Mean Deviation Index Research Articles

Exercise-Induced Changes in Ocular Blood Flow Parameters in Primary Open-Angle Glaucoma Patients

Purpose: To evaluate exercise-induced changes in ocular blood flow (OBF) parameters in primary open-angle glaucoma (POAG) patients. Methods: A prospective observational study was carried out, in which medically treated patients with POAG were enrolled. Following inclusion, all patients performed a 40-min cycloergometry in a standardized fashion. The following parameters were measured and compared immediately before and 1 and 30 min after the exercise: intraocular pressure (IOP; Goldman applanation tonometry), mean arterial pressure (MAP), ocular pulse amplitude (OPA; assessed by dynamic contour tonometry), and ocular perfusion pressure (OPP; 2/3 MAP – IOP). In addition, we investigated possible factors associated with OBF parameter changes immediately after exercise. Results: A total of 30 eyes (30 patients; mean age was 62.9 ± 1.7 years) were included. Most patients were women (53%), and median visual field mean deviation index was –3.5 dB. Both MAP (mean change, 21%) and IOP (mean change, 17.3%) increased significantly immediately after the workout (p < 0.01), persisting higher than baseline following 30 min (p < 0.01%). Regarding OBF parameters, both OPA (mean change, 58.8%) and OPP (mean change, 21.7%) increased significantly immediately after the workout and persisted higher than baseline 30 min after the workout (p < 0.01). Regression analysis revealed that only age was significantly associated with OPA variation (R² 0.14; p < 0.05). No significant associations were found for OPP (p ≥ 0.19). Conclusion: Aerobic exercise leads to a significant short-time increase in OBF parameters in patients with POAG. Even though IOP seems to present a modest elevation, it is accompanied by a significant increase in MAP, leading to higher OBF measurements. Exercise-induced short-term changes and its possible implications for glaucoma prognosis deserve further investigation.

Variable structure and function relationship of compressive optic neuropathy at the time of diagnosis.

PurposeTo illustrate the structure–function relationship of compressive optic neuropathy (CON) at the time of diagnosis.Patients and methodsThirty-two eyes of newly diagnosed suprasellar CON and 60 healthy eyes were included in the study. The peripapillary retinal nerve fiber layer (RNFL) thickness and macular ganglion cell-inner plexiform layer (GCIPL) thickness were obtained using Cirrus spectral domain optical coherence tomography (SD-OCT). CON eyes were stratified based on the similar degree and pattern of both RNFL and GCIPL.ResultsFrom 32 eyes of newly diagnosed suprasellar CON eyes, 27 eyes had a predominantly nasal hemiretina thinning of macular GCIPL, 4 eyes showed a generalized macular thinning, and 1 eye showed a predominantly superior macular thinning. The corresponding temporal peripapillary RNFL thinning with nasal hemiretina GCIPL thinning were inconsistently manifested. Structure–function analysis of stratified CON eyes with similar thinning profiles showed that a range rather than a fixed value of visual field loss based on mean deviation (MD) index was associated to each thinning profile. The maximal limit of visual field loss range was ubiquitously nonrestricted to any structural thinning profile. While the minimal limit of the associated MD range was gradually reduced from 0 to about −16.0 dB, the nasal hemiretina macular GCIPL thinning was the only manifestation and decreased from 75 to 45 µm. However, the different degrees of temporal hemiretina macular GCIPL and superior–inferior peripapillary RNFL thinning were only seen in 10 of 32 eyes of which their nasal hemiretina GCIPL and temporal RNFL thinning had reached significant thinning. Interestingly when present, the minimal limit of associated MD range continued to decrease from −16.0 to −32.0 dB.ConclusionCON eyes can present with variable structure and function relationship at the time of diagnosis. Using structural parameters at the time of diagnosis to predict the prognosis should be used with caution.

Diagnostic Ability of Macular Vessel Density in the Ganglion Cell-Inner Plexiform Layer on Optical Coherence Tomographic Angiography for Glaucoma.

PurposeThe purpose of this study was to analyze the macular vessel density layer-by-layer and compare the diagnostic value of each in diagnosing glaucoma.MethodsThis was a prospective comparative cross-sectional study, and the setting was glaucoma referral practice. The study participants were patients with primary open-angle glaucoma undergoing treatment with drugs, and age-matched normal controls who visited our clinic for regular eye examinations for refractive errors. All participants were investigated using macular optical coherence tomographic angiography, fundus photography, and 24-2 visual field (VF) testing. Average vessel densities in the retinal nerve fiber–ganglion cell–inner plexiform layer (IPL), retinal nerve fiber–ganglion cell layer (GCL), retinal nerve fiber layer (RNFL), ganglion cell–IPL, GCL, and IPL segments on optical coherence tomographic angiography.ResultsFifty-eight glaucomatous eyes of 58 participants and 52 healthy eyes of 52 normal subjects were included in the study. The average vessel densities of all segments, except the RNFL in the glaucoma group, were significantly lower than that in normal subjects. The average vessel density in the ganglion cell–IPL showed the highest correlation with the mean deviation and VF index of the VF (r = 0.515 and 0.538, respectively) and the best area under receiver operating characteristic curve to discriminate between patients with glaucoma and patients with normal eyes (0.750).ConclusionsThe present study demonstrated that macular vessel density in the ganglion cell–IPL has a higher diagnostic ability and better correlation with functional damage in glaucoma than that in the superficial vascular plexus.Translational RelevanceThese findings suggest that the macular vessel density in the ganglion cell–inner plexiform layer is better than that in the conventional superficial vascular plexus for detecting glaucoma.

Contrast-to-Noise Ratios for Assessing the Detection of Progression in the Various Stages of Glaucoma.

PurposeWe determine the contrast-to-noise ratios (CNRs) of structural and functional measurements to assess their sensitivity to detect progression in the various stages of glaucoma.MethodsWe calculated the CNRs for the mean peripapillary retinal nerve fiber layer (RNFL) thickness measured by spectral domain optical coherence tomography, and the mean deviation (MD) and visual field index (VFI) determined by standard automated perimetry for the transitions between five stages. Longitudinal data from healthy and glaucomatous eyes from a prospective study were used. Contrast was defined as the change in the mean value of the parameter between two successive stages. Noise was defined as the variability of the parameter and calculated from the residuals of linear regression on the data from five subsequent visits per eye.ResultsWe studied 205 eyes from 125 participants (46% men, 54% women). CNRs for different parameters varied considerably across the range of disease severity (0.8–12.2). The RNFL thickness had a higher CNR in the transition from normal to mild glaucoma (12.2) compared to the CNRs of the functional measures (MD 4.1, VFI 4.5). The CNRs for the functional measures were higher in the transition from moderate to advanced (MD 5.2, VFI 5.8) and advanced to severe glaucoma (MD 7.2, VFI 5.8) compared to the RNFL thickness (CNR 0.8 and 3.2, respectively).ConclusionsThe RNFL thickness is more sensitive for detecting glaucomatous progression at the onset of glaucoma compared to the functional measures, while the latter are more sensitive for detecting progression in the later stages of glaucoma.Translational RelevanceThe CNR method can be used to determine which measurement is most sensitive for detecting progression in glaucoma, differentiated for the severity of the disease. Furthermore, it creates a basic toolset for determining the most sensitive measurement in detecting progression not only in glaucoma, but other (ophthalmic) diseases as well.

Correlation between structural progression in glaucoma and obstructive sleep apnea.

To investigate the correlation between obstructive sleep apnea(OSA) severity and the structural and functional progression in patients with glaucoma. This retrospective comparative cohort study included subjects from the polysomnography database in Chang Gung Memorial Hospital between June 1, 2009, and June 1, 2017, by identifying patients who had received diagnoses of primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), or glaucoma suspect. Patients with follow-up time of <3 years and/or <3 consecutive reliable optical coherence tomography (OCT) or visual field (VF) tests were excluded. Progression of overall peripapillary retinal nerve fiber layer (RNFL) thickness on OCT scans and VF mean deviation (MD) or VF index (VFI) were determined through linear regression trend analysis. Thirty-two patients were included. There was a trend to higher percentage of progression on RNFL thickness and VF in higher OSAS severity. After stratifying patients to no OSA/mild OSA (group 1) and moderate/severe OSA (group 2), group 2 exhibited a significantly higher percentage of RNFL thickness progression than did group 1 (64.7% vs 26.7%, P = 0.042). Multivariate Cox regression analysis showed that severe OSA had an 8.448-fold higher risk of RNFL thickness progression after age, sex, diabetes mellitus, hypertension, hyperlipidemia, and body mass index adjustment (95% confidence interval, 1.464-48.752, P = 0.017). Severe OSA is significantly correlated with a higher risk of structural deterioration in patients with glaucoma.

Association between Combined Structure Function Index and Glaucoma Severity.

The aim of this study was to investigate the relationship between combined structure function index (CSFI) and standard automated perimetry (SAP) parameters such as mean deviation (MD) and visual field index (VFI) in open-angle glaucoma (OAG). We retrospectively reviewed medical records from September 2009 to July 2015, which included 195 eyes of 195 patients with OAG or normal-tension glaucoma who underwent SAP and optical coherence tomography on the same day (male: female, 128 : 67; mean age, 61.4 ± 11.3 years; mean spherical equivalent, −2.39 ± 2.3 D). We divided participants into three stages based on MD value: early, MD > −6 dB; middle, −6 dB ≥ MD ≥ −12 dB; and advanced, MD < 12 dB. We then evaluated correlations between CSFI and SAP parameters in each stage using Pearson's correlation coefficient. Mean CSFI (%), mean MD (dB), and VFI (%) in each stage were early (22.4, −2.13, and 94.0); middle (47.9, −8.78, and 75.4); and advanced (68.3, −17.32, and 49.0), respectively. Correlations between CSFI and whole, early, middle, and advanced MD were −0.88 (p < 0.001), −0.68, −0.24, and −0.76, respectively. Correlations between CSFI and whole, early, middle, and advanced VFI were −0.86 (p < 0.001), −0.59, −0.20, and −0.83, respectively. Consistency between CSFI and SAP indices in middle-stage glaucoma was low.

Comparison of head-mounted perimeter (imo®) and Humphrey Field Analyzer.

PurposeThe head-mounted automated perimeter imo® is a new portable perimeter that does not require a dark room and can be used to examine patients in any setting. In this study, imo 24plus (1-2) AIZE examinations were compared with previous Humphrey Field Analyzer (HFA) 30-2 (SITA standard) examinations within the same patient.Patients and methodsimo examinations (either head-mounted [i-H] or fixed [i-F] type) were performed in patients with glaucoma or suspected glaucoma who had already experienced HFA five or more times. Measurement time and correlations of mean deviation (MD) and visual field index (VFI) values were compared between groups for HFA, i-H, i-F, and imo total (i-T). Fixation loss (FL), false-positive (FP), and false-negative (FN) detection rates were compared. The percentage of binocular random single-eye tests under possible non-occlusion conditions using imo was determined. Mann–Whitney U test was performed, and Spearman’s rank-order correlation coefficient was calculated.ResultsThe inclusion period was July to December 2016. Among 273 subjects (543 eyes), 147 (292 eyes) were tested with i-H type and 126 (251 eyes) with i-F type. Mean MD values for HFA and i-T were -6.1±7.8 and -6.2±7.1 dB, respectively. Mean measurement times for HFA, i-H, i-F, and i-T were 15.23±2.07, 10.47±2.11, 11.04±2.31, and 10.54±2.19 minutes, respectively (P<0.01 for HFA vs i-H/i-F). Total mean measurement time was shorter by 30.8% for i-T vs HFA. Correlation coefficients of MD and VFI were R2>0.81 for HFA vs i-H and i-F. FP and FN detection rates were significantly higher with i-T than HFA; there was no significant difference in FL. Binocular random single-eye tests were possible in 85% of cases.Conclusionimo reduced measurement time by 30.8%. imo VFI and MD values were highly correlated with HFA. As i-F and i-H types produced similar results, imo can be used in accordance with the patient’s situation.

Structure-function relationships in glaucoma using enhanced depth imaging optical coherence tomography-derived parameters: a cross-sectional observational study

BackgroundTo investigate structural and functional correlations in glaucoma patients using enhanced depth imaging spectral-domain optical coherence tomography (EDI OCT)-derived parameters.MethodsWe prospectively enrolled healthy participants and glaucomatous patients with a wide range of disease stages. All participants underwent visual field (VF) testing (SITA - Standard 24–2; Carl Zeiss Meditec, Dublin, CA) and EDI OCT imaging (Spectralis; Heidelberg Engineering Co., Heidelberg, Germany). The following optic nerve head parameters were measured on serial vertical EDI OCT B-scans by two experienced examiners masked to patients clinical data: lamina cribrosa (LC) thickness and area, prelaminar neural tissue thickness and area, anterior LC depth, Bruch’s membrane opening (BMO) and average, superior, and inferior BMO-minimum rim width (BMO-MRW). Only good quality images were considered, and whenever both eyes were eligible, one was randomly selected for analysis. Scatter plots were constructed to investigate correlations between each anatomic parameter and patient’s VF status (based on VF index [VFI] values).ResultsA total of 73 eyes of 73 patients were included. All EDI OCT parameters evaluated differed significantly between glaucomatous and control eyes (P ≤ 0.045). A secondary analysis, in which glaucomatous patients were divided according to VF mean deviation index values into 3 groups (mild [G1; > − 6 dB], moderate [G2; − 6 to − 12 dB] and advanced [G3; <− 12 dB] glaucoma), revealed that average BMO-MRW was the EDI OCT parameter that presented more significant differences between the different stages of glaucoma. Significant structure-function correlations were found between VFI values and prelaminar neural tissue area (R2 = 0.20, P = 0.017), average BMO-MRW (R2 = 0.35, P ≤ 0.001), superior BMO-MRW (R2 = 0.21, P = 0.012), and inferior BMO-MRW (R2 = 0.27, P = 0.002). No significant correlations were found for LC area and anterior LC depth (P ≥ 0.452).ConclusionsEvaluating the distribution pattern and structure-function correlations of different laminar and prelaminar EDI OCT-derived parameters in glaucomatous patients, we found better results for neural tissue-based indexes (compared to LC-derived parameters). The diagnostic utility of each parameter deserves further investigations.

Long-term Effect of Continuous Positive Air Pressure Therapy on Intraocular Pressure in Patients with Primary Open-angle Glaucoma with Obstructive Sleep Apnea.

ABSTRACTPurposePrevalence of glaucoma is higher in obstructive sleep apnea (OSA) patients. The gold standard technique to treat OSA is continuous positive airway pressure (CPAP) therapy. The influence of long-term CPAP therapy on intraocular pressure (IOP), blood pressure, ocular perfusion pressure (OPP), and glaucoma progression in primary open-angle glaucoma (POAG) patients was evaluated.DesignProspective study.Materials and methodsIn this study, we enrolled 12 eyes from six POAG patients aged >35 years, with newly diagnosed OSA and with indication for CPAP therapy. The CPAP was performed for 12 months. We monitored the IOP every 3 months. Visual field was determined at baseline and 12 months.ResultsThe mean IOP after CPAP therapy for 12 months was significantly higher than the mean baseline IOP (average IOP 3 months before CPAP therapy) (19.08 ± 3.47 vs 17.83 ± 2.88 mm Hg; p = 0.006). The IOP rising rate was 0.69 ± 0.47/years (p = 0.138) before CPAP therapy and increased to 1.13 ± 0.47/years (p = 0.016) after CPAP therapy. The OPP after 12 months of CPAP was significantly lower than the baseline (42.21 ± 5.29 vs 45.24 ± 7.09 mm Hg; p = 0.06). Results showed that the pattern standard deviation (PSD) value of 24-2 short wavelength automated perimetry (SWAP) visual field was reduced from 5.34 ± 3.92 to 4.77 ± 3.73 (p = 0.025). Antiglaucoma medication was administered to a patient due to increased IOP without glaucoma progression evidence.ConclusionThe POAG and OSA patients demonstrated significant IOP rising after CPAP therapy but did not show progression of glaucomatous damage. Mean deviation (MD), PSD, and visual field index (VFI) were not significantly different after CPAP therapy.PrécisProspective study of POAG and OSA patients demonstrated significant IOP rising after CPAP therapy for a year. The study did not show progression of glaucomatous damage.How to cite this articleHirunpatravong P, Kasemsup T, Ayudhya WN, et al. Long-term Effect of Continuous Positive Air Pressure Therapy on Intraocular Pressure in Patients with Primary Open-angle Glaucoma with Obstructive Sleep Apnea. J Curr Glaucoma Pract 2019;13(3):94–98.

Current state of practice regarding digital radiography exposure indicators and deviation indices: Report of AAPM Imaging Physics Committee Task Group 232.

Beginning with the advent of digital radiography systems in 1981, manufacturers of these systems provided indicators of detector exposure. These indicators were manufacturer-specific, and users in facilities with equipment from multiple manufacturers found it a challenge to monitor and manage variations in indicated exposure in routine clinical use. In 2008, a common definition of exposure index (EI) was realized in International Electrotechnical Commission (IEC) International Standard 62494-1 Ed. 1, which also introduced and defined the deviation index (DI), a number quantifying the difference between the detector EI for a given radiograph and the target exposure index (EIT ). An exposure index that differed by a constant from that established by the IEC and the concept of the deviation index also appear in American Association of Physicists in Medicine (AAPM) Report No. 116 published in 2009. The AAPM Report No. 116 went beyond the IEC standard in supplying a table (TableII in the report of TG-116) titled "Exposure Indicator DI Control Limits for Clinical Images," which listed suggested DI ranges and actions to be considered for each range. As the IEC EI was implemented and clinical DI data were gathered, concerns were voiced that the DI control limits published in the report of TG-116 were too strict and did not accurately reflect clinical practice. The charge of task group 232 (TG-232) and the objective of this final report was to investigate the current state of the practice for CR/DR Exposure and Deviation Indices based on AAPM TG 116 and IEC-62494, for the purpose of establishing achievable goals (reference levels) and action levels in digital radiography. Data corresponding to EI and DI were collected from a range of practice settings for a number of body parts and views (adults and pediatric radiographs) and analyzed in aggregate and separately. A subset of radiographs was also evaluated by radiologists based on criteria adapted from the European Guidelines on Quality Criteria for Diagnostic Radiographic Images from the European Commission. Analysis revealed that typical DI distribution was characterized by a standard deviation (SD) of 1.3-3.6 with mean DI values substantially different from 0.0, and less than 50% of DI values fell within the significant action limits proposed by AAPM TG-116 (-1.0≤DI≤1.0). Recommendations stemming from this analysis include targeting a mean DI value of 0.0 and action limits at ±1 and ±2 SD of the DI based on actual DI data of an individual site. EIT values, DI values, and associated action limits should be reviewed on an ongoing basis and optimization of DI values should be a process of continuous quality improvement with a goal of reducing practice variation.

Comparison of Visual Field Point-Wise Event-Based and Global Trend-Based Analysis for Detecting Glaucomatous Progression.

PurposeTo compare global trend-based and point-wise event-based analysis for detecting visual field progression in eyes with glaucoma.MethodsThe study included a cohort of 367 glaucoma eyes from 265 participants seen over a mean follow-up period of 10 years to develop a computer simulation model of “real-world” visual field results. Progression was evaluated with point-wise event-based analysis using the Guided Progression Analysis (GPA) and global trend-based analysis using the mean deviation (MD) and visual field index (VFI) measures. The specificities of the methods were matched based on a simulated dataset of stable glaucoma eyes, to allow an adequate comparison of their sensitivities for detecting progression.ResultsThe 5-year cumulative false-positive rate for the GPA alert of “possible progression” and “likely progression” (significant change from baseline at two and three consecutive visits, respectively) were 34.0% and 7.0%, respectively. At matched specificities, 27.7% eyes were detected as having progressed after 5 years using the GPA “likely progression” criterion, while 24.6% and 23.8% were detected as having progressed using the global trend–based analysis with MD and VFI, respectively. There was a moderate level of agreement between the GPA and global trend-based analyses.ConclusionsPointwise event-based and global trend–based methods had similar performances to detect glaucoma progression when rigorously matched for specificity.Translational RelevanceAlthough both point-wise event- and global trend–based analyses perform similarly, they could provide complementary information that could be exploited to improve the overall detection of progression in clinical practice and clinical trials.

Factors associated with the presence of parafoveal scotoma in glaucomatous eyes with optic disc hemorrhages.

Glaucomatous eyes with disc hemorrhage (DH) have a greater risk of paracentral visual field (VF) loss. However, not every DH eye presents with parafoveal scotoma (PFS), and contributing factors are still to be determined. In the present study, we investigated clinical and ocular factors associated with the presence of PFS in glaucomatous eyes with DH. A case-control study was carried out. One hundred thirty glaucomatous patients with DH were enrolled. They were divided into two groups based on two reliable 24-2 VF tests: those with PFS (defined as ≥3 adjacent points with p < 5% within the central 10 degrees of fixation, ≥1 point with p < 1% lying at the innermost paracentral points, in the same hemifield) and those without PFS. Clinical and ocular data from the time of DH detection were compared between groups. Factors associated with the presence of PFS were investigated through logistic regression. The PFS group had a higher prevalence of Caucasian patients (82 vs. 47%; p < 0.01). Eyes with PFS had a more negative spherical equivalent and worse VF mean deviation (MD) index (p ≤ 0.01). There was a marginally significant intraocular pressure (IOP) difference between eyes with (15 mmHg) and without PFS (18 mmHg) at the time of DH detection (p = 0.10). Univariable analysis revealed PFS to be significantly associated with Caucasian race (OR, 3.02; p = 0.004), myopia (<-3 diopters; OR, 3.44; p = 0.039), and lower IOP (≤16 mmHg; OR, 2.10; p ≤ 0.047). Multivariable analysis, controlling for VF MD, revealed that only Caucasian race and myopia (as a continuous or categorical variable) remained significant in this model (p ≤ 0.038). Caucasian race and the presence and magnitude of myopia were found to be significantly associated with the presence of PFS in glaucomatous eyes with DH. Our results may help clinicians in the identification and surveillance of these eyes at higher risk of central VF loss.

Can Macula and Optic Nerve Head Parameters Detect Glaucoma Progression in Eyes with Advanced Circumpapillary Retinal Nerve Fiber Layer Damage?

To evaluate the ability of OCT optic nerve head (ONH) and macular parameters to detect disease progression in eyes with advanced structural glaucomatous damage of the circumpapillary retinal nerve fiber layer (cRNFL). Longitudinal study. Forty-four eyes from 37 patients with advanced average cRNFL damage (≤60 μm) followed up for an average of 4.0 years. All patients were examined with spectral-domain OCT and visual field (VF) assessment during at least 4 visits. Visual field mean deviation (MD) and VF index. OCT cRNFL (average, superior, and inferior quadrants), ganglion cell-inner plexiform layer (GCIPL) (average, superior, and inferior), rim area, cup volume, average cup-to-disc (C:D) ratio, and vertical C:D ratio. At baseline, patients had a median VF MD of -10.18 dB and mean cRNFL of 54.55±3.42 μm. The rate of change for MD and VF index were significant. No significant rate of change was noted for cRNFL, whereas significant (P < 0.001) rates were detected for GCIPL (-0.57±0.05 μm/year) and ONH parameters such as rim area (-0.010±0.001 mm2/year). Macula GCIPL and ONH parameters may be useful in tracking progression in patients with advanced glaucoma.

The Effective Dynamic Ranges for Glaucomatous Visual Field Progression With Standard Automated Perimetry and Stimulus Sizes III and V.

PurposeIt has been shown that threshold estimates below approximately 20 dB have little effect on the ability to detect visual field progression in glaucoma. We aimed to compare stimulus size V to stimulus size III, in areas of visual damage, to confirm these findings by using (1) a different dataset, (2) different techniques of progression analysis, and (3) an analysis to evaluate the effect of censoring on mean deviation (MD).MethodsIn the Iowa Variability in Perimetry Study, 120 glaucoma subjects were tested every 6 months for 4 years with size III SITA Standard and size V Full Threshold. Progression was determined with three complementary techniques: pointwise linear regression (PLR), permutation of PLR, and linear regression of the MD index. All analyses were repeated on “censored'' datasets in which threshold estimates below a given criterion value were set to equal the criterion value.ResultsOur analyses confirmed previous observations that threshold estimates below 20 dB contribute much less to visual field progression than estimates above this range. These findings were broadly similar with stimulus sizes III and V.ConclusionsCensoring of threshold values < 20 dB has relatively little impact on the rates of visual field progression in patients with mild to moderate glaucoma. Size V, which has lower retest variability, performs at least as well as size III for longitudinal glaucoma progression analysis and appears to have a larger useful dynamic range owing to the upper sensitivity limit being higher.

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN PATIENTS WITH RETINITIS PIGMENTOSA.

To evaluate the correlation between the flow density measured by optical coherence tomography angiography and functional parameters in patients with retinitis pigmentosa. Twenty eyes of 20 patients with retinitis pigmentosa and 21 eyes of 21 healthy subjects were prospectively included in this study. Optical coherence tomography angiography was performed using RTVue XR Avanti with AngioVue (Optovue Inc). The macula was imaged with a 6 × 6-mm scan, whereas for the optic nerve head a 4.5 × 4.5-mm scan was taken. Visual acuity, visual field parameters (mean deviation and visual field index), full-field electroretinography, and multifocal electroretinography were tested for correlation with flow density data. The flow density (whole en face) in the superficial/deep retinal OCT angiograms and in the optical coherence tomography angiography of the optic nerve head was significantly lower in the retinitis pigmentosa group when compared with the control group (P < 0.001). The flow density in the superficial retinal OCT angiogram (fovea) correlated significantly with the visual acuity (rSpearman = -0.77, P < 0.001) and the visual field parameters (visual field index: rSpearman = 0.56, P = 0.01; mean deviation: rSpearman = 0.54, P = 0.01). Patients with retinitis pigmentosa show a decreased macular and optic nerve head perfusion compared with healthy subjects. The flow density measured using optical coherence tomography angiography correlated with subjective and objective functional parameters.

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN PATIENTS WITH RETINITIS PIGMENTOSA.

To evaluate the correlation between the flow density measured by optical coherence tomography angiography and functional parameters in patients with retinitis pigmentosa. Twenty eyes of 20 patients with retinitis pigmentosa and 21 eyes of 21 healthy subjects were prospectively included in this study. Optical coherence tomography angiography was performed using RTVue XR Avanti with AngioVue (Optovue Inc). The macula was imaged with a 6 × 6-mm scan, whereas for the optic nerve head a 4.5 × 4.5-mm scan was taken. Visual acuity, visual field parameters (mean deviation and visual field index), full-field electroretinography, and multifocal electroretinography were tested for correlation with flow density data. The flow density (whole en face) in the superficial/deep retinal OCT angiograms and in the optical coherence tomography angiography of the optic nerve head was significantly lower in the retinitis pigmentosa group when compared with the control group (P < 0.001). The flow density in the superficial retinal OCT angiogram (fovea) correlated significantly with the visual acuity (rSpearman = -0.77, P < 0.001) and the visual field parameters (visual field index: rSpearman = 0.56, P = 0.01; mean deviation: rSpearman = 0.54, P = 0.01). Patients with retinitis pigmentosa show a decreased macular and optic nerve head perfusion compared with healthy subjects. The flow density measured using optical coherence tomography angiography correlated with subjective and objective functional parameters.

The disc damage likelihood scale: Diagnostic accuracy and correlations with cup-to-disc ratio, structural tests and standard automated perimetry.

Our objective was to compare the diagnostic accuracies of and to determine the correlations between the disc damage likelihood scale (DDLS) and anatomical and functional tests used for glaucoma detection. A total of 54 healthy subjects (54 eyes) and 47 primary open-angle glaucoma patients (47 eyes) were included in this cross-sectional observational study. DDLS scores and cup-to-disc (C/D) ratios were evaluated. Subjects underwent standard automated perimetry (SAP), optic disc and retinal nerve fiber layer (RNFL) imaging with time and spectral-domain optical coherence tomography (TD and SD-OCT), Heidelberg Retina Tomograph (HRT II), and scanning laser polarimetry (GDx-VCC). Areas under the receiver operating characteristic curves (AROCs) for DDLS and diagnostic tests parameters were calculated. DDLS correlations (Spearman's rank) among these parameters were analyzed. Fifty-four eyes were healthy and 47 had glaucoma, including 16 preperimetric glaucoma. DDLS, vertical and horizontal C/D ratios had the largest AROCs (0.92, 0.94 and 0.91, respectively). DDLS diagnostic accuracy was better than the accuracies of HRT II parameters, TD and SD-OCT RNFL thicknesses, and SAP mean deviation (MD) index. There were no significant differences between the accuracies of the DDLS and the C/D ratios, TD-OCT vertical (0.89) and horizontal (0.86) C/D ratios, TD-OCT C/D area ratio (0.89), and GDx-VCC NFI (0.81). DDLS showed significant strong correlations with vertical (r = 0.79) and horizontal (0.74) C/D ratios, and with the parameters vertical C/D ratio and C/D area ratio from HRT II (both 0.77) and TD-OCT (0.75 and 0.72, respectively). DDLS had significant moderate correlations with most of the other structural measurements and SAP MD. The optic disc clinical evaluation with DDLS system and C/D ratio demonstrated excellent accuracy in distinguishing glaucomatous from healthy eyes. DDLS had moderate to strong correlations with most structural and functional parameters. These findings stress the importance of optic disc clinical examination to detect glaucoma in a clinical scenario.

Myopic glaucomatous eyes with or without optic disc shape alteration: a longitudinal study

AimsTo compare the clinical courses of patients with myopic primary open angle glaucoma (POAG) with and without optic disc shape alterations.MethodsIn this longitudinal retrospective study, 146 eyes from 146 patients...

The Effect of Combined Systemic Erythropoietin and Steroid on Non-arteritic Anterior Ischemic Optic Neuropathy: A Prospective Study

ABSTRACTBackground: To investigate the effect of combined intravenous (IV) erythropoietin (EPO) and corticosteroid as well as systemic steroid alone for the treatment of non-arteritic anterior ischemic optic neuropathy (NAION).Methods: In this prospective interventional comparative case series, 113 consecutive patients diagnosed with recent onset (less than 14 days) NAION were included. Patients were categorized into three groups. 40 patients received systemic IV corticosteroid combined with recombinant human erythropoietin (rhEPO) (group 1), 43 patients received systemic corticosteroid alone (group 2), and 30 patients were enrolled as the control group (group 3). Functional and structural outcomes were analyzed 3 and 6 months after treatment. Best corrected visual acuity (BCVA) was the main outcome, and mean deviation (MD) and peripaillary retinal nerve fiber layer thickness (PRNFLT) were secondary outcome measures.Results: The mean BCVA at the time of presentation was 0.98 (±0.65), 0.96 (±0.67), and 1.02 (±0.63) log MAR in groups 1, 2, and 3, respectively (P = 0.95). At month 3, the corresponding values were 0.73 (±0.45), 0.76 (±0.49), and 0.8 (±0.45) log MAR (P = 0.80), and at the 6-month follow-up, they were 0.76 (±0.45), 0.71 (±0.4), and 0.71 (±0.46) log MAR, respectively (P = 0.87). There was no statistically significant difference in BCVA between months 3 and 6, which implies stabilization of the visual acuity by month 3. Considering the visual field, within 6 months of follow-up after disease onset, the MD index improved in all groups with no statistically significant differences between them (P = 0.82). PRNFLT at presentation was 178 (±60), 186 (±59), and 166 (±57) micrometers in groups 1, 2, and 3, respectively (P= 0.99), which decreased to 77 (±16), 83 (±22), and 73 (±11), respectively, at final visit (P = 0.14)Conclusion: We found no beneficial effect of either systemic steroid alone or combined with EPO in the visual outcome of NAION patients.

Peripapillary retinal nerve fiber layer thickness in different glaucoma stages measured by optical coherence tomography

Background/Aim. One of the most reliable methods for structural measurements of glaucomatous damage is spectral domain optical coherence tomography (SD-OCT). The aim of this study was to measure peripapillary retinal nerve fiber layer (RNFL) thickness with SD-OCT in eyes with different stages of glaucoma, as well as to determine which sector in the peripapillary circle is the most vulnerable to glaucomatous damage. Methods. The study included 153 eyes of 93 patients with confirmed primary open angle glaucoma (POAG). All the patients underwent a complete ophthalmic examination, including visual field testing and peripapillary RNFL thickness measured by SD-OCT. They were divided into three subgroups: early, moderate and severe stage of glaucoma based on the mean deviation (MD) index of visual field. The results were presented as mean RNFL thickness: total, in the four quadrants and 12 clock-hour RNFL thickness. Results. The overall mean peripapillary RNFL was 74.95 ? 14.51 ?m. The lower quadrant had the thickest RNFL (92.78 ? 25.84 ?m), followed by upper (88.82 ? 22.04 ?m), nasal (64.31 ? 11.67 ?m) and temporal ones (54.02 ? 12.76 ?m), showing a significant difference (?2 = 273.36, DF = 3, p &lt; 0.001). Comparison between RNFL thickness in early glaucoma and moderate and severe stages revealed that the most sensitive sectors were inferior and superior ones, as well as sectors at 5?7 clock hour position. The greatest decrease in RNFL thickness was observed in the 9 o'clock hour sector in all three glaucoma subgroups (46.99 ? 13.28 ?m), while the RNFL was the thickest in the 6 o'clock hour sector (102.63 ? 34.12 ?m). Conclusion. Peripapillary RNFL thickness is inversely proportional to the degree of glaucomatous damage: the greater the damage, the thinner peripapillary RNFL.