Retinal Nerve Fiber Layer Thickness Research Articles

Secondary silicone-induced glaucoma after vitrectomy for regmatogenic retinal detachment

BACKGROUND: Retinal detachment is a leading cause of impaired vision and blindness, affecting 2–9% of individuals. Research has shown that local immune-inflammatory processes contribute significantly to the development of this condition. Polymethylsiloxane has long been used as a tamponade substance in the treatment of retinal detachment. It is currently utilized in various forms of retinal detachment as well as in the management of complications such as retinal edge folding and vitreous opacity. However, the use of silicone oil in the vitreous cavity can lead to the development of secondary ocular hypertension and glaucoma, with prevalence rates ranging from 2.2% to 64.2% according to studies. AIM: Conduct a comparative analysis of biochemical and morphometric indicators and justify the expediency of conducting immune therapy for patients with secondary silicone-induced glaucoma. METHODS: A prospective study included 22 patients (22 eyes) in the main group and 22 patients in the comparison group (22 eyes). The average age of the patients was 55±5.3 years (46–68 years), with 28 females and 16 males. Patients in the main group received anti-cytokine therapy (aminopropyldithioethylene-diamine sodium and anakinra). The primary endpoint of the study was the assessment of retinal nerve fiber layer thickness and perimetric indices. RESULTS: The results revealed an inverse relationship between cytokine levels and retinal nerve fiber layer thickness in patients who underwent vitrectomy with silicone tamponade. Additionally, a direct relationship was observed between the diameter of emulsified silicone in the anterior chamber and cytokine levels. The impact of mechanical fragmentation of polymethylsiloxane during nystagmus and direct toxic effects on optic nerve fibers requires further investigation. The study also highlighted the need for more accurate methods of selecting anterior chamber fluid for evaluating the effectiveness of immune therapy. Determining the appropriate dosage, duration, and administration method of anti-cytokine drugs also requires further research. Evaluation of ophthalmotonometric indicators, retinal nerve fiber layer thickness, and mean deviation revealed significantly better outcomes in patients receiving anti-cytokine therapy compared to the control group. CONCLUSION: The findings of this study support the use of anti-cytokine therapy to normalize biochemical parameters in the anterior chamber and reduce clinical manifestations of secondary silicone-induced glaucoma.

EVALUATION OF MACULAR GANGLION CELL COMPLEX USING SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IN GLAUCOMA SUSPECT PATIENTS AND TO CORRELATE IT WITH NORMAL POPULATION

PURPOSE:. To evaluate macular ganglion cell complex in glaucoma suspect patients and normal population RESULTS The difference between values of neuroretinal rim thickness,rim area,disc area,average CDR,vertical CDR and cup volume among glaucoma suspect and normal (controls) was found to be statistically significant (p value<0.001). The difference between values of superior,nasal,inferior,temporal and average RNFL thickness among glaucoma suspect and normal (controls) was found to be statistically significant(p value<0.001). The difference between values of superotemporal, superior, superonasal, inferonasal, inferior, inferotemporal, average and minimum GCIPL (Ganglion cell Inner plexiform layer) thickness in µm, as estimated on OCT macula, was found to be statistically significant among glaucoma suspect patients and normal (controls) (p value <0.001). Upon applying Spearman’s rho correlation coefficient test in glaucoma suspect patients for GCIPL thickness and RNFL thickness, statistically significant correlation was found between Inferior RNFL thickness with Inferotemporal GCIPL thickness(p value 0.029) and Temporal RNFL thickness with Inferotemporal GCIPL thickness .(p values 0.006). Upon applying Spearman’s rho correlation coefficient test in normal (controls) for GCIPL thickness and RNFL thickness,statistically significant correlation was found between Superior RNFL thickness with Superior GCIPL thickness(p value 0.038), Superior RNFL thickness with Superonasal GCIPL thickness (p values 0.012 ), and Average RNFL thickness with Average GCIPL thickness (p value 0.033) CONCLUSION: In our study we found there is statistically significant reduction in thickness in all measured quadrants of Macular GCIPL and RNFL in glaucoma suspect patients compared to normal. Also, a statistically significant correlation was found between Inferior RNFL thickness with Inferotemporal GCIPL thickness and Temporal RNFL thickness with Inferotemporal GCIPL thickness in glaucoma suspect patients,suggesting good diagnostic ability of inferotemporal macular GCIPL thickness.

Effects of Cataract on Optic Nerve Head and Macular Analysis Using Optical Coherence Tomography

Purpose: To assess the impact of cataract on optic nerve head (ONH) parameters (disc area, rim area, average cup/disc ratio, vertical cup/disc ratio, cup volume), peripapillary retinal nerve fiber layer (pRNFL) thickness, and macular ganglion cell-inner plexiform layer (mGC-IPL) thickness in patients with glaucoma and in a control group.Methods: A retrospective analysis was conducted on medical records from January to December 2021 for individuals undergoing cataract surgery. This group included normal, glaucoma suspects, and glaucoma patients, totaling 44 individuals and 63 eyes. Measurements of ONH parameters, pRNFL thickness, and mGC-IPL thickness were taken using spectral-domain optical coherence tomography before and after surgery. We analyzed postoperative changes in these parameters and related factors to preoperative segmentation errors.Results: In glaucoma patients, a significant increase in the average thickness of the pRNFL (p = 0.002) was observed after surgery, while no significant changes were seen in ONH parameters and the average thickness of the mGC-IPL (all p > 0.05). Conversely, the control group showed an increase in some areas of mGC-IPL thickness after surgery (p < 0.05). Multivariate regression analysis indicated that in glaucoma patients, thinner preoperative pRNFL and mGC-IPL thickness were predictors of increased average thickness after surgery (p < 0.001 and p = 0.008, respectively).Conclusions: Cataract significantly impacts the pRNFL and mGC-IPL thickness in glaucoma patients, with less effect on ONH parameters. These findings suggest that ONH parameters can be more reliable for monitoring patients undergoing cataract surgery and assessing glaucoma progression simultaneously.

Clinical Characteristics and Visual Prognosis of Idiopathic Intracranial Hypertension in Korea: A Single-center Experience

Purpose: To examine the clinical characteristics, demographic features, and visual prognosis of idiopathic intracranial hypertension (IIH) in Korean patients.Methods: We conducted a retrospective chart review of patients diagnosed with IIH who visited the Neuro-ophthalmology Clinic at Samsung Medical Center from September 2011 to January 2023. This analysis focused on demographic characteristics at onset, clinical manifestations, and visual outcomes at the last follow-up.Results: Out of 34 patients, 20 met the modified Dandy criteria and 14 were presumed to have IIH. The mean age at onset was 32.97 ± 9.6 years with females comprising 85.3% (n = 29) of the sample. The average body mass index (BMI) was 29.15 ± 6.43, with 47.0% of patients (n = 16) classified as obese. The most frequent symptom was headache, reported by 85.3% (n = 29) of patients, followed by pulsatile tinnitus (64.7%, n = 22) and transient visual obscuration (TVO; 32.4%, n = 11). Treatment included observation for 3 patients (8.8%), acetazolamide therapy for 26 patients (76.5%), and ventriculo-peritoneal shunt (V-P shunt) for 2 patients (5.9%). Out of 23 patients with follow-up > 6 months, 87.0%, 8.7%, and 4.3% showed good, fair, and poor visual outcomes, respectively; optic nerve atrophy was observed in 19.6% (9 eyes). The initial peripapillary retinal nerve fiber layer (pRNFL) thickness measured by OCT was 143.56 ± 62.41 μm in the right eye and 139.3 ± 76.38 μm in the left which decreased to 97.39 ± 25.72 and 94.91 ± 19.32 μm, respectively by the last examination.Conclusions: While the proportion of obese patients in this Korean cohort and the average BMI were lower than in western countries, both have increased relative to previous reports from Korea. Most patients experienced a benign course.

Hyper-reflective foci changes in RRMS under natalizumab therapy.

Microglia (MG) is suggested to play an immunopathological role of in Multiple Sclerosis (MS). Since hyper-reflective foci (HRF) might mark MG activation, in vivo analysis by Optic Coherence Tomography (OCT) in MS patients under disease modifying therapies may help to clarify MS immunopathology as well as drug's mechanism of intrathecal action. To analyze HRF in patients treated with Natalizumab (NTZ), a high efficacy therapy for MS. The effect of NTZ on the retina of 36 Relapsing-Remitting MS patients was investigated in a prospective, single-center study. OCT was performed immediately before the first infusion and then between infusion 3 and 4, infusion 6 and 7, infusion 11 and 13. Peripapillary and macular scans were acquired, evaluating peripapillary RNFL thickness, macular volumes (vertical scans), and HRF count (horizontal scan) in Ganglion Cell Layer (GCL), Inner Plexiform Layer (IPL) and Inner Nuclear Layer (INL). Clinical examination was performed every six months. HRF count significantly increased under NTZ therapy (p<0.001) in both GCL (18.85 ± 6.93 at baseline, 28.24 ± 9.55 after 12 months) and IPL (25.73 ± 7.03 at baseline, 33.21 ± 8.50 after 12 months) but remained stable in INL (33.65 ± 7.76 at baseline, 36.06 ± 6.86 after 12 months, p=0.87), while no relevant modification of pRNFL and macular volumes were observed during the study. EDSS remained stable and no clinical relapse was observed between month 6 and 12. In RRMS NTZ affects HRF count in GCL and IPL, but not in INL, suggesting that NTZ does not impact on some aspects of MS immunopathology.

Retinal hyperspectral imaging in mouse models of Parkinson’s disease and healthy aging

Retinal hyperspectral imaging (HSI) is a non-invasive in vivo approach that has shown promise in Alzheimer’s disease. Parkinson’s disease is another neurodegenerative disease where brain pathobiology such as alpha-synuclein and iron overaccumulation have been implicated in the retina. However, it remains unknown whether HSI is altered in in vivo models of Parkinson’s disease, whether it differs from healthy aging, and the mechanisms which drive these changes. To address this, we conducted HSI in two mouse models of Parkinson’s disease across different ages; an alpha-synuclein overaccumulation model (hA53T transgenic line M83, A53T) and an iron deposition model (Tau knock out, TauKO). In comparison to wild-type littermates the A53T and TauKO mice both demonstrated increased reflectivity at short wavelengths ~ 450 to 600 nm. In contrast, healthy aging in three background strains exhibited the opposite effect, a decreased reflectance in the short wavelength spectrum. We also demonstrate that the Parkinson’s hyperspectral signature is similar to that from an Alzheimer’s disease model, 5xFAD mice. Multivariate analyses of HSI were significant when plotted against age. Moreover, when alpha-synuclein, iron or retinal nerve fibre layer thickness were added as a cofactor this improved the R2 values of the correlations in certain groups. This study demonstrates an in vivo hyperspectral signature in Parkinson’s disease that is consistent in two mouse models and is distinct from healthy aging. There is also a suggestion that factors including retinal deposition of alpha-synuclein and iron may play a role in driving the Parkinson’s disease hyperspectral profile and retinal nerve fibre layer thickness in advanced aging. These findings suggest that HSI may be a promising translation tool in Parkinson’s disease.

Peripapillary and subfoveal choroidal vascular index in patients with tension-type headache and migraine.

This study aimed to evaluate the choroidal vascular characteristics of patients followed up with different headache diagnoses. Prospective comparative study. This study included 21 patients with migraine with visual aura (MwA), 20 with migraine without aura, 29 patients experiencing episodic tension-type headache, and 30 healthy participants. The participants was performed refraction values, axial length, and intraocular pressure were examined. Choroidal thickness was determined in all participants with HD-line optical coherence tomography (OCT) in the subfoveal, nasal, and temporal quadrants 500 μm from the fovea. Using special image processing software, luminal area (LA), stromal area, total choroidal area, and choroidal vascular index (CVI) values were calculated in both macular and peripapillary regions. OCT was also used to perform peripapillary retinal nerve fiber layer (pRNFL) thickness and optic disc head measurements. Spherical refraction, axial length, and intraocular pressure values did not significantly differ among the four groups with similar gender and age distributions (P > 0.05). The LA values in both macular and peripapillary regions were found to be statistically significantly lower in the MwA group (P = 0.007 and P = 0.005, respectively). There was no statistically significant difference among the groups in terms of the remaining choroidal area parameters or CVI values (P > 0.05). The groups also did not show any significant difference in the pRNFL or optic disc head measurements performed in different quadrants (P > 0.05). While LA, one of the choroidal vascular parameters, was found to be lower in the MwA group in both the macular and peripapillary regions, there were no statistically significant differences between the groups in terms of the peripapillary or macular CVI values.

Correlation of pre-operative and post-operative retinal nerve fibre layer thickness with visual outcome following decompression of pituitary macroadenoma

ObjectiveTo (i) correlate preoperative retinal nerve fibre layer (RNFL) thickness with visual parameters in patients with pituitary macroadenomas. (ii) study the predictive role of preoperative RNFL in visual outcome following surgery for pituitary macroadenomas (iii) correlate change in postoperative RNFL thickness (RNFLT) with visual outcome. MethodsPreoperative and post-operative RNFL thickness of thirty-three consecutive patients operated for pituitary macro adenoma between June 2022 and May 2023 were measured using Optical Coherence Tomography (OCT) and compared with standard visual examination findings and Magnetic Resonance Imaging (MRI) measurements. ResultsA total of 66 eyes of 33 patients who underwent surgical excision of pituitary macro adenoma between June 2022 and May 2023 were studied. The mean age in years of the study group was 44.36 ± 13.77 and both sexes were equally represented (Male: Female = 16:17). RNFL thinning predominantly involved the temporal (51.21+/-15.19 μm) followed by nasal quadrants (62.67+/- 17.03 μm) and correlated well with the visual field (VF) deficit (p <0.001). Patients with severe disc pallor had extremely thin RNFL (less than 67 +/- 8.68 μm). Patients with moderate to severe visual acuity (VA) deficits had significantly thinner RNFLs (65.08±7.09) compared to patients with normal to mild impairment in vision. (83.185±1.2) (p<0.05). RNFL values were significantly thinner for patients with Wilson Grade C, D and E tumours (66.13 ±12.19 μm) compared to those in Grade A and B (77.67±22.12 μm). The mean preop RNFL of patients who showed post-operative improvement in vision was 87.025± 15.02 μm, of patients in whom vision remained static was 74.58 ±18.31 μm. The mean VA (Decimal) increased from a minimum of 0.60 at the pre-operative timepoint to a maximum of 0.68 at the post-operative timepoint. (Wilcoxon Test: V = 42.5, p = <0.001). The mean RNFLT (µm) increased from 77.14 μm at the pre-operative timepoint to 83.77 μm at the post-operative timepoint. (Wilcoxon Test: V = 218.0, p = <0.001). The mean change of RNFL in patients in whom vision improved was 3.6 μm and the mean change of RNFL in patients in whom vision remained static was 9.51 μm. Absence of postoperative visual improvement was noted despite postoperative RNFL thickness improvement in eyes which showed significant preoperative thinning of the nasal (<65 μm) and temporal (<52μm) quadrants. ConclusionRNFL thinning corelates directly with visual acuity, visual field, and optic disc pallor. Patients with pituitary adenoma have preferential thinning of temporal and nasal quadrants. Visual outcome is better in patients with preserved RNFLT of values more than 82 +/- 5 μm. Reversal of RNFL thinning postoperatively need not necessarily correlate with visual improvement especially in patients who showed significant preoperative thinning of nasal and temporal quadrants.

Optimizing open-angle glaucoma risk assessment in patients with retinal vein occlusions.

To evaluate factors associated with the diagnosis of open-angle glaucoma (OAG) after a retinal vein occlusion (RVO). Retrospective, cross-sectional study. Patients diagnosed with OAG after RVO were matched 2:1 with RVO patients without prior glaucoma. Logistic regression identified factors linked to OAG diagnosis. Of 1178 RVO patients without initial OAG, 51 (4.5%) were later diagnosed with OAG after an average of 5.5 ± 6.1 years. Screening tests for OAG were performed at a higher frequency in patients diagnosed with OAG compared with patients who never received this diagnosis (visual field [VF] testing 21.6% versus 10.8% (P = 0.073) and retinal nerve fiber layer [RNFL] imaging 52.9% versus 27.4% (P = 0.002), respectively). At the time of the first VF obtained after RVO, mean deviation averaged -10.3 dB in the affected eyes, compared with -5.0 dB in the fellow eyes (P < 0.001); in contrast, RNFL thickness was similar between eyes at the time of OAG diagnosis (72 µm versus 74 µm, P = 0.290). Predictive factors for OAG diagnosis included higher intraocular pressure (IOP) and cup-to-disc ratio (CDR) in the unaffected eye, and the absence of macular edema in the RVO-affected eye (R2 = 0.375, P < 0.001). OAG is a significant risk factor for RVO. Our study reveals a reciprocal relationship between RVO and the development of OAG, highlighting the need for glaucoma risk assessment in all patients with RVOs to avoid delays in diagnosis and vision loss from glaucoma.

Role of optical coherence tomography as a diagnostic marker for neurodegeneration in epilepsy: a cross-sectional analytical study

BackgroundProgressive neurodegeneration is a common consequence of epilepsy, which has a negative impact on the patient’s quality of life. This study aimed to predict neurodegeneration in patients with epilepsy (PwE) through assessment of the retinal nerve fiber layer (RNFL), ganglion cell complex (GCC) thickness, and central macular thickness (CMT) using optical coherence tomography (OCT).ResultsA cross-sectional study was done on 60 patients with idiopathic epilepsy and 30 healthy volunteers. They were subjected to a full neurological examination, ophthalmological assessment, and OCT for assessment of retinal layers, and cognitive examination using Addenbrooke’s scale. PwE had lower cognitive scores, including memory (13.97 ± 2.52), attention (15.95 ± 1.85), language (24.08 ± 1.71), and fluency (6.10 ± 2.05), compared to controls (20.53 ± 3.5), (17.13 ± 1.53), (24.83 ± 0.99), and (8.87 ± 2.39), respectively. There was a significant thinning in average RNFL thickness (84.27 ± 7.66), inferior RNFL thickness (99.33 ± 10.19), average GCC thickness (83.17 ± 9.76), and superior GCC thickness (84.83 ± 7.27) in the epilepsy group compared to controls (105.70 ± 8.73), (104.93 ± 9.75), (101.50 ± 4.84), and (100.53 ± 4.09), respectively. PwE had significantly higher focal macular volume loss (1.17 ± 1.22) versus (0.11 ± 0.21) and a higher insignificant global macular volume loss (1.88 ± 2.32) versus (1.37 ± 0.65) in controls, respectively. Superior GCC thickness was significantly lower in the uncontrolled patients (82.53 ± 6.23) compared to the controlled patients (87.13 ± 7.60), while CMT was significantly lower in the polytherapy group compared to the monotherapy group. There was a significant positive correlation between the age of epilepsy onset and verbal fluency (r = 0.382, p = 0.003). Epilepsy duration had significant negative correlations with memory (r = − 0.364, p = 0.004), inferior RNFL thickness (r = − 0.324, p = 0.012), perifoveal thickness (r = − 0.353, p = 0.006), and inferior (perifoveal) thickness (r = − 0.365, p = 0.004).ConclusionPwE receiving anti-seizure medications (ASMs) have reduced GCC, RNFL, and CMT and lower cognitive functions compared to controls. OCT may be a useful tool for detection of neurodegeneration in PwE.

Linking physiology and demographics, non-ocular pathology and pharmaceutical drug use to standard OCT measures of the inner retina: The PPP project.

To assess the associations between physiology and demographics, non-ocular pathology and pharmaceutical drug use against peri-papillary retinal nerve fibre layer thickness (pRNFL T) and other optical coherence tomography (OCT) inner retinal measures in normal, healthy eyes. A retrospective, cross-sectional study of 705 consecutive participants with bilateral normal, healthy optic nerves and maculae. PRNFL Ts, vertical cup/disc ratio (CDR), cup volume and macular ganglion cell layer-inner plexiform layer (GCL-IPL) Ts were extracted from Cirrus OCT scans, then regressed against predictor variables of participants' physiology and demographics (eye laterality, refraction, intraocular pressure [IOP], age, sex, race/ethnicity, etc.) and non-ocular pathology and pharmaceutical drug use according to the World Health Organisation classifications. Associations were assessed for statistical significance (p < 0.05) and clinical significance (|β| > 95% limits of agreement for repeated measures). A multitude of non-ocular pathology and pharmaceutical drug use were statistically and clinically significantly associated with deviations in standard OCT inner retinal measures, exceeding the magnitude of other factors such as age, IOP and race/ethnicity. Thinner inner retina and larger optic nerve cup measures were linked to use of systemic corticosteroids, sex hormones/modulators, presence of vasomotor/allergic rhinitis and other diseases and drugs (up to -29.3 [-49.88, -8.72] μm pRNFL T, 0.31 [0.07, 0.54] vertical CDR, 0.29 [0.03, 0.54] mm3 cup volume and -10.18 [-16.62, -3.74] μm macular GCL-IPL T; all p < 0.05). Thicker inner retina and smaller optic nerve cup measures were diffusely associated with use of antineoplastic agents, presence of liver or urinary diseases and other diseases and drugs (up to 67.12 [64.92, 69.31] μm pRNFL T, -0.31 [-0.53, -0.09] vertical CDR, -0.06 [-0.11, 0] mm3 cup volume and 28.84 [14.51, 43.17] μm macular GCL-IPL T; all p < 0.05). There are a multitude of systemic diseases and drugs associated with altered OCT inner retinal measures, with magnitudes far exceeding those of other factors such as age, IOP and race/ethnicity. These systemic factors should at least be considered during OCT assessments to ensure precise interpretation of normal versus pathological inner retinal health.

A Dual-Modal Fusion Network Using Optical Coherence Tomography and Fundus Images in Detection of Glaucomatous Optic Neuropathy

Purpose We designed a dual-modal fusion network to detect glaucomatous optic neuropathy, which utilized both retinal nerve fiber layer thickness from optical coherence tomography reports and fundus images. Methods A total of 327 healthy subjects (410 eyes) and 87 glaucomatous optic neuropathy patients (113 eyes) were included. The retinal nerve fiber layer thickness from optical coherence tomography reports and fundus images were used as predictors in the dual-modal fusion network to diagnose glaucoma. The area under the receiver operation characteristic curve, accuracy, sensitivity, and specificity were measured to compare our method and other approaches. Results The accuracy of our dual-modal fusion network using both retinal nerve fiber layer thickness from optical coherence tomography reports and fundus images was 0.935 and we achieved a significant larger area under the receiver operation characteristic curve of our method with 0.968 (95% confidence interval, 0.937–0.999). For only using retinal nerve fiber layer thickness, we compared the area under the receiver operation characteristic curves between our network and other three approaches: 0.916 (95% confidence interval, 0.855, 0.977) with our optical coherence tomography Net; 0.841 (95% confidence interval, 0.749, 0.933) with Clock sectors division; 0.862 (95% confidence interval, 0.757, 0.968) with inferior, superior, nasal temporal sectors division and 0.886 (95% confidence interval, 0.815, 0.957) with optic disc sectors division. For only using fundus images, we compared the area under the receiver operation characteristic curves between our network and other two approaches: 0.867 (95% confidence interval: 0.781–0.952) with our Image Net; 0.774 (95% confidence interval: 0.670, 0.878) with ResNet50; 0.747 (95% confidence interval: 0.628, 0.866) with VGG16. Conclusion Our dual-modal fusion network utilizing both retinal nerve fiber layer thickness from optical coherence tomography reports and fundus images can diagnose glaucoma with a much better performance than the current approaches based on optical coherence tomography only or fundus images only.

Effect of brimonidine on vascular density and imagej-derived flow index of optic nerve head and macula in primary open angle glaucoma.

To study the effect of brimonidine on vascular density and flow index of optic nerve head (ONH) and macula in primary open angle glaucoma (POAG) using optical coherence tomography angiography (OCTA). Twenty-three brimonidine-naïve POAG patients were started on brimonidine. They underwent OCTA ONH and macula before commencing brimonidine and one month thereafter. Systemic arterial blood pressure (SABP) and intraocular pressure (IOP) were measured at each visit to calculate mean ocular perfusion pressure (MOPP). The OCT angiograms were analyzed using ImageJ software to calculate ONH and macular flow indices. Thirty-seven eyes (23 patients) with a mean age of 56.7 ± 12.49years were included of whom 60.8% were males. Brimonidine was associated with an increase in the superficial flow index (SFI) (P-value = 0.02) and optic nerve head flow index (ONHFI) (P-value = 0.01). Also, superficial vascular density (SVD) for whole image, superior-hemi and fovea increased (P-value = 0.03, 0.02, 0.03 respectively). ONH inferior-hemi vascular density decreased (P-value = 0.01) despite an increase in inferior quadrant retinal nerve fiber layer thickness (RNFLT) (P-value = 0.03). There was no statistically significant correlation between flow indices and MOPP at baseline and follow-up. A moderate negative correlation was found between SVD and DVD at the fovea and MOPP at baseline and follow-up (P-value = 0.03, 0.05) (P-value = 0.02, 0.01) respectively. Brimonidine was associated with an increase in SFI, ONHFI and SVD indicating improved GCC and RNFL perfusion in POAG. Despite the increase in inferior quadrant RNFLT, the concomitant decrease in inferior-hemi ONHVD precluded a conclusion of hemodynamically-mediated improvement of RNFLT.

Prediction of the Cause of Glaucoma Disease Identified by Glaucoma Optical Coherence Tomography Test in Relation to Diabetes and Hypertension at a National Hospital in Seoul: A Retrospective Study.

Glaucoma remains the primary cause of long-term blindness. While diabetes mellitus (DM) and hypertension (HTN) are known to influence glaucoma, other factors such as age and sex may be involved. In this retrospective study, we aimed to investigate the associations between age, sex, DM, HTN, and glaucoma risk. We employed optical coherence tomography (OCT) conducted using a 200 × 200-pixel optic cube (Cirrus HD OCT 6000, version 10.0; Carl Zeiss Meditec, Dublin, CA, USA). Effects obscured by low-test signals were disregarded. Data were amassed from 1337 patients. Among them, 218 and 402 patients had DM and HTN, respectively, with 133 (10%) exhibiting both. A sex-based comparison revealed slightly greater retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) thickness in females. Patients without DM and HTN were predominantly in their 50 s and 60 s, whereas DM and HTN were most prevalent in those in their 60 s and 70 s. Both RNFL and GCIPL thicknesses decreased with advancing age in most patients. The study revealed that older individuals were more prone to glaucoma than younger individuals, with a higher incidence among patients with DM and HTN and reduced RNFL and GCIPL thicknesses. Furthermore, early detection before advancing age could furnish valuable preventive insights.

The Correlation between Body Mass Index and Intraocular pressure, Retinal Nerve Fiber Layer Thickness and Visual Field

Abstract Background Obesity has become a world-wide medical epidemic. it constitutes an important risk for several eye diseases like cataract, diabetic retinopathy, age related macular degeneration (AMD) and glaucoma.Body mass index (BMI) is one of the most specific and objective measurement to define obesity. Obesity has recently been reported to be negatively associated with visual acuity, but the ocular conditions underlying this association and the potential implications are unclear. Amongst different eye diseases, obesity has been associated with cataract, age-related maculopathy, diabetic retinopathy, and glaucoma. Purpose To investigate the relationship between BMI and IOP and correlate it with changes in RNFL thickness and visual field. Materials and Methods 60 participants divided into three groups (normal, overweight, and obese) according to BMI, were included in this Cross-Sectional Study (pilot study). Participants underwent a complete ophthalmologic assessment, measurement of RNFL thickness and ganglion cell complex (GCC) thickness using SD-OCT, IOP with Goldmann applanation tonometry (GAT) and visual field analysis using Humphrey field analyser. Results IOP was significantly higher in obese group than those in healthy weight and overweight group. Also, IOP was statistically significant higher in overweight group compared with those healthy weight group. There were no significant differences between the three groups in average, superior, inferior, nasal, and temporal RNFL thicknesses or in GCC thickness. Yet, GCC thickness in the obese group showed significant negative correlation with BMI.There were no significant differences between the three groups in MD, and VFI. Conclusion IOP was variable according to the degree of obesity with incremental pattern with advance of BMI. BMI of overweight group had no correlation with IOP, average, superior, inferior, nasal, and temporal RNFL thicknesses. While BMI of obese group showed a significant positive correlation with IOP and negative correlation with GCC thickness.

Imaging the optic nerve with optical coherence tomography.

Optical coherence tomography (OCT) is a non-invasive imaging technology, which may be used to generate in vivo quantitative and qualitative measures of retinal structure. In terms of quantitative metrics, peripapillary retinal nerve fiber layer (pRNFL) thickness provides an indirect evaluation of axonal integrity within the optic nerve. Ganglion layer measures derived from macular scans indirectly reflect retinal ganglion cell status. Notably, ganglion layer indices are platform dependent and may include macular ganglion cell inner plexiform layer (mGCIPL), ganglion cell layer (GCL), and ganglion cell complex (GCC) analyses of thickness or volume. Interpreted together, pRNFL thickness and ganglion layer values can be used to diagnose optic neuropathies, monitor disease progression, and gauge response to therapeutic interventions for neuro-ophthalmic conditions. Qualitative assessments of the optic nerve head, using cross-sectional transverse axial, en face, and circular OCT imaging, may help distinguish papilledema from pseudopapilloedema, and identify outer retinal pathology. Innovations in OCT protocols and approaches including enhanced depth imaging (EDI), swept source (SS) techniques, and angiography (OCTA) may offer future insights regarding the potential pathogenesis of different optic neuropathies. Finally, recent developments in artificial intelligence (AI) utilizing OCT images may overcome longstanding challenges, which have plagued non-vision specialists who often struggle to perform reliable ophthalmoscopy. In this review, we aim to discuss the benefits and pitfalls of OCT, consider the practical applications of this technology in the assessment of optic neuropathies, and highlight scientific discoveries in the realm of optic nerve imaging that will ultimately change how neuro-ophthalmologists care for patients.

Optic nerve head and retinal nerve fiber layer changes by spectral domain optical coherence tomography in glaucoma suspects at tertiary care hospital

Introduction: Glaucoma is a progressive optic neuropathy characterized by functional loss or optic nerve dysfunction which is one of the leading causes of irreversible but preventable blindness. The aim of the study was to determine which of the retinal nerve fiber layer and optic nerve head parameters are reliable markers of optic nerve damage in glaucoma suspects. Methods: Observational cross-sectional study of 250 patient’s including147 glaucoma suspect eyes, 103 normal eyes. All subjects underwent complete eye examination and imaging with the spectral domain optical coherence tomography (SD-OCT) cirrus-TM OCT (Carl Zeiss Meditec, Dublin, CA). Retinal nerve fiber layer (RNFL) and optic nerve head (ONH) OCT protocols were used to evaluate all study participants. The main outcome measures were the difference in OCT parameters among groups. Results: Study shows statistically significant difference in the average RNFL thickness, superior, nasal, inferior, temporal quadrants, rim area, cup volume, average cup to disc ratio (CDR), vertical CDR with P value &lt;0.001 between the two groups. Average CDR, vertical CDR and cup volume had significantly greater AROC values (ROC: 0.99, 0.98, 0.95) than RNFL parameters for discriminating glaucoma suspects from normal eyes. Conclusion: Assessment of RNFL, macular and ONH damage with SD-OCT has been proven useful for diagnosing the disease at different levels of severity, as well as for quantifying risk in glaucoma suspects. In our study ONH measurements, as provided by the SD OCT, have more diagnostic value than RNFL parameters in the diagnosis of glaucoma suspects from normal. Keywords: glaucoma suspects; optic nerve head; retinal nerve fiber layer; optical coherence tomography

Evaluation of macular vessel density among patients with glaucoma, ocular hypertension, and normal participants

Purpose To assess macular vessel density (VD) in open-angle glaucoma (OAG), normal tension glaucoma (NTG), ocular hypertension (OHT), and normal participants by using optical coherence tomography angiography (OCTA). Setting and design This observational case–control study was conducted at Menoufia University, Faculty of Medicine, Department of Ophthalmology. Patients and methods Patients who received OCTA were already diagnosed with glaucoma and were divided into four groups: OAG group, NTG group, OHT group, and normal participants’ group. The ophthalmic parameters, which include best-corrected visual acuity, intraocular pressure, visual field mean deviation, retinal nerve fiber layer thickness, and ganglion cell complex thickness, were recorded. About the macula, the superficial VD, deep VD, and foveal avascular zone (FAZ) were evaluated via OCTA and analyzed by utilizing the default VD analysis program in the same OCTA. Results This study was conducted on 152 eyes, 38 eyes with OAG, 38 eyes with NTG, 38 eyes with OHT, and 38 normal participant eyes. Significant decrease in retinal nerve fiber layer thickness and ganglion cell complex thickness were noticed in OAG and normal tension groups cases. The OAG and NTG groups revealed a reduction in superficial VD and a reduction in deep VD compared to the OHT and the controls. No difference in the FAZ was noticed among all the studied groups. Conclusion Impaired macular circulation was demonstrated in the OAG and NTG patients compared to OHT patients and normal participants. No difference in FAZ among the glaucoma cases and normal individuals.

Differences in Systemic Pulse Waveform Between Individuals With Glaucoma, Glaucoma Suspects, and Healthy Controls.

It has been hypothesized that compromised ocular circulation in glaucoma may be concomitant of systemic changes. The purpose of this study is to test whether systemic blood flow pulse waveform patterns differ between individuals with glaucoma (GL), glaucoma suspects (GLS), and normal healthy controls (HC). The study included 35 bilateral GL, 67 bilateral GLS, 29 individuals with unilateral GL who were considered GLS in the other eye, and 44 healthy controls. Systemic pulsatile blood pressure waveforms were recorded using a finger cuff. A continuous 200Hz plethysmography recording is made to obtain a pulse waveform. Waveform parameters were extracted using custom software from an average of eight pulse cycles. These were compared between GL, GLS, and HC groups on a per-eye basis, using generalized estimating equation models to account for intereye correlations; and plotted against disease severity by visual field linearized mean deviation (MDlin) and retinal nerve fiber layer thickness (RNFLT). Averaged blood pressure was significantly lower in the HC group (mean ± standard deviation 91.7 ±11.7 mm Hg) than the GLS (102.4 ± 13.9) or GL (102.8 ± 13.7) groups, with P < 0.0001 (generalized estimating equation regression). Waveform parameters representing vascular resistance were higher in both GLS and GL groups than the HC group; and were correlated with RNFLT and MDlin (P ≤ 0.05). The shape of the systemic pulsatile waveform differs in individuals with GL/GLS suspects, compared to HC eyes. Blood pressure changes more rapidly in individuals with GL, which suggests higher arterial stiffness.

Prevalence, time course, and visual impact of peripapillary hyperreflective ovoid mass-like structures (PHOMS) in pediatric patients with optic nerve pathologies

BackgroundPeripapillary hyperreflective ovoid masslike structures (PHOMS) are a recently defined optical coherence tomography (OCT) finding. The purpose of this study was to characterize the presence of PHOMS and their visual significance in pediatric patients with and without optic nerve pathologies. MethodsThis retrospective study evaluated 400 patients (<18 years of age) including normal control subjects and patients with optic neuritis, papillitis, optic nerve head drusen (ONHD), and papilledema. Information on demographics, visual function, and structural parameters were obtained. ResultsPHOMS were found in 7 of 2,582 of normal control eyes (7%), 9 of 59 eyes with optic neuritis (15.3%), 58 of 76 eyes with ONHD (76.3%), 3 of 11 eyes with papillitis (27.3%), and 180 of 308 eyes with papilledema (58.4%). PHOMS were more prevalent in the papilledema (P < 0.001), ONHD (P < 0.001), and optic neuritis (P = 0.028) eyes than in control eyes. We identified 5 cases where PHOMS developed de novo. This occurred over an average of 2.3 years (range, 0.2-7.4 years). Sixteen cases of PHOMS resolved over an average of 1.1 years (range, 0.3-4.0 years). Cross-sectionally, PHOMS were not associated with visual acuity (P = 0.551), retinal nerve fiber layer thickness (P = 0.068), ganglion cell volume (P = 0.375), or visual field mean deviation (P = 0.795). ConclusionsPHOMS are present in a majority of children with papilledema or ONHD. PHOMS are dynamic and may form de novo over time with optic nerve pathology and may resolve either through treatment or atrophy. There was no relationship between the presence of PHOMS and poor visual function in our study cohort.