Macular Layer Thickness Research Articles

Statin Use in Relation to Intraocular Pressure, Glaucoma, and Ocular Coherence Tomography Parameters in the UK Biobank.

PurposeThe purpose of this study was to evaluate the relationship between statin use and glaucoma-related traits.MethodsIn a cross-sectional study, we included 118,153 UK Biobank participants with data on statin use and corneal-compensated IOP. In addition, we included 192,283 participants (8982 cases) with data on glaucoma status. After excluding participants with neurodegenerative diseases, 41,638 participants with macular retinal nerve fiber layer thickness (mRNFL) and 41,547 participants with macular ganglion cell inner plexiform layer thickness (mGCIPL) were available for analysis. We examined associations of statin use with IOP, mRNFL, mGCIPL, and glaucoma status utilizing multivariable-adjusted regression models. We assessed whether a glaucoma polygenic risk score (PRS) modified associations. We performed Mendelian randomization (MR) experiments to investigate associations with various glaucoma-related outcomes.ResultsStatin users had higher unadjusted mean IOP ± SD than nonusers, but in a multivariable-adjusted model, IOP did not differ by statin use (difference = 0.05 mm Hg, 95% confidence interval [CI] = −0.02 to 0.13, P = 0.17). Similarly, statin use was not associated with prevalent glaucoma (odds ratio [OR] = 1.05, 95% CI = 0.98 to 1.13). Statin use was weakly associated with thinner mRNFL (difference = −0.15 microns, 95% CI = −0.28 to −0.01, P = 0.03) but not with mGCIPL thickness (difference = −0.12 microns, 95% CI = −0.29 to 0.05, P = 0.17). No association was modified by the glaucoma PRS (Pinteraction ≥ 0.16). MR experiments showed no evidence for a causal association between the cholesterol-altering effect of statins and several glaucoma traits (inverse weighted variance P ≥ 0.14).ConclusionsWe found no evidence of a protective association between statin use and glaucoma or related traits after adjusting for key confounders.

Diagnostic Accuracy of Macular Thickness Map and Texture En Face Images for Detecting Glaucoma in Eyes With Axial High Myopia

To evaluate the diagnostic accuracy of a novel optical coherence tomography texture-based en face image analysis (SALSA-Texture) that requires segmentation of only 1 retinal layer for glaucoma detection in eyes with axial high myopia, and to compare SALSA-Texture with standard macular ganglion cell-inner plexiform layer (GCIPL) thickness, macular retinal nerve fiber layer (mRNFL) thickness, and ganglion cell complex (GCC) thickness maps. Comparison of diagnostic approaches. Cross-sectional data were collected from 92 eyes with primary open-angle glaucoma (POAG) and 44 healthy control eyes with axial high myopia (axial length >26mm). Optical coherence tomography texture en face images, developed using SALSA-Texture to model the spatial arrangement patterns of the pixel intensities in a region, were generated from 70-μm slabs just below the vitreal border of the inner limiting membrane. Areas under the receiver operating characteristic curves (AUROCs) and areas under the precision recall curves (AUPRCs) adjusted for both eyes, axial length, age, disc area, and image quality were used to compare different approaches. The best parameter-adjusted AUROCs (95% confidence intervals) for differentiating between healthy and glaucoma high myopic eyes were 0.92 (0.88-0.94) for texture en face images, 0.88 (0.86-0.91) for macular RNFL thickness, 0.87 (0.83-0.89) for macula GCIPL thickness, and 0.87 (0.84-0.89) for GCC thickness. A subset analysis of highly advanced myopic eyes (axial length ≥27mm; 38 glaucomatous eyes and 22 healthy eyes) showed the best AUROC was 0.92 (0.89-0.94) for texture en face images compared with 0.86 (0.84-0.88) for macular GCIPL, 0.86 (0.84-0.88) for GCC, and 0.84 (0.81-0.87) for RNFL thickness (P ≤ .02 compared with texture for all comparisons). The current results suggest that our novel en face texture-based analysis method can improve on most investigated macular tissue thickness measurements for discriminating between highly myopic glaucomatous and highly myopic healthy eyes. While further investigation is needed, texture en face images show promise for improving the detection of glaucoma in eyes with high myopia where traditional retinal layer segmentation often is challenging.

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

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

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.

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 < 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.

Longitudinal Analysis of the Retina and Choroid in Cognitively Normal Individuals at Higher Genetic Risk of Alzheimer Disease

To assess the baseline differences and longitudinal rate of change in retinal and choroidal imaging parameters between apolipoprotein ε4 (APOE ε4) carriers and noncarriers with normal cognition. Prospective study. Four hundred thirteen eyes of 218 individuals with normal cognition aged ≥ 55 years with known APOE status (98 APOE ε4 carriers and 120 noncarriers). The exclusion criteria included diabetes mellitus, uncontrolled hypertension, glaucoma, and vitreoretinal or neurodegenerative disease. OCT and OCT angiography (OCTA) were performed at baseline and 2 years (Zeiss Cirrus HD-OCT 5000 with AngioPlex; Zeiss Meditec). The groups were compared using sex- and age-adjusted generalized estimating equations. OCT parameters: retinal nerve fiber layer thickness, macular ganglion cell-inner plexiform layer thickness, central subfield thickness (CST), and choroidal vascularity index. OCT angiography parameters: foveal avascular zone area, perfusion density (PD), vessel density, peripapillary capillary PD (CPD), and capillary flux index (CFI). The rate of change per year was calculated. At the baseline, the APOE ε4 carriers had lower CST (P= 0.018), PD in the 6-mm ETDRS circle (P= 0.049), and temporal CFI (P= 0.047). Seventy-one APOE ε4 carriers and 78 noncarriers returned at 2 years; at follow-up, the 6-mm ETDRS circle (P= 0.05) and outer ring (P= 0.049) showed lower PD in the APOE ε4 carriers, with no differences in the rates of change between the groups (all P > 0.05). There was exploratory evidence of differences in the CST, PD, and peripapillary CFI between the APOE ε4 carriers and noncarriers with normal cognition. Larger and longer-term studies may help further elucidate the potential prognostic value of these findings.

Evaluation of University of North Carolina OCT Index for Diagnosis of Early Glaucoma

To evaluate the diagnostic performance of the University of North Carolina (UNC) OCT Index based on Cirrus high-definition OCT to discriminate early glaucomatous eyes from normal eyes in clinical practice. Evaluation of diagnostic test or technology. Ninety-eight patients with early glaucoma and 98 age-matched normal subjects. Macular ganglion cell-inner plexiform layer (GCIPL) thickness, peripapillary retinal nerve fiber layer (RNFL) thickness, and optic nerve head parameters were measured in each subject. The measurements were run through the UNC OCT algorithm to compare their diagnostic abilities. Area under the curve (AUC) of the receiver operating characteristic and sensitivity at 95% specificity. The AUC of the UNC OCT Index was 0.974. The best AUCs of the single parameters were those of the minimum GCIPL (0.926) of the macular GCIPL, average RNFL (0.916) of the peripapillary RNFL, and rim area (0.964) of the optic nerve head. The AUC of the UNC OCT Index was significantly greater than those of the minimum GCIPL and average RNFL (all P values < 0.05), and also outperformed the rim area. The sensitivity value of the UNC OCT Index (90.8) was greater than that of single OCT parameters (minimum GCIPL, 42.9; average RNFL, 64.3; rim area, 84.7) at 95% specificity. The diagnostic performance of the UNC OCT Index in discriminating early glaucomatous eyes from normal eyes is high and exceeds the best optic nerve head, peripapillary RNFL, and macular GCIPL parameters in clinical practice.

Relationship between macular intercapillary area measured by optical coherence tomography angiography and central visual field sensitivity in normal tension glaucoma

PurposeTo investigate the relationship of macular intercapillary area (ICA) with macular ganglion cell-inner plexiform layer (GCIPL) thickness and central visual field sensitivity (CVFS) in normal tension glaucoma (NTG).MethodsSeventy-eight early NTG...

Investigation of Retinal Alterations in Patients Recovered from COVID-19: A Comparative Study

ABSTRACT Aim : To evaluate any abnormalities on retinal examination and retinal microvascularity in patients recovered from COVID-19. Materials and Methods : Cross-sectional, case- control study. Patients between 18 and 65 years old with PCR-confirmed SARS-CoV-2 infection and age matched controls were included. Macular and retinal nerve fiber layer thickness, vessel density of the superficial (SCP) and the deep retinal capillary plexus (DCP) and the foveal avascular zone (FAZ) were measured and compared with controls. Results : This study included 200 eyes of 200 cases totally. Of them 105 cases were patients and 95 cases were controls. Retinal abnormalities were detected by indirect ophthalmoscopic examination in ten patients of 105 cases (10.5%). There was no statistically significant difference in the vessel density of the SCP and the DCP and the mean FAZ measurements. Conclusion : There isn’t any relevant difference between early post-COVID-19 patients and general population in terms of retinal microvascularity.

Optical Coherence Tomography Angiography Compared With Optical Coherence Tomography for Detection of Early Glaucoma With High Myopia.

Purpose: To investigate the diagnostic abilities of the perfusion density (PD) and structural thickness parameters in the peripapillary and macular regions measured by optical coherence tomography angiography (OCTA) and optical coherence tomography (OCT) and to test if their diagnostic abilities of early glaucoma are different between highly myopic (HM) and non-highly myopic (NHM) patients.Methods: A total of 75 glaucoma patients and 65 controls were included in the analyses. The glaucoma detection abilities of macular PD and peripapillary PD, along with macular ganglion cell-inner plexiform layer (mGCIPL) thickness and peripapillary retinal nerve fiber layer (pRNFL) thicknesses were compared between the HM and NHM group. Diagnostic ability was assessed by area under the receiver operating characteristics (AUC) curves, adjusted by age, axial length, and signal strength.Results: The diagnostic ability of macular PD and mGCIPL thickness had no significant difference in both HM and NHM groups. However, the diagnostic ability of peripapillary PD except in the temporal section was significantly lower in the HM group than in the NHM group (all p < 0.05). The diagnostic ability of the superior, nasal, and average pRNFL thickness was also significantly lower in the HM group than in the NHM group (all p < 0.05).Conclusion: This study demonstrated that although peripapillary PD and macular PD were both significantly reduced in patients with highly myopia, the diagnostic ability of peripapillary PD in HM patients was significantly lower than that in NHM patients, while macular PD was not. Macular OCTA along with OCT imaging should be included in the imaging algorithm in early glaucoma diagnosis in highly myopic patients.

Characterization of Retinal Architecture in Spinocerebellar Ataxia Type 3 and Correlation with Disease Severity.

Neurodegeneration affects the brain and peripheral nervous system in spinocerebellar ataxia type 3 (SCA3). As the retina is also involved, studying the retinal architecture in a cohort of patients could reveal clinically relevant biomarkers. The aim is to investigate retinal architecture in SCA3 to identify potential biomarkers. We evaluated 38 patients with SCA3 and 25 healthy age-matched controls, who underwent visual acuity assessment, intraocular pressure measurement, and fundoscopy and macular and peripapillary spectral domain optical coherence tomography (SD-OCT). We measured the peripapillary retinal nerve fiber layer (pRNFL) thickness in each quadrant of the temporal-superior-nasal-inferior-temporal chart and the macular layer thicknesses in each sector of the inner circle of the Early Treatment Diabetic Retinopathy Study (IC-ETDRS) grid. Linear regression analysis was employed to test the associations between retinal parameters and age, disease duration, CAG repeats, and SARA (Scale of the Assessment and Rating of Ataxia) and ICARS (International Cooperative Ataxia Rating Scale) scores in SCA3. In all sectors, except for the temporal quadrant, pRNFL was significantly thinner in SCA3 patients than in controls. Average total macular, ganglion cell layer (GCL), and inner plexiform layer (IPL) thicknesses were significantly decreased in SCA3 patients in comparison to controls. The average total macular thickness and the average thicknesses of RNFL, GCL, and IPL negatively correlated with ICARS scores, whereas average GCL and IPL thicknesses negatively correlated with SARA scores. The retinal ganglion cells, their dendrites, and axons are selectively affected in SCA3 patients. The RNFL, GCL, and IPL thicknesses in SD-OCT correlate with the clinical phenotype and represent potential biomarkers for future clinical trials and natural history studies. © 2021 International Parkinson and Movement Disorder Society.

Baseline Vessel Density Parameters for Predicting Visual Field Progression in Open-Angle Glaucoma Eyes With Central Visual Field Damage

To identify the baseline vessel density (VD) parameters that predict visual field (VF) progression in patients with open-angle glaucoma (OAG) with central visual field (CVF) damage. Retrospective cohort study. This study enrolled 208 eyes from 208 consecutive patients with OAG with CVF damage at baseline and with a minimum 2 years of follow-up. Optical coherence tomography (OCT) angiography was used to measure circumpapillary and macular VDs in the retina and parapapillary VD in the choroid (pCVD) at the baseline. The circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell-inner plexiform layer (mGCIPL) thicknesses were also measured as reference standards. Cox proportional hazard analysis was performed to identify the baseline clinical factors associated with VF progression according to the glaucoma stage. The relationships between the CVF mean sensitivity reduction rate during follow-up and the baseline clinical factors were evaluated. VF progression was detected in 54 eyes (26.0%) during 2.78 years of mean follow-up. A lower pCVD (hazard ratio=0.916, P=.014) at baseline in early-stage OAG eyes and a reduced baseline average mGCIPL thickness (hazard ratio=0.896, P=.001) in eyes with moderate to advanced glaucoma were independent predictors of VF progression. The baseline pCVD (β=0.018, P=.028) in eyes with early-stage glaucoma and the baseline average mGCIPL thickness (β=0.035, P=.013) in eyes with moderate to advanced glaucoma were significantly correlated with the rate (dB/y) of CVF mean sensitivity reduction. In eyes with OAG with CVF damage, a lower baseline pCVD in early-stage glaucoma and a reduced mGCIPL thickness at baseline in moderate to advanced glaucoma are significantly associated with subsequent VF progression.

Transplantation of Bone Marrow Mesenchymal Stem Cells (BMSCs) Overexpressing Circular Zinc Finger Protein 609 Alleviates Diabetic Retinopathy

Diabetic retinopathy (DR) is a chronic complications and its pathogenesis remains unclear. This study aims to elucidate the underlying mechanism by how bone marrow mesenchymal stem cells (BMSCs) affects DR development in a rat model. A rat model of DR was established and injected with BMSCs overexpressing Cir-ZNF609 and shRNA Cir-ZNF609 to vitreous body followed by analysis of the retinal vascular permeability and macular retinal layers thickness, and the levels of HIF-1α, ICAM-1 and VEGF in rat retina by ELISA and immunohistochemistry. Injection of BMSCs overexpressing Cir-ZNF609 resulted in decreased HIF-1α ICAM-1 and VEGF expression, amelioration of retinal ganglion choriocapillaris injury and reducing ganglion cells. Twelve weeks after treatment, neovascularization took place and fibroblasts appeared with some nucleus disappearing and pigment taking off. Besides, permeability also elevated in the presence of overexpressing Cir-ZNF609 and penetration rate for Evans blue (16.36+3.25, 15.45±3.46 μg/g) was lower than healthy rats (28.66±2.08, 32.24±4.36 μg/g) and controls (26.93±3.03, 33.49±5.02 μg/g) (p &lt; 0.01). Moreover, upregulation of Cir-ZNF609 decreased retinal thickness and macular volume in DR rats (p &lt; 0.05). In conclusion, intravitreal injection of mouse BMSCs overexpressing Cir-ZNF609 alleviates retinal injury and decreases retinal thickness and macular volume, and enhances neovascularization. These evidence provides a novel insight into gene therapy for DR.

Symmetry of Peripapillary-Optical Coherence Tomography Angiography Parameters between Dominant and Non-dominant Eyes in Normal Eyes

Purpose: To assess whether optical coherence tomography (OCT) measurements and peripapillary microvascular parameters measured via optical coherence tomography angiography (OCTA) were similar between the dominant and non-dominant eyes of normal subjects.Methods: We retrospectively analyzed spectral domain OCT and OCTA data on healthy Koreans. The “hole-in-the-card” technique was used to determine ocular dominance. The perfusion density (PD) and flux index (FI) of the peripapillary 4.5 × 4.5-mm area were measured via OCTA. Central macular, peripapillary retinal nerve fiber layer, and macular ganglion cell-inner plexiform layer thicknesses were measured with the aid of spectral-domain OCT. The OCT and OCTA data of dominant and non-dominant eyes were compared.Results: A total of 84 eyes of 42 healthy subjects were analyzed. The average age was 27.3 ± 5.63 years. Twenty-eight subjects (66.7%) were right eye-dominant and 14 (33.3%) left eye-dominant. None of the central macular (260.00 ± 14.16 μm, 258.71 ± 15.18 μm, &lt;i&gt;p&lt;/i&gt; = 0.183), macular ganglion cell-inner plexiform layer (82.02 ± 5.07 μm, 82.43 ± 5.60 μm, &lt;i&gt;p&lt;/i&gt; = 0.460), or peripapillary retinal nerve fiber layer thickness (99.36 ± 9.27 μm, 97.90 ± 9.46 μm, &lt;i&gt;p&lt;/i&gt; = 0.091) differed between the eyes; neither did any OCTA-assessed microvascular parameter.Conclusions: No OCT or OCTA parameter differed between dominant and non-dominant eyes. No parameter identified ocular dominance.

Evaluation of Retinal Nerve Fiber Layer Thickness and Macular Thickness in Amblyopic Children

Objective: To compare central macular and retinal nerve fiber layer (RNFL) thickness using Spectral Domain Optical Coherence Tomography (SD-OCT) among patients with hyperopic anisometropic, strabismic and mixed amblyopia and healthy controls. Method: This prospective, cross-sectional study included 39 amblyopic children, their fellow eyes and 20 healthy individuals. Central macular and RNFL (superior, nasal, inferior and temporal quadrants and mean RNFL) thicknesses were measured with SD-OCT. Results: Difference was not statistically significant in the central macular thickness when the anisometropic, strabismic and mixed amblyopia groups were compared among themselves, fellow eyes and healthy control group. In the anisometropic amblyopic group, the inferior RNFL and nasal RNFL values were significantly thicker compared to the fellow eyes (p=0.009, p=0.028, respectively). Mean RNFL measurements were significantly thicker in anisometropic and mixed groups in the amblyopic eyes compared to the fellow eyes (p=0.009, p=0.031, respectively). In the temporal quadrant, the RNFL was found to be statistically significantly thinner in the anisometropic and mixed amblyopic groups compared to the fellow eyes (p=0.049, p=0.010, respectively). Conclusions: There was no considerably difference in the central macular thickness among the amblyopia groups, fellow eyes and healthy controls. However, significant changes were found in the mean RNFL and certain quadrants of the RNFL thicknesses in the anisometropic and mixed amblyopic groups.

Diagnostic accuracy of total macular and ganglion cell layer thickness in differentiating different stages of glaucoma: an SD-OCT study

Purpose: To determine the diagnostic accuracy of mean macular retinal thickness (mRT) and macular ganglion cell layer (mGCL) thickness measured by Spectralis spectral-domain optical coherence tomography (SD-OCT) posterior pole thickness map (PPTM) in differentiating between normal and glaucoma eyes of different severity.Study design: Cross-sectional study.Methods: All subjects were divided into normal and glaucoma groups according to the visual fields-based Glaucoma Staging System. They underwent slit-lamp examination, Humphrey visual field test, and SD-OCT (PPTM) imaging. mRT and mGCL thickness measurements were recorded. Analysis of variance with the least significant difference post hoc test was used for pairwise comparison. Ability to discriminate between normal eyes and those with differing severity of glaucoma was assessed using the area under the receiver operating characteristic curve (AUROC).Results: A total of 201 eyes from 201 subjects were enrolled in this study. The mean glaucoma was 290.2 ± 12.1 μm, 270.1 ± 17.0 μm, and 259.1 ± 15.0 μm, respectively. Mean mGCL thickness for the corresponding three groups was 32.3 ± 2.8 μm, 27.6 ± 3.3 μm and 22.2 ± 3.8μm, respectively. AUROC analysis showed excellent diagnostic discrimination between glaucoma and normal subjects for mRT (AUC: 0.90) and mGCL thickness (AUC: 0.92). The cut-off value of mRT was 274.9 μm (90% sensitivity, 75% specificity) and of mGCL thickness was 27.9 μm (93% sensitivity, 74% specificity). The discrimination ability performance of mRT and mGCL thickness deteriorated with increasing severity of glaucoma with mGCL thickness (AUC: 0.67–0.87) performing slightly better than mRT for all grades (AUC: 0.58–0.71).Conclusions: mRT and mGCL thickness measurement on PPTM showed great sensitivity and specificity to discern between normal and glaucomatous subjects. The discrimination ability of mRT and mGCL thickness, however, decreases with increasing grade of glaucoma. We believe SD-OCT PPTM offers an alternative imaging method to detect early glaucoma.

Hydroxychloroquine retinal toxicity- Can we do better with SD-OCT?

Hydroxychloroquine used in the management of connective tissue diseases also used to treat a wide spectrum of diseases. This disease-modifying anti-rheumatic drug can cause irreversible retinal damage and there are preferred practice guidelines for early screening to aid ophthalmologists and all those involved in the management of these patients. Spectral-Domain Optical Coherence Tomography (SD-OCT) currently an important tool in early detection of possible toxicity. Even with the current guideline-recommended 5mg/kg/day dosage, a baseline SD-OCT of the macula should be taken and repeated at 5 years. Many cross-sectional studies using SD-OCT have shown earlier retina damages, but none had monitored continuously from the beginning of Hydroxychloroquine usage. To evaluate sequential changes of the retina thickness in patients newly treated with hydroxychloroquine. We compared the mean central macular and Retinal Nerve Fiber Layer (RNFL) thickness pre, 3 months and 6 months post hydroxychloroquine using SD-OCT in order to find an association between them over the three time-points.33 previously healthy patients who were newly confirmed clinically and serologically with connective tissue disease planned for hydroxychloroquine who fulfilled the inclusion and exclusion criteria were recruited over 2 years. In consideration of selection criteria and drop-out rate, finally, 26 patients were included in the study.26 eyes of 26 patients (20 females and 6 males) were included in the study. The mean age was 33.92. The macula was significantly thinner (P&amp;#60;0.05) at superior (P&amp;#60;0.032), temporal (P&amp;#60;0.025), and inferior (P&amp;#60;0.016) parafoveal areas. RNFL showed significantly thinning at the temporal quadrant (P&amp;#60;0.041). Further analysis showed significant occurrences of parafoveal inferior thinning at 3 (P&amp;#60;0.035) and 6 (P&amp;#60;0.032) months. Correlation analysis between parafoveal thinning and the mean optic disc RNFL showed a significant result (p =0.004, r=0.55). The mean optic disc RNFL thickness significantly affected lesser (p =0.004, r =0.302) than the perifoveal area (p =0.001, r =0.784) when compared to the typical parafoveal pattern of thinning in this toxicity.There is a need for an earlier repetition of SD-OCT imaging before 5 years to detect potential toxicity. Involvement of RNFL requires further investigation and monitoring.

Spatial positional relationship between macular superficial vessel density and ganglion cell-inner plexiform layer thickness in primary angle closure glaucoma

PurposeTo evaluate the spatial relationship between macular superficial vessel density (SVD) and macular ganglion cell-inner plexiform layer (GCIPL) thickness in primary angle closure glaucoma (PACG), and to investigate diagnostic abilities of macular SVD and foveal avascular zone (FAZ) parameters.MethodsThis was a cross-sectional study on 38 PACG patients (38 eyes) and 25 healthy subjects (25 eyes). Macular region was imaged using a 1050-nm-wavelength swept-source optical coherence tomography (OCT) angiography (OCTA) system (DRI OCT Triton, TOPCON). Vessel density of the macular region was quantified by ImageJ software. The peripapillary retinal nerve fiber layer (pRNFL) thicknesses and macular GCIPL thickness were obtained by swept-source OCT. Pearson correlation analysis was used to evaluate the spatial positional relationship between macular SVD and macular GCIPL thickness. At the same time, the correlation between macular SVD and pRNFL thickness was evaluated. Areas under the receiver operating characteristics curves (AUCs) of OCT, OCTA and FAZ measurement metrics were calculated to assess the diagnostic ability for glaucoma.ResultsMacular GCIPL thickness had a moderate correlation with the macular SVD in the inferonasal sector (r = 0.426, P = 0.008). In addition, there was a strong correlation between inferonasal sector of macular vessel density and 5,6,7,8 clock-hour regions of the pRNFL thicknesses (all r > 0.5). Inferoinferior sector of macular SVD and 6,7 clock-hour regions of pRNFL thicknesses also had strong correlation (all r > 0.5). The AUCs of macular SVD ranged between 0.61 (superonasal sector) and 0.76 (inferoinferior sector). The FAZ circularity index showed the highest diagnostic power (AUC = 0.94;95% CI, 0.85–0.99), followed by superotemporal sector of macular GCIPL thicknesses (0.93;95% CI,0.83–0.98).ConclusionsSector of macular SVD not only had a spatial positional correlation with corresponding macular GCIPL thickness, but also with clock-hour regional pRNFL thicknesses in PACG eyes. FAZ circulation index might be a useful diagnostic parameter.

Cystoid maculopathy is a frequent feature of Cohen syndrome-associated retinopathy

Cohen syndrome (CS) is a rare syndromic form of rod-cone dystrophy. Recent case reports have suggested that cystoid maculopathy (CM) could affect CS patients with an early onset and high prevalence. Our study aims at improving our understanding and management of CM in CS patients through a retrospective case series of ten CS patients with identified pathogenic variants in VPS13B. Longitudinal optical coherence tomography (OCT) imaging was performed and treatment with carbonic anhydrase inhibitors (CAI) was provided to reduce the volume of cystoid spaces. CM affected eight out of ten patients in our cohort. The youngest patient showed a strong progression of macular cysts from the age of 4.5 to 5 years despite oral CAI medication. Other teenage and young adult patients showed stable macular cysts with and without treatment. One patient showed a moderate decrease of cystoid spaces in the absence of treatment at 22 years of age. Through a correlative analysis we found that the volume of cystoid spaces was positively correlated to the thickness of peripheral and macular photoreceptor-related layers. This study suggests that CAI treatments may not suffice to improve CM in CS patients, and that CM may resolve spontaneously during adulthood as photoreceptor dystrophy progresses.

Comparison of the 24-2 and 24-2C Visual Field Grids in Determining the Macular Structure-Function Relationship in Glaucoma.

The 24-2C grid showed significantly greater structure-function (S-F) associations in the global and regional sectors than the 24-2 visual field (VF) grid in open-angle glaucoma eyes. The aim was to compare a Humphrey Field Analyzer (HFA) Swedish Interactive Threshold Algorithm-Faster (SITA-faster) 24-2C grid to a conventional HFA 24-2 grid regarding macular S-F relationships. The macular ganglion cell-inner plexiform layer thickness (mGCIPLT) was measured at different parafoveal sectors using spectral-domain optical coherence tomography in 150 eyes from 150 healthy, preperimetric, and perimetric glaucoma subjects. The central visual field mean sensitivity (VFMS) on the decibel and 1/L scales and the parafoveal mGCIPLT were matched topographically in 4 sectors and the strengths of the S-F relationships were assessed using "weighted" correlation coefficients and compared between 24-2C and 24-2 VF test grids. There were significant global and sectoral correlations between the mGCIPLT and VFMS using both VF grids. The S-F correlations between the average/hemimacular mGCIPLT and the corresponding VFMS using a 24-2C grid were however significantly greater in both the entire and perimetric glaucoma groups (P<0.05), except for the average mGCIPLT of the perimetric glaucoma group in the 1/L scale (P=0.065). The 24-2C grid showed significantly greater S-F associations in the superotemporal and inferotemporal parafoveal sectors than the 24-2 VF grid (both P<0.05). A 24-2C grid may offer an advantage over the conventional 24-2 VF grid in assessing macular S-F relationships.