alterations via structural MRI. We acquired T1WI structural MRI images from 56 subjects including 36 HTG patients and 20 healthy controls. We tested whether the brain morphometry was associated with the mean IOP in HTG patients. Moreover, we conducted moderation analysis to assess the interactions between subject type (HTG - healthy controls) and IOP. In HTG group, cortical thickness was negatively correlated with the mean IOP in the left rostral middle frontal gyrus, left pars triangularis, right precentral gyrus, left postcentral gyrus, left superior temporal gyrus (p < 0.05, FDR corrected). Four of the five regions negatively correlated with mean IOP showed reduced cortical thickness in HTG group compared with healthy controls, which were the left rostral middle frontal gyrus, left pars triangularis, left postcentral gyrus and left superior temporal gyrus (p < 0.05, FDR corrected). IOP moderated the interaction between subject type and cortical thickness of the left rostral middle frontal gyrus (p = 0.0017), left pars triangularis (p = 0.0011), left postcentral gyrus (p = 0.0040) and left superior temporal gyrus (p = 0.0066). Elevated IOP may result brain morphometry alterations such as cortical thinning. The relationship between IOP and brain morphometry underlines the importance of the IOP regulation for HTG patients.

Corneal Biomechanics in Primary Open Angle Glaucoma and Ocular Hypertension: A Systematic Review and Meta-analysis.

Normal tension glaucoma patients had softer corneas than normal controls, whereas high-tension glaucoma and ocular hypertension patients had stiffer corneas. To comprehensively identify the corneal biomechanical differences of patients with primary open angle glaucoma (POAG) and ocular hypertension (OHT) using the Ocular Response Analyzer or the Corvis ST. The electronic databases PubMed, Embase, and Web of Science were comprehensively searched for studies comparing corneal biomechanical differences between POAG and OHT patients with normal controls by Ocular Response Analyzer or Corvis ST. The weighted mean differences and 95% confidence intervals (CIs) were calculated. Subgroup analyses were performed according to the subtypes of POAG, including high-tension glaucoma (HTG) and normal tension glaucoma (NTG). Thirty-one case-control studies were ultimately included, with 2462 POAG patients, 345 OHT patients, and 3281 normal controls. The corneal hysteresis (CH), corneal resistance factor (CRF), and highest concavity time (HC-t) were all lower in POAG patients than in normal controls. The CH, time at the second applanation (A2t), HC-t, highest concavity radius (HC-R), and deformation amplitude at the highest concavity (HC-DA) were lower in OHT patients, while the CRF, time at the first applanation (A1t), and stiffness parameter at the first applanation (SP-A1) were greater in OHT patients than in normal controls. The subgroup analyses showed that the CH, A2t, length at the second applanation (A2L), and HC-DA were lower in HTG, and the CH, CRF, A1t, and HC-t were lower in NTG patients than in normal controls. The corneas of NTG patients are more deformable than normal controls, whereas the corneas of HTG and OHT patients are stiffer.

Analysis of the Optic Nerve Head Microcirculation Using Optical Coherence Tomography Angiography and the Upstream Macrocirculation Using Color Doppler Imaging in Low-Tension and High-Tension Glaucoma Patients

Introduction: The aim of the study was to analyze the optic nerve head (ONH) microcirculation using optical coherence tomography angiography (OCT-A) and the upstream macrocirculation using color Doppler imaging (CDI) in low-tension and high-tension glaucoma (LTG and HTG, respectively). Methods: This cross-sectional study included 67 eyes of 67 HTG patients, 55 eyes of 55 LTG patients, and 42 eyes of 42 healthy controls. We recorded the complete ophthalmological examination, visual fields, retinal nerve fiber layer (RNFL) thickness, ONH vessel density (VD) measured using OCT-A, peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) measured using CDI. SPSS software was used for data analysis. Data are presented as mean ± standard deviation or median (interquartile range) and compared using t test or Mann-Whitney U test, as appropriate. Pearson χ2 test or Fisher’s exact test was used for comparisons, as appropriate. Pearson correlation analysis was used to evaluate the correlations between variables. p < 0.05 was considered statistically significant. Results: The ONH VD and RNFL thickness were considerably lower in glaucomatous eyes than in healthy eyes (both p < 0.001). Compared with the HTG group, the LTG group had lower VD in the peripapillary region (p = 0.027). Compared with the healthy group, the HTG group had lower PSV (p = 0.029 and = 0.023, respectively), lower EDV (p = 0.023 and <0.001, respectively), and higher RI (p = 0.019 and = 0.006, respectively) of the internal carotid artery (ICA) and central retinal artery (CRA). The LTG group had lower PSV (p = 0.015 and <0.001, respectively) and EDV (p = 0.047 and = 0.001, respectively) of the ophthalmic artery (OA) and CRA. The LTG group had lower PSV of CRA than the HTG group (p = 0.034). In glaucomatous eyes, peripapillary VD had a significant association with the mean defect (p < 0.001) and RNFL thickness (p < 0.001), but not with the other CDI indices (all p > 0.05). Conclusion: The ONH microcirculation and upstream macrocirculation of the large arteries exhibited differences in the blood flow characteristics between the LTG and HTG groups. These differences may improve our understanding of glaucoma. There was no correlation between the characteristics of the ONH microcirculation and the upstream macrocirculation of large vessels in the LTG and HTG groups.

Corneal Stiffness and Modulus of Normal-Tension Glaucoma in Chinese

To assess and compare the corneal biomechanics of normal-tension glaucoma (NTG), high-tension glaucoma (HTG), and normal controls based on stiffness and modulus. The correlations among central corneal thickness (CCT), visual field, retinal nerve fiber layer (RNFL) thickness, and corneal biomechanics in glaucoma eyes were also evaluated. A prospective, cross-sectional, comparative study. This study included 334 eyes of 108 NTG patients, 113 HTG patients, and 113 control subjects at Zhongshan Ophthalmic Center, Sun Yat-Sen University. Corneal biomechanics were evaluated using a corneal indentation device (CID) and corneal visualization Scheimpflug technology (Corvis ST). Visual field and RNFL thickness were obtained using standard automated perimetry and spectral-domain optical coherence tomography. One-way analyses of variance with Bonferroni post hoc tests and a multivariable linear regression analysis with adjustment were conducted. Correlations among corneal biomechanical parameters, CCT, visual field, and RNFL thickness were analyzed. The corneal stiffness of the NTG patients (71.0 ± 10.9 N/m) was significantly lower than that of the HTG patients (77.3 ± 15.6 N/m; P=.001) and the CCT- and IOP-matched normal controls (75.6 ± 11.0 N/m; P=.023). The patients in the NTG group had lower corneal stiffness than those in the control group (β=-4.88, 95% CI -9.002, -0.758; P=.020) after adjusting for confounders. Stiffness was positively correlated with CCT in the NTG group (P=.028) but not in the HTG group (P= .509). There was no significant correlation (P > .05) between corneal biomechanics, visual field, or RNFL thickness. The corneas of NTG patients were softer than those of HTG patients and controls, as assessed by CID, which were associated with thinner CCT. These might suggest different ocular biomechanical properties in NTG and HTG.

Age dependence of plasma endothelin levels in glaucoma patients.

The aim of the study was to investigate the endothelin-1 (ET-1) plasma level and its age dependence in patients with normal tension glaucoma (NTG), high tension glaucoma (HTG), and healthy controls. In blood samples from 35 NTG patients, 34 HTG patients, and 36 controls, ET-1 plasma levels were determined by enzyme-linked immunosorbent assay (ELISA). After adjustment for age and gender, the mean ET-1 levels were found to be similar in all three study groups. The age dependency however was highest in NTGs and significantly different from that of the controls. For the HTGs, this dependence was weaker and not significantly different from that of the controls. Our findings suggest that age had a significantly greater influence on ET plasma level in the NTG patients than in the HTG patients and controls. This supports previous reports indicating that ET plays a role in the pathogenesis of glaucoma, and in particular normal NTG.

Prospective Clinical Study of Non-Invasive Intracranial Pressure Measurements in Open-Angle Glaucoma Patients and Healthy Subjects.

Background and Objective: Glaucoma is a progressive optic neuropathy in which the optic nerve is damaged. The optic nerve is exposed not only to intraocular pressure (IOP) in the eye, but also to intracranial pressure (ICP), as it is surrounded by cerebrospinal fluid in the subarachnoid space. Here, we analyse ICP differences between patients with glaucoma and healthy subjects (HSs). Materials and Methods: Ninety-five patients with normal-tension glaucoma (NTG), 60 patients with high-tension glaucoma (HTG), and 62 HSs were included in the prospective clinical study, and ICP was measured non-invasively by two-depth transcranial Doppler (TCD). Results: The mean ICP of NTG patients (9.42 ± 2.83 mmHg) was significantly lower than that of HSs (10.73 ± 2.16 mmHg) (p = 0.007). The mean ICP of HTG patients (8.11 ± 2.68 mmHg) was significantly lower than that of NTG patients (9.42 ± 2.83 mmHg) (p = 0.008) and significantly lower than that of HSs (10.73 ± 2.16 mmHg) (p < 0.001). Conclusions: An abnormal ICP value could be one of the many influential factors in the optic nerve degeneration of NTG patients and should be considered as such instead of just being regarded as a “low ICP”.

Functional Alterations in Resting-State Visual Networks in High-Tension Glaucoma: An Independent Component Analysis.

BackgroundHigh-tension glaucoma (HTG) is the most common type of primary open angle glaucoma and elevated intraocular pressure (IOP) is the major risk factor of the disease. The aim of this study was to assess alterations in resting-state visual networks in patients with HTG and investigate the effect of elevated IOP on the visual networks.MethodsT1-weighted and resting-state functional MRI images were acquired from 36 HTG patients (aged 49.22 ± 15.26 years) and 20 healthy controls (aged 49.90 ± 5.62 years). Group independent component analysis (ICA) was utilized to evaluate altered functional connectivity (FC) in resting-state visual networks between HTG patients and healthy controls. Pearson correlation analysis between mean IOP and altered FCs in the visual networks was performed.ResultsICA demonstrated decreased FCs in HTG group in the left calcarine cortex of the lateral visual network, in the bilateral lingual gyrus of the medial visual network and in the bilateral lingual gyrus of the occipital visual network compared with healthy controls. Furthermore, correlation analysis revealed negative correlation between mean IOP and altered FC within the lateral visual network.ConclusionThe results suggested reduced FCs between primary and higher visual cortices in HTG brain. The IOP elevation might be responsible for the functional alterations in the visual networks.

Brain morphological alterations of cerebral cortex and subcortical nuclei in high-tension glaucoma brain and its associations with intraocular pressure.

To investigate brain morphological alterations of high-tension glaucoma patients and explore the association between brain morphological changes and elevated intraocular pressure. Thirty-six patients with high-tension glaucoma and 20 healthy controls were collected and underwent structural MRI scan. Surface-based morphometry and voxel-based morphometry were applied to assess cortical thickness and subcortical gray matter volume of the enrolled subjects. The association between brain morphometry and intraocular pressure was assessed by partial correlation. Compared with healthy controls, high-tension glaucoma patients showed decreased cortical thickness in the bilateral superior temporal gyrus, bilateral superior parietal gyrus, bilateral lateral occipital gyrus, left fusiform gyrus, left medial orbitofrontal gyrus, right precentral gyrus, and right superior frontal gyrus (p < 0.05). High-tension glaucoma patients also showed reduced gray matter volume in the right hippocampus, bilateral putamen, and bilateral thalamus (p < 0.05). In addition, brain morphological correlates of mean intraocular pressure were found in the left rostral middle frontal gyrus, right precentral gyrus, and left postcentral gyrus in high-tension glaucoma group (p < 0.05). High-tension glaucoma patients experienced morphological reduction in the visual and nonvisual areas throughout the entire brain. Elevated intraocular pressure may contribute to the reduction of cortical thickness in certain areas in the progression of the disease.

This Issue of ACTA

This Issue of ACTA

Functional MRI reveals effects of high intraocular pressure on central nervous system in high-tension glaucoma patients.

To evaluate the effects of high intraocular pressure (IOP) on central nervous system in patients with high-tension glaucoma (HTG) by using resting-state functional magnetic resonance imaging (rs-fMRI). Thirty-six patients with HTG and twenty age- and gender-matched healthy controls (HCs) were recruited and underwent IOP measurement and rs-fMRI scan. The whole brain regional homogeneity (ReHo) value was calculated among the enrolled subjects. Two-sample t tests with permutation test and threshold-free cluster enhancement was performed between HTG group and HCs. Correlation analyses between IOP and ReHo values were conducted. Compared with HCs, HTG group showed increased ReHo values in the left lobule 8 of cerebellar hemisphere, left lobule 4 and 5 of cerebellar hemisphere and left fusiform gyrus (FG) (p<0.05). HTG group showed decreased ReHo value in the left middle frontal gyrus (MFG) (p<0.05). Intraocular pressure of the left eye in HTG group experienced a significant positive correlation with ReHo value of the left FG (r=0.370, p=0.026), IOP of the right eye in HTG group showed a significant negative correlation with ReHo value in the left MFG (r=-0.421, p=0.011). Resting-state fMRI ReHo analyses associated elevated IOP with abnormal regional activity in several brain regions related to higher visual function and visual memory consolidation. High-tension glaucoma patients also showed diminished integration of visual information and cerebellar function. These results may provide imaging support for pathophysiological research of HTG and may reveal new targets for the accurate treatment of HTG.

Correlation between Basal Macular Circulation and Following Glaucomatous Damage in Progressed High-Tension and Normal-Tension Glaucoma

Objectives: Evaluate the correlation between basal macular circulation and late structural damage in progressed high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) via optical coherence tomography angiography (OCTA). Methods: Patients who received an OCTA examination were divided into progressed HTG, progressed NTG, and well-controlled HTG (control) groups. Superficial macular vessel density (SmVD), deep macular vessel density (DmVD), foveal avascular zone (FAZ), and flow area of the outer retina and choriocapillaris were obtained by one OCTA device. Associations between macular angiography and glaucoma parameters, including the visual field, retinal nerve fiber layer, and ganglion cell complex, were analyzed. Results: A total of 60 eyes from 60 patients were enrolled. The progressed HTG and NTG groups had lower SmVD than the control group, while the progressed NTG group had lower DmVD and a larger FAZ than the control group. The flow area of the outer retina in the progressed HTG group was lower than that of the control. A significant correlation between SmVD and glaucoma parameters was found in the progressed HTG group, while a similar correlation between SmVD and DmVD to glaucoma parameters was observed in the progressed NTG group. Conclusion: The progressed HTG and NTG patients showed an impaired vascular intake before significant disease development compared to well-controlled cases.

Heart rate variability: the comparison between high tension and normal tension glaucoma

RelevanceVascular factors may be involved in the development of both high tension glaucoma (HTG) and normal tension (NTG) glaucoma; however, they may be not exactly the same. Autonomic dysfunction characterized by heart rate variability (HRV) is one of the possible reasons of decrease in mean ocular perfusion pressure (MOPP).PurposeTo compare the shift of the HRV parameters in NTG and HTG patients after a cold provocation test (CPT).MethodsMOPP, 24-hour blood pressure and HRV were studied in 30 NTG, 30 HTG patients, and 28 healthy subjects. The cardiovascular fitness assessment was made before and after the CPT. The direction and magnitude of the average group shifts of the HRV parameters after CPT were assessed using the method of comparing regression lines in order to reveal the difference between the groups.ResultsMOPP and minimum daily diastolic blood pressure were decreased in HTG and NTG patients compared to healthy subjects. There was no difference in MOPP between HTG and NTG before the CPT. However, all HRV parameters reflected the predominance of sympathetic innervation in glaucoma patients compared to healthy subjects (P < 0.05).Before the CPT, the standard deviation of NN intervals (SDNN) of HRV was lower in HTG compared to NTG, 27.2 ± 4.1 ms and 35.33 ± 2.43 ms (P = 0.02), respectively. After the CPT, SDNN decreased in NTG by 1.7 ms and increased in HTG and healthy subjects by 5.0 ms and 7.09 ms, respectively (P < 0.05). The analysis of relative shift of other HRV parameters after the CPT also revealed a significant difference between NTG and HTG in regard to the predominance of sympathetic innervation in NTG compared to HTG.ConclusionPatients with NTG have more pronounced disturbance of autonomic nervous system than HTG patients, which is manifested with the activation of sympathetic nervous system in response to CPT. This finding refers to the NTG pathogenesis and suggests the use of HRV assessment in glaucoma diagnosis and monitoring.

Location of the internal carotid artery and ophthalmic artery segments for non-invasive intracranial pressure measurement by multi-depth TCD

ABSTRACTThe aim of the present study was to locate the ophthalmic artery by using the edge of the internal carotid artery (ICA) as the reference depth to perform a reliable non-invasive intracranial pressure measurement via a multi-depth transcranial Doppler device and to then determine the positions and angles of an ultrasonic transducer (UT) on the closed eyelid in the case of located segments. High tension glaucoma (HTG) patients and healthy volunteers (HVs) undergoing non-invasive intracranial pressure measurement were selected for this prospective study. The depth of the edge of the ICA was identified, followed by a selection of the depths of the IOA and EOA segments. The positions and angles of the UT on the closed eyelid were measured. The mean depth of the identified ICA edge for HTG patients was 64.3 mm and was 63.0 mm for HVs (p = 0.21). The mean depth of the selected IOA segment for HTG patients was 59.2 mm and 59.3 mm for HVs (p = 0.91). The mean depth of the selected EOA segment for HTG patients was 48.5 mm and 49.8 mm for HVs (p = 0.14). The difference in the located depths of the segments between groups was not statistically significant. The results showed a significant difference in the measured UT angles in the case of the identified edge of the ICA and selected ophthalmic artery segments (p = 0.0002). We demonstrated that locating the IOA and EOA segments can be achieved using the edge of the ICA as a reference point.Abbreviations: OA: ophthalmic artery; IOA: intracranial segments of the ophthalmic artery; EOA: extracranial segments of the ophthalmic artery; ICA: internal carotid artery; UT: ultrasonic transducer; HTG: high tension glaucoma; SD: standard deviation; ICP: intracranial pressure; TCD: transcranial Doppler

Identification of the Most Accurate Spectral-domain Optical Coherence Tomography Parameters in Eyes With Early High-Tension and Low-Tension Glaucoma.

The aim of the study was to compare the diagnostic ability of macular ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (pRNFL) thickness in high-tension glaucoma (HTG) and low-tension glaucoma (LTG). Glaucoma was defined as glaucomatous optic neuropathy and reproducible visual field defects. Patients were classified as having LTG if untreated intraocular pressure was ≤21 mm Hg on 2 different occasions. Only eyes with early glaucoma (mean deviation <-6 dB) were included. All patients underwent spectral-domain optical coherence tomography (SDOCT) imaging. A total of 56 normal subjects, 64 HTG patients, and 35 LTG patients were enrolled. Overall, after adjusting for mean deviation and age, the average pRNFL thickness in eyes with LTG was 18.7 µm thinner than in eyes with HTG (17% difference, P<0.01). In the HTG group, no significant difference was found between areas under the receiver operating characteristic curve (AUCs) for average GCC and average pRNFL thicknesses (0.77 vs. 0.68, P=0.06). In the LTG group, average pRNFL thickness had a significantly larger AUC compared with average GCC thickness (0.95 vs. 0.81, P<0.001). Comparing AUCs between HTG and LTG groups, although the average GCC had similar AUCs in both groups (P=0.47), the average pRNFL thickness had a significantly larger AUC in the LTG group (P<0.001). In eyes with early glaucoma, the pRNFL thickness scan seems to be a more accurate SDOCT protocol to identify those with LTG compared with the GCC thickness scan.

A Common Variant in MIR182 Is Associated With Primary Open-Angle Glaucoma in the NEIGHBORHOOD Consortium.

PurposeNoncoding microRNAs (miRNAs) have been implicated in the pathogenesis of glaucoma. We aimed to identify common variants in miRNA coding genes (MIR) associated with primary open-angle glaucoma (POAG).MethodsUsing the NEIGHBORHOOD data set (3853 cases/33,480 controls with European ancestry), we first assessed the relation between 85 variants in 76 MIR genes and overall POAG. Subtype-specific analyses were performed in high-tension glaucoma (HTG) and normal-tension glaucoma subsets. Second, we examined the expression of miR-182, which was associated with POAG, in postmortem human ocular tissues (ciliary body, cornea, retina, and trabecular meshwork [TM]), using miRNA sequencing (miRNA-Seq) and droplet digital PCR (ddPCR). Third, miR-182 expression was also examined in human aqueous humor (AH) by using miRNA-Seq. Fourth, exosomes secreted from primary human TM cells were examined for miR-182 expression by using miRNA-Seq. Fifth, using ddPCR we compared miR-182 expression in AH between five HTG cases and five controls.ResultsOnly rs76481776 in MIR182 gene was associated with POAG after adjustment for multiple comparisons (odds ratio [OR] = 1.23, 95% confidence interval [CI]: 1.11–1.42, P = 0.0002). Subtype analysis indicated that the association was primarily in the HTG subset (OR = 1.26, 95% CI: 1.08–1.47, P = 0.004). The risk allele T has been associated with elevated miR-182 expression in vitro. Data from ddPCR and miRNA-Seq confirmed miR-182 expression in all examined ocular tissues and TM-derived exosomes. Interestingly, miR-182 expression in AH was 2-fold higher in HTG patients than nonglaucoma controls (P = 0.03) without controlling for medication treatment.ConclusionsOur integrative study is the first to associate rs76481776 with POAG via elevated miR-182 expression.

TBK1 duplication is found in normal tension and not in high tension glaucoma patients of Indian origin.

TBK1 duplication is found in normal tension and not in high tension glaucoma patients of Indian origin.

Rate of progression of total, upper, and lower visual field defects in patients with open-angle glaucoma and high myopia.

We evaluated the rate of progression of total, upper, and lower visual field defects in patients with treated primary open-angle glaucoma (POAG) with high myopia (HM). Seventy eyes of 70 POAG patients with HM [≤-8 diopters (D)] were examined. The mean deviation (MD) slope and the upper and lower total deviation (upper TD, lower TD) slopes of the Humphrey Field Analyzer were calculated in patients with high-tension glaucoma (HTG) (>21 mmHg) versus normal-tension glaucoma (NTG) (≤21 mmHg). The mean age of all the patients (29 eyes with HTG and 41 eyes with NTG) was 48.5 ± 9.6 years. The MD slope, and upper and lower TD slopes of the HM group were compared to those of the non-HM group (NHM) (>-8 D) selected from 544 eyes in 325 age-matched POAG patients. In all, 70 eyes with HM and NHM were examined. The mean MD slope was -0.33 ± 0.33 dB/year in the HM, and -0.38 ± 0.49 dB/year in the NHM. There were no statistical differences between the HM and NHM (p = 0.9565). In the comparison of HTG versus NTG patients in both groups, the MD slope, and upper and lower TD slopes were similar. The rate of progression of total, upper, and lower visual field defects was similar among patients with HM and NHM. Although HM is a risk factor for the onset of glaucoma, HM may not be a risk factor for progression of visual field defects as assessed by the progression rate under treatment.

Risk Factors for Normal and High-Tension Glaucoma in Poland in Connection with Polymorphisms of the Endothelial Nitric Oxide Synthase Gene.

AimThe purpose of this study was to evaluate the influence of polymorphisms of the eNOS gene on the clinical status of patients with normal and high tension glaucoma.Methods266 Polish Caucasian patients with primary open angle glaucoma were studied. Of the 266, 156 had normal tension glaucoma (NTG) and 110 high tension glaucoma (HTG). DNA material was isolated from peripheral venous blood using commercial kits. Real-time PCR reaction was used to amplify the promoter site of the endothelial nitric oxide synthase (eNOS) gene, including the single nucleotide polymorphism (SNP) site T-786C and part of the 7th exon of eNOS, including G894T SNP. Genotypes were determined with TaqMan SNP Genotyping Assays.ResultsThere were no significant differences in frequencies of the allelic variants of both polymorphisms. In G894T SNP, however, the wild GG form was more common in the HTG group. The SNP of the eNOS gene did not significantly influence the progression rate in either of the groups studied. There were no differences in variants of the eNOS gene regarding the necessity for and success of surgery and the progression of the disease. In the NTG group, no statistical correlation was observed between G894T, T786C polymorphism variants, and risk factors such as optic disc haemorrhages, optic disc notches, and peripapillary atrophy. Mean diastolic and systolic pressure during the day and night were lowest in NTG patients with the CC variant of the T786C polymorphism. No statistical correlation was observed between the G894T and T786C polymorphisms and capillaroscopic examination results.ConclusionsGenotype frequencies are similar for both the eNOS G894T and T-786C polymorphisms in NTG and HTG patients. These polymorphisms do not correlate with risk factors and do not influence the state of the capillary system in NTG patients. Systolic blood pressure is lower in NTG patients with mutated alleles of both polymorphisms.