Macular Measurements Research Articles

Macular pigment optical density measurement by heterochromatic flicker photometry: Challenging a basic premise

Measurement of macular pigment optical density (MPOD) in the human eye is important due to the protection it provides against certain eye diseases such as age-related macular degeneration. A commonly used psychophysical technique is heterochromatic flicker photometry (HFP). This technique assumes a uniformity in the retinal spectral sensitivity from the central fovea to the surrounding parafovea, areas of the retina employed in HFP. We show here that the MPOD spectrum obtained by HFP is characteristic of the carotenoids of which the macular pigment is composed, but only in the blue part of the spectrum. At longer wavelengths, in the red part of the spectrum, the measured MPOD was found to rise with increasing wavelength. We propose that this artefact is due to different contributions to retinal spectral sensitivity in the fovea and parafovea from long- (LWS) and medium-wavelength-sensitive (MWS) cones. By adjusting the LWS/MWS ratio, we could calculate potential retinal spectral sensitivities for the fovea and parafovea that would account for the apparent MPOD in the red part of the spectrum. An LWS/MWS ratio of 4.15 in the parafovea, relative to the fovea, provided the necessary correction, and had the additional effect of providing an increase in the measured peak MPOD at 460 nm. Caution is therefore warranted when using HFP to measure only the peak MPOD, as is commonly the case.

Association of Optic Nerve Head and Macular Optical Coherence Tomography Measures With Glaucoma-Related Disability.

Optical coherence tomography (OCT) estimated retinal nerve fiber layer (RNFL) thickness associated with glaucoma-related disability independent of the visual field (VF) damage and thus may provide additional patient-relevant disability information beyond what is captured by standard VF testing. To examine whether OCT metrics [peripapillary RNFL thickness and macular ganglion cell/inner plexiform layer (GCIPL) thickness] are associated with quality of life (QoL) measures and additional disability metrics, and whether these associations are independent of VF damage. In this cross-sectional study, 156 patients with glaucoma or suspected glaucoma received VF testing and OCT scans to measure RNFL and GCIPL thickness. QoL was assessed using the Glaucoma Quality-of-Life 15 and additional disability measures including fear of falling, reading speed, and steps per day were assessed. Multivariable regression models adjusting for relevant covariates tested whether RNFL or GCIPL thickness from the less-impaired eye were associated with disability measures and whether associations were independent of VF damage. Greater VF damage is associated with worse QoL (95% CI=0.4-1.4; P <0.001) and slower reading speed (CI=-0.06 to -0.02; P <0.001). Lower RNFL and GCIPL thicknesses were associated with lower QoL scores, but not with QoL scores or other disability metrics after correcting for VF damage. However, post hoc analyses in patients with better eye thicknesses between 55 and 75µm demonstrated associations between lower RNFL thickness and worse QoL (CI=-2.2 to -0.1; P =0.04) and greater fear of falling (CI=-6.1 to -0.4; P =0.03) even after accounting for VF damage. No such associations were observed for GCIPL thickness. OCT RNFL, but not GCIPL, thickness is associated with multiple disability measures independent of VF damage severity.

Reproducibilidad de la densidad vascular peripapilar, cabeza del nervio óptico y área macular por OCT-A de acuerdo con la severidad del glaucoma

ObjectiveTo assess the reproducibility of peripapillary, optic nerve head (ONH-PP) and macular vessel density (VD) by spectral domain optical coherence tomography angiography (SD OCT-A) in glaucoma patients and healthy subjects. MethodsCross-sectional study assessing 63 eyes of 63 subjects, including 33 glaucoma patients and 30 healthy subjects. Glaucoma was classified in mild, moderate, or advanced. Two consecutive scans were acquired by spectralis module OCT-A (Heidelberg, Germany), and provided images of the superficial vascular complex (SVC), nerve fiber layer vascular plexus (NFLVP), superficial vascular plexus (SVP), deep vascular complex (DVC), intermediate capillary plexus (ICP) and deep capillary plexus (DCP). VD (%) was calculated by AngioTool. Intraclass correlation coefficients (ICCs) and coefficients of variation (CV) were calculated. ResultsAmong ONH-PP VD, better ICC presented advanced (0.86-0.96) and moderate glaucoma (0.83-0.97) compared with mild glaucoma (0.64-0.86). For the macular VD reproducibility, ICC results for superficial retinal layers were better for mild glaucoma (0.94-0.96) followed by moderated (0.88-0.93) and advanced glaucoma (0.85-0.91), and for deeper retinal layers ICC was better for moderate glaucoma (0,95-0,96) followed by advanced (0.80-0.86) and mild glaucoma (0.74-0.91). CVs ranged from 2.2%% to 10.94%. Among healthy subjects, ICCs for the ONH-PP VD measurements (0.91-0.99) and for the macular VD measurements (0.93-0.97) were excellent in all layers, with CVs from 1.65% to 10.33%. ConclusionsSD OCT-A used to quantify macular and ONH-PP VD showed excellent and good reproducibility in most layers of the retina, both in healthy subjects and in glaucoma patients regardless of the severity of the disease.

Reproducibility of peripapillary, optic nerve head and macular vessel density by OCT-A according to glaucoma severity staging

ObjectiveTo assess the reproducibility of peripapillary, optic nerve head (PP-ONH) and macular vessel density (VD) by Spectral Domain optical coherence tomography angiography (SD OCT-A) in glaucoma patients and healthy subjects. MethodsCross-sectional study assessing 63 eyes of 63 subjects, including 33 glaucoma patients and 30 healthy subjects. Glaucoma was classified in mild, moderate, or advanced. Two consecutive scans were acquired by Spectralis Module OCT-A (Heidelberg, Germany), and provided images of the superficial vascular complex (SVC), nerve fiber layer vascular plexus (NFLVP), superficial vascular plexus (SVP); deep vascular complex (DVC), intermediate capillary plexus (ICP) and deep capillary plexus (DCP). VD (%) was calculated by AngioTool. Intraclass correlation coefficients (ICCs) and coefficients of variation (CV) were calculated. ResultsAmong PP-ONH VD, better ICC presented advanced (ICC 0.86–0.96) and moderate glaucoma (ICC 0.83–0.97) compared with mild glaucoma (0.64−0.86). For the macular VD reproducibility, ICC results for superficial retinal layers were better for mild glaucoma (0.94−0.96) followed by moderated (0.88−0.93) and advanced glaucoma (0.85−0.91), and for deeper retinal layers ICC was better for moderate glaucoma (0.95–0.96) followed by advanced (0.80−0.86) and mild glaucoma (0.74−0.91). CVs ranged from 2.2% to 10.94%. Among healthy subjects, ICCs for the PP-ONH VD measurements (0.91−0.99) and for the macular VD measurements (0.93−0.97) were excellent in all layers, with CVs from 1.65% to 10.33%. ConclusionsSD OCT-A used to quantify macular and PP-ONH VD showed excellent and good reproducibility in most layers of the retina, both in healthy subjects and in glaucoma patients regardless of the severity of the disease.

Diagnostic ability of macular microvasculature with swept-source OCT angiography for highly myopic glaucoma using deep learning

Macular OCT angiography (OCTA) measurements have been reported to be useful for glaucoma diagnostics. However, research on highly myopic glaucoma is lacking, and the diagnostic value of macular OCTA measurements versus OCT parameters remains inconclusive. We aimed to evaluate the diagnostic ability of the macular microvasculature assessed with OCTA for highly myopic glaucoma and to compare it with that of macular thickness parameters, using deep learning (DL). A DL model was trained, validated and tested using 260 pairs of macular OCTA and OCT images from 260 eyes (203 eyes with highly myopic glaucoma, 57 eyes with healthy high myopia). The DL model achieved an AUC of 0.946 with the OCTA superficial capillary plexus (SCP) images, which was comparable to that with the OCT GCL+ (ganglion cell layer + inner plexiform layer; AUC, 0.982; P = 0.268) or OCT GCL++ (retinal nerve fiber layer + ganglion cell layer + inner plexiform layer) images (AUC, 0.997; P = 0.101), and significantly superior to that with the OCTA deep capillary plexus images (AUC, 0.779; P = 0.028). The DL model with macular OCTA SCP images demonstrated excellent and comparable diagnostic ability to that with macular OCT images in highly myopic glaucoma, which suggests macular OCTA microvasculature could serve as a potential biomarker for glaucoma diagnosis in high myopia.

Macular vessel density in the superficial plexus is not associated to cerebrospinal fluid core biomarkers for Alzheimer's disease in individuals with mild cognitive impairment: The NORFACE cohort.

Optical coherence tomography angiography (OCT-A) is a novel method in the dementia field that allows the detection of retinal vascular changes. The comparison of OCT-A measures with established Alzheimer's disease (AD)-related biomarkers is essential to validate the former as a marker of cerebrovascular impairment in the AD continuum. We aimed to investigate the association of macular vessel density (VD) in the superficial plexus quantified by OCT-A with the AT(N) classification based on cerebrospinal fluid (CSF) Aβ1-42, p181-tau and t-tau measurements in individuals with mild cognitive impairment (MCI). Clinical, demographic, ophthalmological, OCT-A and CSF core biomarkers for AD data from the Neuro-ophthalmology Research at Fundació ACE (NORFACE) project were analyzed. Differences in macular VD in four quadrants (superior, nasal, inferior, and temporal) among three AT(N) groups [Normal, Alzheimer and Suspected non-Alzheimer pathology (SNAP)] were assessed in a multivariate regression model, adjusted for age, APOE ε4 status, hypertension, diabetes mellitus, dyslipidemia, heart disease, chronic obstructive pulmonary disease and smoking habit, using the Normal AT(N) group as the reference category. The study cohort comprised 144 MCI participants: 66 Normal AT(N), 45 Alzheimer AT(N) and 33 SNAP AT(N). Regression analysis showed no significant association of the AT(N) groups with any of the regional macular VD measures (all, p > 0.16). The interaction between sex and AT(N) groups had no effect on differentiating VD. Lastly, CSF Aβ1-42, p181-tau and t-tau measures were not correlated to VD (all r < 0.13; p > 0.13). Our study showed that macular VD measures were not associated with the AT(N) classification based on CSF biomarkers in patients with MCI, and did not differ between AD and other underlying causes of cognitive decline in our cohort.

Association between macular and papillary vessel density by optical coherence tomography angiography in a large healthy population

PurposeTo provide a normative data set of the relationship between macular and papillary vessel density (VD) using swept-source optical coherence tomography angiography (SS-OCTA) in a large healthy population. MethodsCross-sectional study conducted on 346 right eyes of healthy subjects. Macular and papillary SS-OCTA VD measurements of the retinal superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC) in the central area and the four quadrants were obtained. Correlations between macular and papillary VD among different quadrants were assessed. ResultsThe mean participant age was 37.7 ± 19.8 years (range 5–83); 59% were women. No correlation was detected neither for the global SCP (R = 0.050; P = 0.040), DCP (R = -0.056; P = 0.038) nor CC (R = 0.102; P < 0.001) between macular and papillary VD. In a subanalysis, there was also no correlation in any of the quadrants studied (R ≤ 0.180; P < 0.001). In a subgroup of 45 left eyes, there was no correlation in the different plexus and layers studied between macular and papillary vasculature. No differences in SCP, DCP and CC were found according to gender, age or axial length in the relationship between macular and papillary VD. ConclusionThere is no association between macular and papillary VD neither in the SCP, DCP or CC in any of the regions studied. Hence, macular and optic nerve head vascularization should be investigated separately to identify which structure is more relevant in each disease.

The Association of Alcohol Consumption with Glaucoma and Related Traits: Findings from the UK Biobank

To examine the associations of alcohol consumption with glaucoma and related traits, to assess whether a genetic predisposition to glaucoma modified these associations, and to perform Mendelian randomization (MR) experiments to probe causal effects. Cross-sectional observational and gene-environment interaction analyses in the UK Biobank. Two-sample MR experiments using summary statistics from large genetic consortia. UK Biobank participants with data on intraocular pressure (IOP) (n=109097), OCT-derived macular inner retinal layer thickness measures (n=46236) and glaucoma status (n=173407). Participants were categorized according to self-reported drinking behaviors. Quantitative estimates of alcohol intake were derived from touchscreen questionnaires and food composition tables. We performed a 2-step analysis, first comparing categories of alcohol consumption (never, infrequent, regular, and former drinkers) before assessing for a dose-response effect in regular drinkers only. Multivariable linear, logistic, and restricted cubic spline regression, adjusted for key sociodemographic, medical, anthropometric, and lifestyle factors, were used to examine associations. We assessed whether any association was modified by a multitrait glaucoma polygenic risk score. The inverse-variance weighted method was used for the main MR analyses. Intraocular pressure, macular retinal nerve fiber layer (mRNFL) thickness, macular ganglion cell-inner plexiform layer (mGCIPL) thickness, and prevalent glaucoma. Compared with infrequent drinkers, regular drinkers had higher IOP (+0.17 mmHg; P<0.001) and thinner mGCIPL (-0.17 μm; P= 0.049), whereas former drinkers had a higher prevalence of glaucoma (odds ratio, 1.53; P= 0.002). In regular drinkers, alcohol intake was adversely associated with all outcomes in a dose-dependent manner (all P<0.001). Restricted cubic spline regression analyses suggested nonlinear associations, with apparent threshold effects at approximately 50 g (∼6 UK or 4 US alcoholic units)/week for mRNFL and mGCIPL thickness. Significantly stronger alcohol-IOP associations were observed in participants at higher genetic susceptibility to glaucoma (Pinteraction < 0.001). Mendelian randomization analyses provided evidence for a causal association with mGCIPL thickness. Alcohol intake was consistently and adversely associated with glaucoma and related traits, and at levels below current United Kingdom (< 112 g/week) and United States (women, < 98 g/week; men, < 196 g/week) guidelines. Although we cannot infer causality definitively, these results will be of interest to people with or at risk of glaucoma and their advising physicians. Proprietary or commercial disclosure may be found after the references.

Microperimetry assessment in foveal hypoplasia: functional results in a series of pediatric patients

ObjectifÉtudier le lien entre les paramètres fonctionnels et morphologiques de la rétine chez des enfants présentant différents degrés d'hypoplasie fovéale (HF). NatureÉtude d'observation rétrospective réalisée dans un seul centre. ParticipantsSur les 21 enfants, 16 répondaient aux critères d'inclusion et présentaient une HF confirmée par tomographie par cohérence optique en domaine spectral (SD-OCT). MéthodesLes données ont été analysées de manière rétrospective. Les patients qui étaient en mesure de subir une micropérimétrie maculaire (MPM) et une SD-OCT ont été inclus dans l'analyse. La corrélation de Pearson a servi à comparer les résultats de la MPM et de la SD-OCT en fonction du degré d'HF et de la meilleure acuité visuelle corrigée (MAVC). RésultatsOnt été analysés 31 yeux de 16 patients (âge moyen : 12,4 ans) présentant différents degrés d'HF : grade 1 chez 2 patients; grade 2 chez 7 patients; grade 3 chez 5 patients et grade 4 chez 2 patients. De ce nombre, 8 patients présentaient un nystagmus clinique. La corrélation entre la MAVC et les données obtenues à la SD-OCT (–0,31) était plus faible que celle entre la MAVC et le nystagmus (0,64), l'indice de fixation P1 (–0,60) et la sensibilité maculaire (–0,63). ConclusionsMalgré les limites que présente notre petit échantillonnage, notre étude confirme la faisabilité de l’évaluation par MPM automatisée chez des enfants qui présentent une HF. Elle est d'autant plus intéressante qu'elle fournit des données sur les liens entre les mesures maculaires anatomiques et fonctionnelles obtenues grâce à la SD-OCT et à la MPM, d'une part, et la MAVC, d'autre part, dans des yeux qui présentent différents degrés d'HF. Des études prospectives de plus grande envergure permettront de confirmer nos résultats.

Reproducibility of macular perfusion parameters in non-proliferative diabetic retinopathy patients by two different OCTA sweep modes.

To assess the reproducibility of macular perfusion parameters in non-proliferative diabetic retinopathy (NPDR) patients measured by different examiners and two different sweep modes of optical coherence tomography angiography (OCTA). Ninety-eight (98 eyes) patients with NPDR were included in this study. All participates were performed three times using Cirrus OCTA with Angiography 3×3 mm2 and 6×6 mm2 sweep mode by two examiners. The macular foveal avascular zone (FAZ) and vessel density (VD) in the superficial retinal layer (SRL) were measured. The reproducibility of the measurements was evaluated with intraclass correlation coefficients (ICC) and coefficient of variation (CoV). The intra-mode ICCs of Angiography 3×3 mm2 and 6×6 mm2 sweep mode were 0.957 to 0.959 and 0.964 to 0.977, respectively; and the inter-mode ICCs were 0.962 to 0.970. The intra-examiner ICCs of macular perfusion parameters were >0.950; and the inter-examiner ICCs were 0.928 to 0.969. All CoVs were <1.0%. Cirrus OCTA can measure macular perfusion parameters in NPDR patients with excellent reproducibility. The measurements of FAZ and VD in the SRL determined by Angiography 3×3 mm2 and 6×6 mm2 sweep mode are highly consistent and both sweep modes are suitable for macular perfusion parameters measurement.

Effect of Ocular Magnification on Macular Choroidal Thickness Measurements Made Using Optical Coherence Tomography in Children

Purpose To evaluate the relationship between ocular magnification correction and macular choroidal thickness (ChT) measurements in children, and to demonstrate when ocular magnification correction is necessary. Methods Chinese children aged 6–9 years with various refractive statuses were included. Swept-source optical coherence tomography was used to measure macular ChT. A self-designed program was adopted to simulate ChT changes in each sector of the ETDRS grid in the macula under various simulated axial lengths (ALs). Results ChT measurements were not affected for all simulated ALs in over 95% of the individuals in the central fovea. In the inferior, superior, and temporal parafoveal sectors, the extent of AL that may include 95% of the individuals narrowed from approximately 22.0 mm to 27.2 mm. In the nasal parafoveal sector and inferior, superior, and temporal perifoveal sectors, the extent of AL that may include 95% of the individuals became even narrower, from approximately 22.8 mm to 26.0 mm. The narrowest extent was observed in the perifoveal nasal sector, ranging from 23.3 mm to 25.5 mm. The effect of ocular magnification was more significant in hyperopes than in myopes in the inferior parafoveal sector and temporal, superior, and nasal perifoveal sectors. Conclusion During macular ChT measurements, ocular magnification correction is not necessary in the central fovea. However, ocular magnification should be corrected normally in the nasal perifoveal region and in individuals with ALs shorter than 22.8 mm or longer than 26.0 mm in the remaining macular regions.

Intraoperative Mounted Optical Coherence Tomography Findings Following Reversal of Optic Nerve Head Cupping in Childhood Glaucoma

To examine the structural changes occurring in the optic nerve head (ONH) and macula in infants with childhood glaucoma and clinically observed ONH cupping reversal following intraocular pressure (IOP)-reducing glaucoma surgery, as captured by intra-operative spectral-domain optical coherence tomography (SD-OCT). Retrospective observational case series from an ongoing prospective cohort study. Included were 18 eyes of 14 patients with childhood glaucoma. All eyes had SD-OCT imaging pre- and post-glaucoma intervention and clinically identified ONH cupping reversal. Patients with poor quality images or persistent optic nerve swelling following IOP reduction were excluded. Outcome measurements included IOP, cup-to-disc ratio, axial length and SD-OCT measurements of the peripapillary retinal nerve fiber layer (pRNFL), transverse horizontal diameter of Bruch membrane opening (BMO-D), cup depth, and macula. Mean age at surgery was 1.14±0.93 years and mean interval between pre- and post-operative imaging was 127 days (range 35-595). Following intervention, mean IOP reduction was 45%, accompanied by significant reductions in the cup-to-disc ratio (0.30±0.12, p<0.001), axial length (0.43±0.28mm, p<0.001) and cup depth (46%, p<0.001). Mean global pRNFL thickness pre- vs. post-treatment was 93.1±14.7µm vs. 93.1±17.1µm, respectively, p=1.0. There was no significant difference in pre- and post-treatment global or sectoral pRNFL, 3mm macular total and segmented retinal layer volumes, or the BMO-D. Clinical ONH cupping reversal after IOP-lowering surgery was associated with axial length reduction and decrease in cup depth, but no significant change in the pRNFL or macular volume measures. ONH cupping reversal likely marks stabilization but any pre-intervention ONH damage persists.

Peripapillary and Macular Vascular Density in Patients With Preperimetric and Early Primary Open Angle Glaucoma.

Decreased circumpapillary vascular density (cpVD) and average retinal nerve fiber layer (RNFL) thickness were detected at different locations in eyes with preperimetric glaucoma (PPG). Although RNFL loss was more prominent in preperimetric eyes, in early glaucoma, both cpVD and RNFL thickness showed comparable diagnostic ability. To evaluate changes in circumpapillary and macular vascular density and investigate correlations between vascular and structural parameters in PPG and early glaucoma. This cross-sectional study included a total of 27 patients with PPG in 1 eye and early primary open angle glaucoma in the fellow eye, as well as a control group consisting of 27 eyes of 27 healthy volunteers. All subjects underwent optical coherence tomography angiography (OCTA) imaging. RNFL and macular ganglion cell complex measurements were obtained simultaneously with vascular parameters by AngioVue OCTA using the single-scan protocol. cpVD was examined in 8 sectors. Diagnostic accuracy was evaluated using the area under the receiver operating characteristic curve. In preperimetric eyes, average RNFL thickness and whole-image vessel density had comparable diagnostic performance (area under the receiver operating characteristic curve =0.853 and 0.753, respectively). Compared with the control group, PPG eyes had significantly lower RNFL thickness in all quadrants (P<0.001-0.003) except for the temporal quadrant, whereas cpVD differed only in the nasal inferior and nasal superior sectors (P=0.001 and 0.041, respectively). In early glaucoma eyes, cpVD differed significantly from controls in all sectors except for the inferotemporal, temporal inferior, and temporal superior sectors, whereas perifoveal macular vascular parameters differed in all quadrants (all P<0.05). cpVD was strongly correlated with RNFL thickness in the superior, nasal, and temporal quadrants (r=0.664, 0.698, and 0.649, respectively, P<0.001) and moderately correlated in the inferior quadrant (r=0.450, P<0.001). Although RNFL involvement is valuable in the diagnosis and follow-up of PPG, the change in nasal cpVD has an important place in these patients. The role of macular vascular parameters and macular ganglion cell complex in glaucoma follow-up becomes important in early glaucoma. Longitudinal studies are needed to determine the place of OCTA in the diagnosis and follow-up of glaucoma.

Evaluation of Macular and Peripapillary Blood Flow in Response to Intraocular Pressure Reduction in Patients With Posner-Schlossman Syndrome.

Purpose: The study aimed to evaluate the effect of intraocular pressure (IOP) reduction on macular and peripapillary microcirculation in patients with Posner–Schlossman syndrome (PSS) by optical coherence tomography angiography (OCTA). Methods: A prospective comparative study was conducted. Patients diagnosed with PSS at the Eye Center of Xiangya Hospital, Central South University, from February 2020 to November 2021 were consecutively included. OCTA was used for the macular and peripapillary microcirculation measurements, and optical coherence tomography (OCT) was employed for the retinal nerve fiber layer (RNFL) and lamina cribrosa depth (LCD) measurements. The patients received OCT and OCTA examinations at baseline and 1 week post-treatment when the IOP was under control. Changes in macular and peripapillary microcirculation, RNFL, and LCD were calculated for all the analyzed areas. Results: Twenty-one eyes from 21 patients were included in the study. Pre-treatment and post-treatment IOP were 43.17 ± 10.36 mm Hg (range, 30–60 mm Hg) and 17.17 ± 2.85 mm Hg (range, 13–23 mm Hg), respectively. No statistically significant changes were detected in RNFL, LCD, or macular and peripapillary microcirculation after significant IOP reduction. Conclusion: The results suggested that a large IOP reduction may not result in a significant increase in peripapillary and macular capillary perfusion in patients with PSS.

Comparison of the Structure-Function Relationship Between Advanced Primary Open Angle Glaucoma and Normal Tension Glaucoma.

The aim was to investigate and compare the characteristics of visual field (VF) defects in primary open angle glaucoma (POAG) and normal-tension glaucoma (NTG) with advanced glaucomatous damage and to determine whether the structure-function relationships found in advanced glaucoma differ based on their glaucoma classification. Ninety-seven eyes of 97 patients (59 eyes with POAG and 38 eyes with NTG) with advanced glaucoma were included in this cross-sectional study. Scores at each test point of the 30-2 VF total deviation map were recorded, and average values at each test point were point-wise compared between the groups. Peripapillary retinal nerve fiber layer (RNFL) and macular thickness (total, RNFL, ganglion cell layer, and inner plexiform layer thickness) were measured. The structure-function relationship based on the map of Garway-Heath was determined and compared between the 2 groups. At advanced stage of glaucoma, POAG eyes demonstrated more diffusely distributed VF defects, whereas NTG eyes had more severe VF defects at the superior nasal quadrant, showing increased asymmetry. Overall, peripapillary RNFL, macular ganglion cell layer, and macular inner plexiform layer thickness showed good relationships with 30-2 VF parameters in both groups. However, in total macula and macular RNFL thickness, the structure-function relationships tended to show different characteristics depending on the glaucoma classification; NTG eyes showed overall better relationships. In advanced glaucoma, differences in patterns of VF damage were found between POAG and NTG eyes. Conventional peripapillary RNFL and macular measurements showed generally good performance for estimating functional status, particularly in NTG eyes.

Correlating Ocular Physiology and Visual Function with Mild Cognitive Loss in Senior Citizens in Taiwan.

Purpose: The transition of Taiwan from an aging to a super-aging society has come with a cost as more elderly now suffer from cognitive impairment. The main purpose of our study was to investigate if early detection can be developed so that timely intervention can be instituted. We analyzed the correlation of cognitive function with ocular physiology and visual functions between senior citizens aged 60 years or older in Taiwan. Methods: Thirty-six healthy subjects were recruited for the study. Addenbrooke’s cognitive examination III (ACE-III), binocular functions (including objective and subjective refraction, distance and near dissociated phoria, stereopsis, contrast sensitivity, adult developmental eye movement (ADEM), and ocular physiology (by using optical coherence tomography, OCT, and macular pigment measurement, MPS) were performed, and the data were analyzed via independent t-test, chi-square test, Pearson correlation, linear regression, and ROC (receiver operating characteristic) curve. Results: Data analysis showed that (1) patients with poor eye movement had a strong correlation with the total score and all dimensions of cognitive functions, (2) the thickness of the macula had a strong correlation with attention and memory, and (3) patients with poor eye movement and poor stereopsis in combination with thinner inferior macula appeared to have lower cognitive abilities. Discussion and Conclusions: Cognitive dysfunction is not readily identified during the early stage of cognitive decline. The use of simple and inexpensive ADEM or stereopsis test and comparing the OCT results that are popular in optometry clinics for reference can be diagnostic in identifying patients with mild cognitive impairments. With the combined use of macular pigment density or retinal thickness measurements, it was possible to effectively predict the early degradation of cognition.

Macular Vessel Density Measurement in Pediatric Renal and Liver Transplant

Microcirculatory dysfunction is known to be associated with organ failure and increased mortality in transplant patients. Noninvasive monitorization of retinal structures of the eye could be a predictor for systemic microvasculature in these patients. Therefore, in this study we aimed to evaluate the retinal microvascular changes in pediatric patients who had undergone liver or renal transplant surgery, using optical coherence tomography angiography. The medical records of pediatric patients who had liver or renal transplant in the past 10 years were reviewed. The macular vessel density parameters were obtained by optical coherence tomography angiography (Avanti RTVue XR). The results were compared with the age-matched, sex-matched, and spherical equivalent-matched healthy participants (control group). The IBM SPSS (version 25.0) statistics program was used for data analysis. We included 32 eyes of 16 liver transplant patients, 20 eyes of 10 renal transplant patients, and 64 eyes of 32 healthy participants (control group). Superficial macular whole image, superficial perifoveal, and deep foveal vessel densities were found to be lower in the liver transplant group compared with the healthy control group (P = .02, P = .01, and P = .01, respectively). Superficial foveal, deep macular whole image, deep foveal, and deep perifoveal vessel densities were found to be lower in the renal transplant group compared with the healthy control group (P = .03, P = .04, P = .01, and P = .02, respectively). Macular vessel density measurements are affected in pediatric renal and liver transplant patients. In those patients, retinal optical coherence tomography and optical coherence tomography angiography measurements may provide a noninvasive window to the microcirculation.

An Exploratory Study to Investigate the Utility of Clinical Screening for Neurodegenerative Disease in Age-Related Eye Disease Research.

Unrecognized neurodegenerative diseases (NDD) in age-related eye disease research studies have the potential to confound vision-specific quality of life and retinal optical coherence tomography (OCT) outcome measures. The aim of this exploratory study was to investigate relationships between NDD screening tools and visual outcome measures in a small cohort of controls from the Colorado Age-Related Macular Degeneration Registry (CO-AMD), to consider the utility of future studies. Twenty-nine controls from the CO-AMD were screened using the Montreal Cognitive Assessment (MoCA), a Colorado Parkinsonian Checklist, and the Lewy Body Composite Risk Score. Univariate and multivariable linear regression modeling was used to assess associations between screening tools and the National Eye Institute Visual Function Questionnaire-25 (VFQ-25) and macular OCT outcome measures, and t tests were used to evaluate outcome measure differences between those with normal vs abnormal MoCA scores. One patient withdrew. The average age was 72.8 years, and 68% were female patients. Ten participants (36%) had abnormal MoCA scores, and their VFQ-25 scores were only 1 point less and not statistically different than those with normal MoCA scores. Macular OCT volumes and thicknesses for retinal nerve fiber layer (RNFL) and retinal ganglion cell layer were consistently and moderately lower for those with abnormal MoCA scores, and a positive association between MoCA and macular RNFL volume was observed, although differences and regression were not significant. Parkinson screening tests were abnormal for only 4 participants and were not associated with OCT or VFQ-25 measures by regression modeling. Given the degree and direction of observed differences, further investigation is warranted regarding the relationship between cognitive screening tools and macular OCT measures in age-related eye disease research, but future investigations regarding the relationship between NDD screening tools and VFQ-25 seem unwarranted.

Thickness measurements taken with the spectralis OCT increase with decreasing signal strength

BackgroundOptical coherence tomography (OCT) is used worldwide by clinicians to evaluate macular and retinal nerve fiber layer (RNFL) characteristics. It is frequently utilized to assess disease severity, progression and efficacy of treatment, and therefore must be reliable and reproducible.ObjectiveTo examine the influence of signal strength on macular thickness parameters, macular volume measurement and RNFL thickness measured by spectral-domain optical coherence tomography (SD-OCT).MethodsMacular thickness parameters, macular volume measurement and RNFL thickness were measured by the Spectralis® OCT (Heidelberg Engineering, Heidelberg, Germany). In each eye, the focusing knob was adjusted to obtain 4 images with different signal strengths – Low (below 15), Moderate (15-20), Good (20-25) and Excellent (above 25). The relationship between signal strength and measured data was assessed using the mixed model procedure.ResultsA total of 71 eyes of 41 healthy subjects were included. Central macular thickness, macular volume and mean RNFL thickness increased with decreasing signal strength. Specifically, eyes with excellent signal strength showed significantly thinner central macular thickness (p = 0.023), macular volume (p = 0.047), and mean RNFL thickness (p = 0.0139).ConclusionsHigher signal strength is associated with lower macular thickness, macular volume and RNFL thickness measurements. The mean differences between excellent and low-quality measurements were small implicating that SD-OCT is a reliable imaging tool even at low quality scans. It is imperative that the physician compares the signal strength of all scans, as minute differences may alter results.

Quantitative Evaluation of Macular Vessel Density Measurement by Optical Coherence Tomography Angiography in Patients with Inactive Ocular Sarcoidosis

ABSTRACT Purpose To evaluate the macular vessel density (VD) in inactive ocular sarcoidosis (OS) and investigatethe relationship between VD and both disease duration and visual acuity (VA). Methods This cross-sectional study was performed at a tertiary hospital. The macular VDs of patients with OSwere obtained using optical coherence tomography angiography and compared withhealthy subjects. Results Deep whole image macular VD (WI-MVD), parafoveal, and perifoveal VDs were lower in OS group (p =.01, p = .01, p = .02, respectively). Negative correlation between diseaseduration and both superficial and deep WI-MVD, parafoveal, and perifoveal VDswas obtained (for all p < .05). There was a positive correlation between VAand superficial VD (p < .001, r = 0.848 for WI-MVD). Conclusion OS affects deep VD significantly. Changes in superficial VD affect VA more. Disease duration is an important factor affecting macular VD.